ANCOR's 2009 DSP Wage Study Released

ANCOR's 2009 DSP Wage Study is now available online. To access visit www.youneedtoknowme.org or click here. Read more!

HHS Awards ARRA Funds to Establish a Center of Excellence in Research on Disability Services, Care Coordination and Integration

The U.S. Department of Health and Human Services Office on Disability today announced the award of over $6 million under the American Recovery and Reinvestment Act of 2009, to establish a Center of Excellence in Research on Disability Services, Care Coordination and Integration.

The contract has been awarded to Mathematica Policy Research, Inc for a two-year period and is aimed at building the infrastructure necessary to support and conduct research on the effectiveness and comparative effectiveness of systems of care for people with disabilities. "With the establishment of a Center of Excellence in Research on Disability Services, Care Coordination and Integration, we will make necessary data improvements to better understand health and support services for people with disabilities," said HHS Secretary Kathleen Sebelius. "The data collected will allow the Office on Disability and the Centers for Medicare and Medicaid Services to examine the effectiveness of different services and supports being provided, and in turn, improve care for people with disabilities."

The center will identify data sources, evaluate the usability of data, conduct research, and disseminate scientifically and clinically relevant information to help patients, providers, policy makers, consumers, caregivers, and family members make decisions on health care.

One of the key components of this effort is the collaboration with the Centers for Medicare and Medicaid Services' Chronic Conditions Warehouse (CCW). "By linking existing Medicaid data sources and other datasets relevant to disability to the CCW, the Center will increase the analytic utility of CCW information for research on people with disabilities and/or chronic conditions," said Rosaly Correa-de-Araujo, M.D., M.Sc., Ph.D., Deputy Director of the Office on Disability and the technical and scientific lead of the initiative.

In addition, Medicaid data - state plan and waiver services supplied by specific states - will be assessed and used to identify and propose ways to achieve greater consistency on how services are used and defined. "This is a unique initiative that creates a broad array of future opportunities in comparative effectiveness research in the field of disability services, including those related to rehabilitation, behavioral and psychosocial interventions. We look forward to advancing science and enhancing services and supports that benefit people with disabilities," said Dr. Correa-de-Araujo.

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HHS Consumer Website Expected July 1; Will Include Data on Public, Private Plans

The Department of Health and Human Services plans to unveil the first iteration of a website designed to help individuals and small businesses find information about insurance options in their state by July 1, according to an interim final rule published in the May 5 Federal Register. The HHS Office of Consumer Information and Insurance Oversight will oversee the web portal that will provide consumers with state-based information about private insurance, high-risk pools, Medicaid, and the Children's Health Insurance Program—as required by the Patient Protection and Affordable Care Act (Pub. L. No. 111-148). To meet PPACA's July 1 deadline, HHS said it will require insurance issuers to submit needed information by May 21, such as product names and types, enrollment data, and product availability. The web portal will include information about plans' services, providers, and formularies, if available. The portal also will include information about eligibility and enrollment procedures for public programs.

Then, in October, HHS will expand the portal to include more detailed information about pricing and benefits, as well as more information about enrollment in public programs. HHS said that for plans offered in states without community rating, any information about premiums will be presented in terms of standard risks, even though insurers can vary rates based on health status. HHS also said it anticipates including medical loss ratio information through the portal, once regulations defining MLRs are promulgated. Under the reform law, insurers must spend a set percentage of premiums on health services, as opposed to administrative costs.

Comments on the interim final rule are due 30 days from its publication.
HHS also said it plans to offer training to states and health insurance issuers about the information that must be submitted for development of the portal.
The rule and further information about it are available at http://www.hhs.gov/ociio/gatheringinfo/index.html.

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ANCOR Calls for FMAP Extension Now!

Respond to ANCOR's FMAP Action Alert Today! ANCOR members are urged to make passage of the FMAP extension a top priority this week! Call Your Senate and House offices and spread the word! Read more!

New Co-Sponsor for Direct Support Professionals Fairness and Security Act

Representative Russ Carnahan (D-MO) signed on as Co-Sponsors for H.R. 868, The Direct Support Professional Fairness and Security Act. Thank you to everyone who contacted their members encouraging them to sign on. Read more!

Gear Up for FMAP Push Next Week

Check your in-box Monday for an Action Alert on the FMAP extension. ANCOR members need Congress to address the bill (HR 4213) that contains the Recovery Act FMAP extension ASAP to help state budget efforts underway now. According to sources on Capitol Hill, there is no loss of political will to move the provision, it's a matter of money. The FMAP extension carries bipartisan support, but members are currently at an impasse over whether the provision should be offset or passed as an emergency measure.

Also circulating behind-the-scenes, under the leadership of Representative Lois Capps (D-CA), is a Dear Colleague letter with a deadline of next week for signatories. The letter to House leadership urges swift action on the FMAP provision in H.R. 4213 and to resolve differences between the House and Senate versions, so the final bill can go to the President for his signature. In addition to Representative Capps (D-CA), other cosponsors are Representatives Chellie Pingree (D-ME), Tammy Baldwin (D-WI), Gene Green (D-TX). ANCOR thanks these Congressional leaders for their support and action on this important issue.

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HHS Releases Second Quarter FMAP Rates

In today’s Federal Register, HHS announced the adjusted FMAP rates for the second quarter of FY 2010, as required in the Recovery Act (ARRA). See today’s Federal Register Notice for your state’s adjusted rate.
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Secretary Sebelius Announces New Members of the Interagency Autism Coordinating Committee

Health and Human Services Secretary Kathleen Sebelius announced today the appointment of five new members to the Interagency Autism Coordinating Committee (IACC), a federal advisory committee created in an effort to accelerate progress in autism spectrum disorder (ASD) research and services. For more information on the IACC, visit http://www.iacc.hhs.gov/
New Members of the Interagency Autism Coordinating Committee

Geraldine Dawson, Ph.D.
As chief science officer for Autism Speaks, Dr. Dawson works with the scientific community and stakeholders to shape and expand the foundation's scientific vision. She also is a licensed clinical psychologist with a research focus on early detection and intervention, early patterns of brain dysfunction and the identification of biological markers for autism genetic studies. Dr. Dawson also serves as research professor of psychiatry at the University of North Carolina at Chapel Hill, adjunct professor of psychiatry at Columbia University and professor emeritus of psychology at University of Washington.

Gerald D. Fischbach, M.D.
Dr. Fischbach is the scientific director for the Simons Foundation where he oversees the Autism Research Initiative. He has spent his career as a neuroscientist studying the formation and maintenance of synapses, the junctions between nerve cells which allow signals to be transmitted. Before joining the Simons Foundation, Dr. Fischbach served as the Director of the National Institute of Neurological Disorders and Stroke from 1998 to 2001 and as the Executive Vice President of Columbia University Medical Center and Dean of the faculties of medicine from 2001 to 2006.

Ari Ne'eman
Mr. Ari Ne'eman is the founding president of the Autistic Self Advocacy Network, where he works to increase the representation of autistic people in public policy discussions. He is an adult on the autism spectrum and a leading advocate in the neurodiversity movement. Mr. Ne'eman has served on the New Jersey Adults with Autism Task Force and the New Jersey Special Education Review Commission, where he authored a minority report advocating legislative action against the use of aversives, restraint and seclusion. He is a board member of TASH, an advocacy group for people with disabilities, and is involved with the Maryland Coalition for Inclusive Education.

Denise D. Resnik
Denise Resnik is the co-founder and board development chair of the Southwest Autism Research & Resource Center (SARRC). She is the mother of an 18-year-old son with autism. Ms. Resnik serves on the Autism Speaks Family Services Committee and Advancing Futures for Adults with Autism (AFAA) Steering Committee. She participated in the 2006 NIMH Autism Matrix Review and the IACC Scientific Workshops to develop the IACC Strategic Plan and subsequent updates.

Marjorie Solomon, Ph.D.
Assistant professor of Clinical Psychiatry at the University of California, Davis Dr. Marjorie Solomon is an Assistant Professor of Clinical Psychiatry in the Department of Psychiatry and Behavioral Sciences at the University of California, Davis. She serves on the Faculty of the Medical Investigation of Neurological Disorders (MIND) Institute and the Autism Research Training Program where she conducts research on a social skills training intervention for high-functioning children with ASD, incorporating parents and siblings in the research. In addition to her clinical research work, Dr. Solomon studies cognition and learning in high-functioning individuals with ASD. Read more!

Bipartisan Group of Representatives, Senators Introduce the Eunice Kennedy Shriver Act

This legislation continues the legacy of Mrs. Shriver by reauthorizing the Special Olympics Sport and Empowerment Act, which has supported persons with disabilities through health, education and global initiatives. This legislation also includes the Best Buddies Empowerment for People with Intellectual Disabilities Act, originally passed by the House in April 2009, to make grants to the Best Buddies organization to expand its programming. In addition, this legislation authorizes grants to support research, training and technical assistance at universities with expertise in serving people with intellectual disabilities and their families. These grants will help improve their quality of life and ensure opportunities for full participation. Mrs. Shriver, who passed away in August 2009, founded the Special Olympics and was a longtime supporter and board member of Best Buddies.
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Pilot Program in U.S. House of Representatives Provides Internship Opportunities to Individuals with Intellectual Disabilities

A story today in the Washington DC newspaper Politico showcases a pilot program aimed at giving individuals with intellectual disabilities opportunities to experience a high profile work place: the U.S. House of Representatives. The internships are part of a pilot program created by Representative Gregg Harper (R-MO), House Administration Committee Republicans and Mason LIFE, a post-secondary program at George Mason University for adults with intellectual disabilities. The students do everything from answering constituent mail and shredding paper to learning how to give tours of the Capitol.
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Social Security Task Force - Commission on Fiscal Responsibility

The National Commission on Fiscal Responsibility and Reform had its first meeting on Tuesday April 27. the commission will hold monthly public meetings and invites the public to submit comments in writing. Meetings are tentatively scheduled for 9:30 am to noon the last Wednesday of May through September as well as Nov. 10 and Dec. 1 - when the commission is supposed to deliver its plan to "stabilize the soaring US debt.
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Debt Commission Convenes First Meeting

At a three-hour White House meeting on Tuesday, debt commission members began discussions to move toward meeting the goal of the commission: bring the deficit down to about 3 percent of the gross domestic product by FY 2015 and begin to slow the long-term growth in the national debt. The panel, as outlined in a February executive order, is supposed to send recommendations to Congress on December 1; however, that requires 14 of the 18 commissioners to approve the package. The panel is made up of 10 Democrats and eight Republicans. Obama selected the co-chairmen and four other members; congressional Democratic and Republican leaders picked members of Congress to serve.

Democrats are concerned that social safety net programs will be targeted for savings, Republican lawmakers and conservative groups including Americans for Tax Reform contend that tax increases should not be part of the panel’s deliberations.

“The reality is that the Congress, the administration and the American people will have to choose among making modifications to entitlement programs such as Medicare and Social Security, restraining federal spending on everything else, accepting higher taxes, or some combination thereof,” said Federal Reserve Chairman Ben S. Bernanke.

Obama and the commission’s co-chairmen — former Senator Alan Simpson, (R-WY) and Erskine Bowles, a White House chief of staff under President Bill Clinton — emphasized that every option for reducing deficits and controlling the long-term growth in debt should be considered. Obama said he would not heed calls to rule out some proposals from the outset.

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FREE Members Only Health Care Reform Webinar

Health Reform. It's big... it's complex... and just what in the world happens next? Most of all, what provisions affect ANCOR members, direct support professionals, and individuals with disabilities?


Date:
Wednesday, April 28, 2010 - 2:00pm - 3:15pm

In this FREE webinar, Suellen Galbraith, ANCOR's Senior Policy Advisor, will outline important facets of the health reform bill including employer responsibilities, individual mandates, and huge Medicaid changes. This webinar is intended to provide a swift explanation of the most significant provisions affecting ANCOR members and give you an opportunity to ask questions.

Do not miss this important program — it is the first in a series from ANCOR to prepare its members for the coming changes. The information you gain by attending will have far-reaching effects on how you manage your organization in light of this restructure of employer-based health insurance.

Some questions to be answered include:

* When do employer requirements become effective? And what are they?
* How will state Medicaid programs be effected and assisted in covering health care costs?
* Is there Federal assistance to encourage states to urge more Home and Community Based Long Term Services and Supports?

This is a "can't miss" webinar for all ANCOR members about the changes created by the health care bill that will impact their organization.

The free, members-only webinar takes place on April 28, 2010, 2:00 - 3:15 pm Eastern. If you are an ANCOR member and this is your first time logging in to ANCOR's new website, you will need to establish a password prior to registration.

Click here to register.

Check out ANCOR's Health Care Reform Issue Brief Series...
Download your ANCOR Health Care Reform Issue Brief!
Download your ANCOR Health Care Reform Medicaid Issue Brief!
Download your ANCOR Health Care Reform Medicaid Related Provisions Issue Brief!
Download your ANCOR Health Care Reform Long Term Services and Supports Issue Brief!

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HHS Sets Up Consumer Information & Insurance Oversight Office To Oversee Health Insurance Reforms

HHS is establishing an Office of Consumer Information and Insurance Oversight charged with developing and implementing major reforms affecting the private insurance market. The new office will design and administer the temporary high-risk pools, establish new rules on medical loss ratios and oversee the state-based health insurance exchanges.

As announced in the April 19th Federal Register, the new office will design and administer the temporary high-risk pools, establish new rules on medical loss ratios and oversee the state-based health insurance exchanges. A director has yet to be announced.

The director of the new office will report to the HHS secretary, according to an HHS Federal Register notice. Four deputy directors will head additional programs established under the new office, including: The Office of Oversight, Office of Insurance Programs, Office of Consumer Support and Office of Health Insurance Exchanges.

The Office of Oversight will be headed by a deputy director and will be responsible for implementing, monitoring compliance with and enforcing new rules governing the insurance market and medical loss ratios; performing rate reviews and issuing rate review grants to states.

The Office of Consumer Support, is to be led by a deputy director, will be responsible for collecting, compiling and maintaining comparative pricing data for the HHS Website; providing assistance to help consumers obtain the maximum benefits from the new health insurance system and establishing and issuing consumer assistance grants to states.

The Office of Insurance Programs will be tasked with administering the temporary high-risk pools and the early retiree reinsurance program.

And the Office of Health Insurance Exchanges will develop and implement policies and rules governing the state-based exchanges; establish and issue planning grants to states; and oversee the operation of the exchanges.

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Obama Nominates Donald Berwick To Be Next Administrator of CMS

President Obama April 19 nominated Harvard professor Donald Berwick to be the next administrator of the Centers for Medicare & Medicaid Services, a post that has been vacant since late 2006. Berwick is a clinical professor of pediatrics and health care policy at the Harvard Medical School and the Harvard School of Public Health. He is also president and chief executive officer of the Institute for Healthcare Improvement, a Cambridge, Massachusetts-based not-for-profit organization that promotes the improvement of health care.

CMS has been without a permanent administrator since October 2006 when Mark McClellan left the agency. Kerry N. Weems served as acting CMS administrator from 2007 until the end of the Bush administration. Charlene Frizzera is currently the agency's acting administrator.

Berwick, whose name surfaced several months ago as a possible nominee for the post, must be approved by the Senate Finance Committee and the entire Senate before beginning his job.

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President Signs Short Term Extension Bill; Negotiations Continue on Jobs Bill with FMAP

Congress this week concluded work on the Continuing Extension Act of 2010 (HR 4851), also referred to as the “extensions bill.” House passage came Thursday evening a few hours after the Senate passed an amended version of the bill, and the president signed it shortly after that.

In addition to extending expanded unemployment benefits through the end of May, the short-term legislation would extend COBRA health insurance subsidies for the unemployed and higher payments for physicians who treat Medicare patients. It also would extend a national flood insurance program and the use of 2009 poverty guidelines for federal programs.

The short-term extension package is designed to buy time for House and Senate negotiators to reach a deal on the American Workers, State and Business Relief Act of 2010 (HR 4213), which extends the unemployment benefits through the end of the year and the temporary FMAP increase originally passed as part of the Recovery Act through June 2011. ANCOR members are encouraged to call their members of Congress and encourage them to swiftly resolve the differences in HR 4213.
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Florida House Proposes Managed Care for People with Developmental Disabilities

Two bills have been drafted by the Florida House Select Policy Council on Strategic & Economic Planning that will require all purchased services to people with developmental disabilities funded through Medicaid be administered by a HMO or Provider Service Network. The drafts are expected to go directly to the floor of the House for consideration. The Florida Senate is expected to consider this or another similar plan next week. Thank you to Joe Aneillo for letting ANCOR know of this development. Read more!

Andy Stern Announces Retirement as SEIU President

Andy Stern, president of the Service Employees International Union, officially announced his retirement on Wednesday, after 14 years at the helm of the 2.2-million member union.

While it was originally speculated that Stern would leave when his term ended in 2012, his immediate retirement puts SEIU Secretary-Treasurer Anna Burger in the role of interim-president until the union’s International Executive Board votes on Stern’s successor. The SEIU constitution stipulates that the IEB must schedule an election within 30 days.
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Kansas Lawsuit Filed Against Huge Medicaid Cuts Denied

The Kansas Supreme Court last week said it lacked jurisdiction to take up a lawsuit filed on behalf of Kansans with disabilities. The action leaves open the door for litigation to be filed in a lower district court as groups representing the disabled reel from a 10 percent cut in Medicaid reimbursements.

The case stems from a 10 percent cut to funding for Medicaid reimbursements—money that Governor Parkinson (D) said he wants to see restored even as lawmakers battle a budget gap now exceeding $400 million. He called restoring the funds "critical."

The 10 percent cut, which was implemented in January, eliminates $22.7 million in state funds for Medicaid programs this year. Of that, about $6.2 million affected services for people with disabilities and mental health programs. The state-level cuts also meant the state lost significant matching federal funds, which pay about 70 percent of Medicaid costs.

The Kansas Department of Social and Rehabilitation Services has seen its waiting list for people with developmental disabilities seeking home and community-based services expand to 2,236 as of February 28. That is up from 1,397 in July 2008 and 1,655 in July 2009.
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Mississippi Health Care Association Files Suit to Stop Medicaid Cuts

The Mississippi Health Care Association, the Independent Nursing Home Association and dozens of nursing homes from across the state filed a lawsuit Thursday seeking to stop the Mississippi Division of Medicaid from making a planned $14 million cut in payments to providers.

The lawsuit filed in Hinds County Chancery Court late Thursday afternoon argues that state reserve funds can be used to shore up the Medicaid budget and the cuts are unnecessary.

The suit seeks an injunction to stop the cuts over the uncertainty of "adequate funding" for providers. The cuts are pending federal permission.

Mississippi Medicaid recently announced plans to cut $14 million in reimbursements to health care providers for services for the remainder of the fiscal year, which ends June 30, because of successive months of revenue collections below estimates. However, tax revenue collections were on target in March.

Calls by Democratic lawmakers to dip into state reserves to close the gap have been rebuked by Governor Barbour (R), who argues the state's savings needs to last for several years.

The largest chunk of money went to public education, and Medicaid was not on the restoration list. About $14 million of an $82 million budget patch-up plan approved by lawmakers, however, was provided via a stimulus-related federal government reimbursement to the Division of Medicaid.


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CMS Initial Medicaid Guidance on Section 2001 of Health Care Law Establishing New Eligibility Group (April 9, 2010)

CMS released initial Medicaid guidance on Section 2001 of Health Care Law Establishing New Eligibility Group. To view the document click here.

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Arizona's CHIP Plan Spared Elimination

Arizona's Children's Health Insurance Program plan (CHIP), which was slated for elimination on June 15, will no longer be cut due to the federal health reform law that President Obama signed into law March 23. According to the Arizona Health Care Cost Containment System, the reprieve came in the form of a maintenance-of-effort provision applicable to children's health care through 2019. It prevents states from changing eligibility requirements in such a manner that would force individuals off existing rolls.

The Legislature now must repeal the action that eliminated the KidsCare program, AHCCCS spokeswoman Monica Coury told BNA April 7. It is expected to do so before the June 15 sunset date.

But the restoration of the program means the state's budget falls out of financial balance, and now must be reconciled either by additional spending cuts or tax increases, something Arizona's legislators have been opposed to doing.

No agreement has been reached on how the fiscal hole may be patched. Arizona's budget must be balanced, under the state's constitution.

The maintenance-of-effort requirement applies to Medicaid generally and was included in the federal stimulus bill, but was scheduled to expire at the end of 2010, according to the AHCCCS website.

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HUD Releases Notice of Funding Availability (NOFA) for Rental Assistance for Non-Elderly Persons with Disabilities

On April 7, 2010 the U.S. Department of Housing and Urban Development (HUD) announced the availability of $30 million in funding for approximately 4,000 Section 8 Housing Choice Vouchers (HCV) for non-elderly disabled households. Funds unobligated under previous HUD NOFAs will also be made available as part of this NOFA, bringing the total funds available to $40 million for approximately 5,300 vouchers. Go to http://portal.hud.gov/portal/page/portal/HUD/program_offices/administration/grants/fundsavail/nednofa.pdf for a complete copy of the NOFA. Applications are due July 7, 2010.

For more information click here.
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Secretary Sebelius Announces Five New HHS Regional Directors

Secretary Sebelius Announces Five New HHS Regional DirectorsHHS Secretary Kathleen Sebelius today announced the appointment of five new regional directors of the U.S. Department of Health and Human Services.

* Christie Hager, Region I - Boston (CT, ME, MA, NH, RI, VT)
* Jaime R. Torres, Region II - New York City (NY NJ, NY, PR, VI)
* Joanne Grossi, Region III - Philadelphia (PA DE, DC, MD, PA, VA, WV)
* Marguerite Salazar, Region VIII - Denver (CO, MT, ND, SD, UT, WY)
* Herb K. Schultz, Region IX - San Francisco (AZ, CA, HI, NV, Guam, PI, AS)

"I am very pleased to welcome Christie, Jaime, Joanne, Marguerite, and Herb to HHS," said Secretary Sebelius. "They will play a vital role in our department's effort to effectively implement the Patient Protection and Affordable Care Act. I look forward to working with them in the months and years ahead to achieve HHS's mission to protect the health of all Americans and provide essential human services."

As HHS regional directors, they will serve as key representatives of Secretary Sebelius in working with federal, state, local, and tribal officials on a wide range of health and social service issues.

Biographies:
Christie Hager, JD, MPH is currently an Adjunct Lecturer on Health Policy at the Harvard School of Public Health. Her research and teaching focus on state regulation of health care and public health, health care access, and the legislative process. From 2004-2009, she served on the staff of the Massachusetts House of Representatives, as Chief Health Counsel in the Office of the Speaker during the development, enactment and first three years of implementation of the health reform law passed in 2006. She previously served as Deputy Director of the Division of Public Health Practice at the Harvard School of Public Health. She was appointed Senior Fellow at the Schneider Institute for Health Policy at Brandeis University's Heller School, where she served as Director and Principal Investigator at the Massachusetts Health Policy Forum, from 1999-2002. She also previously worked on the editorial staff of the New England Journal of Medicine. Ms. Hager received an AB from Smith College, a MPH from the Boston University School of Public Health, and a JD from the University of Connecticut School of Law.

Jaime R. Torres, DPM, MS, is currently Associate Director of Consultative Services at Coler-Goldwater Specialty Hospital, part of New York City's Health and Hospital Corporation--the nation's largest public hospital system. He is the founder and President of Latinos for National Health Insurance, a national coalition working for equality in healthcare. He is on the Board of Directors of the National Hispanic Council on Aging and served on the Advisory Board of the National Hispanic Medical Association (NHMA) from 2000-2006. For eight years he represented the NHMA in the National Diabetes Education Program (NDEP), which is sponsored by the National Institutes of Health and the Centers for Disease Control. As vice-chair of NDEP's Hispanic/Latino Work Group, he was instrumental in creating bilingual health campaigns for people with diabetes. In 2006, he was a spokesperson for the American Podiatric Medical Association's campaign "Descubras sus pies" (Discover Your Feet) which educated the Latino community on how to prevent foot ailments related to diabetes. Dr. Torres received his Doctorate of Podiatric Medicine from the New York College of Podiatric Medicine and a master's degree in Community Health from Long Island University.

For the past seven years, Joanne Grossi has served in the administration of Governor Edward G. Rendell, first as Deputy Secretary of Health and later as the first- ever Director of the Office of Women's Services. During her five-year tenure as Deputy Secretary for Health Promotion and Disease Prevention at the Pennsylvania Department of Health from 2003 to 2008, Ms. Grossi oversaw all the public health programs for the Commonwealth, including tobacco cessation and prevention; obesity prevention; drug and alcohol programs; and maternal and child health programs. As Director of the Office of Women's Services at the Pennsylvania Department of Public Welfare from 2008 to 2010, Ms. Grossi administered statewide programs that provide assistance to women, including family planning/reproductive health; domestic violence; sexual violence; and the breast and cervical cancer treatment program.Before joining the Governor's Administration, Ms. Grossi served for 13 years as a Senior Technical Advisor in the Bureau of Global Health at the United States Agency for International Development, where she oversaw international health programs in developing countries.Earlier in her career, Ms. Grossi served on the staffs of Congressman Peter Kostmayer and Ambassador Millicent H. Fenwick at the American Embassy in Rome, Italy. Ms. Grossi earned her master's degree in International Public Policy at the Johns Hopkins University's School of Advanced International Studies and completed additional graduate education at the Johns Hopkins University's School of Public Health and Hygiene. She earned her B.A. in journalism at Temple University.

Marguerite Salazar has served as President/CEO of Valley Wide Health Services, Inc. (VWHS) since 1989. VWHS is one of the largest rural Community Health Centers in the country, providing primary care to over 40,000 residents of the San Luis, Lower Arkansas and Upper Arkansas Valleys in Southern Colorado. VWHS is recognized for exceptional outcomes with prenatal care and reducing ER utilization through Convenient Care in some of the poorest areas of Colorado. Previously, Ms. Salazar directed Access Social Work Service, a firm that contracted with local public health departments, hospitals and nursing homes to provide social work services. Ms. Salazar is a Fellow in the National Hispana Leadership Institute as well as a Livingston Fellow in the Bonfil Stanton Foundation, a Trustee for the Temple Hoyne Buell Foundation and was appointed by Governor Bill Ritter, Jr. to the Board of Governors for Colorado State University. She was appointed by Governor Bill Owens to serve as a Policy Board Member for the Colorado Children's Basic Health Plan. In 1999, she was awarded the Bernie Valdez Award for Excellence in Health from the Latin American Research and Service Agency (LARASA). She holds a Master's degree in counseling psychology from Adams State College in Colorado.

Herb K. Schultz, MPP, is currently Senior Advisor to Governor Arnold Schwarzenegger, and since January of this year, also the Director of the California Recovery Task Force. In this role, he is responsible for the oversight and implementation of the American Recovery and Reinvestment Act of 2009. As Senior Advisor to the Governor from 2008-2010, he represented the Governor on major domestic policy issues, which included serving as a principal advisor on health care reform. Previously, he served as the Senior Health Policy Advisor to the Governor during California's 2006-2008 state debate on comprehensive health care reform. From 2005-2006, he served as Vice President of Government Programs for McKesson Health Solutions, where he oversaw the company's disease management and nurse advice programs for Medicaid and Medicare beneficiaries. During the first year of Governor Schwarzenegger's Administration, Mr. Schultz served as Acting Director of the California Employment Development Department. He also previously served as a member of former Governor Gray Davis' Cabinet as Acting Secretary for the Labor and Workforce Development Agency. He served as the Agency's Undersecretary before his Cabinet-Level appointment, and remained in both roles until the end of the Davis Administration. Prior to that, he was Deputy Director of External Affairs for the California Department of Managed Health Care, and served as Director of the Advisory Committee on Managed Health Care. Mr. Schultz received his BA in Political Science and International Studies from The American University in Washington, DC and has a Masters Degree in Public Policy from Georgetown University, also in Washington, DC.

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HHS Community Living Initiative Upcoming Stakeholder Dialogues

As part of The Community Living Initiative, HHS is holding dialogues with State and local officials as well as other critical stakeholders with diverse opinions on issues related to community living. These dialogues will help your public officials develop and/or refine their policies and practices to better meet the needs of people with disabilities and older adults, and provide information useful to achieving the goals of the Initiative to improve community living options.

For more information click here.

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Congress Enters Spring Recess

Congress begins their district work period on March 29 and it will run through April 9. Use this opportunity to meet in person with your members of Congress. Meeting with them in their local, district offices or having them visit your organization is the most effective way to educate your Members and their staff on issues important to you. While health care reform has passed the jobs bill with the FMAP extension is still up for debate. Also use this opportunity to ask for co-sponsors for the Direct Support Professionals Fairness and Security Act of 2009 (H.R. 868).
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Harvard Professor to Be Named CMS Head

Donald M. Berwick, a professor at the Harvard School of Public Health, is expected to named head of the Centers for Medicare & Medicaid Services. The announcement is expected during the congressional two-week April recess that begins on March 29.

Berwick is a clinical professor of pediatrics and health care policy at the Harvard Medical School and the Harvard School of Public Health, according to the school. He is also president and chief executive officer of the Institute for Healthcare Improvement, a Cambridge, Mass.-based, a not-for-profit organization that promotes the improvement of health care.

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House and Senate Pass Reconciliation Package

The Senate passed the reconciliation package 56 to 43 and sent it to the House where it was also passed.The bill will go to President Obama's desk where he is expected to sign it on Tuesday. Read more!

Arizona 1st State to Drop CHIP Program

Arizona Gov. Jan Brewer (R) has signed budget legislation that removes the statutory authorization for the state Children's Health Insurance Program (CHIP), thus making Arizona the first state to do so amid fiscal constraints. Brewer and Republicans who control the Arizona Legislature said the elimination of the program, known here as KidsCare, was necessary to help close the state's budget deficit, which is pegged at $2.7 billion in fiscal 2011 beginning on July 1. KidsCare would lose funding June 15.

Meanwhile, Arizona House Democrats, led by Minority Leader David Lujan and Assistant Leader Kyrsten Sinema, are working to head off the program's demise.
They asked House Speaker Kirk Adams (R) in a letter dated March 22 that the authorization be reinstated, and that funding be provided through repeal of a sales tax exemption on retail warranties.

The elimination, Democrats argue, may also have consequences beyond children's health, jeopardizing an estimated $7 billion in federal Medicaid matching funds to the state.
The federal health overhaul plan signed March 23 by President Obama requires states to continue “maintenance of effort,” or providing health care at the same funding level as when the legislation was signed. Elimination of KidsCare would put Arizona in violation of that new law, Democrats argue.

Other states, including California, have considered eliminating their CHIP programs, but none has done so.


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President Obama Signs Underlying Health Reform Legislation into Law

The President signed shortly before noon today into law the underlying Senate-passed health reform legislation--The Patient Protection and Affordable Care Act of 2010 (H.R. 8590). The President signed the bill on behalf of his "mother that while struggling against cancer, she still fought her insurance company;" on behalf of several specific individuals present at the White House ceremony who were uninsured or whose family members struggled in face of inadequate coverage; and on behalf of Presidents since Teddy Roosevelt, countless Congressional leaders, and Senator Ted Kennedy. The Senate will immediately take up the companion "sidecar" reconciliation package passed by the House late Sunday evening. The Senate is expected to finalize the reconciliation package--The American Health Reform and Education Affordability Act of 2010 (H.R. 4872) that makes "fixes" to the underlying Senate bill--by Saturday before joining House members for a two-week recess to work in their states. See ANCOR's health care website for ANCOR's first Issue Brief explaining many parts of the new legislation; text, summaries, and costs of specific provisions; and other timely information.
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House Passes Health Reform Sending Reconciliation Package to Senate

A divided House of Representatives voted March 21, 2010 on historic health reform by way of a two-track process: voting 219 to 212 to clear the Senate bill passed December 24th by a 60-vote super-majority and voting 220 to 211 pass a reconciliation package of fixes. The Senate-passed bill was sent immediately to the President who is expected to sign the legislation into law on March 23rd. However, the Senate must also pass the same reconciliation legislation. It begins floor consideration on March 23rd, where it faces an endless number of amendments and challenges to the Senate “Byrd rule” under reconciliation rules before the bill is required to be passed by a simple majority vote (51). If passed without any changes, the reconciliation package goes immediately to the President for his signature. See ANCOR’s March 9th Issue Brief on Reconciliation for discussion of the reconciliation procedure. See ANCOR links to legislative text and impact on entities.

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Conferencing of “Tax Extenders Act” with FMAP Extension Likely After Health Reform

Last week the Senate passed the American Workers, State and Business Relief Act, also known as the Tax Extenders Act, which includes a six month extension of the temporary increase in states Federal Medical Assistance Percentage (FMAP) through June 10, 2011. Because there are differences between the Senate-passed measure and the version approved by the House in December that must be worked out, ANCOR staff learned this week that the bill will likely be “conferenced” after health reform legislation is wrapped up. At this time, neither chamber has appointed conferees. ANCOR is urging Congress to work quickly to seek agreement on a final bill to ensure the vital FMAP extension.
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Disability Provisions Included in Health Reform

Long Term Services and Supports

• Strengthening long-term services and supports through a two pronged approach:

1. Taking pressure off of the Medicaid program: The Community Living Assistance Services and Supports (CLASS) Act would create a national long term services insurance program which assists eligible individuals and their families to meet long term needs with a cash benefit and without forcing them into poverty to receive Medicaid benefits.
2. Improving the Medicaid program: The Community First Choice Option would help to eliminate the institutional bias by encouraging state states to cover personal attendant services under the state’s optional service plan instead of through the waiver system by offering a 6% increase in the federal share of Medicaid for these services.

• Increasing the federal share of Medicaid, known as the Federal Medical Assistance Percentage (or FMAP), for home and community based services (HCBS) and during periods of economic downturn.
• Allowing states to offer additional services under the 1915(i) Medicaid HCBS Waivers State Plan Option.
• Providing spousal impoverishment protections for HCBS Beneficiaries.

Coverage

• Prohibiting private health insurance exclusions for pre-existing conditions.
• Eliminating annual and lifetime caps in private insurance policies.
• Restricting the consideration of health status in setting premiums.
• Expanding Medicaid to cover individuals with incomes up to 133 percent of the federal poverty line (approximately $29,000 per year for a family of four).

Benefits

Ensuring that minimum covered benefits include products and services that enable people with disabilities to maintain and improve function, such as rehabilitation and habilitation services and devices.

Access to Quality Care

• Improving training of physicians, dentists, and allied health professionals on how to treat persons with disabilities.
• Requiring the Centers for Medicare and Medicaid Services to collect data on beneficiaries with disabilities access to primary care services and the level to which primary care service providers have been trained on disability issues.
• Ensuring prevention programs include a focus on individuals with disabilities.

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Employer and Individual Mandates in Health Reform

The employer responsibility provisions have been altered so that employers who do not offer coverage and have 50 or more employees would have to pay $2,000 per FTE (up from $750), if even one full-time employee get subsidies in the exchange. However, the first 30 employees would be subtracted from the total. These provisions were in the President’s February 24th proposal.

The health reform bill bill encompasses part-time workers when determining whether an employer would be considered a “large employer” (50 or more workers) subject to the tax. Employers who do offer coverage and have a FTE in the exchange must may a penalty of $3,000 per employee.

For the purpose of calculation on whether an employer is a “large employer,” the legislation requires employers to divide the aggregate hours worked by all part-time employees in a month by 120, and that number would be a full-time equivalent. The provision now raises $52 billion over 10 years, up from $28 billion in the underlying bill.

Summary of Employer and Health Reform Benefits and Requirements

The individual mandate will now be phased in. By 2017, the fee for not purchasing coverage will be the greater of $695 or 2.5 percent of income. The provision will now raise $17 billion over 10 years, up from $15 billion.

Summary of Shared Responsibility of Health Reform

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State of Idaho Witholding Medicaid Payments to Providers for 30 Days

The Idaho Department of Health & Welfare plans to delay payment to all providers in the state for the entire month of June, 2010. They are doing this to meet budget cuts to the Medicaid appropriation for FY 2010. The state of Idaho’s constitution does not allow the state to end the fiscal year with a deficit, so their solution is to end the year paying for only 11 months of expenses with 12 months of revenue.

Thank you to Russ McCoy with the South Park, Inc. dba Developmental Options for bringing this to ANCOR's attention. Read more!

Two New Cosponsors Added to the Direct Support Professionals Bill

Representative Eliot Engel (D-NY) and Representative Bob Ethridge (D-NC) signed on as co-sponsors for H.R. 868, the Direct Support Professionals Fairness and Security Act of 2009. Thank you to everyone for reaching out to their members about this important legislation. Read more!

House to Vote Sunday Afternoon on Senate Health Reform Bill and Reconciliation

The House early Thursday afternoon unveiled a 153-page reconciliation package estimated to reduce the deficit by $138 billion in the first decade and $1.2 trillion in the second decade, a feat that has helped attract some Blue Dog “no” votes before an expected health reform vote after 2 PM on Sunday. The Reconciliation Act of 2010 (H.R. 4872), which costs $940 billion in the first 10 years (see CBO score), is very similar to President Obama's February 24th proposal.

Of the $940 billion, $434 billion over 10 years is new federal Medicaid money to cover Medicaid expansion, including newly eligible beneficiaries. In addition, the overall total includes $20 billion over 10 years in new state help. These additional Medicaid dollars do not include long term services dollars or disproportionate share hospital (DSH) payments. The cost of expanding coverage is shared between Medicaid and the new insurance exchange. For most states, only 4% of this Medicaid expansion will be state dollars, the rest will be federal Medicaid dollars for the next 10 years.

House and Senate staffers told ANCOR staff that if this bill does not pass, states will not see new money like this again.

The Senate bill and the reconciliation package will be combined, so the House only has to take one vote; however, Speaker Pelosi will not proceed on a vote until the Democrats reach 216 “yeas.” The Senate will then have to vote on the reconciliation package, which is likely to occur on Tuesday.

Related Summaries:
House Democratic Summary of Reconciliation Package
Health Reform Implementation Timelines
House Energy and Commerce Committee Benefits of Health Reform, District by District Impact Read more!

ANCOR Partners With the U.S. Census Bureau

ANCOR is partnering with the U.S. Census Bureau to spread the word about the 2010 Census. Conducted every 10 years, the census is much more than a population count. Census data are used to reapportion congressional seats to states, and directly affect how more than $400 billion per year in federal funding is distributed to state, local and tribal governments.

Because individuals with disabilities rely on many government and social service programs, accurate representation and funding is especially important. Census data influences the distribution of funding for Medicaid and Housing and Urban Development programs, such as Section 8 Housing Choice Vouchers and the Community Development Block Grant.

A Toolkit for Reaching People with Disabilities is available to help organizations that support people with disabilities communicate the benefits of census participation. Among the available documents are a toolkit overview and 2010 Census Fact Sheet. Questionnaire Assistance Centers (QAC) will be available to assist those unable to read or understand the census form. For those with visual impairments, Language Assistance Guides will be available in large print and Braille. Deaf and hard-of-hearing persons who do not have access to Video Relay Service (VRS) can call 1-866-783-2010 via FedRelay, a free and confidential federal government communications service. In addition to these options, Language Assistance Guides also will be available in 59 languages at all QAC locations.

By law, the Census Bureau cannot share respondents’ answers with anyone, including other federal agencies and law enforcement entities. All Census Bureau employees take an oath of nondisclosure and are sworn for life to protect the confidentiality of the data. The penalty for unlawful disclosure is a fine of up to $250,000 or imprisonment of up to five years, or both.

We will continue to share information with you about upcoming census events we are hosting, as well as those in our community. Below are key dates for the 2010 Census:

• March 2010: 2010 Census forms are delivered.

• April 1, 2010: Census Day – the official day of the population count. Information provided on 2010 Census forms should represent respective households as they exist on this day.

• April – July 2010: Census workers visit households that did not return the forms to take a count in person.

• Dec. 31, 2010: Census Bureau presents population count to the President of the United States.

Watch for additional details in the coming months, or visit 2010census.gov to learn more.


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Confused About All the Talk About "Reconciliation"?--Let ANCOR Help!

ANCOR has prepared a new Issue Brief on the concept of "reconciliation" as an expedited Congressional process to pass legislation that targets deficit-reduction. Read more!

U.S. District Court Judge in Louisiana Agrees to Continue Community Services Pending Final Court Judgment on Cuts

Louisiana has agreed to continue round-the-clock supports to a man with developmental disabilities who is suing state health officials over planned cuts in services. Following the use of a new assessment tool, a determination was reportedly made to reduce 24-hour-a-day assistance to three to seven hours per day. Brian Stein’s parents filed a federal lawsuit last month over cuts they claim would force their son to be institutionalized. They sought a preliminary injunction while the U.S. District Court decided the merits; however U.S. District Judge Ralph Tyson signed off on an agreement between the parties March 8th to continue services pending the court's ruling. According to state advocates, the Stein lawsuit could be the first of many similar actions as the state moves to a new system of assessing individual service needs for individuals living in the community at the same time budget cuts are being considered. Thanks to Joe Aniello of UCP South Florida for forward the information to ANCOR!
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Senate and House Take Formal Steps Toward Passage of Health Reform

In a letter Thursday afternoon to Senate Minority Leader McConnell (R-KY), Senate Majority Leader Reid (D-NV) stated formally for the first time that Democrats plan to use reconciliation. Meanwhile, House Majority Leader Pelosi (D-CA) told her Democratic rank-and-file members Thursday morning that it would have a week to review and discuss a final package of changes to the Senate-passed health care overhaul bill. Language for a health reconciliation bill could go to the House Budget Committee Monday or Tuesday. The committee is required to give 24 notice before taking up the reconciliation bill and a 48-hour wait period before the House Rules Committee takes action. Whether the House can meet the President's deadline for a vote on the Senate-passed bill by next Friday and completion of final passage by Congress by the Easter recess remains to be seen.
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Victory in Senate Wednesday with Passage of Jobs Bill that Includes 6-Month FMAP Extension: Send Your Thanks to Senators Who Voted "Yea."

The Senate passed by a 62-36 vote Wednesday a $140 billion "jobs bill" that includes federal assistance to states providing an additional estimated $25.5 billion in FMAP and an additional $1.2 billion in adjustments to help states with the Medicare Part D payments states are required to make to the federal government. The American Workers, State, and Business Relief Act of 2010 (H.R. 4213) also includes extension of unemployment insurance benefits, blocks cuts to Medicare physician and therapy caps, preserves numerous tax breaks and credits, and extends enhanced COBRA payments through the end of the year. The bill now goes to the House to iron out differences with its jobs bill passed in December. It is not known whether Democratic leaders will use the "ping-pong" process whereby the House votes on the Senate-passed version or the usual conference committee process will be used to craft a single bill with changes requiring both chambers to pass the bill before it is sent to the President. ANCOR members should use the vote summary to guide them in thanking Senators who voted for the jobs bill with FMAP extension. NOTE: ANCOR members should use this news along with the recent HHS/CMS decision to release ARRA funds ($4.2 billion) to assist states with their Medicaid "clawback" funds as you press state officials to preserve services and supports and provider rates. ANCOR has heard from several members who are using this information to reduce cuts.
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New CBO Estimate for Senate Health Reform Bill Is $875 Billion

The Congressional Budget Office released a new estimate of the Senate's health care bill Thursday that showed it would save less money. The non-partisan CBO originally estimated that the Senate's health care bill would cost $871 billion over a 10 year period. The figure will play into the health reform debate as House leaders whip their members to support the Senate bill. But what lawmakers are really waiting for from CBO is its score of President Barack Obama's proposed fixes to health care legislation.
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House Begins Walk-Through of Health Reform Package While House and Senate Democrats Await CBO Cost Estimates Due Out Thursday

House Speaker Nancy Pelosi (D-CA) will start walking her rank-and-file members through major components of the final health care package in a meeting Thursday morning. The briefing comes after another long negotiating session with Senate Democrats and top White House officials in Pelosi’s Capitol office. Meanwhile, Democrats are watching out for two Congressional Budget Office (CBO) cost estimates today on health overhaul measures, an update of the Senate-passed bill and a plan incorporating changes called for by President Obama. The two chambers are trying to resolve a long list of differences, both big and small, between their two bills and discussing changes made through a "reconciliation" process. All parties stated Wednesday that tremendous progress had been made, particularly with issues sensitive to House members who are going to be asked to vote on the Senate-passed version as well as a "side car" bill of changes (reconciliation bill) to deal with issues sensitive to the House in the Senate-passed bill. The changes expected in a reconciliation bill include those the President set out in his February 22nd $905 billion proposal and changes needed to gain House votes--while not upsetting the delicate balance needed to gain 51 votes in the Senate. President Barack Obama pressed Senate Majority Leader Harry Reid Wednesday to go further than Obama had previously disclosed to strip the final reform bill of narrow deals aimed at appeasing specific senators. Read more!

Providers Should Press for State Protection of Services and Supports

CMS March 5th letter to Medicaid Directors affirms HHS announcement regarding additional Federal Relief to states due to ARRA FMAP application to state Medicaid “Clawback.” As ANCOR reported in past WIC’s Updates, HHS announced on February 18th that it would provide $4.3 billion in fiscal relief to states by applying ARRA increased FMAP to the so-called clawback payments states pay to the federal government as required by the Medicare Prescription Drug Improvement and Modernization Act of 2003 that added Medicare cost of assuming drug costs for dually eligible Medicare/Medicaid beneficiaries.The recalibrations mean decreased state contributions for the increased federal FMAP. Providers should take this opportunity to use the additional federal assistance to protect services, supports and rates for individuals with disabilities.
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March Is National Intellectual and Developmental Disabilities Month—One Provider’s Example of Shedding Light on Provider Role and Challenges

Linda Timmons, CEO and President of Mosaic, successfully brought attention to March in with a published column in the Omaha World-Herald as well as providers’ role in reshaping supports and services in the community and enhancing the lives of individuals with disabilities. Timmons also wove this month’s designation to the intersection of debates surrounding health reform and budget challenges. What are you doing to bring positive awareness to the supports and services you provide? Of the challenges you face as an economic and social force in your communities? Of the positive affects you have on individuals with disabilities? Read more!

New Version of "Extender Bill" Passes House and Moves to the Senate

The House sent legislation aimed at spurring job creation back to the Senate Thursday after tacking on language to fully offset the package’s cost.

The move means that the bill will have to return to the Senate for another vote, further delaying implementation of the first portion of the Democrats’ “jobs agenda.”

The centerpiece of the $17.6 billion package is payroll tax relief for businesses that hire new workers, which would cost $13 billion over 10 years. The bill also includes extensions of the Highway Trust Fund, the Build America Bonds program and expense deductions for small businesses.

Certain House Democrats complained that it violated the pay-as-you-go budgetary rule. To make the bill compliant with the rule, the House changed some of the tax provisions that were in the Senate-passed version, including the section on delaying worldwide interest allocation. This is the version that will go back to the Senate for consideration.

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Senate Continues Consideration of Large Jobs Bill with FMAP Extension--No Votes Until Tuesday March 9th

The Senate spent Thursday resuming consideration of H.R. 4213 disposing of a growing number of pending amendments. Majority Leader Reid considered bringing a motion to close debate. However, he announced that the Senate would continue consideration of the bill Friday and Monday with no roll call votes scheduled until Tuesday, March 9th.
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President Obama Calling for Passage of Health Care Bill by March 18th

While deadlines on the overhaul of health have been set repeatedly and unmet repeatedly, the President wants the House to clear the Senate-passed bill by the 18th. Having decided on a two-step process to complete comprehensive health care reform, Democrats plan on using the Senate-passed bill as the foundation bill and passing a side-car bill with changes to the Senate bill agreed to by the administration, House and Senate. House Speaker said she could not guarantee a House vote by the 18th, but expected such a vote before the Easter recess. Obama held a meeting Thursday with a mix of House Democrats in order reverse some previous House "no votes" and potential new House "no" votes to gain the necessary 217 votes to clear the Senate bill with reconciliation changes.
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Senate will take up S. 4213 Thursday morning

The Senate adjourned Wednesday at 8:00 p.m. after considering numerous amendments to the larger $149 billion jobs bill (S. 4213)which extends many tax cuts and federal funding from programs until December 31st -- including temporary federal assistance in the form of enhanced FMAP to states. It will resume consideration of the $149 billion larger jobs bill with FMAP extension on Thursday. Once it passes, the House will take up the measure.


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Center on Budget and Policy Priorities Issues New Briefs

The March 2nd brief finds that if a state cuts a tax, it generally has to make an offsetting cut to expenditures for a program or service in order to maintain balance. This spending cut is likely to reduce demand in the state just as much as the reduction in taxes may stimulate demand.[1] It is at best a zero-sum game, where the gains in one area are offset by the losses in another. Given states’ balanced budget requirements, neither a broad-based tax cut nor a jobs credit can do much to increase overall economic activity in the state. This tax brief is a good companion to the February 16th CBPP brief A Balanced Approach to Closing State Deficits used in connection with ANCOR's February 18th Audio Conference.

CBPP also released on March 3rd an update on state budget cuts. The report found 45 states making cuts that are harmful to vulnerable populations.
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GAO March 2010 Report on State and Local Governments' Fiscal Outlook

The new report found that state and local government sectors continue to face near and long-term fiscal challenges and although the sector's near-term operating balance remains negative the federal Recovery Act assistance alleviated pressure with March 2010 operating balance measures showing an improvement compared to January 2009. In the near-term the sector's fiscal position can be attributed to several factors--including steep revenue declines. Absent any policy changes, GAO projects that the sector's long-term fiscal position will steadily decline through 2060. The decline is primarily driven by rising health care costs. Read more!

Democrats Readying to Move on Comprehensive Health Care Plan

Senate Majority Whip Durbin (D-IL) said Wednesday that House and Senate were “coming to closure” on revised language for comprehensive health care legislation that most likely could muster sufficient votes to pass both chambers—most likely using expedited budget reconciliation procedures. He said that Democratic leaders expect to send legislative language by the end of the week soon to the Congressional Budget Office (CBO) for cost estimates. The process would be at least a two-step process with the House passing the Senate-passed bill and both chambers passing House fixes or Administration changes (amendments to the base Senate bill) as a “side-car” reconciliation bill that allows legislation to avoid filibusters and pass with a simple majority.
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U.S. 9th Circuit Court of Appeals Rules Maintains Injunction Against California Regarding Wage Lawsuit

Thanks to Ron Cohen, President of UCP of Los Angeles, Ventura and Santa Barbara Counties for this news item. The Court today issued a decision against the Schwarzenegger Administration, upholding Federal District Court Judge Wilken's injunction that has blocked since June 2009 the reduction in the state's participation toward in-home supportive worker wages. The decision is a setback to the State of California, which on Monday won a ruling from the California State Court of Appeals on the issue of the Governor's line item vetoes, which that court declared was unconstitutional. The State could decide to appeal the 9th Circuit Court's ruling to the U.S. Supreme Court. The text of 21-page Circuit Court's opinion in Dominguez et al v. Schwarzenegger (formerly Martinez v. Schwarzenegger) and original federal district court case is available on the California Disability Action Center (CDCAN) website at http://www.cdcan.us/.
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Judge Orders New York City to Move Mentally Ill Out of Large, Institutional Housing

A decision in Disability Advocates, Inc. v. David A. Paterson, by Judge Nicholas G. Garaufis of Federal District Court in Brooklyn, followed his ruling in September that the conditions at more than two dozen privately run adult homes in New York City violated the Americans with Disabilities Act by leaving approximately 4,300 individuals with mental illness isolated in warehouse like conditions. The remedial plan offered by Judge Garaufis, drawn from a proposal presented by advocates was backed by the Justice Department, calls on New York to develop at least 1,500 units of supported housing a year for the next three years in New York City. That would give nearly all residents the opportunity to move out of adult homes. The state is considering an appeal, according to a one-sentence statement from Governor Paterson's officer.
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FY 2010 State Budget and Economic Survey

ANCOR State Budget Survey Shows Cuts in Services
Members are Urged to Respond to Next Survey

ANCOR asks its members to fill out a quarterly survey that asks questions about your state budgets and how they affect your organization and its ability to support individuals with disabilities. This survey is important because staff can take this information to Capitol Hill when meeting with members of Congress. The answers you give help paint a picture, with real people—the people you support, their families, and your employees -- of what cuts in Medicaid mean to services and supports for individuals with disabilities. In fact, ANCOR encourages you to talk to your federal lawmakers; the more they hear from you the more they will remember how important Medicaid funding is to the work you do.

ANCOR’s most recent survey yielded 65 respondents and a total of 33 of states. Over half of the agencies that responded to the survey received a cut in reimbursement. To deal with cuts, some providers increased the size of living arrangements and decreased the amount of direct support hours.

ANCOR members report the numbers of individuals on waiting lists continue to increase and in many states no funds are available to provide supports to anyone on the waiting list, while provider capacity to take emergency referrals has diminished.

Many providers have been forced to reduce the amount of support to “essential services,” greatly limiting the participation of individuals in their community and their independence. Defining elements of community life, such as access to social, recreational, and religious opportunities, have become limited or eliminated due to transportation and staffing cuts.

This information is just a snapshot of what ANCOR members report. Specific agency names and those making these reports are kept confidential. We hope as more information is collected over time, we can show more data; however, in the mean time, the information collected in this survey is critical to influencing individual members of Congress. Please watch for another survey in April and take the time to respond. Your influence in Congress depends on it!



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Save the Date: Learn About Cuts to Critical Section 811 Housing Programs

On Wednesday March 10 at 1:00 PM (EST) the Consortium for Citizens with Disabilities (CCD) Housing Task Force in conjunction with the Technical Assistance Collaborative (TAC) will host a very important conference call on HUD Section 811 Supportive Housing for Persons with Disabilities program highlighting drastic cuts to the Section 811 proposed FY 2011 budget and critical Section 811 legislation which must be enacted to reinvigorate the program.
What the Call Will Cover:

• The HUD FY 2011 Budget proposal eliminates all funding for new permanent supportive housing units financed through the Section 811 program until the new legislation is enacted. We need your help to advocate with Congress to restore these cuts.
• Currently critical Section 811 legislation is pending in the Senate and has already passed the House with strong bipartisan support. The call will focus on strategies and information you can use to engage your Senator to sign on as a cosponsor to S.1481 and save the Section 811 program.

Please join this call on Wednesday, March 10 at 1:00 PM (EST) to learn how to engage your Senator to cosponsor this important legislation.

Conference toll free call in number:
866-266-3378
Pass code 8224620005#

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New Reports on Medicaid and State Conditions

Kaiser releases a new report on Medicaid’s Continuing Crunch in a Recession: A Mid-Year Update for State FY 2010 and Preview for FY 2011. From the beginning of state fiscal year 2010, fiscal pressures have escalated and additional program reductions have become a necessity to balance state budgets. Half-way through the states' fiscal year, a total of 44 states and D.C. report that Medicaid enrollment and spending trends are above projected levels. Twenty-nine states report that additional mid-year cuts are likely. The February 22nd issue brief reports on interviews with all Medicaid directors about several issues, including the effects of the recession. Their primary concern is the upcoming end of the enhanced federal Medicaid match (as provided in the ARRA) and what that will mean for state budgets.

Kaiser Update on State Fiscal Conditions and Medicaid on How States Used ARRA Enhanced FMAP and State-by-State Measure of State Fiscal Distress.
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Health Summit Yields No Bipartisan Accord and Sheds Light on Divergent Party Philosophies on Health Care Reform

President Obama and congressional Democrats and Republicans debated health care reform for more than six hours February 25th, but as expected, the meeting did not bring the parties closer to a bipartisan agreement on reform legislation. While participants of the summit found some areas to which there were broad agreement, Republicans stated that they wanted the President to scrap the Senate-and House-passed legislation and White House proposal released on Monday and begin anew with an incremental approach to health care reform. Obama ended the unprecedented, day-long session by saying Democrats and Republicans likely could agree on several reform issues, and he called on Republicans to provide solutions over the next month to six weeks on how to extend coverage to more Americans than under the House GOP bill. If a bipartisan agreement cannot be reached, “then I think we have to go ahead and make some decisions,” the president said. “We cannot have another year-long debate on this.” While some expect the next step will be House and Senate Democrats agreement to the Senate bill and then passage of a "reconciliation" bill with fixes negotiated by Congressional Democrats and the Administration, others are reporting that the President has already prepared a fall-back, scaled down version of health care that would provide coverage to 15 million people rather than 31 million that he might consider should other choices fail to gain enough Congressional support.

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HHS Secretary Response to Senate Letter on Medicaid PERM Rates

In response to a letter from Senator Cornyn (R-TX) asking for CMS information on Medicaid's improper payment rates (PERM) for 2007 and 2008, Secretary Sebilius released a letter February 25th detailing state-by-state Medicaid PERM rates for those years. Cornyn had raised the issue because “CMS had reported Medicaid's improper payment rates average between 8.7 percent and 10.5 percent among the states, which is substantial considering the combined federal/state spending on Medicaid reached approximately $438 billion in 2009.” Sebelius reported a national Medicaid error rate of 9.6 percent in its FY 2009 Agency Financial Report. The error rate was based on a weighted average of the states that were measured in FY 2007 and FY 2008.

In her letter, Secretary Sebelius said that that “CMS uses a 17-state rotation so that each state is reviewed once every three years. FY 2007 was the first year in which states were fully measured in each component of the PERM measurement. Therefore, we are only providing information about state rates for FY 2007 and FY 2008; the remaining states will be measured during the FY 2009 rotation.” She reported that for all the states sampled in FY 2007, the average rate was 10.5% with Rhode Island having the largest PERM rate of all sampled states, at 21%--followed by California at 16% and Georgia at 12 %. The combined rate for all sampled states in FY 2008 was 9%--with the top three PERM rates belonging to Oregon at 21%, Washington, D.oiC. at 20%; and Indiana at 17%. Read more!

FMAP Extension Likely on Next Senate Jobs Bill

Senate Majority Leader Reid (D-NV) is following through on his commitment to extend federal FMAP assistance to states through June 31, 2011. Rumored to be in released draft language on a second jobs bill released Wednesday, Reid is including a number of must-pass "health care provisions"that were not included in the first-Senate jobs bill passed Tuesday. In addition to six-month FMAP extension, the next bill in the Senate's job agenda will include an extension of COBRA subsidies for ten months through December 31, 2010 for individuals who have lost employment, an extension of the current fix to Medicare physician rates through September 2010, a full-year extension of the Medicare therap cap exemption, and other Medicare provisions. Stayed tuned for future Alert on when the second jobs bill is introduced and scheduled for a Senate vote. Thanks to everyone who has already responded to ANCOR's previous February 12th alert on FMAP by contacting both of their Senators!
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Administration's New ARRA Relief to States on "Clawback" Medicaid Funds to Cover Dual Eligibles Will Help States Struggling with Medicaid Budgets

The HHS Secretary in a February 18th call to state governors announced that it would provide $4.3 billion in fiscal relief to states by applying ARRA increased FMAP to the so-called clawback payments states pay to the federal government as required by the Medicare Prescription Drug Improvement and Modernization Act of 2003 that added Medicare cost of assuming drug costs for dually eligible Medicare/Medicaid beneficiaries. This temporary adjustment in the clayback payments will be applied from October 1, 2008 through December 31, 2010. The announcement includes a state-by-state table of newly calculated savings to state matching funds.
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State of the States: The State We're In Report Examines Health Reform Efforts in 2009 and Initiatives Underway in 2010

This new Robert Wood Johnson Foundation report it examines how states responded to declining job-based coverage and rising health care costs, as well as Medicaid eligibility and CHIP enrollment in 2009, when many states went forward with meaningful health care reforms despite the fiscal challenges they faced. Read more!

Health Care Summit Thursday Likely to Determine What's on the Table Friday

President Obama invited a host of Congressional leaders to take part in the six-hour meeting, released his health care proposal on Monday, and invited Republicans to do the same. The meeting centers on four health care reform topics — cost control, insurance reforms, deficit reduction and expanded coverage — with Obama, Health and Human Services Secretary Kathleen Sebelius and Vice President Joseph Biden taking turns introducing each topic. While the "bipartisan health care summit" takes place Thursday, the defining moment will come the day after, when Democrats decide once and for all whether they can "go it alone" or try for Republican support to pass a bill.

House Democratic participants include House Majority Whip Clyburn (SC), Speaker Nancy Pelosi (CA), Majority Leader Steny Hoyer (MD), and Representatives Rangel (NY), Miller (CA), Waxman (CA) and Dingell (MI). Republicans include House Minority Leader Boehner (OH), Minority Whip Cantor (VA.) and Representative Camp (MI.), Barton (TX) and Kline (MN).
Senate Democratic participants include Majority Leader Reid (NV), Majority Whip Durbin (IL) and Senators Baucus (MT), Dodd (CN) and Harkin (IA).

Republicans include Minority Leader McConnell (KY), Senate Minority Whip Kyl (AR) and Senators Grassley (IA) and Enzi (WY).

In addition, House and Senate leaders from both parties were each allowed to bring four lawmakers to represent their chamber. House representatives include Representives Becerra (D-CA), Cooper (D-TN), Slaughter (D-NY), Andrews (D-NJ), Boustany (R-LA), Ryan (R-WI, Blackburn (R-TN) and Roskam (R-IL). Senate representatives include Schumer (D-NY), Murray (D-WA), Rockefeller (D-WV), Coburn (R-OK), Alexander (R-TN), John McCain (R-AR), Conrad (D-ND) and Barrasso (R-WY).
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Senate Passes $15 Billion Jobs Bill--First in Series of Job Creation Agenda

After waiving a Republican point of order, the Senate Wednesday morning  passed a $15 billion jobs bill, by a vote of 70-28. The bill which includes  payroll tax breaks, bond-financing for state and local infrastructure projects, a small-business expensing provision, and an extension of federal highway programs, will be sent to the House for a vote.  The House passed a more comprehensive $154 billion jobs bill in December which included a six-month extension of FMAP. 

Before leaving for their week-long President's Day recess, Majority Leader Reid (D-NV) scrapped a larger, bipartisan jobs bill draft by Senate Finance Chair Baucus (D-MT) and Ranking Member Grassley (R-IA) in favor of a series of smaller jobs bills.  Majority Leader Reid is working on several other jobs bills as part of a jobs creation agenda.  A six-month extension of FMAP, as well as extensions of unemployment insurance and COBRA, are being considered for the next jobs bill. However, timing has not been set for the series of bills or content.  Reid must first determine what items must be costed out under new "pay-go rules" and what combination in each package will bring sufficient support to muster a 60-vote cloture rule to end any filibuster efforts, before proceeding.

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Forty-Seven Governors Urge FMAP Extension

A bipartisan group of 42 governors of states and five governors of U.S. territories sent a letter on February 22 urging House and Senate leaders to extend for at least six months the enhanced federal match for Medicaid included in the American Recovery and Reinvestment Act of 2009. The following governors did not sign the letter: Janice Brewer (R-AZ), C. L. Otter (R-ID), Bobby Jindal (R-LA), Tim Pawlenty (R-MN), John Hoeven (R-ND), Mark Sanford (R-SC), Rick Perry (R-TX), and Gary Herbert (R-UT).
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New HCBS Participant-Directed Services Clearinghouse Online Website

The HCBS Clearinghouse has added a new theme page maintained by the National Resource Center for Participant-Directed Services at Boston College regarding information and resources on participant-directed services (self-directed services). The new site includes an online manual for developing and implementing participant-directed services; CMS guidance on the DRA Section 6087, the “Optional Choice of Self-Directed Personal Assistance Services (PAS) Medicaid state option; and state experiences with managing rebalancing efforts.
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Go Direct - Social Security

Millions of Americans still receive their Social Security and other federal benefit payments by paper check, which can be vulnerable to delays, loss or theft. By supporting the U.S. Department of the Treasury's campaign to encourage the use of electronic payments for federal benefits, you can help senior citizens, people with disabilities and others in your community choose a safer, easier way to get their money. Treasury suggests the use of two electronic payment options:

The U.S. Department of the Treasury encourages the use of two safer, easier alternatives to paper checks for federal benefits: Go Direct and the Direct Express card.

• Treasury's Go Direct® campaign offers Americans with bank accounts a fast, easy way to sign up for direct deposit. For more information about Go Direct and how to sign up please visit http://www.godirect.org/ or call the toll-free Go Direct campaign helpline at (800) 333-1795
  
• The Direct Express® Debit MasterCard® card is designed as a safer, more convenient alternative to paper checks for Social Security and Supplemental Security Income (SSI) benefit recipients who don't have a bank account. For more information about the Direct Express card or how to sign up please visit http://www.usdirectexpress.com/ or call toll-free (877) 212-9991
  
  

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Kaiser Examines Medicaid and Managed Care

The Kaiser Commission on Medicaid and the Unisured issued a policy brief Monday, February 8th which provides an overview of the Medicaid program’s increasing reliance on managed care to deliver services. Medicaid provides health and long-term care coverage to nearly 60 million low-income individuals, or roughly 1 in 5 Americans. About 70 percent of Medicaid enrollees receive some or all of their services through managed care. Adopting managed care also gives states more cost predictability and control over their Medicaid programs, and contracts with managed care plans offer states a mechanism, through quality measurement and improvement requirements, for holding plans accountable for the quality of care they provide to Medicaid enrollees. Read more!

Senate To Move on First Jobs Bill Week of February 8th

Provisions of a Senate $80 billion jobs bill expected in Thursday's Democratic press conference with Majority Leader Reid (D-NV), Durbin (D-IL) and Baucus (D-MT) were not forthcoming as Senators said details for a bill would be unveiled Friday or Monday. Reid expects to vote on the first jobs creation bill by end of next week before the Congressional week-long Presidents' Day recess that begins February 12th.

Senate leaders continued to negotiate a bipartisan package of tax incentives and safety-net spending for laid-off workers Thursday, but the must-pass nature of the bill meant it was beginning to attract unrelated legislative freight. The House-passed jobs bill costs $154 billion heavily focused on infrastructure and FMAP extension. However, the Senate jobs bill is to focus on tax credits and tax payroll relief for small businesses, highway funding, and possibly extension of unemployment insurance and COBRA. At this point, it is not expected to include FMAP extension. See related brief on Reid and Rockefeller bill and push to get FMAP in this jobs bill. Read more!

Senate and House Democratic Leaders Continue to Move Health Reform Process Forward

The leadership of both chambers are negotiating a pathway to resume passage of comprehensive health reform that includes significant provisions related to long-term services' issues. House Democrats remain reluctant to pass the Senate bill without assurances of changes.

In order to avoid an expected 60 vote cloture to end a filibuster Democratic leaders are still pursuing a path in which the House would agree to the Senate bill, but make changes through "the reconciliation process" that would require only 51 votes. Given the level of mistrust between the two chambers, the House wants the Senate to vote first on a reconciliation package that would modify the Senate bill's provisions including the so-called "Cadillac tax" on insurance plans costing more than $8,500 for individuals and deeper subsidies for low-income beneficiaries.

Meanwhile the Senate is pivoting to job creation bills while substance and process are worked out. Read more!

Reid and Rockefeller Introduce Senate Bill to Extend FMAP--Push Next Week to Avert More Job Losses Without FMAP Extension

Senate Majority Leader Reid (D-NV) and Senator Rockefeller (D-WV) introduced legislation Thursday to extend by six-months the temporary federal funding for FMAP in last year's Recovery Act (ARRA). With states expected aggregate budget shortfall at $180 billion and only $40 billion covered by ARRA's FMAP through 2010, the $140 billion expected shortfall would cost a job loss of 900,000 jobs nationally.

ANCOR sent a letter to all Senators Tuesday urging immediate extension of ARRA FMAP funding. In a meeting with Rockefeller's staff last night, ANCOR was told that the bill (yet to have a bill number) has 33 Democratic sponsors. ANCOR asked if the legislation mirrors the House provision included in its job bill passed in December. Senate Finance staff confirmed that it was the same except for adding a provision regarding county pass-throughs. Rockefeller staffer has confirmed that she will be a part of ANCOR's free audio conference on FMAP on Thursday, February 11th.

Senate staff from multiple offices expressed the urgency of immediately including an FMAP extension to avert deeper budget cuts that states are now planning in their 2011 budgets. The temporary extension would be through June 2011. The intention is to include the legislation immediately in the first jobs bill that the Senate is expected to take up next week. Both the National Governors Association and National Conference (NGA) on State Legislatures (NCSL) sent bipartisan letters this week to Congress urging immediate extension of ARRA FMAP funding. ANCOR will have an alert out early next week pending fact sheet being developed by Senate staffers today. Read more!

Administration Issues Paul Wellstone Mental Health Parity Interim Final Rule

The administration Wednesday issued interim final rules implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which requires parity between mental health or substance use disorder benefits and medical/surgical benefits with respect to health care insurance coverage. These interim final regulations are effective on April 5, 2010. Read more!

CMS Issues Clarifying Letter on Ticket to Work Outcome and Milestone Payments to Employment Networks

On Thursday, January 28th, CMS issued a letter to State Medicaid Directors clarifying that Ticket Outcome and Milestone payments to Employment Networks (ENs) under the Ticket to Work program do not conflict with regulatory requirements and do not constitute an overpayment of Federal dollars for services provided because EN payments are payment for an outcome, rather than for a Medicaid service rendered. The letter indicates that State agencies and/or providers interested in participating in the Ticket to Work program as ENs are encouraged to do so.

We know that many organizations have been waiting for this policy clarification in order to make the final decision to become an EN or, if already an EN, to accept Ticket assignments and receive payments. To obtain the EN RFP, visit: http://www.ssa.gov/work/enrfp.html. For assistance with completing the application to become an EN, please contact a CESSI Account Manager at 1-877-743-8237 (v/tty) or visit www.cessi.net/ttw. Existing ENs should contact MAXIMUS at 1-866-949-ENVR (3687) or 1-866-833-2967 (tty) with any questions.

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President Obama Includes FMAP Extension in Budget

President Barack Obama's FY 2011 Budget endorses and includes a $28 billion six month extension of Enhanced Medicaid (FMAP). Without this provision, states would have been expected to make dramatic budget cuts this session to make up for the sudden loss of federal revenue that had previously sustained earlier recession budgets.

The FMAP extension had earlier been passed twice (most recently in December 2009) by the U.S. House of Representatives, but was stalled in the Senate with the aftermath of the demise of the current Health Care Reform bill.
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President Submits FY 2011 Budget Proposal with FMAP Extension, No Medicaid Cuts, and Freeze on Domestic Programs

President Obama submitted a $3.8 trillion budget request to Congress on Monday, while taking in $2.6 trillion in revenues in FY 2011.The budget submission kicks off the annual appropriations' processes in the House and Senate. The budget request includes for the first time federal spending on the wars in Iraq and Afghanistan as well as federal spending to cover the adjusted minimum tax. The administration's proposal includes $25.5 billion for a six month extension to the Recovery Act's federal FMAP funding to help cash-strapped states with their Medicaid budgets. No cuts to Medicaid are included in his budget.

The president will request $561 million in the 2011 budget, an 80 percent increase in discretionary funds to support identification of prevention, and enforcement of Medicaid and Medicare programs. The budget includes cuts in some discretionary spending as well as elimination or consolidation of some federal programs (e.g. VR programs, HUD programs) beginning in FY 2011. The proposal includes about $100 billion worth of policies intended to help create more jobs this year. ANCOR will provide a detailed analysis on its website and in WICs Live early next week.
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President Obama Taps Vice President to Lead Middle Class Task Force

President Obama announced Mondaythe formation of a White House Task Force on Middle Class Working Families that would target raising the living standards of middle-class, working families. In addition to regular meetings, the task force will conduct outreach sessions with labor, business, and advocacy communities. The President set out five goals for the task force. The announcement includes the creation of a new website at www.AStrongMiddleClass.gov that also solicits public comment. ANCOR will explore ways that its policy issues can be brought forward to the task force.

Vice President Bidgen will lead this initiative that will be comprised of top-level administration policy makers including the Secretaries of Labor, Health and Human Services, Education, and Commerce, and the Directors of the National Economic Council, the Office of Managemen and Budget, the Domestic Policy Council, and the Chair of the Council of Economic Advisors. President Obama has set the following goals for the task force: expanding education and lifelong training opportunities; improving work and family balance; restoring labor standards, including workplace safety; helping to protect middle-class and working-family incomes; and protecting retirement security. The first official meeting will be on February 27, 2009 in Philadelphia, Pennsylvania. The topic of the first meeting will be: "Green Jobs: A Pathway to a Strong Middle Class."
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