1) What’s Happening in the Nation’s Capital?
NCIL PASS Subcommittee: Take Action on the Definition of Community
2) National News
NCIL Healthcare Subcommittee Update on Competitive Bidding
Deadline to Comment on DOT’s Proposed Rules for Accessible Air Travel: January 9!
New Affordable Care Act Demonstration to Provide Care at Home for Medicare Patients
3) State News
Landmark Consent Decree Expands Opportunities for Nursing Home Residents with Disabilities!
Governor Cuomo Announces Outer Borough Taxi Agreement
4) Announcements and Additional Resources
ODEP Celebrates 10 Years
The Riot Presents: Space Race, A Game to Teach and Learn about Self-Determination
NCIL PASS Subcommittee: Take Action on the Definition of Community
Advocates across the country are waiting for the final rules for the Community First Choice Option. Unfortunately, those rules have been held up, in part, because of the strong comments made against CMS’s proposed rules about the definition of community. There are those who want to argue that "community" can be defined as cottages on the grounds of a large institution or segregated housing that only has people with a specific disability is “integrated” in the community. Unfortunately they mobilized strong opposition to these rules.
Among the folks that opposed these rules were fourteen state Medicaid agencies and directors. They said they opposed these rules, in large part, because the proposed rules would “limit choices” for people with disabilities. Those 14 states were: Alaska, California, Hawaii, Illinois, Louisiana, Maine, Maryland, Michigan, Missouri, Nevada, Rhode Island, Tennessee, Washington, and Wisconsin. Basically these states said:
- Proximity to a hospital or other institution is desirable to many elderly persons and individuals with adult-onset disabilities and should not be denied to waiver recipients, and there are “good reasons” to allow HCBS programs targeted at the elderly and individuals with adult-onset disabilities to offer recipients the option of living in a residence on the grounds of, or immediately adjacent to, a nursing home or other institution.
- The proposed rule should not be extended to cover private institutions, because states have encouraged providers to convert part of their private institutions into assisted living settings that are on the grounds of, or immediately adjacent to, the institution. They felt that the proposed rules would deny many residents of converted assisted living settings the opportunity to receive Medicaid-funded services.
- CMS should not adopt a rule barring waiver recipients from living in settings designed around diagnoses or disabilities, because the Commenting States favor preserving and expanding the choices currently available to HCBS waiver recipients and oppose any categorical rule that would deny them the opportunity to reside in a setting that is designed to meet the needs of individuals with their particular diagnosis or disability.
- All waiver recipients should be permitted to choose to live in assisted living facilities because for many persons with disabilities—regardless of their age—assisted living settings are the surest way to ensure that they receive the services they need either to move out of an institution or to avoid the need for institutional care in the first place. Medicaid recipients should not be denied access to such a valuable service on the basis of age.
Read their full comments (PDF).
If you are from one of the 14 states that submitted these comments, please consider contacting your state Medicaid Director and organizing a push to urge them to publicly retract their position on these rules. The Center for Disability Rights in Rochester, NY is willing to assist advocates in these states by setting up an email campaign targeted at their Medicaid Director and Governor. Interested folks should email Leah Farrell.
NCIL Healthcare Subcommittee Update on Competitive Bidding
The Centers for Medicare and Medicaid Services (CMS) created a competitive bidding program for purchasing Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). The program establishes rates for certain categories of equipment. It was intended to cut costs and reduce billing discrepancies, as DME has long been a hotspot for Medicare fraud. It has instead resulted in people not being able to find local providers, and delays in deliveries that have lengthened hospital stays and driven up costs. In 2008 the program was delayed, but again resumed stage one in 2011, and is in place in 9 locations.
CMS has announced a timeline to implement round two. Over 100 regions in all 50 states will be affected in 2013 and all areas across the whole nation by 2016. We strongly oppose this program and have been able to delay full implementation of this program, but the beginning stages of round two are upon us.
We applaud the agency’s decision to exempt off-the-shelf orthotics from Round Two of the DME competitive bidding program. Orthotics and prosthetics are clinically-based, complex services that are customized to each individual’s needs. This customization involves a wide variety and configuration of components to achieve maximal function.
However, we have serious concerns regarding items in the new product category “Standard (Power and Manual) Wheelchairs, Scooters, and Related Accessories”
We remain very concerned that CMS plans to bid specialized wheelchair seating cushions and ultra-lightweight manual wheelchairs.
Long-term users of wheelchairs receive immense benefit from customized seating cushions by preserving their skin integrity. We fear that including specialized seating cushions in the program—especially with so many different kinds of cushions being described by so few HCPCS codes—will result in fewer suppliers providing specialized cushions. It would only take a small number of skin ulcers to nullify any cost savings CMS expects from competitively bidding these items. Because receiving the proper seating cushion is integral to the beneficiaries’ health and can prevent very costly and debilitating secondary conditions, we request that CMS reconsider bidding these items in Round Two.
Ultra-lightweight manual wheelchairs and accessories like the specialized wheelchair cushions mentioned above should be exempted from competitive bidding in the same way that complex rehabilitation power wheelchairs were exempted by Congress under Round One. These chairs are customized for long term use and designed to maximize the users’ independence. Any wheelchair accessory that specialized modifications should also be exempt.
We urge you to speak out about this program to you legislators and help us supports H.R. 1041, a bill to repeal the Medicare competitive acquisition program for DMEPOS.
Deadline to Comment on DOT’s Proposed Rules for Accessible Air Travel: January 9!
The U.S. Department of Transportation (DOT) has released a proposed rule titled “Extension and Clarification Notice for ACAA SNPRM on Accessible Web Sites and Automated Kiosks at U.S. Airports”.
The comment period has been extended and comments are now due Monday, January 9, 2012. The purpose of this notice is to give people an opportunity to participate in the rule making prior to the adoption of the rule.
The SNPRM proposed to amend the Department’s disability regulation implementing the Air Carrier Access Act (ACAA) rule, 14 CFR part 382 (Part382), by requiring U.S. and foreign air carriers to ensure that their Web sites and those of their agents are accessible to people with disabilities.
NCIL will submit comments to this proposed rule as a collaborative effort with input from the Technology and Transportation Committees. The final comments will be available to the membership and we will continue to update you on this work as the NCIL staff works closely with the U.S. DOT. Read more information on about this rule at the Regulation Room. Please contact Dara Baldwin, Policy Analyst, at dara@ncil.org with any questions.
New Affordable Care Act Demonstration to Provide Care at Home for Medicare Patients
Up to 10,000 Medicare patients with chronic conditions will now be able to get most of the care they need at home under a new demonstration announced today by the Centers for Medicare & Medicaid Services (CMS).
“This program gives new life to the old practice of house calls, but with 21st Century technology and a team approach,” said CMS Acting Administrator Marilyn Tavenner.
Created by the Affordable Care Act, the new Independence at Home Demonstration greatly expands the scope of in-home services Medicare beneficiaries can receive. The Independence at Home Demonstration will provide chronically ill patients with a complete range of primary care services. Participation in the Demonstration is voluntary for Medicare beneficiaries.
“In my days as a practicing nurse, I saw many patients whose health improved when they were happier with their living conditions,” said Tavenner. “When a critically-ill patient can remain in familiar surroundings, the benefits are many: the person retains greater control over their daily lives, families and caregivers report greater satisfaction with the care, and unnecessary hospitalizations are avoided.”
CMS will join with medical practices to test the effectiveness of delivering primary care services in a home setting on improving care for Medicare beneficiaries with multiple chronic conditions. Medical practices led by physicians or nurse practitioners will provide primary care home visits tailored to the needs of beneficiaries with multiple chronic conditions and functional limitations. Read More.
Landmark Consent Decree Expands Opportunities for Nursing Home Residents with Disabilities!
A groundbreaking Consent Decree approved today in Federal Court will end the forced, long-standing and unnecessary segregation of people with physical disabilities and mental illness living in nursing homes. The agreement in Colbert v. Quinn, signed today by Judge Lefkow, for the first time will give Medicaid-eligible nursing home residents in Cook County a meaningful choice about where they wish to live, affording them the opportunity to live in their own homes and participate in the community.
In Cook County, thousands of people with physical disabilities and mental illness are warehoused in nursing homes because, due to the state’s payment structure, they cannot get the services they need in the community. When the consent decree in Colbert v. Quinn is implemented, the State will provide housing assistance to nursing home residents who wish to transition into the community. “In the nursing home, I lost the freedom to make basic decisions about my own life, like when to get up, what to eat, and who to room with,” said Lenil Colbert, a named plaintiff who lived in a nursing home at the time the original complaint was filed. “I think that everyone in a nursing home should have the option to move out.”
Historically, the biggest obstacle to Medicaid-eligible people with disabilities living in the community has been affordable housing. “Final approval of the Colbert v. Quinn agreement signals a momentous day for nursing home residents with disabilities,” said Steve Libowsky of SNR Denton, the lead attorney for the class. “Because of the way services in Illinois are funded, thousands of people with disabilities are forced to live in nursing homes rather than houses or apartments of their choosing. As a result of this Decree, Illinois will afford people with disabilities a real opportunity to live and participate in their communities and will no longer make a nursing home the only housing option.”
Today’s approval by the Court is the latest development in the case Colbert v. Quinn, originally filed in August 2007 on behalf of a class of nursing home residents with disabilities in Cook County. According to the Americans with Disabilities Act and the 1999 U.S. Supreme Court Olmstead decision, people with disabilities have the right to receive long-term care services in the most integrated setting appropriate to their needs. The vast majority of people with disabilities who are receiving Medicaid have no meaningful alternative to living in a nursing home. “By providing housing assistance, Illinois is addressing the single greatest obstacle to Medicaid-eligible nursing home residents being able to return to the community,” said Steve Gold of the Law Offices of Stephen F. Gold, co-counsel for the class.
“Most of us prefer the comforts of our own homes or apartments, with all the headaches and happiness that can bring. People with disabilities are no different,” said Patti Werner, from Access Living, co-counsel for the class.
Under the Decree, the State will provide housing and related assistance, including personal assistants, to at least 1,100 Cook County nursing home residents with disabilities during the first two and a half year period of the agreement – the first phase. “This Decree is a huge step forward for thousands of people who want to live and participate in communities of their choice,” said Marca Bristo, President & CEO of Access Living. “We commend the Court for approving the decree because it recognizes the right of people with disabilities to choose where to live. We look forward to partnering with the State to implement the agreement.”
After the first phase, the State will continue to provide housing and related assistance to other Cook County nursing home residents with disabilities so they can move into the community. During the second phase, the state will implement a comprehensive plan to move Medicaid-recipients living in nursing homes who desire to move into the community in accordance with a plan based on data collected during the first phase. The State will spend no more, in the aggregate, than what it is now paying to serve people with disabilities living in nursing homes. “Historically, nursing home costs have far exceeded the costs of community-based services,” said Karen Ward of Equip for Equality, co-counsel for the class. “This Decree not only offers people with disabilities the choice to live independently, we believe it will also provide a significant cost savings to the State.”
Colbert v. Quinn is the third in a trio of class actions brought against the State on behalf of people with all types of disabilities living in institutions to assure them the choice to live in the community. The other two cases, Ligas v. Hamos and Williams v. Quinn, reached similar settlement agreements and have also been approved by the Court. “Court approval of the Colbert agreement brings us closer to our goal of ending the involuntary segregation and isolation of people with all types of disabilities in nursing homes and institutions across Cook County and Illinois,” said Benjamin Wolf of the ACLU of Illinois, co-counsel for the class.
Access Living and SNR Denton, which is providing representation on a pro bono basis, are serving as lead counsel on the case. The plaintiffs are also being represented by attorneys from the American Civil Liberties Union of Illinois and Equip for Equality, and by the Law Offices of Stephen F. Gold. Colbert v. Quinn is case number 07 C 4737. For documents related to the settlement, visit www.accessliving.org. For more information, contact Gary Arnold at 312-640-2199 (voice), 773-425-2536 (cell), garnold@accessliving.org .
Governor Cuomo Announces Outer Borough Taxi Agreement
Source: CBS New York
Governor Andrew Cuomo announced a deal Tuesday night to provide taxi service to the outer boroughs. The plan also includes making new medallion cabs accessible to [people with disabilities]. In addition, it will allow livery cabs to pick up street hails for the first time in the outer boroughs.
“It’s very important to me that the bill is something I’m proud of and that all New Yorkers can be proud of. And I don’t believe New Yorkers want a taxi system that is not accessible, period,” Cuomo said Tuesday.
Under the plan, the city will sell 18,000 permits allowing livery cab drivers to pick up passengers north of 96th Street in Manhattan and in the outer four boroughs. “It’s a huge victory for all New Yorkers who have ever sought to hail a cab outside of Manhattan and in northern Manhattan,” Mayor Michael Bloomberg said.
A bill, which would legally permit livery street hails, was passed by the Legislature back in June before it ran into some road blocks, including access for [people with disabilities]. Livery cab advocates also argued that they should be allowed to buy into a medallion system instead of a permit, while yellow cabbies argued the plan would devalue the medallion.
Mayor Bloomberg, a strong proponent of the measure — which also calls for 2,000 additional taxi medallions — believes it would raise much-needed revenue for the city. In fact, the measure could bring in $1 billion of revenue to help the city ease its budget shortfall. Read More. See also: More Disability Advocates Urge Governor to Reject Discriminatory Taxi Bill.
ODEP Celebrates 10 Years
On December 14, the U.S. Department of Labor (DOL) celebrated the tenth anniversary of its Office of Disability Employment Policy (ODEP). In the Great Hall at the Department of Labor, hundreds of DOL staff, Congressional leaders, disability advocates, and individuals with disabilities came together for an afternoon celebration titled “Real People Real Impact”. Secretary Hilda Solis opened the celebration with a speech honoring the team of leaders who developed and implemented legislation to create ODEP. She honored Senator Tom Harkin (D-IA), Chairman of the Senate Committee on Health, Education Labor and Pensions and Representative Steny Hoyer (D-MD), the House Democratic Whip, for their tireless efforts in passing the Americans with Disabilities Act, which enabled the creation of the Presidential Task Force on the Employment of Adults with Disabilities (PTFEAD). ODEP came to exist because of the work done on this important Task Force. Secretary Solis also honored and thanked two of the visionary leaders of ODEP, Former U.S. Congressman from California Anthony “Tony” Coelho and Rebecca “Becky” Ogle who served as Executive Director of the former (PTFEAD).
Assistant Secretary of Labor (ODEP) Kathleen Martinez introduced a short film that explained the history of the creation of ODEP. The film was a documentary style presentation where Tony Coelho and Becky Ogle discussed the process of formulating this department. Tony Coelho was a primary sponsor of the ADA, Chairman of the former President’s Committee on Employment of People with Disabilities (PCEPD), and he worked closely with President Bill Clinton on forming ODEP. He promised President Clinton that after the gathering of data and community outreach there would be enough evidence to prove the necessity for such a department. Becky was charged with collecting this information and she also provided the vision and scope of work that would be done. “ODEP is a sub-cabinet level agency within the DOL. This landmark occasion created, for the first time, a permanent focus on disability within the context of DOL’s overall work.” The focus of the department’s work is to collaborate with federal, state and local government stakeholders to improve employment opportunities for people with disabilities from a public policy perspective.
The next part of the program was a panel moderated by Deputy Secretary of Labor Seth D. Harris, who led a conversation with Assistant Secretary Martinez and two former secretaries: W. Roy Gizzard and Neil Romano. They discussed the fact that the focus of ODEP has moved from whether people with disabilities can work to one focused on effective strategies to facilitate their success. The panel also discussed ODEP’s current focus on making sure skilled and talented people with disabilities are able to be a benefit to employers of all sizes and industries in the 21st Century. The give away to each participant for the celebration was a booklet with a disk titled “Promoting Positive Change: Disability Employment Policy in Action”. In the booklet the department highlighted 15 different people with disabilities working in multiple fields and industries. All 15 were at the celebration and at the end they were introduced while the crowd applauded them for their work and for being highlighted in the book.
See more information about this celebration. The NCIL staff works closely with ODEP and Secretary Martinez on multiple projects. For more information on that work, please contact Dara Baldwin, Policy Analyst, at dara@ncil.org.
The Riot Presents: Space Race, A Game to Teach and Learn about Self-Determination
Space Race is a board game designed to teach people with disabilities and others how to apply self-determination skills to their own lives. Addressing topics like self-advocacy, making decisions, taking responsibility and learning from mistakes, Space Race provides a fun activity for discussing what individuals want regarding relationships, community life, work, housing, health and well-being.
Whether you’re a student transitioning from school to adult life, a person who wants to take charge of your own life, a family member, or a professional supporting people to design their own lives, you will find Space Race a valuable and relevant resource. Learn More.
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January 4, 2012