Healthcare Legislation Offers Mixed Bag for People with Disabilities, Finds Allsup - Safety nets added but questions still remain in the execution and long-term impact for people with disabilities, both while awaiting SSDI benefits and once eligible for Medicare.
The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 are the most powerful developments in decades affecting healthcare coverage for people with disabilities, according to Allsup, a nationwide provider of Social Security disability representation and Medicare plan selection services.
“Many of these healthcare provisions are desperately needed by people with disabilities who require but are unable to secure affordable medical treatment,” said Paul Gada, personal finance director for Allsup who directs Allsup Medicare Advisor®, a Medicare plan selection service for people with disabilities and individuals over 65.
People applying for Social Security Disability Insurance (SSDI) may have to wait months, even years, for their claim to wind through the process. Currently, there are more than 1.7 million people stuck in the SSDI backlog and awaiting a decision on their claim for benefits. These individuals often have limited or no source of income and few healthcare coverage options. In addition, more than 7 million people who rely on SSDI benefits are eligible for Medicare, following a 24-month waiting period.
“People with disabilities need continuous access to affordable healthcare coverage,” said Gada. “They can’t wait until they have SSDI income to finally pay for healthcare coverage or hold out the 24 months required before becoming eligible for Medicare.”
Eliminating Pre-Existing Conditions Provides Some Relief, But Exposes Potential Gaps
One key provision of healthcare legislation having a profound impact on millions of people with disabilities is eliminating the pre-existing condition clause.
Starting later this year, children with pre-existing conditions cannot be denied health insurance coverage. This extends to adults in 2014 when state-run health insurance exchanges, which will have to cover pre-existing conditions, are established.
In the interim, as of June, the legislation creates temporary state-run high-risk insurance pools to offer coverage to individuals with pre-existing medical conditions who have not had insurance for at least six months. Most states have high-risk insurance pools already, but all states are required to establish these pools as of June, or the U.S. Department of Health and Human Services will create one for them. People living in states with a high-risk insurance pool can go to their state insurance commission Web site to learn more, or visit the National Association of State Comprehensive Health Insurance Plans’ Web site for a complete listing at http://www.naschip.org/states_pools.htm.
“The high-risk insurance pools may offer some people a safety net if they’ve exhausted their COBRA coverage or were denied private coverage because of a pre-existing condition. However, more detail on how the pools will operate, how to enroll and costs are needed before people can determine their true value; it’s troubling that individuals will have to wait six months to be eligible,” said Gada.
People relying on Medicare may find fewer coverage options as a result of healthcare legislation. For 2011, the legislation freezes payments to Medicare Advantage plan providers at 2010 rates and further reduces payments over time to bring them in line with traditional Medicare.
Medicare Advantage plans have become increasingly popular because they generally offer more coverage options and are more affordable than traditional Medicare with Medigap supplemental coverage.
Medicare Advantage plans also have always been required to cover most pre-existing conditions, whereas Medigap plans are not required to cover pre-existing conditions and often exclude or limit coverage. As a result, Medicare Advantage plans often have been a better choice for people with disabilities. However, the reduced subsidies to providers under the legislation may reduce the number of insurers offering Medicare Advantage plans, and consumers may see premium increases or reductions in plan coverage benefits.
“With the healthcare provisions, people with disabilities may be caught in a position where they’re unable to afford a Medicare Advantage plan and unable to secure coverage under Medigap,” said Gada. “It is going to be very important for people to carefully review their options when making enrollment choices for this year and beyond.”
Additional Provisions Affecting People with Disabilities. Among the other provisions affecting people with disabilities are:
Expanding Medicaid coverage
Between now and 2014, when expanded Medicaid programs are required in each state, states can choose to apply to the federal government to receive additional Medicaid funding and expand their community health centers. Expansion could take on a variety of forms: an increase in staff, supplies and other resources or increasing the income limit to encompass more people. People can learn more about their state’s Medicaid offerings, when states will be expanding their coverage and how to apply by contacting their local Medicaid office. Contact information is available at http://www.medicare.gov/contacts/organization-search-criteria.aspx. Just search for either a specific State Health Insurance Assistance Program (SHIP) or State Medical Assistance Program.
In 2014 when Medicaid expansion is required, Medicaid in every state will cover people under age 65 who have income of 133 percent of the federal poverty line ($29,326.50 for a family of four in 2010). This is especially important to lower-income individuals applying for SSDI who have limited income and no coverage.
However, the legislation did not raise the asset value requirements of Medicaid eligibility. The maximum allowed asset value is determined by each state; among states that have asset value requirements, the maximum asset value generally ranges from $2,000 to $4,000 for single people and $4,000 to $6,000 for couples.
This excludes someone’s home, one car and their retirement savings, if they are under age 60; however, retirement savings are considered if they are 60 or older. As a result, someone no longer able to work because of their disability who had accumulated more than the allowable assets under Medicaid would have to chip away at this savings before becoming Medicaid eligible.
Expanding long-term care options
Starting in January 2011, the Community Living Assistance Services and Supports (CLASS) Act expands community living assistance options through a voluntary insurance program. Paid for through a payroll deduction of about $75 a month, all working adults will be enrolled automatically, unless they choose to opt-out. After a five-year vesting period, people with mobility issues are eligible for a cash benefit of at least $50 a day on average to buy non-medical services and support. Assistance may include caregiver support, adult day care and home modifications to support daily living, such as installing shower grab bars.
Removing limits on insurance coverage
Starting later this year, individual policyholders no longer will be subject to lifetime caps or have their coverage dropped, except in instances of fraud. Individuals who already have been dropped from their insurance will be eligible for the high-risk pools. In 2014, annual limits are removed and people with health problems can no longer be denied coverage or charged higher premiums; limits also are placed on how much premiums can increase as people age.
Reducing prescription drug costs
Effective immediately, Medicare recipients who have a gap in prescription drug coverage will receive a one-time, $250 rebate to supplement their medical expenses. Medicare Part D plan participants who have hit the donut hole will receive a $250 check. The first checks will go out in June to people who already reached the gap in early 2010. Additional checks will go out as people reach the donut hole, according to the U.S. Department of Health and Human Services. Although details are still being worked out, these checks likely will be processed through prescription drug plans. Individuals who hit the donut hole but do not receive a check should contact their prescription drug plan to learn how to receive their rebate. Starting next year, pharmaceutical companies are required to provide a 50-percent discount on brand-name prescription drugs for Medicare beneficiaries facing the prescription drug donut hole with additional subsidies phased in through 2020 to close the gap.
Adding free preventive care under Medicare
Starting in 2010, Medicare beneficiaries can make free preventive care visits to their healthcare providers, without any copayments or deductibles. People with disabilities may have frequent appointments with specialists; this provision helps ensure basic health needs are addressed.
“All of these provisions have the potential of helping people with disabilities improve their healthcare coverage. However, more detail on how they will be carried out is needed to understand if they deliver,” said Gada.
For more information about Medicare coverage and options, contact the Allsup Disability Life Planning Center at (888) 271-1173.
Allsup is a nationwide provider of Social Security disability, Medicare and workers’ compensation services for individuals, employers and insurance carriers. Founded in 1984, Allsup employs more than 600 professionals who deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. The company is based in Belleville, Ill., near St. Louis. For more information, visit www.Allsup.com.
The information provided is not intended as a substitute for legal or other professional services. Legal or other expert assistance should be sought before making any decision that may affect your situation.
By Allsup - Apr 15, 2010 9:50:24 AM
Wednesday, May 19, 2010
What Will YOU Do? Focus on Ability
By Guest Blogger Tracie Saab, Job Accommodation Network (JAN)
We each have a role to play and benefits to gain by improving employment opportunities for people with disabilities. I know - you’re wondering, “Me? What can I do to make a difference?” You (yes, YOU) have the power to shape attitudes about ability, to mentor a young person with a disability, to change the way people think about disability and employment and ultimately, to promote positive employment outcomes for people with disabilities. The ideas we perpetuate about disability and employment impact successful employment outcomes – either individually through our own positive or negative beliefs about ability or through the assumptions of others who have the power to make employment decisions.
When you were young, were there people who influenced your perception of what you could do when you grew up or played a role in helping you plan for employment? Was there someone, maybe a coach, teacher or mentor, who challenged you to aim high and dream big? When we focus on ability – what we can do – our perspective is wide-open. When young people are told they can achieve, they can win, they can dream - then they will set their sights high and aim to be the best they can be. The same is true for people who are given the opportunity to put their abilities ahead of their disability in the workplace. We influence these aspirations by the way we treat people and by creating opportunities for people to achieve success on the job.
A new public outreach campaign is showing employers that it pays to foster an inclusive and flexible work culture that considers the needs of all employees – including those with disabilities. The Campaign for Disability Employment, a newly-formed collaborative of leading disability and business organizations, has launched What Can YOU Do?, a national effort designed to promote the hiring, retention and advancement of people with disabilities and challenge assumptions about disability and employment. The partners in the Campaign have come together around the common belief that at work, it’s what people can do that matters. People with disabilities want to work and their talents and abilities will positively impact businesses both financially and organizationally.
Myths about disability and employment and attitudinal barriers and negative stereotypes continue to impact employment opportunities for qualified people with disabilities. We can all do our part to change these misperceptions by reminding young people with disabilities that they have the skills to pursue meaningful careers and play an important role in America’s economic success. We can also encourage employers to recognize the value and talent people with disabilities bring to the workplace, as well as what can be realized by fully including everyone. Every day, people with disabilities can and do add value to America’s workplaces.
So what can YOU do to support this effort and improve employment opportunities for people with disabilities?
You can join the effort and support the Campaign by being an ambassador of the What Can YOU Do? message. The Campaign’s Web site, www.whatcanyoudocampaign.org, offers a range of education and outreach tools, designed to engage employers, people with disabilities, families, educators and the general public in the effort. It features practical ideas and resources to support the Campaign’s goal of promoting positive employment outcomes for people with disabilities. Also available are video public service announcements (PSAs) including the Campaign’s “I Can” PSA – featuring seven people with disabilities, not actors, sharing what they “can do” on the job when given the opportunity – and “Meet Sue", winner of the What Can YOU Do? Video Contest. We encourage everyone to share these videos.
Please join the Campaign for Disability Employment in its mission to promote positive employment outcomes for people with disabilities by visiting the What Can YOU Do? Web site to access resources to assist in recruiting, retaining and advancing skilled, qualified employees and by sharing the important message that, “At work, it’s what people can do that matters.”
MORE INFORMATION ABOUT THE CAMPAIGN FOR DISABILITY EMPLOYMENT:
The Campaign for Disability Employment is a collaborative effort among several disability and business organizations that seek to promote positive employment outcomes for people with disabilities by encouraging employers and others to recognize the value and talent they bring to the workplace, as well as the dividend to be realized by fully including people with disabilities at work. These partners include:
• American Association of People with Disabilities (AAPD)
• National Business and Disability Council (NBDC)
• National Council of La Raza (NCLR)
• National Gay and Lesbian Chamber of Commerce (NGLCC)
• Society for Human Resource Management (SHRM)
• Special Olympics (SO)
• U.S. Business Leadership Network (USBLN)
The Campaign is funded by the U.S. Department of Labor’s Office of Disability Employment Policy (ODEP); receives technical assistance from the Job Accommodation Network (JAN); and is supported by the Disability Policy Research Center at West Virginia University.
Tracie Saab is the Project Manager for the Campaign for Disability Employment, funded by the Office of Disability Employment Policy, U.S. Department of Labor. She works to establish collaborative partnerships among disability and business organizations to promote positive employment outcomes for people with disabilities. Before managing the Campaign, Tracie served for many years as a Job Accommodation Network (JAN) consultant and national speaker on accommodation and disability employment issues.
Posted by Diana Z. on Apr 7, 2010 12:11:50 PM in Employment | Permalink | Comments (0) | TrackBack (0)
We each have a role to play and benefits to gain by improving employment opportunities for people with disabilities. I know - you’re wondering, “Me? What can I do to make a difference?” You (yes, YOU) have the power to shape attitudes about ability, to mentor a young person with a disability, to change the way people think about disability and employment and ultimately, to promote positive employment outcomes for people with disabilities. The ideas we perpetuate about disability and employment impact successful employment outcomes – either individually through our own positive or negative beliefs about ability or through the assumptions of others who have the power to make employment decisions.
When you were young, were there people who influenced your perception of what you could do when you grew up or played a role in helping you plan for employment? Was there someone, maybe a coach, teacher or mentor, who challenged you to aim high and dream big? When we focus on ability – what we can do – our perspective is wide-open. When young people are told they can achieve, they can win, they can dream - then they will set their sights high and aim to be the best they can be. The same is true for people who are given the opportunity to put their abilities ahead of their disability in the workplace. We influence these aspirations by the way we treat people and by creating opportunities for people to achieve success on the job.
A new public outreach campaign is showing employers that it pays to foster an inclusive and flexible work culture that considers the needs of all employees – including those with disabilities. The Campaign for Disability Employment, a newly-formed collaborative of leading disability and business organizations, has launched What Can YOU Do?, a national effort designed to promote the hiring, retention and advancement of people with disabilities and challenge assumptions about disability and employment. The partners in the Campaign have come together around the common belief that at work, it’s what people can do that matters. People with disabilities want to work and their talents and abilities will positively impact businesses both financially and organizationally.
Myths about disability and employment and attitudinal barriers and negative stereotypes continue to impact employment opportunities for qualified people with disabilities. We can all do our part to change these misperceptions by reminding young people with disabilities that they have the skills to pursue meaningful careers and play an important role in America’s economic success. We can also encourage employers to recognize the value and talent people with disabilities bring to the workplace, as well as what can be realized by fully including everyone. Every day, people with disabilities can and do add value to America’s workplaces.
So what can YOU do to support this effort and improve employment opportunities for people with disabilities?
You can join the effort and support the Campaign by being an ambassador of the What Can YOU Do? message. The Campaign’s Web site, www.whatcanyoudocampaign.org, offers a range of education and outreach tools, designed to engage employers, people with disabilities, families, educators and the general public in the effort. It features practical ideas and resources to support the Campaign’s goal of promoting positive employment outcomes for people with disabilities. Also available are video public service announcements (PSAs) including the Campaign’s “I Can” PSA – featuring seven people with disabilities, not actors, sharing what they “can do” on the job when given the opportunity – and “Meet Sue", winner of the What Can YOU Do? Video Contest. We encourage everyone to share these videos.
Please join the Campaign for Disability Employment in its mission to promote positive employment outcomes for people with disabilities by visiting the What Can YOU Do? Web site to access resources to assist in recruiting, retaining and advancing skilled, qualified employees and by sharing the important message that, “At work, it’s what people can do that matters.”
MORE INFORMATION ABOUT THE CAMPAIGN FOR DISABILITY EMPLOYMENT:
The Campaign for Disability Employment is a collaborative effort among several disability and business organizations that seek to promote positive employment outcomes for people with disabilities by encouraging employers and others to recognize the value and talent they bring to the workplace, as well as the dividend to be realized by fully including people with disabilities at work. These partners include:
• American Association of People with Disabilities (AAPD)
• National Business and Disability Council (NBDC)
• National Council of La Raza (NCLR)
• National Gay and Lesbian Chamber of Commerce (NGLCC)
• Society for Human Resource Management (SHRM)
• Special Olympics (SO)
• U.S. Business Leadership Network (USBLN)
The Campaign is funded by the U.S. Department of Labor’s Office of Disability Employment Policy (ODEP); receives technical assistance from the Job Accommodation Network (JAN); and is supported by the Disability Policy Research Center at West Virginia University.
Tracie Saab is the Project Manager for the Campaign for Disability Employment, funded by the Office of Disability Employment Policy, U.S. Department of Labor. She works to establish collaborative partnerships among disability and business organizations to promote positive employment outcomes for people with disabilities. Before managing the Campaign, Tracie served for many years as a Job Accommodation Network (JAN) consultant and national speaker on accommodation and disability employment issues.
Posted by Diana Z. on Apr 7, 2010 12:11:50 PM in Employment | Permalink | Comments (0) | TrackBack (0)
Divorce Dilemma: Texas Says Gays Can't Get Divorce
By JAMIE STENGLE
Associated Press Writer
DALLAS (AP) _ After the joy of a wedding and the adoption of a baby came arguments that couldn't be resolved, leading Angelique Naylor to file for divorce.
That left her fighting both the woman she married in Massachusetts and the state of Texas, which says a union granted in a U.S. state where same-sex marriage is legal can't be dissolved with a divorce in a state where it's not.
A judge in Austin granted the divorce, but Texas Attorney General Greg Abbott is appealing the decision. He also is appealing a divorce granted to a gay couple in Dallas, saying protecting the ``traditional definition of marriage'' means doing the same for divorce.
A state appeals court is scheduled to hear arguments in the Dallas case on Wednesday.
The Dallas men, who declined to be interviewed for this story and are known only as J.B. and H.B. in court filings, had an amicable separation, with no disputes on separation of property and no children involved, said attorney Peter Schulte, who represents J.B. The couple, who married in 2006 in Massachusetts and separated two years later, simply want an official divorce, Schulte said.
The drawn-out process has been frustrating for Naylor, who says she didn't file for divorce as an equal rights statement _ she just wants to get on with her life.
``We didn't ask for a marriage; we simply asked for the courtesy of divorce,'' said Naylor, 39, of Austin, who married Sabina Daly in Massachusetts in 2004.
That year, Massachusetts became the first state to let same-sex couples tie the knot. Now, Connecticut, Iowa, New Hampshire, Vermont and the District of Columbia also allow them.
Gay and lesbian couples who turn to the courts when they break up are getting mixed results across the nation. A Pennsylvania judge last month refused to divorce two women who married in Massachusetts, while New York grants such divorces even though the state doesn't allow same-sex marriage.
``The bottom line is that same-sex couples have families and their families have the same needs and problems, but often don't have the same rights,'' said Jennifer Pizer, a lawyer for Lambda Legal, a national legal organization that promotes equal rights for gay, lesbian, bisexual and transgender people.
``It really is an unenviable position that the courts have put these couples in,'' said Karen Loewy, an attorney at the Gay and Lesbian Advocates and Defenders.
Abbott, a Republican seeking re-election, declined to be interviewed for this story. He has argued in court filings that because the state doesn't recognize gay marriage there can be no divorce, but a gay or lesbian Texas couple may have a marriage voided. Attorneys representing such couples argue that voiding a marriage here could leave it intact in other states, creating problems for property divisions and other issues.
``OK, you're recommending voidance, but how does that work?'' asked Jennifer Cochran, Naylor's attorney. ``Is it only void in Texas and can you void a marriage that's valid in another state? The attorney general I feel didn't answer those questions.''
In 2005, Texas voters passed a constitutional ban on same-sex marriage by a 3-to-1 margin even though state law already prohibited it. Abbott has said he is appealing the Dallas divorce ruling for two men to ``defend the traditional definition of marriage that was approved by Texas voters.''
Abbott disagrees with the judge in that case, who ruled in October that the same-sex marriage ban violates equal rights guaranteed by the U.S. Constitution.
Kelly Shackelford, chief counsel for the conservative Liberty Institute in Plano, called that decision ``outrageous judicial activism.'' The institute has filed a friend of the court brief to the appeals court on behalf of the two Republican state lawmakers who co-sponsored the amendment banning gay marriage: state Rep. Warren Chisum and former state Sen. Todd Staples.
``It's a backdoor run at establishing same-sex so-called marriage against the people's vote,'' Shackelford said. ``Once you grant the divorce, you are recognizing that there was a marriage.''
Dallas divorce attorney Tom Greenwald said he's advising gay couples to wait and see how things play out in the courts.
``Getting the court of appeals to even accept the issue is a step in the right direction in getting some clarity on this,'' he said. ``We just don't know how to treat it.''
As for Naylor and Daly _ the latter declined to comment _ they've been trying to figure out what to do since separating in 2007 amid escalating arguments.
The couple, who had real estate-related businesses and renovated homes, toyed with the idea of one of them moving to a state where gay marriage is legal until a divorce is finalized, but that didn't seem practical.
Naylor said that eventually, she and Daly worked out a custody arrangement for their now 4 1/2-year-old son. Naylor said that when she heard about the Dallas divorce, she thought it was worth a try and filed for her own, even though several attorneys she spoke with weren't so sure.
``They said it's too up in the air, wait and see for appeals,'' Naylor said. ``I didn't have a lot of time to wait and see.''
Associated Press Writer
DALLAS (AP) _ After the joy of a wedding and the adoption of a baby came arguments that couldn't be resolved, leading Angelique Naylor to file for divorce.
That left her fighting both the woman she married in Massachusetts and the state of Texas, which says a union granted in a U.S. state where same-sex marriage is legal can't be dissolved with a divorce in a state where it's not.
A judge in Austin granted the divorce, but Texas Attorney General Greg Abbott is appealing the decision. He also is appealing a divorce granted to a gay couple in Dallas, saying protecting the ``traditional definition of marriage'' means doing the same for divorce.
A state appeals court is scheduled to hear arguments in the Dallas case on Wednesday.
The Dallas men, who declined to be interviewed for this story and are known only as J.B. and H.B. in court filings, had an amicable separation, with no disputes on separation of property and no children involved, said attorney Peter Schulte, who represents J.B. The couple, who married in 2006 in Massachusetts and separated two years later, simply want an official divorce, Schulte said.
The drawn-out process has been frustrating for Naylor, who says she didn't file for divorce as an equal rights statement _ she just wants to get on with her life.
``We didn't ask for a marriage; we simply asked for the courtesy of divorce,'' said Naylor, 39, of Austin, who married Sabina Daly in Massachusetts in 2004.
That year, Massachusetts became the first state to let same-sex couples tie the knot. Now, Connecticut, Iowa, New Hampshire, Vermont and the District of Columbia also allow them.
Gay and lesbian couples who turn to the courts when they break up are getting mixed results across the nation. A Pennsylvania judge last month refused to divorce two women who married in Massachusetts, while New York grants such divorces even though the state doesn't allow same-sex marriage.
``The bottom line is that same-sex couples have families and their families have the same needs and problems, but often don't have the same rights,'' said Jennifer Pizer, a lawyer for Lambda Legal, a national legal organization that promotes equal rights for gay, lesbian, bisexual and transgender people.
``It really is an unenviable position that the courts have put these couples in,'' said Karen Loewy, an attorney at the Gay and Lesbian Advocates and Defenders.
Abbott, a Republican seeking re-election, declined to be interviewed for this story. He has argued in court filings that because the state doesn't recognize gay marriage there can be no divorce, but a gay or lesbian Texas couple may have a marriage voided. Attorneys representing such couples argue that voiding a marriage here could leave it intact in other states, creating problems for property divisions and other issues.
``OK, you're recommending voidance, but how does that work?'' asked Jennifer Cochran, Naylor's attorney. ``Is it only void in Texas and can you void a marriage that's valid in another state? The attorney general I feel didn't answer those questions.''
In 2005, Texas voters passed a constitutional ban on same-sex marriage by a 3-to-1 margin even though state law already prohibited it. Abbott has said he is appealing the Dallas divorce ruling for two men to ``defend the traditional definition of marriage that was approved by Texas voters.''
Abbott disagrees with the judge in that case, who ruled in October that the same-sex marriage ban violates equal rights guaranteed by the U.S. Constitution.
Kelly Shackelford, chief counsel for the conservative Liberty Institute in Plano, called that decision ``outrageous judicial activism.'' The institute has filed a friend of the court brief to the appeals court on behalf of the two Republican state lawmakers who co-sponsored the amendment banning gay marriage: state Rep. Warren Chisum and former state Sen. Todd Staples.
``It's a backdoor run at establishing same-sex so-called marriage against the people's vote,'' Shackelford said. ``Once you grant the divorce, you are recognizing that there was a marriage.''
Dallas divorce attorney Tom Greenwald said he's advising gay couples to wait and see how things play out in the courts.
``Getting the court of appeals to even accept the issue is a step in the right direction in getting some clarity on this,'' he said. ``We just don't know how to treat it.''
As for Naylor and Daly _ the latter declined to comment _ they've been trying to figure out what to do since separating in 2007 amid escalating arguments.
The couple, who had real estate-related businesses and renovated homes, toyed with the idea of one of them moving to a state where gay marriage is legal until a divorce is finalized, but that didn't seem practical.
Naylor said that eventually, she and Daly worked out a custody arrangement for their now 4 1/2-year-old son. Naylor said that when she heard about the Dallas divorce, she thought it was worth a try and filed for her own, even though several attorneys she spoke with weren't so sure.
``They said it's too up in the air, wait and see for appeals,'' Naylor said. ``I didn't have a lot of time to wait and see.''
Impact of Health Care Reform on People with Disabilities
Find out how recently enacted healthcare and insurance reforms affects people with disabilities.
United Spinal Association and NSCIA’s public policy collaboration has prepared an analysis of how the new law interfaces with disability. We highlight improvements and discuss problems that still exist. Read on to become an instant expert.
James Weisman
United Spinal Association, General Counsel
The disability community has worked together tirelessly for more than a year to achieve health care reform. After health care reform nearly died several times, Congress revived it and it became law in March 20101.
From any perspective, the final legislation is not perfect, but it will bring important improvements in health care coverage for people with spinal cord injuries and disorders and people with disabilities in general. The insurance market reforms alone are clearly beneficial. Once the permanent provisions go into effect, no longer will health insurers be able to deny coverage, charge outrageous premiums, offer less coverage to people with pre-existing conditions or impose annual or lifetime caps on benefits. In addition, the bill enacts several provisions that encourage home and community based services so that people with disabilities do not have to choose between living at home and getting the services they need.
As of 2014, when many permanent provisions go into effect, states must have health insurance exchanges (or alternatives) through which people and some employers may purchase health insurance. In addition, most people will be required to have health insurance unless they are eligible for health care through government programs such as Medicare, Medicaid, Department of Veterans Affairs and military service. Multistate plans are allowed but individual states can require additional benefits to be covered by health insurance in their states. There will be refundable tax credits for some people based on income and tax credits for some small
businesses that provide health insurance to their employees.
Summarized below are major final health care reform provisions that particularly impact people with disabilities. This list is by no means exhaustive. The final legislation not only reforms health insurance but also addresses many health care issues including prevention and wellness and improving the health care workforce.
With enactment of the law, reform is only beginning. The disability community must stay involved and present as implementing regulations are drafted, proposed, promulgated, and implemented. For the foreseeable future, we will need to be vigilant in making our voices heard with regard to the countless rules and regulations to be issued, advisory boards and commissions to be established, and many other steps to be taken to implement health care reform.
This summary was prepared by Peggy Hathaway, Vice-President for Public Policy, and Andrew Morris, Director of Legislation, for Spinal Cord Advocates, a public policy collaborative of United Spinal Association and the National Spinal Cord Injury Association, and Barbara L. Kornblau, JD, OTR, Dean, University of Michigan - Flint, School of Health Professions and Studies, on behalf of the American Association of People with Disabilities (AAPD).
Insurance Market Reforms
Generally, health care reform legislation includes many provisions that make private market health insurance far more available and affordable to people with disabilities and other chronic conditions.
No Discrimination Based on Pre-Existing Conditions
As of 2014 health insurers will no longer be able to discriminate against people due to disabilities or other pre-existing conditions. Health insurers will no longer be allowed to deny coverage, charge higher premiums, exclude benefits relating to pre-existing conditions, rescind coverage after someone is injured or acquires a new condition, or impose annual caps on benefits. Most of these provisions go into effect for children in September 2010.
Lifetime and Annual Benefits Caps
Lifetime caps on benefits are prohibited immediately. This will end the common insurance practice of imposing lifetime caps such as $1 million. Between now and 2014, the Secretary of Health and Human Services (HHS) may restrict annual caps on benefits. As of 2014, both lifetime and annual caps on benefits are prohibited.
Temporary High-Risk Pools
Between now and 2014, many people with pre-existing conditions are eligible to purchase coverage through high risk pools. Unfortunately, to be eligible to purchase this insurance, people must have been without any health coverage whatsoever for at least six months. Also, the insurance could be unaffordable for many people. Premiums are subject to restrictions, but even so, the law allows insurers to charge older people four times as much as younger people. Limits on out-of-pocket expenses must be consistent with high-deductible health savings account plans—currently $5,950 for an individual and $11,900 for a family.
It is currently uncertain when the temporary high risk pools will become available or where people will apply for insurance in these pools. If a state does not offer the required insurance, HHS will either help establish a pool in that state or residents of that state will be eligible for a national high risk pool. This decision-making process is now underway.
Mandatory Health Plan Coverage Provisions
Essential Benefits
For most health insurance plans (including plans offered in the exchanges and individual and small group plans but excluding grand-fathered individual and employer-sponsored plans) the law mandates coverage of at least the following essential benefits: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services (including behavioral health treatment), prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care.
HHS has the authority to further define essential benefits consistent with these required elements and is expected to do so. If HHS adds essential benefits, the law requires HHS to take into account the health care needs of people with disabilities and other diverse groups. We will continue to make our voices heard as HHS goes through the process of defining essential benefits.
For people with disabilities, it is a substantial improvement that rehabilitation and habilitation services are essential services. Many people with disabilities depend on them (e.g. to maintain muscle bulk and minimize spasticity) but pre-health care reform insurance policies did not cover them or severely limited the number of treatments.
As we understand it, the term “devices” is meant to include all durable medical equipment (including wheelchairs), prosthetics, orthotics and supplies (DMEPOS). This provision would be stronger if it made this point more explicitly. Because DMEPOS are critically important to many people with disabilities, we are advocating that anticipated HHS regulations defining essential benefits will explicitly provide that all DMEPOS are included in the meaning of “devices” as essential medical benefits.
It is important that mental health and substance abuse services are included as essential benefits.
Limits on Cost Sharing
The amount that people will have to pay out-of-pocket cannot be greater than the limits for health savings accounts. Small group market plans are prohibited from deductibles greater than $2,000 for individuals and $4,000 for families. These maximums may increase only in accordance with increases in average per person health insurance premiums.
Home & Community-Based Services
Health care reform has enacted or enhanced several provisions to expand home and community based services to help make it easier for people with disabilities and chronic conditions to live at home and participate in their communities, rather than having to live in a nursing home or other institution in order to receive needed services. No one should have to choose between living at home and receiving the services they need.
Community Living Assistance Services and Supports -CLASS
The CLASS provisions establish a national voluntary, insurance program whereby people with functional limitations receive benefits of not less than an average of $50 per day to pay for services and supports of their choice that help them with activities of daily living. To qualify, people will have had to pay premiums, by means of a voluntary payroll deduction plan, for at least five years. These services can enable them to remain independent, employed and participate in their communities. Unlike Medicaid, CLASS does not require people to be impoverished to qualify for this program. HHS is required to develop an actuarially sound benefit plan so that the program is self-sustaining.
Community First Choice Option
Creates the Community First Choice Option. This allows state Medicaid plans to choose home and community-based services and supports as the rule, rather than the exception, for Medicaid-eligible individuals with disabilities with incomes up to 150% of the Federal Poverty Level, who would otherwise require institutional care. To encourage states to choose this option, states that opt in will receive an additional six percent to the federal government’s share of Medicaid costs (referred to as the Federal Matching Assistance Percentage or FMAP) for five years. Effective October 1, 2011.
Money Follows the Person
Extends the popular Money Follows the Person demonstration grants until September 2016. These grants help state Medicaid programs defray the cost of moving eligible Medicaid recipients who have resided in an in-patient facility for a minimum number of consecutive days into community-based settings for eligible Medicaid recipients.
Home and Community Based Services in Medicaid
Makes it easier for state Medicaid programs to offer home and community based services by allowing states to do so by amending their state plan, rather than having to apply for a Medicaid waiver, which can be a lengthy process.
ADDITIONAL IMPORTANT CHANGES
Substantial Expansion of People Eligible for Medicaid
Health care reform substantially increases the number of people who are eligible for Medicaid. Since many people with disabilities have low or very modest incomes, this Medicaid expansion will give many more people with disabilities the right to health care coverage
As of 2014, health care reform expands Medicaid to cover non-elderly, childless adults for the first time and adults with incomes up to 133% of the Federal Poverty Level. It also expands Medicaid to cover children in families with incomes up to 133% of the Federal Poverty level, and it extends Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) mandates to all children on Medicaid including those in managed care. EPSDT services address developmental disabilities and delays. States will receive an increased Federal matching share for the first few years. In 2009, 133% of the Federal Poverty Level for individuals was $14,404 and for families of four was $29,327.
Between now and 2014, states have the option of extending Medicaid coverage to these groups.
In addition, states are required to maintain their current services under Medicaid and have incentives to cover preventive services and immunizations without cost-sharing to adults under Medicaid.
Note regarding Medicare 2-year waiting period. Under existing law, people found eligible to receive disability benefits under Social Security’s SSDI and other Title II programs must wait two years before they can receive Medicare benefits. In the meantime, many people with disabilities go without needed health care, which often causes dire consequences, including exacerbation of existing conditions and death.
While health care reform does not directly address this problem, it mitigates it for some people in the two-year waiting period. They may be able to obtain health coverage through the temporary high risk pool or through the health insurance exchanges once they go into effect (which cannot discriminate on the basis of pre-existing conditions) or they may qualify for Medicaid under its extended eligibility standards.
Medicare Part D Donut Hole Gap in Prescription Drug Coverage
Phases out the famous “donut hole” in prescription drug coverage under Medicare by
2020. Currently, when Medicare enrollees are in the donut hole (after they reach a certain
limit on prescription drug coverage and before additional coverage kicks in), they must
pay for prescription drugs at full price.
Provides a one-time $250 rebate for prescription drugs after enrollees enter the donut
hole in 2010. Beginning January 1, 2011, it provides a 50 percent discount on brand name
drugs and other discounts for generic drugs for enrollees in the donut hole.
Substantial Increased Funding for Community Health Centers
Provides an additional $11 billion of funding from the Public Health Trust fund for
Community Health Centers located across all 50 states and territories (over 1200
facilities). Community Health Centers are major providers of health care to people who
are uninsured or are underinsured
Medicare Outpatient Therapy Caps
Health care reform extends until December 31, 2010 some exceptions to caps on
Medicare Outpatient Part B Therapy Services, thus allowing Medicare enrollees to get
medically necessary therapy services beyond the $1,860 cap for occupational therapy,
and $1,860 cap for physical therapy and speech-language pathology services.
Accessible Medical Diagnostic Equipment
Requires the U.S. Access Board, in consultation with the Food and Drug Administration,
to establish regulatory standards setting the minimum technical criteria for medical
diagnostic equipment for people with disabilities. While existing law requires medical
equipment to be accessible, these standards are intended to clarify how to comply with
this requirement.
These standards, to be completed in two years, will clarify minimum technical criteria for
medical equipment in doctors’ offices and other medical facilities to be considered
accessible for people with disabilities including people who use wheelchairs. The
standards shall ensure the equipment is accessible to, and usable by, individuals with
accessibility needs, and shall allow independent entry to, use of, and exit from the
equipment by such individuals to the maximum extent possible. At a minimum medical
diagnostic equipment covered by the new standards will include: examination tables,
examination chairs (including chairs used for eye examinations or procedures, and dental
examinations or procedures), weight scales, mammography equipment, x-ray machines,
and other radiological equipment commonly used for diagnostic purposes by health
professionals.
Elimination of Medicare First-Month Purchase Option for Power Wheelchairs
Under existing law, Medicare beneficiaries have the option to purchase their power wheelchairs, rather than rent them. This enables the person with long-term need of a wheelchair to have it adjusted to his or her size and unique needs. Under health care reform, Medicare will only pay for rental, rather than purchase, of certain power wheelchairs for the first thirteen months of use (with exceptions for certain classes of complex rehab power wheelchairs). During the 13-month rental period Medicare will pay 80 percent and the beneficiary will pay 20 percent of the rental cost.
We are concerned because wheelchairs, like people, are not fungible. They require many adjustments to meet the individual user’s size and needs. With purchased wheelchairs, suppliers are likely to bear the cost of individualization, but they are not likely to do so for a rental that can be so easily returned. Without individualization, users frequently suffer exacerbated or secondary conditions that require treatment and often hospitalization, thus offsetting any cost savings to Medicare.
Durable Medical Equipment Excise Tax
A new excise tax ($20 billion over 10 years) on medical devices will be imposed on manufacturers of medical equipment. It is intended to help offset the costs of health reform. Although the tax is imposed on manufacturers, the consumer will ultimately bear the cost because manufacturers are likely to pass these costs on to consumers through increased prices.
Medicare Durable Medical Equipment Competitive Bidding Program
Existing law requires HHS to implement a competitive bidding program for suppliers of wheelchairs and other durable medical equipment, under Medicare, as a cost-savings measure. Wherever competitive bidding goes into effect, Medicare will only pay suppliers selected by HHS. It is likely that there will be far fewer suppliers to choose from for both purchase and repairs of wheelchairs and other durable medical equipment and that the quality of products and repairs may go down. People who use wheelchairs may well have to give up their existing suppliers and find it difficult to get to the new suppliers for repairs.
Health care reform speeds up the pace of expanding competitive bidding to additional Standard Metropolitan Statistical Areas and requires coverage of all areas by 2016.
Medicare Coverage of Annual Wellness Visit Providing a Personalized Prevention Plan
Provides Medicare Part B coverage, with no co-payment or deductible, for personalized prevention plan services. Personalized prevention plan services means the creation of a plan for an individual that includes a health risk assessment and may include other elements, such as updating family history, listing providers that regularly provide medical care to the individuals, body-mass index measurement, and other screenings and risk factors.
Comparative Effectiveness Research
Creates a federal coordinating council for comparative effectiveness that will be responsible for the annual funding of research to compare the effectiveness of various treatments on specific conditions. Comparative effectiveness research compares available treatments to see which works best based on research findings.
The law also creates a patient-centered outcomes research institute responsible for the development of national comparative effectiveness research priorities and the conduct of clinical outcomes research. Research must take into account the potential for differences in the effectiveness of health care treatments, services, and items as used with various sub-populations, and quality of life preferences.
Training of Future Health Practitioners
Requires that medical professionals receive disability awareness training to help reduce the health disparities that exist for people with disabilities. Grants and other incentives are available to develop programs and model curricula to train health professionals and increase the number of health professionals (including dentists) trained to meet the health care needs of individuals with disabilities.
Nondiscrimination
Except as provided elsewhere in the law, prohibits discrimination based on disability under any health program or activity which receives federal assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an Executive Agency or any entity established under this title (or amendments) and provides Section 504 of the Rehabilitation Act as the enforcement mechanism for violations. The Secretary of HHS may promulgate regulations to implement this.
Comprehensive Workplace Wellness Programs
Authorizes an appropriation for grants to eligible small businesses for the purpose of giving their employees access to comprehensive workplace wellness programs that meet criteria to be developed by HHS. Employee wellness programs can be a good way to encourage better health. However, this provision could inadvertently have a negative impact on people with disabilities. For example, a person with a disability may be unable to participate in an exercise program or another benchmark of the wellness program. If employees who do participate receive a reduced deductible under the employer- sponsored health plan (or another financial incentive), the person with a disability who is unable to participate would end up paying a higher deductible (or would not be eligible for other financial incentive). To avoid inadvertent negative impacts on people with disabilities and chronic conditions, it will be important to work with HHS in designing the programs.
Coverage of Anti-seizure, Anti-spasm, and Smoking Cessation Medications
Mandates coverage of barbiturates, benzodiazepines, and tobacco cessation agents under Medicare Part D. Barbiturates include phenobarbital and other medications that treat seizures. Benzodiazepines include sedatives, anti-anxiety medications, and anti-spasm medications. Both of these categories of medications were previously specifically excluded from coverage under Medicare Part D.
Data Collection and Analysis to Understand and Address Health Disparities
Requires the federal government to collect health survey data from people with disabilities to enable better understanding of the health of people with disabilities compared to other minority groups.
Also requires the government to collect survey data from health care providers in order to learn where people with disabilities receive their care, the number of providers with accessible facilities and equipment, and the number of health care professionals trained in meeting the health care needs of patients with disabilities.
Requires the development of recommendations for quality measures to improve the quality of health care for individuals with disabilities.
1 The Patient Protection and Affordable Care Act (HR 3590, Public Law 111-148, signed into law 3/23/10) as modified by the Health Care and Education Reconciliation Act (HR 4872, Public Law 111-152, signed into law 3/30/10).
United Spinal Association and NSCIA’s public policy collaboration has prepared an analysis of how the new law interfaces with disability. We highlight improvements and discuss problems that still exist. Read on to become an instant expert.
James Weisman
United Spinal Association, General Counsel
The disability community has worked together tirelessly for more than a year to achieve health care reform. After health care reform nearly died several times, Congress revived it and it became law in March 20101.
From any perspective, the final legislation is not perfect, but it will bring important improvements in health care coverage for people with spinal cord injuries and disorders and people with disabilities in general. The insurance market reforms alone are clearly beneficial. Once the permanent provisions go into effect, no longer will health insurers be able to deny coverage, charge outrageous premiums, offer less coverage to people with pre-existing conditions or impose annual or lifetime caps on benefits. In addition, the bill enacts several provisions that encourage home and community based services so that people with disabilities do not have to choose between living at home and getting the services they need.
As of 2014, when many permanent provisions go into effect, states must have health insurance exchanges (or alternatives) through which people and some employers may purchase health insurance. In addition, most people will be required to have health insurance unless they are eligible for health care through government programs such as Medicare, Medicaid, Department of Veterans Affairs and military service. Multistate plans are allowed but individual states can require additional benefits to be covered by health insurance in their states. There will be refundable tax credits for some people based on income and tax credits for some small
businesses that provide health insurance to their employees.
Summarized below are major final health care reform provisions that particularly impact people with disabilities. This list is by no means exhaustive. The final legislation not only reforms health insurance but also addresses many health care issues including prevention and wellness and improving the health care workforce.
With enactment of the law, reform is only beginning. The disability community must stay involved and present as implementing regulations are drafted, proposed, promulgated, and implemented. For the foreseeable future, we will need to be vigilant in making our voices heard with regard to the countless rules and regulations to be issued, advisory boards and commissions to be established, and many other steps to be taken to implement health care reform.
This summary was prepared by Peggy Hathaway, Vice-President for Public Policy, and Andrew Morris, Director of Legislation, for Spinal Cord Advocates, a public policy collaborative of United Spinal Association and the National Spinal Cord Injury Association, and Barbara L. Kornblau, JD, OTR, Dean, University of Michigan - Flint, School of Health Professions and Studies, on behalf of the American Association of People with Disabilities (AAPD).
Insurance Market Reforms
Generally, health care reform legislation includes many provisions that make private market health insurance far more available and affordable to people with disabilities and other chronic conditions.
No Discrimination Based on Pre-Existing Conditions
As of 2014 health insurers will no longer be able to discriminate against people due to disabilities or other pre-existing conditions. Health insurers will no longer be allowed to deny coverage, charge higher premiums, exclude benefits relating to pre-existing conditions, rescind coverage after someone is injured or acquires a new condition, or impose annual caps on benefits. Most of these provisions go into effect for children in September 2010.
Lifetime and Annual Benefits Caps
Lifetime caps on benefits are prohibited immediately. This will end the common insurance practice of imposing lifetime caps such as $1 million. Between now and 2014, the Secretary of Health and Human Services (HHS) may restrict annual caps on benefits. As of 2014, both lifetime and annual caps on benefits are prohibited.
Temporary High-Risk Pools
Between now and 2014, many people with pre-existing conditions are eligible to purchase coverage through high risk pools. Unfortunately, to be eligible to purchase this insurance, people must have been without any health coverage whatsoever for at least six months. Also, the insurance could be unaffordable for many people. Premiums are subject to restrictions, but even so, the law allows insurers to charge older people four times as much as younger people. Limits on out-of-pocket expenses must be consistent with high-deductible health savings account plans—currently $5,950 for an individual and $11,900 for a family.
It is currently uncertain when the temporary high risk pools will become available or where people will apply for insurance in these pools. If a state does not offer the required insurance, HHS will either help establish a pool in that state or residents of that state will be eligible for a national high risk pool. This decision-making process is now underway.
Mandatory Health Plan Coverage Provisions
Essential Benefits
For most health insurance plans (including plans offered in the exchanges and individual and small group plans but excluding grand-fathered individual and employer-sponsored plans) the law mandates coverage of at least the following essential benefits: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services (including behavioral health treatment), prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care.
HHS has the authority to further define essential benefits consistent with these required elements and is expected to do so. If HHS adds essential benefits, the law requires HHS to take into account the health care needs of people with disabilities and other diverse groups. We will continue to make our voices heard as HHS goes through the process of defining essential benefits.
For people with disabilities, it is a substantial improvement that rehabilitation and habilitation services are essential services. Many people with disabilities depend on them (e.g. to maintain muscle bulk and minimize spasticity) but pre-health care reform insurance policies did not cover them or severely limited the number of treatments.
As we understand it, the term “devices” is meant to include all durable medical equipment (including wheelchairs), prosthetics, orthotics and supplies (DMEPOS). This provision would be stronger if it made this point more explicitly. Because DMEPOS are critically important to many people with disabilities, we are advocating that anticipated HHS regulations defining essential benefits will explicitly provide that all DMEPOS are included in the meaning of “devices” as essential medical benefits.
It is important that mental health and substance abuse services are included as essential benefits.
Limits on Cost Sharing
The amount that people will have to pay out-of-pocket cannot be greater than the limits for health savings accounts. Small group market plans are prohibited from deductibles greater than $2,000 for individuals and $4,000 for families. These maximums may increase only in accordance with increases in average per person health insurance premiums.
Home & Community-Based Services
Health care reform has enacted or enhanced several provisions to expand home and community based services to help make it easier for people with disabilities and chronic conditions to live at home and participate in their communities, rather than having to live in a nursing home or other institution in order to receive needed services. No one should have to choose between living at home and receiving the services they need.
Community Living Assistance Services and Supports -CLASS
The CLASS provisions establish a national voluntary, insurance program whereby people with functional limitations receive benefits of not less than an average of $50 per day to pay for services and supports of their choice that help them with activities of daily living. To qualify, people will have had to pay premiums, by means of a voluntary payroll deduction plan, for at least five years. These services can enable them to remain independent, employed and participate in their communities. Unlike Medicaid, CLASS does not require people to be impoverished to qualify for this program. HHS is required to develop an actuarially sound benefit plan so that the program is self-sustaining.
Community First Choice Option
Creates the Community First Choice Option. This allows state Medicaid plans to choose home and community-based services and supports as the rule, rather than the exception, for Medicaid-eligible individuals with disabilities with incomes up to 150% of the Federal Poverty Level, who would otherwise require institutional care. To encourage states to choose this option, states that opt in will receive an additional six percent to the federal government’s share of Medicaid costs (referred to as the Federal Matching Assistance Percentage or FMAP) for five years. Effective October 1, 2011.
Money Follows the Person
Extends the popular Money Follows the Person demonstration grants until September 2016. These grants help state Medicaid programs defray the cost of moving eligible Medicaid recipients who have resided in an in-patient facility for a minimum number of consecutive days into community-based settings for eligible Medicaid recipients.
Home and Community Based Services in Medicaid
Makes it easier for state Medicaid programs to offer home and community based services by allowing states to do so by amending their state plan, rather than having to apply for a Medicaid waiver, which can be a lengthy process.
ADDITIONAL IMPORTANT CHANGES
Substantial Expansion of People Eligible for Medicaid
Health care reform substantially increases the number of people who are eligible for Medicaid. Since many people with disabilities have low or very modest incomes, this Medicaid expansion will give many more people with disabilities the right to health care coverage
As of 2014, health care reform expands Medicaid to cover non-elderly, childless adults for the first time and adults with incomes up to 133% of the Federal Poverty Level. It also expands Medicaid to cover children in families with incomes up to 133% of the Federal Poverty level, and it extends Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) mandates to all children on Medicaid including those in managed care. EPSDT services address developmental disabilities and delays. States will receive an increased Federal matching share for the first few years. In 2009, 133% of the Federal Poverty Level for individuals was $14,404 and for families of four was $29,327.
Between now and 2014, states have the option of extending Medicaid coverage to these groups.
In addition, states are required to maintain their current services under Medicaid and have incentives to cover preventive services and immunizations without cost-sharing to adults under Medicaid.
Note regarding Medicare 2-year waiting period. Under existing law, people found eligible to receive disability benefits under Social Security’s SSDI and other Title II programs must wait two years before they can receive Medicare benefits. In the meantime, many people with disabilities go without needed health care, which often causes dire consequences, including exacerbation of existing conditions and death.
While health care reform does not directly address this problem, it mitigates it for some people in the two-year waiting period. They may be able to obtain health coverage through the temporary high risk pool or through the health insurance exchanges once they go into effect (which cannot discriminate on the basis of pre-existing conditions) or they may qualify for Medicaid under its extended eligibility standards.
Medicare Part D Donut Hole Gap in Prescription Drug Coverage
Phases out the famous “donut hole” in prescription drug coverage under Medicare by
2020. Currently, when Medicare enrollees are in the donut hole (after they reach a certain
limit on prescription drug coverage and before additional coverage kicks in), they must
pay for prescription drugs at full price.
Provides a one-time $250 rebate for prescription drugs after enrollees enter the donut
hole in 2010. Beginning January 1, 2011, it provides a 50 percent discount on brand name
drugs and other discounts for generic drugs for enrollees in the donut hole.
Substantial Increased Funding for Community Health Centers
Provides an additional $11 billion of funding from the Public Health Trust fund for
Community Health Centers located across all 50 states and territories (over 1200
facilities). Community Health Centers are major providers of health care to people who
are uninsured or are underinsured
Medicare Outpatient Therapy Caps
Health care reform extends until December 31, 2010 some exceptions to caps on
Medicare Outpatient Part B Therapy Services, thus allowing Medicare enrollees to get
medically necessary therapy services beyond the $1,860 cap for occupational therapy,
and $1,860 cap for physical therapy and speech-language pathology services.
Accessible Medical Diagnostic Equipment
Requires the U.S. Access Board, in consultation with the Food and Drug Administration,
to establish regulatory standards setting the minimum technical criteria for medical
diagnostic equipment for people with disabilities. While existing law requires medical
equipment to be accessible, these standards are intended to clarify how to comply with
this requirement.
These standards, to be completed in two years, will clarify minimum technical criteria for
medical equipment in doctors’ offices and other medical facilities to be considered
accessible for people with disabilities including people who use wheelchairs. The
standards shall ensure the equipment is accessible to, and usable by, individuals with
accessibility needs, and shall allow independent entry to, use of, and exit from the
equipment by such individuals to the maximum extent possible. At a minimum medical
diagnostic equipment covered by the new standards will include: examination tables,
examination chairs (including chairs used for eye examinations or procedures, and dental
examinations or procedures), weight scales, mammography equipment, x-ray machines,
and other radiological equipment commonly used for diagnostic purposes by health
professionals.
Elimination of Medicare First-Month Purchase Option for Power Wheelchairs
Under existing law, Medicare beneficiaries have the option to purchase their power wheelchairs, rather than rent them. This enables the person with long-term need of a wheelchair to have it adjusted to his or her size and unique needs. Under health care reform, Medicare will only pay for rental, rather than purchase, of certain power wheelchairs for the first thirteen months of use (with exceptions for certain classes of complex rehab power wheelchairs). During the 13-month rental period Medicare will pay 80 percent and the beneficiary will pay 20 percent of the rental cost.
We are concerned because wheelchairs, like people, are not fungible. They require many adjustments to meet the individual user’s size and needs. With purchased wheelchairs, suppliers are likely to bear the cost of individualization, but they are not likely to do so for a rental that can be so easily returned. Without individualization, users frequently suffer exacerbated or secondary conditions that require treatment and often hospitalization, thus offsetting any cost savings to Medicare.
Durable Medical Equipment Excise Tax
A new excise tax ($20 billion over 10 years) on medical devices will be imposed on manufacturers of medical equipment. It is intended to help offset the costs of health reform. Although the tax is imposed on manufacturers, the consumer will ultimately bear the cost because manufacturers are likely to pass these costs on to consumers through increased prices.
Medicare Durable Medical Equipment Competitive Bidding Program
Existing law requires HHS to implement a competitive bidding program for suppliers of wheelchairs and other durable medical equipment, under Medicare, as a cost-savings measure. Wherever competitive bidding goes into effect, Medicare will only pay suppliers selected by HHS. It is likely that there will be far fewer suppliers to choose from for both purchase and repairs of wheelchairs and other durable medical equipment and that the quality of products and repairs may go down. People who use wheelchairs may well have to give up their existing suppliers and find it difficult to get to the new suppliers for repairs.
Health care reform speeds up the pace of expanding competitive bidding to additional Standard Metropolitan Statistical Areas and requires coverage of all areas by 2016.
Medicare Coverage of Annual Wellness Visit Providing a Personalized Prevention Plan
Provides Medicare Part B coverage, with no co-payment or deductible, for personalized prevention plan services. Personalized prevention plan services means the creation of a plan for an individual that includes a health risk assessment and may include other elements, such as updating family history, listing providers that regularly provide medical care to the individuals, body-mass index measurement, and other screenings and risk factors.
Comparative Effectiveness Research
Creates a federal coordinating council for comparative effectiveness that will be responsible for the annual funding of research to compare the effectiveness of various treatments on specific conditions. Comparative effectiveness research compares available treatments to see which works best based on research findings.
The law also creates a patient-centered outcomes research institute responsible for the development of national comparative effectiveness research priorities and the conduct of clinical outcomes research. Research must take into account the potential for differences in the effectiveness of health care treatments, services, and items as used with various sub-populations, and quality of life preferences.
Training of Future Health Practitioners
Requires that medical professionals receive disability awareness training to help reduce the health disparities that exist for people with disabilities. Grants and other incentives are available to develop programs and model curricula to train health professionals and increase the number of health professionals (including dentists) trained to meet the health care needs of individuals with disabilities.
Nondiscrimination
Except as provided elsewhere in the law, prohibits discrimination based on disability under any health program or activity which receives federal assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an Executive Agency or any entity established under this title (or amendments) and provides Section 504 of the Rehabilitation Act as the enforcement mechanism for violations. The Secretary of HHS may promulgate regulations to implement this.
Comprehensive Workplace Wellness Programs
Authorizes an appropriation for grants to eligible small businesses for the purpose of giving their employees access to comprehensive workplace wellness programs that meet criteria to be developed by HHS. Employee wellness programs can be a good way to encourage better health. However, this provision could inadvertently have a negative impact on people with disabilities. For example, a person with a disability may be unable to participate in an exercise program or another benchmark of the wellness program. If employees who do participate receive a reduced deductible under the employer- sponsored health plan (or another financial incentive), the person with a disability who is unable to participate would end up paying a higher deductible (or would not be eligible for other financial incentive). To avoid inadvertent negative impacts on people with disabilities and chronic conditions, it will be important to work with HHS in designing the programs.
Coverage of Anti-seizure, Anti-spasm, and Smoking Cessation Medications
Mandates coverage of barbiturates, benzodiazepines, and tobacco cessation agents under Medicare Part D. Barbiturates include phenobarbital and other medications that treat seizures. Benzodiazepines include sedatives, anti-anxiety medications, and anti-spasm medications. Both of these categories of medications were previously specifically excluded from coverage under Medicare Part D.
Data Collection and Analysis to Understand and Address Health Disparities
Requires the federal government to collect health survey data from people with disabilities to enable better understanding of the health of people with disabilities compared to other minority groups.
Also requires the government to collect survey data from health care providers in order to learn where people with disabilities receive their care, the number of providers with accessible facilities and equipment, and the number of health care professionals trained in meeting the health care needs of patients with disabilities.
Requires the development of recommendations for quality measures to improve the quality of health care for individuals with disabilities.
1 The Patient Protection and Affordable Care Act (HR 3590, Public Law 111-148, signed into law 3/23/10) as modified by the Health Care and Education Reconciliation Act (HR 4872, Public Law 111-152, signed into law 3/30/10).
Experts Re-Examine Audio From Kent State Shootings
Were the Troops at Kent State Ordered To Fire? What do YOU THINK?
CLEVELAND (AP) _ A new analysis of a 40-year-old audio recording reveals that someone ordered National Guard troops to prepare to fire on students during a deadly Vietnam War protest at Kent State University in 1970, two forensics experts said.
The recording was enhanced and evaluated by New Jersey-based audio experts Stuart Allen and Tom Owen at the request of The Plain Dealer newspaper. Both concluded that they hear someone shout, ``Guard!'' Seconds later, a voice yells, ``All right, prepare to fire!''
``Get down!'' someone shouts, presumably in the crowd. A voice then says, ``Guard!...'' followed two seconds later by a booming volley of gunshots.
Four Kent State students were killed and nine were wounded.
``I think this is a major development,'' said Alan Canfora, who was shot and wounded in the right wrist during the protest on May 4, 1970. Canfora, who has long believed that the troops were ordered to fire, located a copy of the tape in a library archive in 2007 and has urged that it be professionally reviewed.
The original reel-to-reel audio recording was made by Terry Strubbe, a student who placed a microphone in a window sill of his dormitory that overlooked the anti-war rally.
Allen, president and chief engineer of the Legal Services Group in Plainfield, New Jersey, removed extraneous noises _ wind blowing across the microphone, for example _ that obscured voices on the recording.
Without a voice sample for comparison, the new analysis can't determine who might have issued such a command or why.
Most of the senior Ohio National Guard officers directly in charge of the troops have died.
Ronald Snyder, a former Guard captain who led a unit that was at the Kent State protest but was not involved in the shootings, said the prepare-to-fire phrasing does not seem consistent with how military orders are given.
The FBI investigated whether an order had been given to fire and said it could only speculate. One theory was that a guardsman panicked or fired intentionally at a student and others fired when they heard the shot.
In 1974, eight guardsmen tried on federal civil rights charges were acquitted by a U.S. judge. The surviving victims and families of the dead settled a civil lawsuit for $675,000 in 1979, agreeing to drop all future claims against the Guardsmen.
The significance of the new audio analysis may be more historical than legal, said Sanford Rosen, one of plaintiffs' attorneys in the civil lawsuit.
CLEVELAND (AP) _ A new analysis of a 40-year-old audio recording reveals that someone ordered National Guard troops to prepare to fire on students during a deadly Vietnam War protest at Kent State University in 1970, two forensics experts said.
The recording was enhanced and evaluated by New Jersey-based audio experts Stuart Allen and Tom Owen at the request of The Plain Dealer newspaper. Both concluded that they hear someone shout, ``Guard!'' Seconds later, a voice yells, ``All right, prepare to fire!''
``Get down!'' someone shouts, presumably in the crowd. A voice then says, ``Guard!...'' followed two seconds later by a booming volley of gunshots.
Four Kent State students were killed and nine were wounded.
``I think this is a major development,'' said Alan Canfora, who was shot and wounded in the right wrist during the protest on May 4, 1970. Canfora, who has long believed that the troops were ordered to fire, located a copy of the tape in a library archive in 2007 and has urged that it be professionally reviewed.
The original reel-to-reel audio recording was made by Terry Strubbe, a student who placed a microphone in a window sill of his dormitory that overlooked the anti-war rally.
Allen, president and chief engineer of the Legal Services Group in Plainfield, New Jersey, removed extraneous noises _ wind blowing across the microphone, for example _ that obscured voices on the recording.
Without a voice sample for comparison, the new analysis can't determine who might have issued such a command or why.
Most of the senior Ohio National Guard officers directly in charge of the troops have died.
Ronald Snyder, a former Guard captain who led a unit that was at the Kent State protest but was not involved in the shootings, said the prepare-to-fire phrasing does not seem consistent with how military orders are given.
The FBI investigated whether an order had been given to fire and said it could only speculate. One theory was that a guardsman panicked or fired intentionally at a student and others fired when they heard the shot.
In 1974, eight guardsmen tried on federal civil rights charges were acquitted by a U.S. judge. The surviving victims and families of the dead settled a civil lawsuit for $675,000 in 1979, agreeing to drop all future claims against the Guardsmen.
The significance of the new audio analysis may be more historical than legal, said Sanford Rosen, one of plaintiffs' attorneys in the civil lawsuit.
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