[Hpn] National Council on Disability Speaks Out on Long-Term Care for People with Disabilities

Thomas Cagle nh-adapt@juno.com
Mon, 28 Jul 2003 20:31:08 -0400

From: "Stephanie Thomas" <adapt@adapt.org>

NCD, the National Council on Disabilities, should not be releasing
on long term care before they hold the hearings on MiCASSA and money
following the person and Olmstead that they promised years ago they would
hold.  It is time to call on NCD to get off the dime and hold these
hearings.  Please write to Lex Frieden, Chairperson of the National
on Disabilities (NCD) lfrieden@bcm.tmc.edu and Ethel D. Briggs, Executive
Director.  Tell them we have waited long enough,  you want NCD to live up
their commitment and hold the hearings!
----- Original Message -----
From: "Mark Quigley" <mquigley@ncd.gov>
To: <bulletin@list.ncd.gov>
Sent: Monday, July 28, 2003 6:09 AM
Subject: National Council on Disability Speaks Out on Long-Term Care for
People with Disabilities

> July 28, 2003
> Contact: Mark S. Quigley
> 202-272-2004
> National Council on Disability Speaks Out on Long-Term Care for People
with Disabilities
> WASHINGTON-The National Council on Disability (NCD) today released an
excerpt from its annual report, National Disability Policy: A Progress
which concentrates on the crisis in long-term care facing our nation as
population with disabilities grows and converges with the rapidly
demographic composed of older persons.
> "> Many challenges remain for our citizens who are living with
disabilities and who wish to be more independent, more productive, and
engaged in their families and communities,> ">  said Lex Frieden, NCD
> In 2002 the Congressional Budget Office (CBO) determined that for the
fiscal year 2000 the federal government spent $615 billion on persons
the age of 65 and $148 billion on children. These costs, along with those
providing services and supports for individuals with disabilities will
continue to grow, especially as the baby boomer generation ages.
Furthermore, recent declines in middle class wealth will result in more
boomers depending
> on public sector programs, placing an even greater demand on the long-
term care systems.
> In the face of this crisis, society has an ever-growing obligation to
the available resources wisely, and NCD reports the expense of supports
be far less in the individual's own home and community than in nursing
and other institutional settings. In addition to the economics of this
issue, the Supreme Court has clearly reinforced the integration mandate
its Olmstead decision, and the President's New Freedom Initiative is
designed to effect changes at the federal level to advance the Olmstead
principles. These mandates lead to the compelling need to divert the
estimated 73 percent of federal long-term care funds currently targeted
> institutional settings into community-based supports and services.
> The NCD report describes a variety of cross-programmatic, multi-agency
inter-governmental coordination issues that must be confronted if the
of minimizing unnecessary and costly institutionalization is to be
pointing to the "unprecedented and sometimes baffling complexity" changes
required of state and federal agencies to address resource allocation,
public private partnerships, coordination, and structural and federalism
issues of Olmstead implementation.
> With growing fiscal crises, new concerns arose in 2002 about the
sustainability of progress in Olmstead implementation. NCD highlights the
problems and recommended solutions.
> Federal Coordination - As federal agencies attempt the requisite
coordination to comply with the law's integration mandate, NCD emphasizes
the enormous challenge facing the Federal Government to achieve seamless,
coordinated interagency action. NCD recommends that the Office of
and Budget (OMB) and the Congressional Budget Office (CBO) work
> together to develop unified budget models that link the relevant cross
agency program activities and budget requests of the various agencies.
would allow effective budgeting, and important tracking and reporting for
the multi-agency policy initiatives. Towards this end, the NCD report
> commends the Administration for establishing the Health and Human
(HHS) Office of Disability.
> This new office should contribute considerably to coordination within
and could serve to develop linkages with other agencies. NCD also
the Administration for the Independence Plus waiver programs within
Medicaid, which reflect important early steps towards infusing the
ingredient of consumer direction in community-based services.
if > Olmstead is to become a reality in the lives of individuals with
disabilities, federal leaders must ensure that all aspects of an
individual's life are addressed, including transportation and housing.
> Public Private Partnerships - A full fledged effort to fulfill the
of Olmstead and Title II of the ADA depends on both private and public
resources. Tax laws may well play a vital role in ensuring access to
affordable long-term care insurance, bringing the private sector into the
efforts to support individuals in their homes and communities. NCD
recommends that Congress invite recommendations on coverage packages with
incentives to generate such public private partnerships. In creating new
options, NCD points to the importance of coordinating new resources with
current eligibility requirements for Medicaid/SSI, to ensure that access
these new resources do not inadvertently limit or eliminate Medicaid
eligibility for the individuals for whom the new initiatives are intended
provide expanded, rather than limited, opportunities.
> State Initiatives - The coordination issues required for Olmstead
implementation at the federal level are mirrored at the state level, but
NCD report reflects the grim news that at the end of November 2002 fewer
than half the states had Olmstead implementation plans in effect. With
prospect of huge cuts in Medicaid to address many state budget deficits,
Medicaid waiver programs are especially vulnerable. NCD suggests that
leaders within HHS and Centers for Medicare and Medicaid Services (CMS)
should identify and encourage states to adopt reductions in Medicaid that
are least destructive to Olmstead implementation. NCD also suggests that
should provide additional technical assistance to states on Title II of
ADA and highlight
> exemplary state plans that avoid discrimination against individuals
disabilities. In order to engender the nationwide galvanized responses
needed to give meaning to the promise of Olmstead, NCD recommends that
Administration conduct and publish a comprehensive audit of all
Olmstead implementation activities, highlighting successful state
in full implementation of the integration mandate.
> While this NCD annual report to Congress was under review, the General
Accounting Office (GAO) issued a report on Long-Term Care Services and
recommended that the administrator for CMS strengthen federal oversight
the growing home and community-based settings (HCBS) waiver programs. GAO
was asked to review trends in states' use of HCBS waivers, state quality
assurance approaches and the adequacy of federal oversight of state
The GAO report helped to identify the respective state and federal roles
quality assurance and the potential need for additional federal oversight
resources. GAO found that in the absence of specific federal requirements
for HCBS quality assurance systems, states provide limited information to
CMS on how they assure quality of care in their waiver programs for the
elderly. More than 70 percent of the waivers for the elderly that GAO
reviewed documented one or more quality-of-care problems. According to
GAO report, as of June 2002, almost one-fifth of waivers in place for
years or more had either never been reviewed or had been renewed without
> Regional office personnel explained that limited staff resources and
travel funds often impede the timing and scope of reviews. GAO
that the administrator of CMS take steps to: (a) better ensure that state
quality assurance efforts are adequate to protect the health and welfare
HCBS waiver beneficiaries, and (b) strengthen federal oversight of the
growing HCBS programs. NCD will address this GAO report and follow-up CMS
activity in next year> '> s NCD annual report to Congress covering the
period December 2002 to December 2003.>
> For more information, contact Mark Quigley or Martin Gould at
> # # #
> Mark S. Quigley
> Director of Communications
> National Council on Disability
> 1331 F Street, NW, Suite 850
> Washington, DC  20004
> 202-272-2004
> 202-272-2022 fax
> mquigley@ncd.gov
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