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Current News State News New: The U.S. Department of Education, Office for Civil Rights (OCR) has completed its investigation of OCR Complaint Reference No. 10071116 filed against Shoreline School District No. 412, on April 11, 2007. Click here to read their findings and conclusions. Federal News DPC Conference Call June 18, 2009Agenda: Health Care Reform Purpose of Reform: In terms of Health Reform, it is important, as a backdrop, to keep mind, not only for the President and for members of Congress on both sides of the isle, is to cover the 45 to 50 million Americans who are uninsured, have no insurance coverage, significantly reduce cost to the health care system and in the process of doing so, improve quality, improve access for the estimated 25 million Americans who may have insurance coverage, but who are under insured. It has to be done, the arguments have to be made in terms of the overall purpose. Process: President Obama has asked Congress to send him a Health Reform bill by October or November of this year. Everyone knows that if this is going to be accomplished it has to be done this year, because next year is an election year and 2011 is the beginning of the Presidential Campaign. With respect to the Senate, there are two committees that have jurisdiction, the Health, Education, Labor and Pension committee, chaired by Senator Kennedy, due to his cancer treatment, which is still ongoing, he has asked Senator Dodd to take over for him. The Health Committee has developed a rather partisan bill, they started a mark-up yesterday, which is 116 pages, and the Republicans were quite critical of many of the provisions. Senator Baucus of the Finance Committee, is trying to be a little bit more deliberate and involve the Republicans on his committee, they have had several bipartisan walk through of the bill, and he wants to make the bill bipartisan. He wanted to start a mark-up of a draft next week, but initial estimates on the cost from the Congressional Budget office were about 1.6 trillion dollars and he wanted the estimate to be 1 trillion dollars, so he sent the staff back to cut out 6 trillion dollars and that will take a week so that their mark-up will be after the 4th of July recess. In terms of the Senate Committee’s ambitious schedule, the fact that the Health Committee had a bit of a problem with their mark-up yesterday and the Finance Committee had to delay its markups, things are off to a bit of a rocky start. What happens after these two markups, these bills will be somewhat different, as the Senate has to figure out how to pay for this. These bills will be melted together before they go on to the Senate floor. In terms of tools the Senate can use is called Reconciliation which was part of the Budget Resolution that was passed a couple of months ago. This will allow the Senate to pass with 51 votes, however, Reconciliation only authorizes the bill for 10 years, for that reason Senator Baucus does not want to use it. Reconciliation also does not allow you to do all the insurance market reforms in the bill. Those procedures would require a procedure called the Byrd Rule that requires 60 votes. President Obama has made it clear that Health Reform has to be Budget Neutral and can’t add to the deficit. So every single penny has to be offset either by cuts in programs or increase in revenues. On the House side, there are three committees of jurisdiction, Energy and Commerce, Ways and Means, and Education and Labor. Their process is a little different, Majority Leader Hoyer has been charged by the Speaker with coordinating all of those committees, so they will come up with one bill. Hearings are supposed to start next week, the markups will be after the Fourth of July recess. They plan to have the bill on the floor before the August recess. Everyone anticipates that the House process will be very partisan, no one expects the Democrats to get any Republican votes, however the Democrats have their own challenges within their own caucus, because the progressive want to go one way, they are adamant on inclusion of the Public Plan, preferably run by the Federal Government and Blue Dogs want to go more to the right, and have concerns about a Public Plan. So because the Democrats need every vote they will have to work with these others. Update: The House plans to have bill out as a draft tomorrow. They want comments from people. Insurance Market Reform/Increasing Coverage: There are four important things to remember, there is consensus on the following four points. The President underscores these every time he talks about health reform. One, you should be able to keep the health insurance that you have, if you want to do that. Two, there will be a universal mandate, because that is how the insurance companies will be able to accept the reforms. Three, emphatic on prevention and lot of money be put into prevention. Fourth, market reforms. Market Reforms specific to Affordable Health Choices Act that was introduced by Chairman Dodd on behalf of Chairman Kennedy. This bill is in draft form and includes many options, it does not have a number, and the Republicans have complained that they did not have any input in its development. Already there are 400 to 500 amendments to it for discussion and voting or potential compromise during markup. These Market Reforms are expected to be in every bill. First, there will be a guarantee issue, every insurance plan will have to offer insurance to everyone and they will be guaranteed renewal. Second, there will be probation on pre-existing conditions exclusions. All of these are for the individual and small group markets. Third, there is probation on lifetime annual caps in insurance policies. Fourth, there is a probation on discrimination based on health status and other factors, such as, physical and mental illness, health claims etc. A very long list of factors that constitute discrimination based on health status. In addition, the Kennedy-Dodd bill requires insurance companies plan to expand dependent coverage for young adults to age 26. With respect to expanding coverage, there will be a universal mandate. The bill establishes what are known as gateways, the gateways are going to be done either at the state or regional levels, they will be set up with seed money from HHS, if a state or region refuses to set up a gateway, there is a Federal fallback. There are a lot of regulations and details left to HHS, which is appropriate given the complexities of the issues. Gateways are really the means by which the insurance plans will participate, they will have to meet certain qualifying conditions, they will be approved and then individuals will be able to purchase plans in the gateway. There will be at least 3 plans, and they will vary based on premiums and benefits, at least one of them will have to be an affordable plan. The gateways will have a huge advisory committee of consumer groups, professional groups and others to help develop educational materials for people, navigators to help people understand and how to choose plans that are appropriate to their needs. There will also be subsidies for people who have low income and the amount of those has not been determined yet. Part of that has to do with the overall cost of the bill. The way the subsides work is that the Sec. of HHS will provide them to the gateway and gateway will pay the insurance plan. With the respect to benefits: the HHS Secretary in consultation with the National Institution of Health, the Center for Disease Control or in a contract with the Institute of Medicine. The Secretary is going to establish a medical advisory council. This council is going to take the seven categories of benefits set forth in the bill and decide on which specific benefits will be provided, and then that will be divided up in terms of the plan. The seven categories include the obvious things like out patient ambulatory care, inpatient hospitalization, surgeries, maternity and childbirth, prescription drugs, it also includes laboratory tests, rehabilitating and habilitation services, we were told that it also includes durable medical equipment, wheelchairs, it includes pediatric care and prevention and wellness services. It’s basically the way the gateways are going to work. The way to get universal mandate is there is something called shared responsibility, if you don’t have insurance through your employer that you want to keep, or other insurance that you don’t want to keep, or you don’t purchase insurance through the gateway, or you don’t have Medicaid or Medicare, the Secretary is going to determined what constitutes a shared responsibility payment, you are going to have to pay the IRS. This is how we get to Universal Coverage. Universal Coverage is the prerequisite for the insurance companies accepting all the reforms. There are some controversial issues, one is the Employer mandate, and that isn’t in the Kennedy bill, the details of that are not provided yet, it is called Pay or Play, the second is there should be a Public Plan run by the Federal Government like Medicare or if there should be some cooperative of individuals that would get seed money from the government but the government would not be involved after that, the cooperative would pay medical providers, that is just an idea that in conception, it has not been fully flushed out yet. The other issue is how to pay for it. Prevention Issues/Health Disparities: This is one of the hot issues where there is consensus on the need for emphasis on prevention. Senator Harkin who has been in charge of this on the Health Committee says, “Our country has a sick care system, we don’t have a health care system”. He claims that we spend 95 cents of every dollar on helping people when they are sick and only 5 cents on people preventing them from getting sick. So there is authorization for Prevention and Public Health investment fund that will be housed at the Treasury and will fund a variety of research and prevention in public health and wellness programs. It is authorized for 10 billion dollars for FY 2010 to FY 2019 and thereafter whatever FY 2019 authorization is, that will be the authorization. There are community transformation grants and they have focus in the status and one of the primary focus is on people with disabilities. In addition there will be grants to establish school based health clinics in underserved areas. This is also focus on people with disabilities, there will have to be data collection on several factors, including disabilities. There is a provision requiring the US Access Board to develop standards for medical diagnostic equipment such as exam tables, x-ray machines, etc. With respect to disparities, disabilities are required to be collected as part of Health Disparities. There are some provisions with respect to training primary care physicians, and dentist on disabilities. Improvements to Long Term Services and Supports Policies: First of all, the Class Act that would create long-term services insurance program on a voluntary basis. Your eligibility for it if you receive benefits from the program would be based on functional need not on diagnosis or condition. The benefit would be a cash benefit so that individual/and or the family could determine the best way to assist the individual, this is not a means tested program and it does not mean that you have to stop working. In the Senate, on the Health Committee this is part of the first draft on the current bill, and is part of the markup that is going on now. There is a possibility that the Class Act might come up tomorrow and we are also expecting the cost estimates to come out anytime now. There are many amendments some are focused on the Class Act. On the House side there is no long-term services in the contemplative bill at this point. We have been part of a number of meetings that include people with disabilities and the aging community and we are hitting the House and Senate on a regular basis. There is a possibility if the cost estimate for the Senate version of the Class Act comes out looking good, then there is a possibility that we can get it in the House bill before the markup is finished. The other proposal is the Community Choice Act, which would mandate coverage of community assistance and attendants supports for people who have the level of need that a nursing home or a ICFMR or institution for mental disease. Essentially would require the States to provide a certain package of community-based services to individuals and this as opposed to going on the wavier or on the waiting list. It is based on functional need and addresses the instrumental activities of daily living and health task. The biggest problem with this bill is its cost estimate. We have heard that it would cost 38 billion dollars over 10 years or 68 billion dollars over 10 years, so we will wait and see. It does not look like it will get into either of the Senate bills. So we are looking for some other approach to take in order to get a start, something into the final bill that would allow this type of service to people and allowing it to develop and grow through the future. Representative Davis has written a Dear Colleague letter that he is sending to Democratic members on the Energy and Commerce and the Ways and Means Committees and he is asking for these representatives to join him in signing this letter to leadership of the House, urging them to support a demonstration project, a new option in Medicaid that would essentially place the Community Choice Act’s provisions into the law but not as a mandate. It would either place it into law as a option for States to pick up and choose to provide or to place into law as a demonstration project, possibly modeled after the demonstration project that we had in 1990, the Community Support Living Arrangements, that was available to up to eight states and a certain amount of money, about 30 states applied for it at the time, and that only eight states got it. It really changed the waiver system, and what CMS was willing to do. So even a demonstration project can actually make a significant change in a service system. So that is being thought of right now. That is on the House side. We are still working with Senator Harkins office on the Senate side trying to figure out the direction that they want to take, so there is nothing to report at this time. The last piece is a series of improvements to Medicaid that the Senate Finance committee put into an option package that we saw a few weeks ago and some of these provision come out of the bills that we supported in House and Senate called the Empowered at Home Act, others are new provisions from various areas and they put into their list of options. Some of them would be very positive for people with disabilities and we are still waiting for cost estimates on these. A couple of them, just to remind you what they were, one of them would break the link for eligibility criteria for institution services and home and community based waiver services, many think that this might allow the States to start cutting back on the eligibility for the institution, while opening up eligibility for community based services. Other provisions would allow one percent increase in the Federal Matching rate for community based services, so if you provided services in the institution you would get your regular state reimbursement, if you provided services in the community you would get that rate plus one percent and over time that could make a big difference. Everything on the table and is subject to the cost estimates so we are waiting for that. Potential Offsets: The offsets are going to come from a combination of cuts to Medicare and Medicaid. A lot of the cuts to Medicare will come from providers, trying to get doctors to cut tests, not to be reimbursed on how many tests they do but quality outcomes. There will be changes to Medicaid, but mostly around pharmaceutical rebates. With respect to revenue, there were a verity of proposals in the Senate Finance committee, some that are going nowhere. There were concerns about eliminating itemized deductions for health care, it is unclear whether they are going to do that. Now if you get employer provided health benefits you are not taxed on it. There is talk now about the proposal to impose a tax after it reaches a certain limit on the amount that your employer pays you would be taxed. The numbers have not been developed yet. Senator Grassley yesterday told his colleagues that it was really not fair, for people who do not have employer health benefits to have to pay taxes while people who do have them go basically tax free. Recess Week: Last night a action alert was sent out to Executives and Board Presidents. We will send a alert to all others. Please share with your volunteers and others any information on meetings with your representatives. We need to get support for the Class Act. The aging community is working with us on this. The second alert which will be going out shortly, is about the Community Choice Act, this will be a targeted alert for people whose representatives are on the House Ways and Means and the Energy and Commerce committees. The dates of the recess are June 26 to July 4th. Schedule for next quarter: This will be decided shortly and we will let you know.
A question was asked: What do we say back to our congressmen and women when they say how expensive Medicaid is for people with disabilities? Medicaid: Home and Community based services can only be available through an option the State must pick, and the only people who are eligible for those options is if you can prove you would otherwise be in an institution. It doesn’t make sense in this day and age to link the need for Home and Community based services to the need for institutional services. Once you create home and community based services the assumption is that you get more bang for your buck. Home and Community is usually less costly that institutional services. There are a lot of people who end up on Medicaid from the middle class and upper economic classes because that’s the only way their sons and daughters who have developmental disabilities are going to get served. The Class Act, will allow for those who can afford it, will circumvented the need for Medicaid and thus take pressure off Medicaid by allowing them to buy into the National Long Term Insurance that the Class Act would provide, and that program would create eligibility not by category of disability, but by functional need, it would not be means tested, so people would not have to impoverish themselves to get services. So you are looking at a two-pronged approach. Fix the Medicaid program, so that Home and Community based services work best for people. And if you can, afford Medicaid if you can by buying Long Term Insurance that makes sense for those who can afford it. There was also discussion on the Annual Convention, you can find Convention information on The Arc web site. Hotel reservations can be made now so that you can be sure of a room. The
Washington State Developmental Disabilities Council has just released its
much anticipated DVD guide to the developmental disabilities universe of
resources and services. Informing Families, Building Trust
Informing Families, Building Trust
in an ongoing effort to improve communication and access to information. An editorial board representing
families and key organizations direct the effort.
From Informing Families, Building Trust
Greetings!
The new DDD Assessment will be a big change.
Together, though, we can help people prepare for it when it begins June 1,
2007 (Note: date change). For more information, visit: www.informingfamilies.org
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