Last week, the House Budget Committee Chairman Paul Ryan (R-WI) and Senate Budget Committee Chairwoman Patty Murray (D-WA) reached an agreement on the federal budget. This agreement will help preserve programs that individuals with intellectual and developmental disabilities (I/DD) rely on, restore order to the federal budget and appropriations process, and reduce the deficit by about $23 billion. Additionally the agreement provides $63 billion in sequester relief over two years, that will be split equally between defense and non-defense discretionary programs, preventing further cuts to important programs such as supportive housing, special education, and funding for critical public health programs.
The House passed the Bipartisan Budget Act of 2013 (H.J. Res. 59), and the Senate is expected to debate and pass the measure early this week. The deal is a blueprint for spending and revenue over the next two years. The spending part of the deal would ease the limits on spending for fiscal years 2014 and 2015 that had been put in place by sequestration (across-the-board spending cuts). The spending changes do not take effect with the passage of this budget, however. That still requires an appropriations bill to be passed before January 16, 2014, when temporary funding for the government under the current continuing resolution expires. The two appropriations bills that fund the vast majority of disability-related programs, the Labor-Health and Human Services-and Education bill (L-HHS-ED) and the Transportation and Housing and Urban Development (T-HUD) bills, may ultimately be continued at current spending levels for a while because both have recently encountered opposition in Congress.
While The Arc is pleased that the budget agreement will prevent another government shutdown early next year and does not make major changes to our lifeline programs including Social Security, Medicaid, and Medicare, we are concerned about what appears to be the expansion of the state Medicaid agencies ability to recoup costs from settlements from Medicaid beneficiaries. This could affect payments owed to individuals and families who have been harmed, received compensation, and depend on the compensation to pay for expenses beyond what Medicaid covers. Allowing a state Medicaid agency to recover “any payments” by a third party with legal liability (rather than just those payments for health care items and services, as under current law) would leave beneficiaries without coverage for other basic necessities, such as accessible housing or an accessible van.
The Administration continues to look for ways to help people transition to the new health insurance plans available in the marketplace given the operational problems of the enrollment website (www.healthcare.gov). The Department of Health and Human Services (HHS) announced that it is extending the federally run pre-existing condition insurance plans which were established as a temporary measure for people who could not get insurance. The plans are being extended until January 31, 2014 for people who do not have other coverage. The Administration also extended to December 31, 2013 the deadline for paying premiums for coverage beginning January 1, 2014. HHS is also urging insurance companies to consider additional flexibility such as allowing retroactive coverage in cases where insurance is purchased early in the month.
The House and Senate are moving forward on two tracks to address the problematic formula for reimbursing doctors and other Medicare health care providers. Both chambers are planning to pass a short term measure that would prevent steep cuts to Medicare providers that would happen after January 1, 2014 as part of the budget agreement. The House Ways and Means and Senate Finance Committees both passed separate legislation to permanently repeal the formula and replace it with a new approach. The Senate Finance Committee will also include a provision to repeal the cap on therapy visits in the Medicare program. The House bill did not address the therapy issues or any of the other provisions that are normally extended as a part of the package. The House and Senate have not addressed how the permanent fix will be paid for.
Last year, sequestration cut over $2 billion from general education and over $600 million from special education budgets. Without Congressional action, there will be additional cuts next year. The Council for Exceptional Children (CEC) and National Coalition of Personnel Shortages in Special Education & Related Services surveyed 1000 special education teachers and administrators representing every state asking them about the impact budget cuts have had on their ability to provide educational services to students with disabilities. Over 90% of respondents said their school district had been adversely impacted by budget cuts over the last year. Eighty-two percent of respondents said that the cuts resulted in too few personnel to meet the needs of students with disabilities in their districts. Seventy-eight percent said the cuts have resulted in higher caseloads and 61% in increased class sizes. One-third reported layoffs of support personnel and teachers. Check out CEC’s infographic.
In order to comply with a January 2013 settlement agreement in a federal lawsuit, The Centers for Medicare and Medicaid Services (CMS) issued updates to its Medicare Benefit Policy Manual, the program manual used by Medicare contractors, to clarify that skilled nursing services and skilled therapy services are not contingent on an individual’s potential for improvement. For some time, providers of Medicare home health services relied on an improvement standard to determine eligibility for skilled nursing or therapy services. CMS has clarified in its program manual update that the need for skilled services must be based on medical necessity not the potential for improvement. The manual states that skilled services may be needed by an individual to improve a current condition, to maintain a current condition, or to prevent or slow further deterioration of a condition.
Today the Senate will resume consideration of S. 1197, the 2014 National Defense Authorization Act. On November 19, Senators Patty Murray (D-WA) and Kirsten Gillibrand (D-NY) introduced amendment 2265 to provide access to behavioral health treatment, including applied behavioral analysis (ABA), to children and adults with developmental disabilities in TRICARE, the military’s health care system. A similar provision was passed by the House in June. Behavioral health therapy has been shown to be highly effective for children with significant developmental disabilities. TRICARE currently provides limited coverage of ABA under three different programs.
The Arc’s HealthMeet initiative, which aims to reduce health disparities among people with intellectual disabilities (ID), is launching a short, internet-based survey for family or staff who support people with ID. This survey asks questions about health status of people with ID and can also be used as a checklist to help people identify red flags about the health of the person you support. The survey takes about 15 minutes. Take the survey now. Please share with your friends, families and colleagues who provide support for people with ID.
The Department of Health and Human Services (HHS) has moved the deadline back from December 15 to December 23 for signing up for health insurance in the private marketplace for coverage beginning on January 1, 2014. The open enrollment period continues through March 31, 2014. HHS continues to work on improving the performance of the healthcare.gov website used to enroll in the plans in the states where the federal government established the marketplace.
On November 19, Senators Patty Murray (D-WA) and Kirsten Gillibrand (D-NY) introduced amendment 2265 to provide access to behavioral health treatment, including applied behavioral analysis (ABA), to children and adults with developmental disabilities in the health care system for military families (TRICARE). A similar provision was passed by the House in June. Decades of research show the effectiveness of behavioral health care for children with significant developmental disabilities to be successful in school and live independently. TRICARE currently provides limited coverage of ABA under three different programs.
On November 13, the Fiscal Year 2014 Budget Conference Committee held its second public meeting. Congressional Budget Office (CBO) director Doug Elmendorf presented on CBO’s budget and economic outlook and answered questions. Committee Members inquired about numerous budget issues including spending for entitlement programs (Social Security, Medicaid, and Medicare), investments to spur job creation, income inequality, and overall federal spending and revenues. The Committee’s recommendations are due by December 13. View the archived webcast.
Shortly afterwards, CBO released its report “Options for Reducing the Deficit: 2014-2023” which include numerous options for spending cuts and increased revenue and the estimated costs of those options. The list includes a number of options that would be harmful to people with disabilities, including eliminating Supplemental Security Income (SSI) benefits for children; reducing Social Security benefits for new beneficiaries by 15%; using an alternative measure of inflation (the “chained” consumer price index (CPI)) to index Social Security and other mandatory programs; and raising the full retirement age for Social Security.