Health Care
• expanded state Medicaid coverage for orthotics and protestics.
• established state Medicaid buy-in programs implementing the Ticket to Work and Work Incentives Improvement Act (TWWIIA).
• helped to pass newborn infant hearing screening laws.
• worked to secure Medicare coverage of augmentative communication devices.
  
  Community Living
• encouraged home and community based Medicaid services that include access to assistive technology devices and services and worked to encourage compliance with the Supreme Court's Olmstead decision.
• provided technical assistance to state Medicaid offices for waiver programs that increase state flexibility to offer a broader array of community living options aided by assistive technology devices and services.
  
  Telecommunications
• worked to insure access for people with disabilities to new state information technology services and provided valuable assistance to state information technology officers in complying with Section 508.
• worked to establish a state telecommunications equipment program for persons with disabilities that will provide adaptive telephone equipment, adaptive computer equipment for Internet access, screen reading software and adapted keyboards.
  
  Funding
• helped to secure increased funding for alternative financing programs and low-interest loan programs that allow consumers alternative private means to finance assistive technology and home modifications.
• helped pass sales tax credits for durable medical equipment and assistive technology needed to help employers and employees with disabilities access assistive technology that enables them to obtain or retain a job.
• increased state appropriations for vocational rehabilitation offices to make grants to employers not covered by the ADA to assist them with AT purchases necessary for an employee with disabilities to maintain or obtain employment
  
  Housing
• helped secure state grants for individuals with disabilities to increase accessibility to their homes.
• worked to increase state appropriations for the Independent Living program for purchase of assistive technology devices and services.
• worked to expand senior access to assistive technology devices and services and assisted living options.
  
  Education
• worked to increase state contributions for special education funding including funding for assistive technology.

Considering that many state legislatures only meet a few months out of each year or biannually, the AT Act Projects made considerable progress in increasing access to assistive technology during this period.

2000 STATE LEGISLATIVE AND POLICY REPORT

The AT Act Grantees have worked diligently this year to promote access to Assistive Technology devices and services throughout state systems and in the private sector. Below are highlights of some of this year’s legislative and policy accomplishments. In some states only a little ground has been gained; in others AT Act Projects have helped remove mountainous barriers to access to AT. Much of the work of the projects did not happen over night or within a few weeks. Many times their accomplishments were achieved after months and years or persistence.

Medicaid coverage in Arkansas has been expanded this year. Beginning March 1, 2000, the Arkansas Medicaid State Plan began covering orthotic appliances and prosthetic devices for individuals age 21 and over. The benefit limit on orthotic coverage is $3,000 per state fiscal year and the benefit limit on prothetics is $20,000. Both benefits must be medically necessary and prescribed by a physician. Prior authorization is needed for orthotics of more than $500 and prothestics of $1,000. Orthotics may be replaced every 12 months; prosthetics every 5 years. If replacement for either is needed before the required time period and benefit limits have not been reached, a provider may submit supporting documentation to the Division of Medical Services Utilization Review Section to request additional reimbursement authorization.

Legislative and policy activities in California this year include:

Funding - A $3 million General Fund budget augmentation was approved by the legislature for assistive technology (AT) programs in independent living centers (ILCs). The Governor reduced the augmentation to $2.25 million with future funding to be determined next year. Each of the 29 ILCs will hire an AT Information & Referral Specialist and provide AT services and resource information for consumers. The augmentation also provides the non-profit unit, AT Network, with funds to maintain the AT Network website and AT Services Directory database.

The California Legislature also passed SB 2201 which was signed by the Governor to expand the eligibility requirements for the state’s loan guarantee program to include individuals on the Department of Rehabilitation waiting list under the Order of Selection.

Four bills related to AT have been passed by the legislature and await action by the Governor:

1. AB 2152 - a bill to require Medi-Cal to provide for purchase of durable medical equipment needed to assist a parent or other caretaker with disabilities to care for a child.
2. AB 609 - a bill to require that pupils with exceptional needs who are functionally blind, receive instruction in Braille, unless the IEP team determines this would be inappropriate.
3. AB 496 - a bill to provide for the licensure of home medical device retail facilities and establish standards for such facilities.
4. AB 2697 - a bill to create the Hearing Aid Dispensers Bureau within the Department of Consumer Affairs to administer the licensing and regulatory laws governing hearing aid dispensers.

Medicaid Reimbursement - California’s Protection and Advocacy agency secured an assurance from the State’s Medicaid agency (Medi-Cal) to reimburse wheelchair vendors for their travel time when they respond to emergency requests for repairs. Medi-Cal will meet its commitment by amending its Provider manual to allow for such reimbursements and issuing a notice to enrolled providers informing them of the amendment. This policy change should end current practice by some vendors charging beneficiaries for their travel time.

Medicare - California’s Protection and Advocacy agency has challenged Medicare’s ban on coverage of AAC devices by filing a section 504 complaint with the Office of Civil Rights at the Department of Health and Human Services. In the complaint, it is charged that the AAC exclusion policy has resulted in discrimination against disabled beneficiaries who need AAC devices by denying them full access to the appeals process as afforded by Medicare law to other beneficiaries. This formal challenge is one of the steps being taken aimed at reversing Medicare’s AAC coverage policy. A coalition of advocates and professionals has also formally petitioned the Health Care Financing Administration (HCFA) to cover AAC devices under Medicare. In response, HCFA has removed the existing ban but is yet to add AAC to the list of covered items.

Long Term Care - William Campagna, formerly the Project Director of CATS and currently the Deputy Director of the Department of Rehabilitation's new Independent Living and Systems Change Division, represents the Department on the Executive Committee of the State's Long Term Care Coordinating Council. The Council is providing statewide leadership in developing a coordinated long-term care system that includes a full array of services that promotes personal choice and independence while also assuring fiscal responsibility and equitable access to all long-term care consumers.

Council actions will include modifying, where appropriate, the existing process of assessing individuals residing in institutional settings who wish to transition to a more independent living situation. The Executive Committee is currently organizing Listening Sessions to meet with stakeholders, particularly individuals with disabilities and their families and representatives, to better understand their concerns and the barriers they encounter in accessing services and to engage them as collaborators in planning efforts.

Connecticut adopted web accessibility standards. John Ficarro, Director of the Connecticut Assistive Technology Project served on an interagency sub-committee to develop new standards for accessibility of Connecticut’s website. On the 10th Anniversary of ADA the committee finalized the new standards and presented them to all of the state agencies for a vote. The vote to recommend the new accessibility standards for implementation was unanimous. Under the initiative, state agencies having a presence on the state's website, ConneCT, will incorporate the World Wide Web Consortium's (W3C) Web Content Accessibility Guidelines (WCAG) 1.0, which are among "the most stringent accessibility standards available today" (From the WYFIWYG Newsletter, "Connecticut State Web Site Becomes Accessible.")

Tax Exemption - A state sales tax exemption was reintroduced and died again this year, H.R. 46. A vendor of wheelchairs was advocating for its introduction and passage. A year ago the Georgia Tools for Life Project helped the vendor by gathering information about other sales tax exemption laws passed or in the works in other states and sought unsuccessfully to persuade other advocates supporting the bill to consider a broader exemption to cover all assistive technology over $1,000.

The Spinal Cord and Brain Injury Trust fund legislation which passed the year before last, was amended this year, SB 480. The original law, established a trust fund and funding stream for victims of traumatic brain injury and spinal cord injuries from DUI penalties. The original bill failed to include the Probate Courts as a point of collections for DUI add-on penalties. Passage of SB480 now requires that ALL courts collect the additional fines on DUIs.

The Consortium of AT Resource Centers achieved a budget line item of $150,000 that will be included every year in Georgia's state budget. The Georgia Tools for Life Project plans to return to the legislature next year to seek an increase in the appropriation for the AT Resource Centers to $300,000 annually.

The Hawaii Assistive Technology Project had several bills in its legislative package this year including a bill to specifically designate Assistive Technology Resource Centers of Hawaii as the official AT organization for the State of Hawaii. Other bills in the package addressed specific issues such as transition of assistive technology, AT loan programs, "person first" language relating to disabilities, small business development, and inclusion of AT language as needed in administration measures. While none of the measures passed this year, most had several successful hearings laying the ground for further action next year.

The Idaho Assistive Technology Project was involved in several legislative initiatives this year.

Health Care - In April, Idaho’s Governor Dirk Kempthorne signed HO750 into law. This legislation established an Individual High Risk Reinsurance Pool to provide health insurance coverage to high-risk individuals regardless of health status or claims experience. The pool will also receive funds from a diversion of 25 percent of net premium tax funds received above $45,000,000. The legislation continues the current small employer reinsurance mechanism.

Building Codes - HO 611, a bill to address a lack of accessibility standards in Idaho building codes, was passed and was signed by the Governor in April. This bill mandates that counties adopt fair housing and ADA standards into their building codes and includes provisions for enforcement.

Adoption - S 1526 was introduced and would have impacted parents with disabilities by removing discriminatory language in Idaho Code. This bill was held in committee but the Idaho Assistive Technology Project promises, "we will be back next year to try again."

Funding – The project began an initiative to secure $1.5 million dollars for assistive technology utilizing the un-obligated TANF (Temporary Assistance to Needy Families) funds available in Idaho. These funds would be used to fund AT and other support services for families in which one or both parents have a disability). [The proposal is still in the works, and it looks like funding will be received which will be operated by the AT project.]

Olmstead Implementation - The Idaho Assistive Technology Project continued to object to plans by the Department of Health and Welfare (DHW) to build a large, centralized publicly operated ICF/MR (Intermediate Care Facility for the Mentally Retarded) at the Idaho State School and Hospital. The Idaho project has been working for years to convince the DHW to increase their capacity to deliver home and community-based services, and has won several battles in terms of getting waivers implemented, and policies changed. The DHW has created a new waiver for older persons with provisions related to AT and home modification. This year the legislature decided to create an interim committee to examine long term care issues. However, this committee ended up deadlocked and did not make a recommendation to the legislature before the end of the session. Because of deadlock, DHW gained passage of the proposal to build a 60-bed facility at the state hospital. Idaho Director, Ron Seiler calls such a development "a disaster", if you believe that any person with a disability can be supported to live in their home and community with assistive technology."

Telecommunications - The Idaho Assistive Technology Project was also involved in drafting and attempting to gain passage of a telecommunication equipment distribution bill. This bill was never printed.

AT Tax Credit - Assistive Technology Tax Credit Bill was passed by the Iowa Legislature and signed by the Governor as part of the Omnibus Tax Bill, HF2560. The bill provides a small business tax credit for businesses not required to comply with the ADA. It provides for 50% of the first $5,000 of the cost for purchasing or renting an assistive technology device or making workplace modifications for employees with disabilities. There are approximately 70,000 businesses in Iowa with 20 or fewer employees or approximately 90% of Iowa businesses. Numbers are not available regarding businesses with 14 or fewer employees or gross receipts from the preceding tax year of $3 million or less (noncovered entities under ADA, but covered by this bill).

Assistive Technology Savings Account as part of Medicaid Buy-in Program - The legislation for a Medicaid Buy-in Program was passed in 1999. The Iowa project provided technical assistance for the regulations regarding the Assistive Technology Savings Accounts that were enacted and went into effect this year. Under this program, an individual can put funds into the account to purchase or lease assistive technology and the funds will not be counted as "resources" in determining the individual's eligibility for the Medicaid buy-in, know in Iowa as Medicaid for Employed Persons with Disabilities. A physician, certified vocational rehabilitation counselor, licensed physical therapist, licensed speech therapist, or licensed occupational therapist must establish the need for the technology and that the technology can reasonably be expected to enhance the individual's employment. Note this is generally assistive technology not otherwise covered by Medicaid.

Senior Living Act - SF2193, (formerly the Long Term Care Act) - The goal of the Act is to create a comprehensive long-term care system that is consumer-directed and balanced between the alternatives of institutionally and non-institutionally supplied services. The bill creates a trust fund that appropriates up to $65 million over five years to be used to provide services under the Act. The bill establishes a grant program for nursing homes converting to assisted living. It also provides for the Department of Elder Affairs to use funds to design, maintain and expand home and community- based services for elders and persons with disabilities. The bill authorizes the state to secure PACE grant funds.

One Stops - The budget for the Department of Economic Development, SF 2428, provides money for the Information Technology Services Division to study Iowa Workforce Development's "one-stop" program.

Human Services Budget - SF2435. This bill provided for the increased costs associated with the Medicaid Buy-in program. It recommends using tobacco funds to: expand long-term care alternatives, eliminate excess paperwork and delays in the state CHIP program (HAWK-I); expand home health care and habilitative day care for special needs children; and to extend supported employment in the Medicaid BI and MR Waivers.

Changes in Medicaid Waiver Programs – The Iowa project has provided and continues to provide technical assistance regarding waiver services and programs. Proposed rules have been submitted which remove the 30-day institutional stay requirement for eligibility for the Brain Injury Waiver and the Physical Disability Waiver. Pending the rule change, the Department of

Human Services has issued Guidelines for consumers to request a waiver of the 30-day stay requirement. The Medicaid Waiver programs in general provide a way for individuals with disabilities to gain access to a wide range of assistive technology devices and services.

Olmstead Implementation – In April, the Illinois Assistive Technology Project (IATP), working with the Statewide Independent Living Council and other disability organizations, helped pass a unanimous resolution, HR 765, in the Illinois House of Representatives, directing the Department of Health and Human Services to develop a comprehensive plan to implement the "most integrated setting" requirement of the Americans with Disabilities Act as required under the Supreme Court’s decision in Olmstead v. L.C. This fall, the Illinois Senate expects to consider an identical resolution.

HB 1443, a bill that requires Illinois Department of Human Services (DHS) to maintain waiting lists for a variety of community services, including Community Integrated Living Arrangements (CILAs), supported employment, supported housing, and developmental training, unanimously passed the House in the Spring of 1999 and has been pending in the Senate ever since. It is unlikely to be heard this year. The Governor and DHS have opposed the idea of waiting lists. In light of the Supreme Court's decision in Olmstead, waiting lists now become part of a more comprehensive set of plans regarding community-based supports.

Health Care and Employment – In taking advantage of provisions in the Ticket to Work and Work Incentives Improvement Act (P.L. 106- 170) passed last year, the Illinois Omnibus Budget Bill, HB 4588, contained provisions authorizing the Illinois Department of Public Aid (IDPA) to establish a Medicaid Buy-In program by administrative rule. The final budget included $10 million for this program that will allow working people with disabilities to enroll or remain in Medicaid by paying co-payments or premiums once their incomes reach certain levels.

Medicaid – Also passed as part of the Illinois Budget Implementation bill, HB 4588, was a phased-in increase in the Medicaid income-eligibility threshold for seniors and individuals with disabilities. (HB 3872). Currently, the "non-spend down" eligibility threshold is 41 percent of the Federal Poverty Level. Over the next three years, it will increase to 100 percent, (70 percent in FY 2001, 85 percent in FY 2002, and 100 percent in FY 2003).

Service Providers – The final budget includes a 2.5 percent Cost of Living Adjustment (COLA) for Human Service providers, including nursing homes. This takes effect on July 1, 2000. Beneficiaries of this increase include Centers for Independent Living and community based providers of services to persons with developmental disabilities and mental illnesses.

The budget for state fiscal year 2001 includes funding for a $1.00 per hour wage increase for personal attendants in the Home Services Program. This change is effective July 1, 2000. Budget negotiators moved up the effective date of the wage increase by six months.

Funding –Unfortunately, IATP was unsuccessful in getting money in the budget for new assistive technology initiatives. However, discussions with the Governor's office are ongoing and they are hopeful that something will be accomplished very soon.

SB 1317 protects funds of individuals with developmental disabilities. Signed by Illinois Governor George H. Ryan in June, it applies to counties with property tax caps that have an assessment for funding services for individuals with developmental disabilities. Currently only two counties meet this description, but the number of such counties could grow in the future. The intent of the bill is to protect the funds from being used by the counties for purposes other than for services for individuals with developmental disabilities.

Kentucky Assistive Technology Services Network (KATS) helped to successfully pass an "Information Technology" Bill through an amendment to SB 315, a larger bill to create the Governor’s Office of Technology.

The amendment requires state and state-assisted entities to insure that information technology equipment and software used by the entities provide access to blind and visually impaired, and deaf or hard of hearing individuals. It requires technology-access clauses in contracts for the purchase of information technology and requires the state Finance and Administration Cabinet to develop the contractual language and non-visual access standards. It also establishes that existing equipment, when upgraded, be brought into compliance and would permit a person injured by a violation of access requirements to seek injunctive relief. In April, Kentucky’s Governor, Paul Patton, signed the bill into law including the amendment.

Health Care – Out of Maine’s portion of the Tobacco Litigation settlement, several programs were funded including:

$4,800,000 to expand home-visiting services to parents of newborn infants;

$2,600,944 in additional infant, toddler and preschool childcare subsidies;

$1,196,422 for additional school-age childcare subsidies;

$1,792,873 for incentives for odd hour childcare in underserved areas to at risk; children including those with special needs;

$489,268 to support child care resource development centers.

Maine’s budget also included $596,000 to provide access to Medicaid for pregnant women and $303,323 to fund the costs of expanding eligibility for the State Children’s Health Insurance Program (SHCIP) to children under one year of age.

Details are available on the web at: http://www.state.me.us/legis/ofpr/tobacco.htm.

Massachusetts concluded the second year of a two-year session this year. Several AT related bills fell victim to a debate over Fenway Park.

Deaf-Blind Consumers - A success in this year’s session included the establishment and funding for a community-based program for Deaf-Blind consumers that includes provision of AT for independent living among its services. According to Carol Menton, Policy and Funding Specialist, "the Deaf-Blind population has been vastly underserved, so this is real progress! "

Education – The Massachusetts Legislature considered several special education reforms. One of the most contentious arguments in the debate on special education reform concerned the standard of service to which public schools are held. When a child has an Individual Education Program (IEP), Chapter 766, the Massachusetts special education law, requires that the IEP be designed to develop the student's educational potential to the "maximum extent feasible." This requirement is most often referred to as the maximum feasible benefit (MFB). The federal special education law, under the Individuals with Disabilities Act (IDEA), has a service standard, which is lower than the Massachusetts standard, requiring only that students receive an education, which is "free and appropriate."

The Massachusetts House inserted language into its FY 2001 budget that would eliminate the "maximum feasible benefit" standard, and eliminate independent evaluations at no cost to parents, among other things. In conference committee, despite strong advocacy by parents and advocates, the Massachusetts Senate adopted much of what the House proposed including elimination of the MFB standard, However, independent evaluations would be offered on a sliding scale fee. These changes will take effect in September of 2002. The Massachusetts Assistive Technology Project and other advocates plan to file new legislation next year, before the effective date of the changes, to restore the MFB standard and increase the state's contribution for Special Education funding to school districts.

Minnesota's systems change activities this year included:

Hearing Aids and Eye Glasses – STAR participated in a coalition coordinated by the Commission Serving Deaf and Hard of Hearing People to obtain insurance coverage for hearing aids and eye glasses for persons who are deaf or hard of hearing if dependent on visual communication such as lip reading or sign language.

AT Specialist - STAR drafted recommendations for AT Specialist qualifications as a consumer protection and quality assurance. This guidance, developed by a taskforce of AT Specialists and state therapy association representatives knowledgeable about AT, will be posted on the Minnesota STAR project website. STAR’s next step is to work with the Policy Specialist and Community Supports for Minnesotans with Disabilities division at the Department of Human Services to address reimbursement issues. The project is following the lead of New Hampshire by requesting a rate of $150/hour for AT Specialists. Waiver programs currently reimburse AT Specialists at varying rates and pay for devices necessary for independent living in addition to medically necessary AT within their allowances. NOTE: This is not a licensure or credentialing level activity.

Children’s Issues - STAR assisted in providing a consumer voice through committee membership via TechKids, STAR's listserv for Minnesota families with children with disabilities. For example, STAR recruited consumers/families to participate in Medicaid Advisory Committee Meeting where consumer participation is required by HCFA.

STAR will also be promoting Cash grant options for families with disabilities on Minnesota Health Care Programs to enable them to purchase assistive technology devices and services.

STAR has been supporting federal legislation that will allow parents of children with disabilities to be paid for the Personal Care Assistance services they provide due to the workforce shortage.

Telecommunications – SB 721. With this Act, Missouri becomes the first state to have a telecommunications equipment program for persons with disabilities that provides not only adaptive telephone equipment, but which will also provide adaptive computer equipment for internet access. Items such as screen enlarging software, screen reading software, and adapted keyboard are examples of adaptative computer equipment that will be available. The bill also transferred administration of the telecommunications equipment program to the Missouri Assistive Technology Council. Adaptive equipment needed by persons with all types of disabilities will be available. Another key component of the bill mandates that a system of consumer support be available in the program to assist consumers in areas such as in selecting, installing, or training needed to use the adaptive equipment.

Low Interest Loan Program for Assistive Technology – SB 721. Another section of SB 721 establishes a low-interest loan program to assist Missourians finance needed assistive technology devices and services. The law mandates that interest rates for loans be lower than comparable commercial lending rates. Rules for the program will be promulgated by the Missouri Assistive Technology Council. The legislature also approved a one-time appropriation of $500,000 to help capitalize the program.

Blindness Assistance Program – SB 721. Another section of SB721 creates a Blindness Education, Screening, and Treatment Fund. The bill provides that applicants for registration of motor vehicles and drivers’ licenses may donate one dollar to the fund. Monies in the fund may be used to provide eye screenings and treatment to prevent blindness.

Tax Credits – The Missouri Assistive Technology Project worked this year to pass a tax credit for durable medical equipment and other assistive technology. The bill, SB 1371, was recommended for passage by Committee but did not pass before the end of the session. Another bill, HB 1950, which would have given tax credits to homebuilders that included certain accessibility features, also received a hearing but did not pass in this year’s session.

Education - This bill, which did not pass, would have established a grant to fund a training program for parents of special education students. The training would help parents learn about special education policies and resources, including those related to assistive technology.

Higher Education – HB 2062. This bill, which did not pass, would have required colleges and universities that offered American Sign Language courses to treat the courses the same as foreign language courses for purposes of granting college credits or accepting credits from other institutions.

Health Care – HB 1874 . A bill to require insurance coverage of hearing aids received a hearing but did not pass this session.

Appropriations – $50,000 was appropriated to HB201, a bill passed last session, to implement a system to insure that information technology purchased by state agencies will be accessible to persons with disabilities.

Macular Degeneration- HCR4. This bill passed to establish a legislative interim committee to study, and make policy recommendations, including those related to assistive technology, on Macular Degeneration.

Building Codes - SCR38. This bill passed to extend the authorization for the Building Code Commission established last year that is reviewing alternatives for implementation of a single building code in Missouri. The Commission includes a representative of the Governors Council on Disability among its membership.

Infant Hearing - LB 950, sponsored by Sen. Dennis Byars, passed during the last legislative session. The bill requires hospitals and other birthing facilities to phase in a system of newborn hearing screening. Nebraska’s Department of Health and Human Services (HHS) will assist in the development of recommended screening and be required to establish a tracking system for infants with a hearing loss.

Beginning Dec. 1, 2000, birthing centers will be required to report specific information on hearing screening to the HHS. This information will include infants who return for a follow-up hearing test and the results of those tests. Beginning Jan. 1, 2001, every birthing facility will be required to educate parents of newborns about the importance of receiving a hearing screening test and any necessary follow-up care. Before Dec. 1, 2003, if the number of newborns receiving a hearing-screening test does not equal or exceed 95 percent of the total number of newborns born in the state, HHS will adopt regulations to implement a hearing-screening program.

The bill also requires all birthing facilities, effective Dec. 1, 2003, to include a hearing screening test as part of their standard care for newborns and establishes a mechanism for compliance review. Health insurance coverage for hearing screening tests will be allowed to require co-payments, coinsurance, deductible and dollar-limited provisions. LB 950 was passed by a 39-1 vote.

Technology Access – As part of bill LB 352, language was included requiring all state agency contracts after Jan. 21, 2001, to include a technology access clause, which will provide for equal access to technology for visual and non-visual use. LB 352 was passed by a 37-10 vote.

Housing – The Nebraska Assistive Technology Partnership, working with members of a broader coalition called Home of your Own (HOYO), tried to expand the Nebraska Homestead Exemption for persons with disabilities, thereby decreasing property taxes and increasing the long-term affordability of housing. LB 1358 would have changed the definition of "permanent disability" for purposes of qualifying for the exemption to "any physical or mental impairment that is permanent, that reflects the need for permanent assistance and support, and that results in substantial functional limitation of at least three of seven major life activities. The seven major life activities are self-care, receptive and expressive language, hearing, seeing, learning, walking, and working. Substantial functional limitations would have meant the person was unable to perform the activity, or could only perform the activity with the help of durable medical equipment, assistive technology, a prosthesis, or help from another person. Mark Schultz, Executive Director of the Nebraska Assistive Technology Partnership testified on the bill before the Revenue Committee.

Supportive Housing – The New Jersey Division of Mental Health Services recently drafted regulations for new standards for the licensing of "Supportive Housing" and revised the standards for Community Residences for persons with a mental illness. Following several meetings with consumers and advocates to review the draft, NJP&A offered several recommendations for changes or additions. DMHS accepted NJP&A’s revisions and implemented them into the final draft of the publication entitled Division on Civil Rights, Access to Public Accommodations.

Federal Medicare Reform – NJP&A staff attended a Medicare Press Conference with Congressman Rush Holt (13th District) to discuss Congress' attempts to reform Medicare coverage of Assistive Technology and prescription drugs. Staff participated in a question-and-answer session with the Congressman.

Health Care Appeals; Binding Independent Review – Written testimony was provided to the Senate Health Committee that supported S-2123, that makes decisions rendered by the Independent Health Care Appeals Program binding on insurance carriers.

Expansion of VR Advocacy – Comments were submitted to USDOE, RSA, regarding a proposed program that would provide money for a Client Assistance Program short-term training grant.

Restraint and Seclusion Standards – Comments were submitted to the Joint Commission of Accreditation of Health Care Organizations (JCAHO) regarding Restraint and Seclusion Standards. JCAHO monitors the provision of services in all hospitals nationwide, including state-run psychiatric hospitals.

Medicaid External Review – Comments were submitted to the U.S. Health Care Financing Agency (HCFA) regarding its recent Notice of Proposed Rulemaking regarding External Quality Review of Medicaid Managed Care Organizations.

Appropriations –NMTAP through its Coordinating Council with consumer representation and representation from other state agencies, commissions and nonprofits introduced and worked to pass HB 53 which resulted in a special appropriation of $48,700 to purchase assistive technology to expand the NMTAP Assistive Bank of Loan Equipment (ABLE) to serve students transitioning from school. All state funds for FY2000 expenditures had been used. With the new appropriation, NMTAP was able to provide assistive technology devices and services to 9 students who upon leaving school would not have received these services. They are currently in the process of documenting the students’ use of AT loans and benefits to them.

The New Mexico Protection and Advocacy System also tracked more than 70 bills this last session dealing with a broad range of disability and health care issues. Below are a few of the highlights.

Newborn Infant Hearing Screening – S 172, a bill to adopt rules requiring that all newborns in New Mexico be screened for possible hearing loss or deafness, and an appropriation of $100,000 to carry out the program was tabled in the Senate Finance Committee.

Definition of "Medical Necessity" – While no specific legislation was introduced, State Rep. John Heaton, offered a "memorial, HJM 16 (an expression of legislative desire, usually addressed to another governmental body in the form of a petition or declaration of intent) calling for a study of how the concept of "medical necessity" is applied by insurance companies. Specific health care services, including access to assistive technology, are often denied by both private insurers and state Medicaid or Medical Assistance programs on the basis that the service is not medically necessary. The memorial passed in the New Mexico House but died in a Senate filibuster.

Olmstead – Another New Mexico memorial, HJM 44, noted the lack of a coordinated system and bias toward institutional care and called on the interagency committee on long-term care to undertake a series of tasks toward development of a community-based, consumer-directed system for long-term care and to report recommended actions to the legislature. Again, this memorial passed in the New Mexico House but died in a Senate filibuster.

Employment – The New Mexico Legislature appropriated 1.4 million for implementation of a Medicaid buy-in for working adults with disabilities up to 250 percent of the federal poverty level.

Community Living – A memorial HJM 64, would have asked the Governor’s Council on Concerns for the Handicapped to establish a task force to develop recommendations for legislation in the 2001 that would require a minimum level of accessibility for all new homes constructed in the state. "Visitability" is already required for new apartment complexes. The memorial passed in the House, but did not advance in the Senate Committee on Corporations and Transportation.

Health Care - The Senate adjourned without passing a Patients’ Bill of Rights, which would authorize lawsuits against health-maintenance organizations (HMO’s) arising from disputes over insurance coverage.

Other health care issue activities of the New York TRAID project included:

Working with providers to identify problems with Medicaid process for funding assistive technology devices. These issues were collated and presented to the Medicaid office.

Reviewing proposed changes to the structure of the New York’s Children’s Health Insurance Program to determine the impact on children with disabilities.

Reviewing and submitting comments to the Heath Care Financing Administration to assure the process for determining coverage policies allows more opportunity for assistive technology to be covered.

Providing input on the development of a report to the state legislature recommending ways to address the healthcare needs of individuals with disabilities being served in managed care arrangements.

Participation on a Department of Health workgroup developing a uniform application process and guidelines for consumers applying for home modification services under New York’s Care at Home, Medicaid Waiver.

Education - Submitted comments on the state's Special Education regulations to assure better access to assistive technology.

Employment - Submitted comments on regulations governing vocational rehabilitation services for individuals to the Rehabilitation Services Admininstration.

Medicaid - HB2019 "Oklahoma 2001 Healthcare Initiative," provided an additional $46 million of state funds (which came from the Tobacco Settlement Fund) into the Medicaid appropriations to receive a 70% federal match. The new money will upgrade the Medicaid system for Oklahomans in many ways. The list below is just a few of the changes in the law that provide:

• durable medical equipment to persons over 21
• rate increases to many providers
• an increase of hospital inpatient day limit from 12 days to 24 days per year
• an increase in the home and community based waiver to include persons that are developmentally disabled persons without cognitive impairments
• an increase in funding for a home and community based waiver for children and adults with mental retardation
• eyeglass and denture services for nursing home clients
• pharmacy benefits for QMB recipients, and
• personal needs allowance increases for nursing home residents from $30.00 to $50.00

Managed Care A series of three different bills passed that provided some level of a "Patient Bill of Rights." HB1681 –The law requires a Managed Care Organization (MCO) to provide a specialist and if a specialist is not in the network, then the MCO must refer a patient to the needed specialist. It also outlines that the specialist can become the Primary Care Physician. Both physician and specialist can develop a treatment plan as needed by the patients and if continuing care is necessary there can be a standing referral to the specialist.

HB 1826 – Created an "Oklahoma Managed Care External Review Act." Once an enrollee of a MCO has exhausted the internal review process an external review can be requested.

SB 1206 – Health Care Liability Act. This law gives an enrollee of a MCO the "right to sue" for delay or denial of covered benefits. The law excludes from liability an employer who purchases health insurance from a MCO directly or through an employer purchasing group. An enrollee must have "suffered harm" in order to sue and they must have exhausted all internal and external reviews.

Due Process - HB2356, created a "Complaint Review System Task Force for Persons with Disabilities." The 20-member task force is to undertake a thorough review and study to determine how complaints regarding access to programs and services for persons with disabilities are handled and resolved by various state entities. The membership will comprise of persons with disabilities, several state agencies and ABLE Tech Program Manager Linda Jaco.

Infant Hearing - HR1045, a resolution urging parents of newborn babies to have their hearing tested passed.

Sales Tax - SB1125, a bill proposing a Sales Tax Exemption for Durable Medical Equipment passed in both the House and Senate subcommittees, but due to language changes stalled in Conference Committee. A DME tax relief bill will be reintroduced in the next session.

The Pennsylvania Initiative on Assistive Technology (PIAT) working with the Disability Budget Coalition and the Self-Determination Housing Project was successful in securing AT related appropriations in Pennsylvania’s FY2000-2001 state budget.

Employment - $1,030,000.00 was appropriated to the Department of Labor and Industry, Office of Vocational Rehabilitation for grants to employers whose businesses are not otherwise subject to Title I of the ADA to purchase AT necessary to employ or maintain employment for a person with disabilities.

Alternative Financing - $300,000.00 was appropriated to the Pennsylvania Department of Community and Economic Development, through a contract with the Pennsylvania Assistive Technology Foundation, for state guarantee funds for low-interest loans for the purchase of assistive technology by Pennsylvanian’s with disabilities.

Housing Access Grants - $1,850,000 was appropriated to the Pennsylvania Department of Community and Economic Development for a new program to provide grants to eligible applicants including, redevelopment authorities and municipalities to help low and moderate income persons with permanent disabilities increase accessibility to their homes.

Insurance - PIAT staff working with a coalition of human service advocates was able to include assistive technology as a benefit to be offered in any health insurance policy for uninsured adults under a new coverage proposal derived from Pennsylvania’s share of the tobacco litigation settlement.

Sales Tax Elimination – HB159 PIAT staff worked to provided testimony on the importance and impact of the elimination of state sales tax on access to assistive technology.

Health Care - PIAT staff participated in a coalition supporting funding for newborn infant hearing in the state budgets for 2000 and 2001. Through staff membership on the Maternal and Child Health Advisory Committee of the Pennsylvania Department of Health, infant hearing screening was included in the state’s Title V Work Plan. From October 1999-March 2000, over 1000 infants were screened through 27 participating hospitals with the aid of small start up grants. Of the infants screened118 were referred for follow-up services. The Pennsylvania SFY 2001 budget increased funding for this program from $200,000 to $750,000. PIAT staff working with the PA Speech-Language Hearing Association also advocated for the addition of universal newborn hearing screening to a variety of bills addressing neonatal testing.

Community Living - PIAT staff also provided testimony to the Pennsylvania House Committee on Aging regarding the importance of including assistive technology devices and services in the provision of Assisted Living Services for seniors.

PIAT staff also provided testimony at a hearing and press conferences on the importance of family support legislation, which passed out the House Health and Human Services Committee.

The South Dakota AT Project, Dakota Link, tracked a number of bills through this year’s legislative session. A listing of bills of interest that passed is available on Dakota Link’s website.

South Dakota was able to secure a set-aside of $1,000,000 for devices and $250,000 available for AT services for a Neuromuscular Program to provide assistive devices and services to South Dakotans with severe neuromuscular disabilities that substantially limit major life activities in order for individuals to live more independently in their homes or communities. In subsequent years, a total of $250,000 for devices and services will be available.

Health Care – South Dakota passed a managed care reform bill this session, HB 1032 . Among other things the bill requires health insurance carriers to provide enrollees with specific information on coverage provisions and also requires that they notify enrollees within two days of any coverage decision.

Technology HB1257. According to Project Director Dave Vogel, among other things, this bill establishes an Office of Educational Technology. The Office of Educational Technology is required to assist local school districts in using educational technology including researching, analyzing, procuring, and distributing programs and methods using educational technology in South Dakota K-12 schools and classrooms. In addition, the State Board of Education and the Department of Education and Cultural Affairs will work jointly with other state government agencies to develop standards and practices that ensure that, by the third grade, all children, to the best of their abilities, have learned fundamental reading, mathematics, language, science, and technology skills that form the foundation for further learning.

The Second Session of the 101^st Tennessee General Assembly concluded in June.

Olmstead Implementation - SB 2847, signed by Tennessee Governor Don Sundquist in June, requires the Department of Mental Health and Mental Retardation to make available home and community-based services and supports for the next five years. The bill also creates a new 18-member commission that is charged with the creation of a strategic plan for the Governor’s review by November 1, 2000.

Community Living – SB 3060, the "Tennessee Americans with Disabilities Act of 2000" to create the office of Tennessee Americans with Disabilities Act Compliance within the Tennessee Human Rights Commission was recommended for passage but failed in the Senate. Under this bill, the Compliance Office would: 1) account for the Tennessee Americans with Disabilities Act; 2) serve as an informational clearinghouse on compliance of this bill; 3) operate a toll-free telephone line for Tennessee Americans with Disabilities Act-related assistance; and 4) provide an ombudsman program.

Health Care – SB 0031 required hospitals and the Department of Health to screen newborn infants for hearing loss. It also required some insurance policies to cover screening. If providers fail to screen, they could be charged with a Class C misdemeanor. This bill was withdrawn.

Information on specific bills is available at: http://www.legislature.state.tn.us/

Utah

Information Technology - The Utah Assistive Technology Project has been proactive in working with the Chief Information Officer (CIO) and the state Division of Purchasing to ensure that Section 508 guidelines applying to states are appropriately implemented. Utah AT project staff collaborates with the CIO office to ensure that web design guidelines in Utah for all e-commerce and state government sites are accessibile to individuals with disabilities. The Division of Purchasing agreed to comply with Section 508 in 1994. Guidelines are now being developed to ensure that state information technology purchases meet Section 508 guidelines.

Funding - In collaboration with the Legislative Coalition for People with Disabilities, Utah added $150,000 of state-appropriated funds to the Independent Living program for the purchase of assistive technology devices and services.

A revised interagency memorandum of agreement that provides for cost sharing received final approval and signatures by all directors of state agencies who serve individuals with disabilities in Utah. The final approval in this process is the result of several years work and opens the door to a statewide implementation plan that will enable individuals to acquire needed assistive technology using multiple funding sources.

System Improvement -The Management and Implementation Board of the Utah Assistive Technology Program, comprised of directors of state agencies who serve individuals with disabilities, participated in an 18-month long strategic planning process. This effort culminated in a statewide plan outlining an ideal state system for the provision of assistive technology. The system will be developed by first revising existing policy and procedure and then by modifying regulations. If necessary, legislative activities will be undertaken to implement the system in Utah. State agencies such as the Utah State Office of Education, Utah State Office of Rehabilitation, Division of Services for People with Disabilities, and the Utah Department of Health have all participated in the development of this document and agree in principle to the establishment of the AT system.

During the 2000 legislative session, the Washington Assistive Technology Alliance tracked several state bills of interest to AT users.

Health Care – Patients’ Bill of Rights (2SB6199)

After two years of debate, the Senate version of the Patients’ Bill of Rights passed the full House on March 3 on a vote of 98-0; and was signed by Governor Gary Locke on March 15. The bill requires health carriers to: 1) protect consumer health information; 2) offer to disclose information regarding covered benefits, drug formularies, exclusions, reductions and limitations to covered benefits prior to selling policies; 3) provide access to primary and appropriate specialty care providers; 4) maintain a documented utilization review program description and make clinical protocols available upon request; 5) establish a grievance process and retain records of grievances for three years; 6) provide for a secondary review process of health care decisions through the use of an external independent review board once internal appeals are exhausted; and 7) designate a Medical Director who is a medical doctor. Patients are allowed to sue health plans under the bill for harm proximately caused by the failure of the insurer to follow the accepted standards of care for health care providers. The bill also eliminates retroactive denials of pre-authorized claims. A majority of the provisions were effective July 1, 2001.

Medicaid Assets Test - Engrossed HB 2686

This bill allows the Department of Social and Health Services (DSHS) to ignore asset limits for families who are renewing their Medicaid eligibility, a process required every six months. With the passage of this law, adults who receive family-related medical benefits will no longer have to provide continued proof of their assets (such as cars and savings accounts) when renewing their Medicaid coverage. It was found that it was unusual for recipients, who must have incomes below the poverty level, to have assets that disqualify them from Medicaid. Removing this barrier will streamline the renewal process and reduce administrative costs. The bill also required DSHS to convene a stakeholders group including recipients of public assistance to establish basic customer service performance measures and goals including services for families with special needs.

Employment – The state’s final budget included the following language regarding implementation of the Ticket to Work and Work Incentives Improvement Act. (P.L. 106-170).

" $18,000 of the general fund--state appropriation for fiscal year 2000 and $36,000 of the general fund--state appropriation for fiscal year 2001, for the Institute for Public Policy to identify and assess options for expanding Medicaid eligibility in accordance with H.R. 1180, the federal ‘Ticket to Work and Work Incentives Improvement Act of 1999.’ The assessment shall identify potential state costs and savings and potential participant and public benefits, under alternative eligibility standards and participant cost-sharing requirements. In conducting its analysis, the Institute shall consult with the Governor's Committee on Disability Issues and Employment; the Department of Social and Health Services, other states that have enacted or which are studying similar expansions; and the federal Social Security and Health Care Financing Administrations. The Institute shall report its findings to the Health Care and Fiscal Committees of the legislature by November 1, 2000."

Personal Attendant Services – The Division of Rehabilitation Services (DRS) requested and obtained a $150,000 increase in funding for personal attendant bringing the line item to a total of $300,000.

Certificate of Need – Qualified Medicaid recipients can now avoid a lengthy Certificate of Need process. Legislation passed to make the qualification process faster. This will attract more service providers from which to choose and ensure greater access to services.

CHIPS – Legislation expanded the eligibility for the Children's Health Insurance Program to 200 percent of the federal poverty level. Now a family of four earning as much as $34,000 will be eligible for CHIPS services. It is expected that an additional 14,000 children will be covered under this expansion.

Medicaid Waivers – No legislation was passed this year to expand the two current Medicaid waivers or to add a new Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI) waiver, although key legislators agreed to further explore waiver possibilities. Currently waiver funds have a 3 to 1 match with federal funds and can be used for home modifications.

Information Technology – The information technology bill did not pass this year. It would have required technology purchased by the state to be compatible with software accessibility features and programs to make them accessible to individuals who are blind and visually impaired.

Information on specific legislation for West Virginia is available at http://129.71.161.247/bill_status/2000/bstat_menu.html

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