Federal

Emergency Briefing THIS AFTERNOON Regarding HR 620
1-866-439-4480
59741638#

Congress is on the verge of weakening the Americans with Disabilities Act (ADA). Tomorrow morning, lawmakers are expected to vote on HR 620 – the ADA Education and Reform Act – which removes incentives for businesses to comply with the ADA. This weakens the ADA and people with disabilities’ civil rights because it puts the weight of enforcing the ADA on their shoulders.

Today is our opportunity to stop it. We need you, and like-minded constituents, to tell Congress to vote AGAINST this cruel and unfair bill. Join today at 3:00 pm (ET) to protect the ADA by dialing 1-866-439-4480, 59741638#.

Even if you can’t call in, please take these steps immediately:

  • WHAT: Call your Member of Congress and tell them this bill weakens the rights of people you support.
  • WHEN: Today. Don’t Wait.
  • HOW: Call the Congressional switchboard at (202) 224-3121 or (202) 224-3091 TTY and tell the operators your state and zip code. They will connect you to your representative.

SUGGESTED SCRIPT
“Hello, I am a constituent who cares deeply about people with disabilities. I am calling to ask the US Representative to oppose HR 620 – the ADA Education and Reform Act – because it removes incentives for businesses to comply with the ADA. This weakens the ADA and people with disabilities’ civil rights because it puts the weight of enforcing the ADA on their shoulders. Thank you for your hard work answering the phones.”

Join us today at 3:00 pm (ET) to hear the latest on this problematic legislation, including which legislators could make the difference.

This week the House of Representatives may consider HR 620, a House bill that will weaken Title III of the Americans with Disabilities Act by removing any incentive for businesses, organizations, and anyone who provides services to the general public to make their services accessible.

HR 620 facts:

  • Removes any incentive for voluntary compliance;
  • Rewards non-compliance by allowing businesses generous additional timelines, even though the ADA’s very reasonable requirements are already over 25 years old! The ADA is already carefully crafted to take the needs of businesses into account;
  • Pretends that money damages requested from businesses are part of the ADA. Actually, this part of the ADA doesn’t even allow money damages, so changing the federal ADA will not affect any state law money damage provisions;
  • Ignores the extensive, free educational resources already available today to any business on how to comply with the ADA;
  • Ignores the effective & extensive methods already available to courts and state bar associations to deal with a very few frivolous lawsuits or unscrupulous attorneys. We should use those existing legal mechanisms when needed, rather than deny the civil rights established by the ADA that aid people with disabilities every day; and
  • Look behind the media myths: The vast majority of ADA attorneys and plaintiffs are seeking solutions to fix real denials of access. But the business community has pushed the media to portray “a few bad apples” as a landslide.

The House tentative schedule for the bill is as follows:

Tuesday –The House Rules Committee will meet today (February 13), likely in the later afternoon or evening, to determine the process for consideration of HR 620 on the House floor as well as amendments. Some amendments may try to “improve” the bill; this is not possible. The only way to “improve” a bill that eliminates civil rights is to remove all of its components. Improving a bill that will weaken or gut a set of civil rights really isn’t possible, so amendments are not a strategy. The Rules Committee will ultimately vote on how they will recommend consideration of HR 620 on the House floor, including the amount of time for debate and how or if amendments will be considered.
Wednesday — House leadership on both sides will be counting votes. The rules for considering HR 620 will be on the House floor. Leadership will likely speak to the rules that the Rules Committee has recommended. This will be a time for opposition to highlight the damage this bill will cause if passed.

Thursday — as of Monday morning, HR 620 was the only bill scheduled for a vote on Thursday; the vote will likely be an early afternoon vote. Reps. Hoyer, Scott, and Langevin will likely speak against the bill on the floor before the vote.

If the bill passes, then movement will shift to the Senate where there is not yet a companion bill introduced. We are speaking with many offices to determine what, if any, action will take place in the Senate, and will keep you informed as to that action.

Some additional talking points are as follows:

  • HR 620 removes the civil rights of all citizens with disabilities; it causes people with disabilities to wait for their right to access any service that all citizens have access to immediately. HR 620 asks people with disabilities to wait months — and in some cases years — to be able to enter a restaurant, hotel, store, theater, or to shop online. This would never be asked of any other group;
  • If businesses are concerned about bad actor lawyers, then stop the bad behavior of those lawyers — don’t eliminate the rights of over 50 million Americans because there are a handful of despicable attorneys;
  • If the civil rights of 50 million Americans can be eliminated, then the civil rights of other groups can be as well;
  • Vote “NO” on HR 620.

The bottom line is that HR 620 is being considered this week, has enormous support from over 100 Representatives, and will be voted on this week. Please contact your Congressman and ask them to vote NO. All members of the House of Representatives need to hear that there is great opposition to the bill and that it will permanently harm the civil rights of people with disabilities.

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Today, RCPA received the following alert from one of our national associations. Please contact your Congressman.

We are re-sending this action alert to remind you to ask your U.S. Representative throughout today to oppose tax reform as written – we have both call and email information below.

Very late on Friday, the Senate passed the Tax Cuts and Jobs Act, which seeks to overhaul the tax code but has provisions that could affect IDD services. Today, Monday December 4, the bill is going back to the House for a final vote, since it is a different bill than the tax bill the House voted on, before going to the President for his signature so it becomes law. After the House votes on it there will be no more opportunities to stop the bill. While ANCOR does not have a position on tax reform, we have key positions on how tax reform may impact our services. Given these principles and the passage of the bill out of the Senate, we believe it is important to speak up about the importance of Medicaid to people with I/DD before the House votes on this legislation for the final time.

Please contact your U.S. Representative TODAY to say that you cannot support the legislation in its current form because:

  • The changes proposed to the charitable tax deduction reduce the ability of nonprofit disability service providers to fund important services for people with intellectual and developmental disabilities (I/DD).
  • As the only other federal support for Medicaid long term services and supports, the House passed legislation removing the medical expense deduction could put significant strain on the Medicaid program that serves people with I/DD.
  • The changes to the unrelated business income tax (UBIT) impact the ability of nonprofit providers and their associations to maintain limited but important revenues.
  • The changes to state and local taxes would have a negative impact on certain states that obtain significant funding from these taxes for services for people with I/DD.
  • The House legislation’s elimination of tax breaks on bond financing could significantly undermine the financing for affordable housing for people with I/DD.
  • The addition of $1.5 trillion to the national debt may be used to justify future cuts in Medicaid, Medicare, or Social Security which are the main federal programs that support people with intellectual and developmental disabilities.

Click here to send an email directly to your U.S. Representative! Please do not put this off – a full House vote is expected by this evening.

Given the short turnaround time before the vote, we also highly encourage you to call your U.S. Representative. The Congressional Switchboard can help you identify your Members of Congress and will connect you directly to their office – dial it at (202) 224-3121 or (202) 224-3091 (TTY). A short script you can use is: “I am a constituent who cares deeply about issues affecting people with disabilities. If you do not already oppose the tax reform bill coming for a vote today, please do so because it has provisions that would harm services for people with disabilities. Thank you for your hard work answering the phones.”

This position is in keeping with the Board-approved ANCOR tax reform principles that we adopted at the beginning of this debate.

ANCOR Tax Reform Principles

  1. Any process that includes changes to Medicaid should be accomplished through a process that affords sufficient opportunity for legislators, advocates, and constituents to review and provide feedback on the proposal and legislative language prior to passage.
  2. Individual or corporate tax cuts or expenditures must not be paid for by cuts to Medicaid, Medicare, Social Security, or other mandatory or discretionary programs that promote independence, inclusion, and community living for people with disabilities.
  3. Tax reform should not decrease revenue to an extent that revenue is insufficient to continue to fund the programs and services and supports for people with disabilities at current levels or above.
  4. The charitable deduction should be maintained and improved for the non-profit sector which provides the majority of services and supports for people with disabilities.
  5. Unrelated business income tax should be held harmless to protect the vital role of nonprofits and associations in the disability services sector.

Thank you for your advocacy on behalf of people with disabilities. Should you have any questions or need more information, please contact Sarah Meek, Director of Legislative Affairs, or Jack Phillips, RCPA’s Director of Government Affairs.

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Today, we received the following alert from one of our national associations. Please contact both Senators Casey and Toomey.

ancor

The full Senate will vote very soon on the Tax Cuts and Jobs Act, which has already passed out of the Finance Committee, in an attempt to overhaul the federal tax code. While ANCOR does not have a position on tax reform, we have key positions on how tax reform may impact our services. Given these principles and a Senate tax reform vote as soon as next week, we believe it is important to speak up about the importance of Medicaid to people with I/DD before the Senate votes on this legislation.

Please contact your Senators TODAY and tell them that you cannot support the legislation in its current form because:

  • The changes proposed to the charitable tax deduction reduce the ability of nonprofit disability service providers to fund important services for people with intellectual and developmental disabilities (I/DD).
  • As the only other federal support for Medicaid long term services and supports, the House passed legislation removing the medical expense deduction could put significant strain on the Medicaid program that serves people with I/DD.
  • The changes to the unrelated business income tax (UBIT) impact the ability of nonprofit providers and their associations to maintain limited but important revenues.
  • The changes to state and local taxes would have a negative impact on certain states that obtain significant funding from these taxes for services for people with I/DD.
  • The House legislation’s elimination of tax breaks on bond financing could significantly undermine the financing for affordable housing for people with I/DD.
  • The addition of $1.5 trillion to the national debt may be used to justify future cuts in Medicaid, Medicare, or Social Security which are the main federal programs that support people with intellectual and developmental disabilities.

Click here to send an email directly to your Senators! Please do not put this off — a full Senate vote could happen soon after the Thanksgiving holiday.

This position is in keeping with the Board-approved ANCOR tax reform principles that we adopted at the beginning of this debate.

ANCOR Tax Reform Principles

  1. Any process that includes changes to Medicaid should be accomplished through a process that affords sufficient opportunity for legislators, advocates, and constituents to review and provide feedback on the proposal and legislative language prior to passage.
  2. Individual or corporate tax cuts or expenditures must not be paid for by cuts to Medicaid, Medicare, Social Security, or other mandatory or discretionary programs that promote independence, inclusion, and community living for people with disabilities.
  3. Tax reform should not decrease revenue to an extent that revenue is insufficient to continue to fund the programs and services and supports for people with disabilities at current levels or above.
  4. The charitable deduction should be maintained and improved for the non-profit sector which provides the majority of services and supports for people with disabilities.
  5. Unrelated business income tax should be held harmless to protect the vital role of nonprofits and associations in the disability services sector.

Thank you for your advocacy on behalf of people with disabilities. Should you have any questions or need more information, please contact Sarah Meek, ANCOR’s Director of Legislative Affairs, or Jack Phillips, RCPA’s Director of Government Affairs.

RCPA received the following email from the Senate Aging Committee in Washington, DC. Please contact both Senators Casey and Toomey and your Congressman.

“Welcome back to health care by way of a tax bill.

This afternoon both the Senate and the House added to their tax bills a provision to repeal a key component of the Patient Protection and Affordable Care Act, the individual mandate to obtain health insurance. Repealing this provision would have significant negative effects for people with disabilities, families of children with disabilities, and those who are aging.

  • Repealing the individual mandate will mean 13.8 million people will lose health care coverage (according to an analysis by the Congressional Budget Office); hundreds of thousands of those individuals have disabilities).
  • The repeal of the individual mandate will increase health insurance premiums for those purchasing coverage on the exchange by at least 10% per year for the unforeseeable future (also according to an analysis by the Congressional Budget Office); these premium increases will occur in addition to the increases that are occurring because the executive branch has decided to stop supporting cost sharing reduction (CSR) payments that have driven premiums up by an average of over 20% this year.
  • The repeal of the individual mandate will save approximately $330 billion over ten years that will go toward paying for a cut in corporate taxes and a cut to the tax rate for the most wealthy Americans (according to the CBO).

This new, last minute, major addition to the tax bills will have enormous impact on those with disabilities. In combination with the budget that passed three weeks ago and outlines over $1 trillion in cuts to Medicaid and over $400 billion in cuts to Medicare, the proposed tax cuts and repeal of key provisions of the ACA will increase demand for Medicaid, decrease the funds available for home and community-based services and supports, and reduce the amount of revenue available to states to pay and support Medicaid.

While the tax bill does not directly cut Medicaid, the actions it takes will have the same or even worse effect on Medicaid and other services and supports for people with disabilities. If the House tax bill were to pass:

  • Deductions for medical expenses could not be used to decrease your taxes;
  • It would eliminate a $2,400 tax credit businesses could get when hiring someone with a disability;
  • It would eliminate a $5,000 tax credit for businesses that make their businesses accessible to people with disabilities;
  • It would eliminate the incentive to contribute to nonprofit agencies that often provide support for people with disabilities and their families; and
  • It would remove a tax credit for companies to develop and manufacture orphan drugs.

The assault on people with disabilities and their families is continuing, this time through a tax bill instead of through a health bill. And this is happening quickly with very little coverage. The Senate Finance Committee will likely vote on this bill Thursday or Friday of THIS week.

You can help by:

  • Contacting your Senators and Representatives and telling them the tax bills being considered are an attack on people with disabilities; and
  • Share this information with friends and family.

Thank you for your continued advocacy. Thank you for working to ensure dignity, independence, and economic sufficiency for people with disabilities.”

Questions, contact Jack Phillips, RCPA Director, Government Affairs.

Overdose deaths from heroin and prescription drug abuse pose a public health crisis. In 2016, 4,642 drug-related overdose deaths were reported in Pennsylvania – an increase of 37 percent from 2015 – and every day 13 Pennsylvanians die of a drug overdose.

Yesterday, President Trump officially declared the opioid crisis a public health emergency. This declaration will allow states to redirect federal funds to the opioid crisis. However, it provides no new federal funding. RCPA was pleased to learn that President Trump proposed relaxing the Institutions of Mental Diseases (IMD) exclusion for inpatient substance use disorder treatment. The IMD exclusion, which bars Medicaid payment for services delivered in certain facilities with 16 or more beds, has been a major barrier against patients accessing treatment. Pennsylvania officials have stated on numerous occasions that they clearly understand the severity of the IMD exclusion and are working on numerous ways to resolve the problem. Trump’s announcement will likely make that easier to accomplish. This announcement may also allow for expanded access to telemedicine, including remote prescribing for medication-assisted treatment.

Governor Wolf stated that “President Trump’s decision to declare the opioid epidemic a public health emergency is an important step, but this is only the beginning.” He added that “Without a commitment to fund the crisis in specific ways, it’s difficult to say how much this declaration can do. While an awareness of this critical health emergency is important, an increased availability of grant money would help. Every effort to fund treatment, including medication-assisted treatment options, should be explored.”

Pennsylvania has numerous efforts underway to respond to this crisis. Governor Tom Wolf announced at the end of September that Pennsylvania, through its Department of Drug and Alcohol Programs (DDAP), had been awarded a $5.7 million Medication-Assisted Treatment Prescription Drug and Opioid Addiction (MAT-PDOA) grant from the US Department of Health and Human Services, to help in the state’s ongoing fight against the opioid epidemic. The US Department of Health and Human Services also awarded Pennsylvania a $26.5 million grant, funded by the 21st Century Cures Act, signed into law by President Obama in December 2016. Pennsylvania will soon award four $1 million federal PA Coordinated MAT grants to providers in Pennsylvania, via the 21st Century CURES grant funding. Over the next two years, the grant is intended to help combat the heroin and opioid epidemic. In addition, 45 Centers of Excellence (COE) have been implemented to better initiate people into — and keep them engaged in — treatment. DDAP is also working to expand the “warm handoff” process to get overdose survivors directly into treatment. DDAP has implemented a hotline to direct people needing help with treatment (800-662-HELP).

RCPA members have welcomed these initiatives, but members continue to emphasize the need for more funding for basic services. Many rates provided do not even cover the full cost of treatment; the drug and alcohol program has been chronically underfunded for many years. Increased capacity and improved access must be fully funded and that will take new and additional resources. Persons and families struggling for help with an opioid addiction should not have to wait for beds/placements — it is a matter of life or death.

Contact Lynn Cooper, RCPA Director, Drug & Alcohol Division, with any questions.

On October 26, 2017, the Energy & Commerce Committee and the Ways and Means Committee announced in a press release that they have come to a policy agreement on a permanent repeal of the Medicare therapy caps. The policy/discussion draft will repeal the therapy caps, continue to require an appropriate modifier is included on claims submitted over the new threshold (indicating the services are medically necessary), and continue targeted medical review of claims established by the Medicare Access and CHIP Reauthorization Act (MACRA).

Background:
In 2006, Congress created an exceptions process allowing patients to exceed the cap based on medical necessity. The cap was addressed most recently in 2015 with MACRA (H.R. 2), becoming law. A provision in H.R. 2 established targeted medical review of therapy caps and extended the therapy cap exceptions process until January 1, 2018.

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The means by which Senate Republicans can pass an Affordable Care Act (ACA) repeal/replace bill by a simple majority budget process called reconciliation (and thus not requiring Democratic support of any kind) ends next week, at the end of September.

The Graham/Cassidy bill is now presenting a major threat to Medicaid – it replicates cuts presented in previous health proposals (using exact language from the Better Care Reconciliation Act – BCRA). According to earlier Congressional Budget Office (CBO) estimates, it will cut Medicaid (outside of expansion) by $175 billion between 2020–2026, and $39 billion will be cut from the Medicaid program in 2026 alone.

RCPA requests members to contact Senators Casey and Toomey, and ask them to OPPOSE the Graham/Cassidy bill. For your convenience, the following materials will give you valuable information and talking points when speaking with staff or the Senators.

Questions, contact Jack Phillips, RCPA Director, Government Affairs.

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Please join Sen. Bob Casey (PA) as he addresses the Graham-Cassidy proposal and the effects on Medicaid, adults with disabilities, children with complex health needs, schools, veterans, and those who are aging. Details for joining below:

What: Conference call with Sen. Bob Casey
When: Friday, September 22, 5:45 pm–6:15 pm EDT
Call in number: 866-317-5076, no PIN or ID necessary
No RSVP necessary

Questions, contact Jack Phillips, RCPA Director, Government Affairs

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ALERT – Act Now to Stop Irreparable Medicaid Cuts!
Latest Available data on Graham/Cassidy

The next few days are critical!
Call Congress at (202) 224 3121 and
click here to send your Senators an email to VOTE NO.

The process by which Senate Republicans can pass an Affordable Care Act (ACA) repeal/replace bill by a simple majority budget process called reconciliation (and thus not requiring Democratic support of any kind) ends next week, at the end of September.

The Graham/Cassidy bill is now presenting a major threat to Medicaid – it replicates cuts presented in previous health proposals (using exact language from the Better Care Reconciliation Act – BCRA). According to earlier Congressional Budget Office (CBO) estimates, it will cut Medicaid (outside of expansion) by $175 billion between 2020-2026, and $39 billion will be cut from the Medicaid program in 2026 alone.

The situation has gotten worse. Last night, Chairman Alexander (R-TN) of the Senate HELP Committee who was leading bipartisan ACA fix efforts announced that the bipartisan deal is dead. That leaves the door wide open for Graham/Cassidy passage. Republican Senators are being told that the bill will benefit their state – that is false. This is a bill that seeks to save billions of federal dollars, not make policy improvements to health care programs.

The ACA will be replaced by block grants with likely less funding to states than they currently receive. and all of that money stops flowing completely to states in 10 years. The Medicaid program will be cut significantly and states will be expected to either pick up the bill or make tough decisions about whose lives are most at stake.

So here’s the timeline:

There are two Jewish holidays in the next two weeks that shorten the Senate session calendar. Today, Senators leave to observe Rosh Hashanah and will return Monday. They will have to pass a bill by Wednesday or Thursday because Yom Kippur (also observed by the Senate) begins at sundown next Thursday.

We will soon see a new Congressional Budget Office summary on the impact of Graham/Cassidy, and we expect the bill to be pushed hard next week to get to passage. We need three Republican Senators to oppose the bill in order for it to fail. Key Senators that could stop the bill are the same champions that ANCOR has awarded Congressional Leadership Awards to this year for defending our programs – Senator McCain (R-AZ), Senator Collins (R-ME), and Senator Murkowski (R-AK). Please make sure that if you are a constituent, or have connections in their states, that they hear from you!

IF YOU LIVE OR HAVE FRIENDS, FAMILY, OR COLLEAGUES IN STATES WITH REPUBLICAN SENATORS THEY MUST HEAR FROM US THAT THE GRAHAM/CASSIDY BILL WILL CREATE IRREPARABLE HARM TO PROGRAMS THAT PROTECT PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES!

THE NUMBERS ARE CLEAR THAT THIS IS A BAD DEAL FOR STATES! MAKE SURE YOUR REPUBLICAN REPRESENTATIVES IN THE HOUSE ARE RECEIVING THE SAME MESSAGE!

Capitol  Switchboard: (202) 224-3121

Graham/Cassidy Text

  • Medicaid per capita cap section begins Section 124, page 65
  • Provider tax reduction is Section 123, page 64
  • Penalization to states that overspend, page 66
  • Per capita formula base period, page 68
  • Per capita formula inflation rate (CPI-M+1% until 2026 then CPI-M), page 76

Limited HCBS demo (we have intel this is for fear that per capita caps will end some state HCBS programs and need demo money to survive), page 96