CAPITOL INSIDER 

for the week of December 16, 2013
Recent Major Events

Budget – House and Senate Reach Budget Agreement

Last week, the House Budget Committee Chairman Paul Ryan (R-WI) and Senate
Budget Committee Chairwoman Patty Murray (D-WA) reached an agreement on the
federal budget. This agreement will help preserve programs that individuals with
intellectual and developmental disabilities (I/DD) rely on, restore order to the federal
budget and appropriations process, and reduce the deficit by about $23 billion.
Additionally the agreement provides $63 billion in sequester relief over two years,
that will be split equally between defense and non-defense discretionary programs,
preventing further cuts to important programs such as supportive housing, special
education, and funding for critical public health programs.

The House passed the Bipartisan Budget Act of 2013 (H.J. Res. 59), and the Senate is
expected to debate and pass the measure early this week.  The deal is a blueprint for
spending and revenue over the next two years.  The spending part of the deal would
ease the limits on spending for fiscal years 2014 and 2015 that had been put in place
by sequestration (across-the-board spending cuts). The spending changes do not take
effect with the passage of this budget, however. That still requires an appropriations bill
to be passed before January 16, 2014, when temporary funding for the government under
the current continuing resolution expires. The two appropriations bills that fund the vast
majority of disability-related programs, the Labor-Health and Human Services-and
Education bill (L-HHS-ED) and the Transportation and Housing and Urban Development
(T-HUD) bills, may ultimatel y be continued at current spending levels for a while because
both have recently encountered opposition in Congress.

While The Arc is pleased that the budget agreement will prevent another government
shutdown early next year and does not make major changes to our lifeline programs
including Social Security, Medicaid, and Medicare, we are concerned about what appears
to be the expansion of the state Medicaid agencies ability to recoup costs from settlements
from Medicaid beneficiaries.  This could affect payments owed to individuals and families
who have been harmed, received compensation, and depend on the compensation to pay
for expenses beyond what Medicaid covers.  Allowing a state Medicaid agency to recover
“any payments” by a third party with legal liability (rather than just those payments for
health care items and services, as under current law) would leave beneficiaries without
coverage for other basic necessities, such as accessible housing or an accessible van.

Health Care – New Health Care Extensions

The Administration continues to look for ways to help people transition to the new health
insurance plans available in the marketplace given the operational problems of the
enrollment website (www.healthcare.gov).  The Department of Health and Human Services
(HHS) announced that it is extending the federally run pre-existing condition insurance
plans which were established as a temporary measure for people who could not get
insurance. The plans are being extended until January 31, 2014 for people who do not have
other coverage.   The Administration also extended to December 31, 2013 the deadline for
paying premiums for coverage beginni ng January 1, 2014.  HHS is also urging insurance
companies to consider additional flexibility such as allowing retroactive coverage in cases
where insurance is purchased early in the month.

Health Care – Medicare Reimbursement Rates Addressed by Congress

The House and Senate are moving forward on two tracks to address the problematic
formula for reimbursing doctors and other Medicare health care providers.  Both chambers
are planning to pass a short term measure that would prevent steep cuts to Medicare
providers that would happen after January 1, 2014 as part of the budget agreement.  The
House Ways and Means and Senate Finance Committees both passed separate legislation
to permanently repeal the formula and replace it with a new approach.  The Senate Finance
Committee will also include a provision to repeal the cap on therapy visits in the Medicare
program. The House bill did not address the therapy issues or any of the other provisions
that are normally extended as a part of the package.  The House and Senate have not
addressed how the permanent fix will be paid for.

Education – Budget Cuts Impact Educational Services for Students with Disabilities

Last year, sequestration cut over $2 billion from general education and over $600 million
from special education budgets.  Without Congressional action, there will be additional cuts
next year.  The Council for Exceptional Children (CEC) and National Coalition of Personnel
Shortages in Special Education & Related Services surveyed 1000 special education
teachers and administrators representing every state asking them about the impact budget
cuts have had on their ability to provide educational services to students with disabilities.
Over 90% of respondents said their school district had been adversely impacted by budget
cuts over the last year. Eighty-two percent of respondents said that the cuts resulted in too
few personnel to meet the needs of students with disabilities in their districts.  Seventy-eight
percent said the cuts have resulted in higher caseloads and 61% in increased class sizes.
One-third reported layoffs of support personnel and teachers.  Check out
CEC’s infographic.
Health Care – The Centers for Medicare and Medicaid Services Issues Updates to Medicare
Benefit Policy Manual

In order to comply with a January 2013 settlement agreement in a federal lawsuit, The
Centers for Medicare and Medicaid Services (CMS) issued updates to its­­­ Medicare Benefit
Policy Manual, the program manual used by Medicare contractors, to clarify that skilled
nursing services and skilled therapy services are not contingent on an individual’s potential
for improvement.  For some time, providers of Medicare home health services relied on an
improvement standard to determine eligibi lity for skilled nursing or therapy services.  CMS
has clarified in its program manual update that the need for skilled services must be based
on medical necessity not the potential for improvement.  The manual states that skilled
services may be needed by an individual to improve a current condition, to maintain a current
condition, or to prevent or slow further deterioration of a condition.
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Tony Paulauski
Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423
815-464-1832 (OFFICE)
 
Tony@www.thearcofil.org