Spinal Cord Advocates

May/June, 2010

Here’s a behind the scenes look at some of the issues that have been keeping us busy and some of the things that we have been doing to move these issues along. Please feel free to contact us if you have questions regarding these issues or any of our activities related to them.

Health Care Reform (HCR)

We met weekly with members of the CCD Long Term Services and Supports Task Force to go through sections of the health reform bill that affect long term services and supports. The task force is developing a list of questions and comments to be directed at either Hill staff or staff at HHS.

The CCD Long Term Services and Support co-chairs met with Henry Claypool, Director of the Office on Disability at HHS to start a dialogue about health reform and long term services and supports. We discussed the future of the CLASS Act and where is should be placed as far as which agency has control of the program.

The U.S. Department of Health and Human Services (HHS) established the Office of Consumer Information and Oversight which will be charged with implementing many of the health insurance provisions in the new health care reform law. Jay Angoff, former insurance commissioner of Missouri and former Deputy Insurance Commissioner of New Jersey, will direct the office. The Office is responsible for ensuring compliance with the new insurance market rules, such as the prohibitions on rescissions and on pre-existing condition exclusions for children that take effect this year. It will administer the temporary high risk pool program and provide guidance and oversight for the state-based insurance exchanges.

The Office on Disability at the Department of Health and Human Services held a web chat to discuss how the new health care reform law will affect people with disabilities and their families. Henry Claypool, the Director of the Office on Disability, and Jeff Crowley, Senior Advisor to President Obama on disability, participated in the web chat. The web chat can be watched at: http://www.youtube.com/watch?v=ccKQNklpCWg&feature=player_embedded.

The CCD Long Term Services and Supports and Health Task Forces met together to talk about how to best approach the next steps in health reform. There will be hundreds of regulations coming out in the next few years and we all agreed that writing comments to proposed regulations is more work than any one group or CCD could do. The consortium is looking at options on how to best tackle the next steps of health reform.

We signed on to a letter to the White House and HHS urging adequate funding for a Department of Labor survey of employer-sponsored health insurance that will serve as a foundation for determining essential benefits in health insurance plans under health care reform. Without accurate information, essential health benefits may be endangered.

We have continued to receive positive feedback from the White House, Congress, and other associations regarding the health reform document that we put together. The document is still available on the Spinal Cord Advocates website at www.spinalcordadvocates.org and will be updated as health reform regulations are proposed and finalized.

Medicaid

Congress has struggled to find agreement on how to help states that are in a financial crisis. Many states are counting on Congress to extend the extra Medicaid assistance that is currently in place until the end of June 2011. The current assistance from Congress will end on December 31. If Congress does not act many states will have to lay off employees, reduce services, and possibly roll back advances that have been made to help people with disabilities live in the community.

We met with officials at HHS to discuss the public process of Medicaid waivers. HHS is preparing to issue new regulations that will strengthen the public input process for state Medicaid waivers. States will be required to strengthen the public input process when they apply for Medicaid waivers. During the previous Administration a letter was issued to State Medicaid Directors on various aspects of the Community Living Initiative. As part of the Community Living Initiative, HHS is working with several federal agencies, including the Centers for Medicare and Medicaid Services, to address barriers to community living for individuals with disabilities and those who are aging. The letter to State Medicaid Directors provides information on new tools for community integration, as well as reminds states of already existing tools which they can use to serve people in the most integrated settings. The letter discusses efforts to meet the requirements of the U.S. Supreme Court’s decision in Olmstead and provides some basic information on the new tools available through the Patient Protection and Affordable Care Act, P.L. 111-148 (”health care reform” law), noting that additional guidance on health care reform will be issued in the near future. The letter is located at:
http://www.cms.gov/smdl/downloads/SMD10008.pdf

Medicare

CMS is continuing to educate people who use Medicare how health reform will impact them. For people who use the Part D prescription drug program, they will receive a check for $250 if/when they have reached the “doughnut hole” for the 2010 calendar year.

FY 2011 Budget

It is unlikely that a budget resolution will be passed by Congress for FY 2011. It is expected that Congress will simply do appropriation bills and the majority of appropriations will be done after the November 2010 elections. For funding as of October 1 (the start of FY 2011), Congress is expected to pass Continuing Resolutions that enable agencies to function under FY 2010 spending levels.

Employment and Training

We continue an active role in drafting and developing recommendations requested by the White House from JFAAN at a meeting we attended some months ago. This work includes working with participants in the IRS Real Economic Impact Tour regarding tax incentives and a proposal calling for an executive order for the federal government to adopt a hiring policy for people with disabilities similar to an executive order issued by the Obama Administration to encourage federal employment of Veterans.

We met with Senate HELP Committee staff to discuss the status of reauthorization of the Workforce Investment Act (WIA) and the Rehabilitation Act. The HELP Committee has held some hearings but progress towards introduction of a bill remains slow.

Social Security Disability

In light of the Fiscal Commission’s charge to report its recommendations for deficit reduction and long term solvency by December 1, a new coalition has been formed: Strengthen Social Security. It is in the process of developing its positions and is a large coalition of many groups including unions and those focusing on seniors.

The Fiscal Commission continues to meet, though its subcommittees are not meeting publicly. It has promised an opportunity for public input at its meeting in June.

Adequate funding of SSA’s administrative costs is an on-going problem. The President’s budget gave SSA an 8% increase in its administrative budget, but, as noted above, Congress is not likely to vote on a budget. Given the current fiscal situation, it is necessary to fight to retain the President’s proposed level of funding. SSA has recently shown a slight decrease in the hearing backlog on disability determinations. On the other hand, there have been huge surges in both disability and retirement applications since the onset of the recession, with backlogs increasing at the initial disability determination stage and more appeals/hearings anticipated.

An SSA advisory panel (the Occupational Information Development Advisory Panel – OIDAP) is recommending a new disability determination process that could impair an individualized assessment of a claimant’s ability to work and eligibility for Social Security disability benefits. We are deeply concerned about several issues, including a recommended 12 minute telephone interview to determine the mental status of a claimant. We believe that the medical professionals who treat a claimant are in the best position to evaluate a person’s disabilities. CCD’s Social Security Task Force filed comments on the proposed recommendations in June, and we filed comments in concurrence.

Miscellaneous

The US Department of Justice (DOJ) filed a lawsuit alleging that the state of Arkansas is systemically violating the Americans with Disabilities Act of 1990 (ADA). DOJ filed the ADA action against the state of Arkansas due to its segregation of over 1,000 individuals in 6 intermediate care facilities for individuals with intellectual and developmental disabilities. DOJ believes that many of these people could live in more integrated community-based settings. This action is indicative of the new approach being taken by DOJ in assuring disability rights protections for individuals who reside in large state institutions. Arkansas’ current waiting list for community-based services is about 1,400 and moves very slowly. Read DOJ’s press release at:
http://www.justice.gov/opa/pr/2010/May/10-crt-538.html.

We met with the U.S. Department of Health and Human Services Office on Disability to discuss the award of over $6 million to establish a Center of Excellence in Research on Disability Services, Care Coordination and Integration. The contract has been awarded to Mathematica Policy Research, Inc for a two-year period and is funded through the American Recovery and Reinvestment Act. It is aimed at developing and conducting research on the effectiveness of systems of care for people with disabilities, including those related to rehabilitation, behavioral and psychosocial interventions. For instance, the new Center for Excellence will use Medicaid data (state plan and waiver services supplied by specific states) to identify and propose ways to achieve greater consistency on how these services are defined and used. We will continue following the actions the new Center and will have regular updates from the Office on Disability.

We attended a briefing and are supporting the Prosthetic and Custom Orthotic Parity Act of 2010 (HR 2575/S 3220). The legislation would ensure that there that insurance provide equal coverage for prosthetics and orthotics that it does for other medical treatment.

United Spinal staff Andrew Morris is mentoring an intern with AAPD again this summer. The AAPD internship programs places college students with members of Congress and in the Administration for the summer.

Sign-on’s

In addition to the sign-on letters otherwise mentioned, we signed on to the following:

A letter to the HHS Secretary asking that lifetime and annual caps for insurance plans end when the health reform law requires. There is a loophole that may allow some insurance companies to extend lifetime and annual caps.

A letter in opposition of HR 1255, a bill that would make it more difficult for the Protection and Advocacy System to file suits on behalf of people who are confined to institutions.

A letter asking for $10 million to be appropriated for Family to Family Health Information Centers for children with special health care needs. The funding that they receive now is barely enough to keep the centers open with one or two staff per state.

A letter of support for HR 2059 to enable military personnel who have a family member with a disability to designate a special needs trust to receive military retiree and survivor benefits annuities rather than a natural person. Without this bill, if benefits are paid directly to the family member, the payments can jeopardize that person’s eligibility for Social Security and Medicaid benefits.

Common acronyms in Public Policy Reports