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Legislative Network Alerts Alert Number 7 March 12, 2002 For Your Information National Rehabilitation Association Issue Statements 2002 To: Members of the Legislative Network From: National Rehabilitation Association The following twelve Issue Statements were approved by the National Rehabilitation Association Board of Directors on March 9, 2002 and subsequently presented to the 2002 Governmental Affairs Seminar. -------------------- COMMUNITY ATTENDANT SERVICES The National Rehabilitation Association supports S. 1298, the Medicaid Community-Based Attendant Services and Supports Act (sponsored by Senator Tom Harkin), which would move federal health care funding toward more consumer choice in obtaining personal assistance services. Additionally, the National Rehabilitation Association recommends that any community attendant services legislation incorporate a cap on administrative costs. Citizens recognize the value that institutional care has in meeting the needs of some individuals in the elderly and disability communities. It is clear, however, that a large number of individuals currently residing in institutional settings, or who are at risk of being placed there, can be served more cost effectively with quality care in other settings. This would also allow more consumer choice. Consumers could receive long-term services in the most integrated setting appropriate for their needs, and would have the opportunity to select, manage and dismiss the person who provides that care. One State offering a consumer-directed personal assistance program allows participants to receive services within their local home settings. In 2000, they generally reported a cost that ranged from 10,000 to 18,000 less per individual annually, when compared with 'direct' nursing home costs (e.g. nurses, therapists, aides, food etc.) usually ranging from 23,000 to 33,000 annually, depending upon the level of care. [Status of S. 1298 – introduced in the U.S. Senate on August 1, 2001 and referred to the Senate Committee on Finance where no hearings have been scheduled. H.R. 3612 – was introduced in the House of Representatives on January 23, 2002.] ----------------------- HEALTH AND WELLNESS POLICY The National Rehabilitation Association strongly believes that employment is part of health and wellness. Therefore, return-to-work should be a part of return–to-health. Such policy will impact disability and productivity issues for all citizens. Currently, no public or private health insurance programs cover any services relating to return-to-work, such as disability management, vocational evaluation, vocational rehabilitation or job placement services. Neither the medical community nor the health insurance industry recognizes the importance of employment as a part of health and wellness. Their lack of knowledge of community resources to address such issues is evident by minimal referrals to private or public agencies. Lack of knowledge results in delays of services, which significantly affect the incentives and motivation for persons to return to work. As a result, increased incidence and duration of health and disability claims increase medical and disability costs. The impact is also felt through loss of manpower and productivity and consequently the cost of goods and services in the global economy. The National Rehabilitation Association believes this domino effect can be reduced and subsequently stopped if legislators recognize that work is a health issue. Return to work must be a part of return-to-health. Such a policy promoting good health and increased productivity will reduce the cost of medical intervention and disability and result in a stronger economy for all citizens. -------------------------.IDEA REAUTHORIZATION OF THE INDIVIDUALS WITH DISABILITY EDUCATION ACT OF 1997 The National Rehabilitation Association (NRA) strongly supports the Individuals with Disability Education Act (IDEA) of 1997. NRA supports the IDEA as an effective law that ensures all children the right to a free appropriate public education. The law should remain intact and its existing provisions strengthened and enforced at the federal, state and local levels. The NRA membership furthermore supports the Congress on full mandatory funding of the IDEA. The purpose of this mandatory funding is to ensure that children and adolescents with disabilities have an equal opportunity to fully participate in the educational system. Some of the special education practices that this funding supports include: • Participation of students with disabilities in state and district-wide assessment programs, including alternative assessment. • Development and review of the individualized education program (IEP), including increased emphasis on participation of children and youth with disabilities in the general education curriculum and the involvement of general education teachers in developing the IEP. • Enhanced parent participation in eligibility and placement decisions. • Streamlined student evaluation/reevaluation requirements. • Identification of transition services within a student's course of study as defined by law. • The availability of mediation services as a means of more easily resolving parent-school differences. • Disciplinary procedures for students with disabilities, including allowance for an appropriate interim alternative educational setting. • Allowing children ages 3-9 to be identified as developmentally delayed. The reauthorization of IDEA must be designed to improve the education system and to ensure the enforcement of the statute to serve the educational needs of all students with disabilities. The NRA supports Congress in its intent to ensure all children the right to a free appropriate public education. ----------------------- MEDICARE COVERAGE FOR VISION REHABILITATION In order to champion self-reliance and quality of life for individuals who are blind or partially sighted, the National Rehabilitation Association supports: vision rehabilitation services provided by qualified professionals, third party reimbursement for vision rehabilitation services, access to services and information technology, the right to choose service options and inclusion in the mainstream of society. One in six Americans (17 percent) age 45 and older reports some form of vision impairment even when wearing glasses or contact lenses. This represents 13.5 million adults, 6.6 million of whom are older adults. The prevalence of vision impairment increases dramatically with age from 15 percent at age 45-64 to 26 percent at age 75 and older. The number of people with vision impairments will double by the year 2030, with the projected growth in the older population. No more than 2 percent of people age 45 and over who report vision impairments use any specific vision rehabilitation service. This extremely low figure is the result of lack of public knowledge about vision rehabilitation services and lack of adequate funding to pay for needed services. [Status of H.R. 2484 – Introduced on July 12, 2001 by Congressman Mike Capuano (D-MA), the bill was referred to the House Committee on Energy and Commerce – Subcommittee on Health, as well as to the House Committee on Ways and Means – Subcommittee on Health. S. 1967 – Introduced on February 26, 2002 ] ------------------------ PATIENT’S BILL OF RIGHTS The National Rehabilitation Association strongly urges Congress to quickly pass a meaningful Patient’s Bill of Rights Act. The National Rehabilitation Association strongly advocates that individuals with disabilities have the right to quality health care which should include: 1. A health care system with greater consumer participation, responsibility; and control; 2. Accurate and accessible information regarding healthcare options; 3. Open medical communications allowing medical personnel to discuss all medical / treatment options without repercussions; 4. Elimination of preauthorization for actual emergency services; 5. A health insurance plan that includes access to specialty services, including return to work; 6. Non-discrimination in coverage and delivery of services; and 7. A fair and efficient external complaint, appeal, and review process. The primary goal is to provide quality healthcare at all levels with healthcare decisions being made by an informed patient and appropriate medical personnel rather than an insurance company administrator. [Summary of the status of Patient’s Bill of Rights legislation – S. 1052(sponsored by John McCain, R-AZ) passed the Senate; and H.R. 2563 (sponsored by Greg Ganske, R-IA). The legislation was sent to a House / Senate Conference Committee to reconcile the differences. The House passed legislation which would guarantee access to emergency care, it would guarantee access to specialists, including gynecologists and pediatricians, and it would guarantee access to clinical trials. Additionally, the House bill states that insurers would be required to submit patients’ grievances to an independent review board. The House bill says that Individuals who are denied care would have to exhaust outside appeals before going to court. The Senate bill does not require an individual to have completed their outside appeals before going to court. The House bill does indicate that individuals who are in danger of permanent injury can sue immediately for cost of treatment. In the the House bill, federal court lawsuits would be allowed for contractual disputes. State court suits would be allowed for denials of medical care – where federal rules would apply. The Senate bill would not require that federal rules apply. The House bill states that employers who provide their own health insurance cannot be sued in State courts. The House bill limits court awards for damages for pain and suffering and punitive damages to 1.5 million. The Senate bill has no limits for pain and suffering and a 5 million limit on punitive damages.] ----------------------- PROFESSIONAL CERTIFICATION The National Rehabilitation Association strongly urges that all legislation that impacts individuals with disabilities include the provision that rehabilitation services be provided by qualified rehabilitation professionals who meet nationally recognized professional certification and / or State licensure in both the public and private sectors. The National Rehabilitation Association continues to be extremely concerned that individuals with disabilities be given the best possible opportunity to return to a working environment and full inclusion in society. Research indicates that individuals benefit most from services provided by qualified rehabilitation personnel. -------------------------TANF – REAUTHORIZATION OF THE TEMPORARY ASSISTANCE FOR NEEDY FAMILIES ACT OF 1996 The National Rehabilitation Association (NRA) strongly supports the reauthorization of the Temporary Assistance for Needy Families (TANF) Act. The law should remain intact and its existing provisions strengthened and enforced at the federal, state and local levels to ensure that individuals with disabilities are supported in their efforts to gain self-sufficiency and improve their quality of life. The NRA membership urges the President and the Congress to ensure that TANF be consistent with the principles and goals of national disability policy as stated in the Americans with Disabilities Act (ADA). Further, modifications to TANF law should include the following provisions: • Congress should not reduce TANF Block Grants to states. Block Grants should be sustained to help states tackle more difficult and expensive barriers faced by remaining recipients many of who are individuals with disabilities. • Congress should provide an inflation adjustment to the TANF Block Grant and greater funding to states to support their efforts in assisting individuals with disabilities. • Congress should broaden the definition of “work activities” to take into account the special needs of individuals with disabilities. Similarly, Congress should give states more latitude to define “work activities” under the law – allowing qualifying recipients to receive intensive but temporary “life skills” training before going to work. In addition, Congress should remove restrictions on the extent to which vocational and/or educational training can be counted toward the federal participation rates. • In calculating time limits, Congress should require states to disregard months of assistance received by an individual identified as having significant barriers to employment during any period in which the state did not provide necessary supportive services and supports to the individual. Further, Congress should disregard the months of assistance received when the individual with a disability is unable to meet the work requirements established by the state because of the nature and/or severity of their disability. • Congress should require states to collect reliable and public data on their performance to ensure that services are provided equitably and that civil rights laws are aggressively enforced. Congress should use this data as a research tool to determine the extent to which services and supports are meeting the needs of individuals with disabilities. The reauthorization of TANF must be designed to include provisions for individuals with disabilities and develop strong supportive systems that reflect the multiplicity of barriers facing persons with disabilities. The NRA supports the President and the Congress in its intent to ensure all individuals with disabilities end their dependence on government benefits by promoting job preparation, work and self-sufficiency. ----------------------- SELF-EMPLOYMENT FOR INDIVIDUALS WITH DISABILITIES The National Rehabilitation Association recognizes the disparity between the number of disabled and non-disabled business owners, and the need for appropriate access to business capital, peer support, and assistance here in the United States. National statistics show that 12 percent of the population of people without disabilities are business owners, while less than 1 percent of the population of people with disabilities are business owners. People with disabilities have very limited access to financial assistance for business start-up financing. Surviving on a small fixed income such as Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), makes it extremely difficult to raise venture capital to leverage a loan from any commercial lending institution or the Small Business Administration. The National Rehabilitation Association also recognizes the need to create more employment opportunities for people with disabilities, which include self-employment and recommends the following: ● Fund the Disability Loan Program which already exists within the Small Business Administration ● Set standards to support self-employment outcomes under Title I of the Rehabilitation Act of 1973, as amended. ● Encourage pilot projects for people with disabilities at the National Chamber of Commerce and local business information centers. ● Encourage Federal and State governments to categorize businesses owned by individuals with disabilities as “disadvantaged” for the purpose of awarding contracts. ------------------------- TRANSPORTATION OPTIONS FOR INDIVIDUALS WITH DISABILITIES The National Rehabilitation Association (NRA) recognizes the need for personal mobility of persons with disabilities, both at work and in the community. In many instances, the current Transit System is not a realistic transportation option, especially for those in rural America. Current funding, under Title I of the Rehabilitation Act of 1973 (as amended), is insufficient to afford the cost of vehicle purchase and modification for individuals seeking a vocational goal. This severely limits the use of vocational services, access to jobs and community involvement by people with disabilities; and creates a major disincentive for return to work. The National Rehabilitation Association recommends the following: ●Develop a national “Vehicle Recycling” program, for used government vehicles no longer in service, to be made available to Vocational Rehabilitation programs, Centers for Independent Living and other Disability Service providers. ●Allow the purchase of vehicle modifications through the Medicare/Medicaid program(s), when authorized by a physician and justified by basic human necessity such as, medical visits, essential shopping, community access, and transportation to a work site and/or vocational services. Modifications should include, but not limited to: A) Mobility device lifting equipment B) Automated door openers C) Hand controls D) Specialized environmental controls ------------------------ VOCATIONAL REHABILITATION FUNDING The National Rehabilitation Association strongly recommends that the Administration and the Congress substantially increase the funding for public Vocational Rehabilitation programs that will meet these needs as we enter the 21st Century. The proposed consolidation of certain programs into Title I funding will not meet the needs of individuals with disabilities, will in some cases result in a reduction of State grant funding in certain States and will result in inconsistent services across the nation. RSA has generated data which indicates that every 1.00 spent on rehabilitation services generates 11.00 in tax payments to the government for each successful job placement service of an individuals with disabilities. Two of the major programs impacted by the Administration’s fiscal year 2003 budget proposal are Projects With Industries (PWI) and the Supported Employment (SE) program. The Projects with Industries program was added to the Rehabilitation act in 1968 as a separate budget line item outside of Title I funding. PWI’s and state VR agencies most often work in conjunction with each other and are complementary to each other. The PWI program needs to remain a Federal program. Over its 30 year history, the PWIs have developed relationships with the business community which would be difficult to maintain without substantial involvement of state or local government. Many Projects are national or multi-state in nature. While the Administration plan encourages States to continue the PWI programs, most States are financially unable to do so. Supported Employment has been funded as a separate budget line item since 1986. Separate funding for the Supported employment program has resulted in a strong emphasis on serving individuals with the most significant disabilities. The proposed changes could sharply curtail the use of Supported Employment services by a program that is already underfunded. The Supported Employment program enjoys wide support among consumer groups. The National Rehabilitation Association strongly recommends a continuation of a separate budget line items for both Projects With Industry and Supported Employment. The public Vocational Rehabilitation Program has seen a significant increase in demands placed upon the system due to new and expanded educational and 'return-to-work' type programs such as IDEA, WIA, TANF, Welfare to Work, Ticket to Work, and Assistive Technology advances. These new programs have received, and continue to receive, funding at levels disproportionate to the levels of new dollars appropriated to the Public VR Program. In fact, the Public VR Program has received no new dollars beyond the cost of living (COLA) increases for the last eight years. With the calculation of the current formula used to disperse the COLA dollars some states have actually received fewer dollars in some years than appropriated to them in the previous year. For example, in Federal Fiscal Year (FFY) 2000, five states and the District of Columbia received fewer federal funds than FFY 1999. Twenty (20)states, the District of Columbia, and Puerto Rico received federal funds that reflected less than the 1.24 percent cost of living (CPI) increase. In FFY 2001, twenty-nine (29) states, the District of Columbia, and Puerto Rico received less than the 2.6 percent cost of living (CPI) increase. To combine the Projects With Industry, and Supported Employment programs into Title I funding would further skew the distribution of Title I funds. If the Public VR Program is to meet the needs of individuals with disabilities, language in the Section 110 appropriation should clarify that each state is to receive at least the COLA (CPI) AND will be held harmless by the formula calculation. Additionally, a 5 percent increase above the COLA is imperative if the Public VR Program is to keep up with the increasing demand for its services. The National Rehabilitation Association strongly supports increased funding to meet the needs of both the Independent Living centers and service programs. In line with the devolution of authority for program policy making, the National Rehabilitation Association believes it would be best left to the States, specifically the Statewide Independent Living Council (SILC), to determine the appropriate entity to administer the Independent Living services program within an individual State. Additionally, despite increasing challenges, the rehabilitation education system has not seen an increase in funding from the 39 million level established a decade ago. These challenges include the increased demand on training resources evolving from the Comprehensive System of Personnel Development (CSPD), high turn-over rates of the current VR workforce, and increased demands to train individuals from underserved populations. With the increased demand on the Vocational Rehabilitation program as well as the requirements to upgrade staff credentials, the National Rehabilitation Association supports an increase in training funding. -------------------------- VOTING AND INDIVIDUALS WITH DISABILITIES Legislation is now being considered by the 107th Congress to modernize the voting system across the United States. However, the needs of individuals with disabilities are not addressed in the current plans. Many voters with disabilities encountered accessibility problems in attempting to cast a ballot in the November 7, 2000 election. Some individuals with disabilities were not able to cast a secret ballot because of the lack of accessible materials (survey data compiled by the National Organization on Disability). The National Rehabilitation Association urges that any legislation to modernize the nation’s voting system MUST include: ● Polling places which are fully accessible to individuals with disabilities. ● Voting methods and voting technology which are fully accessible to individuals who are visually impaired as well as individuals with other disabilities thus ensuring privacy and independence. [Status of legislation – S. 953, the Bipartisan Federal Election Reform Act of 2001 (sponsor Senator Mitch McConnell) Establishes a Commission to oversee and modernize federal elections. Including making elections sites and equipment accessible to all individuals with disabilities. Grants to assist States. Referred to Senate Committee on Rules and Administration. Other legislation had left accessibility to the local election officials. Local election officials had been less than willing to make voting sites and equipment accessible.] ------------------------- WORKERS' COMPENSATION NATIONAL MINIMUM STANDARDS The National Rehabilitation Association supports the creation of national return-to-work services standards for injured workers in workers' compensation programs and that such services should be provided by qualified personnel. Continually, studies have shown that every program dollar spent in rehabilitating injured workers results in long-term cost savings to the employer -- and the community since injured workers more quickly become tax-paying members of society. The quality of return to work services varies widely among different states. Approximately 25 percent of the states do not have any specific policy to assist injured workers in returning to work through vocational rehabilitation. Research has shown that the longer an injured worker is out of the workforce, the longer, harder, and more costly it will be before they re-enter the workforce. In some states, inadequate or nonexisting workers' compensation return-to-work policies result in employers not having services delivered to their injured workers. These services were paid for by premiums under the workers’ compensation system. When services are not provided by the workers’ compensation system, the state/federal program, and the taxpayer, are then left with the responsibility for the bill for services received. Quite often it is the injured workers and their families who suffer most since they are left without the resources to safely resume their places in the workforce. Workers’ compensation programs need to be included in an integrated system of health care and rehabilitation service delivery administered by persons trained and skilled in current vocational rehabilitation practices. END |
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