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VOR Weekly E-Mail Update
May 26, 2006
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COMING UP: AN ACTION ALERT TO COINCIDE WITH
VOR'S WASHINGTON INITIATIVE IN
JUNE. There will be no Weekly Updates, June 2,
9, or 16.
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VOR Weekly E-Mail Update
May 26, 2006
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1. U.S. House of Representatives pass Budget
Resolution
2. New Report: A Review of State ICF/MR Leave
Policies
3. SSA's New Disability Determination Process:
Final Rule
4. Medicaid Changes under the DRA - resources
from the Nebraska Appleseed
Center for Law in the Public Interest
5. Kaiser Weekly Update: Reports Explore
Long-Term Care Issues Included in
the Deficit Reduction Act
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1. U.S. House of Representatives pass Budget
Resolution
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Summary: This article pre-dates actual passage
of the House Budget
Resolution. It passed as expected. Compromise
with the Senate is not
expected.
House expected to approve budget
By Amy Fagan
THE WASHINGTON TIMES
Published May 18, 2006
The House was expected to approve a $2.7
trillion budget blueprint early
this morning, after Republican leaders promised
the more liberal wing of
their party some increase in health and
education spending.
"We have the votes, and we expect to pass it
late evening or early
morning," said Ron Bonjean, spokesman for House
Speaker J. Dennis Hastert,
Illinois Republican.
Approval of the nonbinding blueprint for
2007 spending comes after
weeks of negotiations between Republican leaders
and their members. Leaders
were forced to pull the bill from the floor last
month because they lacked
the votes.
Negotiations in the past few weeks centered
mainly on the party's
more-liberal members, who wanted $7 billion more
for health, education and
related programs. Leaders ended up agreeing to
shift $4.1 billion from
defense and foreign operations to education and
health, and promising to
try to find the rest of the $7 billion request
later in the spending
process. That spending also would have to be
paid for by shifting money
from elsewhere in the budget, however.
Rep. Michael N. Castle of Delaware, lead
negotiator for the Republican
liberals, said the deal brought him and several
other lawmakers on board.
While the budget bill is not binding, it
gave the parties a chance to
highlight their differences.
Democrats railed that Mr. Bush yesterday
signed $70 billion in tax-cut
extensions for the rich while the Republicans'
budget would shortchange key
social programs for the middle class.
They also seized on the fact that the budget
has a provision to raise
the national debt automatically by $653 billion.
"Sign a tax cut, have a fundraiser, raise
the national debt again;
that's the fiscal record of this majority," said
Rep. Earl Pomeroy, North
Dakota Democrat, who complained that Republicans
hve raised the debt limit
by $3.7 trillion since 2002.
"You talk a good game, but you don't play a
good game," House Minority
Whip Steny H. Hoyer, Maryland Democrat, told
Republicans.
"I find it surreal to be lectured on
spending by a Democrat," said Rep.
Jeb Hensarling, Texas Republican.
Republicans said the tax-cut extension bill
signed yesterday prevents a
huge tax increase, and the budget bill wisely
holds down most spending.
The bill would stick to President Bush's
$873 billion cap on
discretionary spending, which includes increases
for defense and homeland
security but a virtual freeze on everything
else. Conservatives demanded
that the bill stick to that. The bill also
assumes $228 billion in tax cuts
over five years.
"We can't continue to spend our kids' and
their kids' inheritance,"
said House Majority Leader John A. Boehner, Ohio
Republican.
The Senate blew past Mr. Bush's limit by $16
billion when passing its
budget in March, making it seem unlikely that
the two chambers can agree on
a final version.
But Republican leaders barreled ahead with
the budget blueprint in part
because the House was slated to start
considering the first of 11 2007
spending bills this week, and Republicans said
it's crucial to have
spending parameters in place first.
The budget measure does not go along with
Mr. Bush's proposed cuts to
Medicare, Medicaid and other entitlement
programs. It dedicates $50 billion
to Iraq and Afghanistan -- less than half of
what's expected to be spent
this year.
This article is based in part on wire
service reports.
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2. New Report: A Review of State ICF/MR Leave
Policies
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Monday Morning in Washington, DC
Volume 06, Issue
17
April 24, 2006
The Arc of Washington, DC has released a new
report, "A Review of State
ICF-MR Leave Policies."
Over 100,000 people with developmental
disabilities across the U.S. live in
Medicaid funded Intermediate Care Facilities for
persons with Mental
Retardation (ICFs-MR). ICF-MR residents can
benefit significantly from
opportunities to take periodic overnight
absences to spend time in the
community with family and friends. Each state
sets its own policy to
determine how often its Medicaid program will
pay ICFs-MR to hold a bed
when a resident is absent. Because ICFs-MR are
not required to hold beds
without payment, state leave policies control
ICF-MR residents' ability to
take overnight leave.
The Arc of DC reviewed state ICF-MR leave
policies in response to requests
for help by parents of adult DC residents with
developmental disabilities
who were concerned about the limits of DC's
current policy. While DC only
allows up to 18 absences per year for either
home visits or hospital stays,
most states either place no annual limits on
home visits, or allow an
average of up to 44 "therapeutic leave" days per
year. Twenty- nine states
provide hospital leave and typically reimburse
for up to 14 days in a row
when an ICF-MR resident is hospitalized, with no
annual limits.
A copy of the full report is available at
http://join.buddywalk.org/site/R?i=yA1SFsKz0aAPWx7f9-qF8A..
.
For more information contact T.J. Sutcliffe,
Director of Advocacy & Public
Policy, The Arc of DC, at
tjsutcliffe@arcdc.net.
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3. SSA's New Disability Determination Process:
Final Rule
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Monday Morning in Washington, DC
Volume
06
Issue
19
May 8, 2006
In light of the significant growth in the number
of disability claims and
the increased complexity of those claims, the
need to make substantial
changes in the Social Security Administration's
(SSA) disability
determination process has become urgent. SSA
published a final rule that
amends its administrative review process for
applications for benefits that
are based on whether they are disabled under
title II of the Social
Security Act (the Act), or applications for
supplemental security income
(SSI) payments that are based on whether they
are disabled or blind under
title XVI of the Act. SSA expects that this
final rule will improve the
accuracy, consistency, and timeliness of
decision-making throughout the
disability determination process. In the summer
of 2006, SSA plans to
begin implementation in the Boston Region, which
is comprised of the six
states of Connecticut, Maine, Massachusetts, New
Hampshire, Rhode Island
and Vermont. The rule is effective on August 1,
2006.
The final rule provides for:
* A quick disability determination process for
those who are obviously
disabled. Favorable decisions would be made in
such cases within 20 days
after the claim is received by the state
disability determination agency.
* A new Medical-Vocational Expert System (MVES)
to enhance the expertise
needed to make accurate and timely decisions.
The MVES will be composed of
a Medical-Vocational Expert Unit and a national
network of medical,
psychological and vocational experts who meet
qualification standards
established by the Commissioner.
* A new position -- the Federal Reviewing
Official -- that will review
state agency determinations upon the request of
the claimant. This will
eliminate the reconsideration step of the
current appeals process.
* Retention of the right to request a de novo
hearing and decision from an
Administrative Law Judge if the claimant
disagrees with the decision of the
Federal Reviewing Official.
* Closing the record after the Administrative
Law Judge issues a decision,
with provision for certain good cause exceptions
to this rule.
* A new body -- the Decision Review Board -- to
review and correct
decisional errors and ensure consistent
adjudication at all levels of the
disability determination process. The current
Appeals Council will be
phased out gradually.
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4. Medicaid Changes under the DRA - resources
from the Nebraska Appleseed
Center for Law in the Public Interest
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The Center for Medicare and Medicaid Services
(CMS) has begun to release
information about implementation of last year's
budget bill, the Deficit
Reduction Act (DRA). As you recall, the DRA
contains a number of state
options for making changes to the Medicaid
program. Most of these options
are designed to give states more flexibility to
decrease benefits and to
increase cost-sharing provisions. Once a new
law is passed, CMS releases
guidance to states about how to implement the
changes. A few guidance
documents have been released already. There are
a few documents I thought
might be of interest to you.
Roadmap to Medicaid Reform: This is a general
statement about the DRA and
what Secretary Leavitt sees as the vision for
Medicaid. It can be accessed
at:
http://join.buddywalk.org/site/R?i=p3Ut7hvm-kmcjXa-X49GGg..
CMS State Medicaid Director Letter on
Implementation of the New State
Flexibility in Benefit Packages. It can be
accessed at:
http://join.buddywalk.org/site/R?i=fuY0qfhuil2F14CqEItFVQ..
Remember the new state flexibility in benefit
packages is optional. The
state will have to choose to make this change.
Also, the one major mandatory change to the
Medicaid program is the
requirement that all Medicaid recipients,
including current recipients,
must verify they are U.S. citizens with some
form of valid identification.
CMS has not yet released guidance on this
provision.
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5. Kaiser Weekly Update: Reports Explore
Long-Term Care Issues Included in
the Deficit Reduction Act
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The Foundation's KCMU released five new reports
on long-term care issues
that were addressed by the Medicaid changes in
the Deficit Reduction Act of
2005. One report provides an overview of the
changes to the rules and
direction of Medicaid long-term care services,
and the others examine
changes to asset transfer rules to gain Medicaid
coverage for nursing home
care and efforts to move towards more home- and
community-based Medicaid
long-term care services. The reports are
available at
http://join.buddywalk.org/site/R?i=eonZgEpDVzrsg0b5O5S59Q..
.
Long-term care accounts for 36 percent of
Medicaid spending (over $100
billion annually) and is utilized by many of
Medicaid's most costly
beneficiaries, the low-income elderly and
individuals with disabilities.
The new report, Medicaid Long-Term Services
Reforms in the Deficit
Reduction Act (Pub #7486), provides an overview
of the changes to the rules
and direction of Medicaid long-term care
services as enacted in the DRA.
Three other reports released today focus on the
challenges and efforts of
moving towards more home and community based
Medicaid long-term care
services.
Beyond Cash and Counseling: An Inventory of
Individual Budget-based
Community Long Term Care Programs (Pub #7485)
describes the evolution of
beneficiary-managed home and community-based
services since the original
demonstration and provides an overview of state
activity as of January
2006. The DRA gives states the option to use
this model for an expanded
range of home and community based services in
their state Medicaid plans
without having to obtain a waiver.
Nursing Home Transition Programs: Perspectives
of State Medicaid Officials
(Pub #7484) and Nursing Home Transition
Programs: Perspectives of Medicaid
Care Planners (Pub #7483) draw on interviews
with state Medicaid program
officials and Medicaid care planners for insight
into the issues that arise
in establishing programs to move individuals
with significant long-term
care needs from institutional to community
settings. The five states that
participated in this study--Florida, Louisiana,
New Jersey, Ohio and
Washington--each received federal grants for
nursing home transition
activities and had varied experiences.
Brief Examines How Much High Cost Enrollees
Drive Medicaid Spending This
new brief from the Foundation's KCMU presents
information on the
distribution of Medicaid spending, finding that
fewer than five percent of
enrollees (each exceeding $25,000 in annual
costs) account for almost half
of all Medicaid spending. It is available at
http://join.buddywalk.org/site/R?i=rXQ3zqa9a2lKxei9JP6-UQ..
.
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