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 in part by the Pennsylvania Developmental Disabilities Council.
On March 3, 2015, Pennsylvania Governor Tom Wolf delivered his budget request for the 2015-16 fiscal year. There are many positive proposals in the Governor’s budget for people with disabilities that would restore funding or address waiting lists. But it is, by no means, a done deal. While Democrats described the Governor’s proposals as “bold” and “historic”, Republicans, who control both the House and Senate, said that it was “a shell game…not based in reality.” Advocates will have to work hard to maintain the positive and to get support for additional funding.
The proposal would eliminate the deficit, increase spending and pay for it with tax changes and other new revenue. Revenue sources include: a tax on natural gas drilling; an increase in the personal income tax from 3.07% to 3.7%; an increase in sales tax from 6% to 6.6% (Philadelphia and Pittsburgh would go from 7% to 7.6%.); charging sales tax on more goods and services, like professional services (but food, clothing and prescription drugs would still not be taxed); and raising the cigarette tax and taxing all tobacco products and e-cigarettes. The Governor would also reduce property taxes, make a number of changes in business taxes and raise the minimum wage to $10.10 an hour.
The Governor’s plan to switch from Healthy PA to Medicaid Expansion is estimated to save the state more than $500 million. He also expects to save nearly $200 million in the Department of Human Services through “revenue maximization, additional pharmacy rebates and through increased use of home and community-based services.”
Below PIE summarizes some items of interest to the disability community in the Governor’s budget.* Remember that this is not the final budget. The House and Senate Appropriations Committees will now hold hearings on the budget. After that, a budget bill(s) will be moved. Any or all of the Governor’s proposals can be changed before the budget bills are passed and signed. While that is supposed to be done by the end of June, this could be a year for a late budget. For more information, contact PIE at The Arc of Pennsylvania office at 717-234-2621 or firstname.lastname@example.org.
*All dollar figures are state funds, unless otherwise noted.
Department of Human Services
Intellectual Disability Waivers: Funding of $18,878,000 would be provided for 1000 people–some off the waiting list and some high school graduates. At this point, we don’t know how the money would be split between the two groups or what portion of the year people would receive services. The proposed budget also includes state funds of $952,000 to move 75 people from state centers to the community.
Autism: Increase in state funds of $400,000. This includes $372,000 to serve an additional 50 adults with autism who are waiting for services.
State Centers: Institutions for people with intellectual disabilities would receive an $8.2 million increase for maintenance of current program. The number of people in state centers is projected to go down from 995 in July 2014 to 905 in July 2015
Community Base Funding Intellectual Disabilities: The Governor proposes an increase in Base Funding–$500,000 to collaborate with the Office of Vocational Rehabilitation in promoting competitive employment for people with intellectual disabilities and $4,832,000 as the first installment of a three year plan to restore funds cut in the Human Services Block grant.
Services to Persons with Disabilities: This line item includes funding for the Independence, OBRA and Commcare Waivers. The line item would receive an additional $35,386,000 in state funds. This includes $13,761,000 to serve an additional 1140 people.
Attendant Care: The Attendant Care line item, which includes both the waiver and Act 150, would receive an additional $12.2 million. This includes $2.359 million to serve an additional 324 people.
Human Services Development Fund: $499,000 has been added as the first installment of a three year plan to restore funds cut in the Human Services Block grant.
Mental Health: The proposed budget includes $4.725 million in state funds to move 90 people from state hospitals to the community; this is the same amount as last year when it was intended to pay for six months. It also includes $18.326 million as the first installment of a three year plan to restore funds cut in the Human Services Block grant.
Behavioral Health: BHSI funds would increase from at $43.1 million to $47.2 million. This includes $2.5 million to address the heroin crisis.
Aging Waiver: The Governor proposes $13.2 million State General Funds to serve an additional 1,764 people in the Aging Waiver. The budget also provides $1.7 Million for an additional 144 older adults in the LIFE program.
Nursing Homes (Long Term Care): Nursing homes would receive a $135.5 million increase in State General Funds. But they are losing $132.3 million in tobacco settlement funds and $25 million in Lottery Funds.
Early Intervention (Birth to age 3): DPW’s Early Intervention program is level funded.
Medical Assistance Transportation: Funding is increased by $4,879,000 to reflect increased usage.
Adult Protective Services: There is $3,555,000 in the General Government Operations line item for Adult Protective Services.
Federal Match: The Federal share of Medicaid costs is going up from 51.82% to 52.01%.
Department of Aging
PENNCARE funding is increased from $299,306,000 to $305,190,000, including $1.8 million for 208 people transitioning from the DPW Attendant Care program to the Aging program.
Pre-Admission Assessment would be increased by $5.4 million to support the Area Agencies on Aging in complete assessments on 2,290 people.
Grants to Senior Centers, Caregiver Support and Alzheimer’s Outreach are all level funded.
At the March 3 budget briefing, Acting Secretary Theresa Osborne emphasized the importance of rebalancing long term care. She cited the fact that the state saves $2,450 for each month that a person stays in the community as opposed to a nursing home. She also described the “Senior Initiative” (see article below).
Department of Labor and Industry
Transfer to Vocational Rehabilitation Fund (OVR state match) would increase from $40,473,000 to $45,473,000. The additional $5 million is intended for “Jobs that Pay,” includes initiatives aimed at young people and will be used to pull down additional federal funds. At the Labor and Industry budget briefing, acting Secretary Kathy Manderino indicated that OVR would continue to serve those most in need.
Supported Employment, Assistive Technology Devices (alternative financing program) and Assistive Technology Demonstration and Training (lending library): All of these programs are level funded.
Centers for Independent Living (CILs): CILs would be increased from $1,912,000 to $2,318,000.
Department of Education
Special Education: Special education would be increased by $100 million.
Early Intervention (for ages 3 to 5): level funded.
Approved Private Schools and PA Charter School for the Deaf and Blind: Both would receive increases.
Department of Health
Services for Children with Special Needs would be level funded.
The AIDS Programs and AIDS Special Pharmaceuticals line items are combined and level funded in state dollars.
Epilepsy Support and Tourette Syndrome: The Governor proposes eliminating funding for these two programs. This has happened before and the General Assembly has restored funding.
Sickle Cell would be cut from $1,260,000 state dollars, reducing funding to $1.2 million.
Department of Drug and Alcohol Programs
Assistance to Drug and Alcohol Programs: There is an additional $5 million to combat heroin. There’s also additional funding for this purpose in the DPW budget.
Bills of Interest
Below we summarize some bills of interest to the disability community from the 2015-2016 session. For more information about these or any other state bills, go to: www.legis.state.pa.us/cfdocs/legis/home/session.cfm. At the top of the page is a box labeled, “Legislation Quick Search,” enter the bill number and click on “Search”. The site contains lots of useful information. So, take a few minutes and check it out.
HB 104. Introduced by Representative Dom Costa (D-Allegheny). The bill would amend the Vehicle Code to allow an individual who is diagnosed with an Autism Spectrum Disorder, or the parent of someone under age 18, to ask to have a notation of their diagnosis placed on their driver’s license or identification card. It also adds a section to allow any individual applying for an original or renewal driver’s license or identification card to make a voluntary $1 contribution to a newly created Autism Spectrum Disorder Awareness Account to be used by the Department of Health to offer education and training to professionals working with people on the Autism Spectrum. It was introduced and referred to the House Transportation Committee, January 21, 2015.
HB 133. Introduced by Representative Thomas P. Murt (R-Montgomery). It would establish a bill of rights for individuals with intellectual and developmental disabilities. It was introduced and referred to the House Human Services Committee, January 21, 2015
HB 183. Introduced by Representative Gene DiGirolamo (R-Bucks). This bill would repeal the Human Services Block Grant program and provide for an alternative way to give counties more flexibility in spending human services funds. It was introduced and referred to the House Human Services Committee, February 3, 2015
HB 214. Introduced by Representative Mauree Gingrich (R-Lebanon). This bill would make changes in the law on publically funded, home and community based services for people who are over age 60 and nursing home eligible. It was introduced and referred to the House Aging and Older Adult Services Committee, January 23, 2015.
HB 215. Introduced by Representative Mauree Gingrich (R-Lebanon). It would amend the crimes code to provide for the offense of neglect and abuse of care-dependent people. The bill passed the House on February 10, 2015 and has been referred to the Senate Judiciary Committee.
HB 221. Introduced by Representative Thomas Caltagirone (D-Berks). This bill requires members of law enforcement and the judiciary to have training in understanding and interacting with people with intellectual disabilities, autism and mental illness. It was passed by the full House on February 10, 2015 and out of the Senate Judiciary Committee. It is currently on the Senate calendar.
HB 400. Introduced by Representative Mauree Gingrich (R-Lebanon) The bill provides for the Work Experience for High School Students with Disabilities Act. It was introduced and referred to the House Labor and Industry Committee, February 17, 2015. See also SB 200. Introduced by Senator Lisa Baker (R-Luzerne) and referred to the Senate Labor and Industry Committee, January 16, 2015.
HB 439. Introduced by Representative Jerry Knowles (R-Berks). This bill would expand the Human Services Block Grant Pilot Program to all counties. It was introduced and referred to the House Health Committee, February 10, 2015.
HB 444. Introduced by Representative Todd Stephens (R-Montgomery). Establishes ABLE savings accounts in Pennsylvania, with oversight by a new ABLE Bureau in the Department of Treasury and ABLE Board of Directors. Introduced and referred to the House Finance Committee on February 12, 2015. See also, HB 583.
HB 479. Introduced by Representative Florindo J. Fabrizio (D-Erie). It would enable registered nurses to delegate tasks that do not require nursing judgment or substantial skill. The bill was introduced and referred to the House Health Committee, February 17, 2015
HB 583. Introduced by Representative Dan Miller (D-Alleghany). The bill establishes ABLE Accounts in Pennsylvania, allowing people with disabilities to save for community living costs without losing their Medical Assistance or Social Security eligibility. It was introduced and referred to the House Finance Committee on February 26, 2015. See also, HB 444.
HB 585. Introduced by Representative John Sabatina (D-Philadelphia). This bill prevents organ transplant discrimination for non-medical reasons against people with intellectual, developmental, and physical disabilities. It speeds up organ transplant discrimination complaints. It was introduced and referred to the House Judiciary Committee on February 23, 2015.
SB 12. Introduced by Senator Vincent J. Hughes (D-Montgomery). The bill provides for Medicaid expansion. It was introduced and referred to Senate Public Health and Welfare Committee, January 29, 2015.
SB 21. Introduced by Senator Stewart J. Greenleaf (R-Montgomery). It amends the Mental Health Procedures Act to provide for assisted outpatient treatment programs. It was introduced and referred to Senate Public Health and Welfare Committee, January 14, 2015
SB 90. Introduced by Senator Lisa M. Boscola (D-Lehigh). The bill amends the election code to provide for polling place accessibility and to require the posting of a statement of voter’s rights. It was introduced and referred to the Senate State Government Committee, January 14, 2015
SB 271. Introduced by Senator Christine M. Tartaglione (D-Philadelphia). It would establish in law the Office for People with Disabilities and Advisory Committee for People with Disabilities. It was introduced and referred to the Senate State Government Committee, January 20, 2015.
SB 447. Introduced by Senator Wayne D. Fontana (D-Allegheny). The bill would legalize and regulate ride-sharing services like Uber and Lyft, which connect drivers and riders using smartphone technology. Section 2603(e) deals with how the companies and drivers deal with people with disabilities. The bill was introduced and referred to the Senate Consumer Protection and Professional Licensure Committee, February 13, 2015.
HR 38. Introduced by Representative Robert F. Matzie (D-Allegheny). The resolution urges the Governor to proclaim January 30, 2015, as “Pennsylvanians with Disabilities Day”, and to appoint a committee to recommend how the Commonwealth can best commemorate “Pennsylvanians with Disabilities Day” on an annual basis. It was adopted, February 3, 2015.
HR 73. Introduced by Representative Thomas P. Murt (R-Montgomery) The resolution directs the Legislative Budget and Finance Committee to study changes in access to county-managed Community Mental Health Services between fiscal years 2010 through 2014. It was introduced and referred to the House Human Services Committee, February 9, 2015.
On February 9, 2015 Governor Tom Wolf announced that Pennsylvania will transition from Healthy PA to a traditional Medicaid expansion plan. The Department of Human Services (DHS) will withdraw the “low-risk” health care package known as the “Healthy” option from further federal consideration. Instead of three plans, there will be just one. There will be no gaps in coverage as a result of the transition and no immediate changes for those already in Healthy PA. Over time, DHS will eliminate the use of the Healthy PA screening tool. No changes to eligibility are planned, and people who do not have health care coverage, can continue to apply online at www.compass. Questions regarding Medicaid expansion can be emailed to RA-PWDHSMEDICAIDFAQ@pa.gov.vernor Corbett’s alternative expansion. He will abandon his predecessor’s benefit package reforms and instead create a single
HCBS Transition Plan
On January 16, 2014, The Center for Medicare and Medicaid Services (CMS) published a final rule for Home and Community-Based Services (HCBS) According to this final rule, states must submit a transition plan to CMS detailing how the state will operate all 1915(c) HCBS waivers to comply with the final rule. The Department of Human Services made Pennsylvania’s proposed statewide transition plan for Home and Community-Based Settings available for public review and comment. The comment period ended on March 22, 2015. The proposed statewide transition plan for all ten of Pennsylvania’s HCBS waivers is available at www.dhs.state.pa.us/dhsorganization/officeoflongtermliving/hcbswaiver/index.htm.
Long Term Care Commission
In December, the PA Long Term Care Commission issued its Final Report. The Commission found that the long term services and support delivery system has a lengthy and complicated eligibility process; inefficiencies in service delivery that result in unnecessary costs; inconsistent provider reimbursement rules; silos in funding and services that are not the best way to use resources; and a lack of technology that hampers efforts to assess and ensure quality services. The Commission made four major recommendations:
- Improve Care Coordination– Develop and implement a coordinated, integrated demonstration program and conduct an analysis to identify gaps and barriers that prevent the system from operating in a person-centered, efficient and effective manner
- Improve Service Delivery– Streamline and expedite the eligibility process, increase affordable and accessible housing options, including home modifications as a covered service in all waiver programs, increase assistance and support to unpaid caregivers, and elevate the profession of direct care workers
- Improve Quality and Outcomes– Adopt a uniform assessment for all levels of care and expand electronic health record initiatives to long term care providers
- Make the System More Fiscally Sustainable —Review rate setting and reimbursement systems for all providers; give DHS flexibility to maximize use of appropriated funds; and adopt policies to assure that people are getting needed services in the safest, most appropriate and least restrictive settings possible.
To read the report, go to www.dhs.state.pa.us/cs/groups/webcontent/documents/report/c_134443.pdf.
Long Term Living
On February 27, speaking to the AARP, Governor Wolf revealed a package of legislative and budgetary actions aimed at rebalancing Pennsylvania’s long term care system and increasing opportunities for homecare workers. The governor refers to this as his “Senior Initiative that will improve home and community-based care services for older Pennsylvanians,” but it is also aimed at consumers of long term care services, who are under age 60. The Initiative includes steps to:
- Expand Services for Older Pennsylvanians and Reduce Long Term Care Costs (see the State Budget Article above).
- Phase in Medicaid Managed Long Term Care.
- Improve Long Term Living Waiver Enrollment and Service Plan Development
- Improve Home Modifications Selective
- Implement Online Homecare
- Ensure Seniors have Choices about Where to Receive
The Office of Developmental Programs has issued one new Bulletin which can be seen at www.dhs.state.pa.us/publications/bulletinsearch/index.htm.
Fee Schedule Rates and Department Established Fees (00-14-06) was issued on December 23, 2014 and was effective on July 1, 2014. The Bulletin announces the rates effective July 1, 2014, and a change to the rates for Agency with Choice/Financial Management Services effective January 1, 2015.
On February 11, 2015, Office of Developmental Programs Deputy Secretary Suroviec announced the convening of a Regulation Workgroup to advise the Department on recommended revisions to the Chapter 51 regulations that guide the intellectual disability and autism programs. The new regulations will be Chapter 6100. After a public comment process, publication is expected in late summer or fall of 2016. Karen Kroh will direct the rule-making process. For more information, contact the ODP Deputy Secretary’s office at 717.787.3700.
Prison MH Lawsuit
In January, the Disability Rights Network of Pennsylvania (DRN) announced that it had settled a law suit against the Pennsylvania Department of Corrections (DOC). The suit, filed in federal court in March 2013, alleged that the state violated the constitutional rights of inmates with serious mental illness in 26 state correctional institutions. Many inmates with serious mental illness were kept in solitary confinement in restricted housing units (RHUs) for months or even years. There, they were locked down 23 hours a day, 7 days a week in a cell with little or no access to mental health treatment or other services they needed. In the settlement, DOC has agreed to a complete, state-wide overhaul of its policies and practices affecting prisoners with serious mental illness. The state has agreed to stop housing inmates with serious mental illness in solitary confinement in the RHU; provide significant out-of-cell time both for therapeutic and non-therapeutic activities.
Legislative Committee Chairs
Senate Appropriations Committee:
Majority: Senator Patrick Browne (Lehigh)
Minority: Senator Vincent Hughes (Philadelphia)
Senate Aging and Youth Committee:
Majority: Senator Michelle Brooks (Mercer)
Minority: Senator Arthur Haywood (Montgomery)
Senate Public Health and Welfare Committee:
Majority: Senator Pat Vance (Cumberland)
Minority: Senator Shirley Kitchen (Philadelphia)
Senate Education Committee:
Majority: Senator Lloyd Smucker (Lancaster)
Minority: Senator Andrew Dinniman (Chester)
Senate Labor and Industry Committee:
Majority: Senator Lisa Baker (Luzerne)
Minority: Senator Tina Tartaglione (Philadelphia)
House Appropriations Committee:
Majority: Representative William Adolph Jr. (Delaware)
Minority: Representative Joseph F. Markosek (Allegheny)
House Aging and Older Adult Services Committee:
Majority: Representative Tim Hennessey (Chester)
Minority: Representative Steve Samuelson (Lehigh)
House Education Committee:
Majority: Representative Stan Saylor (York)
Minority: Representative James Roebuck (Philadelphia)
House Labor and Industry Committee:
Majority: Representative Mauree Gingrich, (Lebanon)
Minority: Representative Gergely (Allegheny)
House Health Committee:
Majority: Representative Matt Baker (Bradford)
Minority: Representative Florindo (Flo) Fabrizio (Erie)
House Human Services Committee:
Majority: Representative Gene DiGirolamo (Bucks)
Minority: Representative Angel Cruz (Philadelphia)
In late January, Senator Dominic Pileggi (R-Delaware), who was defeated in his bid to continue as Senate Majority Leader, resigned his chairmanship of the Senate Local Government Committee. He has announced that he is running for the Delaware County Court of Common Pleas.
Governor Wolf has appointed all members of his cabinet who must now go through the Senate confirmation process. Some key cabinet posts are:
- Secretary of Human Services– Ted Dallas most recently served as the secretary of the Maryland Department of Human Resources. For five years before that, he was the executive deputy secretary of the Pennsylvania Department of Public Welfare.
- Secretary of Aging– Teresa Osborne most recently served as executive director of the Luzerne/Wyoming Counties Area Agency on Aging.
- Secretary of Education–Pedro Rivera, former superintendent of the Lancaster School District
- Secretary of Health– Karen Murphy is the former chief executive officer of Moses Taylor Hospital in Scranton.
- Secretary of Labor and Industry—Kathy Manderino served in the PA House of Representatives for 18 years.
- Secretary of Budget– Randy Albright, served as the Democratic Executive Director of the Pennsylvania Senate Appropriations Committee since 2009.
- Secretary of Transportation– Leslie Richards was a Montogomery County Commissioner. Former Secretary, Barry Schoch will serve as a senior advisor to the governor on issues related to transportation and infrastructure.
- Secretary of Corrections– John Wetzel will remain as the head of the Department of Corrections.
- Secretary of State–Pedro Cortés served as secretary of state under Governor Rendell.
- Secretary of Community and Economic Development –Dennis M. Davin, was the director of Allegheny County Economic Development.
- Secretary, Department of Drugs and Alcohol–Gary Tennis will remain as Secretary of the Department.
Federal Budget 2015
Congress passed a budget for the federal fiscal year October 1, 2014 to September 30, 2015 in December, enacting 11 of the 12 appropriations bills for full year funding. The twelfth bill, for the Department of Homeland Security, was not passed until March 2015 due to disputes over immigration rules. Most disability programs are level funded or received small increases.
Federal Budget 2016
The President delivered his budget for the fiscal year 2015-16 to Congress on February 2nd. It includes a proposal to make a small shift in the funding of the large Social Security retirement and survivors program to the smaller Disability Insurance program. The shift is needed to ensure sufficient funds are available beyond 2016. (See SSDI article below). Congress is debating whether to tie other, more sweeping Social Security reforms to measures that would fix the problem. The Social Security Administration 2014 annual report is at this link: www.ssa.gov/oact/trsum/. The President proposed ending sequestration, which has forced harmful spending caps on many programs. The budget will now go to Congress, where members will attempt to pass a Budget Resolution.
The bill that establishes parliamentary rules for the new session of Congress includes a provision which could result in 20% cuts to Social Security Disability Insurance (SSDI) within the next two years. The provision bans a common accounting technique that has been used in the past to prevent benefit cuts. The technique allows the two Social Security funds to borrow from one another as necessary to ensure that benefits can be paid in full each year. SSDI is projected to hit a shortfall in late 2016. The provision included in the rules package prohibits Congress from authorizing a transfer. That will force a showdown over how to finance disability benefits sometime in the next two years, with the threat of a nearly 20 percent cut to SSDI payments looming over the debate.
On February 10, the White House held a ceremony marking the passage of legislation that will set up a way for people with disabilities and their families to have tax-exempt savings up to $100,000 for future expenses such as education, housing, and transportation without losing eligibility for Social Security, Medicaid, and other services. The measure was renamed the Stephen E. Beck, Jr. Act when Congress passed it on December 19, 2014. Mr. Beck, who passed away shortly before the bill became law, was a tireless advocate for the issue. The benefit is modeled on the current 529 plans for college savings and each state must now pass its own law to add the provisions so that people with disabilities can open savings accounts. House Bill 444 and HB 583 would create the ABLE Account Program in PA. (See Bills of Interest.)
Labor Home Care Rule
The federal Department of Labor’s (DOL) Home Care Final Rule, which was supposed to become effective on January 1, 2015, is on hold since two court decisions threw out the Rule. The U.S. District Court for the District of Columbia rejected the third party regulation on December 22, 2014, and the narrowed definition of companionship services on January 14, 2015. The DOL is appealing the two decisions. Until a final decision is reached on appeal, third party employers can still benefit from the minimum wage and overtime exemptions under the companionship rule and the overtime exemption for live-in domestic workers.
Philadelphia has been chosen to host the 2016 Democratic Convention.
The Pennsylvania Health Law Project has expanded and updated its Medical Assistance Eligibility Manual. The manual describes eligibility for Pennsylvania’s Medicaid Assistance (or Medicaid) program in plain language. Readers will learn Medicaid coverage “categories” as well as the program’s income and resource counting rules. The manual is available at www.phlp.org/wp-content/uploads/2015/02/Eligibility-Manual-2015.pdf.
Dental Services Report
On February 24, the Legislative Budget & Finance Committee issued a report called for in Senate Resolution 61 on Dental Services for Persons with Disabilities. The report has findings on the need for and availability of dental care for Pennsylvanians with disabilities, both children and adults, and makes six recommendations to preserve and improve such services. One of the recommendations is that the PA Developmental Disabilities Council take the lead in meeting with representatives of PA’s three dental schools to explore the training needs identified by Pennsylvania dentists. Read the report highlights at http://lbfc.legis.state.pa.us/Resources/Documents/Reports-Highlights/507.pdf and the full report at http://lbfc.legis.state.pa.us/Resources/Documents/Reports/506.pdf