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Medicare Complex Rehabilitation Technology Policy Reform

Medicare Complex Rehabilitation Technology Policy Reform. A Necessary Step Toward Equality for People with Disabilities Paul J. Tobin, MSW President & CEO, Unit ed Spinal Association CELA 2012 Arlington, VA April 17-19, 2012. Medicare Complex Rehabilitation Technology Policy Reform.

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Medicare Complex Rehabilitation Technology Policy Reform

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  1. Medicare Complex Rehabilitation Technology Policy Reform A Necessary Step Toward Equality for People with Disabilities Paul J. Tobin, MSW President & CEO, United Spinal Association CELA 2012 Arlington, VA April 17-19, 2012

  2. Medicare Complex Rehabilitation Technology Policy Reform Independence A Necessary Step Toward Equality for People with Disabilities Paul J. Tobin, MSW President & CEO, United Spinal Association CELA 2012 Arlington, VA April 17-19, 2012

  3. Medicare Complex Rehabilitation Technology Policy Reform Independence A Necessary Step Toward Equality for People with Disabilities Paul J. Tobin, MSW President & CEO, United Spinal Association CELA 2012 Arlington, VA April 17-19, 2012 Employment

  4. Medicare Complex Rehabilitation Technology Policy Reform Independence A Necessary Step Toward Equality for People with Disabilities Paul J. Tobin, MSW President & CEO, United Spinal Association CELA 2012 Arlington, VA April 17-19, 2012 Employment Improved Health Outcomes

  5. Medicare Complex Rehabilitation Technology Policy Reform Fiscally Responsible Independence A Necessary Step Toward Equality for People with Disabilities Paul J. Tobin, MSW President & CEO, United Spinal Association CELA 2012 Arlington, VA April 17-19, 2012 Employment Improved Health Outcomes

  6. Medicare Complex Rehabilitation Technology Policy Reform Fiscally Responsible Independence A Necessary Step Toward Equality for People with Disabilities Paul J. Tobin, MSW President & CEO, United Spinal Association CELA 2012 Arlington, VA April 17-19, 2012 Employment Pragmatic Improved Health Outcomes

  7. Medicare Complex Rehabilitation Technology Policy Reform Fiscally Responsible Independence A Necessary Step Toward Equality for People with Disabilities Paul J. Tobin, MSW President & CEO, United Spinal Association CELA 2012 Arlington, VA April 17-19, 2012 Employment Pragmatic Improved Health Outcomes Just

  8. Medicare Complex Rehabilitation Technology Policy Reform Independence, Pragmatic, & Fiscally Responsible, Employment, & Just Improved Health Outcomes A Necessary Step Toward Equality for People with Disabilities Paul J. Tobin, MSW President & CEO, United Spinal Association CELA 2012 Arlington, VA April 17-19, 2012

  9. Learning Objectives • Identify the contributions of consumer advocates to the development of disability rights and policies in the United States. • Articulate how CRT policy reforms are consistent with the historical evolution of community inclusion of people with disabilities. • Connect your own experiences with CRT policy reform efforts and create a first-hand narrative regarding the importance of CRT on independence, quality of life and/or health care.

  10. Learning Objectives • Identify the contributions of consumer advocates to the development of disability rights and policies in the United States. • Articulate how CRT policy reforms are consistent with the historical evolution of community inclusion of people with disabilities. • Connect your own experiences with CRT policy reform efforts and create a first-hand narrative regarding the importance of CRT on independence, quality of life and/or health care.

  11. Learning Objectives • Identify the contributions of consumer advocates to the development of disability rights and policies in the United States. • Articulate how CRT policy reforms are consistent with the historical evolution of community inclusion of people with disabilities. • Connect your own experiences with CRT policy reform efforts and create a first-hand narrative regarding the importance of CRT on independence, quality of life and/or health care.

  12. Models of Disability • Medical – Medical interventions are utilized by clinicians upon PWD to “normalize” physical or mental infirmities. • Social – systemic barriers, negative attitudes and purposeful or inadvertent exclusion by society creates disabilities.

  13. Medical Model • Failure to achieve “normal” is an unsatisfactory result. • Inability to as “normal” = medical failure. • Predominant model in US healthcare and CMS programs.

  14. Social Model • Inability to participate/work/ is caused by systemic barriers, prejudices, or exclusion. Such barriers create disability. • If society/systems/laws were inclusive and accommodating of physical, sensory, emotional and/or intellectual differences between people, then the concept of disability is diminished.

  15. Barriers Faced by PWD • Attitudinal • Architectural • Legislative • Regulatory • Prejudice • Blatant Discrimination • Intimidation

  16. Belief Systems about PWD over time

  17. Belief Systems about PWD over time “To be put away in some mysterious, unknown place as they should”

  18. Belief Systems about PWD over time “To be put away in some mysterious, unknown place as they should” An expression of God’s displeasure; inconsistent with the image of God.

  19. Belief Systems about PWD over time “To be put away in some mysterious, unknown place as they should” An expression of God’s displeasure; inconsistent with the image of God. Poor Laws established; Worthy vs. Unworthy poor

  20. Belief Systems about PWD over time “To be put away in some mysterious, unknown place as they should” An expression of God’s displeasure; inconsistent with the image of God. Poor Laws established; Worthy vs. Unworthy poor Age of Enlightenment

  21. Dejá Vu “I readily and, I trust, feelingly acknowledge the duty incumbent on us all as men and citizens, and as among our highest and holiest duties, to provide for those who, in the mysterious order of Providence, are subject to want and to disease of body or mind; but I cannot find any authority in the Constitution for making the Federal Government the great almoner of public charity throughout the United States…” - President Franklin Pierce, Veto Message, An Act Making a Grant of Public Lands to the Several States for the Benefit of Indigent Insane Persons, Washington, DC, May 3, 1854

  22. Belief Systems about PWD over time “To be put away in some mysterious, unknown place as they should” An expression of God’s displeasure; inconsistent with the image of God. Poor Laws established; Worthy vs. Unworthy poor Age of Enlightenment

  23. Belief Systems about PWD over time “To be put away in some mysterious, unknown place as they should” An expression of God’s displeasure; inconsistent with the image of God. Poor Laws established; Worthy vs. Unworthy poor Age of Enlightenment Never mind – Darwinism and Eugenics

  24. Chicago City Ordinance, 1911 “No person who is diseased, maimed, mutilated or in any way deformed so as to be an unsightly or disgusting object or improper person to be allowed in or on the public ways of or other places in this city, shall therein or thereon expose himself to public view.” Repealed: 1974

  25. Belief Systems about PWD over time “To be put away in some mysterious, unknown place as they should” An expression of God’s displeasure; inconsistent with the image of God. Poor Laws established; Worthy vs. Unworthy poor Age of Enlightenment Never mind – Darwinism and Eugenics Lots of discrimination and stigma followed by the rise of the independent living movement and adoption of minority identity.

  26. Rise of the Independent Living Movement • Social revolution of the 1960’s led PWD to demand access to mainstream society • Unrest matured to the development of the independent living movement in the early 1970’s. • Judy Heumann, LexFrieden, Ed Roberts: applied the minority model as a foundation of the political process for gaining civil rights. Source: People with Disabilities and Social Work: Historical and Contemporary Issues, Mackelprang, R.W. & Salsgiver, R.O., accessed at http://www.heart-intl.net/HEART/Stigma/Comp/Peoplewithdisabilities&socialwork.htm, 2012

  27. US Disability Policy Milestones • 1935 - Social Security legislation did not include disability insurance but created state-federal assistance programs that covered certain adults and children with disabilities • 1943 - Barden-Lafollette Act expanded eligibility for vocational rehabilitation services to people with cognitive and psychiatric impairments • 1950 - Social Security Act amendments extended state-federal assistance program to include “needy disabled”

  28. US Disability Policy Milestones • 1956 - Social Security Act amendments created Social Security Disability Insurance to provide cash benefits to eligible workers ages 50 to 64 and adult children of deceased or retired workers if the child was disabled before age 18; later amendments expanded eligibility to younger workers • 1961 - American National Standards Institutes (a private group) set first minimum standards for making buildings accessible for “the physically handicapped” • 1961 - President’s Panel on Mental Retardation was created; in 1963 it called for the deinstitutionalizationof people with mental illness

  29. US Disability Policy Milestones • 1965 - Developmentally Disabled Assistance and Bill of Rights Act passed; Medicare and Medicaid programs established; Older Americans Act included provisions related to frail or homebound older people • 1968 - Architectural Barriers Act required accessibility in construction or alteration of federally owned or leased buildings • 1970 - Urban Mass Transportation Act required local authorities to design mass transit systems to be accessible to people with “handicaps”

  30. US Disability Policy Milestones • 1972 - Supplemental Security Income (SSI) program established a federal needs-based income support program for “aged, blind, and disabled” to replace state-federal assistance program; SSI recipients became eligible for Medicaid in most states • 1972- Medicare coverage extended to eligible adults under age 65 with disabilities • 1973 - Rehabilitation Act shifted priority for vocational rehabilitation to severely disabled individuals, provided civil rights protections(including nondiscrimination in federal programs and in hiring by federal agencies and most federal contractors), and created the Access Board to set facility design criteria and improve compliancewith accessibility standards

  31. US Disability Policy Milestones • 1975 - Educationfor All Handicapped Children Act required free, appropriate public education for children with disabilities and authorized financial incentives to promote compliance • 1978 - National Institute on Disability and Rehabilitation Research and National Council on Disability created • 1984 - Voting Accessibility for the Elderly and Handicapped Act passed • 1985 - Amendments to Title V of the Social Security Act changed terminology related to block grant programs from “crippled children” to “children with special health care needs” • 1986 -Air Carriers Access Act passed

  32. US Disability Policy Milestones • 1986 - Electronic Equipment Accessibility amendment (Section 508) to the Rehabilitation Act of 1973 provided guidelines for federal agency procurement • 1988 - Technology-Related Assistance for Individuals with Disabilities Act provided state grants to promote assistive technology • 1988 - Fair Housing Amendments Act prohibited discrimination in housing against people with disabilities • 1990 - Americans with Disabilities Act provided for inclusion and nondiscrimination based on disability in several areas: employment (Title I); government services (Title II); public accommodations, including medical facilities (Title III); telecommunications (Title IV); and certain other services, such as insurance (Title V)

  33. US Disability Policy Milestones • 1990 - Education for All Handicapped Children Act renamed as Individuals with Disabilities Education Act (IDEA) • 1991 - National Center for Medical Rehabilitation Research created in the National Institute of Child Health and Human Development, National Institutes of Health (1990 legislation) • 1996 - Telecommunications Act of 1996 required that broadcast and cable television provide closed captions to improve accessibility for people with hearing loss • 1997 - Amendments to IDEA supported initiatives for transition services for young people moving from school to adult living • 1998 - Assistive Technology Act established grant program for states

  34. US Disability Policy Milestones • 1998 - Amendments to the Rehabilitation Act required electronic and information technology acquired by federal agencies to meet accessibility standards (regulations issued in 2001) • 1999 - Ticket to Work and Work Incentives Improvement Act provided health benefits and other encouragements for people to work rather than rely on cash benefits and reinforced requirements for federal agency purchase of accessible electronic equipment • 2001 - New Freedom Initiative announced by executive order with a focus on access to assistive technologies, work, education, and other opportunities for people with disabilities • 2004 - Amendments to IDEA called for every state to develop a transition monitoring plan

  35. US Disability Policy Milestones • 2006 – Deficit Reduction Act includes Money Follows the Person – an effort to reduce institutionalization and develop community based LTC • 2007 – Community Choice Act introduced requiring Medicaid to cover community based attendant services and supports. Fails. • 2007 – ADA Notification Act fails. • 2008 – ADA Amendments Act – broadens definition of disability and ensures that medications or other mitigating measures cannot be factors determining if a person is disabled.

  36. US Disability Policy Milestones • 2008 – Mental Health Parity and Addiction Equity Act passes. • 2009 – CCA reintroduced; fails. • 2009 – ADA Notification Act reintroduced; fails. • 2010 – 20th Anniversary of ADA • 2010 – Community First Choice Option – similar to CCA, but encourages state participation instead of mandates.

  37. Disability Rights Movement • Movement gained momentum since 1960’s • Era of radical expansion of inclusive policies and practices: • Education • Housing • Transportation • Public Accommodations • Employment • Vocational Rehabilitation • Universal Design

  38. Disability Rights Movement • Things that were once a dream are ubiquitous: • Curb cuts • Ramps • Architectural Barrier removal • Employment protections

  39. What do all of these recent public policy advances have in common? • They were ALL initiated and/or advocated for people with disabilities who demanded that equitable opportunities be available and conditions of social equality be present. • Each law eliminates some barrier to inclusion. • All are jeopardized if people cannot move freely and independently in their communities.

  40. Lessons from Empowered People with Disabilities When people with disabilities are intimately involved in sociopolitical changes at every stage – including conceptualization, drafting, finalization, passage and implementation – we succeed because we are speaking for ourselves.

  41. Lessons from Empowered People with Disabilities People with different disabilities can and will support the cause of social inclusion regardless of personal impact. Coalitions work!

  42. Community Support • There will be widespread support from consumers in support of Complex Rehab Technology reforms.

  43. A World of Contradictions • In the home vs Administration of Community Living (formed April 16, 2012) • Accessible mass transit vs R&N • Ticket to Work vs R&N • Olmstead vs In the Home • Accessible Pools vs R&N/In the Home • Affordable Care Act EBP vs In the home

  44. Capitol Hill is currently experiencing technical difficulties.

  45. Capitol Hill is currently experiencing technical difficulties. Please stand by.

  46. Political Environment • Great contentiousness and discord between political parties • Congressional job approval rating: 12% (+2%) • 2012 Presidential and Congressional elections • 2013 Budget battles • Widely varying Medicare proposals • Budget Control Act of 2011 • Debt Ceiling increase – Jan 2013 • Social Security Payroll Tax break – Jan 2013

  47. Political Environment - Healthcare • Healthcare expenditures • Affordable Care Act before the Supreme Court • Individual mandate, essential health benefits, Medicaid expansion

  48. Political Environment – Medicare & Medicaid • Physician payment cut and “Doc Fix” • OPT Rehab Therapy payment cap appeals mechanism • Medical device tax – Jan 2013 • Competitive Bidding • Pre-payment Authorization

  49. What happens in Medicare…

  50. What happens in Medicare… frames US healthcare policies in the public and private sectors.

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