FEDERAL

On June 3, President Biden signed The Fiscal Responsibility Act of 2023. The bill is the compromise reached following negotiations about the debt ceiling. The legislation includes new spending limits in exchange for increasing the debt ceiling for two years. It is unclear how the spending limits might impact intellectual and other developmental disabilities (I/DD) funding in the coming year. There is some concern that funding for state Councils on Developmental Disabilities could be reduced. 

The legislation also includes new work requirements for food stamps and Temporary Assistance for Needy Families (TANF) recipients without children up to age 54. (The law previously applied to those 49 and younger.) Veterans, the homeless, and people who were children in foster care are exempt from work requirements. The bill did not include work requirements or other changes for Medicaid recipients. 

Under the legislation, $11 billion in rescinded unobligated COVID-19 relief funds and $10 billion in money shifted from the Internal Revenue Service will be used to beef up non-defense discretionary spending. Also, $10 billion in funds repurposed from mandatory programs and $23 billion that’s designated as emergency funding will be shifted.

Plain Language: On June 3, President Biden signed The Fiscal Responsibility Act of 2023.  This bipartisan (Democrat and Republican supported) bill raised the debt ceiling. The debt ceiling is the most amount of money that the federal government can borrow to pay its bills. Congress agreed to raise the debt ceiling and also put some limits on spending.  

There are some new work requirements for the Supplemental Nutrition Assistance Program (SNAP) for people below the age of 54.  Work requirements are a number of hours a person has to work in order to receive SNAP.  This bill has no impact on Medicaid.

Bills Proposed to Improve Interactions Between People with Disabilities and Law Enforcement

On May 17, the House and Senate introduced bills aimed at addressing the increased incidence of violence involving law enforcement and people with disabilities. Research shows that 33-50 percent of all use-of-force instances with law enforcement involve people with mental health disabilities, which is disproportionately higher than the total population without mental health disabilities.

Human-Services Emergency Logistics Program (HELP) Act (S. 1729 / H.R. 3498). This bill will divert non-criminal, non-fire, and non-medical emergency calls from 911 systems to state and regional systems that support people in crisis related to a mental health condition, like 211 and 988. The bill provides resources and oversight for 211 and 988 systems to ensure that they work correctly.

Safe Interactions Act (S. 1731 / H.R. 3550).  This bill will provide grants to enable non-profit disability organizations to develop training programs that support safe interactions between law enforcement and people with disabilities. The training would include people with disabilities as instructors. An advisory council chaired by a person with a disability would be established to oversee the training development and implementation.

Data Interactions and Accountability for Law Enforcement with Individuals with Disabilities (DIALED) Act (S. 1730).  This bill would improve accuracy and transparency of data collection on how people with disabilities are affected by interactions with law enforcement, including use-of-force and fatal interactions. A national advisory council will also be established to develop improved collection and reporting strategies.

Plain Language: On May 17, the House and Senate introduced bills to make people with disabilities safer when they interact with law enforcement officers. The first bill is the Human-Services Emergency Logistics Program (HELP) Act. It would make sure people with disabilities could call for help without having to call the police. The second bill is the Safe Interactions Act.  This bill will give money to disability organizations to create training programs for police officers on best ways to help people with disabilities. The training will be taught by people with disabilities. The third bill is the Data Interactions and Accountability for Law Enforcement with Individuals with Disabilities (DIALED) Act. This bill will make sure the public knows how people with disabilities are affected by interactions with the law enforcement. 

Centers for Medicare & Medicaid Services Proposed Rules 

This effort includes key changes to the rules governing home and community-based services through what’s being called the Ensuring Access to Medicaid Services regulation, or the Access Rule.

Under the proposal, states would be required to reassess the needs of each individual receiving home and community-based services annually and revise service plans accordingly. In addition, the rule would require that at least 80 percent of what Medicaid pays for personal care, homemaker and home health aide services goes directly toward compensation for the person providing the service rather than for administrative purposes or profit. And, states would need to publish the average hourly rate paid to direct care workers.

The regulation also includes new mandates for states to report on how long their waiting lists are, whether people can access services once they get a waiver and various quality measures in their home and community-based services programs. Centers for Medicare and Medicaid Services (CMS) would expect states to maintain an electronic incident management system and respond to incidents within certain time frames. States would also be required to create a grievance process for home and community-based services recipients in traditional Medicaid plans so they can file a complaint against a provider or state much like already exists for those in managed care plans.

In addition to the Access Rule, CMS is also issuing the Managed Care Access, Finance and Quality proposed rule. That regulation would require states to regularly survey managed care enrollees about their experiences, institute maximum appointment wait time standards and require states to conduct secret shopper surveys annually to ensure that managed care plans are complying with appointment wait time standards and that their provider directories are accurate, among other changes.

Both of the proposed rules are up for public comment until July 3.

Plain Language: The agency that oversees Medicaid is proposing rules to improve home and community-based services for people with disabilities. The rules would require states to make sure people get the services they need and to ask people about their experiences with their services. 

STATE

Budget

In response to the House budget, the Senate passed a budget on May 18.  A Conference Committee is currently working to resolve the differences between the two budgets. A final budget is expected at the end of June, first week of July. 

Below is a comparison of key intellectual and other developmental disabilities (I/DD) budget items in the House and Senate budgets:

Plain Language: The NC Legislature is working on the state budget. The House passed a budget bill that included some of the things that advocates have asked for, like better direct support professional (DSP) wages and 250 Innovations slots. The Senate passed a budget that included 350 Innovations slots and money for better DSP wages.  A conference committee is now working to decide on the final numbers in the budget. 

Bills

Medicaid Expansion

H76 – Access to Healthcare Options – This is the Medicaid expansion bill.  This bill extends Medicaid benefits to people who have been in a health care coverage gap. This extends coverage to people under 133 percent of the federal poverty level who have not previously been eligible. 

*Signed into law on 3/27/23. Medicaid Expansion will go into effect when the legislature passes a budget, CMS approves the state’s plan for Medicaid expansion, and the health plans and state are ready to go live. 

HB 11: Schools for Deaf and Blind - Changes oversight of schools and creates local boards of trustees. Changes admission process which could possibly exclude students with behavioral health needs. 

*Passed House and Senate; became law without Governor’s signature

The following bills are at the same point in process since last “Highlights & Hot Topics”. The legislature has been focused on the budget process. 

H77 – Driver’s License Designation/Autism – Directs Department of Motor Vehicles to develop a designation for drivers’ licenses that can be given upon request to persons with autism. It is entirely voluntary and can only be requested by the person who holds the driver’s license. Requires additional training for law enforcement and the database is only accessible to law enforcement. Many concerns raised by opponents have been addressed.

*Passed House; in Senate Rules Committee

H188 – Standards of Student Conduct - This bill removes existing language that prevents schools from labeling behaviors such as dress code violations, non-compliance with staff directives, disrespectful language, and altercations that do not involve injury as serious violations.  These violations tend to disproportionately affect students of color and those with disabilities.

*Passed House; in Senate Rules Committee

H323 – Retain Adult Developmental Vocational Programs - Prohibits Department of Health and Human Services (DHHS) from reducing or eliminating services provided at Adult Developmental and Vocational Programs (ADVP) or Community Rehabilitation Programs (CRP) without (i) fully following procedures regarding stakeholder notification and input and (ii) appropriately funding a robust array of services that reflect choice. 

 * Passed House; in Senate Rules committee

H478 – Support Students with Disabilities - Creates funding mechanism for specialty day schools for students with I/DD and severe behavioral challenges. Allows for Individualized Education Program (IEP) teams to have specialty schools as an option on the continuum. 

 *Bill did not move in House, but funding is in House budget; hoping to get it in final budget

S171 – Dept of Public Safety Agency Bill – Updates our state’s "Silver Alert" system to make it clear that the statewide alert system includes all law enforcement agencies and individuals of any age that have conditions which would make them more vulnerable to abuse, physical harm, neglect, or exploitation. This clarifies that people with I/DD can be included in “Silver Alerts.”. 

* Passed Senate; in House Rules Committee

H580 - Expand Day/Employment Options/IDD - The Department of Health and Human Services (DHHS) shall study the feasibility of adding coverage of a new Medicaid service, entitled Community Activities and Employment Transitions (CAET), that provides individualized services and supports for individuals age 16 or older with intellectual or developmental disabilities. The purpose of this new service is to expand meaningful day and employment services. DHHS must submit a report to the General Assembly by April 1, 2024. 

*Introduced in early April; revised on June 6; referred to Appropriations Committee

Plain Language:  The legislators are working on bills that affect people with disabilities. Advocates are supporting bills that would create more safety in the community for people and bills that would support students with disabilities in schools. Another bill requires the state to develop some new day services for people with IDD.