Correction: It's 2010! Last week we reported on upcoming JFAAN Organizers Forums. The title of the article incrrectly labeled them as 2009 events. The dates listed were otherwise accurate.
1) What’s Happening in the Nation’s Capital?
Healthcare Reform Update
2) National News
2011 Federal Budget Released Today
New Rules Promise Better Mental Health Coverage
Budget Reconciliation: What It Is!
3) State News
New Hampshire Adaptive Ski Program Faces ADA Suit
4) Announcements and Additional Resources
ODEP Currently Holding Listening Sessions Nationwide
Massive Medicaid Fraud Lawsuit Unsealed
Healthcare Reform Update
Healthcare advocates, experts, and lobbyists are still waiting to see what Congressional Leadership intends to do “post-Massachusetts”.
Intelligence from Capitol Hill confirms that the options being considered to salvage reform, which were outlined in last week’s edition of the WhAM! , are still on the table but uncertainty remains. To pass the Senate Bill “as-is” in the House and then make some changes through “Budget Reconciliation” sounds simple but is in fact is extremely difficult and contentious.
NCIL thanks the members who called their Senators and Representatives last week. If you have not yet done so, please take the time to tell Congress that healthcare reform cannot die! Later this week, NCIL will issue a challenge to our members and allies push for reform in each state. We must show Congress that there is support for reform at a grassroots level. Please watch your inbox for details.
If you have questions about healthcare reform or the process, contact NCIL Policy Analyst Jason Beloungy at 202-207-0334 (toll-free: 1-877-525-3400), ext. 1008, or jason@ncil.org.
2011 Federal Budget Released Today
President Obama releases his federal budget today. During his State of the Union Address last Wednesday, the President announced Administration’s intention to freeze some domestic spending for three years. The Obama Administration wants to be clear that while there will be an overall freeze on spending levels, that some programs within each agency could see increases in spending, some could see budget cuts, and many will be frozen at 2010 levels.
The Administration announced today that they will provide an additional $25 Billion to the Medicaid program, a six-month extension of the stimulus funds that were provided to states to help with significant budget shortfalls in the face of growing deficits and Medicaid expenditures.
Last week, NCIL Policy Analysts Jason Beloungy and Lacy Pittman joined a call with the Office on Management and Budget (OMB), an opportunity to hear from the budget office for the Executive Branch about the upcoming 2011 Federal Budget. Few new details were relayed on the call, but we learned that spending on Medicare, Medicaid and Social Security will not be affected. This is of some relief, as these programs already face significant problems on the federal and state level, and a freeze in programmatic spending would further worsen the situation.
Today, NCIL’s Policy Analysts will attend meetings at the Department of Health and Human Services and the Department of Education to learn about the President’s budget proposals for 2011with regard to programs that significantly impact the lives of people with disabilities, as well as the proposed budget lines for the Independent Living Program. NCIL will report next week on its findings.
New Rules Promise Better Mental Health Coverage
Source: New York Times, by Robert Pear
The Obama administration issued new rules on Friday that promise to improve insurance coverage of mental health care for more than 140 million people insured through their jobs. In general, under the rules, employers and group health plans cannot provide less coverage for mental health care than for the treatment of physical conditions like cancer and heart disease.
Insurers cannot set higher co-payments and deductibles or stricter limits on treatment for mental illness and addiction disorders. Nor can they establish separate deductibles for mental health care and for the treatment of physical illnesses.
Such disparities are common in the insurance industry. By sweeping away such restrictions, doctors said, the rules will make it easier for people to obtain treatment for a wide range of conditions, including depression, autism, schizophrenia, eating disorders and alcohol and drug abuse. For decades, many health plans have had limits on hospital inpatient days and outpatient visits for mental health treatments, but not for other types of care. Kathleen Sebelius, the secretary of health and human services, said the rules guaranteed that people with debilitating mental disorders would not suffer “needless or arbitrary limits on their care.”
The rules, which take effect on July 1, carry out a 2008 law that was adopted with bipartisan support. They significantly expand the rights of people with mental illness, much of which goes untreated because of insurance restrictions. Under the rules, insurers can still review claims for “medical necessity,” can still require prior approval of some services and can still charge consumers more for using doctors and hospitals that are not on a list of preferred providers. But under the rules, insurers cannot use these techniques in a more restrictive way for mental health care than for other medical services.
The administration said the new requirements could increase premiums by four-tenths of 1 percent, or $25.6 billion over 10 years. Businesses with 50 or fewer employees are exempt. The rules apply to group health insurance plans of the kind typically offered by employers. Federal health officials said the rules did not apply to the individual insurance market, where policies are sold directly to individuals and families. However, some states have laws that apply to the individual market. Read More.
Budget Reconciliation: What It Is!
The only items that can be included in reconciliation are hose that affect revenue and expenditures in the federal budget. These items would be bundled together, so it would take some time to ensure that the items included would not cost much because to ensure the votes needed for passage.
Reconciliation can only be used when it has been included as an option in the federal budget process, which imposes a time limit the process. As part of the 2010 Federal Budget, passed late last year, Congress put that option on the table, but it will expire June 15th. If there is no action by then, the reconciliation cannot be used again until the 2011 federal budget process.
Another difficult aspect of this process is that the Senate Parliamentarian is the de facto editor of a reconciliation bill. The Parliamentarian has to make a decision on each provision to determine if they qualify for reconciliation. This is a heavy burden of judgment to be placed on one person, who could significantly alter the scope and size of the reconciliation bill.
Finally, reconciliation is a lengthy process. All five committees that have jurisdiction over healthcare reform would mark up the reconciliation bill. From there, the reconciliation bill goes to each Chamber’s floor. The rules in the House would likely allow for quick passage if the votes were there to pass the bill. In the Senate, however, there would again be a lengthy debate, followed by unlimited amendments unless there is unanimous consent to end that process, a very unlikely scenario.
If the reconciliation bill were passed by each Chamber without any difference between the two versions, there would be a formal conference committee to iron out the differences. Nothing new could be added to the bills at this point. If a final bill was agreed upon, it would only take a simple majority in both Chambers to pass it.
The House Committee on Rules website also gives an explanation of the budget reconciliation process.
New Hampshire Adaptive Ski Program Faces ADA Suit
Source: The Concord Monitor, by Annmarie Timmins, Max Bittle
Martin Wallem speaks by blinking through an eye-gaze board at his home in Epping. Wallem has been living with Lou Gehrig’s disease for eight years and stays active through adaptive sports programs. He and the Disability Rights Center are suing Bretton Woods for barring him from skiing there.
Martin Wallem breathes with a ventilator and can only move only his eyes and grind his teeth. He uses those limited movements to tell his son when it's bedtime and his wife when he wants to go deep-sea fishing, hunting and downhill skiing. In other words, Wallem, 39, of Epping, isn't giving in to his amyotrophic lateral sclerosis - or Lou Gehrig's disease. Since his diagnosis eight years ago, Wallem has been on several outdoor adventures with the help of adaptive equipment and tireless caregivers.
So when the Bretton Woods Adaptive ski program, a recreation program with specialized equipment for people with disabilities, told Wallem last year that he could no longer ski with them, he objected. And after the program declined to reconsider, saying it no longer accommodated people on ventilators, Wallem went to court. In pleadings filed last week, the Disabilities Rights Center of Concord asked the U.S. District Court to order the adaptive ski program and the owners of Bretton Woods to allow Wallem to immediately resume skiing there. Read More.
ODEP Currently Holding Listening Sessions Nationwide
From January through March the U.S. Department of Labor's (DOL) Office of Disability Employment Policy (ODEP) and its federal partners will hold a series of six Listening Sessions across the country. These sessions will provide an opportunity for members of the public to provide input to senior federal officials on their ideas for more effective ways to employ women, Veterans and minorities with disabilities, and what is currently working in their communities to increase employment among people with disabilities. Here is the
schedule:
- Dallas: January 21 (completed) (Region IV: Arkansas, CO, LA, MT, NM, ND, OK, SD, TX, UT, WY)
- Philadelphia: January 27 (completed) (Region II: DC, MD, PA, VA, WV)
- Chicago: February 11 (Region V: IL, IN, MI, MN, OH, IO, KS, MO, NE, WI)
- San Francisco: February 16 (Region VI: AK, AZ, CA, HA, ID, NV, OR, WA, Guam)
- Atlanta: February 24 (Region III: AL, FL, GA, KY, MS, NC, SC, TN)
- Boston: March 3 (Region I: CT, ME, MA, NH, NJ, NY, RI, VT, PR, VI)
You must be a resident of the appropriate region to speak and/or submit comments. More information is available at: http://www.disabilitylisteningtour.com/. Click on the event on the schedule to go to the registration page.
Massive Medicaid Fraud Lawsuit Unsealed
Source: PsychRights
A major Medicaid Fraud lawsuit by the Law Project for Psychiatric Rights (PsychRights®) against psychiatrists, their employers, pharmacies, state officials, and a medical education and publishing company for their roles in submitting fraudulent claims to Medicaid was unsealed.
The lawsuit, which was filed on April 27, 2009, and required to be kept under seal (secret) until now, is brought under the federal False Claims Act, which authorizes private parties to bring fraud actions on behalf of the Government. These cases are also called "whistleblower suits" or "qui tam," actions, and those who file them are entitled to a share in the recovery, if any. Each offending prescription carries a minimum penalty of $5,500.
The Complaint walks through the lack of science supporting the practice and the methods used by the pharmaceutical industry to induce psychiatrists to improperly prescribe these drugs. "Even though the drug companies have been using these methods to induce psychiatrists to prescribe these drugs, it is the psychiatrists' responsibility to base their decisions on the facts, not drug company marketing," said Mr. Gottstein, continuing, "the uncritical acceptance of pharmaceutical company hype represents a massive betrayal of trust by the psychiatrists prescribing these drugs to children and youth."
PsychRights has also developed a streamlined model Qui Tam Complaint for use around the country. The model Qui Tam Complaint is drafted for former foster youth to bring the lawsuits and receive the whistleblower's share of the recovery, but anyone with knowledge of specific offending prescriptions, such as parents and mental health workers, can bring these suits. Read More.
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February 1, 2010