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A pdf version of this newsletter can be found at http://www.pascenter.org/newsletter/CenterforPASBulletinOct06.pdf

Previous newsletters can be found at http://www.pascenter.org/newsletter/index.php

Center for Personal Assistance Services Bulletin

October 2006 - Volume 3, Issue 4

In this issue:

• Center for PAS State of the Science Conference
• On the Center for PAS website
• Resources
• News
• Research articles and reports
• Presentations and New Projects
• SELECTED CONFERENCES DURING October, November and December 2006

Center for Personal Assistance Services State of the Science Conference

The Center for Personal Assistance Services will host its State of the Science Conference, entitled "Meeting the Nation's Need for Personal Assistance Services: State of the Science" on April 27, 2007 at the National Press Club in Washington, DC.

The conference objectives are:

• To learn and discuss the current research and policy implications for personal assistance services in the home, community, and workplace
• To identify the potential future directions for research and policy regarding personal assistance services

Registration is now open. Registration for the conference is free but space is limited so please register in advance. Housing will be available at the Renaissance Washington DC Hotel.

Registration and hotel information is available on the PAS Center website at http://www.pascenter.org/sos_conference.

The Research and Training Center on Personal Assistance Services is based at the University of California, San Francisco and includes the Topeka Independent Living Resource Center, InfoUse, Paraprofessional Healthcare Institute, Institute for the Future of Aging Services, and faculty members at the University of Maryland, Baltimore County, University of Michigan, and West Virginia University's Job Accommodation Network (JAN). The Center is funded by the National Institute on Disability and Rehabilitation Research (NIDRR) #H133B031102.

In addition to our NIDRR funding, the Center is very pleased to receive a conference grant from the Agency for Healthcare Research and Quality (#1R13 HS016608-01) to assist with the funding of the conference in Washington, DC. The conference grant will not only help with funding the conference and will allow us not to have an registration fee but it will also allow us to bring the PAS Center advisory board members to the conference in DC.

On the Center for PAS website

The following are new resources available on the Center for PAS website (http://www.pascenter.org)

• State by state data on Home and Community-Based Services: Medicaid Research and Demonstration Waivers

  To retrieve data on these topics by state, go to http://www.pascenter.org/state_based_stats/demoWaivers.php?title=Demo+Waivers+Information

• Two reports on HCBS have been revised for 2006. They are presented as promising practices and are titled:
  "The Arkansas Medicaid State Plan Personal Care Services Program"
  

  To retrieve this report, go to http://www.pascenter.org/home_and_community/Arkansas.php

  "The Texas Medicaid State Plan Personal Care Services Program"
  To retrieve this report, go to http://www.pascenter.org/home_and_community/Texas.php

  To see all the promising practices on Medicaid State Plan Options, go to http://www.pascenter.org/home_and_community/index.php

• Ask Mike replies to the question "How many states offer the personal assistance program?"
  To see Mike's reply, go to http://www.pascenter.org/pas_users/ask_mike5.php

• 17 new PAS workforce papers and 12 new workplace PAS publications have been added to the library.

  To retrieve the PAS workforce papers, go to http://www.pascenter.org/publications/library.php?audience=workforce

  To retrieve the workplace PAS papers, go to http://www.pascenter.org/publications/library.php?audience=workplace

Resources

Recently, the following new resources related to personal assistance services have been released.

Nursing Home Relocation Impact Calculator

The National Academy for State Health Policy in Portland, Oregon and Hendrickson Consulting have developed a "Nursing Home Relocation Impact Calculator" which can be used to determine exactly how much Medicaid funds a State will save per person if the State receives an "enhanced" MFP federal match and if the State then moves persons out of a nursing facility.

Steve Gold, a disability rights attorney, is willing to provide people with the Calculator. Email him with what state you are interested in and he will send you an individual attachment with the Calculator in an Excel spreadsheet format.

Once you have it, you must obtain and insert some simple information from the State in which you are interested. You must know:

• 1. the State's Medicaid per day reimbursement for Nursing Facilities;
• 2. the federal-match % of the State's Medicaid;
• 3. whether or not the State has a "bed tax." If it does have a bed tax, then keep the 3% on the Calculator, but if the State does not have a bed tax, then delete the 3% and insert 0; and
• 4. the average annual waiver Medicaid cost per person for home and community services (HCBS), which can be found in the appendix to the State's Waiver application for persons who are either "aged" or "physical disability."

To reach Steve Gold, email him at stevegoldada@cs.com

Fact Sheets Summarize Medicaid Program Changes in KY and VT

States are moving forward with changes to their Medicaid programs using new options under the Deficit Reduction Act (DRA) of 2005 and existing Medicaid waiver rules. The Kaiser Commission on Medicaid and the Uninsured has released fact sheets examining how Kentucky and Vermont are using DRA to change their Medicaid programs. Kentucky is imposing new cost sharing requirements with a redesign of their Medicaid long-term care program. The goal of the redesign is equal access to institutional and home and community-based services. Vermont is using a Section 1115 waiver in its Medicaid long-term care program to better support caregiving families.

To retrieve the fact sheets, go to the following links:
for Kentucky -
http://www.kff.org/medicaid/7530.cfm
for Vermont -
http://www.kff.org/medicaid/7540.cfm

New "Talking About Medicare" Consumer Guide Available Online

The Kaiser Family Foundation released a new, online consumer guide, "Talking About Medicare," to help people on Medicare and their family members and caregivers to make informed decisions about their health care. "Talking About Medicare" helps to answer basic questions about Medicare eligibility and coverage.

The guide is available at http://www.kff.org/talkingaboutmedicare

Home and Community-Based Long-Term Services and Supports for Older People

How assistance with daily activities provided by home and community-based long-term services helps people with disabilities remain in their homes, the sources of payment for these services, and the types of programs that provide it are discussed in this AARP Public Policy Institute Fact Sheet.

For more information go to http://www.aarp.org/research/longtermcare/programfunding/fs90r_hcbltc.html

Fact Sheet Summarizes State Fiscal Conditions and Medicaid

A new fact sheet from the Kaiser Commission on Medicaid and the Uninsured (KCMU) summarizes the relationship of Medicaid with state budgets and provides an update about the fiscal situation in the states and how it is affecting Medicaid programs.

For more information go to http://www.kff.org/medicaid/4087-04.cfm

News

Recently, the following grant programs related to personal assistance services have been announced by federal agencies.

Money Follows the Person Demonstration Grants

On July 26, 2006, the Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services announced the 2007 Money Follows the Person (MFP) demonstration grants to States. This initiative will assist States in their efforts to reduce their reliance on institutional care while developing community-based longterm care opportunities, enabling the elderly and people with disabilities to fully participate in their communities. Under the program, states would receive funds to sustain Medicaid beneficiaries, who would otherwise be in nursing homes, in their communities or in their homes. Funds could be used not only for home health care but also to modify the home to allow the care recipient to stay there. Respite care for family caregivers is also an allowable service. There will be $250 million available beginning January 1, 2007 and a total $1.75 billion for five years. These are competitive grants. States were to develop and submit a plan to receive a grant. Proposals are due November 1, 2006.

To see the press release, go to http://www.hhs.gov/news/press/2006pres/20060726.html

To see the program announcement, go to http://www.cms.hhs.gov/NewFreedomInitiative/ downloads/MFP_2007_Announcement.pdf

States Receive Federal Grants to Help People with Disabilities Live in the Community

The U.S. Department of Health and Human Services (DHHS) announced nearly $20 million in Real Choice Systems Change Grants for Community Living to states in order to develop programs for people with disabilities or long term illnesses. These grants will help states and territories "rebalance" their long-term support programs to help people with chronic illness or disabilities reside in their homes and participate fully in community life. The eight states receiving 2006 awards are California, Virginia, Michigan, North Carolina, New York, New Jersey, Rhode Island and Kansas. Since 2001, the Centers for Medicare and Medicaid Services (CMS) has awarded 306 Real Choices grants, totaling approximately $237 million

To see the press release, go to http://www.hhs.gov/news/press/2006pres/20060915.html

CMS Announces New Steps to Sustain Medicaid Long-Term Care Coverage

New policies introduced by CMS will allow Medicaid to keep covering nursing home care for people dually eligible for Medicare and Medicaid. The policies, however, also seek to lower Medicaid costs by encouraging older Americans and their caregivers to buy private long-term care insurance, toughening penalties for transferring assets to speed eligibility for the program, and improving coordination of services between Medicaid and Medicare.

To see the press release, go to http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1911

Research articles and reports

Studies Expose Serious Challenges in Direct Care at Home

Two reports released recently by AARP, both authored by researchers at PHI, find inadequate backup services and the low wages and benefits paid to home care workers to be major quality problems that home care must overcome.

One of the reports, “Bridging the Gaps: State and Local Strategies for Ensuring Backup Personal Care Services,” looks at state and local initiatives to ensure that people with disabilities can have their personal needs met on the days when their home care workers don’t show. The second report, ““Paying For Quality Care: State and Local Strategies for Improving Wages & Benefits for Personal Care Assistants,” finds low wages and lack of benefits to be the biggest obstacles to attracting enough qualified direct care workers to meet the increasing demand for home care.

The report on backup services can be found at http://www.aarp.org/research/longtermcare/quality/2006_19_pcs.html

The report on wages can be found at http://www.aarp.org/research/housingmobility/homecare/2006_18_care.html

UCP Report Releases Analysis of State Medicaid Services for Individuals With Developmental Disabilities

A report by United Cerebral Palsy (UCP), "A Case for Inclusion: An Analysis of Medicaid and Americans with Mental Retardation and Developmental Disabilities", provides information on state Medicaid services for individuals with DD and MR, and ranks and grades the states on such services.

The report can be found online at http://www.ucp.org/uploads/full_inclusion_state_report.pdf

Medicaid 1915 (c) Home and Community- Based Waiver Expenditures 1999-2004

In this memorandum, Federal Fiscal Years 1999-2004 are classified for each individual HCBS waiver by the target population served. The distribution of HCBS waiver expenditures across long term care populations is also included.

For more information, go to http://www.hcbs.org/moreInfo.php/nb/doc/1254/

New Study Probes Why Institutions and Nursing Homes Are More Prevalent in Some U.S. States Than Others

The results of this recent study conclude that a state's political culture determines the prevalence of the use of institutions and nursing homes in the care of persons with developmental disabilities.

The study can be found at http://www.uic.edu/orgs/rrtcamr/NursingHomeStudy.pdf

New Report Reviews Enforcement of CRIPA

"The Civil Rights of Institutionalized Persons Act: Has It Fulfilled Its Promise?", a report published by the National Council on Disability, examines the U.S. Department of Justice's (DOJ) enforcement of the Civil Rights of Institutionalized Persons Act (CRIPA), which was enacted by Congress in 1980 to protect the rights of people in staterun nursing homes, mental health facilities, institutions for people with intellectual and developmental disabilities, and correctional facilities for children and adults.

For more information, go to http://www.ncd.gov/newsroom/publications/2005/personsact.htm

Reports Explore Long-Term Care Issues Included in Deficit Reduction Act

The Deficit Reduction Act (DRA) of 2005, which became law this February, includes several significant changes to Medicaid longterm care policies. The Kaiser Family Foundation's Commission on Medicaid and the Uninsured is releasing five new reports on long-term care issues that were addressed by the DRA changes. Long-term care accounts for 36 percent of Medicaid spending (over $100 billion annually) and is utilized by many of Medicaid's most costly beneficiaries, elders with low-income and individuals with disabilities.

The reports can be found at http://www.kff.org/medicaid/kcmu041706pkg.cfm

Presentations and New Projects

Lewis Kraus of the Center for PAS presented Promising Practices in Workplace Personal Assistance Services at the JAN 2006 Annual Conference in Boston, MA, hosted by Job Accommodation Network (JAN). He was joined by Linda Jackson, the Director of the Center for Disability Services, Office of Civil Rights and Equal Opportunity at the Social Security Administration, who presented the promising practice the Center for PAS identified from that organization.

Martin Kitchener of the Center for PAS joined Rosalie Kane from the University of Minnesota and Lisa Rotegard from the Minnesota Department of Human Services, Aging and Adult Service Division to present a workshop on Developing Medicaid Home and Community-Based Services: National Trends and Interstate Variations at the 22nd National Home and Community Based Services Conference and the Minnesota Age and Disabilities Odyssey convened by the National Association of State Units on Aging, the Minnesota Department of Human Services, and the Minnesota Board on Aging.

At the same Home and Community Based Services conference, Lewis Kraus joined Sharron Kirby from the Shepherd Center in Georgia, Christine Loose, a Flexible Case Manager from the Minnesota Department of Human Services, and Jane Vujovich the Project Manager of the Cash & Counseling Grant at the Minnesota Department of Human Services in workshop entitled Consumer Direction: Taking it to the Streets.

Susan Stoddard of the Center for PAS will serve as an advisor on research design and workplace practices for the recently awarded Department of Labor grant for the "Disability Case Study Research Consortium on Employer Organizational Practices in Employing People With Disabilities." This consortium is led by Syracuse University and also includes Cornell, JAN, Georgia Tech, Rutgers, NORC and the US Chamber. The consortium will conduct case studies, and will include workplace accommodation. Stoddard was a researcher on the groundbreaking Berkeley Planning Associates' study of workplace accommodation for DOL.

Center researcher Steve Kaye along with Center researchers from InfoUse staff will join with the new Pacific Disability and Business Technical Assistance Center (DBTAC) headed by Erica Jones. Kaye and InfoUse will conduct new research into business participation in employing people with disabilities.

SELECTED CONFERENCES during October, November and December 2006

October

November

December

The Center for Personal Assistance Services provides research, training, dissemination and technical assistance on issues of personal assistance services (PAS) in the United States. Personal assistance services (PAS) refer to help provided to people with disabilities to assist them with tasks essential for daily living. These tasks include bathing, dressing, getting around, toileting, eating, shopping, remembering things, and other activities. PAS, along with assistive technology such as wheelchairs, text readers, and hearing aides, help people with disabilities to participate in activities at home, at work, and in the community.

The purpose of this newsletter is to provide the latest news on issues relating to formal and informal PAS, home & community- based services, the PAS workforce, and workplace PAS within and outside of the Center.

Detail about the Center staff and advisors can be found at http://www.pascenter.org/about/