| Volume 08 | Issue 46 | November 17, 2008 |
Welcome to Monday Morning in Washington, D.C., published weekly by The Arc of the United States. We will bring to you news of interest to self advocates and their families, volunteers, professionals, and supporters of the disability movement. Please send any comments to mmwdc@thearc.org. You are welcome to reproduce and distribute items from Monday Morning in Washington, D.C., but please credit Monday Morning in Washington, D.C. (The Arc of the United States, 2007).
The Arc of the United States advocates for the rights and full participation of all children and adults with intellectual and developmental disabilities. Together with our network of members and affiliated chapters, we improve systems of supports and services; connect families; inspire communities; and influence public policy.
[NOTE: Having trouble reading this newsletter? Read it online.] [Past Issues]
For more information, and a complete summary of the Social Security changes, please visit http://www.ssa.gov/cola/colafacts2009.htm.
New web community, www.gettinghired.com - careers and community for people with disabilities. GettingHired.com is designed to connect people with disabilities with each other and employers committed to hiring them. There are tools to build your resume & create your profile so employers can tap into one of the most under-utilized labor pools…people with disabilities!
Bridges4Kids NewDigest, November 10, 2008
Inclusion Champion Award to Honor Efforts on Behalf of Youth With Disabilities
The Mitsubishi Electric America Foundation, which works to help young people with disabilities to lead full and productive lives, is accepting nominations for the MEAF Inclusion Champion Award. The award honors individuals who have made significant efforts to promote the full inclusion of youth with disabilities in society. Deadline: December 1, 2008. Visit http://meaf.org/ for more information.
American Bar Association Invites Nominations for Disability Rights Award
The Paul G. Hearne award honors an individual or organization that has performed exemplary service in increasing access to justice for people with disabilities.... Deadline: April 1, 2009 Posted: November 10, 2008 http://foundationcenter.org/pnd/rfp/rfp_item.jhtml?id=233100014
[nectac-enotes] NECTAC eNotes - November 14, 2008
Current and past issues of eNotes can be searched online at http://www.nectac.org/enotes/enotes.asp. In this Issue:
November 2008 NCPAD Monthly Newsletter
A monthly publication of NCPAD - the NATIONAL CENTER on PHYSICAL ACTIVITY and DISABILITY www.ncpad.org
The Disability Law & Policy e-Newsletter Vol 5, No. 9
An electronic publication of The Law, Health Policy & Disability Center at the University of Iowa College of Law http://disability.law.uiowa.edu/ and The Burton Blatt Institute at Syracuse University http://bbi.syr.edu
Medicaid Reductions and People with Disabilities -
Information Bulletin # 266 (11/08)
As the economy continues to dramatically impact on State budgets, Medicaid
expenditures will come under attack. Here are some suggestions advocates
might wish to consider. I think it is very important to keep emphasizing
the ADA and the importance of keeping people with disabilities and the
elderly in the community.
1. Focus on your state's Medicaid nursing facility expenditures.
Nationally, from FY 2002 through FY 2007, the national % increase in
Medicaid nursing facilities' expenditures was only 1.3%. However, many
states had significantly larger increases.
The following 21 states had more than a 20% increase in nursing home
expenditures during these six years: Alabama, Alaska(45%), California,
Colorado, Connecticut, Delaware, Florida, Hawaii, Kentucky, Maine,
Maryland, Mississippi (55%), Nevada (45%), New Hampshire, North Carolina,
Oregon, South Carolina, Tennessee, Utah (70%), West Virginia (35%), and
Wyoming.
Organize to force your state to cap its nursing facility expenditures.
As long as your state continues to increase its Medicaid nursing home
expenditures, nursing facilities will have an incentive to admit people
who could otherwise live in the community. Therefore, no more Medicaid
increases to unnecessarily institutionalize people with disabilities.
2. Save Medicaid funds by transferring nursing homes expenditures.
Get your state to tell nursing home residents that if a person moved to
the community each of them will receive at least 90% of the amount of
Medicaid funds your State spends on them in nursing facilities. In FY
2007, nationally states spent nearly $47 billion of Medicaid expenditures
on nursing homes, compared to only $6.3 billion on all Aged/Disabled
Waivers in the community.
For people who want to live in the community, your state could save 10% of
the nursing home expenditures and, at the same time, do what people want
- permit them to reside in their own homes and apartments with services
paid with the 90% of the nursing home costs.
3. Save Medicaid funds in hospital reimbursements.
In FY 2007, nationally states spent $43 billion on in-patient
hospitalizations. Many of those people were hospitalized for some time
because there was not a community-based support system where they could
receive the same supportive services they were receiving in the hospitals.
I do not have good data that reflects how many days people were
unnecessarily hospitalized primarily because there was not system to
provide services in the community. However, I do know that nearly 60% of
nursing home admissions are directly from acute care hospitals. Many of
those people would not have gone to a nursing facility if there were a
real choice and if someone explained to talked to them about
community-based services.
4. Close the front door of nursing homes.
I am still dumbfounded why 11% of nursing home admissions are for persons
who were in their own homes and apartments and had not received any home
health services before they went straight into a nursing facility. (This
11% is separate from the 60% who were admitted from an acute care
hospital.) Clearly, states have not "closed the front door," but still
permit people to be admitted directly into nursing homes without the state
Medicaid officials or advocates for elderly and disabled asking these
folks what services they might need and want to stay in their own homes
and apartments.
5. Other Suggestions - I'd like to hear other suggestions.
Please email
to stevegoldada@cs.com, subject: "save Medicaid funds".
Steve Gold, The Disability Odyssey continues
Back issues of other Information Bulletins are available online at
http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects.
To contact Steve Gold directly, write to stevegoldada@cs.com or call
215-627-7100.
Back issues of other Information Bulletins are available online at
http://www.stevegoldada.com
hcbs.org > Clearinghouse CLIPS: November 12, 2008
CMS has issued a new letter, part of a series of CMS communications, that supports state efforts to improve the quality of services and supports provided through the Medicaid Home and Community-based Services waiver program.
CMS Letter: HCBS Quality Communication #14
Summary: This communication announces three new items designed to assist states in enhancing oversight and operations: GAO Mortality Study in Developmental Disabilities, HCBS Quality Requirements Grid: A Technical Assistance Tool and the National HCBS Quality Enterprise award to Thomson Reuters.
Topic(s): Developmental/Psychiatric Disabilities, Long-Term Care, Money Follows the Person, Quality
Source: CMS
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2415
Archived Conference Materials:
HCBS Conference 2008 – Agenda and Presentations
Summary: The 24th Annual Home and Community Based Services Conference was held in Boston in October, 2008. Administrators, researchers, educators and providers met to learn about policies, research, and new waiver and technical assistance and training opportunities. The full range of HCBS issues was covered including Medicaid basics, creativity in wavier design, balancing long term services, nursing home diversion issues and quality management strategies.
Topic(s): Accessibility, Aging Issues, Consumer Direction, Deficit Reduction Act, Financing HCBS, Housing, Long-Term Care, Mental Health, Money Follows the Person, Physical Disabilities, Quality, State/Agency Information, Transition/Diversion from Institutions, Waiver, Workforce/Direct Care
Source: NASUA; National Association of State Units on Aging
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2414
2008 ADRC National Meeting - Agenda and Presentations
Summary: The 2008 national Aging and Disability Resource Center meeting took place in October in Boston. Find here the presentations and handouts from the workshops and plenary sessions. Topics ranged from nursing home diversion to quality to information flow and technology.
Topic(s): Accessibility, Aging Issues, Financing HCBS, Quality, Resource Center, Single Point of Entry/No Wrong Door, Transition/Diversion from Institutions
Source: The Lewin Group
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2418
NASHP's 2008 State Health Policy Conference Presentations: Charting a Course for State Health Policy
Summary: Presentations from NASHP’s 21st annual state health policy conference are now available. The conference is planned by state health policymakers for state agencies' staff, legislators, and legislative staff. Review the presentations to learn how others are improving and innovating healthcare through state-level policy.
Topic(s): Employment Programs, Financing HCBS, Long-Term Care, Mental Health, Quality, Transition/Diversion from Institutions, Workforce/Direct Care
Source: National Academy for State Health Policy; NASHP
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2422
Family Support 360 Presentation: TA Call on Emergency Preparedness with Commissioner Morrissey
Summary: This is a presentation hosted by the Administration on Developmental Disabilities and their TA providers, BETAH Associates, which includes a discussion of emergency preparedness, with a focus on individuals with disabilities. The presentation was given by Patricia A. Morrissey, Commissioner of the federal Administration on Developmental Disabilities. The last few slides contain a list of additional resources.
Topic(s): Developmental/Psychiatric Disabilities, Organizational Change, Physical Disabilities
Source: Administration on Developmental Disabilities
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2424
New Resources:
2008 Actuarial Report on the Financial Outlook for Medicaid
Summary: Determining how to optimally balance our demand for the best health care with limited funding represents one of the most challenging policy dilemmas facing the U.S. To help understand how to best accomplish this task, the document authors forecast Medicaid expenditures and enrollment for the next ten years. The data are organized by enrollment groups and service settings/categories.
Topic(s): Aging Issues, Financing HCBS, Long-Term Care, State/Agency Information, Sustainability
Source: CMS
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2420
ADRC Marketing Plan - Kansas
Summary: This is a marketing plan developed by the Kansas ADRC to describe their program. They use the message, "Kansas Aging and Disability Resource Connection offers a starting point for access to person-centered information and assistance that supports independence." Review their ideas on how to reach partners.
Topic(s): Aging Issues, Developmental/Psychiatric Disabilities, Resource Center
Source: Grantee produced, Kansas ADRC
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2425
ArchiveADA: The Path to Equality – Website
Summary: Here is a one stop resource of documents and history related to the Americans with Disabilities Act of 1990 (ADA) and the ADA Amendments Act of 2008 (ADAAA). In addition to the text, summary, and legislative history of the laws, you can find advocacy resources, news and analysis. The attached article serves as a general summary of the history of the ADA and the effort to restore its original intent of achieving full civil rights for people with disabilities through the ADAAA.
Topic(s): Accessibility, Resource Center
Source: Georgetown Law
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2423
Choices in Living Resource Center Brochure - Arkansas
Summary: This brochure offers information for older adults, caregivers and individuals with disabilities living in Arkansas on long-term living supports and services. The brochure serves as example of how other ADRCs might consider spreading the word about their program and services.
Topic(s): Aging Issues, Physical Disabilities, Resource Center
Source: Grantee produced, Arkansas
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2412
Client Satisfaction / Program Evaluation Plan for Case Managed Programs at the Area Agency on Aging of Pasco-Pinellas, Inc.
Summary: This document describes new processes developed at an Area Agency on Aging (AAA) in Florida to ensure that clients are receiving quality case management services. The report contains flow diagrams depicting evaluation process for monthly home visits, provider review during annual monitoring, and complaint tracking as well as the new client satisfaction process which is to implemented annually.
Topic(s): Quality, Resource Center, State/Agency Information
Source: Area Agency on Aging of Pasco-Pinellas, Inc.
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2431
Common Intake Form - Arizona Links ADRC
Summary: This document includes the “Arizona Links” common intake form as well as the instructions for completing the form. This common intake is intended be filed on behalf of a consumer, who is a resident or intends to become a resident of Arizona, and who is seeking or requiring direct services in the state.
Topic(s): Aging Issues, Developmental/Psychiatric Disabilities, Physical Disabilities, Resource Center
Source: Grantee produced, Arizona
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2410
Disability and Health in the United States, 2001-2005
Summary: Charts and data illustrate health-related differences between disabled and non-disabled noninstitutionalized adults in this report. Data are from the National Health Interview Survey. One section illustrates differences in access to care and health insurance coverage. Numbers on the prevalence of disabilities, demographics, and health behaviors and risks are also given.
Topic(s): Aging Issues, Developmental/Psychiatric Disabilities, Long-Term Care, Mental Health, Physical Disabilities
Source: National Center for Health Statistics
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2426
Going from Good to Great: Livable Communities Surveys in Ohio
Summary: Is your area a livable community? You can use this survey and accompanying reports as a model for finding out. AARP defines a livable community as one that allows people to maintain their independence and quality of life as they age and retire. Aspects that make a community livable include mobility, community supports, and affordable housing. Residents age 45 years and older in two OH counties were surveyed to measure whether these things are truly available in their communities.
Topic(s): Accessibility, Aging Issues, Housing
Source: AARP; American Association of Retired Persons
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2430
HCBS Quality Requirements Grid: A Technical Assistance Tool
Summary: In an effort to address integration across CMS Home and Community-based Services Programs, CMS worked with its National Quality Contractor to develop an this matrix. The Grid highlights specific quality requirements across HCBS program authorities that include program standards, measures, accountability, and sources of financing for quality activities. The tool is expected to be a helpful resource for planning purposes and for providing technical assistance to states and researchers.
Topic(s): Quality, Waiver
Source: CMS, Thomson Reuters (formerly Medstat)
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2417
Headed for a Crunch: An Update on Medicaid Spending, Coverage and Policy Heading into an Economic Downturn: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2008 and 2009
Summary: This is the eighth consecutive year that state Medicaid officials were surveyed to track program trends. In addition to data on expenditures and enrollment, the report outlines policy enhancements and restrictions in all states and the District of Columbia. The resource ends with a discussion of current key Medicaid issues and perspectives of State Medicaid Directors.
Topic(s): Financing HCBS, Long-Term Care, State/Agency Information, Waiver
Source: Kaiser Commission on Medicaid and the Uninsured; KCMU; Health Management Associates; HMA
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2421
Healthy Aging Programs for Older Adults - Online Training
Summary: This is an online training module on evidence-based health promotion for older adults, which is designed primarily for aging services providers. This training module will define health promotion concepts, frameworks and terms, and will provide interactive exercises, downloadable tools and resources that can help the user plan for, implement, and reinforce the quality of health promotion programs.
Topic(s): Aging Issues
Source: National Council on Aging
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2411
How Do Employment Outcomes of Medicaid Buy-In Participants Vary Based on Prior Medicaid Coverage? An Example from Massachusetts
Summary: This brief, the eighth in a series on working with disability, looks at the employment outcomes of participants in CommonHealth Working (CHW), Massachusetts’s Medicaid Buy-In program. Differences in post-enrollment employment rates, monthly hours worked and earnings, and private health insurance coverage are compared between new CHW enrollees previously covered by MassHealth, Massachusetts’s Medicaid program, and those without prior MassHealth coverage.
Topic(s): Employment Programs
Source: Mathematica
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2427
How Do Medicaid Buy-In Participants Compare with Other Medicaid Enrollees with Disabilities?
Summary: Answering the question posed in the title is one key to evaluating Medicaid Buy-In (MBI) programs. This issue brief, the fifth in a series on workers with disabilities, compares demographics, health status, and expenditures between these groups. Significant areas of difference that were identified are race, gender, diagnoses, and expenditures.
Topic(s): Employment Programs
Source: Mathematica
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2406
Interaction of Medicaid Buy-In and other Federal Efforts to Improve Access to Health Coverage for Adults with Disabilities
Summary: The Medicaid Buy-In (MBI), Social Security Disability Income (SSDI), and Supplemental Security Income (SSI) programs all provide workers with disabilities options to maintain health coverage if they earn too much for Medicaid or Medicare benefits. The first issue brief explains how these programs compare and interact in terms of eligibility, coverage, populations, and enrollment. The second examines how MBI participants that collect SSDI utilize SSDI work incentives.
Topic(s): Employment Programs, Financing HCBS
Source: Mathematica
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2407
Keeping Track: National Disability Status and Program Performance Indicators
Summary: Federal data is used to describe the status of Americans with disabilities and their quality of life. The report measures indicators such as employment, education, health status and health care, financial security, leisure and recreation, personal relationships, and crime and safety. The authors also lay out a road map for the federal government to expand the national disability indicator set, as well as for installing the set into a key national indicator system.
Topic(s): Accessibility, Physical Disabilities, State/Agency Information
Source: National Council on Disability; NCD
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2401
Medicaid Home And Community-Based Waivers: CMS Should Encourage States to Conduct Mortality Reviews for Individuals with Developmental Disabilities
Summary: The GAO conducted a study in which they examined the extent to which states (1) include, as a critical incident, deaths among individuals with developmental disabilities in waiver programs; (2) have basic components in place to review such deaths; and (3) have adopted additional components to review deaths. The report outlines six basic mortality review components. Review the two key recommendations offered to CMS.
Topic(s): Developmental/Psychiatric Disabilities, Waiver
Source: GAO: Government Accountability Office
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2416
State of the Science: Professional Partners Supporting Family Caregiving
Summary: A symposium was held in January, 2008 to help the nursing and social work professions collaborate to support family caregivers. This report springs from that event. Participants explored caregiver demographics and challenges. It also identifies competency areas, best practices and support strategies for professional partners, as well as priorities for future research in the area.
Topic(s): Aging Issues, Long-Term Care
Source: American Journal of Nursing
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2409
Status Report on the Use of Wheelchairs and Other Mobility Devices on Public and Private Transportation
Summary: The Easter Seals Project ACTION commissioned this report to make the use of mobility devices in transportation safer and easier. A diverse advisory group used several research methods to create best practices in vehicle and equipment design, wheelchair design and usage, transit operations and training, and policy. The appendices provide links to regulatory sources and sample brochures. Riders, manufacturers, transit operators, researchers, and policymakers may all find this useful.
Topic(s): Accessibility, Physical Disabilities
Source: Nelson/Nygaard Consulting Associates
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2408
The Changing Face of Technology: Document Imaging Meets the Challenge – Video
Summary: Watch employers attest to how their business’ needs are met by skills that workers with developmental disabilities have brought to the workplace. The five firms included in the video found that those skills are crucial as they convert to computerized record systems in order to increase efficiency and drive down record keeping costs.
Topic(s): Developmental/Psychiatric Disabilities, Employment Programs
Source: Minnesota Governor’s Council on Developmental Disabilities; Wallace Group
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2419
The State of 21st Century Financial Incentives for Americans with Disabilities
Summary: This report offers recommendations to increase opportunities for people with disabilities to become fully involved in the economic mainstream of society. It presents research findings in key areas such as education and health care. It also describes selected state-level innovations affecting asset development and wealth accumulation. Finally, the report makes policy recommendations for securing meaningful employment, career advancement, and benefits needed for daily living and accommodations.
Topic(s): Employment Programs, Financing HCBS, Housing, Long-Term Care
Source: National Council on Disability; NCD
More Info: http://www.hcbs.org/moreInfo.php/nb/doc/2402
KaiserFamilyFoundation@cme.kff.org
Medicaid Budget Policy
Updated data from the latest 50-state Medicaid budget survey by KCMU on state Medicaid budget policies to control costs in Medicaid or to expand the program are now available for state FY2008 and FY2009. The number of states that have implemented or proposed Medicaid cost-containment actions related to provider payment changes, eligibility cuts, pharmacy controls, benefit reductions, co-pays, managed care expansions, disease and case management, fraud and abuse, and long term care are available by state. Also available is information about “positive” Medicaid policy actions, which increase provider payments, expand benefits, increase eligibility, or change the delivery of long term care services. Medicaid Budget Policy - http://www.statehealthfacts.org/comparetable.jsp?ind=188&cat=4
Supplemental Security Income (SSI) Beneficiaries
The latest information from the Social Security Administration (SSA) on Supplemental Security Income (SSI) beneficiaries has been added for 2007 for all states and the nation. The total number of SSI beneficiaries; SSI beneficiaries as a percent of the population; distribution of total SSI beneficiaries by age; total number of aged SSI beneficiaries; aged SSI beneficiaries as a percent of the population; SSI beneficiaries with disabilities; and SSI beneficiaries with disabilities as a percent of the population are now available.
Supplemental Security Income (SSI) Beneficiaries - http://www.statehealthfacts.org/comparemaptable.jsp?ind=253&cat=4
[The following is excerpted from the report.]
Over the past several years various stakeholder groups, including the Council of State Administrators of Vocational Rehabilitation (CSAVR), community rehabilitation providers and representatives of individuals with disabilities have been meeting as part of what is known as the “Future’s Workgroup on the Definition of Most Significant Disability” (Workgroup). The Workgroup’s stated mission is to discuss, among other things, whether and how to modify the order of selection policy and whether Congress should prescribe a national definition for persons with the most significant disabilities and if so, what criteria should Congress adopt. The overall intent of the Workgroup is to increase the national VR program order of selection consistency and portability of services.
The Office of Special Education and Rehabilitation Services (OSERS), U.S. Department of Education, in announcing the funding opportunity for the Rehabilitation and Research Training Center (RRTC) on vocational rehabilitation, specified that the RRTC must focus on increasing knowledge of the order of selection provision used for prioritizing and providing services to individuals with the most significant disabilities when the State VR agency cannot serve all eligible individuals. The RRTC must contribute to this outcome by conducting research on the administration and implementation of an order of selection in serving individuals with the most significant disabilities by their respective State VR programs.
The purpose of this policy analysis is to help inform policymakers and other stakeholders, including State VR agencies, State Rehabilitation Councils (SRC), community rehabilitation providers, and individuals with disabilities and their representatives, about the federal policy framework and state policies currently used by selected states for addressing order of selection policy when a State VR agency anticipates that it will not have sufficient fiscal and/or personnel resources to fully serve all individuals eligible for vocational rehabilitation services. Under order of selection, individuals with the most significant disabilities are selected first for the provision of vocational rehabilitation services. It is not the purpose of this policy analysis to determine or judge the merits of any particular state policy and thus the descriptions of state policies included in this paper should not be construed as constituting “best practices” among State VR programs.
REFERENCE POINTS:
New Edition of "State of the States in Developmental Disabilities" Available
The new "State of the States in Developmental Disabilities" documents 30 years of financial and programmatic trends in services and funding for people with developmental disabilities in the U.S. This year's edition includes recent reductions in disability support in the face of economic recession and may serve as a reference for decision makers tackling cutbacks in spending during this time of economic crisis. Highlights include: (1) The period between 2004-2006 saw the slowest increase in the past 30 years in state spending on community and institutional services per $1000 of statewide personal income; (2) Support for public and private institutions declined 6% nationally; (3) Ten states and the District of Columbia no longer run state-operated institutions; and (4) Twenty nine states and the District of Columbia projected overall budget gaps for the current fiscal year (2009) appropriations. For more information go to http://bookstore.aaidd.org. From: AAIDD F.Y.I.--November 2008
Until Next week
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