The following is a public service announcement from VOR's Susan Jennings about the importance of ICF care.

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Today, providers who serve persons with intellectual and developmental disabilities (I/DD) have the privilege of caring for thousands of children and adults with varying levels of disability, including autism, brain injury and other complex behavioral and medical needs. But 40 years ago, these individuals were isolated and effectively hidden away from society. Thanks to advancements like the Americans with Disabilities Act and the U.S. Supreme Court’s Olmstead Decision of 1999, those with I/DD now enjoy greater freedoms and more opportunities.

The ADA’s groundbreaking protections against discrimination have been copied around the world. Because of this law, the disabled have greater access to housing, employment, education and public spaces. The Olmstead Decision enhanced these protections by outlawing unjustified segregation based on disability and mandating that states provide community-based services under Medicaid when appropriate. The driving force behind both these reforms is the idea that every American, regardless of disability, should have the right to decide how they want to live, work, and spend their time. Everyone agrees the old policy of forcing people into institutions was wrong and discriminatory. Today, there is a trend toward greater community integration, and in fact, living in the community is often a requirement for drawing down federal funding.

Federal funding for special education will rise the most it has in years under a newly approved government spending plan.

The increase comes as part of a $1.4 trillion package signed late last year by President Donald Trump that will fund the federal government through the end of September.

The measure includes level funding or increases for most programs that people with disabilities rely on, advocates said.

But special education is a big winner with a $400 million rise over last year. That’s the largest increase the program has seen since 2016, according to Annie Acosta, director of fiscal and family support policy at The Arc. The added funds are the culmination of many years of advocacy driven by school groups and disability advocates alike who have been frustrated by underfunding of special education, she said.

Outside of special education, funding to support respite care initiatives is up $2 million in the spending plan — a 48 percent increase — and the federal government will grow its support for vocational rehabilitation as well as a program to train professionals to screen and diagnose autism. The Centers for Disease Control and Prevention’s National Center on Birth Defects and Developmental Disabilities will also see a bump.

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With the federal government looking to crack down on the programs used for shoring up Medicaid reimbursements for nursing homes and other care facilities, billions of dollars could soon be in the balance.

The Centers for Medicare and Medicaid Services (CMS) this past November proposed a rule that would rein in spending on Medicaid supplemental payment programs, due to concerns about the arrangements that have evolved over time.

“We have seen a proliferation of payment arrangements that mask or circumvent the rules where shady recycling schemes drive up taxpayer costs and pervert the system,” CMS administrator Seema Verma said in a statement announcing the Medicaid Fiscal Accountability Regulation (MFAR).

With the comment deadline for the proposed rule recently extended to February 1 from January 17, SNN dove into some of the statistics on a state-by-state basis, as listed by the Medicaid and CHIP Payment and Access Commission’s (MACPAC) December 2019 data book.

MACPAC is a non-partisan government agency that advises Congress on Medicaid issues, similar to the Medicare Payment Advisory Commission’s (MedPAC) role on Medicare policy.

In the fiscal year 2018, nursing facilities (NFs) and intermediate care facilities for people with intellectual disabilities (ICF/IDs) received $50.54 billion in Medicaid fee-for-service payments across the U.S., according to the data book.

According to a letter from state Medicaid Director Mike Randol to Iowa Total Care CEO Mitch Wasden, the state will withhold the payment until the company has corrected "claims payment issues and encounter data issues." 

The state claims Iowa Total Care has failed to pay 106,000 claims. The money withheld amounts to just over a quarter of the company's monthly payment.

The letter states the company was issued multiple verbal and written warning about the issue. The state said will make the decision to release the money at the end of February.

This video is from ACCSES, an organization representing disability service providers including providers of work centers (sheltered workshops). On 7/25/18, the organization held a Capitol Hill Briefing in defense of a broad range of work settings for people with disabilities including work centers for people who would otherwise be unable to compete for employment. Self-advocates who participate in these work programs were scheduled to speak, but they were shouted down and the meeting disrupted by other self-advocates from disability organizations with opposing views. 

According to ACCSES, this is what happened:

“Despite what disability policy seems to indicate: People with disabilities are not a monolithic group. Rather, people with disabilities are individuals, with the same right to choose where they want to live, work, and thrive as anyone else. That basic civil right to live life with dignity and respect is being subsumed by feel-good laws that do not benefit many individuals, and advocates who support those laws over individual rights. That’s the rub.

Right now, current and proposed laws and regulations, as well as policymakers, agencies, and some advocates—even those with good intentions—are putting a broad range of employment, residential, and community support options for people with disabilities at risk. In doing so, they are taking away the civil rights of individuals with disabilities.