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.
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The state budget for the July 1, 2018 to June 30, 2019 fiscal year was passed before the June 30 deadline and with very little controversy. The Governor’s proposed merger of the Departments of Health and Human Services is not reflected in the enacted budget, and no language enabling such action is included. Below we summarize funding levels for some items of interest to the disability community. There are no work requirements, benefit reductions, or eligibility restrictions included in the budget package. The enacted budget information is at http://www.budget.pa.gov/ .Except where otherwise noted, all dollar figures include state funds only.
- The budget includes an additional $61,210,000 in state funds for the Intellectual Disabilities community waivers, a 4% increase. The Governor had indicated that this would expand waiver services to an additional 925 individuals including: 100 people on the emergency waiting list; 800 students graduating from special education; and 25 people coming out of state centers.
- State funding for the Autism Intervention and Services is increased by $3,673,000 which includes the Adult Autism Waiver and ASERT centers. The governor had proposed an increase of $688,000 in state funding to serve an additional 40 adults in the adult community autism program (ACAP).
- The budget assumes the closure of the Hamburg state center and funding for state centers is reduced by 8.9%. An update on Hamburg is provided below.
- Intellectual Disabilities Community Base Program funding is reduced by $1,355,000 (.9%) that reflects the Governor’s Spring Update for spending.
- While state funding for Mental Health of $776,853,000–$580,000 more than the Governor proposed—appears to increase, funding for community services may actually be reduced. (The mental health line item funds both mental hospitals and community services.) There is no funding for any additional people out of state hospitals (CHIPPs) or for restoration of the funds cut under the 2012-13 human service block grant. Although state funding for the 2017-18 fiscal year was reduced by $7,622,000 as part of the supplemental appropriations bill, the administration has indicated that some unspent funds could pay for CHIPPs in 2018-19.
- State funding for Medical Assistance for Workers with Disabilities (MAWD) would increase by 17.8%. MAWD is also to receive 30% or $103.6 million of tobacco settlement funds.
- Medical Assistance Transportation (MATP) funding increases by 6.6%. The enacted Human Services Code bill Directs the department to amend the commonwealth’s state plan to provide nonemergency medical transportation services under the Medicaid program through either a regional or statewide brokerage model;
- MA Community HealthChoices is a new line item with $662,269,000 state funds for services in the Southwest Region for a full year and in the Southeast Region for six months. That’s $40,000,000 less than the $702,269,000 that the Governor proposed. As noted below, funds from several other line items were transferred to this line. Community HealthChoices will also receive $341 million of one time tobacco settlement funds.
- For the Aging Waiver (Home & Community-Based Services) state funds are reduced $75,088,000. This is offset by a transfer to the Community HealthChoices line item. According to the Governor’s budget request, it includes funds to serve 2,290 additional older Pennsylvanians.
- State funding for the LIFE program (Long-Term Care Managed Care) is increased by $8,632,000, including funds to serve 480 additional older Pennsylvanians.
- Services to Persons with Disabilities (OBRA and Independence waivers) state funding is decreased. This is offset by a transfer to the Community HealthChoices line. It includes funds to serve 1,500 additional people with disabilities. Services to former COMMCARE participants are now provided through the Independence waiver.
- State funding for the MA Long-Term Care line item (nursing homes) is reduced. This is offset by the transfer to the Community HealthChoices line item. Nursing home rates were increased 1% effective 1/1/19 for non-CHC areas.
- State funding for Attendant Care (Act 150 program and waiver) is decreased. This is offset by a transfer to the Community HealthChoices line. It includes funding to serve 960 additional people with disabilities.
- The federal financial participation rate (the federal share of Medicaid) will increase from 51.82% to 52.25%.
- The final budget restores level funding for Epilepsy Support Services, Sickle Cell, Tourette’s syndrome and most of the other specialized health programs. Each year, the governor defunds these programs, and every year the General Assembly reinstates their funding. Services for Children with Special Needs and New Born Hearing Screening would be level-funded.
Labor & Industry
- The Office of Vocational Rehabilitation (OVR) receives $737,000 or a 1.6% increase in state match.
- Supported Employment, Centers for Independent Living and Assistive Technology Demonstration and Training receive the same amount of funding as last year. Assistive Technology Financing receives an additional $50,000, a 12.5% increase.
- State funding for special education increases by $15 million (1.3%). The Governor had asked for a $20 million increase.
- Pre-school early intervention increases by $21,622,000, an 8.2% increase–$10 million more than the Governor requested.
- Funding for chartered schools for those who are deaf and blind increases 4.3% and approved private school funding increases 2.9%.
The Lottery appropriations in the Department of Aging total $520.2 million, $15 million more than the governor’s proposal. Appropriations for the Department of Aging from the Lottery Fund include:
- $333.8 million for PENNCARE;
- $155 million for transfer to the Pharmaceutical Assistance Fund (PACE); and
- $2 million for grants to senior centers.
The budget also includes $308.4 million in appropriations from the Lottery Fund to the Department of Human Services, which is the same as the governor’s request. These appropriations support Medicaid programs that serve older adults.
Bills of Interest
Below we summarize some bills of interest to the disability community from the 2017-2018 session. For more information about these or any other state bills, go to: http://www.legis.state.pa.us/cfdocs/legis/home/session.cfm. At the top of the page in the box labeled, “Legislation Quick Search,” enter the bill number and click on “Search”. The site contains lots of useful information.
HB 1124. Introduced by Representative Jim Cox (R-Berks). This bill would further provide for the offense of neglect of a care-dependent person, and to create the offense of abuse of a care-dependent person. It was introduced and referred to the House Judiciary Committee, May 5, 2017. Third consideration and final passage, Dec. 12, 2017 (192-0). Referred to Senate Judiciary, Jan. 2, 2018.
Approved by the Governor, June 28, 2018
Act No. 53
HB 1233. Introduced by Representative Thomas P. Murt (R-Montgomery). This bill would establish a new standard for court ordered assisted outpatient treatment in the community, while leaving in place the clear and present danger standard for involuntary hospitalization. The new standard would be based on a medical determination of whether a person with serious mental illness needs and can benefit from assisted outpatient treatment to survive safely in the community. The bill was voted out of the House on June 21, 2017 and has been referred to the Senate Health and Human Services Committee.
Laid on the table (Pursuant to Senate Rule 9), May 21, 2018
HB1535. Introduced by Representative Judy Ward (R-Blair). This bill would amend the Human Services code to provide for transparency in the setting of home and community based rates for service to individuals with autism or intellectual disability. Referred to Insurance, June 12, 2017.
Re-referred to Human Services, Oct. 16, 2017
Laid on the table, June 20, 2018
HB 1641. Introduced by Representative Bryan Cutler (R-Lancaster). This bill introduces “The Employment First Act,” designed to promote the employment of people with disabilities at competitive wages by Pennsylvania employers. It was introduced and referred to the Labor and Industry Committee, June 29, 2017. Third Consideration and final passage, December 11, 2017, 191 to 0. Referred to Senate Labor and Industry, Jan. 2, 2018. Third consideration and final passage, June 12, 2018 (49-0)
Approved by the Governor, June 19, 2018
Act No. 36
HB 2049. Introduced by Representative Dan Moul (R-Adams). This bill would create the Pennsylvania Assistance and Service Animal Integrity Act. This legislation would take verification one step further and impose penalties for those who misrepresent themselves as disabled or misrepresent their animal as an assistance or service animal. It was referred to the House Urban Affairs, Feb. 2, 2018
Third consideration and final passage, April 9, 2018 (194-0)
Re-referred to Senate Appropriations, June 18, 2018
HB 2069. Introduced by Representative Thomas P. Murt (R-Montgomery). This bill would codify an expiring grant program which has provided a lifeline for many deafblind Pennsylvanians by providing access to support service providers who facilitate communication and provide sighted guidance. It was referred to the House Health Committee, Feb. 12, 2018.
Reported as amended, April 18, 2018
First consideration, April 18, 2018
Laid on the table, June 20, 2018
HB 2121. Introduced by Representative Stan Saylor (R-York). Budget bill sent to the full House Appropriations Committee, March 12, 2018.
Approved by the Governor, June 22, 2018
Act No. 1A
HR 707. Introduced by Representative Stephen Kinsey (D-Philadelphia). This resolution designated March 2018 as “Disabilities Awareness Month” in Pennsylvania. It was introduced as Noncontroversial Resolution Under Rule 35, March 6, 2018.
Adopted, March 14, 2018 (188-0)
HB 1216. Introduced by Representative Frank A. Farry (R-Berks). This bill would provide for definitions, for the offense of neglect of animal and for the offense of attack of guide dog; for the offense of discrimination on account of guide, signal or service dog or other aid animal.
Referred to Judiciary, April 17, 2017
Final passage, July 7, 2017 (190-0)
Referred to Senate Judiciary, July 14, 2017
Second consideration, with amendments, June 22, 2018
HB 2262. Introduced by Representative Anthony M. DeLuca (D-Allegheny). This bill would provide for departmental powers and duties as to small personal care homes.
Referred to Health, April 16, 2018
HB 2266. Introduced by Representative Angel Cruz (D-Philadelphia). This bill would Amend Title 18 (Crimes and Offenses) of the Pennsylvania Consolidated Statutes, Uniform Firearms Act, requiring notification of mental health adjudication, treatment, commitment, drug use or addiction to Pennsylvania State Police within 72 hours.
Referred to Judiciary, May 3, 2018
Re-committed to Rules, June 20, 2018
HB 2325. Introduced by Representative Garth D. Everett (R-Lycoming). This bill would provide for procedures to protect victims and witnesses with intellectual disabilities or autism.
Referred to Judiciary, May 3, 2018
Third consideration and final passage, June 12, 2018 (195-1)
Referred to Senate Judiciary, June 15, 2018
HB 2491. Introduced by Representative Jason Ortitay (R-Allegheny). This bill would provide for definitions and providing for employment and advancement of qualified individuals with a disability.
Referred to Finance, June 18, 2018
SB 698. Introduced by Senator Patrick Browne (R-Lehigh). This bill would further provide for the department of Aging to conduct an ongoing campaign designed to inform and educate older adults, professionals and the general public about the need for an availability of protective services including an individual’s rights, responsibilities and choice of managed care organizations to cover long-term care services and supports. The department shall consult with other departments of the Commonwealth on the design and implementation of the ongoing public awareness campaign.
Referred to Aging and Youth, June 22, 2018
SB 859. Introduced by Senator Stewart J. Greenleaf (R-Montgomery). This bill would further provide for the Pennsylvania Commission on Crime and Delinquency; and establishing the Mental Health and Justice Advisory Committee and the Mental Health and Justice Grant Program.
Referred to Judiciary, Aug. 29, 2017
Re-referred to Appropriations, April 16, 2018
Re-reported as committed, June 4, 2018
Laid on the table (Pursuant to Senate Rule 9), June 22, 2018
SB 1155. Introduced by Senator Jay Costa (D-Allegheny). This bill would codify an expiring grant program which has provided a lifeline for many deafblind Pennsylvanians by providing access to support service providers who facilitate communication and provide sighted guidance.
Referred to the Labor and Industry, May 7, 2018
HR 754. Introduced by Representative Kerry A. Benninghoff (R-Centre). This resolution directs the Joint State Government Commission to study what the long-term health care workforce and workforce training needs of this Commonwealth will be over the next five years. Referred to Labor and Industry, March 13, 2018. Adopted, April 10, 2018 (189-1).
HR 756. Introduced by Representative Tarah Toohil (R-Luzerne). This resolution recognized the month of March 2018 as “Intellectual Disability Awareness Month” in Pennsylvania. It was introduced as Noncontroversial Resolution Under Rule 35, March 13, 2018. Adopted, March 14, 2018 (188-0).
HR 760. Introduced by Representative Angel Cruz (D-Philadelphia). A Concurrent Resolution declaring that the General Assembly of the Commonwealth of Pennsylvania is committed to equal rights for individuals with cognitive disabilities to technology and information access and calling for implementation of these rights with deliberate speed. Referred to Human Services, March 15, 2018. Removed from table, June 20, 2018.
HR 804. Introduced by Representative Warren Kampf (R-Chester). This resolution directs the Joint State Government Commission to establish an advisory committee to conduct a study on mental health services, including the identification and treatment of mental illness, for individuals under the age of 21 in this Commonwealth. Referred to Health, April 6, 2018.
HR 1008. Introduced by Representative Rosemary M. Brown (R-Monroe). This resolution designated the week of July 22 through 28, 2018, as “ADA Week” in Pennsylvania.
It was introduced as Noncontroversial Resolution Under Rule 35, June 25, 2018
Adopted, June 25, 2018 (196-0)
SR 356. Introduced by Senator Vincent J. Hughes (D-Montgomery). This resolution recognized the importance of ensuring access to technology and information for individuals with cognitive disabilities. Referred Health and Human Services, May 21, 2018
Department of Human Services
The Department of Human Services (DHS) Secretary Teresa Miller Programs has announced that the Hamburg State Center for people with intellectual and/or developmental disabilities will officially close on August 3, 2018. The closure comes 19 months after the announcement of the planned closure of the Berks County facility, where 80 individuals lived. Secretary Miller said that “Transitioning residents of the Hamburg State Center will help them grow and thrive in new ways and sets the foundation for a long-term increased quality of life.” This closure is part of the Wolf Administration’s commitment to reduce reliance on institutional care and serve more people in the community. Read this and other press releases at www.dhs.pa.gov, in the Newsroom tab.
The Department of Human Services launched the Community HealthChoices (CHC) program on January 1, 2018 in 14 counties in Southwestern Pennsylvania and is serving about 81,000 people (of which 16% are getting home and community-based services). The state contracts with three managed care organizations (MCO’s) to serve participants in the OLTL waivers (except OBRA), nursing home residents on Medicaid, and additional individuals living in the community who are eligible for both Medicare and Medicaid. Affected individuals in the Southwest Region chose an MCO or one was chosen for them prior to the launch. All individuals can change their selected plan at any time. The six-month period during which participants received the same services from their current providers ended on June 30, 2018. The three MCOs for HealthChoices are AmeriHealth Caritas, PA Health & Wellness, and UPMC Community HealthChoices.
The Department is preparing for the launch of the CHC program in the Southeast Region on January 1, 2018 that includes Philadelphia, Bucks, Delaware, Montgomery and Chester counties. The number of participants is projected to be 127,726 (of which 33% are getting home and community-based services). Communication with participants is scheduled to begin mid-summer and 60 informational meetings are scheduled. In the Southeast, AmeriHealth Caritas is known as Keystone First Community HealthChoices. Updated information is available at this link including contact information for the MCOs and participant communications: http://www.healthchoices.pa.gov/info/about/community/ .
In addition, the monthly Managed Long-Term Services and Supports (MLTSS) Medical Assistance Advisory Committee (MAAC) meeting reviews information about other aspects of the program implementation including OLTL oversight of the program and implementation of the Person-Centered Planning process, enrollment statistics, grievances and appeals, access to home modifications and to medical and non-medical transportation, and nursing home transition statistics. Presentations, transcripts, and the 2018 meeting dates are available at http://www.dhs.pa.gov/communitypartners/informationforadvocatesandstakeholders/mltss/index.htm.
The Office of Developmental Programs (ODP) has issued two new Bulletins:
- Guidelines Concerning Sexual Health, Personal Relationships, and Sexuality (00-18-01), was issued on April 30, 2018 and was effective on that date. The Bulletin distributes the Guidelines and encourages provider agencies to develop policies consistent with the Guidelines.
- Home and Community-Based Services (HCBS) Eligibility/Ineligibility/Change Form (PA 1768) and Instructions (00-18-02) was issued on May 10, 2018 and was effective on that date. The Bulletin disseminates an updated PA 1768 Form and provides guidance for completion of the form.
On June 23, 2018 The Office of Developmental Programs (ODP) published amendments to the P/FDS and Consolidated waivers for a 30 day public comment period. The changes bring them in alignment with the newly approved Community Living Waiver that began on January 1, 2018. Both of these waivers were renewed on July 1, 2017. The changes include eligibility, service definitions, provider qualifications and other changes to ensure consistency. In addition, the service “Transportation Trip” is proposed to be moved to a fee schedule on 1/1/19 and to have other operational changes. The other amendments are slated for a November 1, 2018 effective date.
The Office of Mental Health and Substance Abuse Services (OMHSAS) has issued one new Bulletin: Consent to Mental Health Treatment for Minor Children (OMHSAS-18-01) was issued on June 29, 2018 and was effective immediately. The Bulletin addresses who can provide consent to voluntary mental health treatment for minors who are 14 to 18 years of age in both inpatient and outpatient settings.
Act 80 of 2012
On July 18, 2018, the Pennsylvania Supreme Court ruled that Act 80 of 2012 is unconstitutional because the bill violated the “single subject rule” and failed to follow the legislative process. Act 80 eliminated the “general assistance” program that provided cash benefits to low-income households and individuals with disabilities. Prior to the enactment of HB 1261 (Act 80) of 2012, the bill originally was intended to determine eligibility based upon the factors at the applicant’s place of permanent legal residence. When HB 1261 moved to the Senate, the bill was amended into an omnibus Human Services bill that ended the general assistance program, expanded the 100 hours per month work requirement for Medical Needy program, required applicants for Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP) to apply for three jobs each week, established the Human Services Block Grant and extended the child welfare services to children ages 18 to 21. At this juncture, it is unclear whether and when the program will be reinstated, or what other changes might result.
Federal Budget 2019
Congress has begun work on the appropriations bills for the federal fiscal year that starts October 1, 2018. The Appropriations committees will develop the spending bills within the framework of the Bipartisan Budget Act of 2108. So far, Congress has completed committee work on most appropriations bills including a grouping of three bills to avoid a large “omnibus” bill. The status of all bills in each chamber is found at this link:
The Trump Administration has cut the funding to Affordable Care Act (ACA) Navigators who assist individuals with understanding and signing up for health insurance plans through the exchanges or other coverage they may be eligible for. The funding to the non-profit agencies that operate the programs had been $62.5 million, then was cut last year to $36.8 million including reductions in advertising. The amount available nationwide for upcoming grants for 2019 is $10 million. Some community-based agencies have said they may end their participation in the program. In addition, new rules remove the requirement that the navigators are physically located in the area in which consumers are enrolling. PA Insurance Commissioner Jessica K. Altman has communicated the Wolf Administration’s commitment to make sure Pennsylvanians continue to have the information they need to make decisions about their coverage. FamiliesUSA has issued a press release about the impact: https://familiesusa.org/press-release/2018/trump-administration-slashes-funding-help-families-enroll-health-insurance .
On September 30, 2016, the Money Follows the Person (MFP) program expired. Since 2005, this Medicaid demonstration has helped over 75,000 seniors and individuals with disabilities nationwide to move out of nursing homes and other institutions. Almost every state participated, including Pennsylvania, and funds earned to date can be spent until 2020. Reauthorization is needed to continue access to an enhanced Medicaid rate that supports the program. Success stories about MFP, including one from Pennsylvania, are posted on the CMS website at https://www.medicaid.gov/state-resource-center/medicaid-state-technical-assistance/money-follows-the-person-tech-assist/success-stories/index.html . By the end of 2018, over 3,000 Pennsylvanians will have been transitioned to the community. A bi-partisan bill to improve and extend the program for five years has been introduced called the EMPOWER Care Act (S.2227). Advocacy information is available through Autism Speaks at https://www.autismspeaks.org/advocacy/advocacy-news/empower-care-act-introduced-reauthorize-money-follows-person and ANCOR at http://ancor.org/newsroom/news/ancor-joins-235-organizations-letter-supporting-mfp-reauthorization .
On May 16, 2018, the Centers for Medicare and Medicaid Services (CMS) issued long-awaited guidance on the new requirements for electronic visit verification (EVV) as described in section 12006 of the 21st Century Cures Act for Personal Care Services (PCS). The guidance includes a Frequently Asked Questions (FAQ) for public information (https://www.medicaid.gov/federal-policy-guidance/downloads/faq051618.pdf ) and a 19 page Informational Bulletin (https://www.medicaid.gov/federal-policy-guidance/downloads/cib051618.pdf ) for State Medicaid Directors. The documents include a CMS interpretation that the meaning of an “in-home visit” does not apply to congregate residential settings where 24 hour service is available. Advocates are still concerned about using EVV for participant-directed services. To address concerns about the feasibility of the January 1, 2019 compliance deadline, Congress passed H.R 6042 on July 17, 2018 that enacts a one year delay of the effective date. The bill also mandates that CMS convenes stakeholders to discuss implementation.
NASUAD on EVV
The National Association of States United for Aging and Disabilities (NASUAD) has released a report describing various options and policy approaches to implementing EVV, developed in partnership with Jennifer Burnett, former Deputy Secretary of the Pennsylvania Office of Long Term Living. According to NASUAD, there are many considerations that should be taken into account when developing a system that meets the statutory requirements while also improving quality of care and promoting participant choice. Access the 32 page report at this link:
DREDF on EVV concerns
The Disability Rights Education and Defense Fund (DREDF) released a statement in March, 2018 on concerns with the use of electronic visit verification (EVV). DREDF opposes electronic visit verification when it threatens disabled people’s civil and privacy rights and impedes personal choice, autonomy, and community participation and believes that disabled people have the right to receive home and community-based services in a manner that maximizes personal autonomy and independence and that does not compromise privacy. EVV could potentially infringe on these principles. The statement describes specific concerns. Access it at this link: https://dredf.org/2018/03/07/dredf-statemenDt-on-electronic-visit-verification/ .
CHC Advocates Guide
On May 30, 2018, The Center for Advocacy for the Rights and Interests of the Elderly (CARIE) issued an Advocates Guide to Community HealthChoices. The 101 page booklet describes the new managed care program being implemented in Pennsylvania, including eligibility, services, assessments and participant rights. Access the document at this link:
The PA Health Law Project (PHLP) has made available information for consumers on how to appeal a denial in Community HealthChoices that defines and describes participant rights and the process that the CHC managed care organizations must follow. The information covers if the MCO denies a request for a service, such as personal care assistance, or if the MCO stops or reduces a service, including timeframes, how to continue to receive services during an appeal, and how to get legal assistance with an appeal. Access the information at this ink: ADD LINK HERE
Preventing Sexual Assault
Through the work of Joseph Shapiro and his investigative news series, “Abused and Betrayed,” an NPR special report on sexual abuse among people with intellectual disabilities and the additional coverage on reports on the PBS News Hour, the issue of sexual assault has been brought to the forefront. The Office of Developmental Programs has disseminated information and provided links to resources including a course on recognizing the history of abuse and neglect in both the mental health and intellectual disability population on MyODP.org. For an overview and the list of resources, go to https://s3-us-west-2.amazonaws.com/palms-awss3-repository/Communications/ODP/Newsletter/2018/external_February2018_FINAL.pdf .
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