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.

 

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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”

May Washington Update

May 16, 2017 Volume 23, No. 5

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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 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.

 

 

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.

 

October Washington Update

October 18, 2016 Volume 22, No. 10

***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.

Congress Approves CR, Includes PVA Priorities

Prior to recessing for the November election at the end of September, Congress approved H.R. 5325, the “Continuing Appropriations and Military Construction and Veterans Affairs Appropriations Act for FY 2017,” that included full-year funding for the Department of Veterans Affairs (VA). The bill contains three very important priorities for PVA. These include:

1. Reinstatement of the annual capacity reporting requirement. While a date for implementation has not been established, this is an important accomplishment that will bolster the work done by the PVA Medical Services site visit teams.
2. Authorization of the provision of reproductive services through VA, to include in vitro fertilization (IVF). This has long been a high priority for PVA. For the first time, veterans with service-connected catastrophic disabilities that preclude them from having children will have access to reproductive services through the VA. Unfortunately, we will have to defeat an amendment included in the Labor/HHS Appropriations bill, introduced by Rep. Andy Harris (R-MD), that risks undermining the authority to provide IVF services both at VA as well as the Department of Defense.
3. Beneficiary travel for “some” non-service connected catastrophically disabled veterans, including those with SCI, blindness and amputation. The language in the bill states that it can be provided to those who travel to an inpatient rehabilitation facility, such as an SCI center, and are admitted for overnight stay or provided temporary lodging. Assuming appropriate interpretation, this should at least open the opportunity for beneficiary travel for PVA members receiving annual physicals; however, we do not believe it authorizes beneficiary travel for non-service connected veterans for same-day appointments. Additionally, it remains to be seen when this benefit will actually go into effect. We will obviously have to track implementation of this closely.

Sarah Dean, PVA Associate Legislative Director, deserves a great deal of credit for her tireless work on the capacity reporting issue and the IVF provisions specifically. Hard work remains to ensure that proper implementation of these important provisions occurs. This will be particularly true of the capacity report and the beneficiary travel provisions, which I anticipate VA will be resistant to acting on.

Legislation Stalled in the Senate

While key provisions were included in the CR, the lack of compromise generally led to a number of important pieces of legislation being left unfinished. Perhaps the biggest issue that has yet to be resolved is the appeals reform included in H.R. 5620, the “Accountability First and Appeals Reform Act,” introduced by House VA Committee Chairman Jeff Miller (R-FL). That legislation also included strong accountability measures for VA staff. The legislation passed the House in September with strong bipartisan support, but it is being held up in the Senate, primarily over disagreements on the accountability provisions.

Our work also continues on H.R. 3471, the “Veterans Mobility Safety Act.” While we were able to get it passed in the Senate, there has been continued resistance in the Senate. However, Gabe Stultz, Associate Legislative Director, has worked closely with Senator Jerry Moran’s (R-KS) office and they are prepared to move an amended version of H.R. 3471 that will satisfy all interested parties when Congress returns after the election.

Finally, the Senate has been unable to advance S. 2921, the “Veterans First Act.” Of highest importance to PVA in that legislation is provisions that will expand access to the Comprehensive Family Caregiver program to veterans of all eras, not just those injured after September 11, 2001. Unfortunately, cost remains a hurdle to advancing that effort. Additionally, provisions that are generally perceived to water down accountability, per the request of the government unions, have led a stalemate over the bill.

We anticipate a lot of focus on appeals reform and accountability when Congress returns for a lame duck session after the election in November.

DOT ACCESS Committee Completes Work

The U.S. Department of Transportation’s Advisory Committee on Accessible Air Transportation (ACCESS Committee) completed its business on Friday, October 14, 2016. The 25 member Committee was charged with negotiating in good faith to reach consensus on a proposed rule addressing inflight entertainment, service animals, and accessible lavatories on single aisle aircraft. The department intends to use the consensus agreement from the ACCESS Committee as the basis for a proposed rule. After six months’ worth of work, there were varying degrees of success. The Committee focused on three key areas—lavatories, service animals, and inflight entertainment. The following is a review of that work.

Lavatories

The Committee reached consensus that all new aircraft of a certain size shall have accessible lavatories by a certain date. Recognizing that a prior committee failed in this process in 1993 and that there is expense to the industry in complying, the Committee adopted a two tiered approach in providing accessible lavatories on new single aisle aircraft.

The first tier includes all new aircraft delivered three years after the effective date of the final rule. The second tier includes aircraft that are ordered 18 years and delivered 20 or more years after the effective date of the final rule; or are a new type design for which application is filed with the FAA or a foreign carrier civil aviation authority more than 1 year after the effective date of the final rule. Both tiers have multiple levels of access for passengers with disabilities. Access that begins in the first tier carries over into the second tier of accessibility.

Specifically, the first tier applies to all carriers operating aircraft that have FAA-certified maximum passenger capacity of 60 or more seats. This will include flight attendant training on an annual basis to proficiency in use of the new DOT onboard wheelchair and assembly or modifications to the accessible features of the lavatory. Carriers must also provide information upon request to passengers with disability concerning the accessible features of the lavatory including controls and dispensers and the information must be on the carrier’s website, in electronic or printed forms with picture diagrams, on the aircraft. Carrier will also remove the international symbol of accessibility (ISA) from all lavatories new and in service that cannot facilitate an independent seated transfer.

All first and second tier aircraft with FAA-certified maximum passenger capacity of 125 or more seats will have at least one lavatory that meets the following specifications. The aircraft shall have a standard toilet seat height ranging from 17-19 inches high, assist handles that support 250 pounds and an array of controls and dispensers that are tactilely accessible and measured for a performance specification that meets the definition of a person with a disability in a seated position. These interior lavatory components include: attendant call buttons, door lock, flush control, faucet controls, paper towel and soap dispensers, and trash and bio waste units. All components where reasonably available in supplier catalogs shall be operable with one hand and shall not require tight grasping, pinching, or twisting of the wrist.

Other features that will apply to a first tier aircraft include a visual barrier that shall be available upon request. It will provide passengers with disabilities using the lavatory (with the door possibly open) a level of privacy substantially equivalent to that provided to ambulatory users. Most importantly is a door sill or threshold that provides minimum obstruction to the passage of the on board wheelchair across the sill while preventing leakage of fluid or causing a tripping hazard during evacuation. The door sill threshold applies to both tiers of access.

New covered single aisle aircraft with FAA-certified maximum passenger capacity of 125 or more seats entering service three years after the effective date of the final rule must have onboard wheelchairs that meet new standards to be developed by DOT. DOT will consult with advocates, airlines, wheelchair manufacturers, flight attendants and other stake holders in developing these standards. The purpose of the onboard wheelchair standards is to improve the safety of traditional models of onboard wheelchairs and develop, if feasible, specifications for an over-the-toilet onboard wheelchair design. The target date to complete the onboard wheelchair standards is February 2017.
Second tier aircraft with FAA-certified maximum passenger capacity of 125 or more seats in which lavatories are provided will be required to have one lavatory of sufficient size / design to permit a passenger with a disability to perform a seated independent and dependent transfer from the onboard wheelchair to and from the toilet within a closed space that affords to persons using the onboard wheelchair privacy equal to that afforded by ambulatory passengers. To ensure these new lavatories meet the performance specifications they will be designed/modeled with the 95 percent male (6’2, 246lbs) and 5 percent female (4’11,125lbs) range to meet the required transfers, including the use of a 95 percent male to assist a dependent 95 percent male with a transfer from the onboard wheelchair to and from to toilet within the closed lavatory space.

The committee reached a consensus vote of 17 for the agreement, 1 no vote and 3 abstentions. PVA supported this agreement as first tier accessibility will provide increased access to lavatories in the short-term and ensure full-access at a time-certain in the future.

Service Animals

Despite good faith negotiations, the ACCESS Committee reached an impasse in its efforts to come to a consensus on revising the definition of a service animal and the requirements for access for those animals under the ACAA.

The impasse resulted due to an inability to find a suitable alternative to current regulations which allow airlines to request as a condition of access that users of psychiatric and emotional support animals provide current documentation from a mental health professional stating that they have a mental or emotional disability for which they need the animal. Airlines and advocates considered imposition of a requirement for all service animal and emotional support animal users to complete an attestation confirming that they were a person with a disability and that the animal was needed either in flight or at the destination due to the disability. The proposed attestation would also have alerted the individual to the possibility that attempting to pass a pet as a service animal or emotional support animal could result in penalties. Ultimately, we were unable to find a solution that would free psychiatric and emotional support animal users from the burdens of medical documentation without imposing new, unacceptable burdens on all service animal users.

Another issue that remains unresolved is the types of species of service animals that should be allowed under the ACAA. Currently, domestic carriers are never required to permit access for unusual service animals such as snakes, rodents, and spiders, but must otherwise permit access for service animals unless the carrier determines that there are factors that preclude the animal from traveling in the cabin. Foreign carriers do not have to provide access to service animal species other than dogs. Stakeholders generally agreed that dogs, miniature horses, and capuchin monkeys should be classified as service animals. An unresolved question remained whether cats should also be included.
In addition, stakeholders were unable to resolve whether emotional support animals should continue to have access. Under the ACAA, the definition of service animal includes emotional supports animals. Stakeholders considered removing emotional support animals from the definition and reclassifying those and other similar animals as “support animals.” Species considered for support animals included dogs, cats, and rabbits. Those animals would have had more limited access than service animals as in many cases they would have been required to travel in a pet-carrier but still able to perform disability mitigation, if needed.

In light of the failure of these negotiations to reach consensus, DOT will now be charged with developing a proposed rule on this issue. The efforts of disability advocates, including PVA, have provided DOT with significant insight. We look forward to weighing in with DOT to ensure that any proposed rule preserves the access rights of all service animal users.

Inflight Entertainment

The ACCESS Committee still has work to do in trying to reach consensus on the issue of accessible inflight entertainment and communication. Currently, airlines are not providing captioning for the deaf or audio description for the blind on movies or television shows packaged by the airlines for inflight entertainment. The problem revolves around technical hardware and software mechanical issues of the seatback display systems that in service airplanes use. The work group on inflight entertainment and communication will meet November 2, 2016 to finish their negotiation in hopes of reaching a consensus.

The DOT Facilitators’ report is due in early December. The report will reflect the entire work of the ACCESS Committee in the three areas they were charged to reach agreement on and all public documents that were sent to the Committee in support of the issues. The DOT onboard wheelchair standards are due in February 2017 and the Department hopes to publish a Notice of Proposed Rulemaking in the Federal Register by the end of June 2017.

PVA Participates in Suicide Roundtable Discussion
On September 23, 2016, VA gathered a large group of veterans’ service organizations (VSOs) to discuss opportunities for collaboration and some of the salient issues with regard to confronting veteran suicide. The primary issues discussed related to both identifying at risk veterans and getting those veterans to engage in VA-provided services. An additional challenge is that even if veterans are identified, not all are eligible for care.

VA discussed briefly the mental health summits that it is holding throughout all VAMCs. The American Legion mentioned that many of their NSOs were not made aware of these summits, and the opportunity for VSOs to reach out to their local members was lost. VA will reevaluate its communications with VSOs for the summits, and they provided the upcoming schedule of all summits so that VSOs can alert their field offices.

VA also explained briefly some of their efforts to assist families of veterans who are contemplating suicide and community providers handling veteran patients contemplating suicide.

Ultimately, the forum was a chance for VA to ask PVA and our fellow VSOs as individual organizations to decide how we can partner with VA to reach veterans who are struggling. Suicide prevention materials being shared publicly by the VA can be viewed at the video links below:

• Newest Suicide Prevention PSA “Be There: Help Save a Life”: https://youtube/MCSZ7FjTq5I
• Suicide Prevention PSA “I’m good. But are you ready to listen?”: https://youtu.be/YPFo9EvUUvA
• Suicide Prevention PSA “The Power of 1”: https://youtu.be/WSx11Kmnmrg
• Veterans Crisis Line – After the Call: https://youtu.be/l8cQHTzZTIs

Deadline for Claims in Department of Justice’s Historic Settlement with Greyhound for ADA Violations Approaching

On February 8, 2016, the Department of Justice announced a consent decree resolving a complaint against Greyhound for alleged violations under the Americans with Disabilities (ADA). Allegations against Greyhound included failing to maintain accessibility features on buses, failing to provide assistance to passengers with disabilities, and failing to allow passengers using wheelchairs to complete reservations online. As a result of the consent decree, Greyhound will be required to compensate travelers with disabilities who experienced disability discrimination while traveling or attempting to travel on Greyhound.

The deadline for passengers with disabilities who encountered disability-related discrimination on Greyhound to submit a claim for compensation is November 10, 2016.
To be eligible for compensation, an individual must have a disability; have traveled or attempted to travel on Greyhound between February 8, 2013, and February 8, 2016; and have experienced a disability-related incident during travel or while attempting to travel. Examples of incidents include lack of accessible transportation and failure to make disability-related accommodations.

Individuals who believe they meet these requirements must submit a claim online, by email, or mail to Greyhound’s appointed claims administrator by November 10, 2016. Instructions regarding the claims process are available at: http://www.dojvgreyhoundsettlement.com. To contact the Claims Administrator, please call 1-844-502-5953 or by email at GRYsettlement@classactionadmin.com.

ADA Notification Act Legislation Introduced in the Senate

On September 28, 2016, Sen. Jeff Flake (R-AZ) introduced S. 3446, the “ADA Education and Reform Act of 2016.” This legislation would require a person with a disability to give notice to a public accommodation of an architectural barrier under the Americans with Disabilities Act (ADA) prior to filing a lawsuit. Sen. Flake’s legislation is a companion bill to H.R. 3765, which was introduced by Rep. Ted Poe (R-TX) and passed by the House Judiciary Committee in July. Despite concerns that H.R. 3765 might be brought to the House floor for a vote in September, no further action on this legislation has occurred.
PVA strongly opposes proposed ADA notification requirements. Notification laws put the onus on the person with a disability to find ADA violations and notify a public accommodation of those violations. No other civil rights group is forced to shoulder the burden of triggering compliance with the law and, once they have done so, to wait to enforce their civil rights. Accessibility standards, such as those the ADA includes, are extremely important. Covered entities should continuously evaluate their businesses for appropriate access under the ADA and not wait to receive a notification before acting to make them fully accessible.

OFCCP Hosts Business Roundtable for National Disability Employment Awareness Month

On October 6, 2016, the Office of Federal Contract Compliance Programs (OFCCP) hosted a forum highlighting successful business strategies for outreach to and recruitment of people with disabilities into the nation’s workforce. OFCCP is the agency within the Department of Labor (DOL) responsible for enforcing government contractors’ compliance with Section 503 and VEVRAA. Those regulations require federal contractors to take affirmative steps to recruit and hire people with disabilities and certain targeted veterans, including those with disabilities. The roundtable was part of OFCCP’s observance of National Disability Employment Awareness Month and brought together representatives of companies that have excelled in making disability inclusion a vital part of their workforce diversity efforts.

In a keynote address, Robert J. O’Hara, Vice President with United Technologies Corp., expressed support for the regulations that require companies to document their progress in bringing more people with disabilities into their operations. He also described challenges they encountered in broadening their disability outreach including appropriate ways to encourage people to identify as someone with a disability and connecting with talent pipelines to find qualified applicants. Among the strategies that worked for UT and for others at the forum were participation in networking conferences sponsored by organizations such as U.S. Business Leadership Network and National Organization on Disability, creating partnerships with universities to reach students with disabilities, and involvement of top corporate leadership in disability inclusion efforts.

For more information about DOL initiatives undertaken for National Disability Employment Awareness Month go to https://www.dol.g

February Washington Update

February 18, 2016                                                            Volume 22, No. 2

Administration Releases FY 2017 Budget Request, Includes Inadequate Advance Appropriations for FY 2018

PVA, along with our partners in The Independent Budget, believe that the FY 2017, VA Budget Request is a generally good budget.  The Administration’s budget request is $78.7 billion in total discretionary spending for FY 2017.  When considering the additional $5.7 billion that the Administration projects spending from the Choice Act, the total projected expenditure from VA in FY 2017 is approximately $84.2 billion.  The Independent Budget veterans’ service organizations (IBVSOs) recommend $84.4 billion in total funding for the VA.

PVA believes that significant attention must be placed on ensuring adequate resources are provided through the Medical Services account to ensure timely delivery of high quality health care.  We are generally pleased with the Administration’s revised overall medical care funding level for FY 2017, and overall discretionary funding level, but believe the advance appropriations recommendation for Medical Services in FY 2018, approximately $54.3 billion, is woefully inadequate to meet continually growing demand for health care services.  The Administration appears to have punted responsibility for properly addressing the funding question for VA medical care to a new Administration following this fall’s election.  This is an unacceptable proposition.  For FY 2018, the IBVSOs recommend approximately $64 billion in advance appropriations for Medical Services.

Similarly, PVA has serious concerns about the massive growth in expenditures in community care spending in FY 2017, totaling $12.2 billion.  While we understand the need for leveraging community care to expand access to health care for many veterans, as discussed in The Independent Budget framework, we are troubled by the rapid growth in this area of health care spending.  Congress and the Administration must ensure that it devotes critical resources to expand capacity and increase staffing of the existing health care system, particularly for specialized services such as spinal cord injury or disease, not just punts this responsibility into the private sector.  Simply outsourcing more care to the community will ultimately undermine the larger health care system which many veterans with the most catastrophic disabilities rely upon.

Also as we have previously stated, we believe the advance appropriations amount for FY 2017, provided for by Congress in the “FY 2016 Consolidated and Further Continuing Appropriations Act,” approved in December 2015, is not sufficient to meet the full demand for services being placed on the system.  For FY 2017, the IB recommends approximately $72.8 billion for total Medical Care.  Congress recently approved only $66.6 billion for total Medical Care (based on an assumption that includes approximately $3.3 billion for medical care collections).

PVA is also pleased to see another significant increase in funding for Medical and Prosthetic Research.  For FY 2017, the Administration recommends approximately $663 million for research nearly matching the recommendation of the IBVSOs.  However, we are disappointed that the Administration did not similarly match our recommendation—$75 million—for dedicated funding for the Million Veterans Program.

Perhaps of greatest concern is the Administration’s terribly inadequate funding request for Major and Minor Construction.  For FY 2017, the VA recommends only $528 million for Major Construction and $372 million for Minor Construction.  The IBVSOs recommend $1.5 billion for Major Construction and $749 million for Minor Construction.  VA leaderships’ reasoning for these inadequate requests is particularly galling—they would prefer to wait and see what recommendations the Congressionally-mandated Commission on Care makes with regards to infrastructure before committing significant new resources to projects.  This despite the fact that the VA currently has more than 30 major construction projects that are either partially funded or funded through completion, but in which construction is incomplete.  It is time for the projects that have been in limbo for years or that present a safety risk to veterans and employees to be put on a course to completion.

The President’s Request for DOL and VETS

The President’s Budget Request for FY 2017 also included $12.8 billion overall for the Department of Labor (DOL).  This represents an increase of $600 million over FY 2016.  The Veterans Employment and Training Service (VETS) received a five percent increase to $285 million and funding for the Homeless Veterans Reintegration Program (HVRP) was set at the full authorization level of $50 million for the first time.  The HVRP has long been lauded as one of the most cost-effective programs in the federal government, and yet it has never been fully funded at the $50 million level.

The Jobs for Veterans State Grants program that supports Disabled Veterans Outreach Program (DVOP) staff and Local Veterans Employment Representatives (LVER) was flat funded at $175 million.  Within DOL’s Employment and Training Administration, adult workforce system programs were increased by $27 million and dislocated worker programs received a $93 million increase.  The Office of Disability Employment Policy received a modest increase in the President’ budget going from $38.2 million in FY 2016 to $38.5 million in FY 2017.

HVAC Begins Series of Hearings on VA Community Care Consolidation Plan

The House Committee on Veterans’ Affairs, Subcommittee on Health began a 4-part series of hearings this month related to the VA’s recently released plan to consolidate its purchased care programs into one New Veterans Choice Program.  The first hearing was held on February 2, 2016, and addressed eligibility requirements for care in the community.  Carl Blake, Associate Executive Director for Government Relations, testified on behalf of PVA.

Although the new VA plan does much to address the convoluted system of granting veterans access to community care, VA still plans to employ a 30-day and 40-mile eligibility standard.  PVA has consistently advocated for abolishing this arbitrary standard and implementing a system which determines when and where a veteran receives by keeping such clinical decisions between a veteran and his or her doctor.

The forum also provided PVA an opportunity to propose to the Committee expanding travel benefits to include non-service connected, catastrophically disabled veterans who are already granted high priority.  Ranking Member Julia Brownley (D-CA) specifically noted in her opening remarks that one aspect of health care often overlooked is the cost associated with veterans with disabilities who require the assistance of caregivers to access care.  She has proposed legislation that would authorize payment of beneficiary travel expenses for veterans with vision impairment, spinal cord injury or disease, or double or multiple amputations, whose travel is in connection with care provided through VA.  Following the hearing, Rep. Ralph Abraham (R-LA), Chairman of the House VA Subcommittee on Disability Assistance and Memorial Affairs, expressed interest in advancing the proposal.

PVA also had an opportunity to address VA’s proposal for expanded urgent and emergency care, along with the new co-payments.  While PVA supports the idea of expanding access to emergency and urgent care services, we strongly oppose the co-payments recommended for those services—$100 for emergency care and $50 for urgent care.  This co-payment would be required of any enrolled veteran seeking emergency or urgent care regardless if they have service-connected disability or are exempted from co-payments as a catastrophically disabled, Priority Group 4 veteran.

The second hearing was held on February 11, 2016, and focused on improving VA community care billing and reimbursement.  Representatives from the American Legion and the Veterans of Foreign Wars (VFW) testified in addition to VA officials.  Much of the discussion with VA officials revolved around the monumental task of overhauling the technology framework needed to implement its plan.  The VSO representatives brought attention during their testimony to the issue of third party administrators failing to promptly pay providers.  When providers are not paid, many times they turn to the veteran to seek payment for care VA was supposed to pay for.  In numerous cases, veterans unable to foot the bill have had significant negative impact on their personal credit.

To read PVA’s statement from the February 2nd hearing, please visit www.pva.org.

PVA Testifies on VA’s Specially Adapted Housing Grant Program

On February 10, 2016, the House Committee on Veterans’ Affairs, Subcommittee on Economic Opportunity held a hearing regarding VA’s Loan Guaranty and Specially Adaptive Housing Grant Programs.  Heather Ansley, Associate General Counsel for Corporate and Government Relations, testified on behalf of PVA.

VA’s Specially Adapted Housing (SAH) grant program allows veterans and servicemembers who are permanently and totally disabled as a result of their military service, and who have a disability such as loss or loss of use of both legs, with assistance to remodel an existing home or build or purchase a home that will accommodate their disability-related needs.  Accommodations may include wider doorways, ramps, roll-in showers, and other modifications that allow individuals with catastrophic disabilities greater independence.  In fiscal year 2015, VA approved 1,648 SAH grants for a total amount of $94,449,587.

PVA’s testimony detailed areas of concern that must be addressed to ensure that the program is able to meet the needs of all eligible veterans, including those with diseases such as amyotrophic lateral sclerosis (ALS).

One of the biggest challenges PVA encounters in the SAH program is the length of time it takes for grants to be processed and approved.  The difficulties that these delays create are especially concerning for veterans living with ALS.  These veterans are critical users of the SAH grant program; however, the grant process is not well suited to veterans with rapidly changing diseases.  Ultimately, the SAH program must be flexible enough to assist veterans who have relatively static disabilities, such as spinal cord injuries, and those who have progressive diseases.

In many parts of the country, inadequate staffing also contributes to delays in processing grants and results in poor customer service for veterans.  According to PVA’s service officers, many veterans are having a difficult time contacting their SAH agents as phone calls and emails are not returned in a timely manner.  Insufficient staffing also leads to retention problems as agents leave their positions due to the excessive workload and extensive travel requirements.

Investments in staffing and streamlined and expedited grant processing for veterans with terminal diseases, along with increased benefits and improved program outreach, will lead to a stronger SAH program.  We look forward to working with Congress and the Administration to address the critical issues raised.

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

PVA Launches AirAccess30.org and Air Carrier Access Advocacy Initiative

At the end of January, PVA’s Government Relations program formally launched its initiative to amend the Air Carrier Access Act (ACAA) to better benefit people with disabilities who travel by air.  The ACAA, signed on Oct. 2, 1986, by then-President Ronald Reagan, guarantees that people with disabilities receive consistent and nondiscriminatory treatment during air travel and requires air carriers to accommodate the needs of passengers with disabilities. PVA played a leading role in the passage of the ACAA.  The ACAA along with the Fair Housing Amendments Act of 1988 were two laws that laid the groundwork for the landmark Americans with Disabilities Act (ADA) in 1990.

Now, PVA is working with the broader disability community to bring attention to the successes and failures in air travel for passengers with disabilities.  As a part of this initiative, individuals with disabilities now have a platform for sharing their stories, photos, videos and graphics about their air travel experiences.  PVA needs all members to actively engage with us in this effort.  AirAccess30.org, launched in January 2016, by PVA, enables passengers with disabilities who utilize air travel to share positive and negative stories about their experiences. The new website seeks the input of passengers with disabilities in showing the progress that has been made as well as the work that remains to accomplish the true spirit of the ACAA.

Please share the www.AirAccess30.org website and encourage all people with disabilities to share their stories.  We will be using these stories to increase advocacy around the ACAA and improve air travel for passengers with disabilities.

PVA Participates in Amtrak Compliance Meeting

On February 5, 2016, PVA’s National Advocacy staff met with Amtrak Vice President Joe McHugh and Americans with Disabilities Act (ADA) Coordinator Gary Talbot as well as other representatives of the disability community for the quarterly Amtrak ADA compliance review.  Amtrak was required to be compliant with the regulations of the ADA in 2010.  Congress originally gave Amtrak 20 years after the passage of the ADA to comply recognizing the cost and infrastructural changes that would need to be made at stations and on board the train to fully accommodate travelers with disabilities. Whereas PVA has been involved with Amtrak beginning in 1992, and throughout the 1990’s, with training of personnel and designing communication pieces, Amtrak did not begin infrastructure changes until 2008.

Review topics from the meeting included an overview of the ADA Stations Program (ASP) and ADA Compliance Effort for FY 2014 and FY 2015, and project plans for FY 2016 with a status update on current projects.  Those projects include elevator installation at Union Station in Washington, DC, on track 27/28; the new “set back” platform in Ann Arbor, MI; level boarding platform construction at Roanoke, VA; and an update on the Paoli, PA station renovation that resulted from a National Disability Rights Network (NDRN) lawsuit.

The meeting concluded with discussions about the Federal Railroad Administration (FRA)/Amtrak ASP Five Year Plan (FY 2017 to FY 2021), and implementation of P.L. 114-94, the “Fixing America’s Surface Transportation (FAST) Act.”  The next meeting compliance review meeting will be held later this summer.