Agency Wrong in Money Distribution

An appeals court Monday found that the state Agency for Persons with Disabilities did not properly carry out a law that created a new system of funding services for people with developmental disabilities.

The case, brought on behalf of four people with disabilities, focused on a system known as "iBudgets." Lawmakers in 2010 approved moving to iBudgets, but Monday's decision by the 1st District Court of Appeal said rules proposed by the agency to carry out the law "directly conflict with and contravene the Legislature's clear language."

The basic idea of iBudgets is to provide set amounts of money to people, depending on their needs, and then give them flexibility in how the money is spent on services. That differs from past systems that required money to be spent on specific services.

The plaintiffs in the case stood to lose thousands of dollars in assistance under the iBudget system. The legal challenge focused on a mathematical formula, or algorithm, that the agency was required to develop and use in allocating money.

A three-judge panel said the agency improperly used the algorithm as a "starting point" and made adjustments that could affect funding for services.

"We recognize the difficulty in adhering to the Legislature’s command to create an algorithm solely capable of determining each client’s level of need,'' said the eight-page ruling, written by Judge William Van Nortwick and joined by judges Robert Benton and Timothy Osterhaus.

"Further, we accept that APD is attempting to find a reasonable way to administer funds to the tens of thousands of people in need that it assists. However, when, as here, the Legislature is clear, there is no room for deviation."

The ruling overturned a decision last year by an administrative law judge.

By News Service of Florida

News and updates to help you

The Arc of Florida is proud to announce the Dental Program has once again been funded and is open for business.

The Arc of Florida is a 501c (3) non-profit organization serving individuals with intellectual and developmental disabilities throughout the State of Florida. The Arc of Florida has received a continuation of a legislative appropriation to directly pay dentists for preventive and acute dental services for this population. The Legislature has approved, the Governor has signed it into law, and the Agency for Persons with Disabilities (APD) has signed a contract for continuation of this program for state fiscal year 2014 (July 2014 – June 2015).

Individuals on the APD waitlist for services and those on the iBudget Waiver are eligible to receive dental services through The Arc of Florida Dental Program. If there are funds in your iBudget waiver cost plan for limited dental, you can still be eligible for this funding. The Arc of Florida, along with the help of your local APD regional office and local Arc chapter, identified you as an individual who may be in need of dental services.

The Arc of Florida has provided you with an application that will need to be filled out, signed and returned to us through one of the following ways:

Fax: 850.921.0418 Email: dental@arcflorida.org

Mail: The Arc of Florida Attn: Dental Services

2898 Mahan Drive Suite 1

Tallahassee, Florida 32308

Our priority is to serve individuals who are in immediate pain. Due to high frequency of submissions it may take between 30-60 days to process and approve your application. Once approved, we will immediately contact you. We are able to sometimes provide for routine dental services. We make these decisions based upon the number of dental applications we receive for more immediate dental needs. Please be aware that we must verify and first use any dental insurance you currently have for dental care before accessing these funds.

If you have questions, please call The Arc of Florida Dental Services Program at 1.855.322.6735.

Click this link to fill out a application.

News and information to help you.

Employment - Joint Employment in Consumer-Directed Programs

Last week, the Department of Labor (DOL) held a briefing to address joint employment in consumer-directed programs as outlined in the Federal Register in October 2013. Officials reviewed an Administrator’s Interpretation from last month that defines companionship services, clarifies the duties test, and limits the use of the companionship services exemption and the live-in domestic service employee overtime exemption to individuals or their representatives only. Most workers in consumer-directed programs will have a third-party joint employer and therefore must be paid in compliance with the Fair Labor Standards Act’s minimum wage and overtime requirements. However, the exemption may be applied in situations in which the consumer is the sole employer. Third party employers may no longer claim exemptions under this rule. The Centers for Medicare & Medicaid Services recently released guidance on state options for Medicaid reimbursement for overtime and travel costs that may result from the Final Rule. For more information, please visit www.homecare.gov for a fact sheet and other information related to minimum wage and overtime pay for direct care workers.



Convention on the Rights of Persons with Disabilities

Last week, Senator Tom Harkin (D-IA) met with members of the disability advocacy community to ask for continued support in urging the Senate’s passage of the Convention on the Rights of Persons with Disabilities (CRPD). The treaty has been placed on the agenda of the Senate Foreign Relations Committee business meeting for mark-up on Tu esday, July 22. Supporters are hopeful that the treaty will pass out of committee and go to the Senate floor for a vote the week of July 28.

The Treaty was adopted by the United Nations (UN) General Assembly on December 13, 2006 and was signed by President Obama on June 30, 2009. The Senate took the treaty up for consideration in December of 2012 but fell five votes short of the 67 needed for ratification. To learn more, please see The Arc’s fact sheet and blog entry, as well as a video message from Sen. Harkin. To contact your Senator about this critical issue, please visit The Arc’s Action Center or Tweet using #ISupportCRPD.



Budget & Appropriations – FY 2015 Spending Bills Face Likely Continuing Resolution

Senate Appropriations Chairwoman Barbara Mikulski (D-MD) announced that, despite having strongly pushed for regular order in the appropriations process, she is now seeking to move an omnibus package of bills for the fiscal year that begins on October 1, 2014. One or more short-term continuing resolutions (CRs) may be necessary if Congress cannot pass all 12 individual spending bills or a combination of bills before October 1. CRs typically provide level funding from the previous year, though they are not required to do so. Read this story from January to see how disability-related programs fared in the FY 2014 spending bill.

The Agency for Persons with Disabilities (APD) Director Barbara Palmer. Was aked some important questions.

Barbara Palmer was appointed director of the Agency for Persons with Disabilities in August 2012, after serving as the agency's chief of staff for just under a year. Before that, she'd been assistant secretary for administration at the Department of Children and Families.

By then, Palmer had had a full career already. A pioneer in the development of programs for female athletes, she was among the first inductees into the Florida Women's Hall of Fame in 1982 due to her lobbying work on Title IX, the 1972 federal mandate to ensure equitable treatment of girls and women in school athletic programs.

Palmer earned her bachelor's and master's degrees from Florida State University. In 1977, she became the first director of women's athletics at FSU, which won five national championships and 226 All-American awards under her leadership. She then became FSU's associate vice-president for governmental relations, and director of the Division of Hotels and Restaurants at the Department of Business and Professional Regulation. For 15 years, she was president and CEO of Palmer, Musick & Associates, where she worked on issues such as athletics, education, mental health, health care and regulation before state and local governments.

The News Service of Florida has five questions for Barbara Palmer:

Q: Gov. Scott's budget has a lot of good news for your agency. Talk about that.

PALMER: Well, we're very excited. This is the second year in a row that the governor's recommended dollars to take people off the wait list.

As you probably know, we have thousands of people on the wait list. They all have different levels of need, but we've identified about 3,000 that need to come off as quickly as possible because they have critical needs. So last year we put a plan together, and the governor recommended $36 million and the Legislature funded that, and so we were able to take about 1,600 people off. So this year he asked what it would take to get the rest of them off that are in the critical-need category. So he is recommending $20 million, which we're very excited about. We're still running the numbers, but we believe that that's going to be enough to get the rest of those 3,000 off.

He also recommended some additional dollars for employment, which we're very excited about. ... I actually read and sign every crisis that comes up here. So I know the needs of these families, and they are very, very heart-wrenching in many cases. A lot of it, though, has to do with kids transitioning out of school. If they don't go on our waiver, somebody in that household has to quit their job.

So what we're focusing on for employment is that transition -- and that's not to say we don't want to help other people, because certainly we do. But we need to catch people at that point when they're really at the height of learning and they're excited about being part of a productive society instead of sitting home in front of a TV, really losing that self-esteem. Just like we all need. When we work, it makes you feel so much better about yourself.

And so we're excited about the money. Last year he gave us a half a million and the Legislature funded it. And we've spent all year trying to work on a sustainable system working with the school systems that will allow that transition. When a school identifies nine people graduating with special needs, for example, we want to know who's going on to higher education, who maybe already has a job, and what are the interests of the others, so that we can match them properly with the different businesses out there. So we're partnering with different businesses so we can match people. And this year the governor has put a million dollars in. So we're very excited. So that's the next step.

Q: What would it take to eliminate the entire waiting list? Could it ever happen?

PALMER: I think there always will be (a waiting list), but there are a lot of people that are on the wait list that really, at this point in time, are not urgent for services.

There are about 9,500 that are on our wait list that are under 21 that, if they're Medicaid-eligible right now, they would already get services through the Agency for Health Care Administration. So they're really not on our waiting list, but they are, because they know that when they turn 21, they're going to want to get our services. So that's an example.

But we also have people that -- I think they feel like they have to get on the waiting list. But we really don't provide services based on when somebody comes on. It's based on need. And so we have a whole formula for how we take people off the waiting list that the providers and stakeholders and individuals with disabilities and their families helped us design. This was not something we came up with ourselves. They helped us.

And it really is based on need, like caregiver aging out: People that are over 70 and have paid taxes all their lives, and they have needs; we need to help them. ...

Then we've got those that are absolutely just on the verge of crisis. And crisis for us is identified (as) an individual that is either a danger to themselves and others, or they're homeless. And that's what happens a lot with those that transition out of schools. So we're very attuned to this employment initiative, along with the wait list.

Q: How many people are using the iBudget now, and how is that going?

PALMER: We have about 29,000 people, around 29 to 30 (thousand), somewhere in there. And it's taken a year and a half to roll out completely, and we are extremely happy with the results.

We're in the middle of some lawsuits which, frankly, have created some workload issues for the people out in the field. It's unfortunate. However, for the most part, people are very excited about the iBudget because it gives them so much flexibility. Before, if they got their money, their money would come down for some type of specific service, or for the adult day training, or for transportation, and it was in categories and they had to spend it within that category. And if they didn't spend it, they lost it. So what the iBudget does is give them a lot of flexibility to use their money as they need. And you know, that's what we all do. We all have budgets. I have to save up if I have a crown, or something dental that's massive, or even an operation. So this gives them that kind of flexibility so they can plan, just like anyone.

Q: Is the Developmental Disabilities Home and Community Based Services Waiver operating within its budget now, after eight years of operating at a deficit?

PALMER: We ended this past year (2012-13) for the first time within our budget. And we're on our way this next year as well.

And I know there are a lot of people that wonder why we left some money on the table. And I want to address that, because I think it's very important that people understand that this agency has gotten in trouble over the years because they spent every penny they had, and then the next year as people's needs increased, they went into a deficit.

So it's very important that we do keep that cushion, so that the next year there is some room, because people's needs are going to change. They're going to change. They're going to get worse. They don't get better. And so we have to plan for that.

And so for the first time, because we were within our budget, we are doing some long-range planning. And in the category, for example, the caregiver aging out: Why should we start looking at age 60? Where do you want your child to be when you pass on? That's the big question everybody always asks. So let's help them plan with some of those things.

And the same thing with people with Alzheimer's. People are living longer, caregivers and the people we serve. And so we need to be planning for that. There's a lot of research to be done, and that's one of the areas where we're doing some long-range planning.

Q: What do you hope to accomplish at APD before you leave?

PALMER: Well, I feel like we've accomplished a lot already. But what I really would like to do is do this comprehensive study for the housing options, because I think that what we have right now is something that probably was built 20 years ago or more. And just because that's the way we did it 20 years doesn't make it right.

And I talked about dual diagnosis, and that's one that's very obvious. You can see that if you have somebody with severe mental challenges, and you put them in a house with somebody that doesn't, it would be a very, very difficult situation for people, especially people with developmental disabilities that don't understand that. So we have to make sure that whatever housing options we come up with are serving people with those needs.

And when I say that, I don't mean I want to put someone in a place and they stay there forever. We need intensive behavior types of therapies that are short-term, where we work with the person and then they get better. And so those are the kinds of things we're looking at.

We also need to be looking at the Alzheimer's, because this is something that is happening. What do you do? Do you support people aging in place? Well, if you do, and they're in a house where nobody else has Alzheimer's, how do you deal with that? Well, training, for one thing. And people coming in and working with the other people in the house to understand.

So we have to look at new ways to do the kinds of services we're doing, but doing it differently.

Train Week - How Accessible is Amtrak in Florida?

Friday, July 19, 2013

The National Railroad Passenger Corporation, known as Amtrak, has provided critical cross-country transportation services since its founding in 1971. An average of over 85,000 passengers ride Amtrak trains every day. During the 2012 fiscal year, Amtrak had more than 31.2 million passengers.


Amtrak Florida has 31 Amtrak stations of various types - auto, bus, and train.Yet according to its 2010 Report to Congress, only about 10% of Amtrak stations nationwide (about 48) are fully compliant with the 1990 Americans with Disabilities Act. According to recent information, the number has risen only slightly.


The result is that today many people with disabilities are unable to access America’s Amtrak trains to get to where they need to go. They encounter barriers such as inaccessible bathrooms, parking lots, and ticketing kiosks, audio systems with no visual equivalent,and a website and mobile app that many people with disabilities cannot use. Many Amtrak stations do not have platform lifts or level boarding which makes it impossible for some people to get on and off the trains. Amtrak also does not allow people with disabilities to purchase tickets to some destinations because there is no way for them to get off the train once they arrive.


To highlight these issues, Disability Rights Florida, is joining with other state and national disability rights organizations to conduct Train Week. In recognition of the 23rd Anniversary of the Americans with Disabilities Act, our staff will visit Florida's bus and rail stations across the country to review and record accessibility problems, as well as accessibility accomplishments.


If you encounter accessibility problems attempting to use Amtrak in Florida, you may call Disability Rights Florida at 1-800-342-0823 to request information and assistance. You may also request assistance via our online form at http://www.disabilityrightsflorida.org/contact/select_form

Notice of Development of Rulemaking. AGENCY FOR HEALTH CARE ADMINISTRATION

CDC+ CONSUMERS, REPRESENTATIVES, CONSULTANTS, CDC+ FIELD OFFICE STAFF (AREA LIAISONS), CDC+ CENTRAL OFFICE STAFF

Please refer to the announcement below submitted by the Agency for Health Care Administration for publication in the Florida Administrative Register, Vol. 39, No. 111, June 7, 2013.Â

Notice of Development of Rulemaking

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid
RULE NO.: RULE TITLE:
59G-13.088: Developmental Disabilities Consumer Directed Care Plus
PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-13.088 is to update the description for restricted services, the definition for behavior assistant services, and background screening information pursuant to the 2012 Florida Statute changes; remove language referring to the provider call center; and add the definition and limitations and special conditions for vehicle modification.
SUBJECT AREA TO BE ADDRESSED: Developmental Disabilities Medicaid Waivers Consumer-Directed Care Plus Program.
An additional area to be addressed during the workshop will be the potential regulatory impact Rule 59G-13.088 will have as provided for under sections 120.54 and 120.541, Florida Statutes.
RULEMAKING AUTHORITY: 409.221 FS.
LAW IMPLEMENTED: 409.902, 409.907, 409.908, 409.912, 409.913, 409.221 FS.
A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
DATE AND TIME: Monday, June 24, 2013, from 10:00 a.m. to 11:00 a.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room D, Tallahassee, Florida 32308-5407.
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 48 hours before the workshop/meeting by contacting: Danielle Reatherford at the Bureau of Medicaid Services, 850-412-4263. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Danielle Reatherford, Medicaid Services, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: 850-412-4263, e-mail: danielle.reatherford@ahca.myflorida.com.
To download a draft copy of the reference material, if available, go to http://ahca.myflorida.com/Medicaid/review/index.shtml.

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:
59G-13.088 Developmental Disabilities Consumer-Directed Care Plus
(1) Individuals enrolled in the Developmental Disabilities Medicaid Waivers Program for Consumer-Directed Care Plus, along with all program representatives, consultants, employees, vendors, and Agency for Persons with Disabilities staff must be in compliance with the provisions of the Florida Medicaid Developmental Disabilities Medicaid Waivers Consumer-Directed Care Plus Program Coverage, Limitations, and Reimbursement Handbook, ____________July, 2012, which is incorporated by reference. The handbook is available from the Medicaid fiscal agent’s Web site at www.mymedicaid-florida.com. Select Public Information for Providers, then Provider Support, and then Provider Handbooks. Paper copies of the handbook may be obtained by calling the Provider Contact Center at (800) 289-7799 and selecting Option 7.
(2) The following appendices are incorporated by reference: Appendix A; CDC+ New Participant Training Program Affirmation Form, July 2012; Appendix B: CDC+ New Participant Training Registration, July 2012; Appendix C: CDC+ Participant Refresher Training Program Affirmation Form, March 1, 2011; Appendix D: CDC+ Participant Refresher Training Registration, March 1, 2011; Appendix E: CDC+ Purchasing Plan, February 14, 2012; Appendix F: CDC+ Quick Update to My Purchasing Plan, June 1, 2009; Appendix G: Florida CDC+ Weekly Timesheet, January 1, 2011; and Appendix H: CDC+ Participant Information Update Form, November 1, 2009. These forms are available by photocopying them from the Developmental Disabilities Medicaid Waivers Consumer-Directed Care Plus Program Coverage, Limitations, and Reimbursement Handbook.
Rulemaking Authority 409.221 FS. Law Implemented 409.221, 409.902, 409.907, 409.908, 409.912, 409.913 FS. History–New 11-12-12, Amended ____________.

If you have a question, please get in touch with us via the contact info below.

Consumer-Directed Care Plus Program (CDC+)
Toll-Free Customer Service Line: 1-866-761-7043
Toll-Free Fax: 1-888-329-2731

Please visit the CDC+ Website for program updates, announcements, and additional information: http://apdcares.org/cdcplus/

Disability News from around the country.

Wanting More and Finding Disability Justice Mia Mingus was recently honored by the White House as a Champion of Change for her efforts as an AAPI Women leader working in the area of disability justice. She is a writer, organizer, and member of the Bay Area Transformative Justice Collaborative. In a blog posted on the White House website, she writes: “Most of my work takes the form of educating communities about disability because disability is something that we are taught to know very little about. Most of my work has been in political movements for social justice and queer and trans, people of color and feminist communities, with fellow activists and organizers, pushing them to respectfully integrate a disability justice analysis in to their work and lives. Most people only know about disability from a very individual and medical understanding and have not connected disability to their work for justice and liberation. For many significant and important reasons, disability has been very segregated from others social justice movements. I work to change that.” Read Mia’s full blog post at the following link: http://www.whitehouse.gov/blog/2013/05/13/wanting-more-and-finding-disability-justice Agency News: The Secretary of the Department of Transportation Speaks at Gallaudet University’s 144th Commencement Address Secretary of Transportation Ray LaHood delivers the commencement address at Gallaudet University Secretary of Transportation Ray LaHood delivers the commencement address at Gallaudet University on Friday, May 17th. Photo Credit: Department of Transportation Fast Lane Blog Secretary of Transportation Ray LaHood spoke at the 144th Commencement Address to the graduating class of Gallaudet University last Friday. This week, he reflected on the experience with a blog post: "At colleges and universities across America, a wave of commencements is underway. For thousands of students, crossing the threshold and becoming graduates is a moment when everything is possible. And for the Class of 2013 at Gallaudet University, a world leader in educating deaf and hard of hearing students, this is particularly true. Because the 144th graduating class at Gallaudet has already faced their share of adversity, and they have responded with their share of boldness." Continue reading at the following link: http://fastlane.dot.gov/2013/05/at-gallaudet-a-commencement-message-for-the-hearing-and-non-hearing-alike-be-bold-work-together.html Agency News: U.S. Department of State Hosts EMPOWER Conference to Advance Disability Rights Worldwide The U.S. Department of State’s Bureau of Educational and Cultural Affairs recently announced the first EMPOWER Conference on disability inclusive diplomacy. The EMPOWER program is a series of two-way exchanges aimed at bolstering the rights of persons with disabilities around the world. Persons with disabilities have the same rights as non-disabled persons, and must be provided access, opportunity, inclusion, and full participation on an equal basis with others. The conference will take place on Wednesday, May 22 in the George Marshall Center, starting at 8:45am. It will include 34 disability rights advocates from Kazakhstan, Kyrgyzstan, Pakistan, the Philippines, Tajikistan, and Uganda who are here for one-month fellowships in cities across the United States. Learn more about the event and program at the following link: http://www.state.gov/r/pa/prs/ps/2013/05/209697.htm Agency News: Applications Now Available to Improve Education and Employment Outcomes for Low-Income Children with Disabilities The U.S. Department of Education has published a Notice in the Federal Register inviting applications for a new competitive grant program, Promoting Readiness of Minors in Supplemental Security Income (PROMISE). PROMISE was proposed by the Obama Administration to improve the education and career outcomes of low income children with disabilities receiving Supplemental Security Income (SSI). The program is designed to serve children with disabilities, ages 14-16, who are receiving SSI and their families. For too long, the current system has not been effective in supporting child SSI recipients. Child SSI recipients who become adult SSI recipients continue to face many challenges, such as low educational attainment and employment rates. Read the full press release at the following link: http://www.ed.gov/news/press-releases/applications-now-available-improve-education-and-employment-outcomes-low-income- Agency News: EEOC Issues Revised Publications on the Employment Rights of People with Specific Disabilities The U.S. Equal Employment Opportunity Commission (EEOC) recently issued four revised documents on protection against disability discrimination, pursuant to the goal of the agency's Strategic Plan to provide up-to-date guidance on the requirements of antidiscrimination laws. The documents address how the Americans with Disabilities Act (ADA) applies to applicants and employees with cancer, diabetes, epilepsy, and intellectual disabilities. These documents are available on the agency's website at "Disability Discrimination, The Question and Answer Series," http://www.eeoc.gov/laws/types/disability.cfm. Read the full press release at the following link: http://www.eeoc.gov/eeoc/newsroom/release/5-15-13.cfm Agency News: Justice Department Reaches Fair Housing Settlement with Design Professional in Disability Lawsuit The Justice Department recently announced a settlement with the architects and civil engineers involved in the design and construction of multifamily housing complexes located in Mississippi, Louisiana and Tennessee. The department’s lawsuit alleges that nine multifamily housing complexes with more than 800 units covered by the Fair Housing Act’s accessibility requirements were designed and built without required accessible features. Read more about the settlement at the following link: http://www.justice.gov/opa/pr/2013/May/13-crt-570.html

Florida warehouses disabled kids in nursing homes

Federal investigators say Florida officials are violating federal law by unnecessarily warehousing hundreds of children with disabilities in geriatric nursing homes. The Department of Justice sent a letter to state Attorney General Pam Bondi this week, saying that in visits to six nursing homes around the state, investigators identified numerous children who didn't need to be there and who "would benefit from moving home with their families or other community settings." The Miami Herald reports that, according to the letter written by Assistant U.S. Attorney General Thomas E. Perez, hundreds of Florida children spend their formative years with virtually no education or socialization. Some children, the letter stated, "are unnecessarily separated from their families and communities for years," including some who entered facilities as infants or toddlers, and have spent a decade or longer institutionalized. Florida, the letter states, administers a system providing "unnecessary segregation and isolation of children, often for many years, in nursing home facilities." Federal officials concluded the state has made it difficult for children to get medical services that would allow them to move back home. Bondi's office is defending the state against a previously filed lawsuit that claims the institutionalization of children violates federal law, including Title II of the Americans With Disabilities Act. Critics have said that Florida has in recent years repealed state rules limiting the number of children that can be housed with adults in nursing homes, and have relied more and more upon nursing home facilities to house children who could receive care safely - and more cheaply - with their families. Perez states that if the state does not take steps outlined in the letter to "correct" the practice, the Justice Department may take action of its own. Bondi's office did not immediately respond to a request for comment. During its investigation, Justice officials visited nursing homes in Miami, Fort Lauderdale, Orlando, Tampa and St. Petersburg that collectively house more than 200 children. Family members and caregivers were also interviewed. The DOJ investigation found that Florida had implemented policies "that impair access to medically necessary services and supports that would enable children to transition home or to other community-based settings." Among the practices cited are the state's reducing or limiting the availability of medically prescribed in-home services "without reasonably considering the child's actual needs"; and making substantial cuts to programs designed to support children and adults with developmental disabilities in the community while simultaneously expanding facility-based care, including enhanced perdiem rates. For a majority of the children referred to these facilities, Florida pays more than $500 per day per child - more than double what the facilities receive from the state for their elderly residents. CBS Station WFOR reported earlier this year that the families of more than 250 children were suing Florida for unnecessarily institutionalizing their children, claiming the state told them needed medical care would be withheld unless the children were placed into a nursing care facility. DOJ said the state's policies put children with medically complex or medically fragile conditions who currently live at home at risk of placement in nursing facilities and other segregated institutional environments if they are to receive necessary care. "Nursing homes are not made for children," attorney Matt Dietz told WFOR correspondent Michele Gillen. "A parent should not have a gun placed to their head - 'Take less care, or your child's going to go into a nursing home.'"

The Affordable Care Act: What Disability Advocates Need to Know

The Arc’s national office policy staff has prepared this issue of National Policy Matters on The Affordable Care Act and the elements of the law that impact people with intellectual and developmental disabilities. National Policy Matters is a product produced by the national office that previously was sent only to chapters of The Arc. We are sending this issue to you because you are signed up to receive legislative updates via the Capitol Insider weekly e-newsletter, and we thought this publication would interest you as well. Introduction Now that the U.S. Supreme Court has affirmed the constitutionality of the Affordable Care Act (ACA), the disability community must work to better understand the law and the many benefits it can provide to people with disabilities. This will be critical to the community’s role in helping to move states forward with implementation. Numerous ACA provisions related to both acute care and long term services and supports hold great promise for improving the health and wellbeing of people with disabilities. This issue of National Policy Matters provides information about the major provisions and the status of their implementation. Why does The Arc support implementation of the Affordable Care Act? The Arc has long supported expanding Medicaid to cover more low income individuals and expanding private health insurance options to achieve universal coverage. The law contains significant nondiscrimination provisions and improvements to the Medicaid long term services and support system that are critical to meeting the needs of people with I/DD. For too long, insurance companies have been able to charge people higher rates because of their health conditions, deny insurance coverage of people with I/DD, and limit coverage of needed health care treatments, services and supports. How many people with I/DD are uninsured or underinsured? While exact numbers are not available for persons with I/DD specifically, a recent study[1] found that of adults age 18-64 with cognitive difficulty, 13.6 % had no insurance, 32.1% private insurance, 41.0% Medicaid, and 27.0% Medicare. * People with intellectual disability would be a subset of people with cognitive difficulty which also includes people with Alzheimer’s, dementia, and other conditions. Many people with I/DD are not in the labor force and lack access to employer sponsored insurance. Even when people have employer sponsored health insurance, they may not have access to the services and supports they need because many private insurance plans do not cover many disability related therapies and services. How does this impact the health of people with I/DD? People who have access to comprehensive and affordable health insurance are more likely to receive the prescription drugs, therapies, and medical treatment they need to be healthy and maintain the ability to function in the community. People with I/DD often have multiple health conditions and are at risk of developing secondary disabilities without quality health care. Studies have documented a higher prevalence of adverse conditions, inadequate attention to health care needs, inadequate focus on health promotion, and inadequate access to quality health care services. How will the ACA reduce costs for states? The ACA will help ensure that individuals have access to health care to prevent costly hospitalizations and institutionalizations that occur when individuals forego treatment. For example, expanding home and community based long term services and supports (LTSS) will reduce the need for nursing home and other institutional settings. In the long run, these investments in health care and home and community based services (HCBS) will improve health and reduce dependence on costly institutions. Investments in improving public health and coverage of prevention services will also save money by reducing the cost of treating health conditions that could have been prevented. How will the ACA reduce costs for individuals? Expanding Medicaid and private health insurance options: Individuals who are currently uninsured and become insured will spend less of their income paying for needed health care services. The health insurance reforms mean that insurance will cover more of the services that people with pre-existing conditions need, thereby reducing costs to the individual. The inclusion of essential benefits in health insurance plans means that a core set of health care services that people with I/DD need will be covered by many health plans. Subsidies and cost sharing for low and middle income people with make health insurance coverage more affordable for people purchasing insurance in the exchanges. (These issues are described in more detail later in this update). Expanding the risk pool: Since the law requires most individuals to purchase insurance or face penalties, it is expected that more people will purchase health insurance. This will allow for the law’s private insurance reforms to work without sky-high premiums. For example, requiring insurance companies to insure people with pre-existing conditions can only be affordable if healthy people also share the risk before they need medical care due to illness or injury. Covering preventive services: Eliminating cost-sharing for preventive services saves money for individuals and families immediately and reduces medical costs over the long term. How Does the ACA Reform Health Insurance? Eliminates pre-existing condition exclusions: Health insurance companies are not allowed to deny enrollment or specific benefits based on pre-existing conditions for individuals under the age of 19. Effective in 2014, the ban will also apply to adults. A pre-existing condition is one that existed before the date of enrollment for health insurance coverage and can include common conditions such as diabetes, seizures, asthma, and others. Bans annual and lifetime limits: The use of lifetime limits in health plans and insurance policies is prohibited. A lifetime limit is the total amount of money that a health insurance company will pay for health care over the lifetime of a policy. An annual limit is the total amount of money that a health insurance company will cover in one calendar year. Annual limits are being phased out and will end in 2014. Ends the practice of rescissions: A rescission is when insurance coverage is retroactively cancelled when a person develops an expensive health condition. Now insurance companies will only be able to drop coverage if there is fraud or intentional misrepresentation. Requires private health insurance reforms in 2014: The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, it eliminates the ability of insurance companies to charge higher rates due to gender or health status. The Department of Health and Human Services (HHS) has yet to develop regulations implementing these critical protections. Improves appeals process including independent reviews: The law requires greater consistency of consumer protections and adds standards that insurance companies must meet. Plans must also provide for an external appeal to an independent decision maker. Requires that 80% of health insurance premium dollars are paying for health care and if the goals are not met, consumers receive a rebate: Prior to the ACA, many insurance companies spent a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing. One goal of the ACA is to bring overhead of the insurance companies down to under 20% for individual and small group coverage and under 15% for large group insurance. Insurers will be required to make the first round of rebates to consumers by August 1, 2012. Enrollees owed a rebate will see a reduction in their premiums, receive a rebate check, or, if the enrollee paid by credit card or debit card, a lump-sum reimbursement to the same account that the enrollee used to pay the premium. In some cases, the rebate may go to the employer that paid the premium on the enrollee’s behalf. Regardless of whether the rebate is provided to enrollees directly or indirectly through their employer, each enrollee must receive a rebate that is proportional to the premium amount paid by that enrollee. Enhances state capacity to regulate unfair increases in insurance rates: The ACA seeks to curb premium increases by requiring vigorous reviews that assure cost estimates use verifiable medical trend data and realistic administrative cost projections. Starting September 1, 2011, insurers seeking rate increases of 10 percent or more for non-grandfathered plans in the individual and small group markets must publicly disclose the proposed increases and the justification for them. In future years, the threshold for review of increases will be set on a state-by-state basis using data that reflect insurance and health cost trends in each state. States were provided grants to strengthen their capacity to review rates. How Does the ACA Expand Coverage? Establishes temporary high risk pools to cover those who are currently uninsured: These pre-existing conditions plans were established in every state for people who have pre-existing conditions and could not obtain health insurance. They will expire in 2014 when the health insurance exchanges become available and pre-existing condition exclusions are prohibited. In many states, the federal government is running the plan. Requires coverage for dependents until age 26: Effective for health plan years beginning on or after September 23, 2010, dependents are able to continue to be covered under their parents’ health insurance plans until age 26. Employers are not obligated to provide dependent coverage, but if they do, the coverage must be provided through the age of 26. Creates health insurance exchanges (or marketplaces) for individuals and small employers to purchase insurance: In 2014, each state will have health insurance exchanges which are a marketplace to sell private insurance that meets certain criteria to individuals and small businesses. In states that choose not to create an exchange, the federal government will create and run the exchange. Forty nine states and DC have taken the exchange planning grants, the first in a series of grants available to states to build the exchanges. The exchanges are required to: Implement insurance market reforms; Ensure non-discrimination; Establish consumer education campaigns and consumer assistance programs; Expand technical capabilities and create accessible electronic information systems; and Create a seamless eligibility and enrollment systems. Numerous specific features of the exchange are particularly important to people with disabilities, including: Significant subsidies to assist low income individuals to afford coverage; All plans sold in the exchange must include 10 essential benefits which includes coverage of pediatric, dental and vision care for children, mental health services, rehabilitative and habilitative services and devices, and other critical disability services; Plans must offer varying levels of coverage between 60% of the cost of covered benefits to 90% of covered benefits; and Exchanges must operate a risk adjustment system and implement the requirement that issuers calculate risk across all of their health plans inside and outside an exchange. To date, 11 states have enacted state exchange laws and 3 states have used executive orders. For more information, see:http://www.cbpp.org/files/CBPP-Analysis-on-the-Status-of-State-Exchange-Implementation.pdf Requires certain individuals to purchase insurance or pay a penalty: The law requires U.S. citizens and legal residents to have qualifying health coverage. Those without coverage pay a tax penalty of the greater of $695 for individuals, per year up to a maximum of three times that amount ($2,085) per family, or 2.5% of household income. The penalty will be phased-in according to the following schedule: 2014: the greater of $95 or 1.0% of taxable income 2015: the greater of $325 or 2.0% of taxable income 2016: the greater of $695 or 2.5% of taxable income 2017 and after: the greater of $695 or 2.5%, as adjusted for inflation each year Exemptions will be granted to individuals for financial hardship, religious objections, American Indians, those without coverage for less than three months, undocumented immigrants, incarcerated individuals, those for whom the lowest cost plan option exceeds 8% of an individual’s income, and those with incomes below the tax filing threshold (in 2009 the threshold for taxpayers under age 65 was $9,350 for singles and $18,700 for couples). Requires cost-sharing and premium credits: The law will provide cost-sharing subsidies to eligible low and middle income individuals and families. The lower the income, the less individuals and families will pay in out-of-pocket costs (out-of-pockets costs include such things as deductibles, co-pays, and/or co-insurance). The ACA will provide refundable and advanceable premium credits to eligible individuals and families with incomes between 100-400% of the federal poverty level to purchase insurance through the exchanges starting on January 1, 2014. The premium credits will be tied to the second lowest cost plan in the area. It will be set on a sliding scale such that the premium contributions are limited to the following percentages of income for specified income levels, meaning that the people with the lowest income will receive the most help: 1. Income as percent of poverty - 2. Annual income for a family of four - 3. Premium contribution as a percent of income - 4. Monthly dollar amount for family of four - 1. 2. 3. 4. 133% $29,326 3% $73 150% $33,075 4% $110 200% $44,100 6.3% $232 250% $55,125 8.05% $372 300% $66,150 9.5% $524 350% $77,175 9.5% $610 400% $88,200 9.5% $608 Requires certain employers to provide health insurance or pay a penalty: The law builds upon our current system of employer sponsored health insurance and provides a disincentive to large employers to drop coverage or not provide coverage at all. It requires employers with 50 or more full-time employees that do not offer coverage to pay a fee if at least one full-time employee enters the exchange and receives a premium tax credit. Employers with up to 50 full-time employees are exempt from any penalties (Effective January 1, 2014). Employers are not required to provide insurance to part-time employees. Click here to read The Arc’s National Policy Matters issue on the ACA’s employer provisions. How Does the ACA Expand Essential Benefits? What are essential benefits? The ACA requires all qualified health benefit plans including those offered through the exchanges, those offered in the individual and small group markets outside the exchanges (except grandfathered plans), and Medicaid benchmark plans, to offer at least the essential health benefits package. The 10 categories of essential health benefits are: Hospitalization; Emergency services; Ambulatory (i.e. outpatient) services; Prescription drugs; Rehabilitative and habilitative services and devices; Mental health and substance abuse disorder services including behavioral health treatment; Preventative and wellness services and chronic disease management; Pediatric services including dental and vision care; Laboratory services; and Maternity and newborn care. Why is this important to people with I/DD? Many people with I/DD will benefit from the inclusion of habilitative and rehabilitative services and devices, mental health and behavioral services, chronic disease management and pediatric services including dental and vision care. Currently, private health insurance may limit the availability of some of these services. What are the major principles to guide the development of the essential benefits package to meet the needs of people with disabilities? The law also requires: An “appropriate balance” among the ten categories of essential care. The Arc views this, in part, as a prohibition of unreasonable restrictions and exclusions in one benefit category (e.g., rehabilitation) if similar restrictions are not placed on other categories; Benefit design that does not discriminate against, and takes into account the health care needs of, persons with disabilities. As part of this, health plans may be required to disclose severity-adjusted quality indicators of access, outcomes, consumer satisfaction and disenrollment rates; and Essential benefits are not subject to denial to individuals against their wishes on the basis of the individual’s present or predicted disability, degree of medical dependency, or quality of life. This is intended to ensure that negative judgments about the quality of life of a person with a disability are not used against people with disabilities when establishing the essential benefits package. In advance of regulating the essential health benefits package, HHS has released non-binding guidance instructing states to choose an existing plan as a benchmark for their essential health benefits package. It also instructs states to enhance that plan in areas where it does not cover all 10 of the required essential health benefit categories. States are provided significant flexibility to pick from several different types of health plans to be their benchmark. What is covered by habilitative and rehabilitative services and devices? This is intended to broadly cover a number of important services, including durable medical equipment, prosthetics, orthotics, and habilitative and rehabilitative services. What is habilitation? The Medicaid program defines habilitation services as “services designed to assist participants in acquiring, retaining and improving the self-help, socialization, and adaptive skills necessary to reside successfully in home and community-based settings.” Many different services, therapies and supports are considered to be habilitation. For example, habilitation may include teaching someone with a developmental disability: basic social skills; how to administer his/her own medication safely; about his/her rights to privacy; how to use a phone; how to ask a healthcare professionals questions and expect to get answers; and how to reliably report how they are feeling. Are there other definitions of habilitation? There has been considerable debate about what habilitation means and how it should be covered. Insurers and others do not want a broad definition such as the Medicaid definition and have pushed for a more narrow interpretation. The HHS proposed rules on how plans should describe the key benefits defined habilitation as: “Health care services that help a person keep, learn or improve skills and functioning for daily living. Examples include therapy for a child who isn’t walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings.” While more narrow than the Medicaid definition, it does address many of the habilitation services. Ensuring that habilitation includes learning a new skill or function is a critical aspect of the definition. What is rehabilitation? In proposed rules, HHS defines rehabilitation as follows: “Health care services that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled. These services may include physical and occupational therapy, speech-language pathology and psychiatric rehabilitation services in a variety of inpatient and/or outpatient settings.” What did Congress intend regarding the definition of rehabilitation and habilitation? States will likely decide how these terms will be defined. As states debate different definitions, it is important to consider what Congress intended. Congress is familiar with the definition of habilitation used by the Medicaid program. It has been in the statute for many years. During the House debate, then-Chairman George Miller, House Committee on Education and Labor, explained that the term rehabilitative and habilitative services “includes items and services used to restore functional capacity, minimize limitations on physical and cognitive functions, and maintain or prevent deterioration of functioning. Such services also include training of individuals with mental and physical disabilities to enhance functional development.” [Congressional Record, H1882 (March 21, 2010)] How is habilitation different from rehabilitation? The key difference is that habilitation usually refers to acquiring or learning skills whereas rehabilitation is usually involves regaining skills that have been lost or improving or preventing deterioration of skills. There are many anecdotal examples of the unfair practice of a service being approved for rehabilitation purposes but not for habilitation: Habilitation Rehabilitation An occupational therapist teaching adults with developmental disabilities the fine motor coordination required to dress themselves An occupational therapist teaching adults who have had a stroke the fine motor skills required to re-learn how to dress themselves A speech therapist providing speech therapy to a 3-year old with autism who has never had speech A speech therapist providing speech therapy to a 3-year old to regain speech after a traumatic brain injury A physical therapist providing a strength training program for an individual with a congenital spine condition to prevent osteoporosis and decline in function as he ages A physical therapist providing a strength training program for an individual who recently acquired a spinal cord injury A physical therapist making a splint for an adult with a chronic condition, such as arthritis, to prevent hand deformities A physical therapist making a splint for an adult who has had hand surgery for a torn tendon Does private insurance cover habilitation? A few states have mandates that require habilitation services for children. For instance, many of the states with autism mandates use the term habilitation to cover the broad range of services and supports required in that state. However, some insurance plans may refuse services such as those described in the chart above that they view as habilitation. What if a state picks a benchmark plan that does not include habilitation services? HHS has said that states have a lot of flexibility in how they add benefits, but they must make sure habilitation is added. In its study of essential benefits, the Institute of Medicine (IOM) recommended that the states look toward Medicaid: “The committee is guided by the unambiguous direction of Section 1302 to start with a commercial health insurance benefit; however, it suggests that the Secretary compare, in particular, how Medicaid plan benefits for habilitation and mental health and substance abuse services compare with commercial plans that currently include such services. For example, Maryland has requirements to cover habilitation services in children under age 19 in its small business standards for health insurance (Maryland Insurance Administration, 2009). On the basis of this review, the Secretary would add selected services to the preliminary list to fulfill the 10-category requirement.” IOM Report: Essential Benefits: Balancing Coverage and Cost (2011), p. 5-3 How does the ACA Impact Medicaid? Expands Medicaid eligibility to 138% of the federal poverty level: The ACA requires states to expand Medicaid eligibility to 138% of the federal poverty level and to childless adults, a group that few states cover in their Medicaid program. The ACA established a new method of determining income and eliminated the asset test for the new beneficiaries. The newly eligible individuals will have access to Medicaid benchmark plans designed by the state. The government estimated that 16 million new beneficiaries would receive Medicaid by 2019. While not a perfect measure of how many people with disabilities are uninsured, the Urban Institute estimates that 12% of uninsured adults with incomes below 138% of the federal poverty level report limited ability to work or unable to work. The new eligibility level for a family of four equals approximately $30,000 per year. How does the Supreme Court ruling affect the Medicaid expansion? The Supreme Court ruling that the federal government cannot withhold existing Medicaid funding if the state does not expand its Medicaid program as called for by the ACA has the effect of making the Medicaid expansion optional for the states. It appears that the states that do go forward will need to follow the provisions of the law and will receive the very generous Medicaid match. (The federal government will pay 100% of the costs of the newly eligible individuals through 2016 with a phase down to 90% by 2020). The ACA also has a maintenance of effort (MOE) provision that does not allow states to reduce eligibility in advance of the expansion but that will expire in 2014. This provision has been opposed by states but is a logical provision to prevent states from trying to game the system by dropping people from Medicaid and enrolling them after 2014 when the federal government will pay the cost. The numerous other changes to the Medicaid program are not impacted by the Supreme Court decision. According to the Kaiser Commission on Medicaid and the Uninsured, since April 2010 when the option became available, eight states (CA, CT, CO, DC, MN, MO, NJ, and WA) have received approval to expand Medicaid to adults early through the new option and/or a Section 1115 waiver. For an interactive map of states and the Medicaid expansion, see: http://www.americanprogress.org/issues/2012/07/medicaid_expansion_map.html Creates an option to provide health homes for Medicaid enrollees with chronic conditions: The ACA provides states with a new option to reform the delivery system for beneficiaries with chronic conditions by providing “health home” services and authorizes a temporary 90% federal match rate for these services to allow states to build person-centered systems of care to improve outcomes for Medicaid beneficiaries. The health home model for service delivery integrates primary, acute, behavioral health and long term services and supports for persons with chronic illness. As of April 2012, the Centers for Medicare and Medicaid Services (CMS) has approved six state plan amendments (SPA) in four states to provide health home services: two in MO; two in RI, one in NY, and one in OR. There are two additional health home SPAs under review in NC and WA, and CMS is reviewing draft proposals in five states (AL, IA, IL, OH, and OK). In addition, CMS has approved funding requests from 15 states for planning activities to develop a health home SPA. Eliminates Medicare Part D (drug coverage) co-pays for Dual eligibles receiving waiver services: Effective January 1, 2012, full benefit Dual eligibles (people receiving Medicare and Medicaid benefits) receiving home and community based waiver services will have no cost sharing for Part D covered drugs. This creates parity with how Dual eligibles in nursing homes and institutional settings are treated. Improves Medicare Part D access to key anti-seizure, anti-anxiety and anti-spasm medications: Starting in 2013, Part D will cover benzodiazepines and will cover barbiturates used in the treatment of epilepsy, cancer, or a chronic mental disorder. Starting in 2014, Medicaid programs will no longer be able to exclude smoking cessation agents, barbiturates, and benzodiazepines from coverage under Medicaid. Because Part D covered drugs are defined generally as those drugs that are covered under Medicaid, this new provision will result in a small expansion of Part D coverage of barbiturates. The current six protected classes of drugs (which includes critical anti-seizure, anti-depressant and other drugs used to treat mental illness) remain protected until the Secretary decides to change it. How Does the ACA Expand Long Term Services and Supports? Several provisions of the ACA are designed to assist states to balance their long term care systems and help people move from institutions to the community. They reflect a broad consensus that people who need long term supports want to receive them in their homes and communities and not in institutional settings. Community First Choice Option (CFC) Through the CFC Option, states may choose to provide participant-directed or agency-provider home and community-based attendant services and supports as part of their state Medicaid plan. States that choose the option will receive a 6% increase in their Federal Medical Assistance Percentages ( FMAP) (the portion of state Medicaid costs the federal government covers) for the CFC services. CFC services are for people of any age with any type of disability who would have to go to an institution if they did not receive the services. Institutions include: hospitals; nursing facilities; intermediate care facilities for people with intellectual/developmental disabilities; institutions providing psychiatric services for individuals under age 21; and institutions for mental diseases for individuals age 65 or over If a state takes up the CFC Option, the state must provide home and community-based attendant services and supports to anyone who qualifies. Since this is not a “waiver” program, the state cannot set limits on the number of people served. Attendant services and supports are: assistance with activities of daily living (ADLs, such as dressing and bathing); instrumental activities of daily living (IADLs, such as money management or shopping for food); and health-related tasks (such as taking medications). Attendant services and supports are provided through hands-on assistance, supervision, and/or cueing and include helping an individual learn the skills to complete ADLs, IADLs, and health-related tasks more independently. States may choose to provide additional services such as transition services, including rent and utility deposits, bedding, basic kitchen supplies and other necessities that someone who is moving out of an institution into the community might need. The rules for the Community First Choice Option program became final in April 2012. State Plan Home and Community-Based Services Option (also known as Sec. 1915(i) option) States have had the option to include home and community based services (HCBS) in their state Medicaid plans without a waiver since 2005. The ACA made improvements to the option by making it easier for individuals to qualify for services and to allow states to target specific populations (such as persons with I/DD). If a state chooses to add HCBS to its state plan, the state: must use needs-based criteria for the home and community-based benefit that are less stringent than institutional level of care criteria; must provide these services to all Medicaid recipients who meet eligibility criteria for the services; is not allowed to have waiting lists; may make self-direction of services available; and must offer independent assessments (professionals who evaluate a person for eligibility for the services cannot be provider of the home and community-based services and supports). Money Follows the Person The Money Follows the Person Rebalancing Demonstration (MFP) program was originally authorized by Congress in 2005 at $1.75 billion. The ACA extended the program to September 30, 2016 and authorized an additional $2.25 billion. States may choose to participate in the MFP demonstration and receive an enhanced FMAP (portion of state Medicaid costs the federal government covers) for 12 months to help transition people who are elderly or have disabilities from institutions to home and community-based services and supports. States may use grants to pay for things such as housing coordinators and relocation expenses. As of March 2012, 43 states and the District of Columbia had MFP grants and 22,500 individuals had transitioned to the community. States participating in MFP as of June 2012: AR, CA, CO, CT, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, TN, TX, VA, VT, WA, WI, WV, and the District of Columbia. Balancing Incentive Payments Program (BIPP) BIPP is a $3 billion grant program that encourages states to rebalance their Medicaid long term services spending away from institutional care and toward home and community-based services and supports. This program addresses all disability and aging long term services spending. States that spent less than 50% of their total Medicaid long term services dollars on non-institutional services in Fiscal Year 2009 may participate in the program. It provides different levels of incentives depending on the state’s spending on HCBS: States that spent between 25% and 50% of their Medicaid long term care budget on home and community-based services are eligible for a 2% FMAP increase (2% increase in the portion of state Medicaid costs the federal government covers) for new or expanded home and community-based services. States that spent less than 25% of their total Medicaid long term services budget on home and community-based services (Mississippi) are eligible for a 5% FMAP increase (5% increase in the portion of state Medicaid costs the federal government covers) for new or expanded home and community-based services. In exchange for the increase in federal dollars, states must: provide conflict-free case management services (the case manager may not be the provider of community-based services); use a standard assessment instrument for individuals across the state who may be eligible for leaving an institution and receiving home and community-based services; and create a system that has “no wrong door” (people can obtain all necessary information and apply for the services in one place). The program began in October 2011 and runs through October 1, 2015. As of June 2012, six states had received BIPP grants (New Hampshire, Maryland, Iowa, Mississippi, Missouri, and Georgia). Medicare-Medicaid Coordination Office The ACA created the Medicare-Medicaid Coordination Office (MMCO) within CMS to coordinate policy for individuals who are eligible for both Medicare and Medicaid. These individuals, who sometimes are referred to as Duals, have multiple chronic conditions (diabetes, hypertension, Alzheimer’s, serious mental illness, developmental disabilities, physical disabilities) and very low incomes. Two-thirds of the Duals are over the age of 65 and one-third are between 18 and 64. Because of their complex health needs, Duals tend to represent a disproportionate share of Medicare and Medicaid costs. MMCO has awarded 15 states $1 million grants to design plans to improve health care for Duals and reduce costs. Centers for Medicare and Medicaid Services Innovation Center The ACA created the Innovation Center within CMS to find new ways to pay for and deliver health care in better, less costly ways. The Innovation Center tests innovative payment and service delivery models that enhance the quality of health care services while lowering costs. How Does the ACA Emphasize Prevention? Eliminates cost-sharing for critical prevention services: The ACA provides states with a 1% increase in their FMAP for offering Medicaid coverage of and removal of cost-sharing for preventive services. Preventive services are those that are highly rated by the U. S. Preventive Services Task Force. Examples of these services include: immunizations; screenings for diabetes and depression autism screening for children at 18 and 24 months; developmental screenings for children under age 3; behavioral assessments throughout childhood; and well visits with assessments and individualized prevention for Medicare beneficiaries. Creates the Prevention and Public Health Fund (PPHF): This program provides new funding for transformational investments in promoting wellness, preventing disease, and other public health priorities. The ACA also creates a grant program to support the delivery of evidence-based and community-based prevention and wellness services. The grants have primarily gone to state departments of health which in turn are partnering with local community based organizations, schools, and other agencies. Are There Other ACA Provisions Important to People with I/DD? Improves accessibility of medical diagnostic equipment: The Access Board is developing standards for accessible medical equipment. The standards address access for people with disabilities to examination tables and chairs, weight scales, mammography equipment, and other equipment used for diagnostic purposes. The draft standards were published for public comment on February 9, 2012. Improves data collection about people with disabilities: The ACA requires the collection of data on “disability status for applicants, recipients, or participants” by “any federally conducted or supported health care or public health program, activity or survey.” This is a very broad requirement and will take some time to include disability status in all these activities. Once implemented it will expand the information that researchers, policy makers and advocates will have about the health care status of people with disabilities. The ACA is a very comprehensive law and includes numerous other provisions that will expand the health care workforce, make changes to existing programs, test new ways to pay for health care services and other provisions affecting people with disabilities not discussed in this update.

President Obama met with some youth with disabilities.

Watch the video Today, the White House released a video recapping a meeting President Obama participated in with youth with disabilities. This once again demonstrates the President’s commitment to Americans with disabilities and their future. As President Obama has so often said, change in America happens from the bottom up. It happens when people organize, speak out, and have a seat at the table. Recently, President Obama met with some youth with disabilities. He wanted to hear their thoughts about the future of disability policy. So, he sat down with participants from the American Association of People with Disabilities internship program. These future leaders spent their summer in DC, interning with various organizations. Watch the video. http://www.youtube.com/watch?v=qceocris2uE&feature=youtu.be

White House Monthly Disability Call

Hello everyone, In order to help keep you more informed, we host monthly calls to update you on various disability issues as well as to introduce you to persons who work on disability issues in the Federal government. This month’s call will feature Senior Advisor to President Obama, Valerie Jarrett, and Director of the White House Domestic Policy Council, Cecilia Muñoz. Both will also take questions. If you received this email as a forward but would like to be added to the White House Disability Group email distribution list, please visit our website at http://www.whitehouse.gov/disability-issues-contact and fill out the "contact us" form in the disabilities section, or you can email us at disability@who.eop.gov and provide your full name, city, state, and organization. We strongly urge and ask that you distribute this email broadly to your networks and listservs so that everyone has the opportunity to learn this valuable information. I would encourage you to call in about five minutes early due to the large volume of callers. The conference call information is below. Date of Call: Friday, August 24, 2012 Start Time: 2:00 p.m. EDT (dial in 5 minutes early) Dial in: (800) 762-7308 Code: White House Disability Call For live captioning, at the start time of the event, please login by clicking on the link below. Please only use this feature if you are deaf or hard of hearing. http://www.fedrcc.us//Enter.aspx?EventID=1998026&CustomerID=321

Vote No to Florida’s Medically Needy Waiver

We know it’s hard to keep track of the quick pace at which Medicaid policy is moving. Even as we engage in the fight to make sure 1 million Florida lives aren’t left out of the promise of Medicaid expansion, we continue to advocate for Floridians whose health security depends upon waiver proposals that would weaken the safety-net which they rely upon. Please take 2 minutes to say NO to the cruel effort to place Floridians with catastrophic medical conditions at the mercy of managed care plans. If Florida gets its way, Medicaid recipients in the Medically Needy program would be forced into managed care plans and pay up to 90% of their monthly income on premiums. This could mean that a lupus/ cancer/ transplant survivor (or someone with similar medical condition that is over regular Medicaid income levels) could pay up to $1,800 a month in premiums in order to ensure continued access to essential care. Vote Now at CMS’s (Center for Medicare and Medicaid Services) website against Florida’s Medically Needy waiver. http://cmsideas.uservoice.com/forums/161095-section-1115-demonstrations-florida-meds-ad/suggestions/2874908-state-says-medneedy-must-pay-huge-premiums-up-to-