State Discriminated Against Mentally Ill, Judge Rules

New York Federal District Judge Ruled in ADA Case Against New York City. The judge ruled that the state was violating the Americans With Disabilities Act by housing more than 4,300 mentally ill people in New York City in more than two dozen adult homes. He said the residents had little hope of mingling with anyone in the wider community. The ruling, which applies to individuals with mental illness who are not considered dangerous to themselves or others, suggested that the state would have to begin finding individual apartments or small homes for virtually all adult-home residents who wanted one. Look for the article in the September 9th edition of the New York Times.
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Senator Harkin Takes Over as Chair of HELP Committee

It was announced this week that Senator Tom Harkin (D-IA) will be the new Chair of the Senate Health, Education, Labor, and Pensions Committee following the death of former HELP Chairman Ted Kennedy. This ended the speculation as to whether the committee’s most senior Democrat, Senator Chris Dodd (-CT)—who lead the committee through health care reform when Senator Kennedy became ill—would choose to become the new chairman. Dodd chose to remain Chair of the Senate Banking Committee and Senator Harkin gave up his chairmanship of the Senate Agriculture, Nutrition, and Forestry Committee.
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New HCBS Promising Practice

CMS has posted a new HCBS Promsing Practice to the CMS website entitled, "Lessons Learned from Using a Health Information Technology Program that Combines Claims-Level Data with Service-Level Data". It can be found at http://www.cms.hhs.gov/promisingpractices/downloads/medicaiddata.pdf. A list of all the HCBS Promising Practices can be found at http://www.cms.hhs.gov/PromisingPractices/HCBSPPR/list.asp#TopOfPage. This new report describes how Medicaid claims data can be combined with service-level data to improve the quality and cost-effectiveness of services provided in community mental health centers (CMHCs). It describes how CMHCs in three States have used a particular system, Service Process Quality Management (SPQM), to improve quality and achieve cost savings. Read more!

HHS Conference Call on H1N1

HHS will be hosting an information sharing conference call on H1N1 on September 14, 2009.

Call: 1-800-837-1935; Conference ID: 2H1N1
Date: September 14, 2009
Time: 1:30 -3:00 pm, Eastern DS Time

Opening Remarks --- Chair- Dr. Nicole Lurie, Assistant Secretary for Preparedness and Response
Co-Chairs – CAPT Clare Helminiak, Dr. Sally Phillips, and RADM Ann Knebel
Moderator – Susie Butler, CMS Office of External Affairs

Agenda
The purpose of this information session is to update and inform the provider community about issues around H1N1 preparedness and response, vaccine availability, infection control, and other questions that have come in. We will cover the following topic areas:

1. General Update

2. Vaccines and Antivirals

3. Special Populations

4. Healthcare System Surge Capacity

5. Infection Control and Personal Protective Equipment

Submit questions in advance: We invite you to submit questions now at: H1N1.listening@hhs.gov

Please note – we know that we cannot respond to each individual email question. Submitting questions prior to the call will allow us to address as many questions as possible.

Helpful websites, should you have questions:

· www.flu.gov

· www.cdc.gov/H1N1flu

· http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm100228.htm -- information on antivirals

· http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6539.pdf -- CMS billing information

· http://www.cms.hhs.gov/Emergency/Downloads/Medicare_FFS_Emergency_Qs_As_082609.pdf --Information for Medicare Fee-for-Service Providers

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All callers, please dial: 1-800-837-1935 and use Conference ID 2H1N1.


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Virginia Announces Plan to Address FY2010 Budget Shortfall

Governor Tim Kain today announced his plan to address the FY 2010 budget shortfall of over $1.35 billion.

While there are no projected rate cuts for Medicaid services in the plan offered by the Governor today, the plan does:

• eliminate 100 of the 200 MR/ID Waiver slots which were approved by the General Assembly for January 1, 2010
• reduce funding for community services boards by 5%
• eliminate 20 DBHDS Central Office positions and require a one day furlough for all executive branch staff (for most the Friday before Memorial Day)
• eliminate direct management of the Community Resources Pharmacy

It also projects a General Fund savings of $97M because the federal Medicaid share has increased from a projected 60.19% to 61.58% for the last quarter of FY 09 and for FY10 as a result of the Federal stimulus package.

Click here to read the entire report.

Special thanks to Jennifer Fidura for providing us with this information.

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Ohio Joins Other States in Removing Condition of “Mental Retardation” from State Agency’s Name

Thanks to Than Johnson of Champaign Residential Services, Inc. for reporting to ANCOR that the “Ohio Department of Mental Retardation and Development Disabilities” will be changing its name, following passage of bills unanimously by both state legislative chambers, to drop the term “mental retardation.” Governor Ted Strickland signed the legislation on June 7th—which becomes effective in 90 days of enactment—renames the agencgy the Department of Developmental Disabilities. More than 40 other states have made similar changes by removing the term “mental retardation.” Individual Ohio county “MR/DD boards” have already begun changing their names. Read more!

WICS Live: Around the States

Wisconsin: HHS Extends SeniorCare Program: Governor Jim Doyle (D) and the state's congressional delegation announced August 18th that the state's prescription drug plan, SeniorCare, will be extended to 2012. SeniorCare, which was first initiated in 2002, offers a comprehensive prescription drug benefit to Wisconsin residents aged 65 and older with income at or below 200 % of the Federal poverty level (FPL) and are not otherwise receiving full Medicaid benefits. SeniorCare serves nearly 90,000 Wisconsin seniors.


In other news, the state plans to require competitive bids from managed care organizations (MCOs) to oversee the BadgerCare Plus program in populous southeastern Wisconsin for the first time. It is s part of a plan to save $600 million from the program, provides health insurance primarily for low-income families with children under 19. The state also plans to use the contracts to impose stricter performance requirements for MCOs that contract with the state for the program. Read more!

WICS Live: Around the States

Utah: State’s Health Exchange “Open for Business”: Under the new program, participating small businesses will pay employees a stipend, which they can use to purchase health insurance. The new state-run web site then allows workers to compare the available 72 insurance plans on the site and select the health insurance plans that best fits their needs. Proponents believe it is a small step to help the state’s uninsured purchase health coverage, while critics say that the program will make things worse by encouraging companies to drop employer-based coverage and that the available policies are designed for younger—and healthier—workers. Read more!

WICS Live: Around the States

Oregon: Despite Budget, Health Care Reform Moves Forward: State lawmakers passed several initiatives during the legislative session to continue remaking the state’s health care system. One bill, HB 2009, established a Health Care Workforce Strategic Fund to “coordinate efforts to recruit and educate health care professionals and retain a quality workforce to meet the demand that will be created by the expansion in health care coverage, system transformations and an increasingly diverse population.” The bill also creates the Oregon Health Authority, the Oregon Health Authority Fund, and the Oregon Health Policy Board, the latter of which is charged with “ensur[ing] that Oregon’s health care workforce is sufficient in numbers and training to meet the demand that will be created by the expansion in health coverage, health care system transformations, an increasingly diverse population and an aging workforce.” Another bill, HB 2116, funds the Health Care for All Oregon Children program to provide health insurance coverage for uninsured children and also channels funding to community health centers to ensure services for low-income adults. Read more!

WICS Live: Around the States

New York: New Law Allows Unmarried Children to Remain on Parents’ Health Insurance: The new law, signed by Governor David Patterson (D) on August 5th is available to families with children up to age 29. More than 30% of the state’s uninsured population is between the ages of 19-29. Until now, many of those people became ineligible for coverage under their parents' policy after 19 or when they graduated from college. An increasing number are also unemployed or have low-paying jobs that do not offer health coverage. The new law took effect September 1st. The law also extends eligibility for COBRA-- which allows former employees to buy insurance from their company's group health plan at its full cost -- from 18 months to 36 months. Read more!

WICS Live: Around the States

New Jersey: State to Require Insurers to Provide Screening, Therapy for Children with Autism: Governor Jon S. Corzine (D) signed legislation August 13th, requiring individual and group health plans and health maintenance organizations in New Jersey to cover expenses associated with screening for autism and other developmental disabilities and provide medically necessary physical, occupational, and speech therapy. The legislation, which is effective 180 days after enactment, also requires insurers to cover up to $36,000 a year in expenses for medically necessary behavioral intervention for individuals younger than 21 who are diagnosed with autism. The mandatory benefit amount will be adjusted yearly for inflation beginning in 2012. Insurers are barred from denying coverage on the basis that the treatment is not restorative. Read more!

WICS Live: Around the States

Nebraska: State Expands SCHIP Program: Effective September 1st, children in families with incomes up to 200% of the Federal Poverty Level (FPL) are eligible for Kids Connection, the state’s CHIP. The law raises the state’s income ceiling from 185% FPL to about $44,100 annually for a family of four. Nebraska joins 15 other states who have raised their income eligibility to 200% FPL. The Kids Connection expansion was part of the Legislature's response to the Safe Haven crisis last summer, in which parents dropped off 36 children at hospitals. Read more!

WICS Live: Around the States

Massachusetts: Governor Announces State to Provide Health Coverage for Legal Immigrants: Governor Duval Patrick (D) announced August 31st that the state will continue to provide health care coverage for the state’s estimated 31,000 legal immigrants through a new state-funded program that will provide slightly scaled-back coverage. . Earlier in the year, state lawmakers voted to end coverage as part of an effort to address the state’s budget shortfall. Legal immigrants have had access to health insurance since 2006 under Commonwealth Care, the state’s mandatory health insurance law. The program's implementation will be staggered over a three-month period. Patrick's office said it is expected that a significant number of members will be enrolled in October and all members of the new plan will be enrolled by December 1st. Read more!

WICS Live: Around the States

Maine: Governor John Baldacci (D) held a ceremonial bill signing August 24th, marking the enactment of two health-related bills.A Health Care Bills of Rights is intended to provide more transparency in the state’s healthcare marketplace and provide more public information about quality and costs of health care. The second bill requires insurers to provide a clear explanation of benefits for services when claims are filed. Both laws take effect September 12th. Read more!

WICS Live: Around the States

Delaware: New Law Increases State CHIP’s Reach: Governor Jack Markell (D) August 27th signed legislation to extend the state's Children's Health Insurance Program (CHIP) to children in families with incomes over 200% of the federal poverty level (FPL). Delaware has about 20,000 uninsured children, but only about half of them are eligible for CHIP and Medicaid coverage. The new law will permit approximately 9,000 families to buy into the state’s SCHIP at the state’s cost. To be eligible, a child over age 2 in a family with income above 200% of poverty must have been uninsured for at least three consecutive months, unless his or her parent is eligible for unemployment benefits or lost health benefits coverage involuntarily. Read more!

California: Governor’s Line-Item Vetoes in Budget Unconstitutional State Legislative Counsel Bureau Concludes: In the state’s revised budget, Governor Arnold Schwarzenegger (R) made line-item vetoes totaling $489 million, including cutting an additional $50 million from the state’s CHIP program, that Schwarzenegger said were necessary to maintain sufficient reserve funds. In responding the Democratic lawmakers who requested the review by the Legislative Counsel Bureau (LCB), the LCB determined that Schwarzenegger overstepped his constitutional authority, largely because the governor already exercised his line-item veto authority on previous appropriations in the state’s initial FY 09-10 budget enacted in February. The LCB also opined that the governor's line-item veto authority only can be used to decrease an appropriation and cannot be used to increase a budget reduction proposed by the Legislature. Schwarzenegger's Legal Affairs Secretary Andrea Lynn Hoch disagreed, stating that a budget, whether orginal or amended, can only contain legislative appropriations and a governor’s authority to veto appropriations is unquestioned, setting the stage for potential litigation over the line-item vetoes. Read more!

WICS Live: Around the States

Connecticut, Arizona Strike Budget Deals; Pennsylvania Remains Without Budget: Nearly two months into the current fiscal year, Pennsylvania is the only state without a FY 2009 budget Type In Connecticut, Governor Jodi Rell (R) announced September 2nd that she will allow a biennial budget written by Democratic lawmakers to take law without her signature on September 8th, ending the longest budget battle in state history. The two-year, $37 billion budget includes an increase in the state income tax for certain individuals, reduces the estate tax and increases the cigarette tax by $1 to $3 per pack. Rell did exercise her line-item veto authority, cutting about $8.3 million in spending. Arizona’s budget battle ended Friday, September 4th. Governor Jan Brewer's (R) mix of vetoes and bill signings. However, work remains to close a $4 billion spending gap. Read more!

WICS Live: Around the States

Medicaid: States Can Get 90% FFP for Medicaid Administrative Activities Related to Adoption of EHRs: A new State Medicaid Directors letter offers preliminary guidance on State expenses related to activities in support of the administration of incentive payments to providers for the adoption of electronic health records. While 100% match for provider incentive payments to adopt ERHs will not be immediately available, the letter reminds states that they can begin to receive the 90 percent federal financial participation (FFP) match for some initial planning activities related to the administration of the incentive payments. The letter is available at http://www.cms.hhs.gov/smdl/downloads/SMD090109.pdf. Read more!

WICS Live: Around the States

Washington: Restraining Order Lifted, State May Implement Law Prohibiting Payment for In-home Support Services Provided by Agency Employees Related to the Client: The U.S. District Court for the Western District of Washington ruled August 12 that a group of Medicaid beneficiaries and individuals who provide supports and services in the home through agencies were not likely to prevail on their claim that the new law, SBH 2361, violated their rights under the Americans with Disabilities Act or the Medicaid Act. SBH 2361 prevents the state Department of Social and Health Services from paying a home care agency for services provided by a family member of the client. The law applies only to home care agency-associated providers (APs) and does not prevent Medicaid beneficiaries from obtaining services from their relatives as “individual providers” (IPs), the court said. In making its decision, the court noted that the question before it was whether the state statute violated the constitutional rights of the beneficiaries or the personal care services providers, not whether the Washington Legislature had made an appropriate legislative policy decision. Read more!

WICS Live: Around the States

Utah: State Failing to Make Medicaid Fraud Recoveries: Results released in mid-August of a legislative audit shows that the state is losing $20 million in funding it could recover in Medicaid funding The Department of Health’s Bureau of Program Integrity, which is charged with checking for waste, fraud, and abuse in the state’s Medicaid program, failed to follow policies regarding prior authorization for services, and, due to an outdated cost-recovery tool, failed to review 78% of inpatient medical records, according to the audit. Read more!

WICS Live: Around the States

Louisiana: Impact of Medicaid Cuts Still Unknown: As of August 4th, payment rates for Medicaid providers in the state were reduced, in some cases more than 6%. The move is intended to close a $100 million budget gap in the current fiscal year. While providers and advocates are concerned of the long-term effects of the cuts, it is still too early to tell what the effects will be. Read more!

WICS Live: Around the States

Florida: Study Shows Medicaid Pilot Saves Money: A new study shows that the state’s Medicaid pilot program, which enrolled Medicaid beneficiaries in Duval and Broward Counties into manages care plans, is accomplishing one of its goals: saving money. The new report from the University of Florida found that the program, cut the size of beneficiaries’ medical bills over the programs first two years, compared with traditional Medicaid. The report also found that monthly spending on beneficiaries with disabilities dropped an average of $26 dollars while it rose $150 for beneficiaries in other counties. The new report—and the pilot program—are not without critics. Some critics belief that the report shows only short-terms savings, and long-term savings won’t be realized. The pilot was originally intended to be expanded statewide. The state faces a $300 million penalty from the federal government if it doesn't expand the program by 2011. Read more!

WICS Live: Around the States

Colorado: Governor Announces Medicaid Rate Cuts: Governor Bill Ritter (D) announced the cuts Tuesday, August 18th, reducing rates by 2.5% for providers of behavioral health and developmental disability services and by 1.5 % for medical providers to help close a $318 million budget shortfall. Such cuts should save the state $34.2 million in the fiscal year that ends June 30, 2010. The latest reductions follow a 2% rate cut for Medicaid providers on July 1st that was used to bridge a $1.4 billion budget gap that had existed previously. The Legislature also passed a bill creating a new fee on hospital beds beginning this fiscal year that is expected to allow more uninsured Coloradans to receive health coverage and to increase the provider reimbursement rates slightly. Read more!

WICS Live: Around the States

California: Court Again Upholds Injunction Against Medi-Cal Reimbursement Rate Cuts: In the ongoing legal battle over Medi-Cal rate reductions, the U.S. Court of Appeals for the Ninth Circuit August 7th issued another decision blocking Medi-Cal reimbursement rate cuts, this time for medical transportation and home health care services. The Appeals Court rules that a federal trial court properly issued an injunction preventing the state from reducing rates, solely because of the state's need to reduce expenditures, without complying with Medicaid Act requirements that the state to consider the effect of those cuts on efficient access to economical and high quality care. The appeals court also found that the petitioners, including Independent Living Center of Southern California Inc., demonstrated that they were likely to suffer irreparable harm if the injunction were denied. There was evidence before the trial court that state Medicaid transportation providers and home health care agencies already were reducing the scope or range of services because of the cuts, the Ninth Circuit said. Read more!

WICS Live: Around the States

Arizona: Medicaid Enrollment Increasing Rapidly, Adding to Budget Woes: Officials with the Arizona Health Care Cost Containment System, the state’s Medicaid agency said in normal year, new enrollments increase about 60,000. But with the downturn in the state’s service and construction industries, the state anticipates adding up to 300,000 new enrollees this year. The state is already having difficulty keeping up with the program’s current costs and is contributing to the state’s current budget standoff between Governor Jan Brewer (R) and the Republican-controlled legislature. They are at odds over the Governor’s 1% sales tax increase to close a $3 billion budget gap. Read more!

WICS Live: Around the States

Alaska: Lawsuit Filed Over Waiver Service Moratorium: As a result of HHS’ July moratorium on all new Medicaid waiver services, a class action lawsuit was filed in mid-August by four named individuals and others who all have medical and other disabilities and wish to receive services in their homes. The suit alleges that HHS Secretary Kathleen Sebelius of overstepping her authority in imposing the ban and also says the state’s Department of Health and Social Services’ Commission should have never agreed to the moratorium. The state was supposed to submit a detailed report to CMS by September 1st. Read more!

Bipartisan Senate “Gang of Six” Health Care Negotiators to Talk by Phone on September 4th

The group of six Finance negotiators include Finance Chairman Baucus(D-MT) and Ranking Member Grassley (R-IA), Democratic Senators Jeff Bingaman (N.M.) and Kent Conrad (N.D.), and Republican Mike Enzi (WY) and Olympia Snowe (ME). The group met once during the August recess, with no breakthroughs in the talks. The call is rumored to be the means of “jump starting” talks on Finance health care legislation following the August recess. The Senate Finance Committee expects to unveil its health care proposal by September 15th.
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Congratulations to Tim Kral and ORA on Oregon Nonprofit Award

The Oregon Rehabilitation Association was named a 100 Best Nonprofit by the Oregon Business Magazine. The award ceremony will be held in September. Visit ORA’s website for more information on this prestigious award. Read more!

UPDATE: HUD Releases Section 811 NOFA

The Department of Housing and Urban Development (HUD) released the 2009 Notice of Funds Available (NOFA) for Section 811 funds. The deadline for application submission is now December 16, 2009. Read more!

Deadline Extended to September 11, 2009 - Encourage Your DSPs to Participate TODAY!

ANCOR, through the National Advocacy Campaign, is gathering information on the proficiency and use of certain technologies by the direct support workforce both personally and in their work. This information is being collected by ANCOR to study and consider ways in which certain technologies may:

1. Mitigate the anticipated impact of the growing direct support workforce crisis on our industry and ability to deliver quality supports;

2. Improve the efficiency of supports provided by DSPs;

3. Provide cost saving opportunities for providers.

This survey is intended for response by DSPs only. This survey is anonymous and poses questions related to proficiency, usage and opinions of Direct Support Professionals (DSPs) related to technology, in general.

ANCOR will use the results of this survey to recommend practices and policies for better use of technology, resulting in more efficient delivery of supports provided by the direct support workforce to people with disabilities.

We encourage agencies to share this survey with their DSPs and solicit their participation.

We also encourage DSPs that are interested in participating in this survey to notify their agency and/or immediate supervisor of their interest prior to completing the form.

The survey is active now through September 11, 2009.

Click here to access the survey.

We appreciate your involvement as we work to develop sound policies and practices that strengthen the ability of providers and DSPs to efficiently deliver quality supports to their clients.

Thank you in advance for your participation. Please contact Jeff Britt at jbritt@mwcllc.com should you have any questions.
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ANCOR Meets with White House Officials on Home and Community Based Services

On August 27, as a follow-up to the meeting that President Obama had with disability community representatives on July 24, ANCOR, as part of a group of advocates for home and community-based long-term services and supports met with Nancy-Ann DeParle and other senior staff at the White House to discuss the Community First Choice Option.

The meeting participants had a frank and productive discussion concerning the possible opportunities and barriers of including a Community First Choice Medicaid State option (CFC Option) in the final health reform legislation. The CFC Option is a broadly supported proposal that emerged from discussions with Senator Harkin's office and Representative Davis's office as a way to make progress on home and community-based services and supports under Medicaid and a way to lay the foundation for later enactment of the Community Choice Act.

The disability representatives thanked the President's staff for his strong leadership on enacting comprehensive health reform that will help advance the goals of the Americans with Disabilities Act by eliminating disability-based discrimination in health care coverage and barring pre-existing condition exclusions. They also thanked the White House Staff for their time and support for expanding choices in long-term services and supports, and all agreed to keep open the lines of communication as health care reform heats up again when Congress returns from the August recess.

Attending the meeting from the White House were Nancy-Ann DeParle, Director of the White House Office of Health Care Reform; Jeff Crowley, Director of the White House Office on National AIDS Policy and Senior Advisor on Disability Policy within the Domestic Policy Council; Kareem Dale, Special Assistant to the President for Disability Policy; and Keith Fontenot from the Office of Management and Budget.

Those invited to meet with White House staff were Mike Oxford and Cassie James from ADAPT, Kelly Buckland and Lou Ann Kibbee from the National Council on Independent Living, Marty Ford of The Arc/UCP Disability Policy Collaboration and Consortium for Citizens with Disabilities (CCD), Chester Finn of Self Advocates Becoming Empowered, Daniel Fisher of the National Coalition of Mental Health Consumer Survivor Organizations, Ari Ne'eman of the Autistic Self Advocacy Network, Suellen Galbraith of ANCOR and CCD, Lee Page of Paralyzed Veterans of America, Andy Imparato of the American Association of People with Disabilities, and Bob Williams, President Clinton's Deputy Assistant Secretary for Disability and Long-term Care Policy who attended as a private citizen.
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President’s Council of Advisors on Science and Technology (PCAST) releases report assessing H1N1 preparations

A Presidential advisory group released a report assessing the Obama Administration’s preparations for the expected fall resurgence of H1N1 virus and outlining key steps officials can take to minimize the virus’s impact on the nation.

The report concludes that the 2009 H1N1 virus will most likely not resemble the pandemic of 1918-1919 however, it “poses a serious health threat” to the nation when compared to the benign swine flu from 1976. The H1N1 virus is not deadlier than previous viruses, rather it affects more people because it is a new virus that few people have immunity to.

The group lists several prime recommendations including: accelerating the preparation of flu vaccines for distribution to high-risk individuals; clarifying guidelines for the use of antiviral medicines; upgrading the current system for tracking the pandemic’s progress and making resource allocation decisions; accelerating the development of communication strategies—including Web-based social networking tools—to broadcast public health messages that can help mitigate the pandemic’s impact; and identifying a White House point person with primary authority to coordinate key decisions across the government as the pandemic evolves.
For more about PCAST, visit: http://www.ostp.gov/cs/pcast.

The Obama administration is already taking action based on the recommendations of PCAST. The CDC is expected to release revised flu treatment guidelines by the end of the month.

At the same time, problems with vaccine production are arising. The government expected to have 120 million vaccines available October 15th, however it now estimates it will only have 45 million vaccines ready and 20 million more would be ready each week through the end of December. Read more!

State Updates on H1N1 Virus

New York and Arizona both have had changes to the handling of the H1N1 virus.

The New York State Health Department is requiring health care workers across the state to be vaccinated for the seasonal flu and the H1N1 virus. The regulation affects workers and volunteers who come into contacts with patients at hospitals, in home health care agencies, and in hospice care, but through a technicality in state law, not in nursing homes.

Banner Hospitals across the state of Arizona have discontinued using the one-hour H1N1 virus test. The decision to halt use of the test, which was primarily used in emergency rooms, came because of the high number of false negatives the test produced. According to Banner microbiologist, roughly 50% of patients with negative results actually had the virus. Banner hospitals will now rely on the standard H1N1 test that takes 24 to 72 hours to complete.
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CDC Releases Business Plan for Upcoming Flu Season

The Department of Commerce Secretary Gary Locke, Department of Health and Human Services Secretary Kathleen Sebelius, and Department of Homeland Security Secretary Janet Napolitano announced new guidance for businesses to plan for and respond to the upcoming flu season. The CDC designed the guidance to help employers prepare for the impact the seasonal and 2009 H1N1 virus could have this fall and winter on their employees and operations.

The guidance may be found at http://www.flu.gov/plan/workplaceplanning/guidance.html. CDC has also produced a communication toolkit for businesses and employers, which is attached and may also be found at http://www.flu.gov/plan/workplaceplanning/toolkit.html.
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Effective Emergency Management: Making Improvements for Communities and People with Disabilities

EAD & Associates along with The National Council on Disability (NCD) released a report titled Effective Emergency Management: Making Improvements for Communities and People with Disabilities. The report recommends changes in emergency management and goes over practices that would better address the needs of people with disabilities. The report dives into examples of existing successful practices and evaluates emergency preparedness, disaster relief, and homeland security program efforts taken by both public and private sectors. Read more!

No COLA for Social Security and SSI Beneficiaries Possible for 2010

The recent Social Security Trustees report indicates the possibility of no cost of living adjustment (COLA) for Social Security and SSI beneficiaries for 2010. Annual Social Security benefits increases are, by law, based on the rate of inflation in the third quarter of the previous year; the law prevents benefits from being reduced based on negative inflation. Since it is predicted that this years' third quarter (July through September) will show no increase in inflation, the expectation is that there will be no COLA for benefits in 2010. Advocates for Congressional intervention point out that an automatic increase in Medicare prescription drug program premiums will result in reduced funds available to meet beneficiaries' monthly expenses. The Social Security Administration typically reports on the up-coming COLA amounts in mid-October. Read more!

Please Send a Thank You Letter to Your Senators for National Direct Support Professionals Week!

In a show of bipartisan support, the U.S. Senate unanimously approved Senate Resolution 228 designating the week beginning September 14 as "National Direct Support Professionals Recognition Week." Sponsored by Senator Ben Nelson (D-NE), the resolution recognizes the invaluable supports Direct Support Professionals (DSPs) provide and the difference this workforce makes in the lives of Americans with disabilities.

Please use ANCOR’s Action Center to send a note thanking your Senators for National DSP Week. If one of your Senators was one of the original co-sponsors be sure to give them special recognition. Sponsoring any National DSP Week activity is a great opportunity to thank your Senators by mentioning them during your activities. If you sponsor any National DSP Week activities or media outreach, please let ANCOR know by contacting Mary Pauline Jones. Read more!

HHS Delegates Authority for the HIPAA Security Rule to Office for Civil Rights

HHS Secretary Kathleen Sebelius announced that the Office for Civil Rights (OCR) will take over from the Centers for Medicare & Medicaid Services (CMS) authority for the administration and enforcement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The switch is to eliminate duplication and increase efficiency in how health information privacy is protected. Read more!

Grants.Gov Web Site Offers New Feature for Information on Applying for All ARRA Federal Grants – Webinars Available to Learn New Feature

HHS Secretary Kathleen Sebelius released a new feature on Grants.gov to help users find and apply for The American Recovery and Reinvestment Act (ARRA) grant opportunities. The Recovery Act feature will be on the homepage of Grants.gov and will direct users to Recovery Act opportunities, other Recovery Act resources, upcoming Webinars and links to www.whitehouse.gov/recovery.

HHS will host a webinar series on August 12, 13, 18, and 20. The Webinar sessions will target potential grant applicants and will include Introduction to Grants.gov and the Recovery Act, Finding Recovery Act Opportunities and Registration to Submit Recovery Act Opportunities. Each webinar session will be recorded and made available on Grants.gov after the series is completed. For more information on the webinars go to, http://www.grants.gov/applicants/recovery_webinar.jsp.
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Energy and Commerce Finishes Health Reform Legislation Markup; Senate Finance Pushes Theirs to September

On Friday, July 31, the House Energy and Commerce voted 31-28--along party lines--to approve the America's Affordable Health Choices Act (H.R. 3200). The House Education and Labor and Ways and Means Committees and the Senate HELP Committee have already passed their versions of health reform legislation. The Senate Finance Committee, the only committee of jurisdiction that has not marked up a health reform bill, will not mark up before the Senate recesses on August 7, pushing back the timeline even further for a Senate floor vote. Before the full chamber can vote on a bill, the Senate HELP and Finance Committees must merge their bills. The Senate HELP Committee was the first congressional committee to complete its mark up of healthcare reform legislation, on July 15th.

Read more!

WICS Live: Around the States

Minnesota: New Law Requires Providers, Payers to Use Electronic Billing Takes Effect. The law, which was enacted in 2007, is anticipated to save millions in administrative costs. The Department of Health estimated that e-billing will save both providers and payers about $60 million annually, while streamlining billing processes, and increasing accuracy and, as a result, efficiency. The law also mandates that providers and payers electronically exchanging payment remittances, effective December 15th. Costs savings is also expected from this switch. Read more!

WICS Live: Around the States

Connecticut: State Lawmakers Override Governor’s Veto, Approve Framework for Universal Health Care Program in State. The legislation, approved by lawmakers July 20th following Governor Jodi Rell’s (R) veto July 8th, establishes a 9-member board of directors that must submit recommendations on the implementation of SustiNet Plan by January 1, 2011. SustiNet will be a self-insured health care plan that will be offered to state employees and retirees, current HUSKY enrollees (which is the state’s CHIP), Medicaid beneficiaries, and persons without or unable to afford employer-sponsored health insurance. The legislation also calls for the panel to make recommendations on numerous other aspects of the plan, including development of a model benefits package, public outreach and methods of identifying uninsured citizens, and the creation of task forces to study specific issues including obesity, tobacco use and the health care workforce. The legislation does not specify from where funds for the program will come. While Rell lauded the goal of SustiNet, she vetoed the legislation because, she believed, the state could not afford to proceed with the plan given its financial implications. The program is estimated to cost $1 billion annually. Read more!

WICS Live: Around the States

State Tax Revenues at Record Low, Report Finds. A recent report bythe Rockefeller Institute of Government found that the lackluster economy decimated state tax collections during the first quarter of the year. The drop in state revenues was the steepest in the 46 years that data is available. State coffers fared no better in the second quarter, and suggests that many states will have to resort to move spending cuts or tax increases to balance their budgets. Over all, the report found that state tax collections dropped 11.7 percent in the first quarter of 2009, compared with the same period last year. After adjusting for inflation and new changes, the report found that tax revenues had declined in 47 of the 50 states in the quarter. As bad as the first quarter was, the second quarter is shaping up to be even worse, the report said. Preliminary data for the first two months of the quarter, April and May, collected from 45 states, indicated that tax revenues declined by 20% compared with the same period last year. Read more!

WICS Live: Around the States

Pennsylvania: Still No Budget Deal. With the state’s budget is a month overdue, little progress seems to be made in reaching a budget compromise. While lawmakers continue to try and hammer out a compromise with Governor Ed Rendell, state workers July 31st had their first “Payless Friday”, as state workers are remaining on the job during the budget impasse. Read more!

WICS Live: Around the States

California: Budget Signed but Medi-Cal Takes Big Hit. A revised budge signed July 28th by Governor Arnold Schwarzenegger contained an additional $2 billion in cuts to health case, including $1.4 billion in new Medi-Cal spending reductions. The bulk of reduced state Medi-Cal expenditures—$1 billion—is expected to be restored by increased federal Medicaid funding under waivers and payment of past due amounts. As reported elsewhere in this issue, the budget package also authorizes the Department of Health Care Services to seek federal waivers allowing California to restructure Medi-Cal to better coordinate care among providers and provide incentives for improved treatment outcomes for high-cost enrollees—including seniors, individuals with disabilities, children with significant medical needs, and individuals with behavioral health issues. The remaining reductions come from adjustments implementation of new federal and state drug pricing policies; a line item veto reducing county funding to administer Medi-Cal; expanded efforts to combat fraud, waste, and abuse; freezing program rates as of August 1, 2009, among other items. The budget also seeks $1 billion in savings by 2012-13 by requiring online enrollment and eligibility for the Medi-Cal, CalWORKs—the state’s welfare-to-work program, and Food Stamp programs. The budget package also cuts $178.6 million from the state's Children's Health Insurance Program (CHIP) program, Healthy Families. Read more!

WICS Live: Around the States

New Hampshire: Medicaid Funding Running Out, According to State Officials.Just two weeks into the state’s new fiscal year, rising unemployment and increased Medicaid enrollment is pushing the state’s Medicaid budget into the red. The new budget projected a 1% increase in Medicaid enrollment in the current fiscal year, which began July 1st. As of July 14th, the state’s Medicaid director predicted that the Medicaid program was only 39 new enrollees away from running a deficit. Already, providers have laid off staff and limited Medicaid services. Read more!

WICS Live: Around the States

State Briefs. Colorado: $5.3 Million Recovered By AG’s Medicaid Fraud Control Unit: The amount is the highest the state has recovered since the unit began keeping records in 1983 and possibly since the unit’s formation in 1978. The money comes from civil fraud cases and criminal restitution, with the bulk of the amount stemming from interstate settlements between large companies and the federal government, in conjunction with the states.

North Carolina: State Will Repay $300 Million In Incorrectly Charged Federal Funds: A database error in November 2008 to reflect FMAP changes incorrectly charged public hospital payments to the federal government instead of a state account. The state has made CMS aware of the error and reached a repayment plan for the federal government to recoup the funds. Read more!

WICS Live: Around the States

Governors Question Medicaid Expansion While Some States Do More With CHIP. At last month’s National Governors Association meeting in Biloxi, Mississippi, the nation’s governors voiced their concern with emerging health reform proposals in Congress. Governors on both sides of the aisle fear states will have additional Medicaid obligations under the reform proposals without any additional money to pay for them. While many governors support health care reform, the precarious financial situation in their states make it a terrible time to shift additional costs to the states, the governors told HHS Secretary—and former Kansas governor—Kathleen Sebelius. At the same time, at least 13 states have expanded their state CHIP programs over the last year, investing millions of dollars to cover an additional 250,000 uninsured children. The new CHIP reauthorization law providing over $30 billion in new financing over the next five years, paid largely with an increase in federal tobacco taxes, that allows states to expand coverage to children at higher incomes. States that have expanded eligibility include Alabama, Colorado, Arkansas, Indiana, Iowa, Montana, Nebraska, North Dakota, Oklahoma, Oregon and West Virginia. Read more!

WICS Live: Around the States

Washington: Department of Social and Health Services Barred from Eliminating Services to Certain Adults with Disabilities. The U.S. District Court for the Western District issued the temporary restraining order July 13th, directing the agency to ensure that medically necessary services are available to 900 Medicaid beneficiaries affected by the state’s budget cuts. On July 1st, the Department reduced Medicaid-funded long-term services and supports to people with disabilities residing in family homes and boarding homes, which was mandated by the state’s 2009-2011 operating budget. On June 1st, beneficiaries were notified via letter that services were being terminated, but did not including information about replacement services or how to appeal termination of the services. The plaintiffs charged that the Department failed to provide adequate notice, which denied them their right to due process and amounted to discriminated under the Americans with Disabilities Act, forcing plaintiffs to go without community-based services to maintain their independence in the community and enter institutions. While failing to certify the plaintiffs as a class, the court urged the Department to complete case management activities for those individuals to ensure that medically necessary services are provided.


In other news, the court was scheduled July 31st to hold a hearing on a motion for a preliminary injunction issued July 2 preventing the Department from reducing Medicaid in-home health care services for 3,500 children with disabilities. In the July 2nd order, the court blocked the state agency from carrying out the reductions, scheduled to take effect July 1st, until August 1st. The temporary restraining order applies to reductions in the Medicaid-funded personal care services for children age 20 and younger. The state's 2009-2011 operating budget also directs the department to reduce in-home personal care hours for children.

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WICS Live: Around the States

Tennessee: CMS Approves TennCare Proposal to Allow MCOs to Coordinate Beneficiaries’ Long Term Services and Supports. Currently, TennCare enrollees may have to with different entities for physical, behavioral, and long-term care. Now, the enrollee will be able to work with their managed care organizations (MCOs) to coordinate all needed services. The approval of the waiver brings the state closer to implementing legislation enacted in 2008 aimed at expanding home care and community-based services for individuals with disabilities and the elderly under TennCare, the state’s Medicaid program. Integrating long-term services into the managed care delivery system will take between six months and nine months to implement, according to state officials, since contracts with insurers need to be renegotiated and appropriate rates must be set. Read more!

WICS Live: Around the States

Colorado: Last Fiscal Year Saw Record Medicaid Enrollment. As of June 30th, nearly 500, 000 Coloradans were enrolled in the program, the highest amount in the program’s 40 year history. The number is 14% higher than the same month last year and 11% higher the total enrollment over the previous fiscal year. This figure means approximately 10% of state residents are currently enrolled in Medicaid. There was also record enrollment in the state’s CHIP. The increase in Medicaid enrollment comes at the same time the state must fill budget gaps. Despite Federal stimulus funding, the state has had to cut reimbursement rates to providers and with another $1 billion budget gap looming over the next two years, more program cuts are to be expected. Read more!

WICS Live: Around the States

California: State Officials Seeking Broader Waiver Authority to Boost Federal Funding.The current Section 1115 Demonstration Waiver, which was approved in 2005, prohibits intergovernmental transfers and provider taxes as means of drawing down additional Federal funds and includes a “coverage initiative” that provides funding for county initiatives to offer care to about 100,000 previously uninsured individuals (see related Budget Round Up article). The $18 billion waiver expires in August 2010, and the Schwarzenegger administration is already putting together a concept paper for Centers for Medicare and Medicaid (CMS) officials. The state is apparently looking at changes to financing safety-net hospitals, whose finding is capped under the current waiver but provide significant care to the state’s uninsured population. The state is likely to propose to address the needs of high-cost populations, such as individuals with disabilities and children with special needs, according to state officials. Governor Arnold Schwarzenegger (R) also wants flexibility in the next waiver to address eligibility standards and funding. There is some uncertainty, however, how any new state waiver will mesh with the current federal health reform debate—or if it will need to. Read more!

Housing Briefs

Section 811 reform legislation and FY 2010 T-HUD appropriations continue to move through the House and Senate. HUD released a letter on Section 8 Housing Choice Voucher shortages to Public Housing Authorities and the Technical Assistance Collaborative released a new Opening Doors on using the Neighborhood Stabilization fund from the Recovery Act to help create permanent, supportive housing.

House Passes Section 811 Reform Bill

The House of Representatives passed last week the Frank Melville Supportive Housing Investment Act of 2009 (H.R. 1675) which will significantly reform the Section 811 program. This ANCOR-supported bill would implement a new demonstration program that would triple the number of units to be built through use of other federal or state funds. The legislation was initially introduced by Reps. Christopher Murphy (D-CT) and Rep. Judy Biggert (R-IL). In addition, Senators Robert Menendez (D-NJ) and Mike Johanns (R-NE) introduced an identical companion version of the Frank Melville Supportive Housing Investment Act of 2009 (S. 1481).

FY 2010 HUD Appropriations

The Senate Appropriations Committee Thursday voted 30-0, after no debate, to approve a $122 billion spending bill for transportation and housing programs for fiscal 2010. The Senate and House (passed July 20) versions also differ slightly.

The Senate bill would provide $265 million for the Section 811 program, compared to $350 in the House version. The Section 202 program fares better in the House at $1 billion than the Senate's $785 million. The Senate bill would provide $18.1billion for Section 8 tenant-based vouchers, compared with $18.2 billion in the House bill, and $8.1 billion for the Section 8 project-based rental assistance account, compared with $8.7 billion in the House bill.

The Senate bill includes $4 billion for formula grants through the Community Development Block Grants program, compared with $4.2 billion in the House bill.

HUD Releases Letter on Section 8 Voucher Shortfall

The letter, sent July 30th to Public Housing Authorities (PHA), updates them on steps HUD is taking to minimize the effects of the Section 8 Housing Choice Voucher shortfalls some PHAs are experiencing and how to prevent termination of vouchers.

New Opening Doors from the Technical Assistance Collaborative

This issue of Opening Doors provides an overview of HUD’s new Neighborhood Stabilization Program (NSP), documents the purpose and history of the program, discusses how the funds are distributed, describes the ways that NSP can be used to create permanent supportive housing, and suggests strategies that can be used by the disability community to work with NSP grantees.








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August Recess Begins Next Week--Request Meetings or Site Visits with Your Members of Congress

The House begins their district work period on Monday and Senate begins theirs on August 10th--both chambers resume business on September 7th. District work periods or congressional recesses are a great time to meet in person with your members of Congress. In fact, 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. This allows Members and staff to hear and see how you carry out your important mission of providing supports to people with disabilities, to visit with direct support workers, to hear about the challenges you face, and to even gain some local media attention and goodwill. Eventually your persistence will pay off and you will be given the opportunity to help Members and their staff understand how federal policies impact your work. Please let ANCOR know when you have scheduled your visits by filling out a short webform. Read more!

Resolution Highlights Service of Direct Support Professionals

In a show of bipartisan support, the U.S. Senate unanimously approved Senate Resolution 228 designating the week beginning September 14 as "National Direct Support Professionals Recognition Week." Sponsored by Senator Ben Nelson (D-NE), the resolution recognizes the invaluable supports Direct Support Professionals (DSPs) provide and the difference this workforce makes in the lives of Americans with disabilities.

As part of the National Advocacy Campaign, ANCOR worked with Senator Nelson and key ANCOR members on this resolution to coincide with the annual Governmental Activities Seminar taking place September 13-15 in Washington, D.C.

The resolution received considerable attention in the Senate and gained nine co-sponsors including, Senator Sam Brownback (R-KS), Senator Jim Bunning (R-KY), Senator Thomas Carper (D-DE), Senator Susan Collins (R-ME), Senator Christopher Dodd (D-CT) Senator Edward Kennedy (D-MA), Senator John Kerry (D-MA), Senator Charles Schumer (D-NY), and Senator Olympia Snowe (R-ME). Thank you to all of the state teams so instrumental in gathering these original co-sponsors!

Along with the passage of this Resolution by the U.S. Senate, ANCOR has worked with key members in the states to successfully have gubernatorial DSP Recognition Week proclamations issued in Colorado, Maine, Nebraska, New York and Virginia. We hope to add more states in the coming weeks!

Click here for more information about DSP Recognition Week and ways you can celebrate and advocate for DSPs.
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H1N1 Virus Webcast and Update

Join HHS Secretary Sebelius, DHS Secretary Napolitano and Education Secretary Duncan for an important webcast on emergency preparedness related to the flu epidemic.

Participants will be able to learn about: the latest information on vaccine development; vaccine planning and preparedness efforts; federal funding support for sate efforts and ; progress on planning and preparedness for schools, child care centers, businesses and communities.

Registration is not required. To view the Webcast, visit www.flu.gov at 3:00 pm EDT on Tuesday, August 4. Please note, you will need Flash (http://www.adobe.com) installed on your computer in order to view the live video stream.

Other Questions? Please email HHSIGA@hhs.gov

Flu Panel Creates Priority List for Vaccine
A 15-member panel of experts met Wednesday at the Centers for Disease Control and Prevention in Atlanta to create a list of who should get the pandemic flue vaccine first. When the vaccine is available in September, the first to receive it will be pregnant women, the caretakers of infants, children and young adults ages 6 months to 24, people with chronic illness ages 25 to 64, and health-care workers.

Unlike most flu strains, people over the age of 65 are rarely contracting this strain. Speculation is that it is due from exposure to similar flu strains that circulated years ago. Children under 6 month are not able to receive the vaccine due to their immune system not being developed.

The vaccine will come in two forms: the traditional flu shot and a “live” vaccine squirted into the nose. The question of whether one or two shots is needed has still not been answered and the vaccination program is expected to start before an answer is found.

For More information please visit www.flu.gov.
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California Enacts Revised Budget with Additional $1.4 Billion in Medicaid Cuts

Governor Arnold Schwarzenegger (R) signed a revised budget July 28 containing $1.4 billion in new spending reductions for the state's Medicaid program, Medi-Cal. According to the revised budget from Schwarzenegger’s Department of Finance, most of the cuts to the state Medi-Cal program ($1 billion) is expected to be restored by increased federal Medicaid funding from waivers and payments of past due amounts. The California Medical Association called this money “shaky revenues” that would lead to further cuts if the federal government does not agree.

•a line item veto reducing county funding to administer Medi-Cal ($60.5 million)
•expanded efforts to combat fraud, waste, and abuse within the Medi-Cal program ($46.8 million)
•and limiting adult day care visits to three days per week and freezing program rates as of Aug. 1, 2009 ($28.1 million)
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Scan Foundation Report on Long-Term Care in Health Care Reform

The Scan Foundation released a policy brief entitled “Long-Term Care in Health Care Reform: Policy Options to Improve Both”. The policy brief discusses four options to improve the current health care system.

The first two proposals seek to improve long-term care in Medicaid through improving long-term care for people with low incomes and limited financial resources. Option one, is to “expand Medicaid support for home and community-based services”. This would fix the limited and variable access through Medicaid to personal assistance in home and community settings. Option two would “improve coordination of medical and long-term care for Medicare-Medicaid Dual Eligibles”. This proposal promotes the development and testing of integrated care programs for dual eligibles with the hope of improving the quality and cost-effectiveness of services for people who rely on both Medicare and Medicaid.

The second two proposals are to improve long-term care for the broader population. Option three aims to “improve coordination of medical and long-term care for Medicare enrollees with chronic conditions”. The proposal would promote innovation and distribution of service delivery and payment models designed to improve quality and efficiency by coordinating the full range of medical and long-term services people with chronic condition may need. Option four is to “establish public insurance protection for long-term care for the broad population”. This last proposal would create a public insurance program, financed by participants through premiums or taxes, which would spread the risk across a broad population and offer protection to participants of all ages and incomes.
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$220 Million DOL Grant Program Targets Health Workers

The U.S. Department of Labor launched a $220 million grant program aimed at training new workers for health care and other high-growth industries. The American Recovery and Reinvestment Act of 2009 provides funding and the Employment and Training Administration (ETA) will administer the program. The purpose of the program is to promote economic recover through assisting individuals impacted by the recession receive training and employment opportunities.

A DOL fact sheet was released explaining the details and requirements to qualify for the program. The Federal Register published the notice for the grant on July 22nd.
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International Convention on the Rights of Persons with Disabilities

On July 24, 2009, President Obama announced during a speech celebrating the anniversary of the Americans with Disabilities Act that the United States will sign the International Convention on the Rights of Persons with Disabilities. United States Ambassador to the United Nations Susan Rice will sign the treaty on Thursday, July 30th. Until the Senate ratifies the treaty with a 2/3 majority the United States is not legally bound to the treaty. There is no official word yet as to when President Obama will submit the treaty to the Senate. Read more!

White House Revises Lobbying Restrictions

On July 24, 2009, the White House revised their policy on banning lobbyists from meetings on the stimulus projects and funds. Lobbyists will once again be allowed to meet with and have telephone conversations with staff members and provide their expertise to help members make “merit based” decisions for stimulus projects. The American League of Lobbyists (ALL), Citizens for Responsible Ethics in Washington, and the American Civil Liberties Union (ACLU) partnered together to achieve these revisions. Read more!

Ohio State Budget Update

Governor Strickland signed the Ohio budget on July 24, 2009. After a tough process, the Waiver program rates will be frozen for 2 years unless. Throughout the budget process, the ICF/MR program went from a 1% increase each year, to a $50 million cut, to a slight increase. To avoid the $50 million cut the providers agreed to delay payment of 2 weeks at the end of the next biennium to save millions in this current budget. Within the next 2 years, providers will need to address their cash flow.

Thank you to Ohio state association member, Than Johnson, for providing ANCOR with this information.
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Health Reform Updates

Health Care Reform Likely Delayed in the House; Floor Votes Not Likely Before August Recess

House Democrats spent this week negotiating their health reform overhaul and making little progress. Blue Dog Democrats on the Energy and Commerce Committee continue to raise concerns about certain provisions, particularly the public plan. Frustrations with not having enough votes to pass the Energy and Commerce Committee may cause Democratic leaders to send the bill directly to the floor without that committee's input.

President Obama Thursday said he can accept that his August deadline will pass without an overhaul of the health care system, but he insisted that a bill reach his desk this fall.

Energy and Commerce Committee Includes CLASS Act in Health Reform Bill Mark Up

The Energy and Commerce Committee Monday approved by voice vote the CLASS Act as part of their mark up, which has not been completed. However, if the Democratic leadership decides not to wait for the committee to complete its mark up, the long term supports and services provisions will not be in the bill voted on the floor.

Health Reform Resources
See other WICs Live articles on Health Reform!

Kaiser: Side-by-Side Comparison of Major Health Care Reform Proposals
This interactive side-by-side compares the leading comprehensive reform proposals by the President and members of Congress across a number of key characteristics and plan components.
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Minimum Wage Increases to $7.25 Per Hour

The U.S. Department of Labor’s Wage and Hour Division announced this week that the federal minimum wage increases to $7.25 today. With this change, employees who are covered by the federal Fair Labor Standards Act will be entitled to be paid no less than $7.25 per hour. This increase is the last of three provided by the enactment of the Fair Minimum Wage Act of 2007. A revised Federal minimum wage poster is now available for viewing, downloading, and posting. Every employer of employees subject to the Fair Labor Standard Act’s minimum wage provisions must post, and keep posted, a notice explaining the Act in a conspicuous place in all of their establishments so as to permit employees to readily read it.
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ANCOR State Share Survey

ANCOR is collecting information in preparation for this year’s State Share, with a particular focus on the results of states’ budgets and their effects on ANCOR providers.

State Share information will be collected using a web-based survey instrument and will include the entire ANCOR membership to ensure information from as many states as possible is collected and presented at the Government Activities Seminar in September.

State Share Survey

You only need to fill it out once; however, if your state's information changes you please complete it again with the updated information. ANCOR will track the submissions and report using the most up-to-date information.

If you have any questions when filling out this survey, please contact ANCOR staff Jessica Sadowsky.

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Senators Introduce Section 811 Reform Bill

Senators Robert Menendez (D-NJ) and Mike Johanns (R-NE), members of the Senate Banking, Housing and Urban Affairs Committee – today introduced legislation aimed at ensuring that low-income disabled Americans have access to affordable housing options. The Frank Melville Supportive Housing Investment Act increases the availability of affordable housing for persons with disabilities and helps provide them with rental assistance.

“It is often hard for those who are disabled to find affordable housing that allows them to live independently, and that is particularly true during these tough times,” said Menendez, who is Chairman of the Banking Subcommittee on Housing, Transportation and Community Development. “We are working to help ensure that disabled members of our communities can keep a roof over their heads and can get some relief for their personal finances. We can do this by helping to increase the availability and reduce the cost of their housing, and we look forward to working with our colleagues to get this done.”

“I take very seriously our responsibility to ensure people with disabilities have the opportunity to contribute to our communities and this legislation is an important step,” Johanns said. “In a time when many are facing difficult struggles, it is our duty to see that no one is overlooked. This legislation helps people with disabilities to find affordable places to live, which is often key to their independence.”

The legislation would improve HUD’s Section 811 program by:
• Increasing the number of available housing vouchers for people with disabilities and ensuring that vouchers continue to be used to help people with disabilities.
• Encouraging the integration of mixed-used developments into the program and allowing funds from Low Income Housing Tax Credits and the HOME program to be used.
• Extending the length of rental assistance contract terms from 20 years to 30 years for projects using Low Income Housing Tax Credits.
Thank you to Mona McGee of Mosaic for reaching out to Senator Johanns’ office and other ANCOR members instrumental in getting this bill introduced in the Senate.
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Massachusetts Budget Results in Cuts to Disability Services

Massachusetts Governor Deval Patrick (D) signed the state’s budget June 29th, which makes $36 million in cuts to disability services, including residential, day, vocational, and family supports. In addition, $3.2 million was cut from the Mass Rehabilitation Commission, reducing a training program primarily for developmentally disabled individuals and $3.7 million was cut from early intervention programs.

Thank you to Massachusetts state association member, Bob Richards for informing ANCOR of this development.
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House Ways and Means, Education and Labor, and Senate HELP Committees Pass Health Reform Bill Along Party Lines; Senate Finance Delays Consideration

The three House committees with jurisdiction over health care reform and the Senate HELP committee continued to move their health reform bills this week, while the Senate Finance committee continues to delay their mark up in order to continue bi-partisan negotiations. The House Education and Labor took their final vote this morning and approved 26-22 the America’s Affordable Health Choices Act (H.R. 3200). Ways and Means took their final vote on the bill at 1:16 a.m. today, more than 16 hours after the markup started Thursday morning. The House Energy and Commerce Committee also began its mark up on Thursday, but do not expect final votes until later next week. Ways and Means and Education and Labor has yet to include long term services and supports (see below) in their mark up.

The Senate Health Education Labor and Pensions (HELP) committee passed its health reform bill by a 13-10 party-line vote Wednesday morning, leaving the Senate Finance Committee as the most likely arena for a bipartisan compromise. The bill contains the Community Living Assistance Supports and Services (CLASS) Act, which creates a voluntary opt-out payroll deduction that would provide people experiencing functional impairments with tiered benefits if they have contributed a monthly premium over five years.

Meanwhile, a bi-partisan group of Senate Finance committee members led by Ben Nelson (D-NE) is pushing back against the rush to complete a health reform bill by mid-August. Nelson, joined by Sens. Joe Lieberman (ID-CT), Mary Landrieu (D-LA), Ron Wyden (D-OR), Susan Collins (R-ME) and Olympia Snowe (R-ME), today released to Senate leaders a suggestion that the chamber adopt a more reasonable time frame in order to ensure the measure actually saves money in the long run. Nelson said on Thursday that getting the Finance Committee to report a bill may be achievable before lawmakers return to their home districts for the August recess. Amid pressure from President Obama, the Finance panel had been rushing to put out a bipartisan bill this week, but Chairman Max Baucus (D-MT) said Thursday that he needed a few more days of negotiation.


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CMS Places Moratorium on Alaska Waiver Services

CMS issued Tuesday a moratorium on all new Medicaid waiver services in Alaska, effective immediately, and putting services on hold for over 1000 individuals.
A CMS team spent a week in a “focused site visit” reviewing implications of a an assessment backlog of about 2000 people waiting for service. CMS left the site visit instructing Alaska to immediately address the backlog and other issues of non-compliance and followed with a written report reiterating those instructions and additional corrective action, including the moratorium on new admissions or enrollments into Alaska’s four HCBS waiver programs. Alaska must now send a detailed report to CMS by September 1st. According to the Anchorage Daily News, the moratorium is expected to last four or five months. Thank you to Emily Ennis, Executive Director of Fairbanks Resource Agency for providing additional information on this issue. Read more!

ANCOR’s 2009 Government Activities Seminar

Join your provider colleagues at ANCOR’s 2009 Government Activities Seminar September 13-15 at the Washington Court Hotel in Washington, DC. Register Today!

Also, register for a special 3-hour pre-conference on Surviving a World of Increased Medicaid Accountability and Scrutiny: A Proactive Primer for Providers Amid Severe Budget Challenges featuring Barbara Edwards, principal in Health Management Associates, former interim director of the National Association of State Medicaid Directors, and former Ohio State Medicaid Director. Ms. Edwards will:

• walk participants through the basics of a federal Medicaid audit,
• discuss what factors that determine whether provider audit findings result in financial recoveries, and
• explore how providers can best prepare for audits.
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Understanding and Implementing Active Treatment, Preparing for an ICF/MR Survey and Navigating the ICF/MR Assessment

Need Help Understanding and Implementing Active Treatment, Preparing for an ICF/MR Survey or Navigating the ICF/MR Assessment Process? ANCOR and H&W Independent Solutions have three books that can help you:
o Positive Outcomes: A Provider's Guide to Active Treatment
o The Surveyors Are Coming: Now What? A Guide to Survey Expectations and Preparations
o ICF/MR Assessments: From Admission to Discharge - What is Expected?

Purchase all three books together and save! For a limited time ANCOR is offering the set of three books for $120 (plus shipping). Purchased individually, these books are valued at $175 giving you a savings of $55!

Call Dana Calisi at 703 535-7850 ext. 101 to take advantage of this offer!
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WICS Live: Around the States

California: Federal Court of Appeals Ruling Blocks State from Implementing Medi-Cal Provider Cuts: The U.S. Court of Appeals July 8th upheld a lower court ruling, preventing the state from reducing Medicaid provider reimbursements by 10% that was to take effect in July 2008. The appeals court ruled that the state violated federal Medicaid law by failing to consider how the across-the-board provider rate cuts would affect quality and access to care. The court said a state budget crisis could not be used as a justification for illegal cuts in the Medicaid program. California can appeal the ruling or ask for an en banc ruling. However, the ruling could cost the state $56 million in retroactive payments; it could be more if providers are entitled to interest. This ruling now jeopardizes a second-round of rate cuts that took effect March 1st and are also before the 9th Circuit. As part of its budget compromise, the state is implmenting a rate freeze, beginning August 1st. Read more!

State Budget Updates

Following the passage of the Indiana state budget, Family and Social Service Agency Secretary Anne Murphy has assured Indiana provider association, INARF, that there would not be a 5% reduction in Medicaid rates, although no written language was included in the budget. Other senior officials indicated the ability to continue aggressively taking people off the waiting list.

Colorado ended their 2008/2009 legislative session with no reduction to community services for individuals with developmental disabilities.

Both Indiana and Colorado note that their budgets would not have been preserved with out the temporary increase in FMAP from the Recovery Act. Indiana received $2.4 billion in Recovery Act funding. The total stimulus revenue available for the state budget is $2.4 billion, $1.4 billion for Medicaid and one billion dollars for fiscal stabilization.

ANCOR staff would like to thank State Association Executives Jim Hammond with INARF from Indiana and Chris Collins with Alliance from Colorado for these updates.

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CMS Issues ICF/MR Clarifying Memo on “Client Right to Manage Financial Affairs and Money Management Training”

CMS issued the letter on July 10th. ANCOR offered comments prior to the letter publication and many suggestions were incorporated. The letter puts the assessment and determination for the need for formal money management programs in the hands of the interdisciplinary team (IDT). Providers who are cited will want to have this letter handy – as long as their IDTs review the comprehensive functional assessment (CFA) and discuss the need for a formal program for each client (who is the chronological age to utilize money) and document their reasoning when there is no formal objective. If the surveyors find that the CFA and the individual’s skills (and age) support the need for a formal program, and there is not one, they can cite a deficiency during the survey process.

ANCOR suggestions incorporated into the letter:
· Added the use of the “formal objective” vs. just saying money management program
· Changed several “must be” to “is” to show that the standard regarding use of CFA continues and is not new
· Softened what must be included in the assessment from dictating - “Assessment findings should include at a minimum:” and changed it to “Assessment findings to be considered by the team include skills that can be cross-utilized in training programs such as:”
· Took out the use of the work “transferable” but changed it to “cross-utilized”.
· Added that the CFA must be reviewed at least annually, but did leave in that the annual review “should always include an update to the CFA and take into consideration any changes in the individual’s circumstances since the last IDT.”

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FY 2010 Appropriations Likely to Take Center Stage on House and Senate Floors in July

With three months remaining in FY 2009, Congress has yet to pass all twelve FY 2010 appropriations before the October 1st start of the fiscal year. The House has passed four of its bills, the Senate none. The House is scheduled to vote on four more this week while the Senate hopes to complete action on two. The House Appropriations Labor-HHS-Education Subcommittee approved by voice vote today a FY 2010 spending bill that would provide $160.7 billion in discretionary spending, about $5 billion more than the 2009 enacted level and $52 million below what the president requested. Housing and Urban Development has not yet been considered. Labor-HHS-Education and T-HUD are tentatively scheduled for action on the House floor before the summer recess. Read more!

Administration Releases Grants to States and Calls on Nation to Prepare for Fall Flu and H1N1 Virus

HHS July 7th sent out a press release asking the public to prepare for the fall flu season and ongoing H1N1 flu outbreak. Secretary Sebelius asks the “American people to become actively engaged with their own preparation and prevention. It’s a responsibility we all share.” HHS launched a new website www.flu.gov to help centralize communications about the H1N1 flu as well as a Public Service Announcement campaign to encourage the public to become more involved.

UPDATE July 10, 2009: States Now Eligible to Receive $350 Million for H1N1, Seasonal Flu Preparedness Efforts--Grants Will Support Work to Protect Public Health, Prepare for H1N1 and Seasonal Flu

Secretary Sebelius today announced the availability of $350 million in grants to help states and territories prepare for the H1N1 flu virus and the fall flu season. The grants were funded by the recent supplemental appropriations bill that was passed by Congress and signed into law by the President on June 24, 2009.


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Send State Budget and Medicaid Updates to ANCOR

Don’t forget! ANCOR wants to hear from you on state specific news related to Medicaid, budgets, or other issues of importance to providers. Sharing this information with ANCOR gives you the opportunity to inform ANCOR membership about what is happening in your state—your news will be published in WICs Live! Send updates to ANCOR staff, Mary Pauline Jones at mpjones@ancor.org.
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States Continue to Face Short Falls as FY 2010 Budgets Wrap Up—Watch for ANCOR Survey

At least 48 states addressed or are facing shortfalls in their budgets for the upcoming year totaling $166 billion or 24 percent of state budgets. The Center on Budget and Policy Priorities reports that a majority of states expect shortfalls in 2011 as well. Most states start their fiscal year July 1st and have either adopted budgets for fiscal year 2010 or will do so shortly. Combining those new shortfalls with the fiscal year 2010 gaps already addressed, and those faced by states that have not yet completed their budgets, the total amount for fiscal year 2010 is at least $166 billion.

Watch for a survey late next week from ANCOR that asks members about the effect of their states’ budgets on providers. Read more!

Judge Decertifies Class Seeking Rights of Illinois Institutional Residents to LIve in the Community

On July 7, a federal district court issued an order decertifying an Illinois class in Elias v. Maram, a lawsuit seeking to provide individuals with developmental disabilities in Illinois the opportunity to live in the community.Advocates in Illinois had reached a settlement with the state to place 6,000 people in the community over a multi-year period. The suit, filed four years ago, alleges that Illinois does too little to offer community-based living options to people with disabilities as guaranteed in the Supreme Court’s 1999 Olmstead ruling. Under that decision, the court said that states have an obligation to provide care for people with disabilities in a community setting, where medically possible. However, according to the American Association for People with Disabilities, the Voice of the Retarded (VOR) rallied objections, leading the judge to decertify the class. The VOR stated their family members are best cared for in institutions and feared the settlement would divert funding from those facilities.
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Please Welcome Our New Government Relations Staff Member Mary Pauline Jones

Mary Pauline Jones comes to us from the House Oversight and Government Reform Committee where she worked under former Congressman Tom Davis (R-VA). Previously, she has worked for the U.S. Department of Education Office of Special Education and Rehabilitative Services and has done political consulting in Virginia. Mary Pauline is ANCOR members’ direct contact on state budget and Medicaid, Emergency Preparedness, and ANCOR’s grassroots efforts. Mary Pauline can be contacted at mpjones@ancor.org.

Please join ANCOR in welcoming Mary Pauline!
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Braddock Releases Study on Illinois Developmental Disability Services and Funding

Dr. David Braddock today released Services and Funding for People with Developmental Disabilities in Illinois: A Multi-State Comparative Analysis, an analysis of services and funding for people with developmental disabilities in the state of IllinoisThe study compares the performance of Illinois with five other Midwestern states of Indiana, Michigan, Minnesota, Ohio, and Wisconsin. Data for this report is drawn from the seventh edition of the State of the States in Developmental Disabilities and supplemented with data from the state of Illinois.
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Franken Takes Seat in Senate and on HELP Committee

Al Franken (D-MN) was installed as Minnesota’s junior Senator. With Franken’s swearing-in, the Democratic caucus would now have a filibuster-proof, 60-vote majority, if Senators Kennedy (D-MA) and Byrd (D-WV) were not absent for health reasons. Franken will serve on the HELP committee, relieving Senator Whitehouse (D-RI) of his temporary duty on that committee. Franken will also serve on the Aging, Indian Affairs, and Judiciary committees. Read more!

HUD Releases 4000 Section 8 Housing Choice Vouchers

July 10, 2009 Reminder: Comments on the Section 8 Housing Choice Voucher Notice of Available Funding are due Monday, July 13th. ANCOR will be commenting on the notice. See below for a link to the notice from HUD.

On July 1st, HUD joined President Obama's commemoration of the tenth anniversary of the Supreme Court's Olmstead decision by announcing that it will offer rental assistance to 4,000 non-elderly families with disabilities, including 1,000 vouchers specifically targeted to those transitioning out of nursing homes and other facilities. Through its funding notice, HUD is seeking comment from public housing authorities and others to ensure this critically needed assistance is distributed and administered in the most effective manner possible.

Today's announcement coincides with the tenth anniversary of the Supreme Court's ruling in Olmstead v. L.C. & E.W. which affirmed the rights of individuals with disabilities to live independently. To commemorate this landmark decision, President Obama declared 2009 the Year of Community Living.(see related article)

"As individuals with disabilities leave institutional care, it is essential that they have housing options that will allow them to live independently," said HUD Secretary Shaun Donovan. "As we prepare to launch this initiative, we also want to make certain that we get input from local housing experts, disability rights advocates and others who can help us target this assistance to those who need it most. We also recognize how important it is for HUD and HHS to coordinate our resources to enable community-living for those individuals that live with disabilities."

HUD's Notice of Funding Availability (NOFA) will make $30 million in voucher assistance available to support approximately 4,000 Housing Choice Vouchers for non-elderly disabled families. HUD is making a 1,000 of those vouchers available specifically for individuals transitioning out of nursing homes and other institutions. These vouchers directly support a $1.75 billion initiative of the U.S. Department of Health and Human Services (HHS) to help persons who reside in health care settings move to community-based living. While HHS' Money Follows the Person (MFP) program offers health care, case management and other services to qualified families, it does not include funding for housing. HUD's funding initiative is designed to fill that gap.

The remaining 3,000 Housing Choice Vouchers are available to assist any non-elderly disabled family. The Department is encouraging local housing authorities to give strong consideration to using some or all of these vouchers to provide housing for those non-elderly persons that are living in the community, but are at-risk for institutionalization. Comments on the NOFA are due Monday, July 13th. ANCOR will be submitting comments. Read more!

CMS Releases New FMAP Frequently Asked Questions

Today, the CMS released one of a series of Medicaid Frequently Asked Questions (FAQs) designed to provide guidance on the implementation of the American Recovery and Reinvestment Act of 2009 (ARRA), Public Law 111-5.The FAQs address questions that have been submitted to the ARRA mailbox, CMSOARRAQuestions@cms.hhs.gov. Future Medicaid FAQs letters will be issued in the coming weeks and months. This CMS document, along with other CMS documents on the FMAP increase under the ARRA stimulus legislation is available on ANCOR’s Economic Recovery web page. Read more!

Long Term Services Provisions Gain Bi-Partisan Approval in Senate HELP Committee Health Legislation Mark Up

The Senate HELP Committee today finished marking up long-term service provisions, also known as the Community Living Assistance Supports and Services (CLASS) Act, included in the panel's healthcare overhaul. The measure received bi-partisan support from the committee after members agreed by voice vote to add a provision that would ensure the program’s solvency. ANCOR supports the CLASS Act, which creates a voluntary opt-out payroll deduction that would provide people experiencing functional impairments with tiered benefits if they have contributed a monthly premium over five years. The Congressional Budget Office estimated the program will save the government $58 billion over the first 10 years—taking pressure off Medicaid as the primary financier of long-term care. In addition, the program would be a new, private source of funding for ANCOR members and others that provide long-term supports and services. The Obama administration supports including the long-term care measures in healthcare reform. In a letter sent to Senate Democrats today, HHS Secretary Sebelius called the plan "innovative."

Thank you to ANCOR members that urged their Senators to support the CLASS Act and the inclusion of long-term services and supports in health reform legislation.


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Secretary Sebelius Releases New State by State Reports Highlighting Urgent Need for Health Reform

HHS Secretary Kathleen Sebelius today released a series of new reports on the health care status quo that highlight the urgent need for health reform across the nation. The new reports are available at www.HealthReform.gov and include information on health care cost and quality in all fifty states. Read more!

Make Appointments to Meet with Your Member of Congress During July 4th Recess

Make appointments to meet with your members of Congress during the July 4th Congressional recess (June 30th -July 3rd)! Watch for Town Hall Meeting notices from ANCOR that list other opportunities to reach out to members of Congress and their staff. Read more!

DOL Annouces Disability Employment Month Theme: Expectation + Opportunity = Full Participation

The U.S. Department of Labor today announced “Expectation + Opportunity = Full Participation” as the official theme for October’s National Disability Employment Awareness Month. It is intended to urge employers, as they seek to fill positions, to embrace the richness of America’s diversity by considering the talents of all workers, including workers with disabilities.

This year’s theme emphasizes the vision of the Labor Department’s Office of Disability Employment Policy (ODEP): a world in which people with disabilities have unlimited employment opportunities. Early selection of an annual theme for upcoming National Disability Employment Awareness Month helps the private sector; federal, state and local governments; and advocacy organizations plan events and programs that showcase the abilities and skills of job seekers and working Americans who have disabilities.

ODEP is the nation’s first assistant secretary-led office that addresses policies that impact upon the employment of people with disabilities. The office provides national leadership on disability employment policy by developing and influencing the use of evidence-based disability employment policies and practices, building collaborative partnerships, and delivering authoritative and credible data on the employment of people with disabilities.

As background for National Disability Employment Awareness Month, Public Law 176, enacted by Congress in 1945, designated the first week in October as “National Employ the Physically Handicapped Week.” President Harry S. Truman designated the (now former) President’s Committee on Employment of People with Disabilities to carry out the law. Congress changed the name to “National Disability Employment Awareness Month” in 1988. The responsibility for leading the nationwide recognition was transferred to the newly created ODEP in 2001. Read more!

Six New Co-Sponsors in June for Workforce Bill

Representatives Betty McCollum (D-MN), Pete Sessions (R-TX), Rosa DeLauro (D-CT, and Steve Isreal (D-NY) have recently signed on to the Direct Support Professional Fairness and Security Act (H.R. 868)! Thank you to ANCOR members in Minnesota, Texas, Connecticut, and New York for reaching out to these members.

See all 23 members of Congress supporting the bill so far! Read more!

Questions About Pan Flu?

ANCOR will continue its dialog with CMS as this situation unfolds. If you have questions about pandemic flu or emergency preparedness, or information on what your state is doing to prepare providers, please contact Jessica Sadowsky (jsadowsky@ancor.org) Read more!

CMS June 17th Letter to Medicaid Directors Summarizing ARRA

This letter is one of a series designed to provide guidance on the implementation of the American Recovery and Reinvestment Act of 2009 (ARRA), Public Law 111-5. It summarizes most sections of ARRA that impact titles XIX (the Medicaid program) and XXI (the Children’s Health Insurance Program, or CHIP) of the Social Security Act (the Act) and provides detail on the sections specific to payments that should not be counted for purposes of eligibility for Federal programs. This letter includes information on the FMAP and disregard of one-time only SSI $250 check for purposes of all federally funded programs. Read more!

State Revenues Plunge

Personal income taxes paid to the states plummeted 26 percent, or $28.8 billion, in the first four months of 2009, compared with the same time period last year, the Nelson A. Rockefeller Institute of Government said in its June 18 report.
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President Proclaims Year of Community Living

Marking the 10th Anniversary of the U.S. Supreme Court’s Olmstead decision, President Obama launched a new effort to assist Americans with disabilities—The Year of Community Living. The President directed Health and Human Services Secretary Kathleen Sebelius and Housing and Urban Development Secretary Shaun Donovan to work together to identify ways to improve access to housing, community supports, and independent living arrangements. In joining the President in commemorating the anniversary of the Olmstead decision, HHS Secretary Sebelius announced that agencies within her department would begin aggressively addressing barriers that prevent some Americans with disabilities from enjoying a meaningful life as part of their community.

Throughout this “Year of Community Living,” HHS will hold listening sessions, giving stakeholders an opportunity to come together for a common purpose: overcoming barriers to community-based living for people with disabilities and the elderly. These forums will help HHS craft the agenda to improve federal programs and better support the efforts of state and local government.

HUD announced that it will make1,000 housing vouchers available for individuals with disabilities transitioning from institutions to the community—targeting states operating Money Follows the Person Demonstration programs. HUD will award an additional 3,000 housing vouchers to serve non-elderly people with disabilities and encourage Public Housing Authorities to form working relationships with state Medicaid agencies interested in addressing community living needs of beneficiaries.
See the next issue of LINKs for more information. Read more!

CMS Issues Advance Notice of HCBS Waiver Rulemaking

The June 22nd Federal Register included a CMS Advanced notice of proposed rulemaking on the Medicaid 1915(c) waiver. The notice invites advanced public comments by August 21, 2009. The “advanced” notice is an announcement of CMS’ intention to publish a proposed rule and solicit public comments on the changes. Last year, ANCOR provided CMS with comments on the areas it is now asking for public comments on in this advanced notice. CMS is seeking to make changes in several areas: providing states with the option of designing 1915(c) waivers to serve more than one targeted population based on functional need rather than diagnosis or condition: recommendations to strengthen person-centered principles in HCBS waiver; requirements related to identifying home and community-based character of HCBS settings; and standards for defining home and community under waivers and CMS approval of a state’s definition. ANCOR will be submitting comments to CMS. Read more!