August 14, 2020
VOR Weekly News Update
VOR is a national organization that advocates for high quality care and human rights for people with intellectual and developmental disabilities
VOR promises to empower you to make and protect quality of life choices for individuals with developmental disabilities
The two articles below should be of concern to VOR members. Although they are not focused on people with I/DD, they are concerned with policies and data that may be reflected in our community. The first article concerns some rather troubling CDC guidelines for workers who have tested positive for COVID-19 but are asymptomatic. The second concerns an uptick in cases of COVID in nursing homes, due to community exposure.
Southern Virginia Mental Health Institute Email to Staff:
If Positive, but Asymptomatic, Keep Working
By John Crane, Danville Register & Bee, August 13, 2020

A recent email to staff at Southern Virginia Mental Health Institute tells those who test positive for the coronavirus but are asymptomatic to keep working.

The facility was hit with a COVID-19 outbreak late last month. The Danville Register & Bee acquired the email shortly after it was sent out.

The email sent on Aug. 4 to SVMHI staff — and meant to be shared with clients — informs them that coronavirus testing would take place on Aug. 5 with results returned by the following Monday.
For staff who test positive, the email informs them that they will coordinate with the local Virginia Department of Health, an infection control coordinator and their own care plans if symptomatic.

However, those who are positive but are showing no symptoms must resume work, according to the email from SVMHI Chief Operating Officer Robin Crews.

"If asymptomatic, CDC [Centers for Disease Control and Prevention] recommends PPE precautions, but continued work routine," she wrote in the email.

New Report Shows Nursing Homes Spike in New COVID Cases due to Community Spread ‘Repeating the Same Mistakes
By Douglas Hook, MassLive, August 12, 2020
The American Health Care Association and National Center for Assisted Living published a report on Wednesday stating that nursing homes in the U.S. have experienced an alarming spike in new COVID-19 cases due to a community spread among the general population.

“With the recent major spikes of COVID cases in many states across the country, we were very concerned this trend would lead to an increase in cases in nursing homes and unfortunately it has,” said Mark Parkinson, president and CEO of the AHCA and NCAL. “This is especially troubling since many nursing homes and other long-term care facilities are still unable to acquire the personal protective equipment and testing, they need to fully combat this virus.”

The report is based on data from the Centers for Medicare & Medicaid Services which showed that coronavirus cases in nursing homes considerably increased in July after having dropped significantly throughout the month of June.
The AHCA and NCAL represent more than 14,000 nursing homes and assisted living communities across the country that provide care to approximately five million people each year.

“Given the fact we are several months into the response of this pandemic and the lack of PPE supplies is still an issue is very concerning. We request governors and state public health agencies to help secure and direct more PPE supplies to nursing homes and assisted living communities, especially N95 masks,” Parkinson wrote in a letter to the National Governors Association.

Using data from Johns Hopkins University, AHCA and NCAL released a state-by-state breakdown showing 33 states with a positive coronavirus test rate of higher than five percent and data from CMS indicating many nursing homes are still facing significant PPE supply shortages, especially for N95 masks and gowns.

National News:
COVID-19 Taking A Toll On Direct Support Professionals
By Shaun Heasley, Disability Scoop, August 14, 2020

The coronavirus is rocking the already unstable workforce of direct support professionals assisting people with developmental disabilities, with a new survey finding nearly half know someone who’s left the profession due to the pandemic.

The survey of nearly 9,000 direct support workers across the nation finds that 34 percent are working more hours since COVID-19 emerged and a quarter say they are more often short-staffed. Only 24 percent reported receiving extra pay related to the increased risks associated with the virus, often another $1 or $2 added to an average wage of $13.63 per hour.

The findings come from research conducted between April 23 and May 27 by the University of Minnesota’s Institute on Community Integration and the National Alliance for Direct Support Professionals. Nearly 60 percent of those who responded had worked as direct support professionals for at least three years. Most were employed by agencies, but a substantial number worked in individual homes.

Some 42 percent of those surveyed said they knew a direct support professional who had left their job since the pandemic began over worries about becoming infected, due to child care issues, contracting COVID-19 or other reasons.

Of those hired since the pandemic started, 27 percent did not receive the typical orientation or preservice training for their jobs, the report found.

A majority of direct support professionals indicated that the people with developmental disabilities they support were good or very good at practicing social distancing. But with 64 percent reporting that the individuals they served were not allowed to see any family or friends, direct support professionals indicated that boredom, depression, behavior issues, loneliness and increased sleeping were common among their clients.

Ed Department Accused Of Diverting Funds From Students With Disabilities
By Michelle Diament, Disability Scoop, August 13, 2020
A lawsuit filed this week accuses the U.S. Department of Education of jeopardizing students with disabilities by misdirecting funds meant to help schools deal with fallout from the pandemic.

Earlier this year, Congress included billions of dollars in funding for schools in the Coronavirus Aid, Relief and Economic Security, or CARES, Act. But rules issued by the Education Department this summer about how that money should be allocated allow a good chunk of the money to be shared with private schools.

Steering the much-needed funds away from public schools is especially problematic for students with disabilities, according to the Council of Parent Attorneys and Advocates, or COPAA, the nonprofit that filed the suit and works to advocate for the rights of students with disabilities and their families. Unlike private schools, public schools are legally required to serve students with disabilities.

According to COPAA, as much as $1.5 billion could be diverted away from public schools under the rule just as these schools are dealing with higher costs for distance learning, changes to how they serve students with disabilities and other needs. Meanwhile, the state tax revenues that fund public schools have declined.

“At a time when students with disabilities are likely to have an increased need for academic and socio-emotional services and supports due to the disruption of their educations during the pandemic, the department through the (rule) has illegally limited the resources available to these students instead,” the lawsuit states.

The suit filed in the U.S. District Court for the District of Maryland names Secretary of Education Betsy DeVos and the Education Department. It calls for the rule to be set aside because it is contrary to the intent of Congress and in violation of the Administrative Procedure Act.

State News:
Pennsylvania - 41 Kids With Intellectual Disabilities Reported Sex Assaults at Philly Area Nonprofit
At the Nation’s Leading Behavioral Health Nonprofit for Youth, Devereux Staff Abused Children in their Care for Years - While Red Flags were Dismissed.
By Lisa Gartner and Barbara Laker,
Philadelphia Inquirer, August 11, 2020
It was just after dinner, on a cloudy evening in February, when a 16-year-old boy named Edward decided he couldn’t take it anymore: He left the cafeteria and walked quickly through campus, searching for someone to help him at Devereux Brandywine.Behind him, Edward’s abuser followed in a van. The boy began to run.

Headquartered 15 miles outside Philadelphia, Devereux Advanced Behavioral Health has specialized in treating children with intellectual disabilities, mental disorders, and trauma for more than a century. Operating 15 residential campuses that serve 5,000 children every year across nine states, Devereux is the nation’s leading nonprofit health organization of its kind.

Its motto: “Unlocking human potential.”

A shy 16-year-old from Clifton Heights, Edward had come to Devereux Brandywine, a campus in Glenmoore, four months earlier. Diagnosed with autism and developmental delays, Edward — his middle name — had spent his childhood in physical and occupational therapy appointments, learning to grip buttons and zippers, to plant his feet on the ground as he walked.

Now the boy darted toward a program supervisor named Shakira Wilson, standing outside a campus dorm in February 2018. Before the van could reach them, Edward went inside with Wilson. He paced her office, wringing his hands.

Wilson would later say she had never seen Edward act like this before. He had a reputation among staff as a good kid and a rule follower. He had even taken on a big-brother role to a younger boy in his unit. “What’s going on?” she asked him.

Like many children with intellectual disabilities, Edward had been taught to count down to calm himself. He braced himself to say aloud what the Devereux staffer had done to him: “Five, four, three, two, one.”

At least 41 children as young as 12, and with IQs as low as 50, have been raped or sexually assaulted by Devereux staff members in the last 25 years, an Inquirer investigation has found.

Of those, 10 said they were assaulted at Devereux’s three campuses in the Philadelphia suburbs, while the others were abused at facilities in New Jersey, Texas, Florida, Georgia, Connecticut, New York, and Arizona.

Devereux leaders, noting that a sexual assault can happen in almost any care setting, said that in the last two years they have increased safety and reduced risk by adopting a host of safeguards to prevent such abuse and hold staffers accountable.

Yet, between October 2018 and March 2019, three girls at a Devereux campus in Arizona were sexually abused by a male staffer in their bedrooms and the facility’s laundry room, they told police.

In December, at a facility in Texas, a Devereux staffer was charged with allegedly sexually abusing four children, including a 16-year-old girl who said he threatened to have her beaten up, and a 12-year-old who said he molested her several times.

And on that cloudy 2018 evening at Devereux Brandywine, Edward revealed to Wilson that a male staffer had been sexually assaulting him on campus for months. The teenager would later tell law enforcement that he was afraid to speak up, but knew he had to: The man had started abusing Edward’s 14-year-old “little brother” too.

Virginia Group Homes for Adults with Disabilities Feel ‘Forgotten’ in Virus Funding
By Jessica Contrera, Washington Post, August 5, 2020
The letter to Virginia Gov. Ralph Northam warned of a crisis within a crisis: The industry built to support adults with developmental disabilities was being financially crushed by the pandemic.

Day programs had been shuttered for months. Group homes had sunk hundreds of thousands into attempts to keep their residents from contracting the novel coronavirus. A coalition of service providers, desperate for personal protective equipment and other supports, hoped to alert the governor to their increasingly desperate situation.

They say they received no response to the June 1 plea for help.

Now they are calling on Virginia lawmakers to address their needs in the Aug. 18 special session of the General Assembly, and sending another letter to Northam (D), warning that “unless immediate and substantial action is taken,
several providers may face imminent threat of closure.”

“The individuals we’re supporting have been forgotten in these conversations,” said Joanne Orchant Aceto of MVLE, which provides jobs and day programs for adults with disabilities.

Their worries reflect challenges faced by organizations serving people who are more vulnerable to the virus across the Washington region and the country. As the pandemic drags on and leaders brace for many more months ahead, the financial toll of keeping people well is exacerbating long-standing funding challenges.

Arkansas - Booneville Human Development Center Sees Spike in COVID-19 Cases
By Kathryn Gilker, 5 News Online, August 11, 2020
Close to half of the clients who live at the DHS Facility in Logan County have tested positive for COVID-19 and the other half are in quarantine.The Booneville Human Development Center has a total of 123 clients who live at the facility and 265 staff members.

On Tuesday (Aug. 11) DHS says 51 clients and 55 employees have tested positive for COVID-19.

71 clients and 59 employees are currently in quarantine.

Division Director for Developmental Services Melissa Stone says the Arkansas Department of Health (ADH) has sent a team, including an infectious disease specialist, into the facility.
“They’ve been on site. We really value their opinion to make sure that we are doing everything that we are supposed to do in terms of infection disease control," Stone said. "We have an infectious disease nurse that works at that campus.”

While the center is a congregate setting similar to a nursing home, the clients live in six cottages spread out on the campus.
Stone says they have also had another group come in to do an infectious disease survey because they want to make sure they are doing the best job they can.

She says all employees who have to work around the COVID-19 patients wear the full PPE recommended by the ADH and CDC.

“Of course, they should be wearing a mask when they are not at work, so you can’t ever guarantee anything, but we are doing everything possible to not take the virus outside of the campus,” Stone said.

As of Tuesday (Aug. 11), there are a total of 133 active COVID-19 cases in Logan County. 106 of those cases are from the Booneville Human Development Center.

Logan County Judge Ray Gack wants to remind everyone how important it is to wear face coverings.

New York - Nursing Home Worker Tells Lawmakers of COVID-19 Protective Gear Shortage
By Lou Michel, Buffalo News, August 10, 2020
Iris Purks slammed the Covid-19 response at a Town of Tonawanda nursing home she has worked at for 26 years Monday as state lawmakers sought insights into how the pandemic impacted long-term care facilities.

“We lacked PPE and training on how to use it,” said Purks, a certified nursing assistant at Safire Rehabilitation of Northtowns.

One of her co-workers contracted the novel coronavirus and brought it home to her husband, Purks said.

“They both ended up in the hospital. He died. She just returned to work six months later. She still carries the guilt,” said Purks, a member of the 1199SEIU union.
She was one of more than 40 speakers scheduled to testify Tuesday at a second virtual hearing as state legislators investigate the response by Gov. Andrew M. Cuomo's administration to the more than 6,400 Covid-19 deaths at nursing homes.

A representative of the owners of Safire Rehabilitation of Northtowns previously disputed the 1199SEIU's contention that workers were not given adequate protective equipment.

But Purks said it took Safire Northtowns weeks before it provided workers with proper personal protective equipment and training in how to use it.

Rhode Island - Day Program With 100+ People with Developmental Disabilities to Close
By Wayne Miller, Providence Journal, August 10, 2020

After 16 years, a day program serving people living with developmental disabilities will close at the end of September, the program operator, Resources for Human Development, said in a statement. Financial losses led to the “difficult decision” to end the program, the organization’s Manay Gunter wrote.

During its decade and a half, Gunter wrote, “RHD provided arts-based day services, community-based school services and/or skill acquisition services to individuals with a diagnosis of an intellectual or developmental disability with a consistent daily census of over 100 individuals.”

But reimbursement rates, coupled with the coronavirus pandemic, proved to be obstacles the organization could not overcome, Gunter wrote.

“In the three fiscal years preceding the COVID pandemic, RHD lost a total of over $750,000; clearly this number has grown significantly throughout this pandemic and the organization cannot afford to sustain this level of financial loss,” Gunter wrote. “Ultimately, current reimbursement rates are not sufficient to support the program, and as a result, effective September 30, 2020, RHD will no longer be a service provider in Rhode Island.”

Spotlight on State Medicaid Programs:
Oklahoma Withdraws Medicaid Block Grant Proposal
Modern Healthcare, August 13, 2020
Oklahoma has told CMS it won't move forward with its plan to institute a block grant program for Medicaid.

In a brief letter dated Aug. 11, Oklahoma's state Medicaid director Melody Anthony thanked CMS for its efforts and said the state "looks forward to further opportunities to work together on state initiatives."

SoonerCare 2.0 would have allowed Oklahoma to impose premiums and work requirements on Medicaid expansion enrollees while accepting a limit on how many federal dollars the state would receive. Patient groups opposed the plan.

But Oklahomans ultimately voted for a straight Medicaid expansion in June, thwarting Republican Gov. Kevin Stitt's block grant plans.

Oklahoma has the second-highest uninsured rate in the country behind Texas. The Oklahoma Health Care Authority projected that more than 200,000
new Medicaid enrollees may sign up due to the ballot initiative's passage, for a total annual cost of about $1.3 billion. The estimated state share would be about $164 million. But those numbers could be considerably higher given the number of Oklahomans who have lost their jobs and work-related health insurance because of the economic downturn during the coronavirus pandemic.

Before the ballot initiative, Stitt also sought CMS approval for waivers to convert the state's Medicaid program into a capped federal funding model under the Trump administration's newly announced Healthy Adult Opportunity program. He wanted to shift beneficiaries into private Medicaid managed care plans.

By Megan Messerly, Nevada Independent,
August 13, 2020
Nevada Medicaid is moving forward with a planned 6 percent across-the-board rate reduction approved by lawmakers during a special session last month to balance a billion dollar shortfall in the state’s budget.

Though lawmakers were able to restore many proposed cuts to Medicaid programs during the course of the session, Medicaid still bore $130 million in budget cuts, including the 6 percent rate reduction, expected to save the state about $53 million.
Health care providers, who have long argued for increases in Medicaid rates, opposed the reductions.

Medicaid is moving forward with the cuts, which will be discussed during a public hearing on Thursday, even though it is expected to take in an additional $30 million through enhanced federal matching dollars that were extended last month through the end of the year.

Opinion: COVID-19 Demands that Congress Support Arizona’s Medicaid Program
By Siman Qaasim, AZ Mirror, ]August 12, 2020

The COVID-19 pandemic has burdened an already strained health care system for months. For the most at-risk populations, including those with pre-existing conditions and Black and Latino communities, the virus has hit harder and the damage has been deeper. 

There is no road to recovery from this health and economic crisis that doesn’t include our state’s Medicaid system, the Arizona Health Care Cost Containment System (AHCCCS), which provides health coverage to over 2 million Arizonans.

That’s why there have been bipartisan calls from governors, hospitals, and health systems asking Congress to increase federal Medicaid funding as Congress did a decade ago during the Great Recession. While the U.S. House of Representatives passed a bill to invest more in Medicaid, the U.S. Senate’s response, the HEALS Act, fails to include any additional federal relief to state Medicaid programs.

This oversight could cost Arizona dearly.

Our state’s Medicaid enrollment has jumped by more than 125,000 members in the past few months and is projected to increase in overall enrollment by 16% in the next year. These cost pressures come on top of a massive state revenue shortfall. The Joint Legislative Budget Committee is projecting a $700 million budget deficit in the current fiscal year and an even larger shortfall the following year.

To make matters worse, children’s health coverage is uniquely at risk in our state. That’s because Arizona is the only state in the country that can freeze enrollment in its Children’s Health Insurance Program, known here as KidsCare. During the last recession, Arizona did just that and tens of thousands of children lost health coverage. It also froze AHCCCS coverage for low-income adults, rolled back life-saving medical treatments like organ transplants and slashed payments to health care providers.
Without enhanced federal support to our already taxed Medicaid agency, Arizona lawmakers will be looking for places to cut costs.

VOR Bill Watch:
Click on blue link to view information about the bill


H.R. 555 & S. 117 - The Disability Integration Act - This bill has written into it the goal of eliminating "institutional care". In addition to the inherent bias against ICF's and people with severe and profound I/DD, the bill is prohibitively costly and there are not enough Direct Support Professionals to meet the provisions of this act.

H.R. 582 & S. 150 - The Raise the Wage Act - This bill is aimed at raising the minimum wage, but it also has provisions to eliminate 14 (c) wage certificates over the next six years and to immediately stop the issuing of any new certificates. VOR believes the issue of employment options for individuals with intellectual disabilities should not be buried in a bill for raising the federal minimum wage. Both issues deserve clean, stand-alone bills.

H.R. 873 & S. 260 - The Transformation To Competitive Employment Act - This bill has declared the goal of eliminating Sheltered Workshops and 14(c) Wage Certificates, under the mantle of everyone with a disability is capable of competitive integrated employment.
Sponsors of the bill recently added a new summary that significantly downplays the effect the bill would have on eliminating work centers and 14(c) that benefit those who are unable to compete in the employment opportunities the bill promotes.


VOR is concerned about the following bills because they only cover HCBS proivders, and because the sponsors of the bills have consistently fought against ICFs as part of the continuum of care in I/DD services.

H,R. 6305 & S. 3544 - Coronavirus Relief for Seniors and People with Disabilities Act of 2020 - Bill provides FY2020 supplemental appropriations to the Centers for Medicare & Medicaid Services for specified quality improvement and laboratory certification activities. The funds are designated as an emergency requirement, which exempts the funds from discretionary spending limits and other budget enforcement rules.
In addition, the bill (1) temporarily requires state Medicaid programs to provide Medicare cost-sharing assistance to certain individuals who qualify for, or are enrolled in, the low-income subsidy program under the Medicare prescription drug benefit; and (2) authorizes a grant program to support Medicaid home- and community-based services during the public health emergency.


H.R. 6045 & S. 3669 - Recognizing the Role of Direct Support Professionals Act - To require the Office of Management and Budget to revise the Standard Occupational Classification system to establish a separate code for direct support professionals, and for other purposes.

H.R. 5443 & S. 3220 - Ensuring Access to Direct Support Professionals Act -
To amend title XIX of the Social Security Act to clarify that the provision of home and community-based services is not prohibited in an acute care hospital, and for other purposes.

H.R. 2417 - The HEADs UP Act - To amend the Public Health Service Act to expand and improve health care services by health centers and the National Health Service Corps for individuals with a developmental disability as a Medically Underserved Population (MUP).

H.R. 1379 & S. 560 - Ensuring Lasting Smiles Act - To require that group and individual health insurance coverage and group health plans provide coverage for treatment of a congenital anomaly or birth defect. (i.e. Cleft palate, ectodermal dysplasia, etc.)


During the COVID-19 Pandemic, Health Care Providers have been relying increasingly on Telehealth Services. Members of Congress have proposed a number of bills to learn more about telehealth services, with a possible eye toward expanding these services into our broader system of health care.

VOR has been following the expansion of telehealth, especially how incorporating these services into treatment of people with I/DD might change our delivery systems. Telehealth has the potential to improve care for some people with poor access to professional care, or it could be used as a less-expensive substitute for in-person treatment and quality professional care.

Current Telehealth bills in the 116th Congress include:

H.R. 6474 - Healthcare Broadband Expansion During COVID-19 Act - To provide for the expansion of the Rural Health Care Program of the Federal Communications Commission in response to COVID–19, and for other purposes.

H.R. 7078 - To study the effects of changes to telehealth under the Medicare and Medicaid programs during the COVID-19 emergency.

S. 3999 - A bill to amend title XVIII of the Social Security Act to simplify payments for telehealth services furnished by Federally qualified health centers or rural health clinics under the Medicare program, and for other purposes.

S. 3999 - A bill to amend title XVIII of the Social Security Act to ensure access to mental health and behavioral health services furnished through telehealth under the Medicare program.

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