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

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

Long Term Services and Supports

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

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

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

Coverage

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

Benefits

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

Access to Quality Care

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

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Employer and Individual Mandates in Health Reform

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

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

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

Summary of Employer and Health Reform Benefits and Requirements

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

Summary of Shared Responsibility of Health Reform

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State of Idaho Witholding Medicaid Payments to Providers for 30 Days

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

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

Two New Cosponsors Added to the Direct Support Professionals Bill

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

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

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

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

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

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

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

ANCOR Partners With the U.S. Census Bureau

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

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

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

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

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

• March 2010: 2010 Census forms are delivered.

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

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

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

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


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

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

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

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

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

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

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

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

Providers Should Press for State Protection of Services and Supports

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

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

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

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

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

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

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

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

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

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

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


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Center on Budget and Policy Priorities Issues New Briefs

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

CBPP also released on March 3rd an update on state budget cuts. The report found 45 states making cuts that are harmful to vulnerable populations.
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