August Washington Update

August 14, 2017                                                                Volume 23, No. 8

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The Government Relations staff is still looking for stories about problems that our members have experienced during air travel.  Please visit www.AirAccess30.org and share your story. 

Congress Approves Choice Funding Extension

Prior to leaving for the August recess, the House of Representatives and Senate approved legislation that would provide additional funding to keep the Department of Veterans Affairs (VA) Choice program operating. Due to significant increases in utilization of the Choice program over the last 6 months, the VA faced the prospect of the program running out of funding by August 15th. In an effort to relieve that problem, Congress approved a bill that provides approximately $2.1 billion to keep the Choice program running for an additional six months. The bill also includes funding to open 28 capital leases that have been held up for budget reasons for nearly two years, as well as provisions to improve workforce innovation, recruitment and retention of providers in the VA health care system.

Unfortunately, Congress will be forced to deal with this issue again six months from now. A long term solution for how VA will manage its community care programs, which includes the current Choice program, has not been finalized. Meanwhile, the House and Senate Committees on Veterans’ Affairs are already developing their own legislative solutions to community care. They range from VA coordinating all community care decisions to veterans having unfettered choice to decide when and where they will seek care.

PVA has already testified on a couple of occasions this year on the future of the Choice program. In the spring, the VA unveiled its own C.A.R.E. program that it hopes to make the basis of all of its community care going forward. However, much work remains to reach a consensus on the final program, to include how VA will invest in and sustain its “foundational commitments” (spinal cord injury/disease care, blinded rehabilitation, prosthetics, etc).

Congress Approves Permanent Change to the Post-9/11 GI Bill

The latest update to the Post-9/11 GI Bill made its way through Congress prior to the August recess and now awaits the President’s signature. The “Harry W. Colmery Veterans Education Assistance Act of 2017,” wielded strong bipartisan support throughout both chambers of Congress allowing the bill to be fast-tracked to the President’s desk. After a unanimous vote in the House, the Senate followed suit by passing the bill by voice vote.

The bill’s namesake, the Forever GI Bill, comes from the elimination of the “use it or lose it rule” that requires the benefit to be used within fifteen years. In today’s world, it is common for veterans to make career changes later in life. This makes it all the more important to retain education benefits that can help facilitate successful transitions. One significant change makes all Purple Heart recipients eligible for 100 percent of the benefit. Because the benefit percentages are based on time in service, veterans removed from service due to wounds sustained in combat were often unable to reach the full 100 percent rating.

The bill addresses a number of other inadvertent inequities as well. One deals with the Fry Scholarship. Surviving spouses and children of service members who die in the line of duty after September 10, 2001, who are utilizing the GI Bill to attend school are currently ineligible for the Yellow Ribbon Program which fills the gap between the GI Bill benefit amount and full tuition at private institutions. Another oversight in the original law precluded reservists mobilized in support of a Department of Defense (DOD) combatant command and when Governors’ request federal assistance in responding to major disasters or emergencies from counting that service time for eligibility.

Other changes include a long-overdue increase in monthly payments for Dependents’ Education Assistance (DEA) by approximately $200. However, the eligibility time period will be reduced from 45 months to 36 months. Most, if not all, GI Bill benefits now cover 36 months of education time, which equates to approximately four school calendar years. The bill also encourages more students to enter into science, technology, engineering and math (STEM) programs, and it restores benefits to students whose schools closed or lost accreditation in the middle of a semester, costing the veteran a semester of eligibility without actually earning any credits.

While the provisions in the bill were far from controversial, the bill got off to a rocky start as VSOs battled over how it would be funded. The original proposal that had widespread support would have mimicked the Montgomery GI Bill, which required active duty service members to pay a nominal amount of their salary into the program to become eligible. Some groups, however, balked at forcing service members to pay for this benefit. The visceral backlash sunk the bill initially. It regained momentum, however, and was ultimately successful using a different funding mechanism which aligns Basic Allowance for Housing (BAH) rates for GI Bill users with current DOD rates for active duty service members. The GI Bill’s current rates were higher than DOD rates, and the reduction in amount will ultimately cover the cost of expanding the GI Bill.

Senate Approves Appeals Modernization Act

On August 2, 2017, the Senate moved appeals modernization one step closer to becoming a reality. H.R. 2288, the “Veterans Appeals Improvement and Modernization Act of 2017,” was introduced and overwhelmingly passed in the House earlier this year. The Senate tacked on a few more technical refinements and passed the bill under voice vote just before the August recess. Despite being in recess, the House passed the appeals modernization bill by unanimous consent (meaning there were no objections to the minor technical changes) on August 11, 2017.

Once the bill is enacted into law, the earliest changes are expected to be seen approximately eighteen months after enactment. The massive overhaul of the disability claims and appeals process has long been in the works, but the new law will require extensive efforts to implement and widespread changes to the regulations that govern the process.

PVA Files Lawsuit over Wheelchair Damage Rule

At the end of July, PVA filed suit against the Department of Transportation (DOT) for abruptly rolling back a rule intended to make airline travel safer and easier for passengers with disabilities. The rule, which requires domestic airlines to track and report data on lost and damaged wheelchairs and scooters, was delayed by the Administration without seeking input from people with disabilities. DOT originally published the rule in November 2016, following a five-year rulemaking process that included input from air travelers, consumer and disability advocacy groups, and airlines.

The rule was scheduled for implementation in January 2018. In March 2017, DOT abruptly delayed the rule’s implementation date by one year, until January 2019, without providing the public any notice or opportunity to comment, in violation of the Administrative Procedure Act. DOT claimed the delay was necessary due to implementation “challenges” faced by the airline industry. However, the only evidence of these challenges DOT presented was a single email the agency received from the airline industry.

Since DOT’s decision, PVA has informed Administration officials and members of Congress about how the rule’s delay will hurt people with disabilities and asked that DOT allow these critical protections to move forward. Together with the complaint, PVA filed a motion to reinstate the rule’s original effective date. The case was filed in the United States District Court for the District of Columbia.

Senate Effort to Repeal and Replace Affordable Care Act Fails

In a series of votes over the course of a week in late July, the Senate rejected a variety of proposals intended to repeal all or parts of the Affordable Care Act (ACA) and replace the 2010, health care law with dramatically different provisions that would have resulted in increased numbers of uninsured Americans and millions more exposed to insurance discrimination due to pre-existing health conditions and disabilities. Senators were first presented with an amendment to the bill that passed the House of Representatives in May that would have capped and cut Medicaid by over $700 billion, eliminated most home and community based services programs in Medicaid, adjusted downward the ACA’s affordability tax credits and allowed insurers to sell health plans that imposed lifetime caps on benefits and excluded from coverage many services vital to people with disabilities. That bill—the “Better Care Reconciliation Act (BCRA)”—failed on a vote of 43 to 57.

The Senate then considered a motion to repeal the entire ACA with nothing to replace it. The effective date of the repeal would have been delayed for two years under the assumption that Republicans would draft a replacement plan during that period. The Congressional Budget Office (CBO) estimated that this proposal would have resulted in 32 million more uninsured over the next decade. That proposal also failed with all Democrats and seven Republicans voting against the measure.

During the course of the week, numerous motions were made to send the bill to the appropriate committees with instructions to conduct hearings on the proposals to amend the ACA, obtain CBO scores and receive input from stakeholders affected by suggested changes to the law. All of these efforts failed along with other motions designed largely for political messaging purposes

In a final effort to pass something that could ostensibly go to conference with the House-passed bill, the Senate GOP leadership put forward what was called “Skinny Repeal and Replace.” This amendment would have eliminated both the individual and employer mandates of the ACA as well as the medical device tax but left the remainder of the ACA intact. Even so, this measure would have destabilized insurance markets, added 16 million Americans to the ranks of the uninsured and still have cut Medicaid by over $200 billion. Moreover, there were serious concerns among Senators on both sides of the aisle that a conference report would be drafted in secret and return with provisions reinstating insurance discrimination, making steep reductions in financial assistance to make insurance affordable and even more damaging cuts to Medicaid. These were the concerns that had compelled the opposition of Senators Collins and Murkowski throughout the debate and which led them to vote “No” on this final package. Their votes, coupled with the 48 Democratic votes against the amendment, set the stage for one of the most dramatic scenes witnessed in the Senate in years.

Earlier in the week, Sen. John McCain (R-AZ) returned to the Senate after being diagnosed with an aggressive form of brain cancer to vote in favor of advancing the debate on health care reform. Sen. McCain made a very eloquent statement about the failure of the Senate to pursue bipartisan solutions to health care reform and to follow “regular order” on this very important legislation. Regular order is a Senate term of art which means that the health care bill or bills would have been considered in committee hearings, been open to amendment, received full vetting by the CBO and provided opportunities for those affected by the proposals to testify. In the early morning hours of July 28, the vote on the “skinny repeal” was defeated when Sen. McCain shockingly voted against the measure.

At the beginning of debate, PVA sent a letter to all Senators echoing the concerns expressed by Sen. McCain. Lack of transparency in the development of the Senate bill and the method under which the legislation was put forward meant that many of PVA’s objections to the legislation could not be addressed. As written, the Senate bill would continue to exclude the children of catastrophically disabled veterans covered by CHAMPVA from its provisions ensuring dependent insurance coverage up to age 26. Unanswered questions remained regarding the availability of affordability tax credits for veterans who are not enrolled in the VA health care system if the Senate bill had become law. Perhaps most significantly, little attention was paid to the impact of Medicaid cuts to over 2 million veterans that rely on that program and what that might mean for increased demand on the VA health care system. The VA Secretary himself had expressed concern about potential new demand on the VA health care system if these veterans lose Medicaid coverage but without hearings on the bill there was no chance to examine this issue.

There is increasing bipartisan consensus that something must be done to help those in the small employer and individual insurance markets who face increasing premiums, excessive deductibles and loss of health plan choices. Perhaps most urgent is an impending need to fund the ACA’s cost sharing subsidies for lower income health plan customers. Insurers will soon be making decisions for 2018, about their participation in the health insurance exchanges based on these subsidies.

Senators Lamar Alexander (R-TN) and Patty Murray (D-WA), the chairman and ranking member of the Health, Education and Labor Committee, plan to hold hearings in September to explore options for shoring up the financing of health insurance exchanges and other fixes to the ACA that have bipartisan support. Meanwhile, in the House, a Problem Solvers Caucus that is almost evenly comprised of Republicans and Democrats has begun putting together proposals that would increase the number of workers from 50 to 500 for companies subject to the ACA employer mandate and create a federal stability fund to help states reduce premiums and other costs for those with expensive medical needs.

It remains to be seen how far these discussions will progress after the August recess in light of other demands on Congressional time, such as completion of the budget and the need to increase the debt limit. PVA will nonetheless be encouraging Congress to pursue a more open and bipartisan approach to health system reforms that respond to the needs of all Americans, including veterans and people with disabilities.

 

July’s Washington Update

July 18, 2017 Volume 23, No. 7

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The Government Relations staff is still looking for stories about problems that our members have experienced during air travel. Please visit www.AirAccess30.org and share your story.

Senate Committee on Aging Considers Military Caregivers

On June 14, 2017, Senator Elizabeth Dole testified before the Senate Special Committee on Aging regarding the needs of military caregivers. Joining the Senator’s remarks with his own testimony was Hidden Heroes ambassador and actor, Ryan Phillipe. A second panel included veterans, their caregivers, and researchers from the RAND Corporation who shared the findings of a report commissioned by the Elizabeth Dole Foundation outlining the critical needs of caregivers.

There are currently 5.5 million veteran and military caregivers. Many post-9/11 service connected veterans have found support through the VA Comprehensive Family Caregiver Program. However, the majority of veterans with service-connected disabilities are remain ineligible. Senator Dole extolled the moral urgency of correcting this inequality. And while most members of the committee ardently agreed to expansion in principle, the cost of the effort remains a concern not yet alleviated.

Additionally, Senator Dole illustrated the toll of the duties of caregiving on those providing it. The wellbeing of the caregiver is directly linked to the wellbeing of the veteran. As a caregiver’s health declines or is interrupted so too does the quality of assistance. Other deleterious factors in providing care are the loss or insecurity of income. Caregivers often decrease the hours they can work or quit their jobs altogether to care for a veteran. Caregivers, similar to their veterans, often experience devastating isolation in their roles that can take them out of their communities and social interactions necessary to maintaining emotional wellbeing.

The Elizabeth Dole Foundation works to raise awareness of the role of caregivers in our society. Last September, the Foundation launched Hidden Heroes to push forward solutions to the daily challenges caregivers face. PVA has developed a relationship with the Foundation to advance legislation that will expand eligibility for the Comprehensive Family Caregiver Program permanently.

PVA Testifies Before Subcommittee on Economic Opportunity

On June 29, 2017, Gabe Stultz, Legislative Counsel for PVA, testified before the House Veterans’ Affairs Committee, Subcommittee on Economic Opportunity. The Subcommittee considered a number of bills, including efforts to better track bonuses and the reasons behind transfers of VA employees. PVA testified specifically on a draft proposal that would restructure the way home adaptations are delivered as part of the Independent Living Services in the Vocational Rehabilitation and Employment (VR&E) program. For anyone qualifying for home adaptations under the VR&E program, the draft bill would have the VA’s Specially Adapted Housing (SAH) office carry out the actual delivery of services.

Because the Loan Guaranty office currently administers both the SAH and SHA grants, the effect would be to consolidate all administrative authorities for home modifications under one office within VA. The HISA grant would remain separate and continue to be administered by the Prosthetics and Sensory Aids department within the Veterans Health Administration (VHA). PVA called for oversight to ensure that as VA consolidates the administrative functions that it does not suddenly increase the workload in the SAH program without a corresponding increase in staff.

PVA Participates in Public Hearing on Implementation of the Veterans Mobility Safety Act

In December 2016, Congress enacted the “Veterans Mobility Safety Act,” a bill that requires VA to ensure that vehicle adaptations are carried out by qualified individuals. While VA has standards for the specific equipment being installed on vehicles, it never had any standards for who was installing that equipment. Simply put, the safety of the equipment itself is irrelevant if the person installing it is incompetent.

The law called for VA to develop a policy related to safety certification for installers. VA began the process by soliciting comments from stakeholders in writing back in February of this year. On June 13, 2017, VA continued this process by hosting an in-person hearing where stakeholders could voice their opinions. Fred Downs, Prosthetics Consultant for PVA, provided an oral statement on our organization’s behalf. The following is an excerpt from the oral statement and highlights our main position on the matter:

When PVA first involved itself in the passage of the Veterans Mobility Safety Act, our biggest concern was ensuring that as safety standards for installing automotive adaptive equipment were implemented, the end user would not be negatively impacted. The risks as we saw them were that, either by design or by poor implementation of this law, veterans might begin to lose access to vendors who have long provided disabled veterans with safe products.

VA is charged with developing safety standards, but these standards were not intended to govern the entire industry. They are only supposed to serve as a benchmark by which others are judged. VA’s standards should only be directly employed when a provider fails to present certification from the product manufacturer or a trade association that incorporates adherence to stringent safety standards as part of its membership.

This law should not be viewed as an opportunity for VA to expand regulations on the industry. The goal is to identify providers who are offering substandard installations and unwilling to adhere to basic industry safety standards. When those providers are identified, they should face a choice: become certified under VA’s standards or stop doing business with VA.”

We remain concerned that VA has not developed a sound policy yet to ensure proper implementation of these requirements. We will continue to work with VA staff to ensure that this necessary change is not haphazardly carried out.

House and Senate FAA Reauthorization Bills Include Provisions to Improve Air Travel for Passengers with Disabilities

PVA’s efforts to improve air travel for passengers with disabilities have led to the inclusion of disability-related provisions in the House and Senate versions of the Federal Aviation Administration (FAA) Reauthorization bills currently pending on Capitol Hill. Many of these provisions are similar to those found in the S. 1318, the “Air Carrier Access Amendments Act,” that is strongly supported by PVA.

The “21st Century Aviation Innovation, Reform, and Reauthorization Act” (H.R. 2997), the House’s version of the FAA Reauthorization, includes four disability-related provisions as passed by the House Transportation and Infrastructure Committee on June 27. Sections 541, 542, and 543 would establish a select subcommittee on passengers with disabilities to advise the Secretary of Transportation, require a study concerning airport accessibility and air carrier training policies, and mandate research into the feasibility of allowing passengers with disabilities to fly from their wheelchairs. An amendment added during the committee’s markup would also require the Department of Transportation (DOT) to move forward in promulgating rules on service animals, lavatories on single-aisle aircraft, and in-flight entertainment.

As passed out of the Senate Commerce, Science, and Transportation Committee on June 29, S. 1405, the “FAA Reauthorization Act of 2017,” would require a study concerning airport accessibility, a determination on the feasibility of using in cabin wheelchair restraint systems, and the creation of an advisory committee on the air travel needs of passengers with disabilities to advise the Secretary of Transportation on implementation of the Air Carrier Access Act (ACAA). The Senate FAA Reauthorization also includes a requirement for airlines to provide wheelchair and scooter information to DOT beginning January 1, 2018. This requirement was delayed by the Department earlier this year. Other provisions added during the committee’s markup include an airline passengers with disabilities bill of rights, increased civil penalties for harm to assistive devices or passengers with disabilities due to ACAA violations, and a requirement for hands on training for those who provide that type of assistance to passengers with disabilities.

Both the House and Senate versions of the FAA Reauthorization are currently pending floor action. Each includes provisions unrelated to the disability sections that may make it difficult for either bill to pass. The current FAA authorization expires at the end of September. Congress must take action to either extend the current authorization or pass a reauthorization before that time.

In the meantime, PVA will continue to seek additional co-sponsors for S. 1318, and support for further amendments to the FAA Reauthorization bills to foster additional improvements in air travel for passengers with disabilities.

Senate Health Care Reform Bill Introduced

On June 22, 2017, Senate Majority Leader Mitch McConnell released the Better Care Reconciliation Act (BCRA), the Senate’s version of a bill to “repeal and replace” the Affordable Care Act (ACA). Developed largely in secret by a few allies of the Majority Leader, the bill was intended for a quick vote under simple majority rules prior to the July 4th Congressional recess. However, strong bipartisan opposition to the measure, including among moderate and conservative Republicans, arose and forced Leader McConnell to postpone the vote. A revised version of the bill was unveiled on July 13. The majority leader has been working to corral the necessary 50 votes (Vice President Pence would be the tie breaker) to proceed under reconciliation rules. Among the provisions of the bill in its latest form are:

Cuts to Medicaid – In addition to phasing out the ACA’s Medicaid expansion, which has covered roughly 340,000 veterans nationwide, according to FamiliesUSA, the Senate bill would, according to the Congressional Budget Office, reduce spending in the basic Medicaid program by 35 percent by 2036. Under the limits on Medicaid funding contained in the bill, states would likely be forced to severely restrict the populations covered and services provided by the program. This could put at risk approximately 1.75 million veterans currently covered by traditional Medicaid.

  • Pre-existing condition exclusions – The BCRA permits states to waive portions of the ACA’s essential health benefit (EHBs) requirements. The ACA requires that certain benefits be included in any insurance plan offered on the individual and small group market. These EHBs include outpatient services, emergency room care, hospitalization, maternity care, mental health and substance abuse services, prescription drugs, rehabilitative and habilitative services, lab tests, preventative care, and pediatric care. With a state waiver, insurers would be able to deny numerous services that people with disabilities, and others with pre-existing conditions rely upon. It would also mean that individuals living in one state may be able to access the services they need, while those in another state may not. People with pre-existing conditions could technically still be able to purchase insurance, just not the insurance that includes the services they need at a cost they can afford.

 

  • Lifetime and annual limits on benefits – The ACA limits the amount that insurers can charge annually to individuals and families for out-of-pocket payments. The Senate proposal would make it easier for states to apply to the federal government to waive these limits. Similarly, while there is language in the bill that continues the prohibition on lifetime coverage caps, these only apply to limits on essential health benefits. If a state changes or eliminates the essential benefit options, lifetime coverage caps could effectively be reinstated. This would have a disproportionate impact on individuals with disabilities who depend on many services now required to be offered under the EHB rules.
  • Creation of high risk pools – A state stability fund is proposed to help states bring down premiums and start programs that lower costs for insurers and consumers. The bill includes more than $180 billion for this fund. Prior to the ACA, 35 states had created high-risk pools to offer coverage to state residents with pre-existing conditions that made them uninsurable. Features adopted by the states to limit enrollment, and thus costs, included premiums set well above the standard non-group market rates, 6 to 12 month exclusion periods for pre-existing conditions, lifetime and annual dollar limits on coverage and deductibles between $1000 and $5000.

 

  • Other provisions – The revised bill retains several of the taxes included in the ACA such as the 3.8 percent investment income tax on people making over $200,000 a year, a tax on incomes of health insurance executives and the Medicare health insurance tax that was created to extend the life of the Hospital Insurance trust fund. The newest version of the BCRA includes $45 billion in funding to address the opioid crisis. Another new provision in the bill would allow funds in Health Savings Accounts to go toward insurance costs.
  • Cruz amendment – An amendment is expected to be offered by Sen. Ted Cruz (R-TX) allowing health plans with slimmer benefits packages to be sold on and off the health market exchanges under the assumption that this would make these insurance plans cheaper. However, insurers would also be required to sell at least one ACA-compliant plan. Critics of this amendment fear that segmenting the market in this fashion would drive younger, healthier people to the minimalist plans, leaving older, sicker constituents with the more expansive health plans. This would likely cause premiums for the more robust insurance plans to increase significantly. To protect insurers who attract a disproportionate share of “high risk” individuals, the bill will include a $70 billion fund to offset costs for these companies.

Since the 115th Congress began debating health care reform, PVA has expressed its strong desire that these deliberations be done in a bipartisan fashion under regular order with stakeholders given an opportunity to consider and weigh in on various policy options. By using reconciliation, which requires only a 50 vote margin to win passage, to advance the Senate’s legislation, several issues of particular concern to PVA will go unaddressed. For example, the children of catastrophically disabled veterans covered by CHAMPVA will continue to be excluded from current policies that provide for dependent insurance coverage up to age 26. There have been some questions whether the tax credits meant to make health insurance affordable would be available to veterans who are eligible but not enrolled in the VA health care system. PVA has been informed that reconciliation procedures preclude the opportunity to clarify this issue.

The new version of the BCRA retains almost $800 billion in Medicaid cuts over ten years. Between traditional Medicaid, the Medicaid expansion as well as the ACA premium tax credits, there has been a 40 percent decrease in uninsured non-elderly veterans between 2013 and 2015.1 Most of these veterans are older than 45, the age group most adversely affected by the Senate bill’s provisions allowing older individuals to be charged up to five times the standard premium amount.

Some of these veterans may be able to enroll in the VA health care system under current rules but others, because of policies that bar enrollment to certain veterans above modest income thresholds, will be denied access to the VA. Congress could act to open up the VA health care system to all veterans but it is unclear whether the VA has the budgetary and system capacities able to handle even half of the veterans now covered under Medicaid.

As of the deadline for the Update, the BCRA was tabled as several Republican senators have come out in opposition to the bill, including Sen. Rand Paul (R-KY), Sen. Susan Collins (R-ME), Sen. Jerry Moran (R-KS), and Sen. Mike Lee (R-UT). Sen. McConnell has indicated that he may bring a simple ACA repeal bill to the floor for consideration given the failing support for the BCRA. PVA staff will continue to monitor this effort and reach out to chapters as this debate continues.

Social Security Trustees Issue Annual Report on System’s Status

On July 13, 2017, the Social Security Trustees released their annual report on the current and projected financial status of the Social Security trust funds. The 2017 Trustees Report highlights that the Social Security system continues to operate well for the American people. The Social Security system’s financial outlook remains stable, and can continue to pay all scheduled old age, survivors, and disability benefits until 2034. With modest increases in revenue, Social Security will be able to pay full benefits throughout the century and beyond. The 2017 Trustees Report finds that Social Security is fully solvent until 2034, but faces a moderate long-term shortfall.

In 2016, Social Security took in roughly $35 billion more in total income, including interest, than it paid out. Its reserves were $2.85 trillion at the end of 2016. If Congress does not act before 2034, the reserves would be drawn down, and revenue coming into the Trust Funds would cover about 77 percent of scheduled benefits. The Trustees Report also projects that Social Security’s Disability Insurance (SSDI) trust fund by itself can pay all scheduled benefits until 2028—5 years longer than projected in the 2016 Trustees Report. If Congress takes no action before 2028, the Trustees project that thereafter the SSDI trust fund will be able to pay about 93 percent of scheduled benefits.

Royal Caribbean Disability Advisory Board Meets

In June, Susan Prokop, PVA Senior Associate Advocacy Director, attended the meeting of the Royal Caribbean (RCCL) Disability Advisory Board to receive updates on the company’s efforts to make its cruises accessible and to promote itself as an inclusive employer to people with disabilities. PVA was appointed as a member of the Advisory Board in 2016.

Members of the advisory board heard presentations on Royal Caribbean’s efforts to track special needs requests and training modules developed for customer contact center staff to assist guests with disabilities. The cruise line has also recently established an employee resource group (ERG) for staff with disabilities in three of its call center sites in South Florida, Wichita, Kansas and Springfield, OR. RCCL hopes to use this ERG to engage with local chapters of its three disability advisory boards.

1 Urban Institute, April 2017, “Veterans Saw Broad Coverage Gains Between 2013 and 2015”

June’s Washington Update

June 19 2017                                                                    Volume 23, No. 6

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The Government Relations staff is still looking for stories about problems that our members have experienced during air travel.  Please visit www.AirAccess30.org and share your story. 

Administration Finally Releases its FY 2018 Budget Request

On May 23, 2017, the President finally released his Administration’s detailed Budget Request for all federal programs, including the Department of Veterans Affairs (VA), for FY 2018. The request includes a fair increase for VA programs (despite most other federal agencies getting significant cuts). The budget proposal does include a significant reduction in funding for Major and Minor Construction in VA, as well as cuts to Medical and Prosthetic Research, the Veterans Benefits Administration, and Information Technology.

The House Committee on Veterans’ Affairs subsequently held a hearing on the President’s Budget Request on May 24, 2017 followed by a hearing before the Senate Committee on Veterans’ Affairs on June 14, 2017. PVA Associate Executive Director of Government Relations Carl Blake testified for the Senate VA Committee hearing. In testimony, PVA expressed serious concerns with the VA’s plan for continued funding through a mandatory account.  We believe that Congress must reject continued funding of the Choice program through a mandatory account and place it in line with all other community care funded through the discretionary Community Care account established previously.

Additionally, we expressed strong opposition to two legislative proposals that are being used to fund the Choice program continuation—round down of cost-of-living adjustment (COLA) payments to the nearest whole dollar and the elimination of Individual Unemployability (IU) for veterans who reach Social Security eligibility age (62). It is beyond comprehension that the Administration would propose such a benefit reduction in order to pay for a flawed funding mechanism for a program (Choice) that sometimes provides health care access to non-service connected disabled veterans. Eliminating IU benefits for veterans over the age of 62 provokes numerous questions. Will veterans who have statutorily protected evaluations (the 20-year rule) also be subject to reduction? Will those dependents using Chapter 35 education benefits based on their sponsor’s IU rating be forced to drop out of school? Will those veterans on IU who are covered by Service-Disabled Life Insurance at no premium be forced to now pay premiums in order to keep coverage? What about state benefits, such as property tax exemptions or state education benefits that are based on 100 percent VA disability ratings? How will this proposal affect efforts to combat veteran suicide and homelessness? The impact of the answers to these questions clearly dictates that Congress should reject this proposal out of hand.

PVA’s formal written statement for the record on behalf of The Independent Budget—co-authored with DAV and VFW can be viewed at www.pva.org.  support for the Senate bill.

PVA Testifies Before Senate Committee on the Evolution of the Choice Program

On June 7, 2017, the Senate Committee on Veterans’ Affairs held a hearing entitled “Examining the Veterans Choice Program and the Future of Care in the Community.”  Gabe Stultz, Legislative Counsel for PVA, testified on PVA’s behalf. This testimony marked Gabe’s first opportunity to testify before the U.S. Congress. VA Secretary David Shulkin unveiled during the hearing what he hopes will be the next iteration of the Choice Program, called the C.A.R.E. (Coordinated Access and Rewarding Experiences) Program. PVA has contributed extensively to VA’s planning efforts over the last year and into the new administration, and while we support many of the major components being offered, we still have concerns over a number of details and omissions.

The major change to the previous plans for expanding the Choice program is a change to the eligibility standards. Current eligibility is determined by whether the veteran will have to wait more than 30 days for a needed service or if the veteran lives more than 40 miles from a VA facility. The new eligibility would be based on a clinical decision that would consider whether the service is available at VA, how long the wait times are, and whether it is feasible to force the veteran to travel to VA for the services. This decision would be made by the VA clinician based on conversations with the veteran instead of a bureaucrat or administrator.

The second component allows VA to offer Choice to all veterans who are affected when the quality of a particular service line falls below the local community standards. VA will identify underperforming service lines, such as urology or cardiology, within its own system, and then it will compare those services with the individual local health care market. If the service line is also underperforming as compared to the local market, VA will allow veterans needing those services to use the community until that service line is fixed.

Finally, a new addition to the plan is for veterans to have the ability to utilize walk-in clinics two times per year subject only to the copayment structure they use with VA. Any visits after two will be charged a copayment of $50, regardless of service-connection.

The hearing covered the basics of this plan. However, Senator Patty Murray (D-WA) pointed out a few details that looked reminiscent of privatization plans highlighted in a straw man document used by the Commission on Care last year. She pointed out a few pilot project authorizations that would allow VA to try out different payment models and governance structures reminiscent of the ideas recommended by Concerned Veterans for America.

PVA continued to express our concern that all of the attention is focused on expanding Choice while failing to plan simultaneously for strengthening VA’s own specialized services. We noted that the Secretary has committed verbally to PVA that VA will increase nursing staff levels by more than 1,000; however, we need to see definitive action taken on this promise. VA must invest in its own foundational services, such as SCI/D care, in order to successfully build a high-performing network.

Senator Tester also highlighted PVA’s testimony on the importance of ensuring that veterans getting care in the community are protected in the event of medical malpractice. In an exchange with PVA, he stressed the point to his colleagues that veterans out in the community are not eligible for service-connected status due to malpractice. If a veteran is injured receiving care inside a VA medical center, he or she is eligible for service-connection under 38 U.S.C § 1151.

Going forward, VA has proposed legislative text, and it is our understanding that the Hill will also be offering legislative packages in the coming weeks representing the future of VA care delivered in the community. To read PVA’s full written statement, please visit www.pva.org.

Bi-Partisan Accountability Bill Passed by Congress

On June 13, 2017, the House of Representatives approved the “VA Accountability and Whistleblower Protection Act,” which was previously passed by the Senate, ensuring that the bill will become law. The bill was originally introduced by Senate VA Committee Chairman Johnny Isakson (R-GA) and Ranking Member Jon Tester (D-MT). The legislation was also co-sponsored by Senator Marco Rubio (R-FL). PVA offered our strong support for this critical piece of legislation. The principle goal of the legislation is to allow the Department of Veterans Affairs (VA) to terminate bad employees faster while also strengthening protections for whistleblowers. The bill streamlines the VA’s process for reviewing and firing employees who engage in misconduct or perform poorly without sacrificing their due process rights.

Subsequent to passage of the bill, PVA Executive Director Sherman Gillums offered the following statement in support of the bill:

“No other large healthcare system rivals VA’s competence to deliver specialized services at a national level, such as spinal cord injury and disease and polytrauma care, or synthesizes access to healthcare, benefits, support, and peer mentorship better than VA. But what VA needs most right now is the one ‘ability’ it presently lacks and can no longer be taken for granted — accountability. Whether that means better protecting whistleblowers, shortening the reprimand process, or recouping ill-gotten bonuses and relocation expenses, achieving a state of being answerable to the public, the Congress, and most importantly, veterans, will be dictated by the worst behavior the VA Secretary has to tolerate. This bill will be a major step toward having to tolerate such behavior no more.”

PVA also had the opportunity to participate in a press conference following House passage of the bill where we reiterated our support for stronger accountability. Our support is based on our exposure to problems during our annual site visits to VA medical centers that have resulted from lack of proper accountability of VA employees at several levels.

Air Carrier Access Amendments Act Introduced in the Senate

On June 8, 2017, Senator Tammy Baldwin (D-WI) introduced S. 1318, the “Air Carrier Access Amendments Act.” This legislation would make needed improvements to the Air Carrier Access Act (ACAA) and provide increased opportunities for stakeholders to work with airlines and the U.S. Department of Transportation to improve the air travel experience for passengers with disabilities. Four original co-sponsors, Senators Richard Blumenthal (D-CT), Edward Markey (D-MA), Maggie Hassan (D-NH), and Tammy Duckworth (D-IL), joined with Senator Baldwin in supporting the legislation.

Over 30 years ago, President Ronald Reagan signed the ACAA into law. The ACAA prohibits discrimination based on disability in air travel. Despite progress, too many travelers with disabilities still encounter significant barriers, such as damaged assistive devices, delayed assistance, and lack of seating accommodations. Unlike most other civil rights laws, the ACAA lacks a guaranteed private right of action. Consequently, people with disabilities typically receive little if any redress to their specific grievances.

Access for people with disabilities in air travel must move into the 21st century. Otherwise, people with disabilities will be left behind unable to compete in today’s job market or enjoy the opportunities available to other Americans.

The Air Carrier Access Amendments Act (S. 1318) will address these problems by:

  • Strengthening ACAA enforcement through referral of certain complaints to the U.S. Attorney General, increased civil penalties for damaged wheelchairs, and a private right of action.
  • Ensuring airlines acquire airplanes that meet broad accessibility standards. Improved structural access includes safe and effective boarding and deplaning processes, procedures, and equipment, along with better stowage options for assistive devices.
  • Improving training for air carrier personnel and their contractors, including requiring heightened training for personnel who assist with the boarding and deplaning process.
  • Requiring the Secretary of Transportation to work with stakeholders to develop an Airline Passengers with Disabilities Bill of Rights.
  • Creating a U.S. Department of Transportation Advisory Committee on the Air Travel Needs of Passengers with Disabilities.

PVA urges its members to contact their U.S. Senators and ask them to co-sponsor this important legislation. It is our hope that this legislation will be attached to the FAA Reauthorization currently pending in Congress. It is critical that we show widespread support for S. 1318 in the coming weeks.

President’s Budget Proposes Cuts to Important Disability Programs

While the Administration’s FY 2018 Budget Request provides some increases to the VA, it proposes significant cuts in a number of programs important to people with disabilities. Those programs are outlined below:

Social Security – In a reversal of campaign promises not to cut Social Security, the President’s proposed 2018 budget recommends over $74.2 billion in cuts over ten years from Social Security, including $72.4 billion in proposed reductions to Social Security’s disability programs. The budget projects nearly $50 billion in savings would be generated through Social Security demonstration programs to help disability beneficiaries to stay at work or return to work. Cuts of this magnitude would likely be accomplished through stringent work requirements and other measures aimed at reducing benefits or cutting off eligibility entirely for those who do not comply with the work rules.

At the same time, the budget also proposes offsetting unemployment benefits and disability payments for a savings of $2.5 billion. Beneficiaries who attempt to work, but get laid off from a job through no fault of their own, may qualify for Unemployment Insurance benefits that their employers have paid for. Cuts to these benefits would put beneficiaries’ ability to meet their day to day living expenses at risk and would create disincentives by punishing people who attempt to work. Another $10 billion in savings would be achieved by reducing retroactive SSDI benefits to six months from the current 12 months retroactive payments, which has been the standard since 1958. The average disabled worker receives approximately $1,170 per month in SSDI and those affected by this change could lose over $7,000 per year by this cut. The budget proposes to cut an additional $4 billion out of Social Security—including the retirement, survivors’, and disability programs.

Department of Health and Human Services – The budget proposes more than $1 trillion in Medicaid cuts (estimates have been as high as over $1.4 trillion) over the next 10 years from a combination of repealing and replacing the ACA and an estimated $610 billion in additional cuts. Block grants in the President’s budget would make even further cuts than those allowed under the American Health Care Act (AHCA). The budget also proposes a $142.4 million decrease in overall funding for the Administration for Community Living and level funds one component of the nationwide Independent Living system at $78 million. However, the budget consolidates money for a second Independent Living account with funding for State Councils on Developmental Disabilities and Traumatic Brain Injury funding into one “Partnership for Innovation, Inclusion, and Independence.” The funding for this new Partnership line item is $45 million, a $57 million loss from the $102 million combined for all these programs in funding in FY 2017. The cuts resulting from this consolidation would be detrimental to all three programs.

Department of Labor – The President’s budget proposes to eliminate roughly one fifth of the Department of Labor’s (DOL) overall budget. To achieve a $2.5 billion cut, the document calls for the elimination of “duplicative, unnecessary, unproven, or ineffective” programs while focusing on “highest priority functions” but provides few details on particular program reductions or eliminations. One of the few specifics in the document concerns the Office of Disability Employment Policy (ODEP) which is directed to eliminate “less critical technical assistance grants.” Advocates are concerned that the Job Accommodation Network (JAN), one of the main grant programs, may fall victim to these budgetary directions. The DOL budget proposal also includes elimination of the Office of Federal Contract Compliance Programs (OFCCP) which oversees implementation of VEVRAA and Section 503 governing federal contractor obligations to recruit and hire targeted veterans and people with disabilities. These OFCCP functions would be transferred to the Equal Employment Opportunity Commission (EEOC). Civil rights supporters are concerned that such a move would impede the work of both the OFCCP and the EEOC as each have distinct missions and expertise, and thereby undermine the civil rights protections that employers and workers have relied on for almost fifty years.

Update on the ADA Education and Reform Act of 2017

The ADA Education and Reform Act of 2017, H.R. 620, has gained additional co-sponsors in recent weeks. PVA opposes H.R. 620 because it would ultimately lead to decreased accessibility in public accommodations under Title III of the ADA. The legislation was introduced in January by Representative Ted Poe (D-CA), with co-sponsors Representatives Scott Peters (D-CA), Ken Calvert (R-CA), Ami Bera (D-CA), Jackie Speier (D-CA), and Michael Conaway (R-TX).

As of June 14, the following members have signed on as co-sponsors:

  • Representative Pete Aguilar (D-CA)
  • Representative Ralph Lee Abraham (R-LA)
  • Representative J. Luis Correa (D-CA)
  • Representative Doug Collins (R-GA)
  • Representative Bill Foster (D-IL)
  • Representative Jeff Denham (R-CA)
  • Representative Krysten Sinema (D-AZ)
  • Representative Paul Mitchell (R-MI)
  • Representative Darrell E. Issa (R-CA)
  • Representative Bobby Rush (D-IL)
  • Representative Tom Emmer (R-MN)
  • Representative Terri Sewell (D-AL)
  • Representative Mike Coffman (R-CO)

Please contact your Representatives to let them know that PVA opposes this legislation. We are opposed to H.R. 620, because it would require a person with a disability to send a very specific letter of notification to the owner or operator of a non-compliant business prior to being able to file a lawsuit. There is no penalty under the ADA that accrues for the length of time that a business was out of compliance. As a result, businesses (large and small) could decide to simply wait until a person with a disability provides them with the required notice before taking any action to meet ADA accessibility requirements. We believe that businesses should proactively seek to comply with the ADA and work with the ADA National Network and other entities for any needed technical assistance.

The bill is pending before the House Judiciary Committee and may be marked up by the full committee in the coming weeks.

ADA Symposium

In May, National Advocacy staff attended the annual National ADA Symposium in Rosemont, Illinois. Hosted this year by the Great Plains ADA Center, this annual conference brings together disability advocates, subject matter experts, government officials and service providers for three days of workshops and networking opportunities. Sessions ranged from basics about the Americans with Disabilities Act and its enforcement to advanced workshops delving into specific components of disability law such as internet accessibility, workplace leave policies as employment accommodations, and accessible housing requirements under the International Building Code, Architectural Barriers Act and ADA.

Ann Raish, Acting Chief of the Department of Justice Disability Rights Division, presented an update on that agency’s work in enforcing the ADA’s Title II (State and local governments) and Title III (public accommodations) and continued efforts to implement the 1999 Supreme Court Olmstead decision calling for federal programs to serve people with disabilities in the least restrictive environment. Other workshops focused on what is likely to happen to long term services and supports in the wake of revisions to the Affordable Care Act, how service animals are treated under different disability rights laws, emergency preparedness for people with disabilities, and ADA requirements for light rail and commuter transportation systems. The 2018 ADA Symposium will take place in Pittsburgh, PA.

PVA Participates in Afghan Disability Rights Conference

The Embassy of Afghanistan hosted a disability rights conference from May 23-24 during which PVA was invited to take part in an employment panel on the second day of the meeting. Organized by the U.S. Council on Disabilities (USCID), the U.S.-Afghan Women’s Council, and Georgetown University Center for Child and Human Development, the conference was a follow up to the first National Conference for Persons with Disabilities held in Kabul, Afghanistan in the fall of 2016. A 2012 signatory to the United Nation’s Convention on the Rights of People with Disabilities, Afghanistan has over 600,000 people with disabilities in that small country. The Georgetown University meeting was intended to highlight progress and challenges since the 2016 conference and bring together advocates and subject matter experts from the U.S. with their Afghan counterparts to discuss practical approaches for inclusive education, public health care and employment programs and policies.

The theme of the conference’s first day was “From Policy to Programming” and featured presentations on education reforms as well as public health and vocational training initiatives being undertaken by the government and various non-profit organizations in the country. Attendees were welcomed by Dr. Hamdulla Mohib, Afghanistan’s Ambassador to the U.S., who spoke of the challenges implementing a law adopted by his country requiring that 3 percent of government jobs be reserved for individuals with disabilities. Many of the difficulties faced by Afghanistan in living up to the spirit of this law would sound familiar to many Americans with disabilities including inaccessible buildings, lack of funding resources and stigma. A hopeful note was sounded in a video by First Lady of Afghanistan Rula Ghani who highlighted her commitment and that of President Ghani to measures assuring integration of people with disabilities into society. She was followed by a keynote address from Judy Heumann, former Senior Advisor on International Disability Rights at the U.S. State Department. Heumann urged the Afghan attendees to monitor construction of schools, civic facilities and health centers built with U.S. foreign aid and to raise objections if they fail to include accessible features. Conference delegates also heard from disability rights leader retired Senator Tom Harkin and Tim Shriver, chairman of the Special Olympics.

On the second day of the conference, USCID hosted the Afghan delegates at its offices for a full day of panel presentations from U.S. policy experts and advocates on the three main topics covered by the conference. Susan Prokop, Senior Associate Advocacy Director for PVA, took part in an employment panel along with representatives from RespectAbility and TransCen. In her remarks, Susan discussed the history and scope of vocational services offered to U.S. veterans and described PVA’s own vocational rehabilitation program, Paving Access to Veterans Employment (PAVE). Posts from the conference can be found on Twitter at #AFGDisabilityConf.

 

 

 

May Washington Update

May 16, 2017 Volume 23, No. 5

***PRIORITY***

The Government Relations staff is still looking for stories about problems that our members have experienced during air travel. Please visit http://www.AirAccess30.org and share your story.

Bi-Partisan Accountability Bill Introduced

On May 11, 2017, Senate VA Committee Chairman Johnny Isakson (R-GA) and Ranking Member Jon Tester (D-MT) introduced the “VA Accountability and Whistleblower Protection Act.” The legislation was also co-sponsored by Senator Marco Rubio (R-FL). PVA offered our strong support for this critical piece of legislation. The principle goal of the legislation is to allow the Department of Veterans Affairs (VA) to terminate bad employees faster while also strengthening protections for whistleblowers. The bill streamlines the VA’s process for reviewing and firing employees who engage in misconduct or perform poorly without sacrificing their due process rights.

The “VA Accountability and Whistleblower Protection Act” has three major provisions:

1. Increase accountability within the VA by:

a. Giving the VA Secretary the authority to expedite the removal, demotion or suspension of employees at the VA based on performance or misconduct.

b. Shortening the process to remove employees at all levels of the department when evidence proves that they have engaged in misconduct or are performing poorly.

c. Incentivizing managers to address poor performance and misconduct among employees by including these issues in the annual performance plan.

d. Prohibiting bonuses for employees who have been found guilty of wrongdoing.

e. Prohibiting relocation expenses for employees who abuse the system.

2. Protect whistleblowers by:

a. Codifying the Office of Accountability and Whistleblower Protection at the VA and mandating that the head of the office be selected by the President with the advice and consent of the Senate, giving Congress more oversight over the department.

b. Requiring the VA to evaluate supervisors based on their handling of whistleblowers.

c. Requiring the VA to provide department-wide training regarding whistleblower complaints once a year.

3. Strengthen VA leadership by:

a. Giving the VA Secretary additional flexibility in hiring and firing senior executives.

b. Removing bureaucratic barriers to holding senior executive accountable by expediting executive appeals and sending them directly to the VA Secretary.

c. Reducing benefits for employees who are disciplined or removed for misconduct.

Along with PVA, this legislation is supported by the American Legion, Veterans of Foreign Wars, Iraq and Afghanistan Veterans of America, Military Order of the Purple Heart, the Project on Government Oversight, AMVETS, and Got Your 6.

PVA Executive Director Sherman Gillums offered the following statement in support of the bill:

Paralyzed Veterans of America has long called for measures that bring greater accountability and protects those employees who have the courage to call out fraud, waste, and abuse in the Department of Veterans Affairs. We firmly believe that the culture of a company, organization, or federal agency is shaped by the worst behaviors its leader is willing to tolerate. The “VA Accountability & Whistleblower Protection Act” is the first major step toward reshaping behavior in VA by tolerating bad behavior and poor performance no more. Our veterans deserve it; and so do the hardworking public servants of VA who are tired of being overshadowed by the performance of substandard managers and employees.

The focus will now turn to the House VA Committee to bring companion legislation forward. During the last Congress, the House and Senate VA Committees were unable to come to a compromise on accountability legislation; however, House VA Committee Chairman Phil Roe (R-TN) and Ranking Member Tim Walz (D-MN) have both offered support for the Senate bill.

House Subcommittee Holds Roundtable on Caregiver Support Programs

On April 27, 2017, the House Veterans’ Affairs Subcommittee on Health held a roundtable to examine how the Department of Veterans Affairs (VA) can improve the Caregiver Support Program, available to veterans of all eras, and the Comprehensive Family Caregiver Support Program, limited to veterans who were catastrophically injured after September 11, 2001. Members of the subcommittee and their staffs engaged representatives from the veterans’ service organization (VSO) community, the Veterans Health Administration (VHA), and the Department of Health and Human Services (DHHS).

At the forefront of the discussion was the date of injury eligibility requirement of the Comprehensive Family Caregiver Program. Members of Congress generally support expanding the program, but are deeply hesitant to approving this necessary change due to cost considerations. Some veterans groups support the idea of delaying expansion until the current program is made essentially perfect. This is a position that PVA strongly opposes. Representatives of the VA welcome the program’s expansion but expressed concern Congress would not provide them the support and resources needed to meet such an overwhelming need. PVA, DAV, VFW, and the American Legion continue to advocate expansion without hesitation.

Our position remains clear—it is unjust to provide critically needed support services to one group of veterans, and deny it to another, for no other reason than cost. PVA will continue to advocate for the Caregiver Support program to be properly resourced and the Comprehensive Family Caregiver Support Program to be opened to those who would otherwise be eligible, and are in critical need.

HVAC Pushes Forward with Appeals Modernization in the 115th Congress

On May 2, 2017, the House Committee on Veterans’ Affairs held a hearing on H.R. 2288, the “Veterans Appeals Improvement and Modernization Act of 2017.” The bill’s introduction follows on the heels of the recent Congressional round table hosted by the Chairman of the Subcommittee on Disability Assistance and Memorial Affairs, Mike Bost (R-IL). He and Ranking Member Elizabeth Esty (D-CT) are the original co-sponsors of the legislation.

The bill is an evolution from efforts throughout last year to present Congress with a new framework for processing disability claims and appeals. Much of the criticism last year dealt with the lack of a plan for implementation, a comprehensive risk assessment, and an understanding of what resources would be needed. There must be enough resources to ensure that VA does not leave behind veterans already who are already waiting while it starts a new program. PVA supports the new framework, and we also support this legislation’s requirements for extensive reporting by VA as it moves forward with implementation.

It is notable that the House and Senate have been working closely on this legislation, and shortly after the hearing it was announced that the Senate would be introducing a companion version of the House bill that has bipartisan and bicameral support.

PVA’s full statement for the record can be viewed at: http://docs.house.gov/Committee/Calendar/ByEvent.aspx?EventID=105902

VA Adopts New Standards for Medical Diagnostic Equipment

The U.S. Department of Veterans Affairs (VA) will adopt new accessibility standards issued by the U.S. Access Board to ensure access to medical diagnostic equipment (MDE) at its health care facilities. Under an agreement governing acquisition, the VA will require that new equipment meet the MDE standards which were published in January of this year. The VA’s health care network, the largest integrated health care system in the U.S., includes 152 medical centers, nearly 800 community-based outpatient clinics, and over 125 nursing home care units.

Access to MDE has been problematic for people with disabilities, including those who use wheelchairs and other mobility aids. The Board’s standards provide design criteria for examination tables and chairs, including those used for dental or optical exams, weight scales, radiological equipment, mammography equipment and other equipment used for diagnostic purposes by health professionals.

The MDE standards, as issued by the Board, are not mandatory unless adopted by a federal agency. The VA’s use of these standards will help it meet responsibilities under section 504 of the Rehabilitation Act which requires access to federally funded programs and services. Other entities, including health care providers and state and local governments, can voluntarily adopt and apply the standards as well.

For further information on the MDE standards, visit the Board’s website or contact Earlene Sesker at sesker@access-board.gov, (202) 272-0022 (v), or (202) 272-0091 (TTY). Questions about the new VA acquisition policy should be directed to Laurence Meyer at Laurence.Meyer@va.gov.

House Passes American Health Care Act

On May 4, 2017, the U. S. House of Representatives passed H. R. 1628, the American Health Care Act (AHCA), by a vote of 217 to 213. The bill would significantly modify the Patient Protection and Affordable Care Act (ACA), also known as Obamacare. Twenty Republicans joined all of the Democrats in the House in voting against the measure. The bill is not a complete repeal of the ACA, as has been promised by Republicans for seven years, but deals only with those parts of the ACA with budgetary implications in order for the Senate to pass it with a simple majority vote, a process none as reconciliation.

The AHCA reduces funding for subsidies provided under the ACA to make health insurance coverage purchased through the health exchanges more affordable and tilts the benefits of those subsidies toward younger people. However, it also creates tax credits that would be available to people to purchase health plans outside the exchanges. The measure eliminates a number of taxes, including those on health insurers, under the ACA that were designed to pay for its provisions. Instead of a mandate that individuals carry health insurance, H.R. 1628 would allow insurers to charge those with coverage gaps longer than 63 days a one-year, 30 percent surcharge on their insurance premiums. In addition, the House bill cuts over $800 billion from Medicaid over ten years and, in 2020, would end the ACA’s expansion of Medicaid through which some 11 million Americans have gained health care coverage. The bill also eliminates funding for several public health programs aimed at preventing bioterrorism and disease outbreaks.

The AHCA would make a number of changes to the types of health insurance plans that would be available by changing the rules governing protections for those with pre-existing conditions and by eliminating requirements that health plans cover certain benefits. States would be allowed to seek a waiver from the Department of Health and Human Services (HHS) so that insurers could charge higher premiums to those with pre-existing conditions. If HHS does not respond to a state’s request within 60 days, those changes would automatically go into effect. As part of a waiver application, states would have to set up a high risk insurance pool or design a subsidy program of their own for residents with pre-existing conditions who might be priced out of the insurance market as a result of the waiver.

In a letter to the House, PVA expressed concern about a number of the provisions in H.R. 1628 that could have harmful effects on veterans and people with disabilities. Under the bill’s changes to financing of Medicaid, the federal government would no longer share in the costs of providing health care services and community services beyond a capped amount. This would eliminate the enhanced federal match for the Community First Choice Option under Medicaid that provides attendant care services in the community. Thanks to this program, many poor veterans with serious non-service connected disabilities have been able to move from nursing homes into their communities. Data from the Robert Wood Johnson Foundation shows that the Medicaid expansion that would be eliminated by the bill has helped thousands of veterans and their caregivers.

By allowing states to seek waivers that would permit insurers to charge higher premiums to people with pre-existing conditions, people with disabilities and expensive health conditions could again be exposed to significantly higher medical costs. The waivers would also relieve states of the ACA’s requirement that certain essential health benefits must be provided, including crucial services for people with disabilities such as prescription drugs, rehabilitative and habilitative services and devices, preventative and wellness services and chronic disease management. In combination, these changes would very likely make it difficult for people with pre-existing conditions to find affordable plans that cover basic health care services.

For veterans and PVA members in particular, the AHCA continues several problematic policies of the ACA as well as troubling new provisions that could affect the ability of many veterans and their family members to afford health insurance in the private market. Those provisions include:

• Retains coverage of adults up to age 26 on parents’ health policies but continues to exclude CHAMPVA beneficiaries—dependents of the most catastrophically disabled veterans—from this benefit.

• Fails to remove the prohibition on enrollment into the VA health care system for Priority Group 8 veterans, thus denying these veterans access to a viable option for health care.

• Offers tax credits meant to make health insurance affordable to anyone except those eligible for a host of other federal health programs, including those “eligible” for coverage under Title 38 health care programs. This would prevent many veterans who may be “eligible for” but not enrolled in the VA health care system from accessing these tax credits intended to help people buy insurance.

The Senate has begun to discuss parameters of a health care reform bill but is not expected to use H.R. 1628 as the basis for its efforts. Over the coming months, PVA plans to reach out to the Senate committee leadership involved in developing its legislation to ensure that veterans and people with disabilities are not disadvantaged in the process.

April’s Washington Update

April 18, 2017                                                                  Volume 23, No. 4

***PRIORITY***

The Government Relations staff is still looking for stories about problems that our members have experienced during air travel. Please visit www.AirAccess30.org and share your story.

House VA Health Subcommittee Considers Pending Legislation

On March 29, 2017, the House Committee on Veterans’ Affairs, Subcommittee on Health, held a hearing on pending legislation. Sarah Dean, Associate Legislative Director, testified on behalf of PVA. This testimony was Sarah’s first opportunity to testify before Congress.

Of particular importance to PVA was H.R. 95, the “Veterans’ Access to Child Care Act.” This legislation, introduced by Rep. Julia Brownley (D-CA), would make permanent the provision of child care for a veteran receiving covered health services at VA. PVA knows child-care is critical to expanding access to care. When veterans have reliable child care their participation in their own health increases, no-shows and cancelations decrease. Women veterans particularly report the inability to obtain child-care as one of their greatest barriers to VA.

PVA also supported H.R. 907, the “Newborn Improvement Act,” introduced by Rep. Doug Collins (R-GA). This bill would authorize hospital stays of up to 42 days for newborns under VA care. Currently, only seven days after birth is covered, after which the veteran takes on the cost. As the average hospital stay for a health newborn is two day, any newborn needing additional coverage is likely to be facing serious complications. PVA is specifically concerned about veterans with catastrophic injuries that can cause or exacerbate high-risk pregnancies or pre-term deliveries. A seven day limit arguably impacts veterans with disabilities at a greater rate than other veterans.

PVA also offered support for H.R. 1545, the “VA Prescription Data Accountability Act of 2017,” introduced by Rep. Ann Kuster (D-NH). All VA facilities now share prescription information of veterans and their dependents with state Prescription Database Monitoring Program (PDMP). However, due to technical oversight in the law the information of non-dependent, non-veteran, VA beneficiaries is not shared. This bill would rectify the flaw. While PVA strongly supports the bill, we expressed concern that the PDMPs may not be capturing those veterans who travel across multiple states to receive care from the SCI/D Centers. PVA encouraged Congress to ensure state PDMPs are able to share information across multiple state lines to offer all veterans the benefits that will come from these opioid safety measures.

All of the bills considered in this hearing were later passed by the subcommittee and sent to the full committee for consideration.

To read PVA’s full written testimony, please visit www.pva.org.

House VA Subcommittee on Disability Assistance and Memorial Affairs Holds Legislative Hearing

On April 5, 2017, the House Veterans Affairs’ Subcommittee on Disability Assistance and Memorial Affairs held a legislative hearing to consider a number of bills. Among them were two provisions affecting the annual cost-of-living allowance (COLA). PVA supported both measures. The first bill would authorize a cost of living adjustment effective December 1, 2017 equal to the percentage increase implemented by Social Security. The second provision being considered would make the annual adjustment automatic, not requiring Congressional action. Historically, the annual COLA bill has been important legislation that must pass each year. During times of particularly contentious relations in Congress, this legislation has been used as a vehicle to pass other important veterans legislation. While we have voiced this concern in the past, PVA did not object to making the COLA adjustment automatic going forward, as it would add a level of certainty for veterans expecting annual increases.

PVA also supported Ranking Member Tim Walz’s (D-MN) legislation which would prevent VA from demanding redundant compensation and pension (C&P) exams when veterans provide private medical evidence. While VA has the legal authority to rely on private medical evidence, too often it seems that VA requires a second medical exam from the veteran with a VA doctor despite having quality evidence already in hand. The pattern suggests a prejudice toward private medical evidence and the possibility that VA is seeking further evidence solely to avoid granting a claim.

Rep. Brownley (D-CA) offered a bill, H.R. 105 that would add greater protections to veterans who are fraudulently deprived of benefits being administered by a fiduciary. Currently, VA may only reissue lost benefits to veterans who are harmed by fiduciaries who administer benefits to more than ten veterans or if the fiduciary is an institution. If the veteran is not served by a qualifying fiduciary, VA can only reissue benefits to the extent that it recoups money from the bad actor. PVA supported this measure because it would allow VA to reissue benefits under all circumstances, regardless of whether it recoups the funds.

PVA also continues to support a service-connected presumption for Blue Water Navy Veterans who are claiming exposure to herbicides containing dioxin, including Agent Orange. We stressed that as more evidence and information becomes available on the connection that Congress take appropriate steps to ensure these veterans receive the appropriate care and compensation.

Finally, PVA supported H.R. 1390. Currently, VA is only authorized to transport veterans’ remains to the nearest national cemetery with available burial space. This proposal, though, would extend the options to state and tribal cemeteries. It would limit, however, the amount of reimbursement to the cost of the nearest national cemetery so as not to increase the financial burden on VA.

To view PVA’s full statement, please visit www.pva.org.

Congress Passes Choice Program Extension

With the Choice program set to expire on August 7, 2017, Congress recently passed a law eliminating the mandatory expiration date for the program, allowing it to continue to deliver health care services to veterans in the community and use up the remaining funds in the program. Without the extension, the projected remaining funds would be returned to the Treasury. This extension now provides extra time for Congress to address the shortfalls of the current program and move toward a wider and more permanent health care reform in VA. The bill now awaits the President’s signature.

Subcommittee on Disability Assistance and Memorial Affairs Leadership Holds Round Table on Appeals Reform

On March 28, 2017, PVA participated in a widely attended round table sponsored by Disability Assistance and Memorial Affairs Subcommittee Chairman Mike Bost (R-IL) and Ranking Member Elizabeth Esty (D-CT) to discuss moving forward with plans developed over the last year to modernize the disability claims and appeals process. The legislation proposed during the last Congress reflected the work product of numerous veterans’ service organizations, organizations representing private attorneys practicing veterans’ law, and leadership from the Board of Veterans Appeals and the Veterans Benefits Administration. The legislation ultimately failed to secure passage due to a number of concerns, primarily related to the necessity of further discussions on how the new system would be implemented without hurting veterans who have current claims pending. A renewed effort by stakeholders to push the legislation forward during this Congress is gaining traction, and a hearing on an updated version of the legislation is expected to take place in the coming months.

ACA Repeal and Replace Health Care Reform Effort Fails

In early March, the House of Representatives took up legislation to repeal the Affordable Care Act (ACA) and replace it with the American Health Care Act (AHCA). While portrayed as an effort to reduce health care costs for American consumers, the bill also proposed major changes to the Medicaid program through per capita caps and block grants and to repeal many provisions of the ACA that are critical to people with disabilities. In addition, the AHCA continued several problematic policies for veterans left over from the last effort to reform the health care system and created a potential roadblock for veterans to take advantage of tax credits offered in that measure.

The AHCA included cuts in Medicaid of some $880 billion along with caps on federal spending for the program. In return for greater flexibility for designing their own Medicaid programs, states would have received a lump sum—either in the form of block grants or a per capita spending formula—to provide services to their residents. Under the cap and cut proposal, the federal government would no longer share in the costs of providing health care services and community services beyond the capped amount. This would eliminate the enhanced federal match for the Community First Choice Option under Medicaid that provides attendant care services in the community. Thanks to this program, many poor veterans with serious nonservice-connected disabilities have been able to move from nursing homes into their communities. The AHCA would also have ended the ACA Medicaid expansion at a date earlier than current law. Data from the Robert Wood Johnson Foundation shows that the Medicaid expansion has helped thousands of veterans and caregivers obtain affordable health insurance coverage.

During its time under consideration in the House, the AHCA went through a number of changes in an effort by the leadership to garner sufficient votes to ensure its passage. However, each successive version made the bill even more challenging for people with pre-existing health conditions.

  • Loss of essential health benefits: One proposed change was to give states the option to waive important consumer protections in current law. For example, states could choose to ignore the essential health benefits rules that ensure that health plans cover basic services, many of which are particularly important to people with disabilities. Without a requirement that basic services be included in health insurance plans, insurers are likely to drop coverage of therapies or medications that support people with more health care needs.
  • No more protections for pre-existing conditions: Another troubling change being discussed was to let states waive the requirement for community rating. This would allow insurance companies to charge people with pre-existing conditions – including people with disabilities — whatever they wanted, essentially making any pre-existing condition protections meaningless. The combination of these changes would make it nearly impossible for people with pre-existing conditions to find affordable plans that cover basic health care services.

For veterans and PVA members in particular, the AHCA would have continued several problematic policies of the ACA as well as troubling new provisions that could affect the ability of many veterans to afford health insurance in the private market. The AHCA:

  • Continued to exclude CHAMPVA beneficiaries—dependents of the most catastrophically disabled veterans—from the dependents’ coverage policy up to age 26.
  • Failed to remove the prohibition on enrollment into the VA health care system for Priority Group 8 veterans, thus denying these veterans access to the principal health care system for veterans.
  • Denied access to tax credits making health insurance affordable to anyone eligible for a host of other federal health programs, including those “eligible” for coverage under Title 38 health care programs. This would prevent many veterans who may be “eligible for” but not enrolled in the VA health care system from accessing these tax credits intended to help people buy insurance.

On March 24, 2017, House Speaker Paul Ryan declared that there were not enough votes for the bill to pass the House of Representatives and the bill was pulled from the calendar. Nevertheless, discussions have continued between the Congressional leadership and the White House to craft a version of the AHCA that will be acceptable to a majority of Republicans in the House and Senate. PVA plans to continue monitoring developments in the health care reform debate to ensure that veterans and people with disabilities are not harmed by changes to vital health care programs on which they depend.

Update on the ADA Education and Reform Act of 2017

The “ADA Education and Reform Act of 2017,” H.R. 620, continues to gain co-sponsors. PVA opposes this legislation because it would limit the ability of people with disabilities to enforce their rights under Title III of the ADA. It was introduced by Rep. Ted Poe (R-TX). Original co-sponsors include Rep. Scott Peters (D-CA), Rep. Ken Calvert (R-CA), Rep. Ami Bera (D-CA), Rep. Jackie Speier (D-CA), and Rep. Michael Conaway (R-TX).

H.R. 620 has gained nine additional co-sponsors since it was introduced on January 24th:

  • Representative Pete Aguilar (D-CA)
  • Representative Ralph Lee Abraham (R-LA)
  • Representative J. Luis Correa (D-CA)
  • Representative Doug Collins (R-GA)
  • Representative Bill Foster (D-IL)
  • Representative Jeff Denham (R-CA)
  • Representative Krysten Sinema (D-AZ)
  • Representative Paul Mitchell (R-MI)
  • Representative Darrell E. Issa (R-CA)

Please contact your Representatives to let them know that PVA opposes this legislation because it would require a person with a disability to send a letter of notification to the business that it was out of compliance with the law giving it a grace period before one could file suit. Instead of complying with the law now, businesses (large and small) could employ a “wait and see” approach, continuing to violate the law with impunity. Instead, businesses should be proactive in complying with the ADA and work with the ADA National Network and other entities for any needed technical assistance.

The bill is pending before the House Judiciary Committee and may be marked up by the full committee in the coming weeks.

The “Social Security 2100 Act” Reintroduced

On April 5, 2017, PVA Senior Associate Advocacy Director Susan Prokop joined Members of Congress, disability advocates and representatives of the aging community at a Capitol Hill roll out of H.R. 1920, the “Social Security 2100 Act,” introduced by Rep. John Larson (D-CT). Rep. Larson is Ranking Minority Member on the House Ways and Means Social Security Subcommittee. Citing polling data that shows 72 percent of Americans believe that Social Security benefits should be increased, not cut, Rep. Larson described provisions in his bill favored by 7 out of 10 Americans. Among those provisions are:

  • Adoption of the CPI-E for inflation increases: Using the CPI-E for the annual Social Security cost of living adjustment (COLA) would better reflect the costs incurred by seniors and people with disabilities who spend a greater portion of their income on health care, utilities and other necessities.
  • Protections for low income workers: To ensure that low income working people who pay into the system over a lifetime don’t retire into poverty, the bill establishes a new minimum benefit set at 25 percent above the poverty line.
  • Adjustments in the payroll tax wage base to help finance the system: Presently, payroll taxes are not collected on annual wages over $127,000. H.R. 1902 would apply the payroll tax to wages above $400,000 which would affect the top 0.4 percent of wage earners.
  • A gradual increase over 20 years in the payroll contribution rate to keep the system solvent: Beginning in 2018, FICA taxes would rise 0.05 percent annually so that workers and employers would pay an additional 1.2 percent by 2041. For the average worker this would mean paying an additional 50 cents per week to ensure the system’s longevity.

In addition, HR 1902 would provide a modest increase in benefits for all beneficiaries equivalent to 2 percent of the average benefit, cut taxes for upper income beneficiaries by raising the thresholds at which benefits are taxed to $50,000 for individuals and $100,000 for couples and combine the old age and survivors and disability insurance trust funds to foreclose future arguments over the disability insurance program by eliminating the artificial separation of the trust funds.

PVA supports H.R. 1902 because of its more realistic cost-of-living-adjustment for beneficiaries, enhanced protections for low income workers, and long overdue adjustments in the financing mechanisms for the system. Indeed, an independent analysis by the Social Security Administration’s Chief Actuary indicates that this legislation will extend the financial health of the system beyond the next 75 years. PVA believes this legislation demonstrates that preserving and strengthening Social Security can be done without causing harm to beneficiaries.

U.S. Access Board Issues Guidance on the International Symbol

of Accessibility

The U.S. Access Board has released guidance on the International Symbol of Accessibility (ISA) to address questions that have arisen on the use of alternative symbols. Some cities and states have adopted a different symbol that was created to be more dynamic and suggestive of movement. The Board’s guidance explains how use of a symbol other than the ISA impacts compliance with the Americans with Disabilities Act (ADA).

Standards issued under the ADA require that the ISA label certain accessible elements, spaces, and vehicles, including parking spaces, entrances, restrooms, and rail cars. Similar requirements are contained in standards issued under the Architectural Barriers Act (ABA) for federally funded facilities. The ISA, which is maintained by the International Organization for Standardization (ISO), has served as a world-wide accessibility icon for almost 50 years.

“Consistency in the use of universal symbols is important, especially for persons with limited vision or cognitive disabilities,” states Marsha Mazz, Director of the Board’s Office of Technical and Information Services. “In addition to the ADA and ABA Standards, many codes and regulations in the U.S. and abroad also require display of the ISA.”

While the ADA Standards do not recognize specific substitutes for the ISA, they do generally allow alternatives to prescribed requirements that provide substantially equivalent or greater accessibility and usability under a provision known as “equivalent facilitation.” However, in the event of a legal challenge, the entity pursuing an alternative has the burden of proof in demonstrating equivalent facilitation. Under the ABA Standards, use of a symbol other than the ISA requires issuance of a modification or waiver by the appropriate standard-setting agency.

The ISA bulletin is posted on the Board’s website along with other issued guidance on the ADA Standards and the ABA Standards.

 

 

February Washington Update

February 16, 2017 Volume 23, No. 2

***PRIORITY***

The Government Relations staff is still looking for stories about problems that our members have experienced during air travel. Please visit http://www.AirAccess30.org and share your story.

Senate Unanimously Confirms Dr. David Shulkin as Secretary of Veterans of Affairs

On February 13, 2017, the Senate unanimously confirmed Dr. David Shulkin as the next Secretary to lead the Department of Veterans Affairs. Despite a week of all-night debates as part of efforts to delay more controversial Cabinet Appointees, debate on Secretary Shulkin lasted a mere ten minutes. His confirmation is historic in that he will be the first person to lead the Department never having served in uniform. A strong compensating factor, though, is that for the past two years, he has served as the Under Secretary of the Veterans Health Administration (VHA), specifically leading the efforts to reform veterans’ health care.

His successful private sector career in health care coupled with experience working at the highest level of VA suggests he is uniquely suited to hit the ground running. With this favorable blend of experience, though, comes added scrutiny. While Secretary Shulkin has publicly committed to not “privatizing the VA,” PVA will continue to stress with Secretary Shulkin, as we have in the past, the importance of protecting specialized services and appropriate staffing levels in providing high-quality care to veterans with a spinal cord injury or disease.

One specific challenge he is expected to face is the requirement to broaden his view beyond VHA and lead the Department as a whole. As he already acknowledged during his confirmation hearing before the Senate Committee on Veterans’ Affairs, there is an intersection between VHA and the Veterans Benefits Administration (VBA) in the world of disability claims adjudication that cannot be ignored. Put simply, in most instances, veterans cannot receive health care from VA until they receive a rating from VBA. It is imperative the claims and appeals are adjudicated swiftly, efficiently, and, most of all, accurately.

The Independent Budget Policy Agenda for the 115th Congress Released

In February, the co-authors of The Independent Budget (IB)—DAV, Paralyzed Veterans of America, and Veterans of Foreign Wars—released the IB Policy Agenda for the 115th Congress. This year marks the 30th edition of this important endeavor. Since the release of our last policy agenda at the start of the 114th Congress in January 2015, we have seen significant attention on reforming key elements of the delivery of veterans’ health care and benefits. Our focus remains on informing and influencing key policy decisions directed by the administration and Congress that will have a direct impact on veterans and their families.

This year’s document highlights six critical issues that we believe require the greatest attention for the 115th Congress. The critical issues include:

1. Strengthen, Reform, and Sustain the VA Health Care System—The IB focuses on the framework for veterans’ health care delivery reform proposed in 2015. Inherent in this framework is the preservation and strengthening of a robust Department of Veterans Affairs (VA) health care system, particularly specialized services such as spinal cord injury and disease care, blind and vision impaired care, polytrauma care, traumatic brain injury care, and mental health care services. Our recommendations are also meant to frame the debate in the context of the VA’s community care consolidation plan, the Commission on Care recommendations, and recommendations from the Independent Assessment conducted by the MITRE and RAND corporations.

2. Remove Budget Constraints that Negatively Impact Veterans Programs—This edition focuses on the structural impediments that lead to insufficient resources being provided to ensure VA has adequate capacity to meet the needs of veterans. It addresses ongoing budget caps, sequestration, PAYGO and other budget and appropriations rules as well as the need to complete appropriations reform providing all VA programs advance appropriations.

3. Reform the Claims and Appeals Process—Appeals modernization and reform has been a primary objective of VA leadership and has been widely discussed in the House and Senate. The IB focuses on the issues that must be addressed in the course of implementation of claims and appeals reform irrespective of the final outcome of appeals reform legislation.

4. Realign and Modernize Capital Infrastructure—The misalignment and deterioration of much of VA’s capital infrastructure is a commonly discussed problem that continues to negatively impact the delivery of care to veterans. The Commission on Care and the MITRE-RAND Independent Assessment recognized the significant funding gap for VA’s infrastructure and the need to realign and right-size that infrastructure to best serve veterans, efficiently deploy resources and remain viable in the future

5. Improvements Needed in the Program of Comprehensive Assistance for Family Caregivers (PCAFC) of Severely Injured Veterans—Expansion of the comprehensive family caregiver program administered by the VA to veterans of all eras remains a high priority for the IB. Additionally, key facets of that program must be improved to ensure efficient implementation and effective delivery of services. At the same time, other programs that offer similar support services for catastrophically disabled veterans must be enhanced.

6. Ensure that VA Provides High-Quality, Effective Programs and Services to Meet the Unique Needs of Women Veterans—Much work remains to ensure that women veterans are able to access the full range of health care services that are appropriate to their unique needs. Additionally, benefits and service support programs must be enhanced to ensure that women veterans receive equitable treatment in the delivery of their earned benefits and services.

The IB serves as a guide for our legislative work in Congress and as a resource for both the Department of Veterans Affairs (VA). This policy agenda will soon be followed by the budget report for FY 2018 and FY 2019, scheduled to be released before the end of February.

To view the full IB Policy Agenda for the 115th Congress, visit http://www.independentbudget.org.

HVAC Subcommittee on Disability Assistance and Memorial Affairs Examines Impact of National Work Queue

The Subcommittee on Disability Assistance and Memorial Affairs kicked off the 115th Congress with a hearing examining the progress of VBA’s new method of allocating disability claims among its processors, the National Work Queue (NWQ). Historically, claims were processed by the local Regional Office (RO) where it was submitted. Naturally, some offices experience a relatively light workload or exceptional productivity while others are inundated with an overwhelming number of claims or, for any number of reasons, are plagued with low productivity and slow processing times. In an attempt to move into the 21st Century, VBA developed and began using a digital system designed to gather all disability claims submitted by veterans throughout the United States and distribute them to RO’s based on capacity. The practical effect for veterans is that if your local RO is handling claims in a timely manner, your claim will likely be adjudicated locally. But if your local RO is struggling to process claims within a standard of 125 days, the NWQ will take the excess claims that the local office cannot handle and move them to an RO that can.

Moving to a digital system and changing the landscape of where claims are normally processed brought both increased efficiency and accuracy. But it is also still facing certain challenges. Chairman Mike Bost (R-IL) touched on one of these challenges, the paradox of VBA increasing efficiency in processing claims and yet the backlog continues to rise. The Veterans Health Administration faces the same issue – as access to care improves, more veterans want in to use VA health care. Likewise with claims – as processing times and accuracy improve, more veterans find it worth it to submit a claim. In essence, the efficiency is offset by increased demand, and it ultimately looks like VA is making no progress.

New Ranking Member Elizabeth Esty (D-CT) and Chairman Bost both attempted to flesh out the VSOs’ collective concerns, though, with claims that are no longer local. Under the old system, the VSO service officers would be able to review the RO’s decision prior to it being issued, mostly to correct any clerical or blatant errors before the decision was made final. VFW noted that, by its calculations, 1 in 10 claims experience errors that were easily correctable. Being able to inform the RO of a mistake before the decision is finalized prevents a large number of veterans from being unnecessarily forced into the arduous and lengthy appeals process. It similarly prevents VA from having to do unnecessary work. Under the new digital system, VA’s attempt to re-create this feature just is not working. Service officers are struggling to track down claims that have been distributed to other RO’s and they are not able to prevent final decisions from being made with mistakes. VBA officials have yet to produce an acceptable remedy, and this hearing was a chance for Congress and VSO’s to apply more pressure to VBA for a fix.

PVA has observed a particular concern with the NWQ as it relates to special issues, specifically Amyotrophic Lateral Sclerosis (ALS) claims, homelessness, and terminal issues. When these claims are arriving in the NWQ, they are not being flagged appropriately and worked by the appropriate team. Instead they are being worked in the order of the date of claim. This creates a delay in these claims which could cause the veteran to die before seeing benefits. PVA hopes to work with VBA to alleviate this problem.

ADA Education and Reform Act of 2017 Reintroduced in the House

On January 24, 2017, Representative Ted Poe (R-TX) reintroduced the “ADA Education and Reform Act of 2017.” This legislation would limit the ability of people with disabilities to enforce their rights under the ADA by requiring a person with a disability to send a letter of notification to a business alerting the owner that it is out of compliance due to an architectural barrier prior to being able to file a lawsuit. Other co-sponsors include Representatives Scott Peters (D-CA), Ken Calvert (R-CA), Ami Bera (D-CA), Jackie Speier (D-CA), and Michael Conaway (R-TX).

PVA opposes this legislation. We believe that it would remove the incentive for businesses, social service establishments, and other places of public accommodation to comply with the ADA’s accessibility requirements. Businesses could employ a “wait and see” approach, continuing to violate the law with impunity. Instead, businesses should be proactive in complying with the ADA and work with the ADA National Network and other entities for any needed educational resources.

DOT Releases Annual Report on Disability-Related Complaints for 2015

In February 2017, DOT released the latest figures on complaints filed directly with airlines. In 2015, passengers filed 30,830 disability-related complaints as reported by 176 domestic and foreign air carriers, which represents a nearly twelve percent increase over 2014. Top complaints with U.S. carriers for passengers with paraplegia or quadriplegia include failure to provide assistance and seating accommodation. In 2015, passengers also filed 939 disability-related complaints directly with DOT.

 

January 2017 Washington Update

January 17, 2017                                                   Volume 23, No. 1

***PRIORITY***

The Government Relations staff is still looking for stories about problems that our members have experienced during air travel.  Please visit www.AirAccess30.org and share your story. 

PVA Outlines Policy Priorities for the 1st Session of the 115th Congress

Prior to the Christmas holiday, the Government Relations Department finalized our primary policy priorities for 2017. A brief outline of those issues that will comprise our point papers for the Advocacy and Legislative Seminar in March is below:

  1. Protection of Specialized Services: The highest priority is to strengthen and sustain VA’s specialized services, such as spinal cord injury/disease care, blinded care, poly-trauma care, and mental health care, which are not duplicated in the private sector. This will include advocating for sufficient funding to hire additional physicians, nurses, psychologists, social workers and rehab therapists. We will also focus on the need to retain title 38 U.S.C. protections for veterans getting care in the community.
  2. Expand Eligibility for VA’s Comprehensive Family Caregiver Program: Congress must expand eligibility for caregiver services provided through the VA’s Comprehensive Family Caregiver Program veterans with service-connected injuries or illnesses incurred prior to September 11, 2001.
  3. Comprehensive Reform of the Claims Appeals Process Needed: Support comprehensive reform of the benefit claims and appeals process to modernize and streamline the process, in accordance with the legislation developed and agreed to in 2016 by senior leaders of VA, VBA, the Board of Veterans Appeals, VSOs and other stakeholders.
  4. Improve Benefits for Catastrophically Disabled Veterans: Improve benefits for veterans with the most severe disabilities, to include increasing the rates of Special Monthly Compensation as well as Aid and Attendance benefits.
  5. Air Carrier Access Act (ACAA) Problems for People with Disabilities: Improve access to air travel for people with disabilities by strengthening protections in the ACAA to ensure safe and efficient assistance and accommodations in air travel and increasing enforcement of these protections.
  6. Americans with Disabilities Act (ADA) Notification: Protect the rights of people with disabilities to seek redress of discriminatory barriers in public accommodations under the ADA by refusing to enact notification requirements under the ADA.
  7. Protect and Strengthen Social Security and Medicare (Entitlement Reform): Social Security and Medicare should be strengthened and efforts to undermine these programs through benefit cuts or privatization must be rejected.

Members of House VA Committee Chosen

The House Committee on Veterans’ Affairs recently announced the members who will sit on the Committee for the 115th Congress. As previously discussed, Rep. Phil Roe (R-TN), will serve as the Committee Chairman. The following Republicans were also chosen to serve on the Committee:

Doug Lamborn (R-CO)

Gus M. Bilirakis (R-FL)

Mike Coffman (R-CO)

Brad Wenstrup (R-OH)

Amata Coleman Radewagen (R-American Samoa)

Mike Bost (R-IL)

Jodey Arrington (R-TX)

Jim Banks (R-IN)

Jack Bergman (R-MI)

Neal Dunn (R-FL)

Clay Higgins (R-LA)

John Rutherford (R-FL)

Additionally, the following assignments for Subcommittee leadership were made:

Rep. Mike Bost (R-IL): Chairman, Subcommittee on Disability Assistance and Memorial Affairs

Rep. Jodey Arrington (R-TX): Chairman, Subcommittee on Economic Opportunity

Rep. Brad Wenstrup (R-OH): Chairman, Subcommittee on Health

Rep. Jack Bergman (R-MI): Chairman, Subcommittee on Oversight and Investigations

Announcements for the Democratic membership of the Committee have yet to be made. However, we anticipate a number of previous members of the Committee to be moving on to other House Committee assignments.

Meanwhile, as previously reported, the Senate Committee on Veterans’ Affairs will be chaired by Senator Johnny Isakson (R-GA), and the new Ranking Member will be Senator Jon Tester (D-MT). While it has not been formally announced, the Committee membership is not expected to change significantly.

Camp Lejeune Presumption of Service-Connection Granted for Eight Conditions

On January 13, 2017, the Department of Veterans Affairs published a Final Rule granting presumptive service connection to certain diseases associated with contaminants present in the base water supply at U.S. Marine Corps Base Camp Lejeune, North Carolina. The presumption is rebuttable. The rule covers veterans who served a minimum of 30 days at Camp Lejeune during the period of August 1, 1953 through December 31, 1987. Reservists and members of the National Guard meeting the 30-day requirement will be considered veterans for purposes of this presumption. The rule is expected to become effective on approximately March 15, 2017.

The presumption of service-connection applies to the following eight diseases: 1. Kidney cancer; 2. Liver cancer; 3. Non-Hodgkin’s lymphoma; 4. Adult leukemia; 5. Multiple myeloma; 6. Parkinson’s disease; 7. Aplastic anemia and other myelodysplastic syndromes; 8. Bladder cancer. This list of diseases now receiving a presumption of service-connection does not affect the list of fifteen diseases which qualify for free medical care through the VA as provided in the “Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012.”

Affordable Care Act Repeal Begins But Raises Many Questions

Congress has begun taking the first steps toward repealing the Patient Protection and Affordable Care Act (ACA) with a Senate vote on January 12. The vote was on a fiscal year 2017 budget reconciliation measure and followed party lines with 51 Republicans voting in favor to 47 Democrats opposed. Sen. Rand Paul (R-Ky.) also voted no, in part over concerns that GOP leaders have not committed to a plan to replace the Affordable Care Act after it is repealed. The bill was expected to go to the House of Representatives for a vote on Friday January 13 and be passed easily. The reconciliation bill contains instructions to several House and Senate Committees to work out the details of repeal and report back with legislation to implement repeal by the end of January.

A large part of the ACA can be repealed through reconciliation, which only needs the support of 51 senators – an easier threshold to achieve than the 60 votes required by most other pieces of legislation in the Senate. Among the elements of the ACA that are targeted for removal are the individual penalties for non-coverage, premium supports and tax credits making coverage affordable, the Medicaid expansions with federal matching funds that have been adopted by over 30 states and taxes on high-income households and the health care industry that helped pay for the ACA’s coverage expansions.

The dilemma facing the Republican leadership is that they and President-elect Trump have promised to offer a replacement health care proposal in conjunction with ACA repeal. They have also offered assurances that many of the popular provisions in ACA will be retained, including the protections against discriminatory health insurance policies and coverage of dependents up to age 26. Some in the leadership have suggested that the effective date of repeal could be delayed for several years while a replacement plan was developed and put in place. Aides to House leaders have cautioned that any replacement legislation will only be partial because of the need to get changes through the Senate with 51 votes and the reconciliation rules that require measures to have a budgetary impact. Developing a more comprehensive replacement to the ACA would need 60 Senate votes and significant Democratic support.

According to some analyses, removing the coverage mandates and premium subsidies could cause turmoil in the individual insurance market as some companies that had expected more customers pull out and those companies that remain are forced to raise premiums to account for uncertainty. The Congressional Budget Office has estimated that eliminating the individual mandate would cause premiums in the individual market to rise by 20 percent. This in turn would likely cause large numbers of younger, healthier individuals to drop their insurance, leaving people with serious health conditions to remain in the individual market facing ever increasing premiums.

Other effects of passage of the reconciliation bill as outlined by the Urban Institute include:

  • An increase in the number of uninsured people from 28.9 million to 58.7 million in 2019, an increase of 103 percent. The share of nonelderly people without insurance would increase from 11 percent to 21 percent, a higher rate of un-insured than before the ACA because of the disruption to the non-group insurance market. Of the 29.8 million newly uninsured, 22.5 million people become uninsured as a result of eliminating the premium tax credits, the Medicaid expansion, and the individual mandate. The additional 7.3 million people become uninsured because of the near collapse of the non-group or individual insurance market.
  • A reduction in numbers of those covered by Medicaid or the Childrens’ Health Insurance Program by 12.9 million people.
  • A reduction in Federal government spending on health care for the non-elderly [including many people with disabilities under age 65] by $109 billion in 2019 and by $1.3 trillion from 2019 to 2028 because the Medicaid expansion, premium tax credits, and cost-sharing assistance would be eliminated.

Several amendments were offered during the Senate budget reconciliation debate by Senators Bernie Sanders (I-VT) and Bob Casey (D-PA) to protect Medicaid, Medicare and other safety net programs. They were all defeated on partisan votes with only one or two Republicans voting in their favor. Once the committees return with their plans at the end of January, a clearer picture of any replacement legislation will emerge. Subsequent actions on health reform are likely to arise in the context of tax reform proposals and possibly reauthorization of the Childrens’ Health Insurance Program. As deliberations on the fate of ACA continue, PVA will continue working with its allies in the disability community and in Congress to raise with policymakers the severe, adverse impact on people with disabilities that will attend repeal of the ACA.

DOT Releases New Air Carrier Access Act Training Materials

The U.S. Department of Transportation (DOT) has released new training materials targeted at the top areas in which passengers with disabilities encounter difficulties in air travel.

In December 2015, DOT originally announced its intent to develop new materials that airlines and their contractors can use to supplement their current training programs addressing the four issues on which DOT receives the largest number of disability-related complaints. The materials cover (1) wheelchair and guide assistance; (2) stowage, loss, delay, and damage of wheelchairs and other mobility assistive devices; (3) aircraft seating accommodations; and (4) travel with service animals. PVA participated in DOT-led focus groups along with other members of the disability community and the airlines in the development of the materials.

The training materials, which are available online, include videos, brochures, digital content designed for viewing on a mobile device, and a tip sheet and are organized by topic. DOT will also be posting two interactive guides in the near future. In addition to developing materials for airline personnel and their contractors, companion pieces for passengers with disabilities are also available.

To access the materials, please visit: https://www.transportation.gov/airconsumer/disability-training/. These materials should be circulated broadly to ensure that people with disabilities have a better understanding of their rights and responsibilities under the Air Carrier Access Act.

Consent Order Issued Against American Airlines In Response to ACAA Training Violation

The U.S. Department of Transportation (DOT) has issued its first consent order for 2017 under the Air Carrier Access Act (ACAA) in response to a formal complaint filed by Mr. Kevin Crowell, a veteran with a disability, against American Airlines.

Mr. Crowell, who uses a service animal for PTSD and mobility issues, encountered difficulties in securing a bulkhead seat on an American flight in April 2014. Under the ACAA, people who use service animals have priority access to bulkhead seats. Mr. Crowell contacted American prior to his travels to secure the accommodation. Once he arrived at the gate for a connecting flight, however, his wife was informed that pets are not allowed to sit in the bulkhead. Despite providing information to the agent showing that his animal was not a pet, he was directed to a non-bulkhead seat. His animal would not fit and he requested his original seating assignment. American allegedly asked him to take his assigned seat or deplane. Once he deplaned, he alleged that a Customer Care Manager was called to meet with him, and offered to accommodate him on the next flight to his destination, but he declined the offer.

In his formal complaint, Mr .Crowell alleged that American Airlines denied him transportation on the basis of his disability, failed to accommodate his service animal, and failed to train their staff to proficiency as required under the ACAA. DOT found that American did not deny transportation or fail to accommodate his service animal because American asserted in its response to the complaint that although there was initial confusion they offered to accommodate him on his originally scheduled flight. As a result of the errors that led to the confusion, DOT found that the airline failed to train its staff to proficiency regarding the ACAA rights of passengers using service animals.

The order requires American to provide supplemental training to reservations and gate agents and to ensure that supplemental materials are included in the training programs for new agents. The order is available here: https://www.transportation.gov/airconsumer/eo-2017-1-11

PVA Trains Wheelchair Attendants for Virgin America Airlines

In early December, Senior Associate Advocacy Director Lee Page and Heather Ansley, Associate General Counsel for Corporate and Government Relations, met with representatives from Virgin America Airlines at Dulles International Airport (DIA) in northern Virginia. The meeting was at Virgin’s request to facilitate a discussion around the boarding process and demonstrate proper technics for transfers in and out of an aisle chair. Virgin America contracts with Huntleigh USA Corp. at Dulles for wheelchair assistance to assist passengers with disabilities in boarding and deplaning as part of their responsibility under the Air Carrier Access Act (ACAA).

After introductions, Mr. Page and Ms. Ansley thoroughly explained the Air Carrier Access Act and the legal responsibilities of the airline–Virgin America—and its contractor—Huntleigh—in what services are required to be provided to qualified passengers with disabilities. Mr. Page with the assistance of Huntleigh personnel demonstrated proper transfer technics on and off two different aisle chairs that were provided. Whereas Huntleigh personnel knew what to do in the transfers, Mr. Page emphasized that they need to take direction from the passenger with the disability.

The discussion lasted about two hours and included approximately 25 participants from Virgin America, Huntleigh USA, and a few representatives from Alaska Airlines. PVA agreed to work with Virgin America and Alaska Airlines to develop future opportunities to educate personnel on the specific needs of passengers with disabilities.

U.S. Access Board Releases Accessibility Standards for Medical Diagnostic Equipment

The U.S. Access Board has issued new accessibility standards for medical diagnostic equipment (MDE) in response to a requirement in the Affordable Care Act. The standards provide design criteria for examination tables and chairs, weight scales, radiological and mammography equipment, and other diagnostic equipment that are accessible to people with disabilities. They include requirements for equipment that requires transfer from mobility aids and address transfer surfaces, support rails, armrests, and other features. PVA was a member of the MDE Accessibility Standards Advisory Committee that made recommendations to the Access Board.

Barriers to diagnostic equipment include equipment height and other dimensions, the lack of supports and features necessary for transfer, and the characteristics of contact surfaces. The standards address these as well as other features such as operable parts and patient instructions. The provisions are organized based on use position and whether transfer from wheelchairs is necessary.

As issued by the Board, the standards are not mandatory on health care providers and equipment manufacturers. The U.S. Department of Justice, which has issued guidance on access to medical care, may adopt them as mandatory requirements under the Americans with Disabilities Act. Other federal agencies may implement them as well under the Rehabilitation Act which requires access to federally funded programs and services.

The standards are available here: https://www.access-board.gov/guidelines-and-standards/health-care/about-this-rulemaking/final-standards.

An overview of the standards are available here: https://www.access-board.gov/guidelines-and-standards/health-care/about-this-rulemaking/background/overview-of-the-mde-standards.