Administration on Community Living New Organizational Structure

Last week the Administration on Community Living (ACL) announced an updated organizational structure to reflect changes implemented as a result of the Workforce Innovation and Opportunity Act. Some key changes are as follows:

  • Creation of the Administration on Disabilities (AOD), led by Commissioner Aaron Bishop
    • Within AOD, the Administration on Intellectual and Developmental Disabilities will be led by a Deputy Director for Developmental Disabilities but remains otherwise unchanged.
    • Also within AOD, is the Independent Living Administration (ILA) created as part of the Rehabilitation Act. ILA’s leader will serve as both the Deputy Commissioner of AOD, and the Director of the ILA. In this dual role, this person serves as a member of the Administrator’s senior leadership team and reports directly to the Administrator for performing the functions of the Director of Independent Living. ILA will manage the independent living programs that moved to ACL under WIOA, as well as programs that serve people with non-developmental disabilities.
  • The National Institute on Disability, Independent Living and Rehabilitation Research is a new center on ACL’s organization chart, but NIDILRR itself is unchanged. It will continue to be led by John Tschida as its director.
  • The Center for Consumer Access and Self-Determination has been renamed the Center for Integrated Programs (CIP). CIP will continue to bridge the aging and disability centers and manage the programs that address both populations.

Date Set for 2015 White House Conference on Aging

Last week, Secretary Burwell of Health & Human Services (HHS) announced that the 2015 White House Conference on Aging will be held on July 13th, 2015. The conference will bring together government officials, members of the public, caregivers, older Americans, business leaders, and community leaders to discuss a vision for aging in the next decade.  A number of disability-related issues are expected to be addressed during this conference, including aging caregivers, the growing need for family support, and reforms to the long term services and supports system.

If you are interested, please see the 2015 White House Conference on Aging video announcement, visit http://www.whitehouseconferenceonaging.gov.

ABLE Act – IRS Publishes Notices to States Providing Some Guidance to States

On March 10, the Internal Revenue Service (IRS) announced Notice 2015-18 to provide advance notification of a provision it expects to be included in the proposed regulations for section 529A of the Internal Revenue Code regarding ABLE Act accounts. The notice makes two important points:

  • First, the “Treasury Department and the IRS do not want the lack of guidance to discourage states from enacting their enabling legislation and creating their ABLE programs, which could delay the ability of the families of disabled individuals or others to begin to fund ABLE accounts for those disabled individuals. Therefore, the Treasury Department and the IRS are assuring states that enact legislation creating an ABLE program in accordance with section 529A, and those individuals establishing ABLE accounts in accordance with such legislation, that they will not fail to receive the benefits of section 529A merely because the legislation or the account documents do not fully comport with the guidance when it is issued. The Treasury Department and the IRS intend to provide transition relief with regard to necessary changes to ensure that the state programs and accounts meet the requirements in the guidance, including providing sufficient time after issuance of the guidance in order for changes to be implemented.”
  • Second, the Treasury Department and the IRS advise the states that the ABLE Act guidance, when issued, may differ in various ways from the current section 529 education programs. “In particular, the Treasury Department and the IRS currently anticipate that, consistent with section 529A(e)(3), the guidance will provide that the owner of an ABLE account is the designated beneficiary of the account. In addition, the Treasury Department and the IRS currently anticipate that the section 529A guidance will provide that, with regard to the ABLE account of a designated beneficiary who is not the person with signature authority over that account, the person with signature authority over the account of the designated beneficiary may neither have nor acquire any beneficial interest in the account and must administer that account for the benefit of the designated beneficiary of that account.”

These are both important clarifications for states moving forward with legislation. The IRS notice can be found at the IRS website.

The ABLE National Resource Center Presents a FREE Webinar: Understanding ABLE

In collaboration with The Arc, National Disability Institute, Autism Speaks, National Down Syndrome Society, and the College Plan Savings Network, The ABLE National Resource Center will host a webinar titled “Understanding ABLE” on Thursday, March 26, 2015 at 2 PM EDT. The event will cover ABLE Act core components, as well as the status of implementation at both the federal and state levels. Marty Ford, Senior Executive Officer for Public Policy, The Arc is one of the featured speakers. Registration for this important event is now open and will be taken on a first come, first serve basis, Should you wish to join us, please sign up online.

Please note: Real time captioning will be provided for this webinar. For other accommodation requests, questions about the webinar, or the registration process, please contact James Thayer.

The Centers for Medicare and Medicaid Offering a New Toolkit

To assist states as they implement the final Home and Community-Based Services (HCBS) rule released in January of this year, the Centers for Medicare and Medicaid (CMS) created the Statewide Transition Plan Toolkit for Alignment with the HCBS Final Regulation’s Settings Requirements. This document provides information on the content and process of the transition plan requirements. The Arc, together with other advocates has made recommendations to improve implementation of the regulations.

Administration for Community Living Releases Guidance on Person-Centered Planning and Self-Direction

Last week, the Administration for Community Living (ACL) released guidance which outlined standards for person-centered planning and self-direction. ACL has indicated that these principles will be embedded into all of the Department of Health and Human Services (HHS)-funded home and community based services (HCBS) as well as within other non-HHS-funded HCBS and long term services and support programs. All HHS entities that provide HCBS funding are expected to incorporate the principles into their regulations, guidance, and/or the technical assistance provided to states.  Additional information is available in a recent ACL Blog post from Sharon Lewis, Principal Deputy Administrator of ACL and Senior Advisor on Disability Policy, HHS.

Technical Assistance to Help States Comply With New Home and Community-Based Setting Rules

The Centers for Medicare and Medicaid Services (CMS) reposted technical assistance documents for states to assist them in complying with the new home and community-based setting rules.   Documents originally posted on the CMS website were taken down and the original links are no longer active.  A new set of documents was posted on March 20 and stakeholders may want to review them for any changes.

Forum on Medicaid Managed Care This Month

The National Council on Disability (NCD) will be holding a forum on Medicaid managed care in Chicago on March 24. This event is part of a national series that NCD is holding across the nation. Previous forums have been in Kansas and Florida.  After Chicago, upcoming forums will be in California and New York.  The goal of the forums is to hear about the impact of Medicaid managed care on people with disabilities, and to share the Medicaid managed care principles that NCD developed.  The conversation at the forum will inform NCD in its ongoing recommendations to the federal government on the topic of Medicaid managed care.

New Report Provides Overview of Ongoing Work to Improve Care for Dual Eligibles

The Medicare-Medicaid Coordination Office released its 2013 Report to Congress providing an overview of activities and accomplishments and ongoing work to improve care for Medicare-Medicaid enrollees.  MMCO made three legislative recommendations to Congress:

  • Streamline the appeals mechanisms available to beneficiaries through health plans and other qualified entities offering Medicare and Medicaid services;
  • Improve access to needed prescription drugs for Medicare-Medicaid enrollees by making the LI NET demonstration permanent; and
  • Develop a pilot for the Program for All-Inclusive Care for the Elderly (PACE) Eligibility for individuals between Ages 21 and 55.

In the report, MMCO identified two areas for further exploration that it believes may have potential to improve the experience of Medicare-Medicaid enrollees:

  • Coverage standards for Medicare-Medicaid enrollees; and
  • Cost-sharing rules for Qualified Medicare Beneficiaries (QMBs).

Update on California and Kansas

California’s Cal MediConnect demonstration to integrate and coordinate healthcare for individuals dually eligible for Medicare and Medicaid will not move forward as planned in one of eight pilot counties.  The Centers for Medicare and Medicaid Services (CMS) performed a performance audit of the sole insurer selected for the duals demonstration in Orange County and found numerous problems.  Orange County has the second largest population (57,000) of dually eligible individuals in the state.  The demonstration is to begin April 1 in the remaining seven counties.

CMS approved the Kansas 1115 Waiver Amendment allowing the state to provide long term supports and services (LTSS) to individuals with intellectual and developmental disabilities (I/DD) through managed care.  Kansas contracts with three for-profit health insurance companies for the delivery of all Medicaid services.  The Kansas legislature delayed the inclusion of I/DD long term services and supports (LTSS) for one year after the start of KanCare, the Kansas managed care program.  CMS imposed an additional one-month delay on the start of KanCare for I/DD LTSS due to questions it had about the program, including concerns about individuals receiving some but not all of the waiver services they need.  Kansas is the first state to use private health insurers as managed care organizations for managed LTSS for individuals with I/DD.