Capitol Insider

The Capitol Insider for the Week of May 20

Major Recent Events
Health: House Passes Bill to Improve the ACA
On May 16, the House of Representatives passed H.R.987, which reverses administrative actions weakening the Affordable Care Act (ACA). It rescinds the Department of Health and Human Services regulation expanding the use of short-term limited-duration insurance (STLDI). STLDI plans are not required to cover people pre-existing conditions, and can charge higher premiums based on age, gender, or health status. Additionally, it restores funding for consumer outreach and education programs and the Navigator Program, which were cut by the Administration.

Major Events Ahead
Housing: House Committee to Hold Hearing on HUD Oversight
On May 21, the House Committee on Financial Services will hold a hearing titled “Housing in America: Oversight of the U.S. Department of Housing and Urban Development.” Housing and Urban Development (HUD) Secretary Dr. Ben Carson will testify. As stated in the Committee’s announcement, the hearing will examine “the U.S. Department of Housing and Urban Development’s current state of affairs and address major changes to agency policies and programs since 2017.” Visit the Committee web site for more information or to access live video on the day of the hearing.

Announcements
Education: GAO Blog Notes Disparities on 65th Anniversary of Brown v. Board of Education
May 17, 2019 marked the 65th Anniversary of Brown v. Board of Education, the 1954 Supreme Court Case that held public school segregation based on race was unconstitutional. In light of this anniversary, the Government Accountability Office (GAO) published a blog post discussing three recent reports on disparities that still exist in education. The first report noted the rise in the percentage of schools where 75% or more of the students were black or Hispanic and eligible for free or reduced-price lunch. The second report discusses the disproportionate use of discipline against black students, boys, and students with disabilities. The third report discusses the limited course offerings at high-poverty schools.
Capitol Insider

The Capitol Insider for the Week of May 13

Major Recent Events

Budget & Appropriations: House Committee Approves L-HHS-ED Appropriations

On May 8, the House Appropriations Committee approved its fiscal year (FY) 2020 Labor, Health and Human Services, Education, and Related Agencies (L-HHS-ED) bill. The bill provides $189.9 billion in funding, a 7% increase over FY 2019. Most of The Arc’s priority programs received increases. Particularly notable increases include the Individuals with Disabilities Education Act (IDEA) Part B State Grants (8.1%), Lifespan Respite Care Program (33.8%), State Grants to Remove Barriers to Voting (28.7%), and Rehabilitation Services Administration Demonstration and Training Programs (26.5%). Funding levels for The Arc’s priority programs can be found here. Senate Appropriators, meanwhile, have declined to move forward with spending bills until a deal is reached to increase the spending caps for discretionary programs. Absent a deal, the spending cap for all non-defense discretionary programs would be reduced by 9% for FY 2020.

Child Welfare & Adoption: House Committee Approves CAPTA Reauthorization

On May 8, the House Committee on Education and Labor approved the Stronger Child Abuse Prevention and Treatment Act (H.R.2480). This bill reauthorizes the Child Abuse Prevention and Treatment Act (CAPTA), which provides federal funding to states to address child abuse and neglect. This bill increases investments to address child maltreatment resulting from the opioid epidemic. Learn more about the legislation here.

Employment/Family Support: House Committee Holds Hearing on Paid Family and Medical Leave

On May 8, the House Committee on Ways and Means held a hearing titled “Paid Family and Medical Leave: Helping Workers and Employers Succeed.” Witnesses were Marisa Howard-Karp, Member, MomsRising; Anthony Sandkamp, Owner, Sandkamp Woodworking; Pronita Gupta, Director of Job Quality, Center for Law and Social Policy; Suzan LeVine, Commissioner, Washington State Employment Security Department; and Rachel Greszler, Research Fellow in Economics, Budget, and Entitlements, Institute for Economic Freedom, The Heritage Foundation. Visit the committee website to review testimony and archived video of the hearing.

Income Support: OMB Seeking Comments on Federal Poverty Level Inflation Measures

On May 7, the Office of Management and Budget (OMB) issued a notice of solicitation of comments on how to measure inflation for purposes of determining the federal poverty level. The agency currently uses the Consumer Price Index for All Urban Consumers (CPI-U) to calculate inflation. One option being considered is the Chained Consumer Price Index for All Urban Consumers (C-CPI-U). The C-CPI-U will result in a lower estimation of inflation than under current practice. Over time, this change would result in people losing eligibility for these critical programs. The Federal Poverty Level (FPL) is used to determine eligibility for several means-tested benefits, including Medicaid and the Supplemental Nutrition Assistance Program (SNAP).

Tax/Housing: HUD Issues Guidance on Treatment of ABLE Accounts

The U.S. Department of Housing and Urban Development (HUD) recently issued long-awaited guidance clarifying that funds in ABLE accounts should not be included in determining a person’s eligibility for means-tested housing assistance. ABLE accounts are available to people with significant disabilities that developed before the age of 26, including those who meet the eligibility requirements under Supplemental Security Income (SSI) or Social Security disability programs, including Social Security Disability Insurance (SSDI). Money in an ABLE account can be used to cover “qualified disability expenses,” such as housing, education, and transportation. In general, to be eligible for some public benefits that many people with disabilities and their families rely on, including Medicaid and housing assistance, an individual is limited to no more than $2,000 in cash savings, retirement funds, and other items of significant value. ABLE accounts are an option for people with disabilities to build savings without taking away their eligibility for these important benefits.

The ABLE Act states that amounts in an ABLE account or contributions to an ABLE account and pay-outs for qualified disability expenses should not be counted for federal means-tested programs. Consistent with Internal Revenue Service and Social Security Administration policy, the HUD notice clarifies that, for the purpose of determining eligibility and continued occupancy for a list of key HUD programs, HUD will disregard amounts in the individual’s ABLE account. Some people with disabilities and their families have heard confusing or inaccurate information about whether or not participation in ABLE could threaten their receipt of other critical federal benefits. The notice is good news for people in HUD-funded programs and should be helpful in addressing questions about the treatment of ABLE account funds.

Announcements

Education: LPI Releases School Discipline Report

On April 18, the Learning Policy Institute (LPI) released a report titled “Protecting Students’ Civil Rights: The Federal Role in School Discipline.” The report discusses the negative impacts of zero-tolerance policies and discrimination in discipline. It notes guidance documents and regulations the Trump administration has targeted for elimination, such as the discipline guidance and the significant disproportionality rule. Additionally, the report discusses strategies to reduce the use of exclusionary discipline, such as teaching social-emotional skills.

Uncategorized

Governor Northam Vetoes Legislation to Change Virginians with Disabilities Act

RICHMOND—Governor Northam today vetoed House Bill 2296, which would change the Virginians with Disabilities Act (VDA) by requiring a claimant to provide at least 120 days of notification to financial entities prior to the commencement of a lawsuit regarding web accessibility.

The Governor’s full veto statement is below.
Retrieved from
https://www.governor.virginia.gov/newsroom/all-releases/2019/may/headline-840397-en.html?fbclid=IwAR1vdEz6r-42Aiv9IpejS-YfkZMhDY47Hby8c5RmNmKQe78ygVIE4FtSyrE

May 3, 2019

Pursuant to Article V, Section 6, of the Constitution of Virginia, I veto House Bill 2296. This legislation changes the Virginians with Disabilities Act (VDA) by requiring a claimant to notify financial entities including banks, trusts, savings institutions, and credit unions, at least 120 days prior to commencement of a lawsuit regarding web accessibility.

This legislation recognizes that as more banking services move online, it is essential that websites are accessible for all Virginians, especially individuals with disabilities. The legislation takes a positive step in ensuring accessibility by establishing web content accessibility guidelines. However, the legislation also creates arbitrary delays in the administration of justice for individuals with disabilities. It creates onerous preconditions for the initiation of a lawsuit and shifts the burden of identifying VDA violations from covered entities to people with disabilities. Additionally, the bill will make it more difficult for people with disabilities to obtain legal representation to aid them in protecting their rights under the VDA. Finally, House Bill 2296 does not address the issue that it seeks to remedy. While the bill makes changes to the VDA, it does not and cannot override the federal Americans with Disabilities Act. With this in mind, I encourage stakeholders to work together to find a solution.

Accordingly, I veto this bill.

Sincerely,

Ralph S. Northam

DOJ Settlements

Over $3.25 Million Paid by Greyhound to Individuals in Disability Settlement

The Department of Justice today announced payments by Greyhound Lines, Inc. totaling $2,966,000 to over 2,100 individuals who experienced disability discrimination while traveling or attempting to travel on Greyhound. The payments were part of a broader settlement from 2016 resolving the Department’s complaint that Greyhound, the nation’s largest provider of intercity bus transportation, engaged in a nationwide pattern or practice of violating the Americans with Disabilities Act (ADA) by failing to provide full and equal transportation services to passengers with disabilities.  The $2,966,000 amount is in addition to $300,000 paid by Greyhound in 2016 to specific individuals identified by the Department, bringing the total distributed to individuals to over $3,250,000. To read the press release regarding this event, click here. For more information about the ADA, call the Department’s toll-free ADA Information Line at 800-514-0301 (TDD 800-514-0383) or access the ADA website at www.ada.gov.

Moms In Motion

CCC Plus Waiver Personal Care for Individuals under 21 No Longer Under EPSDT

GREAT NEWS!   DMAS HAS HEARD ALL OF YOU WHO HAVE BEEN STRUGGLING WITH THE EPSDT PERSONAL CARE CHANGE!

Last year, Medicaid CCC Plus Waiver Personal Care for people under the age of 21 was changed. The change required new forms and a new process for authorizing Personal Care using standards for Early and Periodic Screening, Diagnosis and Treatment (EPSDT). It required the child’s doctor to fill out the DMAS-7 form and left no room for error.  The changes were confusing and resulted in some young people experiencing a lapse in Personal Care services while waiting on the form and/or receiving fewer hours of Personal Care than they had in the past. 

The Virginia Department of Medical Assistance Services (DMAS) has worked with the federal Centers for Medicare and Medicaid Services (CMS) to reverse the change that was made last year. The new changes will be effective May 1 for people under the age of 21 who use the CCC Plus Waiver.  Effective May 1, Personal Care hours for those under 21 who are on the CCC Plus Waiver will no longer go through Early and Periodic Screening, Diagnosis and Treatment (EPSDT)! 

What does this mean for those under 21 on the CCC Plus Waiver?  It means you will no longer be required to get the DMAS-7 form filled out and signed by the doctor in order to get an authorization for Personal Care hours.  Instead, your Service Facilitator will be able to do a plan of care which does not necessarily require input from your doctor (unless certain supervision tasks are needed), just like they used to prior to the EPSDT change on September 1, 2018.  This is great news for all involved!!!  

For the time being, individuals with the Community Living (CL) or Family and Individual Supports (FIS) Waivers will continue to get the Personal Care authorizations through EPSDT.  Also, those on straight EPSDT that do not have a waiver will continue to need the DMAS-7 filled out by the doctor in order to get an authorization for Personal Care hours.  Also those with the CCC Plus Waiver that receive Personal Care hours in school, these Personal Hours will also be through EPSDT.

A few Q’s & A’s.  Only applies to those under 21 with a CCC Plus Waiver:

Q:  So is EPSDT totally gone?
A:  No, for those on the Community Living (CL) Waiver, Family & Individual Supports (FIS) Waiver, and for those with Medicaid under 21 getting Personal Care through EPSDT and not on a waiver, EPSDT will continue to exist.  Also, for those under 21 with a CCC Plus Waiver who are getting Personal Care hours in school, those specific hours will still be requested through EPSDT.  For all of these individuals, Personal Care hours authorization will continue to require a DMAS-7 from the doctor.

Q: What if my authorization for Personal Care ends on 4/29/19?  My new authorization will start on 4/30/19, so do I need a DMAS-7 from my doctor?
A:  You, will still be required to get a DMAS-7 form from your doctor up to and through 4/30/19 as this request will still have to go through EPSDT.

Q:  What if my authorization for Personal Care ends on 4/30/19?  My new authorization will start on 5/1/19, so do I need to get the DMAS-7 from my doctor?
A:  No, your Service Facilitator will write your plan of care using their own assessment and visit data.  This will still require the Employer of Record to review and sign the plan of care.

Q: What if my Personal Care hours were reduced when I submitted the DMAS-7 form?  Do I get those hours back now?
A:  No, not necessarily.  In cases where there is a clear justification for requesting an increase in hours, a new request for authorization can be done to try to get that increase.  Please work with your Care Coordinator and Service Facilitator if you think this applies to you.  Also, there is no guarantee that a new request with an increase will be approved or that you will get back all of the hours you had prior to the change.

Q: What if I made the decision to just use Respite hours instead of dealing with the DMAS-7?  Can I now get Personal Care hours back without getting my doctor involved?
A:  Yes!  On and after May 1, 2019, you will no longer be required to get the DMAS-7 form filled out by your doctor in order to get Personal Care hours.  Simply contact your Service Facilitator and schedule a visit if you haven’t had a recent one.  Again, this will be a new request and does not guarantee you will get the same number of hours you had prior to the change.

Q: What if my Personal Care hours lapsed while I was trying to get the DMAS-7 from my doctor, will I be able to get my authorization back dated to cover that gap now?
A: Unfortunately, no.  An authorization for hours starts the day it is submitted to the approving organization (MCO’s) and unfortunately cannot be backdated.  If there is no authorization in place, Personal Care aides should not be working.

Q: Does this change mean that I cannot get more than 35 hours per week of Personal Care?
A: No it does not.  In cases where there is a clear reason and thorough justification for more than 35 hours, a request can be made for more.  Again, there is no guarantee that a request for more than 35 hours will be approved for more than 35 hours.  

Please note:  In an effort to get authorizations in place for those of you that are affected by this change and who are our Moms In Motion clients, we may need some information from you.  In order to protect your personal health information, we will likely ask for that information via secure email.  It will come from Zixmail.  Often, these emails go to spam.  If your Service Facilitator tells you that they are sending you a secure email, please be on the lookout for it and respond to it quickly as it may impact your re-authorization for Personal Care hours.
Webinar to Learn More!

A webinar has been scheduled for people with disabilities who are under 21 and their families to receive information directly from DMAS about this change. The webinar is not for personal care agencies and services facilitators (other training opportunities have been scheduled for them).

Tuesday, April 30, 1:00pm
Register Here

After registering, you will receive a confirmation email containing information about joining the webinar. The webinar will be presented by DMAS and is sponsored by the Virginia Association of Centers for Independent Living.
Useful Links

Moms In Motion congratulates all the parents who advocated to bring this change. Way to go!

Efficient advocacy is needed to influence change in policy. Here are links you may want to bookmark for the future.
Who is My Legislator? DMAS Appeal FormsThe Virginia Ombudsman
Keep an eye out for our newsletters. Moms In Motion’s newsletters will keep you informed! Moms In Motion will be sending weekly updates to you on this topic.  Some of the info may repeat, but we will also add any new information we learn. Be sure you are subscribed to our newsletters, here.