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!

Senate Health Reform Proposals Hit Bumps

The HELP committee began marking up this week its version of health care reform as scheduled. The incomplete proposal, according to the CBO, has an initial price tag of $1 trillion. HELP and Finance originally planned to mark up their bills this month and then merge negotiations after the July Fourth recess. However, Senate Finance Chairman Baucus (D-MT) announced that the Finance committee’s scheduled markup next week would be delayed until after July Fourth due to his determination to bring the $1.6 trillion Finance proposal down to less than $1 trillion AND make it deficit neutral. Read more!

House Plan for Health Care Reform Unveiled

House Democrats released today an 852-page discussion draft of their health care reform proposal. The three House committees that worked together on the proposal(Ways and Means, Energy and Commerce, Education and Labor) will begin debate on the measure in hearings next week. They are expected to mark up the bill soon after the July Fourth recess. Watch WICs Live and ANCOR's web for more information next week. Read more!

Iowa Makes Good on Pledge to Use Enhanced FMAP Exempt Providers from Across Board Cuts

Iowa Governor Chet Culver implemented an across-the-board cut of 6.5% in his FY09 budget. For FY10 beginning July 1, 2009 there was an additional across-the-board cut of 4.8% on top of the previous 6.5%. The good news for Iowa providers is that the Governor made a commitment to them that they would be exempted from the across-the-board cuts if Congress came through with the enhanced FMAP funding via the American Recovery and Reinvestment Act (ARRA) of 2009. The Governor kept his commitment and providers were exempt. Thanks to Rod Braun of Christian Opportunity for this update. Read more!

Federal Sick Leave Bill Introduced

Senator Kennedy (D-MA) and Representative DeLauro (D-CT) introduced The Healthy Families Act (S.1152 and H.R. 2160) which would require employers with 15 or more employees to accrue paid sick leave (with up to 56 hours of paid sick leave) for every 30 hours worked. The paid sick leave could be used after 60 days for an employee to care for the medical needs of a child, parent, spouse, or any blood relative, or for their own medical needs including those resulting from domestic violence. The HFA mandated sick leave would be in addition to leave required under the Family Medical Leave Act or state workers compensation laws, and employers' leave policies would have to be meet the HFA requirements should it be enacted. The Senate bill has 20 cosponsors and the House bill has 105 cosponsors. ANCOR will provide members with additional information on the HFA. Read more!

Bill Watch: The Community Choice Act

The Community Choice Act would provide Americans with equal access to community-based services and supports. This ANCOR-supported bill would provide individuals with disabilities in nursing homes and other institutional settings with options to receive community-based services.Senators Tom Harkin (D-IA) and Arlen Specter (R-PA) along with Representative Danny Davis (D-IL) introduced the Community Choice Act (S. 683; H.R. 1670) on March 23, 2009. The legislation has bi-partisan support. The Community Choice Act has been referenced in testimony at hearings concerning long-term services and supports within the context of health care reform. For more information visit www.passthechoiceact.com. Read more!

Senate Schedule Calls for a Single Bill to Come to Floor in July

Earlier this year, Senators Baucus (D-MT) and Kennedy (D-MA), chairmen of Senate Finance and HELP committees respectively (the Senate committees with jurisdiction over health care), established a joint process to lead a single health care bill to be merged on the Senate floor. Following committee mark-ups, the plans are to take one to two weeks to combine the two bills after the July 4th recess. Type rest of the post here. Read more!

Finance Committee to Release Health Care Reform June 17th

Senate Finance Chairman Baucus (D-MT) is expected to release his health care document in time for a June 18th committee mark up. Finishing touches are being made this weekend on the reform.Baucus said earlier this week that he will keep on schedule, despite still needing cost information from the Congressional Budget Office. The word is that the Finance Committee document will include several of the Medicaid long-term options discussed in an earlier document and supported by ANCOR. Read more!

HELP Committee Releases Health Reform Bill That Includes Long Term Services

Senate HELP Committee Chairman Kennedy (D-MA) released the Affordable Health Choices Act Tuesday which includes the following five major elements: choice, cost reduction, prevention, health system modernization, and long term services and supports. The committee will begin consideration of the 615-page bill, Tuesday, June 16th. The Chairman’s inclusion of his CLASS Act (S. 697), supported by ANCOR, would create a new national insurance program to help adults who have or develop functional impairments to remain independent, employed, and stay a part of their community, is incorporated. This new program, self-funded and actuarially sound, would provide significant savings to the Medicaid program, relieving state and federal budgets as the primary funder of long-term services. It would offer a new funding resource for providers of home and community-based services. Senator Dodd (D-CT), second in Democratic seniority on the committee, is managing the day-to-day work of the HELP Committee during Chairman Kennedy’s absence. Read more!

Celebrate Landmark Olmstead Decision 10th Anniversary

June 22, 2009 marks the 10th anniversary of the U.S. Supreme Court Olmstead decision that upholds the Americans with Disabilities Act requirement that states serve people with disabilities in community settings, rather than segregated institutions. June 22, 2009 marks the 10th anniversary of the U.S. Supreme Court Olmstead decision that upholds the Americans with Disabilities Act requirement that states serve people with disabilities in community settings, rather than segregated institutions. Read more!

Campaign for Disability Employment Announces Video Contest

The Campaign for Disability Employment, a newly-formed collaborative of leading disability organizations funded by the Office of Disability Employment Policy of the U.S. Department of Labor, has announced an online video contest to promote the talent and skills that people with disabilities bring to America's workforce and economy. Videos received by July 15, 2009 will be judged by a panel of representatives from member organizations of the Campaign for Disability Employment. Type rest of the post here. Read more!

Did You Know?

A record 10,552 fair housing discrimination complaints were filed in fiscal year 2008, according to a report released by the U.S. Department of Housing and Urban Development (HUD). The report shows that a large portion of the complaints, 44 percent, were filed by persons with disabilities. Type rest of the post here. Read more!

Chairman Pallone Introduces Senate Version of Empowered at Home Act

House Energy and Commerce Subcommittee on Health Chairman Frank Pallone (D-NJ) introduced today the House version of the Empowered at Home Act (H.R. 2688). This bill would improve the state plan amendment option (1915i) for providing home and community-based services under the Medicaid Program. The state plan amendment option was passed as part of the DRA. Senators John Kerry (D-MA) and Charles Grassley (R-IA) introduced the Senate version in July. Read more!

Survey Shows Weak Fiscal Outlook for States

Although federal Recovery Act dollars have helped states avoid the most drastic budget cuts, state fiscal conditions declined for nearly every state during fiscal year (FY) 2009, according to the latest Fiscal Survey of the States from NGA and the National Association of State Budget Officers (NASBO). Overall, NGA and NASBO found that while general fund expenditures and revenue collections increased for many states in FY 2008, the ongoing recession is adversely affecting states' fiscal outlook for the next several years. Between FY 2009 and 2011, states must fill more than $183.3 billion in budget gaps, after previously closing gaps totaling $46.2 billion.
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Energy & Commerce Committee Summary of Health Care Reform Legislation

The House Energy and Commerce Committee released today its outline of health reform legislation. House Majority Leader Steny Hoyer (D-MD) said on Monday, "We hope to pass health care reform by August," adding, "That is a target, not a deadline."

Structural Overview
• Ability to keep what you have and minimize disruption.
• Provide a National Health Exchange for individuals and the smallest employers
• Requires shared responsibility among individuals, employers, and the Federal and State Government.
• Provides affordability credits to low and middle income individuals.
• Implements delivery system reforms to promote efficiency and reduce costs.
• Invests in the health care workforce and public health.
• Slows the growth of health care costs and maintains fiscal sustainability.

National Health Exchange, Affordability Credits, Medicaid Improvements
Role of the Exchange
• New independent entity would make health insurance choices available to those without an employer offer, and smallest businesses (the first year: biz under 10 employees; second year: under 20 employees; etc). It would be open to large businesses over time.
• The Exchange would set and enforce standards for health plans; facilitate enrollment; receive/monitor complaints; and administer affordability credits.

Affordability
• Creates Sliding scale affordability for use in exchange for eligible individuals with incomes between Medicaid eligibility and $88,200 for family of 4 (400% of poverty); everyone would be protected by an annual cap on out-of-pocket spending

Choice
• Ensures choice of private and public health insurance plans; provides new options for employers; and maintains and improves Medicaid for low-income individuals and families.

New Public Health Insurance Plan
• Health exchange includes a new public health insurance plan that would be subject to the same market reforms and consumer protections as private plans.
• Plan would have geographic adjusters for prices.
• Plan would ensure transparency, accountability, cost-containment and competition in the market.
• The public health insurance plan would likely be run by HHS, and would be independent of the Health Exchange.
• It would not have government subsidies-it’ll compete on its own.
Provider Participation and Payment
• The public plan would build on Medicare providers and rates, similar to the practices of private plans today.
Benefits, Insurance Market and Reforms, and Consumer Protections
• A public private independent advisory committee would recommend benefit packages based generally on the Federal Employee Health Benefit Plan.
• Several levels of benefits would be available in the Health Exchange. They would predominately differ by cost sharing but additional benefits would be available in higher cost plans.
• After several years employer sponsored health plans would either have to meet the minimum benefit standard of plans operating within the Health Exchange or allow their employees to purchase coverage in the Health Exchange.

Market Reforms and Consumer Protections
• Health insurers, both inside and outside the Exchange, would be required to adhere to new insurance market reforms and consumer protections.

Shared Responsibility- Individual, Employer & Government Requirements
• Individual Responsibility: Individuals would be responsible for having health insurance.
• Employer Responsibility: employers would have the choice to “play” by offering health insurance to employees, or contribute:
o Play: Employers would offer and contribute towards the health coverage of their full-time employees and their dependents.
o Pay: Employers who do not “play” would “pay” by contributing a percentage of payroll.

Investments in Health Care Workforce
• Expand the primary care, nursing and public health work forces through increased support for key programs.
• Create a broad, inter-disciplinary commission to examine ongoing health workforce issues.
• Support workforce diversity efforts including data collection and expansion of workforce programs.
• Remove barriers so hospitals can more easily train residents in community settings.
• Increase funding for scholarships and loan forgiveness to promote primary and nursing care.

Improving Health & Wellness
Prevention & Wellness Programs
• Reduce disparities by supporting evidence-based, community wide efforts & health empowerment zones to improve health and wellness.
• Incorporate and improve prevention services provided in Medicare, Medicaid.
• Strengthen State Departments of Public Health.
• Substantially increased support for Comm Health Centers.
• Data collection improvements; Health IT providing & collecting data to reduce disparities
Read more!