June’s Washington Update

June 19 2017                                                                    Volume 23, No. 6

***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. 

Administration Finally Releases its FY 2018 Budget Request

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

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

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

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

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

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

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

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

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

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

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

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

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

Bi-Partisan Accountability Bill Passed by Congress

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

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

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

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

Air Carrier Access Amendments Act Introduced in the Senate

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

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

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

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

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

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

President’s Budget Proposes Cuts to Important Disability Programs

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

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

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

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

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

Update on the ADA Education and Reform Act of 2017

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

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

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

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

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

ADA Symposium

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

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

PVA Participates in Afghan Disability Rights Conference

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

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

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

 

 

 

May Washington Update

May 16, 2017 Volume 23, No. 5

***PRIORITY***

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

Bi-Partisan Accountability Bill Introduced

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

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

1. Increase accountability within the VA by:

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

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

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

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

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

2. Protect whistleblowers by:

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

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

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

3. Strengthen VA leadership by:

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

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

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

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

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

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

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

House Subcommittee Holds Roundtable on Caregiver Support Programs

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

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

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

HVAC Pushes Forward with Appeals Modernization in the 115th Congress

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

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

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

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

VA Adopts New Standards for Medical Diagnostic Equipment

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

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

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

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

House Passes American Health Care Act

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

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

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

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

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

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

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

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

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

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

March Washington Update

March 17, 2017                                                                Volume 23, No. 3

***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 Annual Advocacy and Legislation Seminar

The PVA Government Relations Department held its annual Advocacy and Legislation Seminar, from March 6-9, 2017, in Washington, D.C. The seminar serves as an opportunity to bring in representatives from every PVA chapter to Washington to learn about the policy priorities of the organization and then to carry that message to their representatives and senators in Congress.

This year’s seminar focused on two main areas. The Advocacy portion discussed in great detail our continued efforts, and the work we have ahead of us, on the Air Carrier Access Act, and efforts to improve air travel for people with disabilities. A panel of experts we have worked with on this issue included representatives from the Department of Transportation, Virgin America Airlines, and the Flight Attendants Association. Government Relations’ Advocacy staff also discussed entitlement reform, specifically Social Security, Medicare and Medicaid, as well efforts to undermine the Americans with Disabilities Act (ADA) known as ADA notification.

The Legislative portion of the seminar focused significant attention on the delivery of veterans’ health care, particularly in the area of specialized services such as spinal cord injury and disease (SCI/D) care. Attendees had the opportunity to hear from Dr. Manosha Wickremasinghe, the incoming Executive Director of the Spinal Cord Injury/Disease Service at the Department of Veterans Affairs (VA). There were several discussions about the many ideas being proposed for VA health care in the future and how that might impact SCI/D care. Government Relations’ Legislative staff also discussed appeals reform as well as the expansion of the Comprehensive Family Caregiver Program at VA.

PVA members then spent two days storming the halls of Congress to discuss our policy priorities. In addition to our members meeting with members of the House and Senate, on March 9, PVA National President Al Kovach, Jr. presented his annual testimony before a joint hearing of the House and Senate Committees on Veterans’ Affairs.

He emphasized the importance of VA health care to him personally following his injury. The seminar wrapped up with a Congressional reception that evening to allow PVA members to continue to interact with congressional staff from both the House and Senate.

This year’s seminar was a major success. National staff has already begun outreach to offices that have expressed an interest in advancing our priorities. We were also able to increase digital engagement with the organization and we leveraged the PVA app to communicate much of our information quickly and effectively. The inclusion of state-specific information on the VA’s SCI/D service proved very useful in our members’ meetings with their representatives and senators. We are already beginning our planning for the 2018 Advocacy and Legislation Seminar.

House Committee on Veterans’ Affairs Holds Hearing on

Community Care

On March 7, 2017, the House Committee on Veterans’ Affairs (HVAC) held a hearing entitled, “Shaping the Future: Consolidating and Improving VA Community Care.” With the Choice program set to expire on August 7, 2017, HVAC Chairman Phil Roe (R-TN) sponsored a bill, H.R. 369, which would eliminate 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. New funds will eventually be needed, though, and with that request a much-needed revamp of the Choice program – Choice 2.0 as Secretary Shulkin called it during the hearing.

During the hearing, Secretary Shulkin made a number of commitments indicating a continued preference of strengthening the VA health care system’s ability to deliver direct care and developing an integrated network of providers to help fill gaps in service throughout the country. Over the last two years, much controversy has surrounded the issue of granting veterans unfettered choice of where they receive care. This proposal has proven cost-prohibitive. As a result, the administration, VA and other stakeholders are coalescing around the idea of fitting greater expansion of veterans’ choice into a consolidated community care program that utilizes an integrated network of providers.

In a markup the day after the Choice hearing, the Committee added two provisions to H.R. 369 that would give VA the ability to become the primary payer as well as share certain limited patient information with community care doctors treating veterans without seeking the veteran’s affirmative consent. VA has long asked for these provisions since putting forth its community care consolidation plan back in October 2015. VA serving as primary payer will hopefully alleviate the many instances where community care providers turn medical bills over to the veteran when VA takes too long to pay for services.

The hearing also drew two major announcements from the Secretary, one of which received a standing ovation. The first is that VA plans to get away from developing its own IT solutions and start purchasing more commercial off-the-shelf products. The second, and perhaps even more substantial announcement, was that VA will begin offering mental health care services to veterans who received an other-than-honorable discharge from the military. The logistics, timeframe and other eligibility details were not discussed, but VA’s decision to not wait for Congress to force the issue through legislation drew significant praise from the Committee.

PVA Presents Senator Patty Murray (D-WA) the 2017 Gordon H. Mansfield Congressional Leadership Award

On March 9, 2016, Paralyzed Veterans of America honored Senator Patty Murray (D-WA) with the 2017 Gordon H. Mansfield Congressional Leadership Award. Senator Murray and her staff have worked tirelessly with PVA’s Government Relations staff to advance and see implemented the legislation that enables VA to provide in vitro fertilization (IVF) to eligible veterans and their spouses. These long-awaited procreative services finally became available to veterans on January 19 of this year, and are approved through September 30, 2018.

Senator Murray has been a champion of IVF for veterans for years. Yet her persistence that Congress do the right thing never wavered. She continues to lead the effort to see that IVF become a permanent benefit.

The Gordon H. Mansfield Congressional Leadership Award is named for the Honorable Gordon Mansfield, former Acting Secretary of the Department of Veterans Affairs and Executive Director of Paralyzed Veterans. The award reflects upon his services as the former Assistant Secretary for Congressional and Legislative Affairs at the VA, and Paralyzed Veterans’ first associate executive director of government relations. The late Mr. Mansfield was a combat-injured Vietnam veteran who was awarded the Distinguished Service Cross.

Senator Murray was notified of the award earlier this year, and was presented with it March 9th at a private meeting during Paralyzed Veterans of America’s annual Advocacy/Legislation Week. The Senator issued the following statement of recognition: “Military families sacrifice so much on our behalf, and they deserve to know their country will be there for them, no matter what. Making sure veterans and their spouses have access to reproductive assistance is just one way we can fulfill that promise, and I couldn’t be more proud to have Paralyzed Veterans of America by my side as we work together to make sure we are doing everything we can for the men and women who sacrifice so much in their service to our country.”

Caregiver Expansion Bill Introduced

On March 9, 2016, Senator Patty Murray (D-WA) introduced S. 591 and Rep. Jim Langevin (D-RI) introduced the house companion bill, H.R. 1472, the “Military and Veteran Caregiver Services Improvement Act.” This bipartisan legislation would expand VA’s Comprehensive Family Caregiver Program to veterans of all eras. Currently, a veteran has to have been severely injured on or after September 11, 2001 in order to be eligible. Expansion would make available the resources that caregivers need to provide quality care to veterans. These resources include a monthly stipend based on the hours of care provided, healthcare through CHAMPVA, respite care, and additional training among other services.

Caregivers play the most critical role in the wellbeing of a catastrophically disabled veteran. From activities of daily living, to psycho-social interaction, to maintaining good health that prevents institutional care- these caregivers have been sacrificing their own financial and physical wellbeing to care for veterans, with little to no support from VA. Congress has no justification for denying access to pre-9/11 veterans. This legislation would rectify this inequity.

Among other things, the Military and Veteran Caregiver Services Improvement Act would:

  • Make the program more inclusive of mental health injuries.
  • Reauthorize the Lifespan Respite Care Act and expand essential respite options for caregivers.
  • Give veterans the opportunity to transfer GI Bill benefits to a dependent, to help unemployed or underemployed spouses of injured veterans prepare to become the primary income for the family.
  • Make caregivers who work in the federal government eligible for flexible work schedules.
  • Provide assistance with childcare, financial advice and legal counseling, which are all top, and currently unmet, needs.

We urge all PVA members to contact their senators and ask them to support S. 591 and contact their representatives and ask them to support H.R. 1472. These bills will have a significant impact on our members, many of whom rely upon caregivers on a daily basis.

PVA Prosthetics Consultant Participates in Brain Awareness

Week Program

The National Museum of Health and Medicine hosted its 18th annual Brain Awareness Week (BAW) program March 13 -17, 2017. The museum wanted to showcase the DEKA Robotic Arm in an exhibit called “Advances in Military Medicine”. Fred Downs, PVA Prosthetics Consultant, provided live demonstrations of the DEKA Robotic Arm to the students. Mr. Downs described how he dons the arm, and demonstrated how he controlled the arm and hand with movements of his feet to which inertial measurement units (IMU) are attached. The IMUs send wireless signals to 10 computers in the arm that move the elbow and hand into different positions and grips. He uses the various functions they perform to increase his independence.

During BAW, the Museum invites middle school students to visit the museum to learn about neuroscience from a variety of professionals through hands-on interactions. The museum will host about 120 students per day (60 in a morning session and 60 in an afternoon session) who rotate through 5-6 activity stations for about 15 minutes per station. The goal is to provide an opportunity to use STEAM (science, technology, engineering, art and math) to inspire students to pursue studies and careers in the sciences.

The museum has both DOD and civilian partners who help share excitement about the neurosciences with the students to include the Walter Reed National Military Medical Center Speech and Audiology Clinics, Defense and Veterans Brain Injury Center, Uniformed Services University, Society for Neuroscience, Howard University, Rutgers, Congressionally Directed Medical Research Programs, and NIH. These BAW partners are engaged in some of the most cutting edge brain science research in the country. Brain Awareness Week at the National Museum of Health and Medicine highlights that research and promotes the field as a career option.

DOT Delays Implementation of Final Rule Requiring US Airlines

to Report Wheelchair Data

On March 2, 2017, the Department of Transportation (DOT) announced that it will delay the implementation by one-year of the final rule requiring large domestic airlines to track and report information about wheelchairs and scooters. The rule was published on November 2, 2016, and went into effect on December 2, 2016.

As originally published, airlines would be required to provide DOT with information on the total number of wheelchairs and scooters they enplane on a monthly basis for flights taking place on or after January 1, 2018. Airlines would also need to report how many of those wheelchairs and scooters were “mishandled.” The new date for implementation announced by DOT is January 1, 2019.

DOT took this action in response to a request from airlines to delay the implementation of the regulation in the spirit of a memorandum issued by the White House Chief of Staff on January 20. In part, the memorandum directed agencies to delay for 60 days the effective date of published regulations that had not yet taken effect.

PVA believes that delaying the reporting requirement for wheelchair and scooter data in the spirit of this memorandum was an overly broad interpretation of its application. The regulation had already been in effect for nearly 90 days when DOT announced its intent to delay implementation. Furthermore, DOT took this action without providing all stakeholders with a formal opportunity to comment.

PVA has communicated our concerns about the delay publicly and directly to DOT. We will continue to closely follow this matter. At this time, the delay has not been published in the Federal Register.

PVA Trains Wheelchair Attendants for Virgin America Airlines

On March 8, 2017, 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 Reagan National Airport (DCA) in Washington, D.C. The meeting was at Virgin’s request so we could 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 Reagan National 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 ACAA as well as the legal responsibilities of the airline, Virgin America and their contractor Huntleigh, for 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 an aisle chair that was 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 there were around 25 participants from Virgin America, Huntleigh and a few representatives of Alaska Airlines, which is buying Virgin America. PVA will continue to work with Virgin America and Alaska Airlines to create future opportunities to educate personnel on the specific needs of passengers with disabilities.

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.

 

December Washington Update

December 15, 2016                                                         Volume 22, No. 12

***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.

Key Leaders Chosen for House and Senate Committees

During the lame duck session following the November election, the Republican and Democratic caucuses in the House or Representatives and Senate chose the members who will serve as the Chairmen and Ranking Members of Committees during the 115th Congress beginning in January 2017. In the House, Rep. Phil Roe (R-TN) was chosen as the next Chairman of the House Committee on Veterans’ Affairs. Rep. Roe is replacing Rep. Jeff Miller (R-FL) who is retiring at the end of this year. Rep. Roe is a doctor who has used his experience to inform his views on the reform of veterans’ health care delivery. He has supported greater choice for care in the community for veterans, but he has generally opposed outright privatization of the Department of Veterans Affairs (VA) health care system. The House VA Committee Ranking Minority Member position has not been decided yet; however, it is expected to be either Rep. Mark Takano (D-CA) or Rep. Tim Walz (D-MN). Leadership for the four Subcommittees is expected to be chosen in January.

In the Senate, Senator Johnny Isakson (R-GA) will continue as the Chairman of the Senate Committee on Veterans’ Affairs. Senator Isakson has previously expressed support for expansion of the Comprehensive Family Caregiver Program—a high priority for PVA—to veterans of all eras. He has also lead efforts to improve accountability without undermining employees’ rights. Importantly, he also supports greater choice for veterans seeking health care. Senator Jon Tester (D-MT) will be the new Ranking Minority Member of the Senate VA Committee.

The National Advocacy Program staff will continue to work with a number of key committees through our work on the Air Carrier Access Act, entitlement reform, and the Americans with Disabilities Act (ADA). The expected chairman of the Senate Commerce, Science and Transportation Committee is Senator John Thune (R-SD), who is the current chairman of the committee. Also returning will be Ranking Member Bill Nelson (D-FL). The returning chairman of the House Transportation and Infrastructure Committee is Rep. Bill Shuster (R-PA), while Rep. Peter DeFazio (D-OR) is expected to remain the ranking member of the committee.

PVA’s efforts to strengthen the Air Carrier Access Act (ACAA) must go through these committees. PVA worked with these committees in 2016 when we were successful in having PVA-drafted language included in the 2016 FAA Extension. This language required GAO to conduct a review of disability-related training for airline staff and their contractors. In 2017, we will be working to ensure that legislation to reauthorize the FAA, which must be completed by September, includes additional PVA-supported language that will increase enforcement of the ACAA and improve the travel experience for passengers with disabilities.

A number of committees will address potential entitlement reform, specifically the Social Security and Medicare programs. Senator Orrin Hatch (R-UT) is expected to remain the chairman of the Senate Finance Committee. Also returning will be ranking member Ron Wyden (D-OR). The new chairman of the House Energy and Commerce Committee is Rep. Greg Walden (R-OR), while the Ranking Member is expected to be Rep. Frank Pallone (D-NJ).

The returning chairman of the House Ways and Means Committee is Congressman Kevin Brady (R-TX), while Rep. Richard Neal (D-MA) is expected to become the ranking member. The outgoing chairman of the Social Security Subcommittee, Rep. Sam Johnson (R-TX), recently dropped a placeholder Social Security reform bill that focuses on benefit cuts. This legislation is expected to be the basis for reform during the 115th Congress beginning in January 2017. The expected new ranking member on the Social Security Subcommittee is Rep. John Larson (D-CT) who is the main sponsor of a bill to expand Social Security.

We also anticipate work that will have an impact on ongoing implementation of the ADA. With this in mind, the expected chairman of the Senate Judiciary Committee is current Chairman Charles Grassley (R-IA). Senator Dianne Feinstein (D-CA) will be the new ranking member of the Senate committee. The chairman of the House Judiciary Committee is current Chairman Robert Goodlatte (R-VA). Rep. John Conyers (D-MI), current ranking member of the Judiciary Committee, is expected to retain his position.

PVA’s efforts to protect the Americans with Disabilities Act (ADA) are under the purview of the Senate and House Judiciary Committees. PVA is concerned about efforts to require people with disabilities to notify businesses of architectural barriers prior to filing a lawsuit under the ADA. Legislation that would have required notification was introduced in the House and Senate in the 114th Congress and passed the House committee. We anticipate this issue to return in 2017.

There are also additional committees that the Government Relations Department will engage with during the 115th Congress. The expected chairman of the Senate Health, Education, Labor and Pensions Committee is Senator Lamar Alexander (R-TN), who is the current chairman of the committee. Also returning will be Ranking Member Patty Murray (D-WA). The new chairwoman of the House Education and the Workforce Committee is Rep. Virginia Fox (R-NC), while Rep. Robert Scott (D-VA) is expected tp be the ranking of that committee once again. The expected new chairman of the Senate Banking, Housing and Urban Affairs Committee is Senator Michael Crapo (R-ID), and the returning ranking member is Senator Sherrod Brown (D-OH). The returning chairman of the House Financial Services Committee is Rep. Jeb Hensarling (R-TX), and Rep. Maxine Waters (D-CA) is expected to remain the ranking member of the committee.

We will update PVA members as additional key leadership positions in the House and Senate are determined early in January.

“Veterans Mobility Safety Act” Approved by Congress”

On November 29, 2017, the House gave final approval to H.R. 3471, the “Veterans Mobility Safety Act.” The revised bill includes significant language changes to address concerns brought by outside equipment dealers to PVA leadership earlier this year. Gabe Stultz, Associate Legislative Director, deserves a great deal of credit for his relentless advocacy work on this issue. This bill was championed by Rep. Jackie Walorski (R-IN), who is a member of the House VA Committee, and it was pushed in the Senate by Senator Jerry Moran (R-KS).

PVA has spent the last year working to get this important piece of legislation enacted. Support for this legislation was compromised at various points by competing business interests that appeared to be more interested in getting an advantage over their competition, rather than focusing on the most important priority of the legislation—veterans being served. Fortunately, Congress managed to overcome a great deal of misinformation, and in some cases blatant falsehoods, to take this positive step.

Moving forward, PVA will work with the VA to ensure that we have a prominent role in the implementation of this requirement.

Large Veterans Omnibus Bill Approved by Congress

Prior to adjourning the 114th Congress, the House and Senate passed a large veterans omnibus bill that contained a wide array of provisions that had previously been considered throughout the course of the last two years, but not finally approved. On December 6, 2016, the House approved H.R. 6416, the “Jeff Miller and Richard Blumenthal Veterans Health Care and Benefits Improvement Act.” The Senate approved the bill by voice vote prior to adjourning for the year.

While the bill is a tapered version of the “Veterans First Act,” which passed the Senate unanimously in May, it does contain 76 provisions pertaining to veterans’ health care, disability benefits, and homelessness assistance. However the bill excludes two important concepts that were high priority issues with bipartisan support—expansion of the VA’s Comprehensive Family Caregiver Program to veterans of all eras and Appeals Reform.

The measure is named after Senator Richard Blumenthal (D-CT), former Ranking Member of the Senate VA Committee, and retiring Chairman of the House Committee on Veterans’ Affairs, Rep. Jeff Miller (R-FL). It temporarily increases the number of judges for the U.S. Court of Appeals for Veterans Claims from seven to nine to help address the large backlog of veterans’ appeals that may soon arrive at the court.

The act will allow for the hiring of more mental health providers and emergency room doctors and extends education benefits to surviving family members. It also begins the research needed to help descendants of veterans exposed to toxic substances.

PVA is ultimately disappointed that the House and Senate sacrificed some extremely important programs and legislative priorities in the interest of passing “some” legislation to improve benefits and services for veterans.

U.S. Access Board Updates ADA Guidelines for Buses and Vans

The U.S. Access Board has issued a final rule updating sections of its accessibility guidelines for transportation vehicles covered by the Americans with Disabilities Act (ADA). The rule revises provisions in the guidelines that apply to buses and vans to enhance accessibility and to address industry trends and improvements in design and technology. The guidelines, which the Board originally published in 1991, apply to new or remanufactured vehicles.

The guidelines for buses and vans address boarding access, fare devices, interior circulation, seating and securement, signs, lighting, and announcement systems. The rule reduces the maximum slope for vehicle ramps because low floor buses are now ubiquitous in fixed route systems. New provisions also address level boarding systems and incorporate updated standards for wheelchair securement systems. The rule improves communication access by requiring that buses in fixed route systems with at least 100 buses have automated stop and route announcements that are visual as well as audible. Further, access to over-the-road buses, which are typically used in commuter and long-distance bus lines and charter services, is more comprehensively addressed. In addition to these substantive changes, the rule features a new format and numbering system. An assessment of the costs and benefits is included with the rule.

The Board previously issued versions of the rule in draft and proposed forms for public comment and has finalized the rule based on the feedback received. At a later date, the Board will propose updates to sections of the guidelines covering vehicles in fixed guideway systems, including rapid, light, commuter, and intercity rail, according to recommendations from an advisory committee it chartered, the Rail Vehicles Access Advisory Committee, which submitted its report to the Board last year.

The Board’s vehicle guidelines serve as the basis for mandatory standards issued by the Department of Transportation (DOT) under the ADA. Compliance with the updated requirements for buses and vans will become mandatory once specified by DOT in a future update of its ADA standards.

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.

PVA Attends Universal Access in Airports Conference

From November 14 – 16, 2016, Senior Associate Advocacy Director, Lee Page and Heather Ansley, Associate General Counsel for Corporate and Government Relations attended the sixth Universal Access in Airports (UAIA) conference in San Francisco. The conference was hosted by the Open Doors Organization (ODO) of Chicago.

ODO is a 501(c)(3) non-profit organization based in Chicago, Illinois, was founded in 2000 for the purpose of creating a society in which all persons with disabilities have the same consumer opportunities as everyone else. They aspire to teach businesses how to succeed in the disability market, while simultaneously empowering the disability community.

The UAIA Conference focuses on what’s new in aviation, to include regulations, technology, and innovative best practices. The conference also addresses service gaps and barriers that still prevent air travel from being fully accessible to older adults and people with disabilities. Attendees to the conference included representatives of airlines, DOT and FAA regulators, Architects and ADA coordinators for airports, TSA, customer service senior management, product manufactures, contracted service management and persons with disability.

The two days of information sharing included a briefing from the Department of Transportation on the recently concluded ACCESS Committee that had consensus agreement for rulemaking around Lavatories on single aisle aircraft of a certain size, and inflight entertainment and communication for the deaf and hard of hearing and those who are blind or limited vision. Other panels focused on products of accessibility that could increase access at airports in the realm of seating design and website accessibility. A consumer panel focused on the experience of navigating through the airport and the problems of going through TSA security checks and the utilization of contract service employees who assist passengers with disabilities.

Overall, this conference is heavily attended by the airline industry and provides a good opportunity to network. The next conference will be in Minneapolis, MN in 2018.

ADA Transportation Survey

The ADA Participation Action Research Consortium (ADA_PARC), a collaborative research project of the ADA Regional Centers, is conducting a study on the accessibility of public transportation for people with disabilities. The purpose of the study is to increase the knowledge base about transportation access for people with disabilities with the hope of improving access to transportation at the regional and national levels

The survey is available at: https://unco.co1.qualtrics.com/jfe/form/SV_00wcGeTOzGL2lQ9. It will be open until mid-January 2017.

 

We encourage our members to participate in this important study.

August Washington Update

 

August 19, 2016                                                               Volume 22, No. 8

***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. 

Presidential Campaigns Wrap-up Nominating Conventions

The House and Senate recessed in mid-July to accommodate the Republican and Democratic National Conventions held over the last two weeks of July.  The Republican National Convention (RNC) was held the first week after recess in Cleveland, OH.  During the convention, Donald Trump and Mike Pence were formally nominated as the Republican candidates for the President and Vice President.  The Democratic National Convention (DNC) was held the following week in Philadelphia, PA.  During the DNC, Hillary Clinton and Senator Tim Kaine were formally nominated as the Democratic candidates for President and Vice President.

The conventions also included approval of the official party platforms for the Republican and Democratic parties.  Both platforms recommit to America’s sacred trust to veterans, they expound at length the heroic character of our service members, and regrettable consequences that befall them and their families.  Where their similarities diverge is in each party’s perception of primary problems and the corresponding plans to address them.  The full RNC platform can be accessed at:  https://gop.com/platform/.  The full DNC platform can be accessed at:  https://www.demconvention.com/platform/.

The RNC platform denounces the wait-time scandals concerning VA.  In response to these controversies, Republicans seek accountability of senior leadership and fundamental changes to their structure.  Regarding veterans’ health care, Republicans will seek to consolidate VA’s existing community care authorities to make a single program.  In order to combat bureaucratic stagnancy, they encourage VA partnerships with private enterprises, VSOs and competitive bidding, predicting such work will allow for high quality VA care, reduce backlogs, and save resources.  Additionally, Republicans will retain veterans’ preference, support a broader range of options for health care, including faith-based programs to respond to the opioid crisis, and encourage private sector and public school hiring of veterans.

The Democrats, equally enraged by VA scandals, propose fully resourcing VA to meet the needs of all veterans and reject attempts at privatization.  The platform emphasizes the need for more education benefits and job training, preservation of the post-9/11 GI Bill, and fair treatment of reservists and Guard members.  They recommit to ending chronic homelessness and suicide.  Regarding veterans’ health care, they emphasize veteran-centric care, resources for military sexual trauma (MST), the growth of mental health programs, treatment of invisible and toxic wounds and the expansion of the VA Caregiver Program to veterans of all eras. They seek to provide women with full and equal treatment, including reproductive health services. The DNC platform also proposes workplace policies that are more equitable for caregivers, as well as the expansion of a well-paid home care workforce and increased access to long-term care. They disfavor the deportation of immigrants who are veterans, while also highlighting the housing crisis for veterans in Indian Country.

The only identical policy proposal from both parties, aside from vaguely ensuring high quality health care and benefits for veterans (achieved differently), is a commitment to veterans treatment courts to prioritize rehabilitation over incarceration.

The respective platforms also offer views on some disability policy, albeit with slightly different inflections. The Republican platform highlighted the GOP’s historic support of the Americans with Disabilities Act (ADA) and the role of Republican leadership in the enactment of the Workforce Innovation and Opportunity Act (WIOA), ABLE Act and the Steve Gleason Act.  WIOA was the first major overhaul of the nation’s workforce system in almost 20 years while the ABLE Act was a measure that lets people with disabilities maintain access to services while saving to develop assets.  The Gleason law bears the name of former NFL player Steve Gleason who developed ALS.  The law provides access to speech-generating devices. To encourage entrepreneurship, the platform endorsed opening the Small Business Administration’s 8(a) certification program to people with disabilities, something that PVA has long supported.  The platform continued the party’s opposition to embryonic stem cell research and the Convention on the Rights of Persons with Disabilities.  Social Security was addressed largely from the perspective of reforms needed to the retirement system with Republicans calling for “all options,” other than tax increases, to be considered for modernizing this important social insurance program.

The Democratic platform addressed a number of issues important to individuals with disabilities including affirmation of support for the ADA and promises to expand access to appropriate accommodations and supports people with disabilities need to live in integrated community settings. The party endorsed policies that would bring to an end sub-minimum wage work, improve the lives of caregivers of people with disabilities, increase federal funding for affordable housing for low-income families, people with disabilities, veterans and the elderly, improve access to meaningful and gainful employment for people with disabilities and vowed to continue to fight for ratification of the Convention on the Rights of Persons with Disabilities.

In sections of the platform concerning restoration of the full protections of the Voting Rights Act (VRA), the Democrats highlight support for full funding of the Help America Vote Act (HAVA) to ensure that all registration materials, voting materials, polling places, and voting machines are fully accessible to seniors and Americans with disabilities.  With regard to Social Security, the platform opposes efforts to cut or privatize the program or raise the retirement age and supports improvements to the cost-of-living formula that better reflects the fixed expenses of seniors and people with disabilities. The party also proposes measures to ensure the long term solvency of Social Security by asking those earning above $250,000, a year to contribute more to the system and to provide sufficient financial support to the Social Security Administration to ensure it can provide timely benefits and high quality services to all beneficiaries.

Ultimately, the platforms only serve as a guide for the two parties during the course of the political campaigns with the goal to influence the policy positions of the major party candidates.  However, the presidential candidates are not obligated to adopt the platform proposals.  During next month’s Washington Update, we will highlight the individual candidates’ policies directed towards veterans and people with disabilities.

PVA Attends VA Joint Symposium: Safeguarding the Integrity of GI Bill Benefit

On August 3, 2016, VA and the Deputy Under Secretary for Economic Opportunity, Curtis Coy, hosted a joint symposium to address VA’s enforcement of its consumer protection authorities to protect veterans from dishonest schools.  VA has faced considerable criticism for failing to take action against predatory for-profit colleges targeting veterans and service members.  Current law calls for VA to cease distribution of federal funds when it finds that a school is employing aggressive, deceptive or fraudulent recruiting practices in order to get access to the lucrative GI Bill and Defense Department Tuition Assistance.  So far, however, VA has taken relatively few enforcement steps despite numerous reports of deceptive behavior.

PVA and its VSO partners discussed the various legal authorities VA has at its disposal and advocated for greater enforcement efforts against such schools.  We also encouraged VA to develop a support structure for veterans who have already been harmed by these schools or are otherwise forced to try and transfer into a different school to continue their education.

PVA Conducts Survey to Support Access Committee Work

In May, PVA was notified that Lee Page, Senior Associate Advocacy Director, was selected to be a member of the Access Advisory Committee on Accessible Air Transportation overseen by the Department of Transportation (DOT).  The Committee is comprised of representatives from the disability community as well as the airline industry.  During its first meeting, the ACCESS Committee selected PVA to chair the workgroup evaluating the need for accessible lavatories on board aircraft.

In order to assist the ACCESS Committee, PVA recently conducted a survey/poll to disability stakeholders addressing seven questions that gauge their expectations for an accessible lavatory on a new single aisle aircraft. The poll was conducted over a three week period, with final results being collected on August 1, 2016. During that time period, 931 total respondents and 515 PVA members registered their opinions.  We were particularly pleased with the response rate—8 percent—to the survey (industry standards consider 3 percent response rate to any survey to be good).

The overall results show that current lavatories are too small and more space is needed. The other significant take away was the lack of ability to get to the lavatory.  Many respondents indicated that they were not aware of on board wheelchairs and had trouble getting the assistance needed to obtain them or their personal assistive devices.  Additionally, airline personnel need more training in order to assist passengers throughout the process.

Review of AirAccess30.org Website

With the www.AirAccess30.org website now having been live for six months, we have analyzed visitor traffic on the site.  In the first six months, there have been approximately 3,200 total visits to the website and approximately 2,700, unique visits.  While visits to the website decreased during April and May, there was a significant increase in June and July.  Some of this can be attributed to more awareness from PVA members as they traveled to our Annual Convention in May and to the significant number of athletes who traveled to the National Veterans’ Wheelchair Games in June and July.  Additionally, the time spent on the website during each visit increased significantly during June and July.  The website currently includes 39 individual stories with additional stories that will be posted soon.  We will continue to promote the website widely leading up to the 30th anniversary of the Air Carrier Access Act signing in October and carrying into the new Congress next year.

Election Assistance Commission Focused on Security for Elections

The U.S. Election Assistance Commission (EAC) was established by the Help America Vote Act (HAVA) in 2002.  The EAC is an independent, bipartisan commission charged with developing guidance to meet HAVA requirements, adopting voluntary voting system guidelines, and serving as a national clearinghouse of information on election administration.  The EAC is currently working with all levels of government to facilitate the conversation regarding securing the election process and to support election officials’ efforts to provide an accessible and secure voting process. Since the creation of its Voting System Testing and Certification Program, in partnership with the National Institute of Standards and Technology, the EAC has led in ensuring voting systems brought to the market have been vigorously tested against security standards.  Voting systems certified by the EAC are not connected to the Internet. Further, the EAC has worked with local and state election officials—as well as election stakeholders, from accessibility experts to scientists and academics—to ensure that best practices are shared nationwide.  These best practices include pre-election testing, security, continuity planning, and post-election audits.  Already this year, the EAC has conducted a series of events related to the #BeReady16 initiative, and more are underway and planned, including activities addressing Election Security Preparedness. Voters are encouraged to get involved with their state and local election officials, and ask questions about their election process. The vast majority of election offices offer numerous opportunities for voters to engage in the process, including witnessing pre-election testing of the voting systems.  Election officials welcome voters’ questions and

participation because they want voters to have confidence and to participate in the process. The EAC also encourages voters to work at the polls as election workers. The election process benefits from full engagement from all people, and election administrators across the country are seeking election workers now for November.  With 50 days before the deadline to mail ballots to military and overseas voters, the EAC is working with all stakeholders to lead discussions productively so that voters can have the utmost confidence in the election process.

For more questions about accessible voting, contact PVA Senior Associate Advocacy Director Lee Page.

Washington Updates January 2014

January 16, 2014                                                                                   Volume 20,   No. 1

PVA Legislative Priorities for 2014

In preparation for the second session of the 113th Congress, Paralyzed Veterans of America (PVA) outlined its legislative priorities to Rep. Jeff Miller (R-FL), Chairman of the House Committee on Veterans’ Affairs, and Sen. Bernie Sanders (I-VT), Chairman of the Senate Committee on Veterans’ Affairs.  PVA is committed to work on issues important to our members, veterans with spinal cord injury or dysfunction, specifically, and to all veterans.  With this in mind, our priorities include:

  • Ensure sufficient funding is provided for the Department of Veterans Affairs (VA) for FY 2015 and advance appropriations for medical care programs for FY 2016.  Similarly, we urge passage of legislation to make all accounts of the VA advance appropriations.
  • Expand the eligibility for VA caregiver support services to include veterans of all eras and veterans with catastrophic illness.
  • Reinstate the capacity reporting requirement for VA specialized systems of care, to include the spinal cord injury (SCI) service.
  • Eliminate the one percent reduction in cost-of-living adjustments for military retirees, particularly those veterans who were retired for medical reasons under Chapter 61, Title 10, as provided for in the recently approved budget agreement.
  • Provide pro-creative services to catastrophically disabled veterans and their families.
  • Improve benefits for the most severely disabled veterans, specifically addressing the needs of severely disabled veterans who are in receipt of Special Monthly Compensation and Aid and Attendance benefits, as well as providing travel reimbursement for catastrophically disabled non-service connected veterans.
  • Eliminate the cap on the number of veterans that can be served by the VA’s Independent Living program.

Sufficient, Timely, and Predictable Funding for VA and Advance Appropriations
As Congress and the Administration continue to face immense pressure to reduce federal spending, we cannot emphasize enough the importance of ensuring that sufficient, timely and predictable funding is provided to the VA.  We anxiously await the budget submission to be released by the Administration that will include funding recommendations for VA programs for FY 2015, the advance appropriation recommendation for FY 2016, and presumably an updated analysis of the funding needs for health care programs for FY 2015.  We remain concerned that the funding levels being considered by the House and Senate Committees on Appropriations in their efforts to develop a final omnibus appropriations bill will be insufficient to address the continuously growing demand for VA health care services.
Additionally, PVA calls on the House and Senate to pass H.R. 813 and S. 932, the “Putting Veterans Funding First Act.”  These bills would authorize advance appropriations for all VA discretionary accounts:  Medical and Prosthetic Research, General Operating Expenditures, Information Technology, National Cemetery Administration, Inspector General, Major Construction, Minor Construction, State Home Construction Grants, State Cemetery Grants and Other Discretionary Accounts.  While the enactment of advance appropriations authority for VA medical care has been successful in helping the VA health care system operate more efficiently and rationally during budget stalemates, the remaining VA budget accounts continue to be negatively affected by unrelated political and partisan fights.

Expand Eligibility for VA Caregiver Support Services
Severely disabled veterans with a service-connected injury or illness do not have full access to caregiver support programs and services from the Department of Veterans Affairs (VA).  As a result of Public Law 111-163, the “Caregivers and Veterans Omnibus Health Services Act of 2010,” the VA only provides comprehensive benefits as part of the Caregiver Support Program to caregivers of veterans with a service-connected injury that was incurred after September 11, 2001.  Specifically, these benefits include health care coverage through the VA’s Civilian Health and Medical Program of Veterans Affairs, a monthly stipend based on the care provided, and payment for travel and lodging when participating in medical appointments with a veteran.

The majority of PVA members are excluded from these VA caregiver benefits because of the arbitrary selection of the September 11, 2001 date; or because the law also excludes veterans with serious illnesses or diseases such as Amyotrophic Lateral Sclerosis (ALS) and Multiple Sclerosis (MS), both of which have a catastrophic impact on activities of daily living, and eventually leave veterans dependent upon caregivers.  The need for caregiver support services does not change for service-connected, catastrophically disabled veterans based on the date of injury.   No reasonable justification (other than cost considerations) can be provided as to why pre-9/11 veterans with a service-connected injury or illness should be excluded from the comprehensive caregiver program.

With this in mind, PVA fully supports H.R. 3383 and S. 851, the “Caregiver Expansion and Improvement Act of 2013,” as it would expand eligibility for VA caregiver assistance benefits to veterans who became injured prior to September 11, 2001.  Additionally, we will advocate for legislation to expand eligibility for the VA Caregiver Support program to veterans who have incurred a serious illness or disease as a result of their service.

Reinstate Capacity Reporting Mandate for Specialized Systems of Care
The Department of Veterans Affairs has not maintained its capacity to provide for the unique health care needs of severely disabled veterans—veterans with spinal cord injury/disorder, blindness, amputations and mental illness—as mandated by P.L. 104-262, the “Veterans’ Health Care Eligibility Reform Act of 1996.”  This law requires VA to maintain its capacity to provide for the special treatment and rehabilitative needs of catastrophically disabled veterans.

As a result of P.L. 104-262, the VA developed policy that required the baseline of capacity for SCI/D centers to be measured by the number of staffed beds and the number of full-time equivalent employees assigned to provide care.  The VA was also required to provide Congress with an annual “capacity” reporting requirement to be reviewed by the Office of the Inspector General.  Unfortunately, this reporting requirement expired in 2004.

Currently, within the Spinal Cord Injury/Disorder (SCI/D) System of Care, the VA is not meeting capacity requirements for staffing and the number of inpatient beds that must be available for SCI/D veterans. Reductions of both inpatient beds and staff in VA’s acute and extended care settings have been continuously reported throughout the SCI/D system of care.  VA has eliminated staffing positions that are necessary for SCI/D centers or clinics to maintain its mandated capacity to provide care, or the facilities are operating with vacant health care positions for prolonged periods of time.  When this occurs veterans’ access to VA care decreases, remaining staff becomes overwhelmed with increased responsibilities, and the overall quality of health care is compromised.

The VA’s capacity to provide health care through its specialized health systems is based on disabled veterans having access to quality care in VA rehabilitation programs.  To provide such care, as a component of workforce planning, the VA tracks the status of vacant and staffed health care positions throughout the Veterans Health Administration, as well as the number of veterans utilizing health care within the specialized systems of care.  With this information readily available, the VA would be able to use and compile the collected data for annual reports and assess its ability to meet the capacity mandate.

PVA recommends that Congress reinstate the aforementioned reporting requirement for VA specialized services to complete an annual capacity report without a specific end date to prevent future expiration of the mandate.  This requirement will make certain that catastrophically disabled veterans’ access to care is not decreased due to the VA’s failure to meet mandated capacity requirements, and hold VA accountable for having the requisite number of available inpatient beds for veterans, as well as required levels of staff to deliver quality care.

Eliminate the COLA Reduction for Military Retirees and Disabled Military Retirees  PVA is particularly disappointed that the bipartisan budget agreement approved by the House and Senate in December 2013 included a provision that is particularly troubling for the military and veterans’ community.  The provision to reduce the rate of the cost-of-living adjustment (COLA) by one percent for military retirees who are under the age of 62 is simply unacceptable.  Moreover, the fact that this COLA rate decrease also includes retirement benefits for those service members who are medically retired from military service under Chapter 61 of Title 10 is especially egregious.  Too many times Congress has attempted to balance the budget on the backs of military service members, veterans, and their families, and this effort is no different.  As such, PVA supports legislation that would eliminate the reduction for Chapter 61 disabled retires or more broadly legislation that would repeal the COLA reduction for all military retirees.

Pro-Creative Services for Catastrophically Disabled Veterans
Another high priority for PVA is the provision of reproductive services for catastrophically disabled service-connected veterans.  One of the most devastating results of spinal cord injury or dysfunction for many individuals is the loss of the ability to have children and raise a family.  PVA has long sought inclusion of reproductive services in the spectrum of health care benefits provided by the VA.  We believe they are critical components of catastrophically disabled veterans’ maximization of independence and quality of life.

Advancements in medical treatments have for some time made it possible to overcome infertility and reproductive disabilities.  For some paralyzed veterans procreative services have been secured in the private sector at great cost to the veteran and family.

Similar to the Department of Defense’s recognition that reproductive services are crucial elements in affording catastrophically disabled individuals and their spouses with life-affirming ability to have children and raise a family, so too will passage of legislation that will authorize the VA to offer similar services to catastrophically disabled veterans.

Benefits for Severely Disabled Veterans
PVA believes that it is time for Congress to make a concerted effort to improve benefits for the most severely disabled veterans, particularly with regards to the rates of Special Monthly Compensation (SMC) paid to severely disabled veterans.  We also believe the Committee should consider the larger benefit that providing travel reimbursement to catastrophically disabled non-service connected veterans will have on the long term care costs that can be saved from this population of veterans.

There is a well-established shortfall in the rates of SMC paid to the most severely disabled veterans that the VA serves.  SMC represents payments for “quality of life” issues, such as the loss of an eye or limb, the inability to naturally control bowel and bladder function, the inability to achieve sexual satisfaction or the need to rely on others for the activities of daily life like bathing, or eating.  To be clear, given the extreme nature of the disabilities incurred by most veterans in receipt of SMC, we do not believe that a veteran can be totally compensated for the impact on quality of life; however, SMC does at least offset some of the loss of quality of life.

PVA believes that an increase in SMC benefits is essential for veterans with severe disabilities.  Many severely injured veterans do not have the means to function independently and need intensive care on a daily basis.  Many veterans spend more on daily home-based care than they are receiving in SMC benefits.  This fact has been supported by the testimony of numerous witnesses in the past.

One of the most important SMC benefits to PVA is Aid and Attendance (A&A).  PVA recommends that A&A benefits be appropriately increased.  Attendant care is very expensive and often the A&A benefits provided to eligible veterans do not cover this cost.  In fact, many PVA members who pay for full-time attendant care incur costs that far exceed the amount they receive as SMC-Aid and Attendance beneficiaries at the R2 compensation level (the highest rate available).

Also, we believe the Committee should consider expanding travel reimbursement benefits to catastrophically disabled non-service connected veterans.  While we recognize that the VA may face tighter budgets in the future, and that this benefit could add a significant cost to the VA, we believe the short term costs of expanding this benefit to this population of veterans would be far outweighed by the potentially greater long term health care costs for these veterans.  Too often, catastrophically disabled veterans choose not to travel to VA medical centers for appointments and procedures due to significant costs associated with their travel.  The result is often the development of far worse health conditions and a higher cost of care.  By ensuring that catastrophically disabled veterans are able to travel to the best location to receive necessary care, their overall health care costs to the VA can be reduced.

Eliminate the Cap on Independent Living Services
With the Independent Living (IL) program proving to be an integral part of the rehabilitation process, Congress has expanded the cap for total participation several times to the current level of 2,700.  As a result, VA Vocational Rehabilitation & Employment (VR&E) management must monitor total veterans enrolled into this program ensuring participation will not exceed the cap.  However, monitoring the program to limit participation is contradictory to the mission of providing the best options for disabled veterans.

Complicating matters is the requirement to count each IL program created for a veteran towards the cap. One veteran may require multiple IL programs within the same fiscal year, and each of those IL programs count towards the cap.  Such a policy has the potential to exclude disabled veterans from receiving services under the IL program even though demand for these services might exceed the limited number.  For this reason, Congress should remove the cap on the Independent Living program.  All rehabilitation options, including independent living, must be available for veterans that require such services, regardless of the number of veterans seeking those services.

The issues discussed here will form the basis for our advocacy efforts for the year, particularly during the annual Advocacy and Legislation Seminar in March.  In the meantime, if there are questions about the issues listed, please contact Carl Blake, National Legislative Director, at 202-416-7708 or by email at carlb@pva.org.

Congress Set to Complete Work on FY 2014 Appropriations

Following months of partisan bickering the House and Senate are set to approve a final FY 2014 Omnibus Appropriations bill.  The bill includes funding for all programs of the Department of Veterans Affairs (VA) through the end of FY 2014 and advance appropriations for VA medical care programs for FY 2015.  The omnibus bill provides funding levels that virtually mirror the recommendations of the Administration made in April 2013.

Paralyzed Veterans of America (PVA) is concerned that the funding levels for medical care for FY 2014 and the advance appropriations for FY 2015 are insufficient to meet the continually growing demand on the VA.  Moreover, we have serious concerns with the reduction of funding particularly for Major Construction, as well as similar cuts in Medical Facilities.  The Omnibus bill provides only $342 million for Major Construction, nearly $800 million less than what The Independent Budget for FY 2014 recommends, and billions less than the true need for construction funding.  Additionally, the bill would slash funding for Medical Facilities, reducing that account by nearly $500 million.

While we appreciate the modest increases provided for Medical Services and the Veterans Benefits Administration, as well as Information Technology, more must be done.  PVA, along with a large coalition of veterans’ service organizations, has called for passage of legislation in the House and Senate (H.R. 813 and S. 932, the “Putting Veterans Funding First Act”) that would make all of the accounts of the VA advance appropriations.  Currently, only the medical care accounts are funded through advance appropriations.

The last couple of years have clearly shown the benefits to the VA of having the health care system funded by advance appropriations.  The VA health care system has been shielded from the severe negative consequences of political gridlock that ultimately led to a partial government shutdown last fall.  It is time that the rest of the VA is afforded the same protection.

Additionally, the Omnibus bill includes a fix to the contentious provision included in the budget agreement approved by the House and Senate in December that would reduce the rate of the cost-of-living adjustment (COLA) for military retirees who are retired for disability under Chapter 61, title 10 U.S.C.  However, it retains the COLA reduction for all other military retirees under the age of 62.

The 28th edition of The Independent Budget—co-authored by PVA, AMVETS, Disabled American Veterans, and Veterans of Foreign Wars—will be released in February 2014.  The document will once again call for sufficient, timely and predictable funding to be provided for all VA programs.

Report on Federal Employment of People with Disabilities

In 2000, President Clinton issued an executive order to increase the number of federal employees by 100,000.  Little progress was made toward that goal, and in 2010, Executive Order 13548 required agencies to submit recruiting and training plans, increase retention and “return to work” of people with disabilities, and report results of employment efforts.  This report for FY 2012 was issued in December, 2013.

Each Federal agency submitted a Disability Plan outlining goals and strategies, and employees from more than 56 agencies have been trained on recruitment techniques, the Schedule A Hiring Authority for People with Disabilities, reasonable accommodation, and the Department of Defense’s Computer/Electronic Accommodations Program (CAP). They have also received training on helping employees who become ill or injured on the job to return to work. (Under Schedule A, individuals with disabilities are eligible for excepted service positions within the federal government and to apply non-competitively to merit promotion announcements. Schedule A has been a strong tool to increase federal employment of people with disabilities. OPM recently issued final regulations, simplifying the Schedule A hiring process for job applicants with disabilities).

Major findings in the report include:  There are more people with disabilities in Federal service both in real terms and by percentage than at any time in the past 32 years.  People with disabilities were hired at the highest percentage in 32 years.

In FY 2012, total full-time permanent employees with disabilities, including 30 percent or more disabled veterans, increased from 203,694 in FY 2011 to 219,975, an increase from 10.97 to 11.89 percent.  In FY 2012, full-time permanent new hires with disabilities, including 30 percent or more disabled veterans, totaled 16,653, representing an increase from 14.65 percent in FY 2011 to 16.31 percent in FY 2012.  Schedule A disability appointee new hires totaled 1,539, an increase from 0.98 percent in FY 2011 to 1.51 percent in FY 2012. Permanent GS 14 and 15 new hires with disabilities totaled 683, an increase from 12.24 percent to 14.65 percent in FY 2012.

The report can be viewed here: http://www.opm.gov/policy-data-oversight/diversity-and-inclusion/reports/#url=Employment-Statistical-Reports.

CMS Issues Final Rule for Medicaid Home and Community Based Services Settings

On January 10, 2014, the Centers for Medicare and Medicaid Services (CMS) issued a final rule establishing new requirements that apply to Medicaid Home and Community Based Services (HCBS).  The rule, which was several years in the making, is of particular importance because it requires that HCBS settings meet certain qualifications in order to be eligible for Medicaid reimbursements.  These qualifications include that HCBS settings should:

  • be integrated in and support full access to the greater community;
  • be selected by consumer choice from among setting options;
  • ensure individual rights of privacy, dignity and respect, and freedom from coercion and restraint;
  • optimize autonomy and independence in making life choices; and
  • facilitate choice regarding services and who provides them.

The rule also identifies which settings are not HCBS settings and describes locations that will be considered institutional unless determined otherwise through some type of review process.  There will be a transitional process for states to ensure that their waivers and state plans meet the new requirements.

In addition, CMS will be hosting a webinar about the rule on January 23, 2014, from 1:00pm-3:00pm ET and again on January 30, 2014, at the same time. Visit the Home & Community Based Services page on Medicaid.gov to read the full rule and to learn more.

Mathematica Presents Update on SSA Ticket to Work Program

In mid-December, Mathematica Policy Research presented findings from its study of the Ticket to Work [TTW] program and regulatory changes made in 2008 intended to enhance participation in the program by vocational rehabilitation providers and beneficiaries.  Ticket to Work began in 2002, and was designed to assist beneficiaries of Social Security Disability Insurance [SSDI] and Supplemental Security Income [SSI] in returning to work and reducing reliance on public benefits.

Responding to provider complaints over administrative burdens and low payment levels, the Social Security Administration [SSA] changed TTW to allow providers to receive payments sooner in a client’s return to work trajectory, to align payments for SSI beneficiaries more closely to those for SSDI beneficiaries, to accelerate payments for SSDI beneficiaries and to equalize total payments for clients served under the two TTW payment systems.  After the changes in regulations, the number of organizations participating in TTW grew from 818 to 1600 and the total number of new Ticket assignments [e.g. beneficiaries placing their Ticket with a vocational rehabilitation provider to develop a return to work plan] rose from 66,000 to almost 94,000.

Another goal of the changes in TTW was to encourage providers to serve beneficiaries interested in or only able to engage in part-time work or who were perceived to have lower employment potential.  Consistent with this goal, the study found that, after the regulatory revisions were made, participants in Ticket to Work were more likely to be under age 25 or to be age 55 or older and to report work limitations due to psychiatric disabilities.

While concluding that the changes in the Ticket to Work program had some positive outcomes on provider and beneficiary participation, Mathematica’s researchers pointed to other flaws in the SSA disability benefits system that continue to impede beneficiaries’ ability to return to work.  These ongoing barriers include significant overpayment assessments against working beneficiaries due to SSA’s failure to terminate benefits in a timely fashion and continuing concern among SSDI and SSI recipients over loss of medical coverage when they go to work.