2006 Legislative SummaryVERMONT COALITION FOR DISABILITY RIGHTS
2007 LEGISLATIVE SUMMARY
The 2007 legislative session is not over yet, with the General Assembly
poised to return on July 11 in response to gubernatorial vetoes, but
“the results are in” for most of the bills of interest to the
disability community. A glossary of acronyms appears at the
end. Feel free to call our office with questions or email us at:
vcdrinfo@sover.net
EDUCATION
H.526 Education Quality and Cost-Control: As the Appropriations bill is
known as the “big bill” of state government finance, this was
undoubtedly the “big bill” of education. Curbing education spending and
hence property tax growth was declared a common priority of the session
by legislators and the Governor, although the means by which this would
be accomplished consumed hours of negotiations, right up until the
close of the session. Needless to say, special education spending
received a lion’s share of attention, and is specifically addressed in
several sections of the bill.
General education costs will be controlled via a cap that limits
high-spending districts’ budget growth to the rate of inflation in the
average spending district plus 1%; budgets with proposed increases up
to this amount are voted upon as usual. Those districts can only exceed
the cap via a 2-step process, in which the cap must be overridden by
second vote. Critics of this 11th hour agreement note the majority of
legislators had little time to consider the merits of the bill, that
school budget growth may be effected by factors over which districts
have no control, and that the ability to pass a budget that exceeds the
cap is likely to be biased toward affluent more districts. Further,
caps are likely to further pit general education against special
education spending, if constrained growth necessitates cuts in areas
serving all children, while special education costs are seen as
uniquely protected.
However, that “protection” may be less than imagined. Special education
costs will be monitored via an annual Special Education Review by the
Commissioner of the Department of Education (DOE), to identify high and
low spending districts. High spending districts are identified as those
which spent at least 20 percent more than the statewide average of
special education eligible costs per average daily membership, while
low spending districts as having spent no more than 80 percent of the
statewide average of special education eligible costs per average daily
membership. High spending districts will be asked to justify their
spending based upon greater than average demand or other
characteristics. Districts that cannot justify spending levels will be
required, to identify alternatives for delivery of services and develop
a remediation plan. High spending districts will have two years
to demonstrate progress on the remediation plan. If the Commissioner
determines satisfactory progress has not been made, 10 percent of the
district’s special education expenditures reimbursement will be
withheld in the ensuing school year. An additional 10 percent can be
withheld in each subsequent year if DOE judges satisfactory progress is
not achieved. Districts may appeal to the State Board of
Education with reasons the district believes it made satisfactory
progress or to explain the reasons it failed to do so, before funds are
withheld.
We are concerned by this portion of the bill for several reasons.
Support by a panel of experts to be provided to high-spending districts
in an earlier version of the bill, has long since been
removed. There is nothing in the bill to ensure pressure to
reduce special education costs does not result in less efficacious
services and children do not loose as a result. Low spending
districts are reviewed to determine whether they may serve as models
for other districts, but there is no obligation to verify whether they
have met all requirements of IDEA. Finally, withholding of
federal funding will require compensation by state funding. This is
hardly consistent with the larger goals of H.526 and may further
exacerbate public perception of special education as the primary
“drain” upon the property tax and increase pressures to cut corners in
this area. Certainly, in our small towns were “everyone knows who
the special needs children are,” parents of children with serve
disabilities already experience enough discomfort at town meetings and
school budget discussions.
Attention to the property tax heightened awareness among legislators of
costs shifts over the years that have occurred as a result of cuts to
the Agency of Human Services (AHS) budget. The bill also includes a
Provision of Special Education Services Study to examine how AHS, DOE,
and the Department of Employment &Training should provide for
special education services for eligible persons less than 22 years of
age in school or out of school and for other human services-related
services for elementary and secondary students. The Vermont
Parent Information Center and VCDR are named among the participants in
this study, to be reported upon or before November 1, 2007. Additional
legislative charges include a study on Medicaid funded educational
services and a report on the fiscal requirements of state and federal
mandates.
H. 534 Prekindergarten Education: This bill is a tangible result of the
study on prekindergarten (pre-K) education from the 2006 legislative
session. It outlines a process for establishing voluntary pre-K
programs through public school the formula for determining the number
of children who will count toward the school’s average daily attendance
(ADM) and places a limit on the number who of ADM
placements that will qualify for state funding. Of importance to
disability rights advocates, the bill does not compromise inclusion by
limiting pre-k programs to “at-risk” children, as had been proposed
last year. In addition, the bill specifies that all children receiving
early essential services can be included in the ADM count. A study to
be performed by DOE and the Department of Children & Families is
ordered that will describe the impact of the pre-K program upon child
behavior and the ADM ceiling upon the state’s ability to fund the child
care subsidy program and meet the needs of Vermont’s children. Results
of the study are due to the legislature on or before January 1, 2010.
Additionally, the Prekindergarten Education Study Committee established
in 2006 is continued until March 1, 2008 to provide periodic oversight.
DEVELOPMENTAL SERVICES & MENTAL HEALTH
H.274 Adult Foster Care: The bill establishes equitable treatment of
providers of child and adult foster care with respect to the homestead
tax. “Difficulty of care” payments to providers of home care for
developmentally disabled adults will be exempted from counted as income
toward property tax. The bill reverses the outcome of last year’s bill,
which would have put in place a $6,500 cap on the exemption in 2008
taxes, a position strongly advocated by the administration. The
bill reestablishes what has in fact been the practice over the years,
counter to the Tax Department’s claim that it is diminishing the
property tax. The Governor has let the bill become law without
his signature, but has also indicated the administration will push to
reverse the decision.
S.121 Relating to Autism Spectrum Disorders (ASD): The Agency of Human
Services (AHS) and the Department of Education must write a plan for a
coordinated, lifelong system of care to address the needs of Vermonters
with autism spectrum disorders. An important strength of the bill
is the range of stakeholders with which AHS and DOE are instructed to
collaborate in developing the plan. Legislators were clearly impressed
by testimony of parents of children with ASD. The bill gives
particular emphasis to the role of people with ASD and their families,
who are to be represented across regions, diagnosis, and severity of
symptoms. Representation by organizations providing support to families
are also identified reflecting the vital role these have played in our
state, where they have often been the primary source of information and
referral to parents. It is not yet clear how this collaboration will be
structured, but our understanding is that legislators intended it to be
substantive and ongoing.
The bill also specifies collaboration with professionals with
established expertise in ASD, which should include where necessary,
professionals from out of state, to augment a recognized paucity of
expertise in Vermont. This bill has broadly recognized a first step
toward creating an improved, coherent set of services for this sizeable
population. It will also establish groundwork needed for Vermont to
benefit from anticipated federal legislation that would provide funding
to states for services. We appreciate the hard work of House and
Senate Education Committee members and the unceasing advocacy of so
many parents. The written plan is due to be presented to the Governor
and Legislature on or before January 15, 2008.
H:449 Transitional Youth: This bill seeks to assist “youth
in a successful transition to an independent adulthood, including the
avoidance of homelessness, incarceration, and substance abuse.” The
first section of this bill extends supports to youth aging out of
foster care or who have recently left foster care. The Governor’s
budget for FY’08 already contained funding for this purpose.
Youth are defined as individuals from 18 to 22 years of age.
There are a significant number of children with disabilities in foster
care; this bill will be particularly beneficial to those who fall
through the cracks for eligibility for Medicaid and other services.
Participating youth are required to be employed or attend an
educational or vocational program; however, youth with disabilities are
exempted from this requirement. Legislators specified that an
array of age-appropriate services be provided, such as housing
assistance, transportation, case management services, and assistance
with obtaining and retaining health insurance or employment. We
applaud the comprehensive nature of this list and advocate that it be a
model for transition supports to other populations.
This bill also provides that there shall be no Medicaid prescription
co-payments for young adults from age 18 to age 21. The
administration had proposed regulations, which would have resulted in
co-payments for this age group, and the legislation was needed to stop
that administrative change. Children under age 18 have no
co-payments. Adults beginning at age 21 have Medicaid co-payments of
$1, $2 or $3 depending on the cost of the drug.
Additionally, the bill charges the Secretary of Administration, in
consultation AHS, the Department of Labor, DAIL, DOC, the Department of
Children and Families (DCF), and DOE to study costs and benefits of
providing transitional services up to age 22 for a youth who has a
functional developmental disability and has been receiving state-funded
services or services under an individualized education program (IEP) on
or before the youth’s 18th birthday; or has been receiving state-funded
services for severe emotional disturbance on or before his or her 18th
birthday; to assist the youth in becoming a self-sufficient adult.
Input from consumes, providers and representatives of disability
advocates is to be summarized in the report. The assignment of primary
responsibility to the Secretary of Administration and inclusion of a
broad range of departments reflects legislators’ intention the study be
comprehensive and coordinated, resulting in meaningful assessments of
costs and benefits of overdue support to these populations. Special
thanks to members of the House Human Service Committee for their
thoughtful work and persistent commitment to the needs of youth with
disabilities.
Finally, a number of initiatives not included in the final bill were
documented in a letter from House Human Services and Senate Health and
Welfare Committee members, addressed to letter to the Secretary of AHS,
calling for a comprehensive examination of the needs of the
transition-age population (ages 18-21). Among the gaps sited in
the letter to AHS are services youth who meet a functional, but not
categorical, definition of developmental disability and to youth with
severe emotional disturbance who are ineligible for adult mental health
services, because they do not meet the clinical eligibility criteria
for youth for adult CRT services.
H.137 Restoration of a Department of Mental Health and Commissioner of
Mental Health: The bill establishes a Department of Mental Health,
headed by a cabinet-level commissioner with educational and practical
experience in the field of mental health. Advocates of the bill have
argued the change will bring a much-needed level of focus and
autonomous leadership to mental health and substance abuse areas. The
department will be responsible for the Vermont State Hospital (VSH).
The bill specifies that integration and coordination with the VT
Department of Health (DVH) that were goals of the AHS reorganization
will be maintained and further developed under the new department and
orders an annual report on the progress of that collaboration.
S.124 Planning and Evaluating Options for Inpatient Psychiatric
Hospital Services (Vermont State Hospital): Frustration with the
administration’s progress and questions about the extent to which
multiple options for replacing VSH have been adequately explored and
fiscally analyzed, prompted the legislature to allocate $100,000 for
consultants to perform an independent evaluation of the state's
proposed plan and alternatives. The possibility of regaining
certification and hence federal funding will be included in the
consultant’s assessment; a preliminary progress report is due on or
before September 1, 2007 and the final report no later than
November 1, 2007. The Governor allowed the bill to be enacted into law
without his signature.
S.128 Repeal of Sunset for Forensic Examinations at
Designated Hospitals: A July 1, 2007 sunset for forensic
evaluations at designated hospitals was repealed; assessments will
continue to be performed at facilities closer to Vermonters’ home
communities, rather than restricting the function to VSH. Preexisting
requirements that a) an individual must be demonstrated to require
treatment by a mental health professional before an inpatient
examination is ordered and b) defendants who are not ordered to return
to court or are not in custody of the Department of Corrections shall
be returned to the community are preserved.
S.97 Correctional Facilities: This bill generated considerable
consternation among disability advocates, based upon a section that
challenged the jurisdiction of the Human Rights Commission to
investigate complaints of violation of Vermont’s Public Accommodations
Act. The challenge resulted from a complaint filed by the family of a
young man with cognitive and mental health impairments. That section of
the bill was ultimately eliminated, while other parts of the bill
direct overdue attention to the needs of inmates with severe mental
illness (SMI). A joint Legislative Corrections Oversight Committee is
charged with coordinating work with the consultants hired by S.124 to
study the number and profile of inmates with SMI, policies from other
states, the advisability of establishing a separate inpatient
psychiatric facility for inmates, DOC policies for the administration
of psychiatric medications, and the possibility of amending the SMI
definition to include “other mental impairments that
significantly and negatively affect daily functioning, including all
forms of developmental disabilities, mental retardation, traumatic
brain injury, autism, and various forms of dementia.” The latter would
extend superior protections of the SMI population to other groups with
disabilities that similarly impact cognitive and behavioral function.
The report is due on or before January 15, 2008.
HEALTH
S.7 Compassionate Use of Marijuana for Medical Purposes (Medical
marijuana): The bill allows a greater range of seriously ill
Vermonters to register to grow their own marijuana for relief of a
disease, chronic condition, or treatment that is chronic, debilitating,
and produces severe, persistent, and one or more intractable symptoms.
It increases the number of plants that may be kept for personal use to
two mature and seven immature plants, lowers the annual registration
fee from $100 to $50, and describes in detail a medical verification
form to developed by VDH for registration in the program. The Governor
has allowed the bill to become enacted law without his signature.
H.44 Patient Choice and Control at End of Life (Physician-assisted
Death): In what was a surprising outcome for many, the House defeated a
bill to allowed physicians to prescribe a lethal dose of medication if
requested by terminally ill patients with less than six months to live.
As the bill was emotionally debated on the floor, an increasing number
of legislators concluded that there were just too many unanswered
questions to enact a law of such monumental significance and with
irreversible consequences.
S.115 Increasing Transparency of Prescription Drug Pricing and
Information: The Office of Vermont Health Access (OVHA) is charged with
maintaining a pharmacy best practices and cost control program to
include an evidence-based preferred drug list, a utilization review
board, and strategies for negotiating with pharmaceutical manufacturers
to lower the cost of prescription drugs for participants, including a
supplemental rebate program. A joint pharmaceuticals
purchasing consortium will be offered on a voluntary basis to private
insurers, with mandatory participation by state or publicly funded
health programs no later than January 1, 2008. Manufacturers of
prescription drugs dispensed under a state directed or administered
health program will report quarterly to OVHA on pharmaceutical pricing
criteria. As we went to press, this bill had not yet reached the
Governor’s office and staff we reached declined to predict what action
he will take.
H.531An Act Relating to Ensuring Success in Health Care Reform and
H.229 An Act Relating to Corrections and Clarifications to the Health
Care Affordability Act of 2006 and Related Legislation These two bills
are the result of the health care reform initiatives passed in the 2007
session. They include many sections detailing how the Health Care
Commission, the Blueprint for Health, technology initiatives and other
aspects of the reform effort will work.
H.531 includes a substantive change in coverage for Catamount Health
(the new health care program scheduled to start on October 1, 2007) and
the Vermont Health Access Plan (VHAP, the existing Medicaid expansion
program for low income Vermonters). Coverage for Catamount and VHAP
will now be retroactive to the date of application rather than
beginning on the date the application is processed. This can be a
significant benefit for previously uninsured beneficiaries and their
providers. H.531 also provides that the Commissioner of the
Department for Children and Families will study the costs and benefits
of providing similar date-of-application eligibility for beneficiaries
of the state-funded pharmacy programs. H.531 also sets goals for
coordinating outreach activities to identify people who are eligible
for Catamount and public health care programs in Vermont and to help
them enroll.
OTHER
H.523, An Act Related to Moving Families out of Poverty. This
bill, signed by the governor on May 17, 2007, is designed to update
Vermont’s Temporary Assistance to Needy Families (TANF) program (also
known as “Reach Up”). This is the program that provides cash
benefits to very low income Vermont families with children. The
bill makes changes in the current TANF/Reach Up program to try to
increase the number of Reach Up participants who are engaged in work
activities, as required by changes in federal law. It maintains
several state-funded programs that do not meet federal funding
requirements including assistance to parents enrolled in post secondary
education programs and assistance to families with young children up to
age 2. There is also a section of the budget that changes funding
sources for the Vermont Earned Income Tax Credit so that Vermont can
get TANF credit for spending this money.
Several changes to the program design are of particular interest to
parents with disabilities or parents of children with
disabilities. H.523 creates a new program called Reach First,
which serves families when they initially apply for benefits and can
give short-term assistance for up to 120 days. Reach First emphasizes
giving families orientation to available services and in-depth
assessment of their service needs before development of a family
development plan. H.523 also allows the state to set up
state-funded programs which do not use federal TANF money for a number
of vulnerable groups, including families in which the parents have
disabilities; families in which one or more child has a disability and
in which a family member is considered a work-eligible individual; and
families in which the parents or caretakers have an application pending
for Supplemental Security Income.
H.527 The State's Transportation Program: On a one-time basis, the bill
adds $156,800 in state transportation funds and $43,200 in
federal funds to the public transit Elders and Persons With
Disabilities Program (E&D), for critical medical care
transportation services that are not covered by Medicaid. The
funds are to be held in reserve by the Agency of Transportation for
emergency supplemental spending, and dispersed to transit agencies with
grant agreements to provide E&D program services, only if a
shortfall of E&D funds occurs as a result of an unanticipated level
of need for critical care services, that would result in a shortfall of
funds available to continue providing nom-Medicaid critical care
transportation. A critical care transportation study
committee is established to review the current service system and
develop recommendations for program stability and funding
predictability for transportation to and from dialysis and cancer
treatment medical services for Vermonters not eligible for Medicaid
transportation services.
While we are pleased by the legislature’s responsiveness to need in
this area, we are very concerned that the original objectives of the
E&D Transportation Program have not received equal attention,
despite considerable testimony about unmet need and the fact that these
have often been sacrificed to meet the demand for critical care
transportation that is not covered by Medicaid. We hope the study
committee will make the protection of funding for basic transportation
to allow Vermonters with disabilities to participate equitably in
community life a priority in its work.
APPROPRIATIONS (a.k.a. THE “BIG BILL” OR H.537 AN ACT RELATING TO MAKING APPROPRIATIONS FOR THE SUPPORT OF GOVERNMENT)
Sick Building Hazards: The Commissioner of the Department of Buildings
and General Services and the Commissioner of the Department of Health
will develop a protocol for identifying and addressing current and
potential health hazards in state office buildings, and to keep
legislators informed of sick building complaints; to be submitted
January 15, 2008.
Catamount Health Assistance; Global Commitment Waiver
If by July 31, 2007, the Centers for Medicare and Medicaid Services has
not responded to the Global Commitment for request to fund Catamount
Health Assistance with Medicaid funds, does not approve the request, or
approves a lower income eligibility limit for Catamount Health
Assistance, the Commission on Health Care Reform may recommend to a)
proceed with all or some programs associated with Catamount Health, b)
delay some or all programs, suspend new enrollment, or c) restrict
eligibility to a lower income. The Emergency Board will make a
determination based on the recommendation by August 30, 2007.
Chiropractic Coverage: As of July 1, 2008, chiropractic coverage
for adult beneficiaries in Medicaid and VHAP programs will be
reinstated with rates comparable to payments to other health care
providers.
Dental: A number of dental initiatives proposed by the Governor were
enacted. Most are advantageous for consumers. However, a rate increase
in provider rates was enacted without a simultaneous increase in the
cap on the benefits adults on Medicaid receive ($495 per year). This
means that adults on Medicaid will now be eligible for fewer
procedures/services per year. (Children on Medicaid are not similarly
impacted, as there is not dental cap for this population.)
New Grievance and Appeal Rules for Global Commitment and Choices for
Care: In response to new grievance and appeal rules for the Global
Commitment and Choices for Care waivers, the legislature will monitor
the implementation of rules, the number and types of grievances,
internal appeals, appeals to the human services board, and the number
of internal appeals that were reversed by an independent
decision-maker.
Choices for Care (CfC) Long-Term Care Waiver: Last year’s
Appropriations Bill instructed that savings due to the implementation
of the CfC waiver be retained by DAIL and reinvested into providing
home- and community-based services under the waiver. Advocates
objected early this session AHS announced it would be transferring
approximately $1.8M in state funds to other areas of the budget as part
of the Budget Adjustment Bill of FY’07. OVHA contended the money
was not savings, but a result of an over-estimate in the program’s
first year budget. Advocates countered that at least a portion of
this “overage” was the result of keeping about 90 people on the waiting
list for months, trimming of services to those receiving the waiver,
and failure to invest in services consistent with the intention of the
waiver. While the legislature ultimately approved the transfer of
funds, it sought to clarify what constitutes savings, ensure that
populations to be covered by the waiver are served on a timely basis,
and protect demonstrated savings against future diversion to another
program.
DIAL is instructed to submit quarterly reports to the legislature about
utilization of services and expenses under CfC, including comparison of
actual to estimated expenditures and projected expenditures for the
full the fiscal year. Reports will also include the amount of
savings generated from providing home- and community-based care rather
than nursing home services. DAIL will also submit a plan that
articulates the method for determining savings: how the savings will be
reinvested in home- and community-based services, and numbers of people
receiving each category of service. Funding priority will be
given to services for the high and highest needs group; remaining funds
from the long-term care appropriation may be used for other long-term
care consistent with the terms and conditions of the waiver.
Unspent appropriated funds shall be carried over to the next fiscal
year.
Substance Abuse & Co-occurring Disorders
VDH will convene a task force to identify current substance abuse
treatment services and how they may be integrated for a community- and
recovery-based system January 15, 2008. The report will contain an
analysis of predicted long-term savings, including those to DOC, and a
strategy to develop a workforce of clinicians qualified to treat
co-occurring mental health and substance abuse disorders.
In response to inadequate FY’07 funding to programs for youth with
co-occurring disorders, VDH is instructed to ensure full funding for
mental health and substance abuse services for eligible children, youth
and adults, and CRT program participants. A report to the legislature
in January will identify spending to date and assess adequacy of
funding to complete the fiscal year.
Success Beyond Six: AHS and DOE will convene a summer study in response
to the impact of fiscal caps under the Global Commitment upon Success
Beyond Six, which has provided a means of funding school-based
community mental health services through Medicaid billing. The study is
charged with determining practice guidelines and how spending will be
managed.
Developmental Services, Mental Health & Substance Abuse funding:
This is the final year of a three-year administrative commitment to a
7.5% increase to the areas of Developmental Services, Mental Health,
and Substance Abuse. As a result of a careful and highly
cooperative process that maximized the use of available resources,
projected caseloads were covered and a 4% increase given to providers.
Special thanks are due to Commissioner of Finance Jim Reardon.
Mental Health:
In a late-session move, the legislature created an Advisory Council for
Mental Health Services Transformation that replaces the current Futures
Advisory Committee and broadens the scope to include all mental health
programs, services, and supports, including inpatient psychiatric
services. Appointments made by the new Commissioner of Mental
Health will include consumers and family members. The ambitious
objective is to establish a holistic, comprehensive continuum of care,
in which consumers are treated with dignity and respect, and services
are client- and family-centered and -driven, accessible, and culturally
competent. A sunset for the council is identified as July 1, 2009.
Total appropriations in the VDH budget for the Vermont State Hospital in FY ’08 are $20,861,837.
Traumatic Brain Injury Study Committee:
This study will include assessment of the nature and extent of need for
support by Vermonters affected by traumatic brain injury, stroke, and
substance-induced brain injury and analysis of insurance coverage for
these conditions. The committee is to include: 2 legislators,
four representatives of AHS, a physician and a member of the
psychiatric or mental health treatment community. VCDR applauds this
much-needed initiative, but notes that representation by advocacy
groups, consumers, and family members is conspicuous by its absence. We
urge the study committee to invite full participation by these
important stakeholders within its process. The report is due by
December 15, 2007.
Home Access Program (HAP): DAIL, in cooperation with the Vermont Center
for Independent Living, will report on the number of people with
physical disabilities at significant risk of, or living in, nursing
homes and other inappropriate settings, and the degree to which
additional funding to HAP would allow individuals to live in the most
integrated setting possible. HAP has been demonstrably under-funded for
a number of years. As of January there was three-year waiting list of
195 people; the cost of eliminating that waiting list was estimated at
$1.5M. The report is due on January 15, 2008.
One-time Funding:
• DAIL received $60,000 in one-time funding to establish a Caregiver Registry.
• DOE received $400,000 to transfer to the DOC for its special education program.
ADVOCATE’S ACRONYM GLOSSARY*
*The magic decoder ring is available with submission of 2,000 coffee cups (empty, please) from the State House cafeteria.
ADM= Average Daily Membership
AHS= Agency of Human Services
ASD= Autism Spectrum Disorder
CfC= Choices for Care Long-term Care Waiver
CRT= Community Rehabilitation and Treatment Program
DAIL= Department of Disability, Aging & Independent Living
DCF= Department of Children & Families
DOC= Department of Corrections
DOE= Department of Education
E&D Transportation Program= Elderly & Disabled Transportation Program
HAP= Home Access Program
IDEA= Individuals with Disabilities Education Act (now actually Individuals with Disabilities Education Improvement Act)
IEP= Individualized Educational Program
SMI= Severe Mental Illness
OVHA= Office of VT Health Access
Pre-K= Prekindergarten
TANF= Temporary Assistance to Needy Families (also known as Reach-Up)
VCDR= VT Coalition For Disability Rights (of course)
VDH= VT Department of Health
VHAP= VT Health Access Program
VSH= VT State Hospital
|