logo.gif (1445 bytes) Government Report 

Published semi-monthly by The Arc, a national organization on mental retardation. 
Governmental Affairs Office; ph 202-785-3388; GAOinfo@thearc.org

Volume 29, Issue 8

August 31, 1999


In Brief

(Click on the highlighted text to jump to a particular article.)

blueball.gif (924 bytes) A bipartisan managed care consumer protection bill was introduced in the House just before Congress left for its August recess. Introduction of this bill could lead to meaningful action on managed care this year.

blueball.gif (924 bytes) Congress will move to reauthorize of the Elementary and Secondary Education Act this fall. The CCD Education Task Force developed principles for Congress on ESEA.

blueball.gif (924 bytes) Congress returns from summer recess to a busy legislative schedule. Agenda items include appropriations and tax bills, work incentives, and DD Act reauthorization.

blueball.gif (924 bytes) HCFA and the Dept. of HHS published an Interim Final Rule on Patients’ Rights, Hospital Conditions of Participation for the Medicare and Medicaid Programs. The Rule was published in the July 2 Federal Register.

blueball.gif (924 bytes) The Arc continues to work on the reauthorization of the DD Act. The Family Support Act will also be reauthorized as a separate title under the DD Act.

blueball.gif (924 bytes) NCD established a Fellowship Program in Washington, DC. The focus will be on developing leadership in young people, including self-advocates, with an interest in disability polic).

blueball.gif (924 bytes) Notes.


Bi-Partisan Managed Care Bill Introduced in House

The Bipartisan Consensus Managed Care Improvement Act of 1999 was introduced in the House just before Congress left for its August recess. The leading sponsors of the bill are Reps. Charles Norwood (R-Ga.) and John Dingell (D-Mich.). Currently, the bill has 66 sponsors – 22 are Republicans. The introduction of this bill could be a golden opportunity for consumers and advocates. It could lead to meaningful action on managed care this year. If H.R. 2723 gets to the House floor it could win because there is only a five member Republican majority. However, the problem will be getting it to the House floor for a vote because it does not have the support of the House Republican leadership. House Speaker Dennis Hastert (R-Ill.) and other House leaders know that they have to do something so they are saying that they will bring another bill – now being developed by Reps. Tom Coburn (R-Okla.) and John Shadegg (R-Ariz.) to the floor. The Coburn-Shadegg bill is still in draft form. While it may have some provisions that are similar to those in H.R. 2723, it will also most likely contain some provisions that will be unacceptable to Democrats, some Republicans, and many consumers. These include Medical Savings Accounts (MSAs) and Mulitple Employer Welfare Arrangements (MEWAs) or Association Health Plans (AHPs). MSAs are essentially more useful for healthy and wealthy people and they could take many of them out of the larger insurance "pool," leading to higher rates for those left behind. MEWAs and AHPs could result in the loss of some of the consumer protections for people who have to go into them.

Even if H.R. 2723 was to pass the House it would still have to go to a House-Senate Conference. The Senate passed a very weak bill earlier this year (July 29 Government Report) so conferees would have to come to some type of compromise. The President has indicated his support for H.R. 2723. He has also said that he would veto anything like the Senate bill.

The goal of consumer groups that support strong managed care protections is to add to the number of Republican and Democratic co-sponsors for H.R. 2723 and to get it to the House floor for a vote. H.R. 2723 has the health insurance industry and business groups in a tither. They have been pulling out the stops over the August recess trying to convince people and Members of Congress that this is a bad bill. The insurance industry has the money for newspaper ads and commercials. Fortunately, the American Medical Association (AMA) recently came out in support of H.R. 2723. The AMA and other medical groups will be running their own ads to counteract the efforts of those who oppose the bill. This is very good news for consumer groups that usually can’t afford expensive publicity campaigns. The Arc Governmental Affairs Office sent out two alerts regarding H.R. 2723. The Consortium for Citizens with Disabilities (CCD) Health Task Force will be blanketing the House of Representatives with letters of support from its member groups on Sept. 8. President of The Arc, Brenda Doss, has signed The Arc letter that will be part of the organized "Hill-drop."

Bipartisan Consensus Managed Care Improvement Act

The Bipartisan Consensus Managed Care Improvement Act of 1999 — while not the Patients’ Bill of Rights (S. 6/H.R. 358) — is a strong bill that should be enacted into law. It is also, most likely, the best managed care reform bill with any chance of passage this year. H.R. 2723 includes a number of provisions important to children and adults with mental retardation and their families. These include:

One concern for The Arc and other disability groups is that the bill does not include a definition of medical necessity like the Patients’ Bill of Rights (S.6/H.R. 358) or like the definition that was in a version of the Senate bi-partisan bill (S. 374). Instead, H.R. 2723 leaves the final decision on medical necessity to the physicians who would conduct an independent external review. Their decisions would be legally binding on the health plan. Claims that can be taken to the external appeals process are those "based in whole or in part on a decision that the item or service is not medically necessary or appropriate or is investigational or experimental or in which the decision as to whether a benefit is covered involves a medical judgement." The bill specifically states that the external reviewers will consider – but not be bound by – a plan’s definition of medical necessity.

The bill would remove the ERISA preemption and allow consumers to hold health plans accountable according to state law. Plans that comply with an external reviewer’s decision may not be held liable for punitive damages. However, if a health plan does not comply with the external reviewers’ recommendations, a consumer could then take a plan to federal court to enforce the decision.

The Arc will continue to work for the passage of strong managed care consumer protections in this Congress.

Managed care legislation web sites:

Compare HR 2723 to other bills: http://www.familiesusa.org/managedcare+u/compare2.htm

Up-to-date information on co-sponsors, etc.: http://www.house.gov/commerce_democrats

Specific CCD Health Task Force positions: http://www.c-c-d.org/tf-health.htm

Congress to Reauthorize Elementary and
Secondary Education Act
(ESEA)

When Congress returns from its summer recess in September, it will move forward on the reauthorization of the Elementary and Secondary Education Act (ESEA). The current law expires Sept. 30, 1999. The ESEA was enacted in 1965 to help the most disadvantaged students. It is the federal government’s single largest investment in elementary and secondary education. Title I of ESEA now provides more than $8 billion each year on behalf of over 11 million children in 45,000 schools. The Act also includes programs dealing with safe and drug free schools, teacher training, magnet schools, education technology, bilingual education and testing. ESEA is intended to support all children, including children with disabilities.

This year the reauthorization of ESEA will provide the context for debates regarding broader education policy, including federal versus local control, discipline in the classrooms, ending social promotion, and teacher quality. There is also a concern that the reauthorization of ESEA could be the next vehicle for ongoing attacks on the Individuals with Disabilities Education Act (IDEA).

The Consortium for Citizens with Disabilities (CCD) Education Task Force developed principles for the reauthorization of the ESEA. Thirty-six CCD member-organizations, including The Arc, signed on to these principles, which were then distributed to all members of Congress over the summer recess. CCD urges members of Congress to enact legislation that follows these principles:

  1. Do no harm to students with disabilities. The reauthorization of the Elementary and Secondary Education Act should be limited to programs under its jurisdiction. The Individuals with Disabilities Education Act (IDEA) must not be weakened during the ESEA reauthorization.
  2. All schools should establish research-based, effective programs that prevent school violence. Effective programs include classroom management strategies to help reduce classroom disruption and increase student learning; positive behavior intervention programs that address the emotional, behavioral, and educational needs of students; and professional development to reduce the level of inappropriate disciplinary actions. All school staff must be trained to recognize and respond appropriately to troubled youth. Students must have immediate access to comprehensive school-based consultation and other mental health services.
  3. Educational services must be continued for students who are suspended or expelled. Students with and without disabilities must be accountable for their actions when they violate school codes of conduct. To ensure safe schools and communities and continue student achievement, students who are suspended or expelled must have access to immediate and appropriate services, including educational and mental health services necessary to prevent the behavior from reoccurring.
  4. Professional development is essential for classroom success. ESEA-supported professional development activities must include activities that enable teachers to appropriately serve all students, including students with disabilities. Professional development activities also must include training for pupil services personnel and paraprofessionals who provide services to children. Professional development activities must be on-going, research-based, reflect state-of-the-art practices and principles as articulated by IDEA, and be carried out by highly qualified personnel. Such training should ensure professionals have the following competencies:
  • a fundamental understanding of different kinds of disability and how disability affects student learning and behavior;
  • an understanding of how to create school environments and provide instruction that is responsive to the diverse and developmental needs of students; and
  • collaboration skills needed to make decisions, solve problems and work together with special education and pupil services personnel to ensure access to and progress in the general curriculum for all students.
  1. Shortages in classroom personnel must be addressed. States need to be given the flexibility to use resources dedicated to hire 100,000 new teachers for hiring of special education teachers, pupil services personnel and qualified paraprofessionals who can work with general education teachers to implement IDEA.
  2. Social promotion policies must not inappropriately penalize students with disabilities. Social promotion policies must not override the special educational needs described in the Individualized Education Program (IEP) of a student with a disability.
  3. Children and youth with disabilities must be included in after-school programs. All applicants to the 21st Century Community Learning Centers (federal grant program begun in 1998 to fund after school activities in rural and inner city schools ) must describe the specific steps they will take to meet the needs of individuals with disabilities.
  4. The number of preschool programs that serve children with and without disabilities must be increased. Preschool programs supported by ESEA must collaborate with preschool programs supported by IDEA.

The Arc will continue to work with Congress and the administration to ensure that students with disabilities are not harmed by any new proposals within the reauthorization of ESEA. Watch for updates on the reauthorization of ESEA in future issues of Capitol Insider and Government Report.n


Congress Returns from Recess to Busy Agenda

Congress returns to Washington on Sept. 8 and will hit the ground running. Its work is cut out for it between now and adjournment, which is currently scheduled for late October.

At the top of the Congressional agenda are tax cuts and FY 2000 appropriations. It remains to be seen who will "blink first" onpicture of congressman running the issues of budget caps and tax cuts – the Congress or the Clinton administration.

While all this is going on, The Arc will be working to ensure the best possible funding for programs of importance in the two remaining – and critical – appropriations bills, Labor-Health and Human Services-Education, and Housing and Urban Development-Veterans-Independent Agencies.

The Arc will also be working for passage of the Work Incentives Improvement Act, strong managed care protections, the reauthorization of the Developmental Disabilities Act, changes in federal housing policy and long term care policy, and to preserve important civil rights protections for people with disabilities.n


HCFA and HHS Publish Interim Final Rule on Patients’ Rights

The Health Care Financing Administration (HCFA) of the U.S. Department of Health and Human Services published an Interim Final Rule on Patients’ Rights, Hospital Conditions of Participation (CoP) for the Medicare and Medicaid Programs in the July 2 Federal Register. Comments on the Interim Rule were accepted until Aug. 31. HCFA decided to publish a (CoP) specifically on patients’ rights because more and more instances of violations of patients’ rights were being brought to its attention. In addition, a series of articles in the Hartford Courant in the spring brought the inappropriate use of restraints and seclusion into public view. Several months ago The Arc and other advocacy groups, such as the National Alliance for the Mentally Ill, the National Mental Health Association, and the Bazelon Center for Mental Health Law met with HCFA to discuss the need for stronger protections against the mis-use of restraints and seclusion with children and adults with disabilities. While this Patients’ Rights (CoP) rule is a step in the right direction and provides protection in acute, psychiatric, children’s, and rehabilitation hospitals, it still does not cover all settings that receive federal Medicaid or Medicare funds.

The Arc’s comments – posted on the Governmental Affairs Web page – make the point that entities that receive federal funds must be required to treat all people with dignity and respect and reflect The Arc’s Position Statement on Behavioral Supports:

The Arc strongly supports the development and use of positive behavioral supports to meet individual needs and the prohibition and prevention of the use of procedures that may cause physical and/or psychological harm, are dehumanizing, and restrict the individual’s right to dignity and self-determination.

The comments target a number of issues. These include the need for:

  • strong protections in all settings,
  • effective monitoring and enforcement of protections,
  • staff training, and
  • reporting of abuse and deaths to the Protection and Advocacy System.

The issue of the use of restraints and seclusion remains on the Congressional agenda with bills introduced in both the House and Senate (See April 29 Government Report).n


DD Act and Family Support Act to be Reauthorized

Staff of The Arc Governmental Affairs Office continue to work with a bi-partisan group of Senate staff on legislation to reauthorize the Developmental Disabilities Act and the Family Support Act (formerly part of IDEA). The current authority for the DD Act expires this year.

The Senate, led by Sens. Jeffords (R-Vt.), Harkin (D-Iowa), and Kennedy (D-Mass.), is looking at ways to rewrite the DD Act so that it better reflects the current needs of individuals with developmental disabilities and their families. They are also looking at ways to increase collaboration between the three DD entities – the Developmental Disabilities Councils, the Protection and Advocacy System, and the University Affiliated Programs. As this issue of Government Report goes to press it appears that the earliest a bill could be introduced in the Senate is mid-to-late September. Time is short for action on a major reauthorization bill since Congress is currently scheduled to adjourn at the end of October. The House has taken no action so far .

The Arc’s efforts on the DD Act have been targeted at ensuring quality services and supports in all settings, including protecting people from abuse and neglect; meeting the specific needs of adults with disabilities and their aging parents; addressing the "waiting list" crisis; and ensuring that people with the most severe disabilities are included in all self-advocacy efforts.

The Arc’s efforts on the Family Support Act have focused on its inclusion as a separate title of the DD Act and ensuring that it meets the needs of a broad range of families, including families with adult children. Other efforts related to family supports include work on S. 707, a bill to amend the Older Americans Act and establish a national family caregiver support program and on S. 1536, the Older Americans Act Amendments of 1999. n


National Council on Disability Establishes Fellowship Program
People with Mental Retardation are Encouraged to Apply

The National Council on Disability (NCD) has established a fellowship program in Washington, DC. The focus of the fellowship program is to provide experience, training and contacts to qualified individuals with disabilities.

Originally, applicants had to be college graduates to be considered for the fellowship. Staff of The Arc and the President’s Committee on Mental Retardation (PCMR) pointed out that the college degree requirement would exclude many self-advocates with mental retardation. NCD agreed and modified its eligibility requirements! To be eligible now, individuals must simply identify as having a disability. The excellent letter written to NCD by Jane Browning, executive director of PCMR, is reprinted in full below.

NCD also extended the deadline for applications to Sept. 15 so that qualified individuals would have a chance to apply with the new requirements. The new application form and more details about the program can be obtained on NCD's Web site or by contacting Stacey Brown at NCD at 202-272-2004 (voice); 202-272-2074 (TTY); 202-272-2022 (fax).n

 

August 6, 1999

Dear Ms. Bristo:

At the recent forum on Youth with Disabilities, I received the announcement of the National Disability Policy Fellowship program. I think this is a fantastic idea. As you may be aware, the President’s Committee on Mental Retardation has been sponsoring a Next Generation of Leadership Symposium for the past three years; the 1999 conference takes place August 26-29. Fostering development of our future leaders is critically important.

Immediately, I began planning to forward the announcement to the two self-advocates among the 14 Next Generation Advisory Committee members: competent, literate, articulate and outspoken advocates who are both professionally employed (but would jump at the chance for this fellowship!)

Imagine my dismay as I read on to discover that emerging leaders with mental retardation and many people with other developmental disabilities are virtually excluded from participation in your fellowship program through the requirement of a college degree. It genuinely strikes me as being discriminatory. Fifteen years ago, I was aware of only a tiny handful of colleges with special education tracks that could accommodate people with learning disabilities; today, Peterson’s publishes an entire college guide on such schools. I have every confidence the curve will continue to evolve to the point of embracing people with significant cognitive disabilities; indeed, I know of at least one recent high school graduate (diploma earned) with Down syndrome who is attending college.

In the meantime, I plead with the National Council on Disability to be forward-thinking in the application of its criteria for this wonderful fellowship program. I am going to encourage my young proteges to submit their applications despite the degree requirement, in the hopes you will give their applications the due consideration they richly deserve.

Thank you very much for your consideration of this proposal. As always, please feel free to call upon me at any time to work with you in inclusive representation of all who have disabilities.

Sincerely,

Jane Browning

Jane Browning

Executive Director

 

book.GIF (1834 bytes)Notes:

blueball.gif (924 bytes) Self-Determination Seminar for providers and advocates. On November 17-18, the National Association of State Directors of Developmental Disabilities Services (NASDDDS) and the National Program Office of the Self-Determination Project will co-sponsor a special two-day seminar in Alexandria, Va. The Seminar is designed to take stock of current nationwide efforts to organize, finance and deliver publicly-financed self-determined services.

In connection with this upcoming seminar, NASDDDS and the National Self-Determination Program Office will be releasing a special, joint report on self-determination and the related changes in policy and practice that are occurring within state/local developmental disabilities service delivery systems. The report will focus primarily on the strategies that are being used in various states to foster the transition of service systems to person-centered, self-directed support models. All seminar registrants will receive a copy of this important new publication.

The registration fee is $250 for NASDDDS members and local MR/DD authorities and $350 for all other registrants. Contact NASDDDS at (703) 683-4202 or fax a note requesting registration information to (703)684 - 1395.

blueball.gif (924 bytes) Publications of Interest to The Arc. Two new inspirational publications are currently available through the American Association on Mental Retardation (AAMR). Both are collections of important work by two individuals with long-time ties to The Arc. In Search of the Promised Land: The Collected Papers of Burton Blatt, edited by Steven Taylor and Steven Blatt; and Ahead of His Time—Selected Speeches of Gunnar Dybwad, Edited by Mary Ann Allard et al. To order, contact AAMR, PH 301-604-1340; e-mail pmds@aamr.com.

 blueball.gif (924 bytes) Social Security Training Opportunity for Young Adults. The 2030 Center, a public policy institute dedicated to improving young adults’ economic circumstances, is sponsoring a Social Security advocacy training and lobby day in Washington, DC on Oct. 22 through 25. The purpose of this training is to bring young adults together to learn from top policy experts and organizers about the national debate regarding the solvency of the Social Security Trust Funds and to lobby members of Congress about young people’s concerns regarding Social Security. All travel and conference costs will be provided for by the 2030 Center.

Chapters of The Arc should encourage young leaders and self-advocates (between the ages of 18 and 34) in the disability field to get involved. Solvency of the Social Security Trust Funds is an important issue for The Arc. We need to be involved in the national debate at every level. For background information, see The Arc Issue Brief, "Solvency of the Social Security Trust Funds: An Issue for The Arc" on the Governmental Affairs section of The Arc web site under Publications.

Application materials for the training are available at www.2030.org, by emailing the Center at 2030@2030.org, or by calling toll-free at 1-877-2030-org.

blueball.gif (924 bytes) E-mail The Arc Governmental Affairs Office. Staff have new email addresses (as of Aug. 1). Following is a directory:

Paul Marchand: Marchand@thearc.org

Marty Ford: Ford@thearc.orgman at computer

Kathy McGinley: McGinley@thearc.org

Evelyn Powell: Powell@thearc.org

Brenda Walker: Walker@c-c-d.org

General information: GAOinfo@thearc.org

Feel free to contact us!


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