on August 5, 1966 and approved by the Public Health Advisory Council on September 6, 1966. The goals of the State Plan for Medical Assistance for the District of Columbia are the promotion of a healthy population, the prevention of illness and premature death, the correction or limitation of disability, and the treatment of all illnesses and the provision of maximum rehabilitation of all persons with impairments. The achievement of these goals involves the fullest possible application of medical knowledge and the use of all our health resources. The State Plan carefully specifies that all of the health services must be readily available to all eligible persons. Moreover, the Plan specifies standards to insure that services will be of a high quality and that methods of administration assure that the services are furnished in a sympathetic and dignified manner. The emphasis is focused on medical care as part of a comprehensive plan for services, not just the payment of a medical bill. The State Plan, in conformity with the requirements of Title XIX, establishes a medical care program which replaces the several provisions for medical care for the needy in Titles I, IV, X, XIV and XVI of the Social Security Act. The Plan also contains a proviso to supplement the basic health insurance benefits for aged persons under Title XVIII of the same act. It represents a genuine effort to expand the amount, duration, scope and quality of comprehensive medical care services now provided to the medically needy by the Department of Public Health of the District of Columbia. Likewise, under the standards of eligibility to receive services under the Plan, and to be administered by the Department of Public Welfare, a greater number of people, previously ineligible, will have access to these services. STATUS OF PROPOSED DISTRICT OF COLUMBIA PLAN As to the status of the medical assistance program for the District of Columbia under title XIX of the Social Security Act as amended (Public Law 89-97), the Secretary of the Board of Commissioners, District of Columbia, advised the committee as follows: GOVERNMENT OF THE DISTRICT OF COLUMBIA, Mr. JAMES T. CLARK, Clerk, Committee on the District of Columbia, EXECUTIVE OFFICE, Washington, D.O., May 4, 1967. DEAR MR. CLARK: This is in further reply to your telephone inquiry regarding the status of the Medical Assistance Program of the District of Columbia under Title XIX of the Social Security Act, Public Law 89-97. The following are excerpts of the Minutes of Board of Commissioner's meeting on this subject: THURSDAY, JANUARY 5, 1967. At the Board Meeting today, Dr. Murray Grant, Director of Public Health, presented to the Commissioners the State Plan covering the operation of the Medical Assistance Program of the District of Columbia under Title XIX of the Social Security Act, Public Law 89-97. Dr. Grant stated in his memorandum dated December 12, 1966 that his Department is continuing to work toward implementation of the plan although it cannot be activated until such time as the required enabling legislation, which was submitted to the 89th Congress, is approved. TUESDAY, JANUARY 24, 1967. The Commissioners approved a memorandum from the Corporation Counsel, dated January 23, 1967, transmitting Certification of Corporation Counsel for State Plan pursuant to Title XIX of the Social Security Act. It was noted that the District's plan cannot become operative until legislation is enacted authorizing the District to engage in such a program notwithstanding certain other provisions of law. The Certification was forwarded to the Director of Public Health. Sincerely yours, F. E. ROPSHAW, Secretary, Board of Commissioners, District of Columbia. MEDICAL CARE 1 123 OUTLINE OF PRIME FEATURES OF THE DISTRICT OF COLUMBIA STATE PLAN FOR MEDICAL ASSISTANCE UNDER TITLE XIX OF THE SOCIAL SECURITY ACT (District of Columbia Department of Public Health) The District of Columbia State plan for medical assistance under title XIX of the Social Security Act has been prepared in accordance with the requirements of the Handbook of Public Assistance Administration, Supplement D, Medical Assistance Programs which is issued by the Welfare Administration of the Department of Health, Education, and Welfare. This plan is now in the process of review by the Department of Health, Education, and Welfare and when finalized, must be in strict compliance with title XIX as contained in Public Law 89-97, and with subsequent amendments thereto. There follows a section by section outline of this plan citing its prime features. THE PLAN This is a 65-page document establishing policy and the basic principles of the Medical Assistance Plan and includes: I. STATE ORGANIZATION This section stipulates that the Department of Public Health is the single State agency authorized to administer the Plan in the District of Columbia. the Associate Director for Medical Care is delegated the authority to implement and coordinate the Plan. the determination of eligibilty for medical assistance under the Plan will be made by the Department of Public Welfare, in accordance with standards, rules and regulations and policies established by the Department of Public Health. there is agreement between these two Departments as to their relationship and respective responsibilities. standard policy statements assuring continuous State-wide operation of the Plan apply. II. APPLICATION, DETERMINATION OF ELIGIBILITY, AND FURNISHING ASSISTANCE This section stipulates that all individuals who wish to apply for medical assistance will receive prompt consideration. individuals fully qualifying will be precertified and issued an identification card, good for a one-year period. individuals qualifying for limited services (those able to meet part of their medical costs) will be certified for a limited period of not more than six months. the eligibility determination process will not violate the individual's privacy, personal dignity, or otherwise violate his constitutional rights. the determination process will be simple of administration. medical care will be furnished promptly. eligibility of an individual will be reconsidered whenever a change indicates the need for such and no less often than every 12 months. notice of decision as to eligibility and specified reasons for ineligibility will be provided to applicants in writing. 1 The proposed Medical Assistance plan, embraced in over 200 pages, is on file with the Committee. The Department of Public Health furnished this outline or summary for the Committee's information. 76-307-67- -9 124 MEDICAL CARE III. COVERAGE AND CONDITIONS OF ELIGIBILITY This section specifies that medical assistance will be made available in the same amount, duration and scope for the following groups of persons: Groups Eligible for Federal Reimbursement under Title XIX: Persons who are aged, blind, permanently and totally disabled, or in families with dependent children and receiving public assistance. Persons who would be eligible for the above public assistance except for durational residence requirements. Persons who would be eligible for the above public assistance except for some other requirement which is prohibited under Title XIX. Persons who would be eligible under one of the three conditions above except that their income exceeds the maximum allowed for public assistance. All other medically needy children under the age of 21. Not Eligible for Federal Financial Participation in Medical Care Costs: All individuals other than those in groups above who meet all other requirements of the Medical Assistance Plan. Financial eligibility requirements include family of four income at or below $4200 per annum. family of four with other resources at or below $1050. income will be measured in such a way as to assure that the maintenance needs of the individual will be protected, and that income in excess of that needed for maintenance will be applied to medical assistance costs before a person can become eligible for care at public expense. that income and resources exempt by law will be excluded from consideration and that only reasonably evaluated actually available income and resources shall be included. that financial responsibility for a patient shall be limited to a spouse, or the parent of a child under 21, or blind, or permanently and totally disabled. Blindness is defined identically to the requirements under public assist ance. Permanent and total disability is defined identically to the requirements of public assistance. IV. MEDICAL ASSISTANCE Within allowable budgetary limitations this section designates— the amount, duration and scope of medical assistance made available under the plan including: physicians' services. dentists' services. inpatient hospital services. skilled nursing homes services. clinical and diagnostic and treatment services. rehabilitation services. home health services. drugs, biologicals, and medical and surgical supplies and appliances. other services, including such as podiatry, optometry, psychology and transportation. Standards to assure acceptable quality of care provided by the general hospitals; psychiatric hospitals; tuberculosis hospitals; nursing homes; laboratories; home health agencies; pharmacies; and rehabilitation centers. These standards are basically the equivalent of those required under Title XVIII of the Social Security Act. Requirements for specified professional and subprofessional persons providing medical care including: physicians dentists nurses dietitians and nutritionists optometrists podiatrists physical therapists occupational therapists psychologists social workers laboratory technicians radiology technicians pharmacists general methodology for evaluating the medical care services provided, and plans for future program development directed toward meeting the goal, as specified in PL 89-97, of providing comprehensive medical services to all medically needy persons by July 1, 1975. that medical assistance provided to aged individuals in institutions for mental diseases will meet the requirements of PL 89-97 with respect to the conditions under which such persons are to receive such care. that within the limitation of available funds, the fee structures will be established as equitably as possible and that participation by providers of service will be limited to those who accept such fees as payment in full. that medical assistance will be equal in the amount, duration and scope for all eligible persons; excess income or resources will be applied to reduce an individual's medical assistance entitlement, but no other charge will be assessed against him and; that deductible and co-payment charges for individuals covered by Parts A and B of Title XVIII will be met by the State in behalf of persons eligible for medical assistance. that the services of an insurance or fiscal agent contract may be used under specified conditions to administer portions of the medical assistance program. that medical assistance will be provided, as required by law, for eligible residents of the District of Columbia who are temporarily absent from the District. that no lien or encumbrance will be imposed against the property of an individual as a result of medical assistance properly provided to an eligible individual. V. ADMINISTRATION This section stipulates administrative policy that will provide proper and efficient operation of the Plan. provide necessary social services to assure access to and appropriate utilization of medical care and services and to rehabilitate and assist eligible persons in attaining or retaining capability for independence or self-care to the greatest possible extent. establish and maintain appropriate cooperation between the Departments of Public Health, Public Welfare and Vocational Rehabilitation to assure coordination of medical care and services under the plan. establish and maintain procedures for the conduct of hearings relative to complaints arising out of the operation of the Plan in accordance with the requirements of the Department of Health, Education, and Welfare. assure the maintenance of records and the making of requisite reports. establish and maintain appropriate protective measures against fraud that do not infringe on the legal rights of persons involved. VI. PERSONNEL ADMINISTRATION This section specifies policies covering personnel administration on a merit basis in accordance with Civil Service Commission regulations. minimum State agency staffing and requirements for staff members in accordance with the requirements of the Department of Health, Education, and Welfare. the operation of a staffi development program which will assure that by July 1, 1975 there will be adequately qualified staff manning the State agency. VII. FISCAL ADMINISTRATION This section stipulates that State funds will be used to pay for all medical assistance provided under the Plan which is not covered by the Title XIX Federal funds and that these funds will be adequately distributed throughout the State. appropriate accounting and fiscal records will be maintained by the State agency. a cost allocation plan enabling full and proper Federal financial participation in the cost of administration, services and training under Title XIX will be established and maintained. VIII. RELATIVE RESPONSIBILITIES This section meets the requirements of Title VI of the Civil Rights Act of 1964 as required. ATTACHED EXHIBITS A. Designates the organization and functions of the 100-member Medical and Hospitals Committee which assisted in evolving the Plan and has an ongoing responsibility to advise the State agency on the operation of the Plan. B. Describes the organization and functions of the Associate Directorate for Medical Care which is responsible for the operation of the Plan for Medical Assistance. C. Certification of the District of Columbia Corporation Counsel, in accordance with the requirements of the Department of Health, Education, and Welfare, that the Department of Public Health is the authorized State agent for the Title XIX Medical Assistance Program in the District of Columbia. D. Cooperative agreement between the Department of Public Health and the Department of Public Welfare as required by the Department of Health, Education, and Welfare. E. Cooperative agreement between the Department of Public Health and the Department of Vocational Rehabilitation as required by the Department of Health, Education, and Welfare. F. Provides further detail regarding the standards of eligibility for medical assistance under the program and the methods by which these standards would be applied. G. Contains the policies and procedures covering the Plan for Alternative Care for Patients with Mental Illness, in accordance with PL 89-97. H. Provides further detail regarding the rates of payment for medical assistance and the program coverage in terms of population and funding. I. Contains the required statement of compliance and method of administration pursuant to Title VI of the Civil Rights Act of 1964. GOVERNMENT OF THE DISTRICT OF COLUMBIA, DEPARTMENT OF PUBLIC HEALTH, Washington, D.C., May 1, 1967. Mr. JAMES T. CLARK, Clerk, Committee on the District of Columbia, House of Representatives, Washington, D.C. DEAR MR. CLARK: The following information relative to the District of Columbia Medical Assistance Plan under title XIX of the Social Security Act is provided in response to your oral request of May 1, 1967. 1. If the District of Columbia were to place its title XIX program in operation in the 1967 fiscal year, the following estimates would apply on a full 1967 fiscal year basis for the family of four, $4,780 eligibility income level: Total number of persons in the eligible population__ Total program cost (millions) __. Federal title XIX reimbursement (millions) Additional cost to the District of Columbia (millions) – 1 Includes $2.2 million which replace present Federal medical assistance reimbursements which are included in the present $32.9 million program, and which will cease when the title XIX reimbursement commences. 2. The attached "Selected Characteristics of the Medical Assistance Program Under Title XIX of the Social Security Act" provides information regarding main features of the D.C. plan. This is patterned along the lines of issuances by the Bureau of Family Services regarding plans in effect in other jurisdiction. I trust that this will fufill your requirements. If we can be of further assistance, please let us know. Sincerely, Attachment. MURRAY GRANT, M.D., D.P.H., SELECTED CHARACTERISTICS OF THE MEDICAL ASSISTANCE PROGRAM UNDER TITLE XIX OF THE SOCIAL SECURITY ACT DISTRICT OF COLUMBIA I. Name of State agency responsible for administering title XIX Department of Public Health. |