October 2011

NACBHDD Fall Board Meeting

Dr. Terry Ryan, Superintendent of the Cuyahoga County Board of Developmental Disabilities and Dan Ohler, Executive Director of the Ohio Association of County Boards Serving People with Developmental Disabilities, attended the Fall Board Meeting of the National Association of County Behavioral Health & Developmental Disability Directors (NACBHDD) in Albany, New York.  The meeting was held in conjunction with the fall conference of the New York State Local Mental Hygiene Directors Association. In New York, the 57 county agencies coordinate services for individuals with mental health, substance abuse & developmental disabilities.  Topics of discussion included HR 3086, a federal bill that would phase out special wage certificates under the Fair Labor Standards Act of 1938 under which individuals with disabilities may be employed at subminimum wage.  A Board conversation with Lynnae Ruttledge, Administrator of the Rehabilitation Services Administration, indicated the President is not in support of the bill in that it would, in effect, prevent the reauthorization of the Rehabilitation Act.  As a result, the NACBHDD Board did not adopt a formal position, but all members present were committed to contacting their legislators about the bill.  In addition to typical Board business, including discussion of finance reports and adoption of a 2012 budget, the Board endorsed the following slate of officers for 2012-13: Patrick Fleming (Utah), President; Patricia Ryan (California), Vice President; Mary Ann Bergeron (Virginia), Treasurer; and, Larry Carroll (Texas), Secretary.  Ohio's Dan Ohler remains an officer as the Immediate Past President. Board members also discussed the issue of the Centers for Medicare & Medicaid Services (CMS) reconsidering their position on providing federal financial participation for room and board under home & community based waivers.  This component was seen as a key factor in more successful efforts to move individuals from facility-based settings to waivers.  Another Olmstead issue discussed was supported employment as a waiver service and the need to create appropriate incentives in quality and payment rates. Representatives from states present discussed challenges with implementation of the Patient Protection & Affordable Care Act and mounting pressure to develop alternative services for children with autism. Managed care was also a point of discussion.  In New York, Medicaid managed care will include individuals with developmental disabilities.  On the contrary, authorities in Texas commissioned a report by Health Management Associates, a private consulting firm, who concluded that managed care for individuals with developmental disabilities was not cost effective.  

Super-Committee Deadline Nears

The Budget Deficit Super-Committee is approaching the November 23rd deadline with a compromise resolution looking very unlikely.  Failure to strike a deal would result in budget freezes across all lines, including Medicaid.  It is not known if this would result in action by CMS that would prevent approval of new waivers, such as Ohio’s SELF Waiver.

Defining an Essential Health Benefit Package for the ACA

While requiring health plans to offer a package of essential health benefits (EHB), the Affordable Care Act (ACA) left the task of defining those benefits to the U.S. Department of Health & Human Services (HHS). The first step toward that definition was released on October 7^th in an HHS commissioned report by the Institute of Medicine (IOM), Essential Health Benefits: Balancing Coverage and Costs.  Rather than spell out a list of services to cover, an activity almost guaranteed to pit provider against provider and interest group against interest group, the IOM advisory committee recommended the EHB package be built on mid-tier health plans currently offered by small employers, expanded to include certain services such as mental health, and squeezed into a real-world budget. The report specifically recommends that while the needs of the most vulnerable should be considered along with medical effectiveness, safety and relative value, the cost of each benefit should be weighed carefully before including it in the EHB.

Community Living Assistance Service and Supports Act

The HHS reports that it has stopped working on the long-term care component of the ACA known as the Community Living Assistance Service and Supports (CLASS) Act because it cannot yet determine how best to ensure the program’s economic solvency. The CLASS Act was intended to serve as a self-sustaining insurance plan for working adults. By paying a voluntary premium while working, they could collect a modest daily cash benefit to help pay for home or nursing home services if they became disabled in later life. The fate of the program remains unknown, but is thought by many disability agencies as a vital program to assure Olmstead compliance.

No Child Left Behind Reform

The Senate Health, Education, Labor, and Pensions (HELP) Committee announced that they would push an overhaul of the No Child Left Behind bill that would hand more control of education over to the states. Changes to proficiency standards are to be considered as well.  Given the bi-partisan agreement of the report, there is a better than average chance the issue will move through Congress.

From First Use to Treatment Admission: 15.6 Years