Inside Washington Final 06 edition

[Guest guest]

INSIDE WASHINGTON

An Update of Important Events in the Nation's Capitol

Published by the National Disability Rights Network

900 Second Street, N.E., Suite 211

Washington, D.C. 20002

voice; tty; fax;

www.ndrn.org

December 22, 2006

Volume 5 No. 16

This edition of Inside Washington will be the final for 2006 and the 109th

Congress. Despite being labeled a " lame duck " Congress, Senators and

Representatives returned for a final week of voting during the week of December

4th and passed several important pieces of legislation. They did not, however,

pass needed appropriations bills, opting instead to pass a continuing resolution

to fund federal programs until February 15th. Many are describing the 109th

Congress as one of the worst in history for its inability to pass legislation

and fund government services. Given the election results, disability advocates

are looking forward to new leadership in Congress, although the optimism is

tempered by the realities of the spiraling deficit and the ongoing costs of the

war in Iraq.

NDRN's Legislative Committee members and Public Policy staff are drafting a

legislative agenda for the 110th Congress which convenes on January 4th. As the

year comes to the end, we would like to wish you all the best for the holiday

season.

--Kathy McGinley, Catriona , Joanna Solkoff

Inside Inside Washington

Congress Wraps Up p. 2

Continuing Resolution Passed p. 4

Disability Legislation Outlook p. 4

Medicaid Commission Makes Recommendations p. 5

Medicaid Directors Meet p. 8

CMS Releases Regulations on Restraints

p. 9

Bush Social Security Agenda Unclear p. 9

House/Senate Committee Assignments Begin p. 10

PANDA Updates:

New SAMSHA Administrator

p. 11

2007 Congressional Schedule

p. 11

Congress Wraps Up

Congress finished up its final week in session just before 6 am on Saturday,

December 9th, closing the 109th Congress. Before leaving, the following pieces

of legislation were passed:

· Appropriations: Congress passed a Continuing Resolution (CR) on

Friday, December 8th, which will fund all government programs at the lower of

the house-passed level, senate-passed level, or the FY 2006 level. Because a

Labor, Health and Human Services, and Education (LHHS) appropriations bill did

not pass the House or Senate this year, all LHHS programs will continue at the

FY 2006 level through February 15th, 2007.

· Combating Autism Act: Despite initial objections by Representative

Joe Barton (R-TX), autism groups were able to strike a deal which saw the

Combating Autism Act (S. 843) passed by both the House and Senate. The bill now

goes to the President's desk to be signed into law.

The legislation authorizes almost $1 billion through 2011 in federal funding for

autism-related research, early detection and intervention. S. 843, authored by

Senators Santorum (R-PA) and Dodd (D-CT), first passed unanimously in the Senate

on August 3, 2006. The U.S. House passed an amended version on December 6, 2006

and a day later the Senate passed the amended version. Key provisions of the

bill include:

ü Developing and implementing a strategic plan for research related to

autism spectrum disorders;

ü Reauthorizing Autism Centers of Excellence and providing funds to the

centers for coordination of services and information for patients;

ü Supporting basic and clinical research;

ü Improving coordination of the various federal, State, and local supports

and services available to persons with autism and families affected by autism;

ü Increasing the number of providers that can screen, diagnosis and

provide interventions to persons with autism; and,

ü Promoting research to determine evidence-based best practices for

diagnosis, early detection, prevention, and intervention for autism spectrum

disorders.

· Lifespan Respite Care Act: On December 6, the House passed the

Lifespan respite Care Act (H.R. 3248) sponsored by Reps. Ferguson (R-NJ)

and Jim Langevin (D-RI). Two days later, the bill was approved by the Senate.

Senators Hillary Clinton (D-NY) and Warner (R-VA) co-sponsored the Senate

bill. The original majority co-sponsor, Senator Olympia Snowe (R-ME), also

helped to secure final Senate passage. The bill now goes to the President's

desk to be signed into law.

The Lifespan Respite Care Act provides $30 million in the first year and almost

$300 million over five years for competitive grants for states and local

agencies to increase the availability of respite care services for family

caregivers of individuals with disabilities and special health care needs

regardless of age. The bill also promotes a coordinated system of accessible

respite care at the state and federal levels.

· Tax Relief and Health Care Act: A last minute bill extended a number

of tax provisions and made changes to the Medicare and Medicaid programs,

including providing language clarifying portions of the Deficit Reduction Act of

2005 (DRA). Among other things, the bill:

ü Extends Transitional Medical Assistance under Section 1925 of the Social

Security Act through June 30, 2007.

ü Reduces the provider tax " safe harbor " upper limit from 6% to 5.5%

ü Exempts from the general cost-sharing rules (a) all individuals in

families with income below 100% of the federal poverty line (FPL). Section 1916

of Title XIX (nominal cost-sharing provisions) would still apply to this income

group, as would the comparability rule regarding amount, duration and scope of

available benefits (Section 1902(a)(10)(). States would still have the option

to impose the special cost-sharing rules for prescribed drugs and non-emergency

care provided in an emergency room to individuals in families with income below

100% FPL.

ü Amend the definition of preferred drugs under Medicaid to include those

that are the most (or more) cost effective prescription drugs within a class of

drugs (as defined by the state).

ü Clarifies that for non-exempt persons with income between 100-150% FPL,

cost-sharing for non-emergency care in an ER may not exceed twice the applicable

nominal amount (up to the 5% aggregate cap).

ü Exempts from the premium and service-related cost-sharing rules newly

eligible children with disabilities (those eligible under the state optional

Family Opportunity Act).

ü Clarifies that, among the groups explicitly exempted from the general

cost-sharing provisions for premiums and cost-sharing, are those receiving child

welfare services made available under Title IV-B on the basis of being a child

in foster care.

ü Specifies that the citizenship documentation requirements do not apply

to an individual declaring to be a citizen or national of the United States who

is eligible for Medicaid:

Ø and is entitled to or enrolled for Medicare benefits;

Ø and is receiving (1) Social Security benefits on the basis of a

disability or (2) SSI benefits;

Ø and with respect to whom (1) child welfare services are made available

under Title IV-B of the Social Security Act or (2) adoption or foster care

assistance is made available under Title IV-E; or

Ø on such basis as the Secretary may specify that satisfactory documentary

evidence has been previously presented.

· White HIV/AIDS Treatment Modernization Act: On December 6th, the

Senate passed the White HIV/AIDS Treatment Modernization Act (H.R. 6143),

after a deal was crafted to appease Senator Clinton (D-NY) and other legislators

concerned over the bill's funding levels for large urban centers. The

reauthorization had pitted cities with larger populations of individuals with

HIV/AIDS against rural communities where HIV/AIDS is now spreading fastest.

Among other steps taken to broker a deal, the reauthorization was shortened to

three years so the money disbursements would be revisited by Congress sooner.

Continuing Resolution Passed

a.. Before leaving for their districts, Congress passed a Continuing

Resolution (CR) to keep the federal government running until February 15, 2007.

For P & A/CAP programs, funding will therefore continue at FY 2006 levels until

that time.

a.. Shortly thereafter, the incoming Chairs of the Appropriations Committees,

Representative Obey (D-WI) and Senator Byrd (D-WV), announced that

they would extend the CR for the remainder of Fiscal Year 2007 when Congress

convenes in January. They also stated that they would exclude all earmarks in

the CR giving appropriators up to $7 billion to increase priority spending for

discretionary programs.

Disability Legislation Outlook for Next Year

· Health, Education, Labor, and Pensions (HELP) Committee staff from the

offices of Senator Kennedy (D-MA) and Senator Enzi (R-WY) met with disability

advocacy groups in November to begin to outline a disability agenda for the

110th Congress. The two offices have a history of bipartisanship on disability

issues and stated that this will continue when Senator Kennedy takes over as the

Committee's Chairman. The HELP Committee will now have 11 Democrats and 10

Republicans. Added on the Democratic side will be Senator (I-VT), Obama

(D-IL), and Brown (D-OH). It appears that the new Republican on the Committee

will be Senator Coburn (R-OK). Subcommittees have not yet been determined,

however Committee staff said that there are no plans to create a disability

subcommittee because of a strong belief disability policy should be part of all

legislation not a set aside group.

· While a couple of pieces of disability legislation were passed during

a lame duck session (Combating Autism Act, Lifespan Respite), the bulk of

disability legislation will be carried over into the next year, including

reauthorization of the Rehabilitation Act, Traumatic Brain Injury Act, Mental

Health Parity, the Higher Education Act, the Protecting Children's Health in

Schools Act, Hate Crimes legislation, and reform of the Javitz-Wagner-O'Day and

Randolph-Sheppard Acts. Other issues on the agenda for the coming year include,

SAMHSA reauthorization and school mental health, the No Child Left Behind Act,

DD Act Reauthorization, and ADA Restoration legislation.

· Other proposals, such as legislation to expand Medicare to everyone

under age 65 as a step toward universal coverage, may take longer to build

support for, Kennedy said. Rather than push for such a bill immediately, Kennedy

said, lawmakers should begin addressing expanding health insurance coverage by

reauthorizing the State Children's Health Insurance Program.

Medicaid Commission Votes on Recommendations & Submits Report to Congress

· The Final Medicaid Commission Meeting was held on November 16th and

17th, during which the Commission members heard public comments, discussed

amendments to their proposed recommendations, and voted on their final

recommendations to submit to Congress. NDRN reviewed the hundreds of

recommendations created by the Commissioners and submitted a list of the best 15

and the worst 14. Unfortunately, it looks like the recommendations NDRN viewed

as worst were the Commission's best.

· It is important to note that the newly Democratic-held Congress may

have a large effect on the implementation of the Commission's final

recommendations. Originally the concept of the Medicaid Commission was created

through a bipartisan effort in the Senate in 2005. Controversy arose when the

Bush Administration implemented the idea through the U.S. Department of Health

and Human Services, and controlled who the members were. Democratic members of

Congress at the time refused to participate or nominate others because the

Commission was set up so that they would hold no voting power. In light of the

all of the controversy around the creation of the Commission, it is very

possible that the now Democrat majority in Congress may be resistant to the

Commission's report and its recommendations. In summary form, final

recommendations of the Commission were:

A. Long-Term Care

1) Public policy should promote individual responsibility and planning for

long-term care needs. Congress, the Administration, and states should implement

measures that encourage individual planning for long-term care, such as:

ü Provide federal and state tax incentives to encourage individuals to

purchase long-term care insurance.

ü Provide federal and state tax incentives to employers to offer long-term

care insurance as an employee benefit.

ü Provide tax deductions/tax credits to encourage those providing informal

care to continue in this effort.

ü Promote the use of home equity by individuals to finance long-term care

services needed to maintain the individual in his or her own residence and

prevent or postpone Medicaid enrollment.

ü Increase state participation in the federally-sponsored Long-Term Care

Awareness Campaign to improve public education about the importance of

individual planning for long-term care needs.

ü The Commission recommends a study of policy options for using

alternative insurance models for the provision of long-term care services. This

study should include analyses of costs, revenue and governmental administration.

2) Changes in Medicaid long-term care policy should address institutional bias

and reflect what most seniors and persons with disabilities say they want and

need, which is to stay at home in their communities in the least restrictive or

most integrated setting appropriate to their long-term care needs in a place

they call home.

ü New Medicaid policy should respect beneficiary preferences.

ü States should explore and build on new long-term care options authorized

by the Deficit Reduction Act of 2005. States, CMS, and Congress should be

encouraged to utilize existing Medicaid resources to maintain and/or incorporate

long-term care services within Medicaid State Plans that include nursing

facilities, personal care, respite care, Intermediate Care Facilities for the

Mentally Retarded (ICF/MR), home health, adult day services and other services

currently offered in state plans and as Home- and Community-Based Services

(HCBS). In most cases, home- and community-based services are less expensive

than institutional services and preferable to the beneficiary.

ü States should expand use of the Cash and Counseling model.

B. Benefit Design

1) States should be given greater flexibility to design Medicaid benefit

packages to meet the needs of covered populations.

2) Federal Medicaid policy should promote partnerships between states and

beneficiaries that emphasize beneficiary rights and responsibilities and reward

beneficiaries who make prudent purchasing, resource-utilization, and lifestyle

decisions.

3) States should have the flexibility to replicate demonstrations that have

operated successfully for at least two years in other states, using an

abbreviated waiver application process.

4) Compliance with existing regulations regarding the public notice and comment

period about state proposals that would significantly restructure Medicaid (1115

waivers and state plan amendments) should be monitored and enforced.

C. Eligibility

1) Medicaid eligibility should be simplified by permitting states to consolidate

and/or redefine eligibility categories without a waiver, provided it is

cost-neutral to the federal government.

2) The federal government should provide new options for the uninsured to obtain

private health insurance through refundable tax credits or other targeted

subsidies so they do not default into Medicaid.

3) Medicaid's core purpose is to serve needy low-income individuals, especially

the most vulnerable populations. Therefore, the Commission recommends a study of

a new " scaled match " funding formula in which the federal government would

reimburse states at an enhanced matching rate for adding lower-income

populations to the program, with the match rate scaling back as they expand

Medicaid to higher-income populations.

D. Health Information Technology

1) The Commission wants to emphasize the importance of investments in health

information technology. The Commission, therefore, recommends that the budget

scoring process utilized by the Congress amortize the cost of investments in

health information technology over a period of five years, while also accounting

for the long-term savings.

2) HHS should continue to aggressively promote and support the implementation of

health information technology through policy and financing initiatives while

ensuring interoperability.

3) All Medicaid beneficiaries should have an electronic health record by 2012.

4) State Medicaid agencies should include in contracts or agreements with health

care providers, health plans, or health insurance issuers that as each provider,

plan, or issuer implements, acquires, or upgrades health information technology

systems, it shall adopt, where available, health information technology systems

and products that meet recognized interoperability standards.

5) HHS, state Medicaid agencies, and their vendors shall assure that health

information technologies that are acquired or upgraded continuously meet federal

and state accessibility requirements.

E. Quality and Care Coordination

1) States should place all categories of Medicaid beneficiaries in a coordinated

system of care premised on a medical home for each beneficiary, without needing

to seek a waiver or any other form of federal approval.

2) The Commission recommends the following reform proposals to support the

development and expansion of integrated care programs that would promote the

development of a medical home and care coordination, while also providing

necessary safeguards, for dual eligible beneficiaries:

ü State Plan Option. Allow states to integrate acute and long-term care

benefits/services for dual eligibles through Special Needs Plans (SNPs) or other

mechanisms via the state plan.

ü Inclusive Participation. Allow states to operate an integrated care

management program that provides for " universal " (automatic) enrollment of dual

eligibles with an opt-out provision, thus preserving beneficiary choice while

allowing states to have a mechanism to improve the care and cost-effectiveness

of care provided.

ü Streamline Medicaid and Medicare Rules/Regulations. Identify

opportunities to reduce administrative barriers to an integrated approach to

care (e.g., marketing, enrollment, performance monitoring, quality reporting,

rate setting/bidding, and grievances and appeals).

ü Dual Eligible Program. Authorize states to implement, at their option, a

new program for dual eligible beneficiaries, called Medicaid Advantage, that

integrates Medicare and Medicaid benefits (e.g., primary, acute, behavioral,

long-term care services and supports).

ü Savings. States and the federal government should share in savings for

dual eligible members that are achieved through innovative care management

strategies resulting in improved clinical and financial outcomes.

3) CMS should establish a National Health Care Innovations Program to 1) support

the implementation of state-led, system-wide demonstrations in health care

reform and 2) make data design specifications available to all other states for

possible adoption.

4) State Medicaid agencies shall make available to beneficiaries the payments

they make to contracted providers for common inpatient, outpatient and physician

services.

5) In order to pay for quality, states must first be able to measure it.

Therefore, states should collect and mine data on how Medicaid money is being

spent to determine which programs, providers, and services are effective and

which need improvement. Payments to Medicaid providers then should be tied to

objective measures of risk- and case-adjusted medical outcomes. This will lead

Medicaid to become more patient focused, i.e., funding health care in a way that

assures patients are getting the care they need.

6) CMS and Congress should support state innovation to deliver value for

taxpayer dollars by purchasing quality health care outcomes as opposed to simply

reimbursing for health care processes. The Commission, therefore, recommends

that CMS and Congress provide enhanced match and/or demonstration funding, to be

recouped from savings over a five-year period, to support upfront investments in

quality improvement in targeted areas: development/enhancement of standardized

performance measures, particularly for children, persons with disabilities,

populations who experience disproportionate health disparities, and the frail

elderly; implementation of care management programs targeted at high-risk, high

cost, co-morbid beneficiaries; and the creation of provider-level

pay-for-performance programs.

Meanwhile Medicaid Directors Meet

· Just prior to the Medicaid Commission's meeting, state Medicaid

directors met in Washington with the hope that Bush administration would reverse

its plans to cut over $12 billion from Medicaid over five years without

consulting Congress. CMS officials told state Medicaid directors that the

administration plans to go ahead with new regulations to address what they term

controversial accounting maneuvers used by some states. Dennis , director

of the federal government's Center for Medicaid and State Operations, addressed

controversial use of Medicaid by schools saying state are claiming that their

administrative expenses are higher than the cost of the actual service.

· In addition to school Medicaid reimbursement, the administration is

seeking the following regulatory changes:

ü Reducing the maximum tax states can impose on providers from 6 percent

to 3 percent.

ü Assuring that government providers (ie. public hospitals) are only

reimbursed for the cost of the services they provide.

ü Putting further limits on the use of intergovernmental transfers (IGTs).

ü Narrowing definitions of rehabilitative services.

The meeting was also attended by members of ADAPT, who distributed flyers on

Money Follows the Person and sought meetings with officials.

CMS Releases Regulations on Use of Restraints

· On December 8th, the Centers for Medicare and Medicaid Services (CMS)

released final regulations on the use of restraints and seclusion governing

hospitals including short-term, psychiatric, rehabilitation, long-term,

children's and alcohol/drug treatment facilities. The regulations are a

condition of participation in the Medicare and Medicaid programs and come more

than seven years after legislation designed to end the inappropriate use of

seclusion and restraint, and months after a report by the Office of the

Inspector General found that hospitals are still relying on deadly restraint

practices and failing to report the resulting deaths.

· Under previous regulations the protection of a face-to-face evaluation

by a physician within an hour of a patient being restrained or secluded for the

management of violent or self-destructive behavior was required. This is

weakened under the new regulations which expand the list of professionals

qualified to do the face-to-face evaluations to include a trained registered

nurse (RN) or physician assistant (PA). The rule requires that when an RN or PA

performs the 1-hour-rule evaluation, the physician treating that patient be

consulted as soon as possible. NDRN had worked with other advocates, including

The Arc of the United States, the Bazelon Center for Mental Health Law, the

National Alliance on Mental Illness, Children and Adults with Attention

Deficit/Hyperactivity Disorder, Mental Health America (formerly the National

Mental Health Association), and United Cerebral Palsy to attempt to maintain the

1-hour physician rule. A letter sent to CMS states that the " one-hour rule " is

essential for ensuring the safety of individuals who have been placed in

restraints or seclusion. The premise that a qualified physician should evaluate

individuals experiencing cardiac or other medical emergencies is unquestioned.

The same principle should apply to individuals who are being restrained or

secluded. P & As are encouraged to monitor implementation of the new

regulations.

Bush Social Security Agenda Unclear

· A day after the November elections, President Bush announced that he

had deputized Henry son Jr., the secretary of the Treasury, to work with the

new Congress on reforming Social Security. Bush then nominated Biggs, an

advocate of privatizing Social Security, to a six-year term as the next deputy

commissioner of Social Security. While son has a reputation for being able

to work in a bipartisan fashion, advocates believe that by nominating Biggs Bush

is signaling his continuing agenda to privatize Social Security. To further

confuse the issue, the next commissioner of Social Security, Astrue, has

publically stated that he would follow the practice of the current commissioner,

Jo Anne Barnhart, who has steered clear of the privatization debate.

House/Senate Committee Assignments Begin

· Speaker-designate Pelosi announced the Chairs of six House

Committees:

ü Congressman (CA) as Chairman of the Education and

Workforce Committee

ü Congressman Henry Waxman (CA) as Chairman of the Government Reform

Committee

ü Congressman Ike Skelton (MO) as Chairman of the Armed Services Committee

ü Congressman Tom Lantos (CA) as Chairman of the International Relations

Committee

ü Congressman Collin (MN) as Chairman of the Agriculture

Committee

ü Congressman Bennie (MS) as Chairman of the Homeland Security

Committee.

Pelosi also named 10 new members to the House Appropriations Committee; they

are:

ü Congresswoman Barbara Lee (CA)

ü Congressman Tom Udall (NM)

ü Congressman Adam Schiff (CA)

ü Congressman Honda (CA)

ü Congresswoman Betty McCollum (MN)

ü Congressman C.A " Dutch " Ruppersberger (MD)

ü Congressman Tim (OH)

ü Congresswoman Debbie Wasserman Schultz (FL)

ü Congressman Ben Chandler (KY)

ü Congressman-elect Ciro (TX)

· Congresswoman Sánchez (CA) was also named to the Education and

Workforce Committee.

· Senate Republicans also completed their proposed list of committee

assignments, adjusting to the fact that they will lose one or two seats on most

committees. Before assignments can be finalized, however, Senate leaders must

agree on the committee ratios, a process that will not take place until January.

Disability-related committee designees are the following new members:

ü Appropriations Committee

Ø Allard (CO)

Ø (TN)

ü Health, Education, Labor and Pensions (HELP) Committee

Ø Murkowski (AK)

Ø Allard (CO)

Ø Coburn (OK)

ü Finance Committee

Ø (KS)

Panda Updates

Terry L. Cline approved as SAMHSA Administrator by HELP Committee

· Before leaving Washington, the Senate Health, Education, Labor and

Pensions (HELP) Committee approved the nomination of Dr. Terry Cline as the

Administrator of the Substance Abuse and Mental Health Services Administration

(SAMSHA). Dr. Cline served as the Oklahoma Secretary of Health and Commissioner

of the Oklahoma Department of Mental Health and Substance Abuse Services. Prior

to that, he served as a Health Care Policy Fellow at SAMSHA.

2007 Congressional Calendar

January 4 - House and Senate Reconvene

January 5 - Senate Recess

February 19-23 - House and Senate Recess

April 3-9 - House and Senate Recess

April 10-13 - House Recess

May 28-June 1 - House and Senate Recess

July 2-6 - House and Senate Recess

August 6-September 3 - House and Senate Recess

October 26 - Target House Adjournment

November 6 - Election Day

All issues of Inside Washington are available at www.ndrn.org under Legislative

Affairs. The Public Policy Staff at NDRN wish you a Happy Holiday season...

T.

Faculty

University of Phoenix

mtbclarion@...

mtbclarion@...

Central Time