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VOR Weekly E-Mail Update
August 11, 2006
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1. August is a GREAT time to visit your Congressional
Representative and
Senators in District Offices
2. VOR commends Harkin for H.R. 3717, the Promoting Wellness
for
Individuals with Disabilities Act of 2006
3. Sunset Bill Pulled From Floor Schedule; Tiahrt Optimistic
About His
Bill's Passage
4. Good News!! Cost Sharing and the DRA
5. HHS Provides Funding to States For Alternatives to Nursing
Home and
ICF/MR Care in Medicaid: "Money Follows the Person" Helps States
Rebalance
Long-Term Care Systems
6. U.S. Issues New Rules and Schools and Disability
7. Gov. Vilsack says joining Maine and Vermont will save $11
million a
year
8. DON'T YOU THINK THIS UPDATE PROVIDES GREAT INFORMATION AND
TIMELY
UPDATES?? Please consider supporting VOR's good work. Join or
contribute
today please! A membership and contribution form is included at
the end of
this update.
COMING UP: State News - Friday, August 18; no Update, Friday,
August 25.
======================================================
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1. August is a GREAT time to visit your Congressional
Representative and
Senators in District Offices
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During the month of August, Congress is in recess and your
federal elected
officials are back in your state. This means it is a great
opportunity for
you to visit your U.S. Representative and Senators in District
offices.
To find out who your Representative and Senators are, visit
http://www.congress.org. This website will also give you
addresses and
phone numbers for District offices.
If you do visit, be sure to acquaint them VOR and our key
issues,
including:
(A) opposition to Sunset Commission proposals (see below)
(B) Support for health care legislation, including H.R. 3717
(see below)
(C) Support for adequate Medicaid funding
To see VOR's positions on these issues, visit:
http://www.vor.net/LeaveBehindPositions2006.html. Updates to
some of our
high priority issues are also contained in this update.
Feel free to share these position papers with your U.S. elected
officials.
Thank you!
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3. VOR commends Harkin for H.R. 3717, the Promoting Wellness for
Individuals with Disabilities Act of 2006
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August 8, 2006
The Honorable Tom Harkin
U.S. Senate
Washington, D.C. 20510
Dear Senator Harkin,
On behalf of VOR's members and our family members with mental
retardation,
it is a great pleasure to extend sincere gratitude to you for
introducing
H.R. 3717, the Promoting Wellness for Individuals with
Disabilities Act of
2006.
In June 2006, VOR members called on Congress to embrace a
"legislative
solution addressing the widespread lack of access to quality
health care
for people with mental retardation." Our position paper [see,
http://www.vor.net/HealthCarePosition.html] included the
following goal,
which is also included in H.R. 3717:
* Incentives for Medical Schools to include disability-specific
curricula,
including required rotations or residencies at residential and
clinical
programs serving people with mental retardation.
Your proposed legislation recognizes that people with mental
retardation
often have extensive health challenges, but lack access to
needed health
care professionals. H.R. 3717, when passed, will put in place a
necessary
foundation to ensure that all future health care professionals
will receive
hands-on training in providing health care to patients with
disabilities,
including people with mental retardation. Your legislation also
includes a
provision that will immediately promote good health outcomes,
wellness
programs, and preventive health screenings.
We believe that H.R. 3717 is an important step forward for our
goal to
address the widespread lack of access to quality health care for
people
with mental retardation. We thank you for your compassionate
leadership.
Sincerely,
/S/Mary McTernan, Ph.D.
President
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3. Sunset Bill Pulled From Floor Schedule; Tiahrt Optimistic
About His
Bill's Passage
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Summary: See vor.net for VOR's recent Action Alert re: the
Sunset
Commission proposals.
Roll Call
Jennifer Yachnin
July 31, 2006
Objections from moderate Republicans put passage of a key budget
reform
sought by conservative GOP lawmakers in limbo last week,
prompting House
leaders to shelve debate on the measure until after the August
recess.
The Government Efficiency Act, authored by Rep. Todd Tiahrt
(R-KS), had
been slated to go to the floor late last week but was scrubbed
from the
schedule Thursday afternoon. The bill would establish a federal
commission
to evaluate government funded agencies or specific programs and
issue
recommendations to Congress on whether those bodies should be
consolidated,
abolished or otherwise altered.
Moderate lawmakers led by Rep. Sherwood Boehlert are seeking a
half-dozen
amendments to the bill, of which the New York Republican stated:
"As
presently constituted, it does not represent good public
policy."
"I question the need and appropriateness of this legislation,"
Boehlert
said Wednesday, testifying before the Rules Committee.
Among his proposed changes, Boehlrt targeted the commission's
composition,
which under the current legislation would include seven members
appointed
by the White House with four of those individuals selected in
consultation
with the majority leadership of both the House and Senate.
The amendments would require all appointments to be made by
Congress and
would add two House Members and two Senators to the panel.
In addition, Boehlrt, who chairs the Science Committee, called
for the
commission to hold public hearings.
Another amendment would extend the period for Congress to review
recommendations from the commission to 45 legislative days from
the 30 days
proposed by Tiahrt. Boehlrt has also called for language that
would allow
Members to offer amendments to the commission's proposals,
something that
would be permitted only in committee under the current bill.
While no one on the Appropriations Committee has offered formal
changes to
the measure, panel members also have questioned the need for
such a
commission.
"We feel pretty comfortable with the level of oversight we have
here on the
committee," Appropriations spokesman John Scofield said before
the Rules
meeting Wednesday.
"We were successful in eliminating 53 programs. That's not just
proposing,
but actually getting through the system," he said, adding that
the House
has slated 95 additional cuts in fiscal 2007 spending bills.
While the Rules Committee reviewed the measures Wednesday, it
has yet to
vote on parameters of debate for the measure, including what
amendments
Members would be allowed to consider on the floor.
Without a decision on whether those amendments will be included
in the
bill, one Republican aide, who spoke on the condition of
anonymity, said:
"Opposition has stayed quite strong from moderates and
Democrats."
But Tiahrt who asserted Friday that his legislation has also
been squeezed
by time constraints as the chamber sought to finish items such
as a minimum
wage proposal in advance of the August recess does not expect
those
objections will defeat the bill.
"I didn't see anything that was not insurmountable," he said. "I
think we
answered almost all the concerns."
Despite the apparent setback, House conservatives expect the
measure, as
well as a broader proposal by Rep. Kevin Brady (R-Texas) to
establish a
sunset commission that would impose automatic expiration dates
for
federally funded programs, will return to the chamber's calendar
in the
fall.
"We look forward to working with leadership to enact real budget
process
reform after the August district work period," said one
Republican aide to
House conservatives.
The review commissions are among four budget reform measures
which also
include earmark reforms, emergency spending guidelines, and line
item veto
legislation that conservative Republicans demanded from House
leadership
during negotiations over the 2007 budget blueprint earlier this
year.
The House approved legislation granting the president line-item
veto
authority in June.
In addition, although discussions between the House and Senate
over lobby
reform legislation have reached a stalemate the standoff
centers on House
leaders' insistence on legislation targeting the political
committees know
as 527s House leaders announced Wednesday they will seek to
amend the
chamber's rules to apply earmark reform measures for the
duration of the
109th Congress.
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4. Good News!! Cost Sharing and the DRA
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As VOR has previously reported, the Deficit Reduction Act
contained an
apparent drafting error that, if enforced, would have allowed
states to
impose unlimited cost sharing obligations on Medicaid
beneficiaries at or
below 100 percent of the Federal Poverty Level. VOR, along with
other
organizations and even Members of Congress, had been calling on
Congress
and the Administration to figure out a fix that would protect
low income
Medicaid beneficiaries. See,
http://www.vor.net/DRACorrection.html for
VOR's position paper on this issue.
Recently, CMS officials reported to VOR that on June 16, 2006,
CMS released
a letter to State Medicaid Directors regarding sections 6041 and
6042 of
the Deficit Reduction Act, which states in part, that CMS plans
"to apply
the limitation of section 1916 of the [Social Security] Act to
beneficiaries at or below 100 percent of the Federal Poverty
Level (FPL).
Further guidance will be provided through the rulemaking
process."
What this says, in essence, is that the DRA provision relating
to cost
sharing and low income Medicaid beneficiaries will not be
enforced and that
CMS will further ensure of that during the rulemaking process.
Of course,
VOR will watch that rulemaking process closely, but we are
heartened by the
attention to our concerns.
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5. HHS Provides Funding to States For Alternatives to Nursing
Home and
ICF/MR Care in Medicaid: "Money Follows the Person" Helps States
Rebalance
Long-Term Care Systems
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Summary: "Money Follows the Person" Demonstration Grants were
passed as
part of the Deficit Reduction Act in February, 2006. Although
VOR opposed
passage of Money Follows the Person, since its passage we have
attempted to
work cooperatively with CMS as it prepares to provide technical
assistance
to states that plan to request funding for MFP initiatives. The
focus of
our communications with CMS has been (a) Choice - MFP should not
be used as
a tool to force the transfers of individuals from facility
settings; and
(b) continuity of care - states need to be prepared with an
adequate
community-based infrastructure, including access to health care,
quality
housing, a quality workforce pool, transportation, etc. Going
forward, VOR
will attempt to assess which states are pursuing MFP grants and
keep you
informed.
PRESS RELEASE
HHS Provides Funding to States For Alternatives to Nursing Home
and ICF/MR
Care in Medicaid --
"Money Follows the Person" Helps States Rebalance Long-Term Care
Systems
States will get additional help from the federal government to
support
elderly and disabled Medicaid recipients who wish to live in the
community
rather than institutions, HHS Secretary Mike Leavitt announced
today.
Through competitive grants, the Centers for Medicare & Medicaid
Services
(CMS) will give states a total of $1.75 billion over five years
to help
shift Medicaid from its historical emphasis on institutional
long-term care
services to a system that offers more choices for seniors and
persons with
disabilities from all age groups, including home and
community-based
services. This Money Follows the Person "rebalancing"
initiative was
included in the Deficit Reduction Act of 2005 (DRA) currently
being
implemented by CMS. This endeavor is also a part of President
Bush's New
Freedom Initiative.
"With this program, people who need long-term care and prefer to
live in
their own homes and communities can do so," Secretary Leavitt
said.
"States will also get more for their money by giving the elderly
and people
with disabilities more control over how and where they get the
Medicaid-funded long-term care services they need."
"We've worked with advocates and states for years to end the
institutional
bias in Medicaid, and now we've got the best opportunity ever to
do it,"
said Mark B. McClellan, M.D., Ph.D., CMS Administrator. "We
need to move
as quickly as possible to make that shift across Medicaid. With
new
Federal funding, there is no longer any excuse for the status
quo."
States interested in applying for a "Money Follows the Person"
grant can
propose new programs to CMS that are aimed at sustaining people
in their
homes or communities who would have otherwise received care in a
nursing
home or other institution. The qualified expenditures may be
eligible for
an enhanced match rate from the federal government equal to an
increase of
50 percent of the usual state Medicaid percentage contribution
in addition
to the usual match rate. In effect, the federal government will
pay for 75
to 90 percent of the costs of transitioning individuals out of
nursing
homes and into community settings, and the associated long-term
care
benefit costs. Grant funds may also be used to help control how
they
receive these services.
The higher matching rate will be applied to certain services
provided to an
individual for a one year period after the individual moves out
of an
institution and into the community. Funds can be used not only
for
alternatives to institutional care services, such as home health
care; they
can also be used for home modification costs, respite services
to augment
informal or unpaid caregivers, personal care and assistive
devices. In
their applications, states are encouraged to coordinate with
local and
state housing authorities to provide coordinated assistance for
community-based housing needs. CMS and the Department of
Housing and Urban
Development (HUD) have made steps to establish a new interagency
liaison to
support this coordination.
"We know that accessible, affordable, integrated housing is
critical to a
person's ability to make the transition into the community, HUD
Secretary
Alphonso Jackson said. "My agency will strongly urge the Public
Housing
Agencies and Housing Finance Agencies in the states to work
collaboratively
with Medicaid programs to help create opportunities for those
moving out of
institutions into the community."
Each state awarded a grant must continue to provide community
services
after the year of enhanced match as long as the person needs
community
services and is Medicaid eligible. The deadline for the first
year's
applications is Nov. 1, 2006. Demonstration grants will be
competitively
awarded to states from Jan. 1, 2007 through Sept. 30, 2011.
Funds will be
available for a five-year period; however, states must
participate in the
demonstration for a minimum of two consecutive years.
The Medicaid program traditionally pays for care for persons who
are
elderly and those with disabilities living in institutions who
needed help
with activities of daily living, because institutional care was
the norm
when the Medicaid law was enacted forty years ago. To provide
home and
community-based services, states must get a "waiver" of normal
program
rules designed to pay for care in institutions. Waivers and
demonstration
programs offer the promise of significantly lower costs per
beneficiary and
reductions in overall Medicaid spending as a result of giving
individuals
control over how to get their services, rather than requiring
them to use
institutional care in order to get Medicaid long-term care
benefits. But
rebalancing Medicaid coverage may have some short-term costs,
which the new
federal program enables states to overcome.
In addition to the Money Follows the Person initiative, the DRA
made many
changes in Medicaid that will allow states to add home and
community-based
services to their permanent array of benefits without having to
go through
the waiver process. For example, under another DRA provision,
states now
have the option to provide home and community-based services
without
needing a waiver.
"Even though personal control leads to better results and lower
costs for
people with a disability, it's still true today that most
elderly or
disabled enrollees do not have a choice about how they get their
long-term
care services under Medicaid," said Dr. McClellan. "By working
with states,
advocates, and Medicaid enrollees to take advantage of these
unprecedented
opportunities, that's going to change."
A copy of the "2006 Money Follows the Person Rebalancing
Initiative
Demonstration Program," including the application forms, can be
obtained at
http://www.grants.gov/. For more details about the New
Freedom Initiative,
visit the CMS Web site at:
http://www.cms.hhs.gov/NewFreedomInitiative/02_WhatsNew.asp
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6. U.S. Issues New Rules and Schools and Disability
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August 4, 2006
The New York Times
WASHINGTON, D.C. For more than 25 years, federal law had
required that
schools nationwide identify children as learning disabled by
comparing
their scores on intelligence tests with their academic
achievement. This
meant that many students had to wait until third or fourth grade
to get the
special education help they needed.
In regulations issued today after changes to the law, the
federal Education
Department said states could not require school districts to
rely on that
method, allowing districts to find other ways to determine which
children
are eligible for extra help.
It was the final step in the federal government's repudiation of
the old
approach, which had come under severe criticism from advocates
for children
with disabilities, testing experts and eventually federal
officials
themselves. Advocates for those children applauded the change.
"If you talk to principals and special ed directors, there is
pent-up
demand for better ways to serve struggling kids than waiting
until they
crash and burn in third and fourth grade," said James H. Wendorf,
executive
director of the National Center for Learning Disabilities.
The new rules also require schools to alert parents as they
begin exploring
whether children may need special education, another change that
won praise
from advocates for children with disabilities.
The regulations come after Congress updated laws covering
special education
for some six million schoolchildren nationwide in late 2004.
Comparing intelligence tests with academic achievement, known as
the
discrepancy model, came under intense criticism in the debates
over the law
and over special education.
Federal officials and advocates for children with disabilities
contended
that the practice of waiting for children to fall behind on
tests in third
or fourth grade before getting them extra help consigned them to
failure,
and opened the way for the disproportionate numbers of poor and
minority
children to be labeled as needing special education.
The 2004 law abandoned reliance on that approach. And the new
regulations
favor alternative methods of identifying children who need
services, like
evaluating the response of struggling children to extra help
before the
third grade.
The 2004 law also streamlined procedures and reduced the
paperwork involved
in providing children special education services, and relaxed
burdens on
schools when children with disabilities had behavioral problems.
A draft of the regulations published in June 2005 prompted an
outpouring of
5,500 letters and comments to the Education Department from
advocates for
children with disabilities, as well as parents, teachers'
unions, and
state, district and local education officials.
The department posted the final regulations on its Web site
today, along
with answers to each of the comments it received. The final
regulations
will be published in the Federal Register on Aug. 14, and will
take effect
60 days later.
In unveiling the new rules, Education Secretary Margaret
Spellings said her
priority was "that we not lose our vigilance for educational
attainment for
every child."
Advocates for children with disabilities said they were
disappointed that
the regulations did not address some problems they saw in the
2004 federal
law.
For example, the law says that instead of reviewing each
disabled child's
educational plan every year automatically, schools could review
them only
once every three years, provided parents agree to the change.
The
regulations do not help ensure parents are properly notified,
advocates
said.
"But who is going to make sure that parents now know what
they're giving up
if they agree to that?" said Ricki Sabia, associate director of
the
National Down Syndrome Society Policy Center. "The department
could have
made clear what constitutes that agreement."
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7. Gov. Vilsack says joining Maine and Vermont will save $11
million a year
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The Des Moines Register
August 3, 2006
Iowa is joining with Maine and Vermont to negotiate lower prices
for the
drugs they buy for Medicaid recipients, Gov. Tom Vilsack
announced
Wednesday.
Vilsack said Iowa and the federal government would save about
$11million a
year under the new pool. The governments spend about $391million
annually
on medicine for Iowa's 300,000 Medicaid recipients, with the
state footing
about a third of the bill.
"Together, our group of states will achieve pharmaceutical
rebates that
will far exceed the amount that each state could provide on its
own," the
governor said in a press release.
The governor said other, unidentified states are talking about
joining the
purchasing pool.
Roger Munns, a spokesman for the Iowa Department of Human
Services, said
any savings would be used to run the Medicaid program, whose
costs are
constantly increasing.
Under the new pool, participating states would retain their
power to
determine which drugs are covered by their Medicaid plans.
Wednesday's news came after the federal government approved the
arrangement.
Federal officials quashed an earlier Vilsack attempt to reduce
state
spending on drugs. Under that 2003 proposal, Iowa would have
arranged
purchases of low-cost Canadian medications for state employees
and
retirees. Vilsack sought federal approval of the idea, but it
died amid
Bush administration concerns over the safety of Canadian drugs.
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Tamie Hopp
REFERRAL/MEMBERSHIP/CONTRIBUTION FORM
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welcome!
You may pay by credit card or check.
TO REFER SOMEONE TO VOR: Use the form below, including the
additional
sections for referrals.
Mail the completed form (if joining or contributing) with
payment to:
Voice of the Retarded
5005 Newport Drive, Suite 108
Rolling Meadows, IL 60008
847-253-6054 fax (for referrals or credit card payments)
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