A "Slice of Pie" is an ongoing publication keeping our readers informed about important public policy issues.

It is the mission of the Policy Information Exchange to educate and inform Pennsylvanians with disabilities, their families and advocates, and the general public, regarding public policy issues and to further the exchange of policy information between the Pennsylvania Developmental Disabilities Council and federal, state and local policy makers.

The Policy Information Exchange is funded by the Pennsylvania Developmental Disabilities Council.

INDEX:

State News
Federal News
Resources  

State News

State Budget

Governor Rendell released his budget request for 2006-07 on February 7. Copies are available at http://www.governor.state.pa.us/governor/
cwp/view.asp?a=1101&q=445371 (click on "Governor's Executive Budget"). For detailed information about the proposed Department of Public Welfare Budget, go to: http://www.dpw.state.pa.us/general/formspub/
adminpublications/budgetinfo/003674522.htm. Traditionally, the Governor's proposed budget is introduced as a starting point, and the General Assembly then makes changes to it. In a twist this year, the House introduced a bill, H.B. 2499, using the dollar amounts for the current year (2005-06) as the starting point of the negotiations. To view a copy of the bill as introduced, go to: http://www.legis.state.pa.us/WU01/
LI/BI/BT/2005/0/HB2499P3673.HTM. The bill was amended and debated in early April and passed by the House on April 4. To view a copy of the bill as amended by the House, go to: http://www.legis.state.pa.us/WU01/
LI/BI/BT/2005/0/HB2499P3850.HTM. H.B. 2499 has been sent to the Senate as we go to press. It is expected that the Senate will strip out the amendments and the bill will wind up in a conference committee. The deadline for passage is June 30, 2006, though the deadline is not always met. While election year politics tend to heighten partisan wrangling, they also provide a powerful incentive for getting the budget done on time.

Despite loss of federal funds, the Governor was able to propose increases for many programs and to do so without raising taxes. The Governor says he was able to balance the budget by increasing efficiency and eliminating waste, as well as continuing to reduce the state workforce. House Republican leaders questioned some techniques that were used to balance the Governor's proposal, including delaying payments to state contractors and using money from funds like the Lottery to replace General Fund dollars. They argued that Pennsylvania couldn't afford the amount of new spending in the Governor's proposal, and that it would lead to tax increases in future years. That was the rationale for using the current budget figures as the starting point for the negotiations.

The following summarizes items of interest to the disability community in the Governor's proposed budget. (A chart which compares the amounts of the Governor's budget request to previous year's funding is available on request from the PIE office at 866.761.6129.) Even though a number of amendments were added to H.B. 2499 during House consideration which would increase funding for programs of interest to the disability community, the use of current year funding as a baseline for legislative negotiations is still a concern. For that reason, it is particularly important that advocates not take for granted the numbers discussed in the following which are in the Governor's budget or in those in House amendments to H.B. 2499, and instead let their state representatives and senators know what is needed. None of these proposals are final until the budget is passed.

Department of Public Welfare:

• No further cuts are proposed for the Medical Assistance program, though the budget assumes that this year's cuts will be implemented.
• The proposed budget would annualize the initiatives from 2005-06 and an additional 806 people would receive community mental retardation services. (As of November, 2005 there were 2,921 people on the Emergency Waiting List.) This includes: residential services to 282 people off the emergency waiting list through the Consolidated Waiver; community services to 156 people off the emergency waiting list through the Person/Family Directed Supports (P/FDS) Waiver; services for 68 young people who are "aging out" of the Early Periodic Screening Diagnosis and Treatment (EPSDT) program; and day programs for 300 graduates of special education programs also through the P/FDS Waiver. (There are about 850 graduates who could benefit and regional program managers will have to select which 300 will benefit most. Some of them are on the waiting list. The goal is to get to them before their needs intensify. The P/FDS Waiver will need to be amended for this purpose.)
• The mental retardation budget also includes state funds to "backfill" or makeup for the loss of federal Social Service Block Grant funds. It assumes the closure of Altoona State Center and the relocation of all residents by June 30. Ninety people will move to the community as a result of the Altoona closure, most from Altoona and some from Ebensburg. The budget anticipates no other state center closures, though OMR hopes to move additional people out. The ICF-MR assessment continues, in its third of five years. In addition, the budget includes $11.3 million in state and federal funds to implement required changes to the waiver programs and $4.56 million to enhance supports coordination, including hiring an additional 120 supports coordinators.
• The budget includes funds for a 2% cost of living increase (COLA) for: community mental health, including Community-Hospital Integration Projects Program (CHIPPs), though there is no money to make up for the loss of Intergovernmental Transfer (IGT) funds for CHIPPS; mental retardation; CSPPPD; attendant care; and the Aging waiver, among others. There is no COLA for the Behavioral Health Services Initiative (BHSI), Act 152 Drug and Alcohol program or the Human Services Development Fund (HSDF). The state is not proposing any restrictions on how the COLA is spent this year, unlike last year. Hospitals, managed care organizations and nursing homes are to receive a 4% COLA.
• Behavioral Health will move to HealthChoices statewide. Counties have the right of first opportunity, and DPW will contract with a private behavioral health managed care organization for those counties which don't exercise the right of first opportunity. Implementation for the counties with the DPW contract is January 1, 2007 and for the county operated programs it is July 1, 2007.
• The state faces a decrease in federal Mental Health Services Block Grant funds. However, the Office of Mental Health and Substance Abuse Services (OMHSAS) has identified savings in a number of areas, including transferring the maintenance of state hospitals to the Department of General Services and transferring payment for psychiatric drugs to Medicare Part D. While the budget anticipates no additional state hospital closings, they hope to have about 60 additional discharges through administrative savings. Harrisburg State Hospital has closed. (See article elsewhere in Slice.)
• The Behavioral Health Services Initiative (BHSI) is level funded. This is the last year for the $12.1 million BHSI Intergovernmental Transfer. Act 152 Drug and Alcohol funding is decreased from $18.2 million to $17 million to reflect HealthChoices expansion.
• The Governor's budget would provide for 748 additional people in the CSPPPD program (98 in OBRA; 600 in Independence; and 50 in Commcare) and 752 additional people in the Attendant Care program (165 in the state funded Act 150 program and 587 in the Attendant Care Waiver), for a total of 1,500 additional people to be served. The increase is intended to accommodate regular program growth as well as increased demand as a result of enhanced nursing home transition activities. There will be enhanced nursing home transition projects in several counties this year (2005-06), with the hope of going statewide next year. (An amendment offered on the House floor to H.B. 2499 contained language for "money follows the person" for people moving out of nursing homes and into these waivers.)
• There's a Program Revision Request (PRR) on "Increasing Efficiency and Integrity" in the DPW Medical Assistance budget. It includes a provision on "Selective Contracting" (limiting the number of possible vendors/providers to those who offer the state the best price and can provide a full range of services) for durable medical equipment, home health, radiology and specialty pharmacy (e.g., injectibles). The Office of Medical Assistance Programs says that consumers will be involved in the Request for Proposal process. The PRR also includes: cracking down more on fraud and abuse (including a five-year lock-in for some consumers); trying harder to make good on third party liability; requiring mental health facilities (like partial hospitalization programs) to participate in Medicare and bill Medicare first; and doing more provider credentialing. (Both OSP and OMR said that they are prepared to adapt in instances of families providing services.)
• Autism would again receive $3 million.
• The Human Services Development Fund is level funded.
• Medical Assistance Transportation Program would receive a 10.6% increase.
• Early Intervention will serve an additional 2,827 children from birth to age three.
• A major portion--$210 million--of the state share of long term care funding would come from the Lottery Fund instead of the General Fund, for the first time since the Thornburgh Administration. The state has been negotiating with nursing homes about a change in the way nursing home rates are set. They are trying to increase efficiency and quality and "pay for performance." Under existing law, DPW can make changes without legislative approval before June 30, 2006, but some legislators are trying to change the law to take away that power. The nursing home assessment will continue.
• Hospitals would face $150 million in cuts.
• One issue which came up in appropriations hearings was the fact that if Pennsylvania doesn't meet its goal for percentage of Temporary Assistance for Needy Families (TANF) participating in work activities by the October deadline, we face a $70 million penalty.

Other Departments:

• Two thousand, eight hundred additional people over age 60 would receive home and community based services in the Aging waiver under the Governor's proposed budget.
• The PACE program will expand to serve 120,000 additional seniors as a wraparound to Medicare Part D (PACE Plus).
• Most Labor and Industry disability programs are recommended for level funding (OVR State only and OVR State match, Supported Employment, I CAN, Assistive Tech Lending Library), but Centers for Independent Living would be reduced to $1,600,000, the same amount that the Governor proposed last year before the General Assembly restored it to $2,250,000 in the final budget.
• In the Department of Health, there are increases for AIDS and for Drug and Alcohol Programs (but only in state funds; overall there is a decrease in Drug and Alcohol). Children with Special Needs is again level funded. The following are all proposed for the same reduced level that the Governor proposed last year, before the General Assembly restored funds: Sickle Cell, Epilepsy, Tourette Syndrome and Newborn Hearing Screening. The amount of Catastrophic Medical Rehabilitation Funds available to the Head Injury Program would double to $6 million.
• A four per cent increase is proposed for special education. All education programs from pre-school to higher education are proposed for increases.
• The Governor has proposed an initiative, which over five years would cover all Pennsylvania kids with health insurance. In the first year, an additional 15,000 kids would be covered. AdultBasic will also expand to serve an additional 8,500 adults.
• The Shared Ride Program for Persons with Disabilities (part of the Fixed Route Transit line of the Department of Transportation budget) would receive a small increase to $2.84 million to annualize the counties added this year. The Governor's budget does not anticipate expansion to additional counties.
• The Community and Economic Development budget includes a new $3 million line item for home modifications under the AccessProgram. It is hoped that the state will be able to double that amount with federal funds.
• The Governor has proposed additional funds for Biomedical Research.

Bills of Interest

Following, we summarize some bills of interest to the disability community. For more information about these or any other bills, go to:http://www.legis.state.pa.us/cfdocs/legis/
home/ses sion.cfm . At the top of the page is a box labeled, "Find Legislation By", choose "Bill #", then enter the bill number and click on "Go".

S.B. 1. Introduced by Senator Jubelirer (R-Blair). The bill requires registration, regulation and disclosure of lobbying activities.  It passed the Senate on April 20, 2005. It has passed the House State Government Committee and been given first consideration by the full House and been moved to the House Appropriations Committee.

S.B. 631. Introduced by Senator Mary Jo White (R-Venango). This bill would provide for Pennsylvania's implementation of the U.S. Supreme Court decision in the Atkins case outlawing the use of the death penalty for people with mental retardation.  It provides for pre-trial determination of mental retardation which is supported by many advocacy groups.  The bill has been voted out of the Senate Judiciary Committee and given first consideration by the full Senate. At the same time, the House is moving H.B. 698 introduced by Representative O'Brien (R-Philadelphia), which provides for post-trial determination. That bill has been voted out of the House Judiciary and Appropriations Committees and given two considerations by the full House. Representative Manderino is prepared to offer an amendment which would change the bill to provide for pre-trial determination.  

S.B. 736. Introduced by Senator Robbins (R-Mercer). Amends the Pennsylvania Construction Code Act. It was signed into law as Act 95 of 1995.  

S.B. 997. Introduced by Senator Erickson (R-Delaware). This bill would take away DPW's ability to revise the way that nursing home rates are calculated. It passed the Senate on April 3, and was voted out of the House Health and Human Services Committee and given first consideration by the full House on April 4.

S.B. 1006. Introduced by Senator Erickson (R-Chester). Would provide for an annual cost of living increase for county mental health and mental retardation programs. It was voted out of the Senate Public Health and Welfare Committee on March 15, 2006 and given first consideration by the full House and is currently in the Senate Appropriations Committee.

S.B. 1158. Introduced by Senator Rhoades (R-Schuylkill). This bill, which was drafted with the support of disability advocates and the Builder's Association, would authorize local tax authorities to offer tax credits to home owners who build or renovate homes to meet visitability standards. Passage of this legislation would enable local governments which have already passed laws providing for tax credits, like the City of Pittsburgh, to move ahead. The bill was voted out of the Senate Local Government Committee on April 4 and given first consideration by the full Senate.

S.B. 1175. Introduced by Senator Rhoades (R-Schuylkill). The bill provides for statewide expansion of the shared-ride program for persons with disabilities and would make an $8.7 million appropriation. It was introduced and referred to the Senate Transportation Committee on March 28, 2006.

H.B. 247. Introduced by Representative Hess (R-Bedford). Provides for licensure of home care agencies. H.B. 247 passed the House in June, 2005 and was voted out of the Senate Aging and Youth Committee and given first consideration by the full Senate on February 13. The bill is currently in the Senate Appropriations Committee. Advocates have expressed concern about how the bill would affect consumer control of home and community based services.

H.B. 257 . Introduced by Representative Mark Cohen (D-Philadelphia). Would increase the state's minimum wage by July 1, 2006. The minimum hourly wage would increase from the current $5.15 to $6.25 and on July 1, 2007 it would increase to $7.15 per hour. This increase would affect workers with disabilities and those providing services to people with disabilities. The bill passed the House on April 5.

H.B. 492 . Introduced by Representative Pistella (D- Allegheny). Provides for tuition reimbursement and financial payments for direct care workers. The bill has been voted out of the House Education and Aging and Older Adult Services Committees and given two considerations by the full House. It is currently in the House Appropriations Committee.

H.B. 755 . Introduced by Representative Kenney (R-Philadelphia). It would amend the law related to Newborn Screening Tests. It was passed by the House on April 3.

H.B. 1318. Introduced by Representative Clymer (R-Bucks). This bill contained a number of changes to election law, including a requirement that all voters have identification and changes on absentee ballot rules. The bill passed both the House and the Senate, but was vetoed by the Governor in part because of the burden that the identification requirement would have placed on some voters.

H.B. 1618. Introduced by Representative Fairchild (R-Snyder). Would require school districts to have a policy to allow children with disabilities who have completed four years of high school to participate in graduation ceremonies with their class even when their IEPs call for them to continue their education to age 21. The bill was passed by the House on December 15, 2005 and the Senate on April 19. It now goes back to the House for concurrence in the Senate amendment.

H.B. 1813. Introduced by Representative Kenney (R-Philadelphia). Provides for a regular cost-of-living adjustment for county mental health and mental retardation programs. The bill passed the House unanimously on January 24 and was voted out of the Senate Public Health and Welfare Committee and given first consideration by the full Senate on March 15, 2006. It is currently in the Senate Appropriations Committee.

S.R. 200. Introduced by Senator Orie (R-Allegheny).Directs the Legislative Budget and Finance Committee to study cost control measures for the Medicaid program and report back to the General Assembly by November 30. The Resolution was adopted on March 22.

H.R. 631. Introduced by Representative George (D- Clearfield). Directs the Legislative Budget and Finance Committee to study the feasibility of increasing the State contribution to the persons with disabilities shared-ride pilot program and expanding the program to include night and weekend hours and intercounty transportation, and report findings within two years. The resolution was adopted March 7, 2006.

H.R. 634. Introduced by Representative Pickett (R-Bradford). Designates April 8, 2006 as "Disability Awareness Day." It was adopted April 3.

Pennsylvania Legislature As a result of the pay raise which the Pennsylvania General Assembly enacted and later repealed, a number of groups have formed calling for reform in the way the legislature does business and, in some cases, for replacing the current crop of legislators. A lot more incumbents face election challenges than typically do. On May 16, the Pennsylvania Primary Election will be held. In November we will elect all 203 State Representatives and half-25-of the State Senators. (We will also be voting in several key statewide races, including Governor and Lieutenant Governor, as well as one of our U.S. Senators.) There is an unusually high number of retirements-23 in the State House and three in the State Senate. A number of incumbents, including several of the leaders in the House and Senate from both parties, face serious challenges, so the election season promises to be a lively one. State Senator Robert Thompson died suddenly on January 28. Senator Thompson represented parts of Chester and Montgomery Counties and chaired the Senate Appropriations Committee. A special election, pitting Democrat Andrew Dinniman against Republican Carol Aichele will be held on primary day, May 16. In other recent special elections, Democrat John Sabatina was elected to represent the 174 th district of Philadelphia, replacing Democrat Allen Butkovitz who resigned and, in unofficial returns, Democrat Shawn Flaherty narrowly defeated Republican Mike Dolan for the Allegheny County seat vacated by Republican Jeff Habay.  

Lobbying Order

In the wake of lobbying scandals in Washington, and in light of Pennsylvania's lack of a lobbyist registration law, Governor Rendell has issued an Executive Order requiring individuals and organizations who communicate directly or indirectly with state government for the purpose of influencing state government to register as lobbyists. The Order applies to for-profit and not for profit organizations. Under the Executive Order, those who attempt to influence a member of the executive branch, like the Department of Public Welfare and its program offices, must register and file quarterly expense reports relating to their activities. Education and advocacy regarding legislation, budget, or any administrative matter, unless done by volunteers, could be considered lobbying under the Order.To register as a lobbyist, go to: http://www.lobbyistdisclosure.state.pa.us/lobbyist/
default.aspx?lobbyistregisterNav=|.

To read the Executive Order, go to: http://www.oa.state.pa.us/oac/cwp/view.asp?A=351&Q
=207098&lobbyistregisterNav.

For more information, go to: http://www.governor.state.pa.us/governor/
cwp/view.asp?a=3&q=446015.

Institution Closings

The Harrisburg State Hospital officially closed on January 27. Approximately 50 patients remain at the hospital receiving services from private providers working with county programs until new residences in the community are established. When the closing began in January, 2005 there were 256 people in the Hospital, and 33 were admitted after that date. Ninety-one people have been transferred to Danville or Wernersville State Hospital. The other 198 people, including those temporarily on the grounds of the Hospital, are being discharged to their home counties. Many of the hospital's employees have moved into other state jobs or are working for community organizations.

On January 30, a federal district court judge refused to stop the Department of Public Welfare from closing the Altoona Center and transferring residents to the community or to Ebensburg Center. Judge Kim Gibson ruled that stopping the closure would amount to federal interference in state policy. Gibson ordered the state to provide an 18-month standby period to allow residents transferred to group homes to leave and enter Ebensburg Center if the family wishes. The state is appealing the portion of his order which requires guardian approval before people are moved to the community.

Medstat Report

On March 24, Thomson Medstat submitted its report, "Home and Community Based Services Reform and Rebalancing Feasibility Analysis" to the Department of Public Welfare. The report recommends changes to the current structure of the state's Medicaid home and community-based services (HCBS) waiver programs in five areas: misaligned management structures; decentralized administration of waiver programs; waiver program policies and procedures; HCBS waiver consolidation and target population changes; and feasibility of Section 1115 Independence Plus Waiver. DPW intends to hold a series of meetings with interested parties to gather input on the recommendations. For a copy of the report, contact Ginny Rogers at virrogers@state.pa.us or the PIE Office at 866.761.6129.

New DPW Office

The Department of Public Welfare (DPW) has created a new Office of Long Term Living. The new office includes the Bureau of Home and Community Based Services (formerly in the Office of Social Programs), the Bureau of Long Term Care Programs (formerly in the Office of Medical Assistance Programs), and support units such as policy and fiscal. The Acting Deputy Director is Pat Brady, who will report to both the Secretary of DPW and the Executive Director of the Long Term Living Council. Contact Pat Brady at 717.783.9821 or by email at patbrady@state.pa.us.

Office of Mental Retardation

The Office of Mental Retardation (OMR) has issued seven new Bulletins. For copies, contact Emily Frola at efrola@state.pa.usor 717.783.5761 or go to: http://www.dpw.state.pa.us/General/Bulletins/
003673169.aspx and enter the Bulletin number for a PDF version.

• Provider Dispute Resolution Protocol for Individuals in the Consolidated Waiver (#00-06-02) was issued on January 20, 2006 and is effective October 1, 2005. The bulletin establishes interim procedures for providers to request OMR's intervention in disputes with an Administrative Entity in the Consolidated Waiver.
• Payment for Sign language Interpreters (#00-06-03) was issued on January 20, 2006 and is effective October 1, 2005. The bulletin advises counties and ICF/MR providers that sign language interpreter s must be provided as needed for effective communication with individuals and families receiving services.
• Revised Units for Service Definitions and Procedure Codes (#00-06-04) were issued on January 31, 2006 and are effective on July 1, 2006. The bulletin sets forth new service definition units that reflect a change in the available units that can be billed for each service.
• County to County Relocations (#00-06-05) was issued on February 24, 2006 and is effective on that date. The bulletin describes the statewide standardized policy for procedures when individuals relocate from one county to another in Pennsylvania.
• Interim Rate Setting Procedures for FY 2006-2007 (#00-06-06) were issued on March 8, 2006 and are effective on that date. The bulletin describes policies and procedures for developing and administering interim rates for FY 2006-2007.
• Provider Qualification Pilot Program (#00-06-07) was issued on April 5, 2006 and is effective on that date. The bulletin describes how providers and professionals can volunteer to participate in a pilot program.
• Employment for Individuals in ICF's/MR (#00-06-08) was issued on April 5, 2006 and is effective on that date. The bulletin clarifies how individuals in ICF's/MR can be employed and receive habilitation services to promote employment outcomes.

OBRA and Independence

The OBRA and the Independence waivers are both due for renewal by the Centers for Medicaid and Medicare effective July 1, 2006. The Bureau of Home and Community Based Services has submitted requests for renewal of both waivers with a few changes. One change would put an age limit of 60 in place for new applicants. Another change would increase the allowable caseload size from 25 to 35 participants per Supports Coordinator. Most other changes are minor and for increased consistency. In addition, new training standards and an assessment tool are being developed. For information contact Carol Ranck, Bureau Director, at 717.787.8091 or by email at cranck@state.pa.us.

Mental Health in State Plan

The Office of Mental Health and Substance Abuse Services (OMHSAS) is proposing to add three new services to the State Medicaid Plan effective in 2006. The state sent the request for the new services to the Centers for Medicaid and Medicare (CMS) in December, 2005. The three new services will be Mobile Mental Health Treatment Services, Peer Support Services, and Structured Treatment Services. For more information, contact the Deputy Secretary's office at 717.787.6443.

Nursing Home Transition Pilots

The Long Term Living Council has identified nursing home transition as a priority and will add components to the existing program in 2006. The current program uses a collaborative approach to identify and work with nursing home residents to offer them relocation to the community. The new components will add two new processes: to quickly identify and transition people most likely to be able to return to the community, and to identify and reach out to newly admitted residents to discuss their community options. For more information, contact Kim Kramer, Office of Social Programs, at kkramer@state.pa.us or phone 717.787.8097.

Property Tax

As we go to press, House and Senate negotiators remain locked in a battle over how to reform the state's property tax system. The House and the Senate have passed different versions of property tax bills, so a six-member conference committee has been appointed. House members are pushing a plan that would offer bigger property tax cuts to more people by temporarily raising the percentage of the state's sales tax until the revenue from slot machines is available in 2009. Senators are reportedly favoring smaller property tax cuts more targeted to senior citizens, while allowing school districts to seek voter approval to increase local income tax as a way of reducing property tax; their version would tap lottery funds to increase rebates to seniors. If and when the conference committee agrees on a compromise, it will go back to both the House and the Senate for approval and then to the Governor for his signature.

adultBasic

In late February, the Department of Insurance offered coverage to 30,000 people on the waitlist for the adultBasic health insurance program.  Each individual who applied for coverage prior to November 30, 2004 was contacted and offered the opportunity to participate in the adultBasic program for a monthly premium of $33.50 per month. This offering was expected to lower the waiting list to approximately 61,000 individuals, the lowest since December of 2003.

Federal News:

Deficit Reduction Act

On February 8, 2006, President Bush signed into law the budget reconciliation bill that passed by two votes and is now known as the Deficit Reduction Act (DRA). The Act will make significant changes to Medicaid, TANF and other programs that affect people with disabilities. For an in depth review of the bill, read the Washington Watch at http://www.ucp.org/ucp_generalsub.cfm/130/8/33 and select Volume 4, February 28, 2006 Issue 1 and 2. As described in the February, 2006 issue of A Slice of PIE, the Act could mean substantial cuts in services to people with disabilities and others reliant on federal programs, like Medicaid. It gives the states flexibility to increase co-payments and reduce benefits. Among the positive provisions is one which would allow states to implement the money follows the person concept. On March 31, 2006, HHS Secretary Michael O. Leavitt outlined new flexibilities available to states under the Deficit Reduction Act and how the new DRA provisions may work with other options available under Medicaid to increase consumer choice and expand access to community services. The Long-Term Care Roadmap to Medicaid Reform can be found on the C MS website at http://www.cms.hhs.gov/NewFreedomInitiative/
02_WhatsNew.asp#TopOfPage (and click on Long Term Care Roadmap).

TANF

The Temporary Assistance for Needy Families (TANF) program was reauthorized through 2010 in the Deficit Reduction Act of 2005. Originally created in 1996, it provides low-income families with assistance to move from welfare to work. Many of the new provisions in the reauthorization make it more difficult for families that include a person with a disability to meet the work requirements. The federal government can impose severe penalties on states that do not meet the work participation rate. The measure includes inadequate child care funding, as well.

2007 Federal Budget

In early February, President Bush released his budget proposal for the 2007 fiscal year that begins on October 1, 2006. Typically the next step is a Budget Resolution that Congress adopts to set certain limits for the appropriations committees to follow. The Senate narrowly passed its Resolution in March. (The Senate Resolution included an amendment co-sponsored by Pennsylvania Senator Arlen Specter to restore $7 billion in funding for key health, human services, education, job training, and human services initiatives.) The House was unable to complete a Budget Resolution before going home for a spring recess. The proposed budget contains deep cuts in various domestic discretionary programs in fiscal years 2007 to 2011, including a number of key programs for people with disabilities. An analysis of the proposed budget by The Center on Budget and Policy Priorities is found at www.cbpp.org/2-23-06bud.htm.

Medicare Drug Benefit

The Medicare Part D Drug Benefit began on January 1 and has a May 15 deadline for individuals to sign up without a penalty and select the plan of their choice. People who are eligible for both Medicare and Medicaid were automatically enrolled and now get their prescription medicine from a Medicare drug plan rather than through their Medical Assistance (ACCESS) card. A settlement in the case of Erb v. McClellan extends the transition period for these dually eligible individuals who were passively enrolled into a Medicare HMO until June 30, 2006.  During the transition period passively enrolled individuals can continue to see out-of-network providers and not have to obtain referrals or prior authorizations and can continue to obtain off-formulary drugs they were taking before January 1. Those who are dually eligible can change plans at any time. Assistance in picking the right plan is available through the state's APPRISE program at 800.783.7067. The Pennsylvania Health Law Project offers Part D information and assistance at 800.274.3258 or at www.phlp.org.

Part D Co-payments Elimination

The Medicare Part D benefit does not require people living in nursing facilities to pay a co-payment. Now a bill has been introduced in the Senate that would also eliminate the prescription drug co-payment for dual-eligible people who live in other facilities or who are served in a home and community based waiver. The other facilities include assisted living, personal care homes, residential care programs and other licensed facilities. For some individuals, the co-payments can use up most of their personal needs allowance. The bill is S. 2409 and is called the Home and Community Based Services Copayment Equity Act of 2006.

Disability Determination

The Social Security Administration recently announced new rules for the disability determination process which become effective August 1, 2006. The rules provide for: a quick disability determination process for those who are "obviously disabled"; new Medical-Vocational Expert System (MVES); a new Federal Reviewing Official who will review state agency determinations upon the request of the claimant; retention of the right to request a de novo hearing and decision from an Administrative Law Judge if the claimant disagrees with the decision of the Federal Reviewing Official; and a new Decision Review Board. For more information, go to: http://www.socialsecurity.gov/disability-new-approach/.

Emergency Preparedness

A bill has been introduced in the House of Representatives that will address the needs of individuals with disabilities in emergency planning and relief efforts in the event of a major disaster, and will improve the accessibility of replacement housing built with Federal funds following Hurricane Katrina and other major disasters. The measure would ensure that people with expertise on disability issues are part of the Department of Homeland Security. The bill is H.R. 4704 and is called the Emergency Preparedness and Response for Individuals with Disabilities Act. It is a companion bill to the Senate emergency preparedness for persons with disabilities bill (S. 2124).

Insurance Changes

The Health Insurance Marketplace Modernization Act (HIMMA), S. 1955, was introduced by Senator Michael Enzi (R-WY) and has been approved by the Senate Health, Education, Labor and Pensions (HELP) Committee. This legislation, if enacted, would remove almost all state-enacted consumer protections for people buying insurance individually or through their employers. Among other changes, it would strip away mandated benefits, like drug and alcohol treatment. For more information, go to: http://www.familiesusa.org/issues/private-insurance/enzi/.

Medicaid Commission

The Department of Health and Human Services Medicaid Commission met in March and is now focusing its efforts on long term care issues. The Commission looked at Florida's Section 1115 Medicaid waiver which begins to restructure the state's acute health care system. The commission also heard testimony from people with disabilities and their families about the importance of Medicaid in their lives.

Resources:

Freedom March

Hold the date: On June 6, Speaking for Ourselves (SFO) will hold a Freedom March for Real Self-Determination in Harrisburg. For more information, contact SFO at 610.825.4592.

Housing Conference

On June 19, 20, and 21 the Pennsylvania Housing Finance Agency will hold its annual Housing Services Conference at the Harrisburg Hilton. For information, go to www.phfa.org.

Voting Machines

The Department of State has set up a website containing links to voting information such as the Pennsylvania Voter Guide, a registration form, and a notice about voting rights for people with disabilities and people over 65 years old. Included is a site that allows voters to try out the voting machine that will be used in their county in the next election. Go to www.votespa.com and click on Voting Systems. Register and select your county.

HAVA Compliance

A nonpartisan group that tracks election reform efforts across the country offers a website with state-specific information. To see how states are doing with the requirements of the Help America Vote Act (HAVA), go to www.electionline.org. To read news articles about what's happening in Pennsylvania, click on the Electionline Today section.

Federal Budget

The Center on Budget and Policy Priorities has issued a report titled "The Administration's Budget would Cut Federal Medicaid Costs by Shifting Costs to States." The report analyzes the President's proposed budget for 2007. One finding is that many of the Federal Medicaid savings proposals would come from shifting costs directly to the states, which could result in some states cutting their Medicaid programs. View the report at http://www.cbpp.org/2-14-06health.htm.

Inclusion Report

United Cerebral Palsy has released a national analysis of State Medicaid services for people with developmental disabilities and mental retardation. The report includes rankings for all 50 states and the District of Columbia as well as letter grades in five key areas. The report shows that top rated states have good community inclusion, and all states have room for improvement. Pennsylvania's overall grade is a C, and is rated 32 on an average out of 51. Go to www.ucp.org/medicaid to read the 15-page report and click on Pennsylvania for our scores.

IDEA and Private Schools

The U.S. Department of Education has published an online resource entitled, "Questions and Answers on Serving Children with Disabilities Placed by Their Parents at Private Schools." This resource is posted to the IDEA 2004 Resources Web page at: www.ed.gov/policy/speced/guid/idea/idea2004.html.

ADAAG Comparison

On March 9, the U.S. Access Board released a side-by-side comparison of the updated ADA guidelines, the original ADA standards, and the International Building Code. Go to www.access-board.gov.

Workforce Resource Center

The Centers for Medicare and Medicaid (C MS) has created the National Direct Service Workforce Resource Center to respond to the shortage of workers who provide direct care to people with disabilities and older adults in the community. The Center offers an online searchable database of information at www.dswresourcecenter.org and advice from experienced workforce policy professionals at 877.822.2647.

Recovery

The Substance Abuse and Mental Health Services Administration recently released a consensus statement outlining principles necessary to achieve mental health recovery. The consensus statement was developed by over 100 panelists representing mental health consumers, families, providers, advocates, researchers, managed care organizations, state and local public officials and others.

The paper outlines the ten fundamental components of recovery, including self-direction, empowerment and peer support. The National Consensus Statement on Mental Health Recovery is available at www.mentalhealth.samhsa.gov or 800.789.2647.

WIA Report

The Center for Law and Social Policy has issued a report on the proposed changes to the Workforce Investment Act (WIA) entitled "Reform or Dismantling?  President's Workforce System Proposal Raises Serious Concerns." http://www.clasp.org/publications/workforce_
07budget.doc.

Accessing Taxis

Easter Seals' Project Action has three brochures on advocating for accessible taxi service: "Moving Forward Together: A Workbook for Initiating and Increasing Accessible Taxi Services in Your Community;" "Taxicab ADA Brochure: The Americans with Disabilities Act and You;" and, "The Taxicab Pocket Guide." To download or order these free publications, go to their site at http://projectaction.easterseals.com and click on "Clearinghouse" and then type in "Taxi".

Emergency Management

The National Organization on Disability recently released a new "Interactive Map of Disability and Emergency Preparedness Resources." http://www.nod.org/EPIResources/interactive_map.html.

Mentoring Youth

Partners for Youth with Disabilities recently announced the opening of their  National Center. The Centers first conference, "Aspire, Achieve, Empower: The First Conference on Mentoring for Youth with Disabilities," will be held in Boston on September 13-15, 2006.  For information about the conference and their Call for Papers, go to www.pyd.org or http://www.pyd..org/national-center/conference.htm.

Disability Market

The U.S. Department of Justice's Disability Rights Section has an online course for businesses, "Reaching Out to Customers with Disabilities," The course explains how the ADA applies to businesses in ten short lessons which will enable businesses to both comply with the ADA and attract the disability market. The course is at: http://www.ada.gov/reachingout/intro1.htm.

Policy Institute

The Burton Blatt Institute, Centers of Innovation on Disability (BBI), located at Syracuse University, was established to advance civic, economic and social participation of persons with disabilities in a global society. Their website is at http://bbi.syr.edu.

Ticket to Work

The Office of Program Development and Research of the Social Security Administration has released a report on the first two years of the implementation of the Ticket-to-Work (TTW) program. The report found that overall, SSA has successfully implemented the TTW, but some problems will need to be addressed, including the slow growth of the program and the waning of provider interest in TTW. The report found that there is little evidence that TTW has prompted a substantial change in the delivery of services to beneficiaries. To see a complete copy of the report go to: http://www.socialsecurity.gov/disabilityresearch/
ttw2/execsum.htm.

Compeer Conference

A one-day technical assistance conference to assist county mental health authorities and community organizations in developing or enhancing local Compeer programs will be held on Wednesday, June 28 at the Holiday Inn in Grantville, Pennsylvania. It is sponsored by the DPW Office of Mental Health and Substance Abuse Services in collaboration with Drexel University College of Medicine/Behavioral Healthcare Education. There is no fee for the conference; however, registration is required and attendance is limited to three (3) persons per county. For more information or to register, contact Joann Roesner at Drexel University 215.831.7804 or by emailing jroesner@drexelmed.edu.

Policy Seminar

The National Council on Disability (NCD) will celebrate the 16th anniversary of the Americans with Disabilities Act with a disability policy seminar in Washington, DC on July 26, 2006. NCD will conduct a half-day seminar based on findings from its National Disability Policy: A Progress Report, which will be released during the seminar. www.ncd.gov.

Important Note to Slice of PIE Readers:
The Policy Information Exchange is trying to save on the cost of printing and mailing A Slice of PIE. Starting with the August edition, we will send our quarterly newsletter by email only unless you ask for a mailed copy by returning the form below by July 31, 2006. You can also call 866.761.6129 or email pie@ucpofpa.org to ask for a mailed copy (be sure to include your name and mailing address). This May, 2006 newsletter is the last one you will get in the mail unless we hear from you. Readers can request both versions.

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Thank you for helping us to manage our resources wisely.

- Slice of PIE is available at the Developmental Disabilities Council Website, www.paddc.org, in the "Legislative" and "Policy News".  Archived editions are also found there.

- Slice is available in alternate format upon request.

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The PIE Team:
Theotis Braddy, Consultant and Executive Director of CIL of Central Pennsylvania;
Joan W. Martin, Executive Director, United Cerebral Palsy of Pennsylvania;
Vini Portzline, Policy Specialist
Terry Roth, Consultant;
Dee Miller, PIE Administrative Assistant