Updated House health care bill section-by-section summary

The House has posted the attached updated (November 1) section by section summary of the health care bill.
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WICS Live: Around the States

Tennessee: State Freezes CHIP Enrollment. As of November 30th, the state will not accept new applications for the state’s expanded CHIP, which provides coverage to children and pregnant women in families with incomes up to 250% of the Federal poverty level and do not qualify for Medicaid. There will be no service cuts to program beneficiaries already enrolled in the program. Read more!

WICS Live: Around the States

Wisconsin: BadgerCare Plus Core Plan Reaches Maximum Enrollment. Governor Jim Doyle (D) announced October 5th that the program, which provides health insurance coverage for adults without children and not enrolled in any other health insurance program, has reached capacity and suspended enrollment as of October 9th. Those applying for coverage now are being placed on a waiting list. Doyle has directed the state Department of Health Services to design a proposal to provide some basic level of health coverage for those on the waiting list. Doyle said the state received 60,000 applications for the new program since the program began June 15th and most applicants had no income. The program must remain budget-neutral, which means the state can only afford to cover approximately 54,000 individuals. Read more!

WICS Live: Around the States

Texas: Harris County Unveils TexHealth Harris County 3-Share Plan. Officials in Harris County, which includes Houston and Sugar Land, unveiled a new small business insurance option October 20th. Harris County alone has over 1 million uninsured residents; Texas has the nation’s largest uninsured rate. The 3-Share Plan, which hopes to make a small dent in the uninsured rate, will divide monthly premiums among the employer, employee, and a subsidy fund. In the program’s first two years, a $5.5 million subsidy pool will make insurance coverage available to 5,000 uninsured workers. Workers making less than $16 an hour would pay 17% of their monthly premiums. Workers making more would split the premium 50-50 with employers. Read more!

WICS Live: Around the States

Minnesota: Governor Proposes Interstate Insurance Compact. In a letter to other governors October 21st, Governor Tim Pawlenty (R) asked his counterparts to join him in establishing an interstate health insurance compact that would call for standards in the health care market, enabling insurers to compete with one another across state boards. According to Pawlenty's letter, the proposed compact would allow states to share common regulatory standards, thereby facilitating the purchase of health insurance across state lines. It would also allow more insurers to do business in states would both increase competition and choice. The proposal would need Congressional consent and would also likely need legislative approval in Minnesota, since state law now requires health care insurers doing business in the state to be non-profit. Read more!

WICS Live: Around the States

Pennsylvania: Budget Stalemate Is Finally Over. After 101 days without a state budget, Governor Ed Rendell (D) and lawmakers reached a budget agreement, with Rendell signing the state’s $27.8 billion budget Friday, October 9th. The measure cuts overall spending by more than 1 percent and relies on nearly $500 million in new taxes on sales of cigarettes, little cigars and business taxes. The bill does not raise sales or income taxes, the state’s two biggest sources of revenue. Read more!

New York: 500 Show Up At Hearing to Protest More Proposed Budget Cuts. The hearing, which was held by the State Senate in Brookhaven, Long Island, was the second in a series to gauge public reaction to mid-year budget cuts proposed by Governor David Paterson (D) to close a current $3 billion budget gap and a projected $2 billion deficit next year. The majority of the attendees at the 5 ½ hour meeting were people with disabilities and disability advocates, who decried Paterson’s proposal to eliminate $65 million in community services and education programs so that individuals with disabilities can live independently. Read more!

New Mexico: Special Legislative Session Ends with Lawmakers Approving 7.6% Cut for All Agencies Under Governor’s Control. The special session was called to address a $650 million revenue shortfall in the state budget. The state Health Department could lose about $38 million in state funding—and an additional $155 million in Federal funding—if Governor Bill Richardson (D) signs the measure. Richardson must decide whether to sign the measure by November 12th. If enacted, cuts will be required for Medicaid, including mental health and substance abuse services for low-income New Mexicans and medical services for uninsured children and individuals with developmental disabilities. Read more!

WICS Live: Around the States

Missouri: Governor Cuts Additional $204M from State Budget. The cuts, made by Governor Jay Nixon (D) on Wednesday, include cuts to some Medicaid providers. The governor’s budget director said the state will cut $32.5 million from Medicaid, some of which will come from reduced payments to providers, and other cost-saving measures, such as more reliance on generic prescription drugs. Provider payments will only be reduced for services where the state’s reimbursement rate is higher than that of Federal rate. Read more!

WICS Live: Around the States

Colorado: Governor Outlines Second Rounds of Budget Cuts. Governor Bill Ritter (D) October 28th laid out his plan to cut another $286 million from the state budget, including reductions in Medicaid provider rates and more cuts to higher education. The governor cut $3.1 million from Medicaid providers, reducing rates by 1%, bringing this year's total cuts to the program to 4.5%. The cuts come on top of the $1.8 billion budget shortfall the state has already covered over the past year. The governor’s office warned that more cuts may be ahead, before the state’s budget year ends in June. State workers have also been ordered to take 4 additional furlough days in an effort to save money. Ritter this week will present his budget for the next fiscal year, and even deeper cuts are expected. The governor’s budget director said additional cuts are needed because of higher-than-expected Medicaid enrollment growth and previous cuts that Ritter backed away from—including $4.5 million he tried to cut for aid to low-income residents and people with disabilities. Read more!

WICS Live: Around the States

Washington: State Agrees to Restore In-Home Supports to Children with Disabilities Enrolled in Medicaid. According to a settlement agreement, the state has agreed to restore services to 4,000 children with disabilities. The settlement comes after a lawsuit was filed to prevent the state from cutting services as of July 1st; the cuts were directed by the Legislature to manage a budget deficit for the 2009-2011 biennium budget. The state is still in discussions with representatives of adults with disabilities. As of October 19th, plaintiffs and representatives from the Department of Social and Health Services in hopes of submitting a consent decree for Federal court approval. Another case involving Medicaid cuts has been appealed to the U.S. Court of Appeals for the Ninth Circuit after a Federal District Court refused to grant a preliminary injunction for beneficiaries and family members providing in-home supports as employees of other agencies. Read more!

WICS Live: Around the States Blog

North Carolina: Budget Cuts Mean Medicaid Program Will Lose $1.5 Billion. The state continues to squeeze savings out of Medicaid program, cutting provider rates, but state officials are warning that service cuts and job losses in health care could be looming. About 11,000 more people than estimated were enrolled in Medicaid during the months of August and September, increasing the pressure on the state budget. Read more!

WICS Live: Around the States

New York: State Will Reimburse Pharmacies that Provide H1N1, Seasonal Flu Vaccine to Medicaid Fee-for-Service Beneficiaries. It is the first time Medicaid-enrolled pharmacies will provide flu shots since a 2008 law took effect, permitting pharmacist to administer the shots. Medicaid recipients enrolled in managed care plans have access to immunizations through their providers. Read more!

WICS Live: Around the States

Louisiana: State to Audit Medicaid Providers to Root out Fraud and Abuse. The state Department of Health and Hospitals announced October 29th that it will roll out a new effort to combat fraud in the state’s Medicaid program by auditing more than 700 private firms that provide in-home services for the elderly and people with disabilities. The audits come in the wake of years of growth in the state’s home and community-based services; in the last 7 years, costs grew by 174% and now cost the state $673 million annually. Read more!

WICS Live: Around the States

Florida: State Previews First Phase of Electronic Health Records. The state Agency for Health Care Administration (ACHA)October 28th unveiled the MyFlorida Health eBook and eBaby Book, making the state the first in the nation to allow Medicaid recipients to access personal health records over the Internet. Within the next month, 2.6 million Medicaid beneficiaries will be able to access their health records and enter and track their health information by using their Medicaid ID number. Medicaid recipients also will be able to track family histories, print them, and share the information with health care providers, AHCA said. Read more!

WICS Live: Around the States

California: Statewide Study Finds Federal Citizenship Requirement Imposes Significant Burden on Counties.The study, conducted by the California Endowment and California Healthcare Foundation, found that the citizenship requirement made it difficult for most individuals, including children over age 16 and people born outside the state, to access Medicaid because they had difficulty finding birth certificates, driver’s licenses, and other acceptable documentation. Officials reported that no cases of existing Medicaid recipients had previously claimed false citizenship. At the same time, all 58 counties in the state reported increased workloads, backlogs, and costs to implement the citizenship verification requirement. Read more!

WICS Live: Around the States

California: State Prevented From Implementing November 1st Cuts to In-Home Support Services. A Federal judge October 19th issued a preliminary injunction to prevent the state from implementing planned cuts to an estimated 130,000 children and adults with disabilities and the elderly because of the substantial harm that would result. U.S. District Court Judge Claudia Wilken ruled that the plaintiffs in the class action suit were likely to show at trial that the service cuts, resulting for the recent state budget, violate Federal law. Read more!

New ANCOR Website

As you may have noticed, ANCOR unveiled a new website today. In addition to being “easy on the eyes,” we hope information posted in our National Issues section will be easier to find. To get to the National Issues page, click on “National Issues” on the left side of ANCOR’s new homepage. Once you click on “National Issues” you will see a tab listing all of the issues on which ANCOR’s Government Relations updates you on the right hand side of the page. Looking for ANCOR’s Action Center? To get there, simply click on the “Action Center” tab on ANCOR’s home page. If you have any questions or need help locating areas of interest on our new site, please contact Tony Yu. Read more!

CLASS Act Not a “Done Deal” in Senate Health Reform Proposal

ANCOR staff has been meeting with key Senate offices all this week to ensure the inclusion of the CLASS Act in the Senate health reform bill. Although the House bill includes the CLASS Act provisions, key Senators have been reluctant to include the CLASS Act as part of the merged Senate Finance and HELP committee bill.If you have not reached out to your Senators yet to support ANCOR’s efforts to get these provisions in the merged Senate bill, it’s not too late. Use ANCOR’s Action Alert to get word to your Senators that the CLASS Act must be in the final Senate bill.

Remember, the CLASS Act would 1) provide a new private source of funding for ANCOR providers of long term supports and services; 2) reduce federal deficit by 74 billion over 10 years; and 3) produce a savings to Medicaid of nearly 2 billion in first five years of implementation.

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Senate Committee Holds Hearing on Disabled and Elderly Housing Issues

Yesterday, the Senate Banking Committee’s subcommittee on Housing, Transportation, and Community Development held a hearing on Modernizing Affordable Housing for Seniors and People with Disabilities. Witnesses discussed the Section 811 reform bill and the Section 202 elderly housing reform bill. ANCOR supports the Section 811 reform bill, the Frank Melville Supportive Housing Investment Act of 2009 (S. 1481) and encourages ANCOR members to ask their Senators to co-sponsor this bill. The identical companion bill, H.R. 1675, passed in the House by unanimous consent this summer.

Chairman Dodd (D-CT) stated strong support for the Melville bill and committed to move it through the Committee and to the floor quickly. In addition to Chairman Menendez (D-NJ), Senators Johanns (R-NE) and Kohl (D-WI) attended.

Click here to view the hearing.

Click here to read witness testimony.

Click here for more information on the Frank Melville Supportive Housing Investment Act of 2009.
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Senate Health Reform Bill Sent to CBO for Score

Cost estimates for a Senate health care reform bill will likely not be available for another week and a half, pushing back Senate Democratic leadership’s plan to begin debating the bill on the floor sometime next week. Senate Majority Leader Harry Reid (D-NV) anticipates having to resubmit some portions of the measure before bringing it to the floor. That means a final bill is unlikely to be ready for floor action prior to the week of November 9th.

That timeline could complicate Reid's ability to finish debate before Thanksgiving, because the Veterans Day holiday on Nov. 11 falls on a Wednesday and the Senate is not expected to be in session that day or the remainder of that week. That would leave just one full week of floor debate on the bill before Thanksgiving on Nov. 26.

Senate Democratic Conference Vice Chairman Charles Schumer (D-NY) said he believes the CBO scoring holdup will not prevent Congress from sending a bill to the president before the end of the year.

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House Health Reform Bill Official CBO Score is $1.055 Trillion; Possible Floor Consideration Late Next Week

The House Democrats' health care plan would cover 36 million more Americans at a cost of $1.055 trillion over the next decade, while reducing the federal deficit overall by $104 billion, according to a preliminary Congressional Budget Office score released late Thursday.

The House bill contains the ANCOR supported CLASS Act, which would 1) provide a new private source of funding for ANCOR providers of long term supports and services; 2) reduce federal deficit by 74 billion over 10 years; and 3) produce a savings to Medicaid of nearly 2 billion in first five years of implementation.

The bill could come to the floor for consideration as early as November 5, House Majority Leader Steny H. Hoyer said Thursday night. A manager’s amendment will be available as soon as November 2, Hoyer added.

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NEWS FLASH: House Includes $23.5 Billion to Extend the ARRA FMAP Increase Through 2011 in Health Reform Bill

The Senate does not have this provision at this time. Details to follow early next week. Read more!

New Co-Sponsors for the Direct Support Professionals Fairness and Security Act

Rep. Christopher Smith (R-NJ), Rep. Mike Ross (D-AR), Rep. Gregory Meeks (D-NY), Rep. Edolphus Towns (D-NY), and Rep. Patrick Kennedy (D-RI) signed on this week as co-sponsors to the Direct Support Professionals Fairness and Security Act (H.R. 868). Thank you to all those who also contacted their members urging them to sign on. Read more!

Massachusetts Governor Makes Budget Deal Protecting Bulk of DD Services

Governor Deval Patrick of Massachusetts, has shielded the bulk of DDS services and supports from an earlier anticipated reduction that would have cut services for thousands of people with developmental disabilities. Specific 9C DDS budget impacts were outlined. To implement the Governor's 9C decisions, the Legislature must still grant the Governor expanded 9C authority.

Special thank you to Gary Blumenthal for providing us with this information. Read more!

Oregon Becomes First State in Nation to Report No ICFs/MR.

On Tuesday, October 27th, the last person in Oregon has been moved out of an ICF/MR with the closure of the Eastern Oregon Training Center. Oregon will have no state (public) or privately-operated ICFs/MR and will be operating 100% under HCBS waivers. Thanks to Mona McGee of Mosaic for this update.

On Oregon’s state budget front, Tim Kral from Oregon’s state association reports that the budget did not include a COLA and developmental disability services only received minor cuts to date. However, if revenues fall, a special session may be held in early 2010 to make cuts. Thanks to Tim for the update.
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Hoyer Announces House to Meet Beyond Targeted Adjournment Date

In a press release, House Majority Leader Steny Hoyer (D-MD) announced the House is scheduled to be in session for the entire week of November 2, and is prepared to be in session the first weekend of November if necessary. In addition to the scheduled session in the week of November 16, members are asked to reserve the following days in case they need to be here to pass health insurance reform: Monday, November 9th; Tuesday, November 10th; Monday, November 23rd; and Tuesday, November 24th. Read more!

FDA Authorizes Emergency Use of Intravenous Antiviral Peramivir for 2009 H1N1 Influenza for Certain Patients, Settings

In response to a request from the CDC, the FDA announced it has issued an emergency use authorization (EUA) for the investigational antiviral drug peramivir intravenous (IV) in certain adult and pediatric patients with confirmed or suspected 2009 H1N1 influenza infection who are admitted to a hospital. Specifically, IV peramivir is authorized only for hospitalized adult and pediatric patients for whom therapy with an IV drug is clinically appropriate, based on one or more of the following reasons:
1. the patient is not responding to either oral or inhaled antiviral therapy, or
2. when drug delivery by a route other than an intravenous route -- e.g., enteral (absorbed by the intestines) or inhaled -- is not expected to be dependable or feasible;
3. for adults only, when the clinician judges IV therapy is appropriate due to other circumstances. Read more!

Obama Declares Swine Flu a National Emergency

October 24th, President Obama declared the swine flu a national emergency, allowing hospitals and local governments to speedily set up alternate sites and procedures if needed to handle any surge of patients. White House spokesman Reid Cherlin emphasized that this declaration was not in response to any new information but was rather a preventative measure. The declaration allows hospitals to apply to the Department of Health and Human Services for waivers from laws that in normal times are intended to protect patients’ privacy and to ensure that they are not discriminated against based on their source of payment for care, including Medicare, Medicaid and the states’ Children’s Health Insurance Program.
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Unionization Voted Down by Illinois Home Care Workers

Illinois Home-Based Support Services workers have voted for no representation by both AFSCME and SEIU here. Governor Quinn signed an Executive Order this past June that allowed for collective bargaining by individual providers of home-based support services to persons with developmental disabilities. Thank you to Ken Lovan for providing ANCOR with this information. Read more!

CLASS Act and Community First Choice Option

Urgent! Contact Senators Critical to CLASS Act Inclusion in Merged Health Reform Bill

This week, Senators working on the merging of the Senate Finance and Senate HELP health care reform bills will be focusing on the CLASS Act. It is essential that ANCOR members who are constituents of the following key Senators call or fax their offices and tell them the CLASS Act MUST be included in the merged health care bill: Senators Reid (D-NV), Baucus (D-MT), Snowe (R-ME), Durbin (D-IL), Feingold (D-WI), Schumer (D-NY), Bingaman (D-NM), Nelson (D-NE), Dodd (D-CT), Harkin (D-IA), Mikulski (D-MD), and Whitehouse (D-RI), Warner (D-VA), Webb (D-VA), Landrieu (D-LA), Bayh (D-IN), Lincoln (D-AR), Pryor (D-AR), and Tim Johnson (D-SD). Use ANCOR’s online congressional directory to get contact information.

We must work on these Senators TODAY. Message: The CLASS Act MUST be included in the merged health care bill.

Over 270 national organizations support the CLASS Act. The CLASS Act would: 1) provide a new private source of funding for ANCOR providers of long term supports and services 2)reduce federal deficit by 74 billion over 10 years 3) produce a savings to Medicaid of nearly 2 billion in first five years of implementation. The CLASS Act is fiscally solvent for 75 years.

Call Jessica Sadowsky 703-535-7850 ext. 104 if you have any questions.

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New York suspends mandatory H1N1 shots for health workers

New York public health workers will no longer be required to be vaccinated against both the seasonal and H1N1 flu virus.The dispute between the public health employees and the New York State Health Department was settled by a vaccine shortage that made the requirement impossible to implement. Read more!

Alston & Bird's Health Care Reform Chart - Updated Version

The updated version Alston & Bird's Health Care Reform Chart summarizes all three of the major health care reform bills currently moving through Congress. The updated chart incorporates the Senate Finance Committee's amended proposal as released by Chairman Max Baucus (D-MT) on October 2, 2009 - after Committee markup. The changes in the amended Senate Finance bill are tracked in the chart.

The chart summarizes all three of the major health care reform bills currently moving through Congress:

(1) the Senate Health, Education, Labor, & Pensions (“HELP”) Committee bill (prior to markup, but incorporating coverage reforms released during markup);

(2) the House Tri-Committee bill drafted by the House Ways & Means, Energy & Commerce, and Education & Labor Committees (prior to markup); and

(3) the Senate Finance Committee bill (after markup).

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45 H.R. 868 Co-Sponsors!!

Rep. Leonard Lance (R-NJ), Rep. Carol Shea-Porter (D-NH), and Rep. Raul Grijalva (D-AZ) signed on as co-sponsors to the Direct Support Professionals Fairness and Security Act (H.R. 868). Thank you to Lowell Arye and the Alliance for the Betterment of Citizens with Disabilities (ABCD)for working with Rep. Lance's office and Tim Sullivan with the Institute of Professional Practice Inc. for working with Rep. Shea-Porter's office. Thank you to all those who also contacted their members urging them to sign on. Read more!

Kaiser Brief on the Class Act Provisions in Health Reform

This Kaiser Family Foundation held a briefing yesterday examining the Class Act provisions in two leading health reform bills. The briefing included a summary of the measure and discussion by an expert panel. This enhanced webcast presentation includes the speakers' slides synced to the video of the briefing. A podcast is also available.

ANCOR urges you to call your Senators to encourage inclusion of the CLASS Act in final health reform legislation. Use ANCOR's online Congressional Directory for contact information. Read more!

Senate Finance statutory language “America’s Healthy Future Act of 2009"

The legislative language from the Senate Finance Committee America's Healthy Future Act has been released.To access the language click on Legislative Language of S. 1796, the America’s Healthy Future Act on the Senate Finance Committee Legislation page.
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New Co-Sponsors for Direct Support Professionals Fairness and Security Act

Rep. Paul Hodes(D-NH) and Rep. Tim Waltz (D-MN) signed on as co-sponsors to the Direct Support Professionals Fairness and Security Act (H.R. 868). Thank you to everyone who contacted their members urging them to sign on. Read more!

Stagnant Prices Prevent Social Security Increase

Social Security recipients will not receive a cost-of-living adjustment (COLA) to their 2010 benefits. The COLA will not be made for this first time since the adjustments began 34 years ago due to consumer prices falling in the July through September quarter this year. President Obama has issued support for a one-time, $250 payment to Social Security beneficiaries to hopefully bolster the finances of seniors who are suffering from the economic downturn and are accustomed to an increase in their monthly checks every January. Read more!

House Democratic Leaders Considering Even Larger Medicaid Expansion in Health Reform Overhaul and Floor Vote in Early November

Although all three of the House Committees working on health care reform adopted legislative language for reform in their areas of jurisdiction, House Democratic leaders are still working on details. This week, Speaker of the House Pelosi (D-CA) said that the House may increase the eligibility for the non-traditional Medicaid population (e.g. childless adults) from the bill’s original 133% of the federal poverty level to 150% of FPL in order to expand health care coverage to more low-income individuals through the less costly Medicaid program. Speaker Pelosi said Thursday that the House will push for the strongest public option possible to take into negotiations with the Senate on a healthcare overhaul and has asked CBO to score three different proposals to create a public health option. In addition, both the House Ways and Means and House Education and Labor Committees have sent reconciliation instructions to the Congressional Budget Office (CBO), laying the groundwork to use the filibuster-proof reconciliation process to pass health care reform this year if necessary. Majority Leader Hoyer (D-MD) said this week that he did not expect a House floor vote until the first week in November. Read more!

Senate Finance Committee Adopts Health Care Plan Moving the Bill Closer to the Next Hurdle—Senate Floor Vote

Ending the suspense regarding not only Republican committee member support but also some Democratic member support, the Senate Finance Committee adopted Chairman Baucus’ health reform plan with all Democrats and Senator Snowe (R-ME) voting 14 to 9 to pass it out of committee. Type The Congressional Budget Office (CBO) has said that the plan is estimated to cost $829 billion over ten years, is fully paid for, and would reduce the federal deficit by $81 billion over the first ten years. The committee’s action this week—the last of five committees to adopt health care reform—brought a “bump” in chances for and “renewed” enthusiasm for health care overhaul this year. The next steps involved some delicate “high-wire” balancing in order to gain sufficient votes to pass a bill on the Senate floor—even before a joint Senate and House final bill can emerge. The Senate Finance plan is different in key areas from the Senate HELP Committee and House health reform bills—the latter two of which include creation of public health options and an employer health care mandate. Senator Burris (D-IL) has reiterated again this week that he will not vote for a health reform bill that does not include a public health option—reducing the possibility of passage relying solely on the 60 votes of all Democrats and two Independents.

Senate Majority Leader Reid (D-NV) began immediately on Wednesday working with Senator Baucus, Senator Dodd (D-CT) who chaired the HELP Committee during its work on a health care reform bill earlier this year while Chairman Kennedy (D-MA) was ill, Director of the White House Office of Health Reform Nancy-Ann DeParle, and President Obama’s Chief of Staff Rahm Emmanuel Health to meld the Finance and HELP bills together in order to bring a single bill to the Senate floor. The Finance plan does not include 1) creation of a public health option (contained in both HELP and House versions) or 2) employer mandate (although it places a penalty on employers who don’t provide health care for each employee that obtains coverage through a Health Exchange) but does include an individual mandate with higher penalties than the House wants. The Finance “plan,” unlike the HELP bill, is in plain text and not in legislative language format. Once the melding of the two bills take place, then a final bill will be written in legislative language and costs will be rescored by CBO. The Senate Democratic leaders will be challenged with bringing a bill forward to the Senate floor that strikes the right balance to gain the necessary 60 votes to end a filibuster. Many amendments are expected to be offered on the Senate floor, including Senate Finance Democrats Rockefeller (WV), Schumer (NY), and Wyden (OR) push for creation of a public option. While Republicans are also expected to bring forth amendments on the floor—tort reform, reduction in individual penalties—such changes if accepted are unlikely to Republican votes. The challenge will be in crafting a Senate bill that does not alienate moderate Democrats in the Senate and may yet attract Senator Snowe and/or a few other Republicans.

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Maine Faces More Budget Cuts

State departments in the state of Maine are being asked to recommend ways to cut their budgets by $200 million. The state departments have two weeks two come up with suggestions as Ryan Low, commissioner of the Department of Administrative and Financial Services, and Gov. John Baldacci prepare a supplemental budget. Each department has been given an individual target with Health and Human Services and Education set to receive the largest cuts.

Thank you to Bonnie Jean Brooks providing this update. Read more!

Chart Tracking States’ Spending

ProPublica has a tracking site for stimulas (ARRA) funding to states. Read more!

Iowa State Budget Update

Thursday, October 8, 2009 Governor Chet Culver of Iowa announced a 10% across the board cut. Up until now, Medicaid providers in Iowa had been exempted from the two previous cuts due to the federal stimulus dollars.

Most Medicaid eligible recipients in Iowa have their local match paid by their county of legal settlement rather than the state. The only savings to the state would be for persons who are state cases and do not have a determined county of legal settlement. The estimate for ICFs/MR is that with a 10% rate cut the state would forfeit $12M in federal funding to save only $400,000 in state dollars, or a loss of $30 for every dollar saved.

It is unsure at the point whether Iowa may require legislative action for cutting Medicaid. That would mean the Governor Culver would have either to call for a special legislative session or wait until the next session convenes in January.

Thank you to Rod Braun from Christian Opportunity for this update.
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Call Your Senate Offices; Ask Them to Include Long Term Services and Supports in Health Reform

As reported in last week’s WICs Live, several important provisions regarding long-term services and supports backed by ANCOR are included in Senate health reform proposals. Senate Finance Chairman Baucus modified his original health care mark by including additional federal assistance to states for Medicaid’s HCBS waiver services, changes in Medicaid’s 1915(j) HCBS state plan option, and a new Medicaid personal attendant state plan option with a 6% enhanced FMAP. The Senate HELP Committee has included the CLASS Act in their version of Health Reform. ANCOR staff made Capitol Hill visits on these and other long-term services’ issues this week in addition to its ANCOR grassroots alert posted in the Action Center. We are asking the Senate to include Long Term Services and Supports in the final version of Health Reform. ANCOR members are encouraged to respond to the alert if they have not already. Read more!

Senate Finance to Vote Tuesday on $829 Billion Health Reform Bill

Senate Majority Leader Harry Reid (D-NV) and Finance Chairman Max Baucus (D-MT) agreed to wait until Tuesday, in order to allow Members to review the Congressional Budget Office’s (CBO) analysis that was released late Wednesday afternoon. Once the committee votes, Reid is expected to begin meeting immediately with White House officials, including Chief of Staff Rahm Emanuel, Baucus, Sen. Chris Dodd (D-CT), and other Members of the Democratic caucus to merge the Finance package with a measure passed out of the Health, Education, Labor and Pensions Committee. Dodd shepherded the HELP bill through the committee in July in the absence of Chairman Kennedy (D-MA).
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New Co-Sponsor for Direct Support Professionals Fairness and Security Act

Rep. Steven Rothman (D-NJ) signed on as a co-sponsor to the Direct Support Professionals Fairness and Security Act (H.R. 868). Thank you to everyone who contacted their members urging them to sign on. Read more!

H1N1 Definitition of "Health-Care Personnel"

During phone calls with CDC, ANCOR requested clarification as to whether direct support professionals are included under “health-care personnel”. CDC stated that they could not clarify that as they are only writing guidelines. CDC emphasized that state health departments execute these recommendations and make the final decisions as to who receives the vaccines first.

ANCOR strongly recommends that everyone contact their state health department and urge them to include direct support professionals in the “health-care personnel” category. Read more!

Florida Nursing Home Residents Win Suit Against the State

A class action lawsuit brought in 2008 on behalf of 8,500 Floridians by AARP Foundation, the Southern Legal Counsel, and National Health Law Program and others, said the state illegally forced residents to live in nursing homes instead of their communities, has been settled with the state agreeing to spend up to $27 million to resolve the lawsuit. The agreement calls for the improvements to be made during the fiscal year ending June 30, 2010. A federal court will monitor the settlement that requires the Florida Agency for Health Care Administration and the Department of Elder Affairs to improve the way they inform Medicaid nursing home residents about making the transition from nursing homes to community-based programs.
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President Obama Announces New Initiatives During National Disability Employment Awareness Month

President Obama announced the Administration is taking steps to ensure that there is fair and equal access to employment for all Americans, particularly the 54 million people in this country living with disabilities.

The following are some of the steps the Obama Administration will take:

•The Office of Personnel Management (OPM) and Department of Labor's Office of Disability Employment Policy (ODEP) will collaborate to sponsor and organize a day long Federal Government-wide job fair for people with disabilities. The Fair will take place in early spring 2010. In addition to the Job Fair, OPM, ODEP, the Equal Employment Opportunity Commission (EEOC) and the Department of Defense's office on Computer and Electronic Accommodations Program (CAP) will provide workshops throughout the day on a variety of topics including the Schedule A hiring waiver and the right to the provision of reasonable accommodations including information on assistive and communications technology
•OPM will develop training on Schedule A for federal Human Resources specialists, hiring managers and selective placement coordinators that will be easily accessible and includes on line training.
•EEOC and the Department of Justice's Civil Rights Division will hold four Town Hall meetings throughout the nation to share information about the ADA Amendments Act proposed regulations and to gather comments on them. All Town Hall meetings will consist of two sessions - one for disability advocates and one for the employer community. These sessions will be completed by November 20th. The four locations are Philadelphia, Chicago, San Francisco, and New Orleans.
•The Department of Justice will release a video that will identify and respond to a number of common myths held by employers about workers with disabilities.
•OPM will create and lead a task force comprised of representatives from key Federal Departments and Agencies that have developed and implemented model practices for recruiting, retaining and advancing employees with disabilities. The task force will report on the innovative practices agencies use to encourage the employment of individuals with disabilities. The report will identify and promote successful practices for conducting outreach, recruiting, hiring qualified candidates, successful accommodations, and providing opportunities for career advancement at all levels.

This year’s theme for National Disability Employment Month is Expectation + Opportunity = Full Participation. This annual October celebration as designated by Congress is an opportunity to highlight the contributions and skills of Americans with disabilities to the workforce. For more information, see last week’s WICs Live article and the Department of Labor’s Office on Disability and Employment Policy web page on NDEM.

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WICS Live: Around the States

Iowa: State Creates New Prescription Drug Voucher Program. Under the new program, unveiled by the state Attorney general’s office September 22nd, eligible Iowans will obtain a voucher, present it to a participating pharmacy, and pay a $3 co-pay for a 90-day supply of medications for high blood pressure, high cholesterol, depression and other maladies. The program will use $420,000 from the state’s settlement with two drug management companies accused of consumer fraud. To be eligible for the program, individuals must be uninsured or under-insured or have an annual income less than 200% of the federal poverty level. More information is available at www.iowapdc.org. Read more!

WICS Live: Around the States

Florida: State Develops Website to Compare State, Federal Privacy Laws. The new web tool,launched September 17th, also helps providers and consumers compare laws and regulations related to electronic health records and health information exchange. The site is available at http://www.fhin.net/PSresourceCtr/index.shtml. Read more!

WICS Live: Around the States

California: Governor Signs Bill Preserving Healthy Families Program. After the state’s financial problems and steep budget cuts threatened to eliminate the Healthy Families Program, the state’s CHIP, as of October 1st, Signed by Governor Arnold Schwarzenegger (R) September 23rd, AB1422 would raise $194 million a year in part by imposing a temporary tax on health care insurers that participate in the state's Medi-Cal program. The bill also would raise the monthly per-child premiums by $4 to $7 for some program participants. The state will also receive $81.4 million from the First 5 California state commission, which oversees Proposition 10 tobacco tax revenue to promote early childhood development. Read more!

WICS Live: Around the States

Arizona: 10,000 Parents Lose Health Coverage As State Program Is Victim of Budget Cuts The KidsCare Parents program, which was an extension of the state’s SCHIP covering low-income working parents, ended September 30th after the state could not pay the $6 million cost to cover the program, following state budget cuts. The state will also lose $18 million in federal funds for administering the program. The state is facing an overall $3 billion budget shortfall. Governor Jan Brewer (R) said she was devastated by the program’s loss. Brewer is now concerned that KidsCare, which serves more than 50,000 children, could be cut in upcoming fiscal 2010-11 budget negotiations. Read more!

WICS Live: Around the States

Alabama: State Plans To Enroll Thousands More Under All Kids Expansion. A major program expansion to All Kids, the state’s CHIP program, beginning October 1st, is expected to enroll 10,000 additional children in the program. The program will be extended to children in families making up to three times the federal poverty level (FPL), or $66,165 for a family of four. The previous limit was two times the FPL. Read more!

WICS Live: Around the States

Pennsylvania: State Budget Impasse Enters Fourth Month. A delicate budget deal that Governor Ed Rendell (D) agreed to with lawmakers in his own party is now in jeopardy after the state House on Friday, October 2nd voted on a nearly party-line basis to swap out proposed taxes on arts and cultural events and on small games of chance and replaced them with new levies on cigars and other tobacco products as well as on natural gas drilling. The new tax provisions are in serious doubt in the Senate. On Saturday, the House passed a public welfare bill as part of state budget package. The Senate is expected to return to session Monday to consider various budget bills, and the bipartisan conference committee is scheduled to reconvene to consider the primary spending bill Monday. Read more!

WICS Live: Around the States

Michigan: A State Budget, Well…Almost. The state avoided a complete government shutdown October 1st, the start of its new fiscal year, with the signing of a 30-day temporary budget after Republican state lawmakers withheld several bills for Governor Jennifer Granholm’s (D) signature in order to force negotiations on several issues. Meanwhile, Granholm said Thursday, October 1st that she will veto portions of the budget sent to her for enactment because it cuts programs too deeply or eliminates them entirely. Granholm said she supports a new tax on physician services to raise $400 in Medicaid to avoid larger program cuts. Read more!

WICS Live: Around the States

New Mexico: State Medicaid Budget in the Red, and Could Reach a $300 Million Deficit in 2011. With more state residents enrolling in Medicaid due to the economy, the state could face a $300 million budget gap in its Medicaid program by next fiscal year. As of September 17th, the state is currently facing a $40 million shortfall in the program that is expected to grow to $60 million in the coming months. The state Human Services Secretary told lawmakers in mid-September that her Department is considering cutting optional Medicaid services, cutting provider payment rates, and eliminating the State Coverage Insurance program, which provides health insurance premium assistance to low-income workers. With the state also facing a general budget shortfall this year and next, Governor Bill Richardson (D) has said he is waiting to see what happens with health reform at the national level before making any decisions for his state. Read more!

WICS Live: Around the States

Montana: State Plans Swift Action to Implement Healthy Montana Kids Program. The program, which combines the state CHIP and Medicaid programs, began October 1st. The Department of Public Health and Human Services estimates that another 30,000 children could be added to the current 70,000 enrollees over the next two years. To help this along, the state September 24th announced a broad outreach effort in an effort to reach uninsured children and their families. The state has also cut the application in half, to 6 pages, and streamlined program administration. Under the new program, families earning up to $55,000 will qualify. Officials estimate there are 34,000 uninsured children in Montana, which ranks the state fifth in uninsured children. Read more!

WICS Live: Around the States

Louisiana: State Facing Mid-Year Medicaid Budget Shortfall. The shortfall is the result of a higher-than-expected health-care spending and delays delays in implementing cost-cutting strategies, the state Health and Hospitals Secretary told lawmakers during a special budget hearing September 22nd. In addition to costs associated with the H1N1 virus, the state also is spending more than anticipated on home-care services for individuals with intellectual and other developmental disabilities, and legislature-approved rate reductions have taken longer to implement. The exact amount of the shortfall must be reported to a House-Senate budget committee by November 1st. The state is already preparing for increasing financial hardship as of July 1st, when the state will see their federal Medicaid match fall from 80% to 63%, adding another $700 million to the budget deficit. A blue-ribbon panel is expected to recommend $802 million in program cuts in its report, due early next year. Read more!

WICS Live: Around the States

Florida: Pfizer Settlement Money Will Fund New Medicaid Fraud Informant Program. The state plans to use $1 million of its share of the multi-state settlement with the drug maker to reward informants who provide original information on Medicaid fraud violations that leads to recovery, civil or criminal penalties, or forfeiture of property. Reward money can be as much as 25% of the amount recovered, up to $500,000. The law authorizing the program also required all Medicaid beneficiaries to receive information annually on the program and how to report Medicaid fraud. Pfizer has agreed to pay a record $2.3 billion for illegally marketing Bextra, an anti-inflammatory drug, of which Florida is to receive $58 million, over $10 million which will go to the Medicaid program. Read more!

WICS Live: Around the States

California: Federal Judge Blocks Cuts to Adult Day Health Care Program, Says Cuts Violate ADA. A judge for the U.S. District Court for the Northern District of California issued a 24-page ruling September 10th, ordering the state to halt cuts to the Adult Day Health Care Program, unless and until the beneficiaries it serves are provided other Medi-Cal services to prevent institutionalization. The ruling came after a Department of Health Care Services lawyer argued that it was up to the individual providers who operate the more than 300 state centers to find alternative services for the beneficiaries. Judge Saundra Brown Armstrong ruled that the three plaintiffs who brought the suit would be high risk of institutionalization if their services under the program were scaled back, which could violate the plaintiffs’ rights under the Americans with Disabilities Act. The cutback is part of the budget agreement reached by the Legislature and Governor Arnold Schwarzenegger (R) and could be rescinded after the state finishes reviewing eligibility requirements. According to a spokesman for the Governor, the Administration is reviewing its legal options. Read more!

WICS Live: Around the States

California: Lawmakers Pass Bill Increasing Medi-Cal Hospital Rates So State Qualifies for Enhanced FMAP. The complex measure is designed to ensure the state continues to qualify for its temporary 11.59% enhancement in federal medical assistance percentage (FMAP), which is the state’s share of $87 billion allocated as part of the American Recovery and Reinvestment Act (ARRA). The bill, which is currently awaiting Governor Arnold Schwarzenegger (R) would increase the upper payment limit by imposing a “quality insurance fee” for outpatient and inpatient services at hospitals that quality for other state health funding other than Medi-Cal. The fee would be levied through December 31, 2010 and is projected to raise $2 billion annually. Revenue from the fee also would offset the impact of an April 6 emergency order by the U.S. Court of Appeals for the Ninth Circuit staying a 10% reduction in hospital Medi-Cal reimbursement rates. It is unclear if Schwarzenegger will sign the legislation; he has stated the bill is fatally flawed and will not receive federal approval.

In other news, lawmakers September 12th also approved legislation to temporarily unemployed Medi-cal beneficiaries with disabilities participating in the state’s Working Disabled Program to remain on Medi-cal for up to 26 weeks as long as federal funding is available. The extension would take effect 30 days after the temporary ARRA-funded increase in the state's Medicaid FMAP is no longer available. The bill was also sent to the governor for signature.
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House Eyeing What the Senate Does on Health Care.

The House appears “eerily quiet” regarding moving its tri-committee health care bill. The three committees of jurisdiction in the House are working on finalizing details in its combined bill HR 3200, but the leadership has provided no timeframe for bringing that bill to the House floor for a vote. The word is that the House Democratic leadership is waiting before pushing its majority party members to vote on its health care bill until it sees what emerges from the Senate. For example, while the House bill includes a public health care option and employer mandate, the Senate Finance bill does not include either, but the HELP bill includes both.

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New Co-Sponsors for the Direct Support Professionals Fairness and Security Act

Eleven Representatives signed on as co-sponsors to the Direct Support Professionals Fairness and Securitye Act (H.R. 868). Those members are Rep. Mark Souder (R-IN), Rep. Lloyd Doggett (D-TX), Rep. Albio Sires (D-NJ), Rep. Patrick Murphy (D-PA), Rep. Shelley Berkley (D-NV), Rep. Carolyn McCarthy (D-NY), Rep. John Yarmuth (D-KY), Rep. David Loebsack (D-IA), Rep. Chellie Pingree (D-ME), Rep. Ben Chandler (D-KY), and Rep. James Langevin (D-RI). Thank you to everyone who contact these members urging them to sign on Read more!

Senate Finance Chairman’s Mark and Amendments Include Long-Term Supports and Services.

While the “dust” has yet to settle on all of the provisions included in the Senate Finance Committee’s health care plan, several important provisions regarding long-term services and supports backed by ANCOR were included. Senate Finance Chairman Baucus modified his original health care mark by including committee member amendments in the health care plan that the Committee began deliberating two weeks ago that provide additional federal assistance to states for Medicaid’s HCBS waiver services, for changes in Medicaid’s 1915(j) HCBS state plan option, and a new Medicaid personal attendant state plan option.

ANCOR staff made Capitol Hill visits on these and other long-term services’ issues this week in addition to its ANCOR grassroots alert. ANCOR and other disability and aging groups will do another round of Capitol Hill visits and grassroots phone-in on Thursday, October 8^th following Senate Finance Committee adoption early next week of its health care plan.

Several important long-term supports and services provisions were included: (1) Senator Schumer’s (D-NY) Community First Choice state option; (2) Senator Cantwell’s (D-WA) Home and Community Balanced Incentives Act that temporarily increases the federal matching rate for HCBS for states that undertake structural reforms over five years to increase diversion for nursing homes, ICFs/MR, and other institutions through either a HCBS waiver or state plan amendment; (3) Senator Kerry’s (D-MA) provision to improve access to HCBS under the Medicaid’s 1915(j) state option –that would let states seek approval from HHS that place services on a par with nursing home and HCBS waiver eligibility criteria to offer “additional services” under the HCBS state and to offer these HCBS to individuals who make more than 150 percent of the federal poverty level (FPL) but no more than 300 percent of the supplemental security income (SSI) level, and (4) Senator Rockefeller’s (D-WV) Sense of the Senate that this Congress should address long-term services and supports in a comprehensive way that guarantees elderly and disabled individuals requiring the Department of Justice to perform an annual evaluation of state compliance with federal Olmsted laws. Work still continues on ANCOR’s NAC efforts to get language regarding the direct support professional workforce issue included in the Committee’s final bill as we did with the HELP Committee bill.




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Senate Finance Wraps Up Health Reform Mark Up Early This Morning and Planning Committee Vote Next Week

The Senate Finance Committee wrapped up its debate on more than 600 amendments to its health care “conceptual” overhaul early Friday. After working through hundreds of amendments to Baucus’ original $900 billion health care bill over the past two weeks, the Finance Committee is expected to review preliminary CBO scoring on the amended Chairman’s mark before a final vote by the on Tuesday. When the marked up bill comes up for vote next week in the committee, it is expected to pass along party lines with Senator Olympia Snowe (R-ME) as the only Republican who may align with the Democrats in favor of the Committee’s bill.

The next phase of moving toward a floor vote on health care reform in the Senate involves merging the Finance bill with a bill previously passed by the Health, Education, Labor and Pensions Committee (HELP). Senate Majority Leader Harry Reid (D-NV) will be directing the melding of the Senate Finance and HELP versions of health care reform in his office along The word is that his efforts will also include top White House officials and Finance Chairman Baucus, HELP Chairman Harkin (D-IA) and Senator Chris Dodd (D-CT) who was the acting the acting HELP Committee Chair with his work on a health reform bill. That “merged” health reform bill require that a Senate bill be drafted in actual “statutory language,” requiring another CBO scoring which may take up to two weeks. This timeframe conflicts with Majority Leader Reid’s announcement that the Senate will forgo its annual Columbus Day week-long recess beginning October 12th because the final Senate bill will be brought to the floor that week.

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Drug Store Groups Sue Three States Over Medicaid Reimbursement Rates.

The National Association of Chain Drug Stores, the National Community Pharmacists Association and other smaller groups filed lawsuits Wednesday in New York, California and Washington State because the Medicaid reimbursement rates are not based on how much it costs the pharmacies to buy the drugs. The three states were charged with violating the Social Security Act and failing to get the new drug prices approved as required by the Centers for Medicare & Medicaid Services.
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President Obama Issues National Disability Employment Month Proclamation

Today President Obama marked the beginning of National Disability Employment Month with a Proclamation recognizing the strides individuals with disabilities have made in achieving employment, acknowledging the work that remains, and calling Americans to celebrate the contributions of individuals with disabilities in the workplace and communities.

As Americans, we possess a range of vocational opportunities to make the most of our talents and succeed in a chosen career; those with disabilities are entitled to the same opportunities.

I call on all Americans to celebrate the contributions of individuals with disabilities to our workplaces and communities, and to promote the employment of individuals with disabilities to create a better, more inclusive America, one in which every person is rightly recognized for his or her abilities and accomplishments.

This year’s theme for National Disability Employment Month is Expectation + Opportunity = Full Participation. This annual October celebration as designated by Congress is an opportunity to highlight the contributions and skills of Americans with disabilities to the workforce. For more information, see last week’s WICs Live article and the Department of Labor’s Office on Disability and Employment Policy web page on NDEM.

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New Kaiser 50-State Survey Reports Sharp Increase in Medicaid Enrollment and Spending Amidst Worst Recession in Decades.

The annual Kaiser Commission on Medicaid and the Uninsured 50-state survey of state Medicaid officials found that the increased federal, temporary Medicaid assistance (FMAP) was critical to states. However, the survey results also find that the number of people on Medicaid and state spending on the program are climbing sharply as a result of the recession, straining state budgets and pressuring officials to curb costs. Total Medicaid spending growth averaged 7.9 percent in FY 2009, the highest rate in five years, well above the 5.8 percent projected growth. For FY 2010, states estimate Medicaid enrollment will grow by 6.6 percent over FY 2009 levels, with Medicaid spending across states expected to grow by an average of at least 6.3 percent in fiscal 2010.
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States Move to Require Some Health Care Workers to Receive H1N1 Vaccination

With the H1N1 pandemic spreading rapidly, many doctors, nurses, and other U.S. health-care workers for the first time are being required by their states to get flu shots, drawing praise from many public-health authorities but condemnation from some employees, unions and other critics who object to mandatory vaccination. Check with your state and local government to find out if they require direct support professionals to receive the H1N1 vaccine.

What's at Issue?
An increasing number of doctors, nurses and other health-care workers for the first time are being required to get flu shots, in part because of concerns that the swine flu pandemic may overwhelm the U.S. health-care system.

Who's Objecting and Why?
Some health-care workers are objecting for a variety of reasons, including concerns about the safety of the vaccine, the sentiment that being vaccinated should remain voluntary and, in some cases, the mistaken fear that the vaccine itself can cause the flu.

For Example...
States: New York this year became the first state to require flu shots, a policy that affects about 522,000 employees.

Hospitals: The Hospital Corp. of America, known as HCA, in Nashville, the nation’s largest private hospital chain, is also requiring the shots this year, a policy that affects an estimated 120,000 employees in 20 states.

Providers: MedStar Health, the largest health-care employer in the Washington region, is requiring flu shots this year for the first time for all 25,000 of its employees and 5,000 affiliated physicians. Read more!

GAO Releases Report on VR Funding Formula

The report, Vocational Rehabilitation Funding Formula: Options for Improving Equity in State Grants and Considerations for Performance Incentives: (1) examines the extent to which the current formula meets generally accepted equity standards, (2) presents options for revising the formula, and (3) identifies issues to consider with incorporating performance incentives into the formula.GAO presents three options for revising the formula to illustrate a range of possibilities: the first distributes funds based on states’ disability populations, the second also accounts for costs of providing services, and the third further accounts for state resources beyond per capita income. Because any formula change would redistribute funds among states, potentially disrupting services to individuals, GAO also presents options for establishing a transition period. Read more!

New Mexico Families Feel Betrayed By Unkept Promise and Funding to Address DD Waiting Lists

Mexico’s Health Department decided not to spend $9.4 million — approved by the Legislature and signed by the governor — to bring 400 children and adults off the 4,800 person waiting list. The worsening economic crisis is the reason the Health Department cites for holding off on spending the funding. Thanks Mona McGee of Mosaic for this update.
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Community First Choice Option Included in Senate Finance Committee Legislation

The Community First Choice Option was proposed by Senator Harkin (D-IA) as a way to include the Community Choice Act (CCA) in health care reform. The option would encourage states to provide Medicaid home and community based attendant services (rather than require them as the original CCA would do).

Senator Charles Schumer (D-NY) introduced the language of the CFC Option as an amendment, but Chairman Baucus (D-MT) included it in modifications to his original mark.

Language on the Community First Choice Option from the Chairman’s Mark:

Insert ―The Chairman’s Mark would establish the Community First Choice Option, which would create a state plan option under section 1915 of the Social Security Act to provide community based attendant supports and services to individuals with disabilities who are Medicaid eligible and who require an institutional level of care. These services and supports include assistance toindividuals with disabilities in accomplishing activities of daily living and health related tasks. States who choose the Community First Choice Option would be eligible for enhanced federal match rate of an additional six percentage points for reimbursable expenses in the program. The option would sunset after five years.

―The Community First Choice Option also would require data collection to help determine how states are currently providing home and community based services, the cost of those services, and whether states are currently offering individuals with disabilities who otherwise qualify for institutional care under Medicaid the choice to instead receive home and community based services, as required by the U.S. Supreme Court in Olmstead v. L.C. (1999).

―The Community First Choice Option would also modify the Money Follows the Person Rebalancing Demonstration to reduce the amount of time required for individuals to qualify for that program to 90 days.

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Two New Housing Voucher Reports Available

The Center on Budget and Policy Priorities published this week two new reports about Section 8 Housing Choice Vouchers. The first report outlines the Section Eight Voucher Reform Act and how the bill would update and streamline the Section 8 voucher program. The second report addresses shortages of Section 8 vouchers in FY 2009. Read more!

Remember: October is National Disability Employment Month

This year’s theme for National Disability Employment Month is Expectation + Opportunity = Full Participation. This annual October celebration as designated by Congress is an opportunity to highlight the contributions and skills of Americans with disabilities to the workforce.NDEM is a time not only to acknowledge the struggle people with disabilities endure to obtain employment, but also to celebrate the strides made by those who have overcome the many barriers to employment. It is also an opportunity to recognize employers, who have hired people with disabilities and are tapping into new sources of creativity in this existing source of employees. NDEM is an excellent opportunity for ANCOR providers of employment and vocational supports to host events and activities that recognize employment accomplishments and draw attention to the 70 percent of unemployed people with significant disabilities —a huge untapped portion of the labor force.

Activities to Recognize National Disability Employment Awareness Month:

• Employer recognition events
• Share successes with the media
• Identify employers who hire people with disabilities to the media
• Host events highlighting employers and individuals
• Meet with and form partnerships with local workforce investment boards and one stop centers
• Work with your governor’s office to issue a proclamation


The Department of Labor’s Office of Disability Employment Policy has made available the NDEM 2009 Poster. The posters are available in one size, 20” x 15,” at no cost to you. Please enter your online order here. The maximum order is 100 posters. You may also download PDF versions of the posters.

ANCOR joins with providers of employment and vocational supports in celebrating NDEM and appreciates all of your efforts to expand opportunities for employment for people with disabilities. Please share any NDEM activities or ideas your agency or state association is sponsoring with Jessica Sadowsky at jsadowsky@ancor.org.
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HIPAA Breach Rule Update—Discount for ANCOR Members

Gilliland & Markette in partnership with ANCOR has developed materials to assist providers comply with the HIPAA Breach Notification Rule. It is a 40+ page document consisting of comprehensive Questions & Answers concerning the Rule, a template Breach Notification Policy, sample breach notification language for business associate contracts, and a copy of the Breach Notification Rule, itself.

The price is $49.50; however, ANCOR members are eligible for a 10% discount. You can order by phone at (800) 894-1243 with a credit card. Just tell the folks at Gilliland & Markette that you are an ANCOR member.

Gilliland & Markette LLP
3905 Vincennes Road, Suite 204
Indianapolis, Indiana 46268

Telephone: (317) 704-2400
Toll Free: (800) 894-1243
Fax: (317) 704-2410
Mail to: thefirm@gillilandmarkette.com
http://www.gillilandmarkette.com
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House and Senate Continue Health Care Debate

House leaders are set to meet today to discuss many of the details of their health care overhaul, including whether to include a public insurance option in the package, while Senate Finance Committee’s health care markup now appears likely to spill over into next week. Speaker Nancy Pelosi (D-CA.) has been reluctant to disclose details about the shape and timing of the bill.

The Senate Finance Committee’s health care markup now appears likely to spill over into next week, due in large part to the sheer number of amendments filed against Chairman Max Baucus’ (D-MT) bill. The markup continued apace Thursday, with Finance members bracing for a third consecutive late night of amendment consideration, as well as a Friday session. But Baucus, who had hoped to conclude the markup by week’s end, hedged when asked if that goal would be met. Still, the Finance chairman said he was happy with the progress on his $900 billion plan so far.

The “public option” remains a major point of contention as Senator Charles Schumer (D-NY) is set to offer an amendment to replace the bill’s nonprofit health insurance cooperatives with a public insurance option. Senate Minority Whip Jon Kyl (R-AZ) said Republicans would likely offer more than 100 amendments before the markup concludes.
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Kaiser Family Foundation Resources

Be sure to take advantage of the resources provided by the Kaiser Family Foundation on their Health Reform page. Specifically, look at their Side-by-Side Comparison of Major Health Care Reform Proposals. Read more!

Massachusetts Appoints New Senator

The Massachusetts state legislature voted to give Governor Deval Patrick authority to appoint someone to fill Former Senator Ted Kennedy’s seat until the special election is held in January. Today Governor Patrick appointed former Kennedy aide Paul Kirk to fill the seat. Kirk will be sworn in tomorrow at 3:15 p.m. by Vice-President Biden. Read more!

H1N1 Vaccine Update

HHS officials have recently announced 3.4 million doses will now be available the first week of October however they will all be in the nasal spray form. The nasal spray, FluMist, contains a weakened live virus, while injections contain a killed and fragmented virus. The spray gives a stronger immune reaction but carries a small risk that the virus will multiply too quickly in people with compromised immunity. The normal side effects of FluMist include fever, headache, muscle aches, runny nose, vomiting and wheezing. These side effects mimic the flu, leading to the rumor that flu vaccines cause the illness. Nevertheless, health agencies say the side effects cannot expand into a life-threatening infection. The nasal spray is not recommended for pregnant women, people over 50, and individuals with asthma or heart conditions. This still allows other target groups to receive immunity faster than expected.

Contrary to what experts expected, clinical trials now show the H1N1 vaccine is effective for adults and children ages 10 to 17 with one dose, not two. Children 9 and under will need two doses. Clinical trials have not yet finished for pregnant women. Studies have concluded that once vaccinated, a person develops immunity to the virus within 8 to 10 days. This recent change means that the vaccine supply will go twice as far, which will allow all people within the CDC’s high risk groups to receive vaccination before the flu’s midwinter peak. Read more!

Kaiser Family Foundation Releases Two HCBS Documents

Kaiser Family Foundation released two documents pertaining to home and community-based settings.

The first, entitled Advancing Access to HCBS discusses how in order for more individuals to be served in home and community-based settings, greater attention to workforce development is necessary.

The second attachment, entitled Efforts in States to Promote Medicaid CBS discusses how to strengthen the long-term service workforce through community based services. Read more!

U.S. Chamber Releases H1N1 Flu Guide to Keep Businesses in Business

The U.S. Chamber of Commerce’s National Security and Emergency Preparedness Department announced the release of It’s Not Flu as Usual: An H1N1 Business Preparedness Guide to provide businesses with suggestions on how to keep employees healthy and maintain business operations during the upcoming flu season. The document is designed for businesses of all sizes and includes a 10-point preparedness checklist in addition to information on topics such as federal guidance for workplace planning, vaccines, antiviral drugs, face masks, and respirators.

More information from the U.S. Chamber of Commerce is available at their pandemic planning website. Read more!

Card Check Legislation Won’t Happen Until After Health Care Reform

UPDATE: See ANCOR's background piece on "card check" from the Governmental Activities Seminar.

One of labor’s most prized legislative goals will take a backseat to the Administration’s most pressing priority—health care reform—for the meanwhile. Reports are that President Obama and White House Chief of Staff Rahm Emanuel told labor on Monday that they will not bring up the Employee Free Choice Act (EFCA) known as “card check” until after Congress completes its work on health care reform. Congress does not plan on picking up formal action until September 15th—the date that Finance Chairman Baucus (D-MT) has set for his committee’s draft and date that House Energy and Commerce Chairman Waxman (D-CA) has set to take up more than 40 amendments to finish his committee’s part of the final House bill. Read more!

New H.R. 868 Co-sponsors

Congressman Dennis Moore (D-KS), Congressman Brett Guthrie (R-KY), and Congressman Maurice Hinchey (D-NY) have signed on as co-sponsors to H.R. 868. Thank you to everyone who sent messages and visited their offices during the Governmental Activities Seminar. Read more!

Federal Judge Blocks Cuts September 9th to Adult Day Health Care Services

In a major victory for disability and senior rights advocates, a federal district court judge September 9, 2009 issued an order blocking California’s budget reductions to Adult Day Health Care services, saying that the cuts would likely be in violation of the federal Americans with Disabilities Act and Section 504 of the federal Rehabilitation Act. Federal District Court Judge Saundra Brown Armstrong issued a preliminary injunction – or temporary order – to stop the cuts until appropriate replacement services are in place. For a copy of the 24 page order, go to www.cdcan.us .
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Post ANCOR 2009 Governmental Activities Seminar Wrap-Up

Thank you to everyone who attended ANCOR's 2009 Governmental Activities Seminar and made it such a wonderful event. Please see ANCOR's website to access presentations and hill visit materials from the Seminar.


Please remember to fax your Hill Visit forms to ANCOR at (703) 535-7860 or use ANCOR's electronic feedback form if you do not have a copy of the form from the Seminar.
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Senate Finance Chairman Baucus Releases Chairman's Mark

Senate Finance Committee Chairman Baucus released his anticipated health reform bill entitled America’s Healthy Future Act of 2009. The bill received praise from the House Blue Dog Coalition but was criticized by both some Democrats and Republicans. Check back on WICs Live for more information as the process continues. Read more!

New Co-Sponsor for H.R. 868

Congresswoman DeGette (D-CO) recently signed onto H.R. 868 as a co-sponsor. We thank Sharon Walters from Mosaic who spent a great deal of time communicating with Congresswoman DeGette's office. Read more!

ANCOR Releases H1N1 Issue Brief

ANCOR has recently released an H1N1 Issue Brief.The issue brief will be updated as new information comes in. To ensure you have the most updated copy check our Pandemic Flu Website. For questions contact Mary Pauline Jones. Read more!

Washington state court case

U.S. District Court Judge in Washington Rules State Violated Rights of Individuals with Disabilities in Cutting Adult Day Health Programs. Cuts to a Washington program that provides rehabilitative therapy and skilled nursing services to disabled individuals living in community-based residential settings must be restored, a federal trial court ruled Sept. 4 (Ryan v. Dreyfus, W.D. Wash., No. 2:09-cv-908, 9/4/09). The U.S. District Court for the Western District of Washington said a class of Medicaid-eligible individuals who had been receiving benefits under Adult Day Health programs were entitled to an injunction against the Washington Department of Social and Health Services (DSHS) and its secretary, Susan N. Dreyfus, because the benefits were terminated without notice. Termination without notice and an opportunity for a hearing violates the due process rights of the individuals who, until July 1, were receiving services through the ADH programs, the court said. The class representatives are entitled to an injunction because they showed they would prevail on their claims that the state violated the 14th Amendment of the U.S. Constitution, as well as the Medicaid Act, and demonstrated an injury that could be redressed by such relief, the court said. The class-wide case management activities that DSHS has undertaken since the commencement of this litigation have provided for post-termination hearings for those individuals who request them. The court ruled: “The class members were entitled to a pre-termination hearing, not a post-termination hearing. Pending a hearing, the class member's ADH services are reinstated. Thus, in order to remedy the due process violation, the class members' ADH services must be immediately reinstated and then DSHS can provide the notice and opportunity to be heard that it should have provided before July 1.
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HIPAA: HHS Issues Rule Requiring Individuals Be Notified of Breaches of Their Health

The breach notification notice of proposed rule making requires HIPAA covered agencies to give notification to affected individuals of breaches of unsecured protected health information (PHI). Business associates of HIPAA covered agencies are required to notify the agency following discovery of a breach of unsecured protected health information maintained by the business associate. The requirement for breach notification applies only to breaches of “unsecured protected health information,” which means PHI that has not been secured by use of a technology or methodology specified in guidance of the Secretary of HHS. That guidance essentially requires encryption or destruction of the PHI. The rule is effective September 23, 2009. However, HHS specifically states, "...we will use our enforcement discretion to not impose sanctions for failure to provide the required notification for breaches that are discovered before 180 calendar days from the publication of this rule, or February 22, 2010. During this initial time period - after this rule has taken effect but before we are imposing sanctions - we expect covered entities to comply with this subpart and will work with covered entities, through technical assistance and voluntary corrective actions, to achieve compliance." ANCOR is working to develop products and other information to assist members with this new development.
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Senate Health Care Update

Senate Finance Chairman Baucus released a draft framework Tuesday and expects to have his Chairman’s report out by September 15th and proceed to a mark-up of a Finance bill the week of September 21st. Read more!

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!