October 6, 2005

NYSRA ReSource

For Perspective and Analysis

The Source of information for providers of community-based services for people of differing abilities.

Annual Conference a Great Success!

This issue of The ReSource has to be kicked off with a sincere thank-you to all of our NYSRA members and others who made last week’s Leadership Training Summit a rousing success.

We on the NYSRA staff are very gratified by the turnout at this year’s conference. Although all the numbers are still being finalized, more than 500 people registered for the conference and virtually every registrant attended.

We couldn’t be more pleased.

It is our hope that all who attended received value from the more than 50 seminars, workshop sessions and panel discussions, as well as listening to the thoughts of our keynote speaker, Urban Miyares, of San Diego and special sessions headed by Peter Brinckerhoff, Connie Farrell, and others.

Although we originally were disappointed that Commissioner Thomas Maul of the state Office of Mental Retardation and Developmental Disabilities would be unable to join us for our Wednesday morning commissioner panel, our disappointment turned to gratitude when the commissioner agreed to speak to our Annual Awards Dinner. Special thanks go to Commissioner Maul for his time and his thoughts.

It was a great privilege to present NYSRA’s awards to our very deserving recipients: The Adrian Levy Award to Mark Foley, of Community Services for the Developmentally Disabled in Buffalo; our Lifetime Achievement Award to Ron House, Ph.D.; and our State Official of the Award to Joe Capobianco, of the Jobs Program at the state Office of Temporary & Disability Assistance. An extra nod of thanks goes to Allen Speiser, Ph.D., for his participation in presenting the award to Dr. House.

This Leadership Training Summit was a terrific opportunity for me to meet some of those folks I hadn’t yet met and to get better acquainted with those I already have been privileged to speak with. For me, this made the conference and its outstanding attendance even more valuable. There are never enough opportunities to speak with and exchange ideas among our membership, but this annual event affords the opportunity to gather everyone for just those types of exchanges.

It meant a great deal to me and to all of the NYSRA staff to do just that.

None of the successes of this conference would have been possible without the hard work of many, many people. Mark Foley most effectively guided the Conference Planning Committee in working to put things together. Larry Barker, CEO, and his staff at NYSID did a tremendous job in handling registrations and other logistics, as well as arranging for a visit from Bob Chamberlin, CEO of NISH. Conference consultant Jackie Negri of Negri Management took care of issues ranging from major concerns to small details. And, of course, the NYSRA Albany staff – Gayle Farman, Pat Dowse, Jennifer Ivery, and Stacie Muscolino — could not have done a better job of preparing for and conducting this major undertaking.

I thank them all for their help in a successful event.

All of us thank all of you who attended and provided us with such a satisfying and informative three days. We hope you, too, left satisfied and informed.

All of us look forward to seeing you again very soon.

-Jeff Wise, NYSRA President and CEO

News from State Agencies/NYSRA Advocacy

Alliance for Full Participation Founding Members

Release Recommendations for Long-Term Medicaid Reform

Calling it a “crucial lifeline for more than 1.8 million individuals of all ages with intellectual and other developmental disabilities,” the Alliance for Full Participation (AFP) has released its much-anticipated recommendations for long-term reform of Medicaid, a joint federal and state program for America’s neediest citizens. The announcement was made at AFP’s “Many Voices, One Vision” national Summit in Washington, D.C. two weeks ago. The Summit audience included over 2,000 people from all branches of the developmental disabilities community, including self advocates, family members, researchers, service providers and direct support professionals. Members of NYSRA were in attendance as well including Jim Bellanca, NYSRA Board member and DD Division Chair. NYSRA has received and has available the specific comments made by self-advocates about employment, transportation and housing. In this article is a summary for your briefing. You are encouraged to attend the DD Division meeting scheduled for November 1, 2005 where these and other important issues will be on the agenda to discuss and plan for NYSRA’s legislative and budget policy agenda.

In the area of Employment self advocates feel that:

• There needs to be more “customized” employment options—There needs to be more variety and availability / options for placement in “non-traditional” job settings and carve outs (e.g. employment in corrections, construction, landscaping / lawn maintenance etc.)

• Explore disability awareness training that focuses on H.R. personnel and those hiring people with disabilities to work as well as training that focuses on sensitizing co-workers. The disability awareness training should be targeted toward colleges, (people coming up through the ranks—e.g. future employers, co-workers)

• For individuals in group home settings, there are no trained personnel (e.g. job coaches and/or counselors) to talk about employment options with. Group home settings need trained personnel that can assess an individual’s readiness for employment as well as what their skill sets are for employment.

• There is a need for more trained and experienced job coaches. Job coaches need to be aware of available employment options as well as know how to access and gain entry to these job options. Some professionals do not recognize the range of employment options that may be available for people with disabilities.

• Many job coaches are in-experienced and lack training in areas such as individual assessment, identifying potential employment options, etc. Job coaches may not be aware of Supported Employment Services and /or may not recognize the need for ongoing support services (transportation, assistive technology, specialized job training, and individually tailored supervision) in order for a person to perform their job.

Approved Providers of Service

The following is a list of OMRDD Approved Providers of Services, as of September 30, that contract with voluntary agencies or OMRDD to provide either transportation or staffing services.

Identifying Number APPROVED PROVIDER NAME

10000 TemPositions Health Care Inc

10001 Rides Unlimited

10002 Restore OT/PT

10003 Superior Clinical Care

10004 A&B Van Service

10005 Tri-County Ambulette Svc., Inc.

10006 Christian Ambulette, Inc.

10007 Arm (aka Ozram) Transportation, Inc.

10008 Brightstar Transportation Svc., Inc.

10009 Professional Transportation Corp.

10010 Adam’s Apple Services, Inc.

10011 Health Care Services of New York

10012 Domino Tansport Service, Inc.

10013 Ross/InHealth Staffing Systems

10014 MYTRANS Corp

10015 B. H. Associates, Inc.

10016 Beacon Therapy Services

10017 Promed Personnel

10018 CLC Transportation Inc.

10019 Empire State Ambulance Corp.

10020 CareStaf of Albany

10021 Aides at Home, Inc.

10022 WILLCARE

10023 Crickett Staffing Services, Inc.

10024 Acme Bus Company

10025 Access Staffing. LLC

10026 Select Temps, Inc.

10027 Select Healthcare, Inc.

10028 Manpower

10029 Hope Ambulette, Inc.

10030 Hamilton Brooks of NY, LLC

10031 Bestcare, Inc.

10032 Quality of Life Adult Services, Inc.

10033 Coastline d/b/a L&L Transport

10034 Mass Ambulette Transporters, Inc.

10035 Superior Ambulette, Inc.

10036 Yorktown Taxi Service, Inc.

10037 Outstanding Transport, Inc.

10038 Plaza Ambulette Service

NEW – Ticket to Work Proposed Regulations

The Social Security Administration has published today their proposed regulations for the Ticket to Work program. They can be found on the NYSRA website at www.nyrehab.org in .pdf form. You can also find them under SSA in the Federal Register dated October 3, 2005.

A quick initial look has been provided by I-NABIR and it indicates the following proposed improvements:

• Beneficiaries will no longer be required to use their ticket when accessing VR services. They may use VR services under the cost reimbursement system, and then use their Ticket subsequently. An EN who then provides the on-going support and follow along services would receive the outcome payments and not the milestones.

• The payment system has been improved to increase the amount of money, particularly for SSI, and the amount of the milestones. It is proposed that payments for SSDI Ticket holders be accelerated to be paid out in 36 months while SSI who may need more on going support will remain at 60 months. The effect of this is to “equalize” the payment amount between SSI and SSDI.

• It is proposed to allow those designated MIE (medical improvement expected) now be allowed to use a ticket.

At first glance it looks like some significant improvements have been proposed. When NYSRA receives a more detailed analysis additional information will be shared with the Vocational Division Employment Options Committee for further discussion with members.

State Workforce Investment Act Strategic Plans (2005 - 2007) Now Available for Access

The U.S. Department of Labor (DOL) Employment & Training Administration (ETA) has posted State Plans authorized under the Workforce Investment Act.

ETA has provided map-and menu-driven links to PDF and web-based versions of the State Workforce Investment Act Strategic Plans (2005 - 2007).

www.doleta.gov/usworkforce/wia/planstatus.cfm

Federal Update

Update on Grassley-Baucus Medicaid Bill

Senators on September 26 blocked a vote on a bipartisan bill (S 1716) that would provide federally funded Medicaid coverage to Hurricane Katrina survivors. Senate Finance Committee Chair Chuck Grassley (R-Iowa) and ranking member Sen. Max Baucus (D-Mont.) on Sept. 14 introduced the bill, which would have the federal government for five months pay 100% of Medicaid costs for survivors from Louisiana, Mississippi and parts of Alabama who have relocated to other states, with the option of extending the coverage for an additional five months. The federal government also would pay 100% of Medicaid costs through the end of 2006 for all beneficiaries in Louisiana, Mississippi and counties in Alabama that have been designated as disaster areas. Some Senators are concerned about the bill’s cost — estimated to be $8.7 billion over five years.

HHS Secretary Mike Leavitt addressed a letter to Senate Majority Leader Bill Frist (R-Tenn.) and Senate Minority Leader Harry Reid (D-Nev.) saying the bill should not be approved. Leavitt in his letter said the Bush administration’s strategy of negotiating waivers with state Medicaid programs “largely precludes the need for the activities” the bill proposes. Leavitt wrote that the bill would require “a new Medicaid entitlement for Katrina survivors, regardless of whether that will work best for those survivors or the states,” adding, “This new program is unnecessary.”

Grassley and Baucus, replying to Leavitt’s letter, wrote that Medicaid waivers do not provide the same eligibility that was provided to New York City residents following the Sept. 11, 2001, attacks, and that it is “fairly obvious” that HHS does not have the statutory authority to provide funds for uncompensated care. In addition, they stated that the waiver process would result in states most affected by the hurricane being responsible for covering Medicaid costs, and many of them would have difficulty paying. Grassley and Baucus said they would redouble their efforts to pass their bill.

Senate Health, Education, Labor and Pensions Committee Chair Michael Enzi (R-Wyo.) and ranking member Sen. Edward Kennedy (D-Mass.) also unveiled bipartisan legislation that would federally fund hurricane survivors’ private health insurance premiums for three months. The bill, which Kennedy’s office said would cost $1 billion, also would locate and track survivors with disabilities and recruit additional health care workers to the impacted region. The bill also would increase the number of sites where survivors can receive health care and would direct additional mental health care funding to the region. Under the measure, health insurers would be prevented from raising rates or canceling survivors’ policies for three months. In addition, the bill would authorize spending for additional inspectors from the Occupational Safety and Health Administration to monitor the safety of emergency and clean-up workers in the region. The measure also includes initiatives to “cut red tape” that might slow federal agency relief efforts during public health emergencies by giving the federal government additional authority following natural disasters.

Government Study Finds More
Oversight Needed on TANF Work Participation

The Government Accountability Office (GAO) released its latest study on the nation’s welfare-to-work system, otherwise known as Temporary Assistance for Needy Families (TANF). This study focused on the work requirements mandated under the law, and found that more oversight was needed from state-to-state.

HIGHLIGHTS FROM GAO-05-821:

Why GAO Did This Study: The debate over reauthorization of the Temporary Assistance for Needy Families (TANF) block grant has focused on work requirements and brought attention to the measure of TANF work participation. The measure is used to assess states’ performance and determine whether a state is subject to penalty for not meeting TANF work requirements. The 2003 work participation rates ranged from 9 to 88 percent for the 50 states based on data they submit to the U.S. Department of Health and Human Services (HHS). To help Congress understand these rates, GAO looked at (1) how selected states are defining the categories of work activities, (2) whether selected states have implemented internal controls over the work participation data, and (3) what guidance and oversight HHS has provided states.

What GAO Found: Differences in how states define the 12 categories of work that count toward meeting TANF work participation requirements have resulted in some states counting activities that other states do not count and, therefore, in an inconsistent measurement of work participation across states. For example, 5 of the 10 states we reviewed considered caring for a disabled household or family member to count toward the federal work participation requirement, while 5 did not consider hours spent in this activity to be countable (see table below). We also found that some states made significant changes in their definitions of the categories of work. As a result, the work participation rates for these states cannot be compared from year to year.

Some of the states in our review have implemented internal controls to help report work participation hours in accordance with HHS guidance, while other states lack such internal controls. Some states have not issued guidance on how to verify that reported hours were actually worked, nor do they monitor data reported by their staff to help ensure that hours are reported correctly. In contrast, a few states have systematic approaches for verifying that hours reported were worked. HHS has provided limited oversight and guidance to states on appropriately defining work activities and reporting hours of work participation.

According to HHS officials, HHS has the authority to regulate states’ definitions of work activities. However, to promote state flexibility, HHS chose not to issue regulations for this purpose. Further, HHS’s guidance lacks specific criteria for determining the appropriate hours to report. Given that HHS has not exercised oversight of states’ definitions and internal controls, states are making different decisions about what to measure. Therefore, there is no standard basis for interpreting states’ rates, and the rates cannot effectively be used to assess and compare states’ performance.

What GAO Recommends: GAO recommends that HHS enact regulations to provide oversight of states’ definitions and more guidance on counting hours of work activities and that HHS identify cost-effective internal control practices and disseminate information on these practices to states. In commenting on our draft report, HHS said it would consider making the recommended revisions in its regulations after TANF reauthorization and is exploring options for implementing the recommendation on internal controls.

Dayhabilitation & Prevocational Rate Development for 2006

NYSRA met by phone with Joanne Howard to discuss how the rates for group day habilitation and prevocational services were to be developed. The following is the information we have to share.

PROCESS AND EXAMPLE:

OMRDD knows the rates your agency has now. It knows the number of units that coincide with those rates.

Then every agency was asked to complete and submit a form identifying future unit needs by person using the definitions by OMRDD as follows:

• Full unit – greater than 4 hours of service

• Half unit – greater than 2 hours but less than four

• No billable unit – less than 2 hours

Example to define how this will work:

On the survey for future use your agency said: 300 people are considered needing a full unit – greater than 4 hours of service; 200 people are considered needing an half unit – greater than 2 hours but less than four; 100 people are considered not able to a “billable” unit – less than 2 hours

So what OMRDD is proposing is that:

Top number: Rate now x the Units now

Bottom number: 100% Full + 50% Half and 0% None

OR using the numbers from the example

Rate now x the Units now New rate for Day Hab or Prevoc

300 + 100

Note : OMRDD will use a different process for Individual Day Hab calculations. The key in this example is that OMRDD is creating better rates by NOT factoring in the non-billable (100 people in our example) thereby in essence creating a “paid” vacancy factor. OMRDD does see the need to look at agencies that have outliers in this category and will conduct desk audits to be certain of what they are funding.

Vermont Begins Medicaid Fund Caps

A growing inability to pay ever-increasing Medicaid costs has forced Vermont into an innovative deal with the federal government that critics fear could jeopardize a safety net dating back to the Great Society.

Gov. James Douglas says he’s confident his Global Commitment to Health, in which the state has agreed to accept caps to federal Medicaid funding over the next five years, will give state officials unprecedented flexibility to manage the health insurance program for the poor and begin to control costs. States across the country, as well as officials in the Bush administration and a congressional commission, are watching Vermont’s approach because it could provide a road map for reforming an entitlement program whose costs have risen beyond most governments’ ability to pay.

There is irony in Vermont, a solidly Democratic state, pursuing a federal funding cap. Vermont was one of the first states to expand Medicaid ambitiously beyond its historic use as a health insurance program for the poor and disabled. Over the past decade, the state has transformed Medicaid into a program in which even middle class families can get their insurance, especially for children. Now, roughly one of every four Vermonters is covered.

But soaring medical inflation, particularly among the traditional users of Medicaid, has forced even this bluest of states to try some fresh thinking.

Both Congress and the Bush administration also have been looking for ways to curb Medicaid inflation that has been running around 20 percent a year. The federal government pays roughly 60 percent of the costs of providing health insurance to the poor and disabled and state governments pay the rest.

States administer Medicaid, but must do so under stringent federal rules, unless they win a waiver of those regulations. States say the 40-year-old rules often stifle creativity and innovation that might make Medicaid cheaper or, at least, easier to run.

Those two goals now are beginning to intersect as both state and federal governments search for ways to reduce spending and the states clamor for flexibility.

A pending agreement calls for total Medicaid spending in Vermont to be no more than $4.7 billion over the next five years, with roughly 60 percent of the bill being paid by Washington. The Douglas administration and the Legislature estimate spending will total only $4.2 billion. The state also estimates that it will save between $135 million and $165 million under the new arrangement over the next five years. But even then, the state’s funding problems will only be partially solved; Vermont will still be short on its contribution to the Medicaid program by $300 million over the whole period.

Katrina Update: Lexington Center

In response to the call for hurricane relief, the Lexington Center sent 1,152 Personal Adult Care Kits consisting of over 13,800 items. The items sent were shampoo, soap, toothbrushes, toothpaste, pocket combs, pocket tissues, deodorant, hair picks, petroleum jelly, skin lotion, soap dishes, and talcum powder. All the items were consolidated and shipped to the affected area through the efforts of local Montgomery county manufacturer Kasson & Keller, Inc.

”Our people want to do something to help”, said Nancy Darrow, director of production for Lexington Industries. “This is a chance for us to give to those who may be without basic items for a long time, and we have this opportunity to be able to ship these items through the effort of Kasson & Keller if we act now.”

Bob Rivenburg, human resource manager for Kasson & Keller, Inc., coordinated the relief effort that gave several groups and individuals in the area the opportunity to be involved in the relief effort.

Students With Disabilities Making Great Strides, New Study Finds

Students with disabilities have made significant progress in their transition to adulthood during the past 25 years with lower dropout rates, an increase in postsecondary enrollment and a higher rate of gainful employment after leaving high school, according to a new report released by the U.S. Department of Education. The report is available at www.nlts2.org.

The National Longitudinal Transition Study-2 (NLTS2) documents the experiences of a national sample of students over several years as they moved from secondary school into adult roles. The NLTS2 report shows that the incidence of students with disabilities completing high school rather than dropping out increased by 17 percentage points between 1987 and 2003.

During the same period, their postsecondary education participation more than doubled to 32 percent. In 2003, 70 percent of students with disabilities who had been out of school for up to two years had paying jobs, compared to only 55 percent in 1987.

The study also shows that the following progress has been made in special education:

Core Academics Improved—Cohort2 high school students with disabilities were much more likely than their cohort1 counterparts to take core academic courses, including mathematics, science, social studies and a foreign language.

Grades Were Higher—Regarding academic performance, more than half of cohort2 students with disabilities received above-average grades, representing a shift from students receiving mostly Cs to more students receiving mostly As or Bs, as reported by teachers.

Age and Grade-Level Match Improved—The proportion of students who were at the typical age for their grade level increased from one-third to more than one-half between 1987 and 2001. As being older than the typical age for a grade level has been shown to be a powerful predictor of disabled students dropping out of school, this indicator signals positive outcomes for youths with disabilities in their efforts to finish high school.

More Support—By 2001, half of 15- to 17-year-old students with disabilities were receiving related or support services from or through their schools, compared with less than one-third of students in 1987.

The study was funded by the Department’s Office of Special Education and Rehabilitative Services and focuses on a wide range of important topics for students with disabilities, such as high school coursework, extracurricular activities, academic performance, postsecondary education and training, employment, independent living and community participation.

VR Program Could Improve Monitoring, GAO Finds

The public vocational rehabilitation (VR) program was at the center of yet another government review, this time concluding that the program could be improved from better measures and monitoring. On September 23rd the Government Accountability Office (GAO) released its report (GAO-05-865), “Vocational Rehabilitation: Better Measures and Monitoring Could Improve the Performance of the VR Program.” The purpose of the GAO audit was to review the effectiveness of the $2.5 billion program. It noted that over $1 million individuals are served annually, and attempted to assess how various legislative changes (e.g., Ticket-to-Work program) have impacted the program.

Of the more than 650,000 individuals exiting the state VR programs in fiscal year 2003, one-third (217,557) obtained a new job or maintained their existing job for at least 90 days after receiving services. Education’s data showed that the remaining two-thirds exited the VR program without employment most often because the individual refused services or failed to cooperate with the VR counselor (46 percent of the time) or could not be located or contacted (24 percent). The VR program purchased more than $1.3 billion in services for all individuals who exited the program in fiscal year 2003, two-thirds of which were used to provide services to individuals exiting with employment. Employment, earnings, and the amount of purchased services received while in the VR program varied significantly by individuals’ disability type and other characteristics. In addition, state VR agencies varied substantially in the employment rates they achieved, the characteristics of individuals they served, their frequency of providing certain services, and their service expenditures.

Education’s performance measures are not comprehensive, and its monitoring of state VR agencies has not resulted in timely feedback. Education does not comprehensively measure the performance of certain key populations, such as students transitioning from school to work, and tracks only the individuals who exit the program, not those still receiving services. In addition, Education’s performance measures do not take into consideration all the variation among the state VR agencies or allow for comparisons with other workforce programs. Education’s monitoring reports, which are its primary means of providing feedback to state VR agencies, are frequently late and based on data that are more than 2 years old. Consequently, state VR agencies do not receive the timely feedback needed to improve the efficiency and effectiveness of their programs. Education recently decided to eliminate its regional offices, which conducted most of the monitoring of state VR agencies, making the details of the future monitoring process unclear.

Education agreed that better measures and monitoring could improve the performance of the VR program, as GAO recommended. These recommendations included aligning performance measures with program goals and developing a better monitoring process that includes timelier feedback to state VR agencies.

Centers for Medicare/Medicaid Services (CMS) approval has been issued approval for 10 national prescription drug plan organizations and hundreds of state or regional stand-alone prescription drug plan organizations (PDPs) to offer services through the new Medicare Part D benefit. In addition, Medicare Advantage plans, which is the latest name for Medicare HMOs, will also offer drug coverage as part of their standard benefit packages. The charts indicate the stand-alone organizations (Table 1) and Medicare Advantage Plans (Table 2) that have been approved in New York. In addition, Table 3 shows those organizations that will receive auto-enrolled beneficiaries in New York.

Table 1: Stand-Alone Prescription Drug Plan Organizations in New York (PDP Region 3)

Data as of September 18, 2005

Table 2: Medicare Advantage Prescription Drug Plan Organizations in New York

Data as of September 18, 2005. The data does not reflect information for 1833 cost-based plans, 1876 Health Care Prepayment Plans (HCPP), some demonstrations, National PACE organizations, Employer sponsored plans, or plans that were not approved by the “As of” date of the chart.

Table 3: Stand-Alone Prescription Drug Plans Eligible to ReceiveAuto-Enrolled Beneficiaries in New York

(PDP Region 3)

Data as of September 18, 2005.

Announcements/Opportunities

Living Well With a Disability Promotion Workshop Series

The Disability and Health Program is seeking organizations to implement the “Living Well with a Disability” program. This is the sixth year that the Disability and Health Program has offered this funding opportunity. They are primarily seeking applications from organizations that have not been funded through this program in the past. Previous awardees are eligible to apply; however new applicants will be eligible for a bonus of 10 points.

“Living Well with a Disability” is an eight-week peer led health promotion workshop series, developed by the University of Montana and the University of Kansas. “Living Well with a Disability” targets the prevention and management of secondary conditions among adults with physical disabilities. The workshop is based on a self-help, health promotion model. It includes eight two-hour sessions that focus on topics including goal setting, problem solving, adopting a hopeful and optimistic attitude, and overcoming depression. In addition, a number of health-seeking behaviors are taught, including communication skills, medical information seeking skills, changing one’s nutritional intake and level of physical activity, and advocacy skills. Additional background information on the “Living Well with a Disability” program can be found at www.livingwellw