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.
State Budget 2016-17
After a year in which the state budget was almost nine months late, you could almost hear a sigh of relief on Capitol Hill when the 2016-17 budget passed less than two weeks past the July 1 start of the state’s fiscal year. In an unusual move, the General Assembly passed a spending bill, SB 1073, which Governor Wolf allowed to become law without his signature, before it passed the legislation needed to fund it. The Revenue Package provided for balancing the budget in a variety of ways, including an increase of $1 a pack for cigarettes, adding other tobacco taxes, taxing digital downloads and lottery winnings and expanding gambling and liquor sales. Below we summarize what we know about how some key disability programs fared. More information will be shared as it becomes available. If you have questions, please contact the PIE office.
The Governor’s budget included proposed expansion of a number of programs affecting people with disabilities. See Volume 17, Issue 1 of A Slice of PIE for a rundown of the Governor’s proposal. Because the amounts appropriated for these programs in the final budget are different than the amounts proposed by the Governor, we do not know yet how many, if any, additional people will be served. As soon as the Departments analyze the new budget numbers and decide how the money will be spent, (that’s known as “re-budgeting”) we’ll share more specific information.
We can compare the amount in the final budget to the amount appropriated for last year and we can also compare it to the Governor’s budget. That should give some idea of what we can expect from the Departments’ re-budgets.
Generally, the line items are less than the Governor proposed, but more than last year. For example, the Intellectual Disability Waivers line item is 5.5% more than it was for 2015-16, but less than the Governor proposed. That would seem to make it unlikely that the state will be able to bring 75 people out of state centers and 250 people off the waiting list under the Consolidated Waiver as had been proposed. There are exceptions to the “increase from last year/decrease from the Governor’s proposal” pattern.
The Autism budget is more than the Governor proposed, though additional funds may be for a specific project. And the Medical Assistance for Workers with Disabilities (MAWD) budget is less than half of the Governor’s request. That is based on the belief that fewer people will need MAWD because more will qualify for Medicaid under the Medicaid Expansion. The Mental Health line item supports both the institutional and the community budgets; despite an increase in state funding, the loss of some federal and other funding results in a budget which is actually less than last year. Other important budget lines include:
- The Attendant Care budget including state and federal funds is 3.8% less than the Governor proposed and 10.1% more than last year, but it provides for no additional people in Act 150.
- The budget includes funds to implement Community HealthChoices. It’s not known how the implementation delay will influence available funds.
- The Governor had proposed adding funds to cover the costs of the second year of a three year initiative to restore funds cut in the 2012-13 Human Services Block Grant pilot. Programs affected include Intellectual Disability (ID) base funding, Behavioral Health and Mental Health. The additional funds do not appear to be in the final budget.
- There is $3 million included for implementing the Medical Marijuana
Labor and Industry
- The Office of Vocational Rehabilitation received an additional two million dollars enabling Pennsylvania to pull down an additional eight million federal dollars.
- The Assistive Technology Financing Program, Assistive Technology Equipment Lending Program, Centers for Independent Living and Supported Employment all continue to be level funded.
- The budget includes a $20 million increase in special education and a $14.6 million increase in Early Intervention for children aged 3 to 5.
- In the Department of Health, the General Assembly restored level funding for a number of small programs, including Lupus, Sickle Cell, Epilepsy, Tourette Syndrome and ALS. Services for Children with Special Needs received a small increase.
- $1.5 million is included for implementation of the ABLE Act.
The chart below includes only state general funds. Other state funds, like the lottery, and federal funds, like Medicaid, are not included. The 2015-16 column includes a few line items which received a “supplemental appropriation,” a change in the appropriated amount, for 2015-16, as part of the 2016-17 budget process. These revised amounts for 2015-16 are listed in bold italics after the original amount appropriated for 2015-16.
|Line Item||2014-15 Actual||2015-16 Appropriated / Total With Supplemental||Governor’s Proposal 2016-2017||Appropriated 2016-17|
|DEPARTMENT OF HUMAN SERVICES|
|ID State centers||$132,984,000||$136,548,000||$141,769,000||$137,770,000|
|Intellectual Disability (ID) Base||$149,681,000||$148,229,000||$158,914,000||$149,950,000|
|ID Community Waiver||$1,074,887,000||$1,202,683,000||$1,283,376,000||$1,283,113,000|
|MA Workers w/Disabilities||$115,450,000||$37,205,000/ $29,753,000||$34,482,000||$13,500,000|
|Attendant Care||$137,229,000||$148,291,000/ $161,741,000||$172,909,000||$171,638,000|
|Services to Persons w/Disabilities||$273,578,000||$313,716,000/$339,077,000||$378,177,000||$370,254,000|
|Long Term Care Nursing homes||$810,545,000||$968,083,000||$1,096,608,000||$996,784,000|
|Early Intervention Birth to Three||$127,974,000||$127,974,000||$129,211,000||$129,211,000|
|DEPARTMENT OF LABOR & INDUSTRY|
|Assistive Tech Lending Library||$399,000||$399,000||$399,000||$399,000|
|Assistive Tech Financing Program||$400,000||$400,000||$400,000||$400,000|
|Centers for Independent Living||$1,912,000||$1,912,000||$2,318,000||$1,912,000|
|OVR State Match/Transfer to Voc. Rehab fund||$40,473,000||$45,473,000||$47,473,000||$47,473,000|
|DEPARTMENT OF EDUCATION|
|Early Intervention (3-5)||$237,516,000||$237,516,000/$241,779,000||$237,516,000||$252,159,000|
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 400. Introduced by Representative Mauree Gingrich (R-Lebanon). This bill would provide for the Work Experience for High School Students with Disabilities Act. It was signed by the Governor, May 17, 2016 becoming Act No. 26 of 2016. See article under “State News.”
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 voted out of the House Health Committee as amended and given first consideration by the full House on April 4, 2016.
HB 1930. Introduced by Representative Kerry A. Benninghoff (R-Centre). This bill would amend the Adult Protective Services Act to establish a statewide registry of individuals who have been convicted of simple assault, aggravated assault or neglect of a care-dependent person. People applying for jobs would be required to submit a certification, not more than one year old, from the department that the prospective employee’s name does not appear on the registry. It was voted out of the House Aging and Older Adult Services, April 1, 2016 and referred to the House Human Services Committee, May 23, 2016.
HB 2031. Introduced by Representative Dan Miller (D-Allegheny). This bill would provide a preference on the Civil Service Exam for people with disabilities. It was introduced and referred to the House State Government Committee on May 9, 2016.
HB 2069. Introduced by Representative Frank Farry (R-Bucks). The bill would expand eligibility and make changes for the PACENET program. It passed the House on June 6, 2016. It was voted out of the Senate Aging and Youth Committee and given two considerations by the full Senate. It is currently in the Senate Appropriations Committee.
HB 2130. Introduced by Representative Bryan Cutler (R-Lancaster). This bill is an “Employment First” bill, designed to promote the employment of people with disabilities at competitive wages. It was introduced and referred to the House Labor and Industry Committee, June 9, 2016. See article on Employment First under State News. See also, SB 1199 introduced by Senator Bob Mensch (R-Berks)which was introduced and referred to the Senate Labor and Industry Committee, April 22, 2016.
HB 2185. Introduced by Representative Michael Peifer (R-Pike). This bill would prohibit the use of Lottery funds appropriated for the PENNCARE program from being used to cover administrative costs of the Aging Department, instead of for home and community based services. It does not address the use of Lottery funds for other purposes. It was voted out of the House Appropriations Committee and given first consideration by the full House on June 29, 2016 and is currently in the House Rules Committee.
SB 3. Introduced by Senator Mike Folmer (R- Lebanon). This bill legalized Medical Marijuana. It was signed by the Governor on April 17, 2016 becoming Act 16 of 2016.
SB 613. Introduced by Senator Pat Vance (R-Cumberland). This bill would give all of Pennsylvania’s 67 counties the opportunity to participate in the Human Services Development Block Grant which is currently limited to 30 counties. The bill passed the Senate on June 29, 2016 and has been referred to the House Health Committee.
SB 879. Introduced by Senator Lisa Baker (R-Luzerne). This bill would provide for the establishment of a savings program by the Treasury Department to encourage eligible individuals with disabilities to save private funds from which the expenses related to their disabilities may be paid to assist them in maintaining health, independence and quality of life. These savings accounts are commonly referred to as ABLE savings accounts. SB 879 was signed by the Governor on April 18, 2016 becoming Act 17 of 2016. Another ABLE bill, HB 1319, introduced by Representative Jim Marshall (R-Beaver) passed the House.
SB 983. Introduced by Senator Thomas McGarrigle (R-Chester). The bill allows parents of children and adult children with disabilities and spouses of people with disabilities to get disability license plates. The bill passed both chambers and was signed into law by the Governor on June 23, 2016, as Act 55 of 2016.
SB 984. Introduced by Senator Camera Bartolotta (R-Beaver). The bill provides for regulation of Transportation Networking Companies such as Uber, Lyft, etc. It includes provisions on non-discrimination against people with disabilities. It passed the Senate on November 24, 2015 and was voted out of the House Consumer Affairs Committee on May 4, 2016 with amendments, and given first consideration by the full House.
HR 808. Introduced by Representative Jason Ortitay (R-Allegheny). This resolution would establish a task force to study and make recommendations regarding voting system technology modernization. The task force will be composed of election directors, county commissioners, a representative of a disability advocacy organization, an election technology expert and others. It was referred to the House State Government Committee, April 12, 2016.
The PA Treasury Department took action to implement the ABLE Act. The Act will establish 529-like savings accounts for people with disabilities who acquired their disability before age 26. An advisory group that includes people with disabilities and their allies has given input on the Pennsylvania program and educational materials. Pennsylvania has joined a group of 10 states working to keep investment fees affordable while the program is new and small. The Treasury has said they are working to make the new benefit available by the end of 2016.
Human Services Changes
House Bill 1062 introduced by Representative Killion (R-Delaware)became the vehicle for changes to the Human Services Code. It was signed into law on July 8 as Act 76 of 2016. Among other things, the bill: starts the phase-out of the 10-percent county share paid annually to the Department of Human Services by counties that operate public nursing facilities due to the rollout of the Community HealthChoices Program; suspends Medical Assistance benefits, rather than terminating them, for people who are incarcerated for no more than two years, so that their benefits will be available when they are released from prison (Senator Vance R-Cumberland has introduced SB 1279which would do this legislatively.); extends the Nursing Facility Budget Adjustment Factor for three years to ensure that payments to nursing facilities don’t exceed the funding appropriated; provides day-one incentive payments to qualified nursing facilities to encourage the facilities to continue to provide services to individuals who are MA-eligible on the day of their admission to the facility; and extends the Nursing Facility Assessment and of the Intermediate Care Facilities for Persons with Intellectual Disabilities (ICF/ID) assessment for three years, which will allow the state to draw down federal matching funds.
Governor Wolf’s Executive Order making Pennsylvania an Employment First state, issued on March 10, 2016, requires the creation of a cross systems plan by July 8, 2016. The public was invited to give comment for 30 days. Steve Suroviec, working out of the DHS Secretary’s office, is directing the development of the plan. The order directs Commonwealth Departments to make competitive integrated employment the first and preferred outcome.
See under Bills of Interest above, HB 2130 which was introduced by Representative Cutler (R-Lancaster) that would establish Employment First principles in law, and would create oversight and advisory bodies for the focus on competitive integrated employment for people with disabilities in Pennsylvania.
Pennsylvania Department of Labor & Industry (L&I) Secretary Kathy Manderino in April announced the availability of wage reimbursements to employers for new hires with disabilities via the single-point-of-contact (SPOC) service delivery system administered by the Office of Vocational Rehabilitation (OVR). The announcement was part of OVR’s 2016 business services and outreach division training held in State College. Conference attendees learned about the Jobs for All on-the-job training program, which creates paid work opportunities for people with disabilities with OVR business partners. The on-the-job training program provides a reimbursement for a percentage of an OVR customer’s wages to employers while they are training a new employee.
Autism and ABA
In June, the United States District Court for the Middle District of Pennsylvania approved the final Settlement Agreement in Sonny O. et al v. Dallas. The Order settles a federal class action lawsuit filed against the Pennsylvania Department of Human Services (DHS) by three Medical Assistance-enrolled children with Autism Spectrum Disorder (ASD) who had been unable obtain a treatment called Applied Behavioral Analysis (ABA), an evidence based treatment that helps children with ASD develop the basic skills that they need to function effectively at home and in the community. The Settlement requires DHS to develop new medical necessity guidelines for ABA, promulgate regulations in the summer of 2017 defining the qualifications required of ABA practitioners, require behavioral health managed care organizations to identify practitioners who are currently qualified to provide ABA and seek out-of-network providers if they do not currently have the capacity to provide ABA, allow all qualified ABA providers to enroll in the Medical Assistance program, develop a bulletin explaining that ABA can be used to address skill building for activities of daily living, as well as appoint a person within DHS to receive complaints from families. A copy of the Settlement Agreement can be found at https://disabilityrightspa.org/wp-content/uploads/2016/04/SonnyOExecutedAgreement.pdf
A celebration of the passing and signing of House Bill 400, which focused on increasing opportunities for young people with disabilities to get work experience.was held on June
23 at the Capitol. It included the advocates who worked over several years to push the legislation. The measure had strong support from both Democrats and Republicans in both chambers.
The Department of Human Services, on June 20, 2016, issued a Bulletin making changes to all regulations, replacing the term “intellectual disability” for the out-dated and offensive “mental retardation. The Bulletin, “Use of Appropriate Terminology in Regulations,” 00-16-15, is intended to promote respect, community integration and an array of opportunities for an individual with an intellectual disability, by using words that are positive and up-to-date.
Community Health Choices
The Department of Human Services has announced that it will delay the January 1, 2017 planned start of the Southwest Region Community Health Choices (CHC) managed long term services and supports until July 1, 2017. The Southeast region is slated to begin on January 1, 2018. The Lehigh/ Capital, Northwest and Northeast regions will begin in 2019. Fourteen managed care organizations responded to the Request For Proposals (RFP). The Department is choosing 2 to 5 health plans to operate in each region. The OBRA waiver, Act 150 Attendant Care, and the Aging Options program will not be included in CHC. Information on CHC is available at www.dhs.pa.gov under Community HealthChoices. See under “Resources” below, information on how to sign up for the CHC listserv.
The Adult Autism Waiver has been renewed by the Center for Medicare and Medicaid Services(CMS) for a five year period effective July 1, 2016. The waiver includes several changes, including starting intake at age 21, changes and additions to service definitions including residential habilitation, behavioral supports, and employment services. The proposed waiver renewal application did not include the addition of person-directed services. Information about the waiver is at www.dhs.pa.gov/learnaboutdhs/waiverinformation/adultautismwaiver/index.htm#.V1XIv-YerJ8.
The Office of Long Term Living has issued three new Bulletins:
- Provider Choice Protocol, 59-16-03, was issued on March 8, 2016, effective on that date. The Bulletin provides updated forms used in the Provider Choice Protocol.
- Act 150 Program Guidelines, 54-16-04 and 59-16-04, was issued on May 18, 2016, effective on that date. The Bulletin provides policy guidance to the Act 150 Program for service coordination entities and direct service providers.
- Act 150 Sliding Fee Scale for Calendar Year 2016, 54-16-05 and 59-16-05, was issued on June 1, 2016, effective on January 1, 2016. The Bulletin provides the most recent sliding fee scale.
The Office of Mental Health and Substance Abuse Services has issued nine new Bulletins:
- Training and Supervision Requirements for Therapeutic Staff Support Workers that implement Plans that include Applied Behavioral Analysis (ABA), OMHSAS-16-02, issued on March 11, 2016, effective April 10, 2016, The Bulletin clarifies the minimum training qualifications for serving an individual diagnosed with Autism Spectrum Disorder (ASD).
- Revised Procedure for OMHSAS Program Regulations and Standards, OMHSAS-16-03, was issued on April 19 2016, effective immediately. The Bulletin updates and clarifies the procedure for submitting and processing requests for waiver of OMHSAS program regulations or standards that are used to license or approve behavioral health providers.
- Training Requirements for Licensed Behavioral Specialists who use Behavioral Specialist Consultant-Autism Spectrum Disorder Services to Provide Applied Behavioral Analysis, OMHSAS-16-04, was issued on April 26, effective on May 15, 2016.
- Guidelines for Referrals and Coordination of Admission to South Mountain Restoration Center for Individuals Discharged from Correctional Facilities, OMHSAS-16-05, was issued on May 10, 2016, effective immediately. Payment for Room and Board when Services are provided by a CARF or COA Accredited Residential Treatment Facility, OMHSAS-16-06, was issued on May 16, 2016, effective immediately. The Bulletin informs facilities of changes to accreditation requirements to receive room and board payments.
- Enrollment and Payment of Provider Entities that do not have a License to Provide Outpatient, Partial Hospitalization, or Family Based Mental Health Services to use Behavioral Specialist Consultant Services and TSS to Provide Applied Behavioral Analysis to Children with Autism Spectrum Disorders, OMHSAS-16-07, was issued on June 6, 2016, effective immediately. The Bulletin notifies providers how to enroll in the MA program and be paid for services.
- Security Guidelines for Regional Forensic Psychiatric Centers (RFPC), OMHSAS-16-08, was issued on June 23, 2016, effective on March 1, 2016. The Bulletin establishes and updates guidelines to ensure that patient care, custody and control is maintained within the Centers.
- Medical Necessity Guidelines for Applied Behavioral Analysis, OMHSAS-16-09, was issued July 1, 2016 effective on July 2, 2016.The Bulletin provides guidelines to be used in reviewing requests for Applied Behavioral Analysis for children with Autism Spectrum Disorders.
In May, the Departments of Human Services (DHS) and of Community and Economic Development (DCED), and the Pennsylvania Housing Finance Agency (PHFA), released a five-year housing strategy to connect Pennsylvanians to affordable, integrated, and supportive housing. “Too many Pennsylvanians live in institutions when they could live at home with the right supports. Too many are rent-burdened and too many Pennsylvanians experience or are at risk of homelessness,” said Governor Tom Wolf. “Ninety-five percent of Pennsylvanians who need these services want to live in their community, not in an institution or a nursing home. But right now, we can only serve 51 percent of them in the community,” said Secretary Dallas. “Governor Wolf and all of us here today are committed to promoting independence and giving all people, regardless of their age or disability, a voice in choosing where they live. If we are successful, the services we provide will match what our clients want and, because community-based care costs about half of institutional care, we can also save millions of taxpayer dollars.”
The plan is aimed at 53,574 Pennsylvanians living in institutions who could live in the community with housing services and supports, as well as homeless and very low income people. The goal is to use internal and external resources to collaborate with all levels of government and private agencies to make housing resources and services more accessible and available.
Some of the initial steps include using some “Money Follows the Person” federal grant funds to expand the number of regional housing coordinators across the state from 11 to at least 14. These coordinators work with local housing authorities and stakeholders to help transition individuals to the community. It also would expand the use of Medicaid dollars to help move people to stable housing and maintain housing through housing-related supports.
For more information, go to www.padisabilitynews.com/news/pennsylvania-unveils-five-year-affordable-housing-strategy#sthash.np06zEwM.dpuf.
Federal Budget 2017
In February, the President introduced his budget for the federal fiscal year that starts on October 1, 2016. Congress has begun the process of considering the appropriations bills. Both the House and Senate Appropriations Committees have completed their work on the twelve spending bills. The bills used the increased spending caps of the amended Balanced Budget Act of 1985. The Bipartisan Budget Act of 2015 provides some budget stability and predictability by suspending the debt limit until March 15, 2017 and amending the Balanced Budget Act of 1985 to increase spending caps through September 30, 2017.
None of the bills have passed and Congress is now in recess until mid-September. A Continuing Resolution is likely to be needed to fund the government after September 30, 2016. For information on the appropriations bills and the President’s proposed disability program funding, go to http://appropriations.house.gov/ , or www.appropriations.senate.gov/ or http://acl.gov/About_ACL/Budget/Index.aspx .
On April 5, thousands of thought bubbles appeared with harsh stigmatizing statements such as, “Mentally ill people are dangerous,” “Most ‘disabled’ people are just scamming the system,” and “There’s no such thing as a learning disability—people just need to work harder.” While offensive, the thought bubbles were posted by volunteers from disability organizations all across Pennsylvania. This is part of the Stigma Campaign, which asks people “What are you thinking?,” drives people to the website where communications are used to change people’s thinking, behavior and attitudes toward people with disabilities. Visitors of www.LetsThinkAgain.org can watch videos, take the Stigma Quiz, pledge to end stigma and participate in other interactive activities. Campaign materials and bracelets are being handed out, while Public Service Announcements will begin airing on radio and television stations. All communications materials lead the public to www.LetsThinkAgain.org and social media channels such as Facebook (facebook.com/LetsThinkAgainPA) and Twitter (twitter.com/LetsThinkAgain_).
Accessible Polling Sites
The Department of Justice has published an updated technical assistance publication on polling place accessibility for voters with disabilities. The publication, “ADA Checklist for Polling Places,” (PDF) includes a survey to guide election officials in evaluating the accessibility of facilities used or being considered for use as polling places.
Prisoners with Disabilities
In June, Amplifying Voices of Prisoners with Disabilities (AVID), a project of Disability Rights Washington, released Making Hard Time Harder: Programmatic Accommodations for Inmates with Disabilities Under the Americans with Disabilities Act. The report outlines lack of accommodations for inmates with disabilities. Recommendations include: creation of independent corrections ombuds offices at the state level in order to address inmate concerns before they rise to the level of litigation; systemic accessibility reviews by state departments of corrections to identify both physical and programmatic barriers for inmates with disabilities; increased federal funding to the protection and advocacy network for corrections based monitoring and advocacy; and increased training for prison ADA coordinators. The report is available at www.AVIDprisonproject.org.
A listserv has been established for ongoing updates on the Community Health Choices program. It is titled OLTL-COMMUNITY-HEALTHCHOICES, and you can visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.
The Department of Justice has launched a new accessible technology section for its Americans with Disabilities Act (ADA) Web site, to help covered entities and people with disabilities understand how the ADA applies to certain technologies, such as Web sites, electronic book readers, online courses, and point-of-sale devices. The new Web pages compile in one place the Department’s technical assistance and guidance about accessible technology, as well as information about the Department’s accessible technology enforcement efforts, regulation development, and other federal accessible technology resources and initiatives. It’s at www.ada.gov/access-technology/index.html.