House Appropriations Committee Issues Report on Departments of Labor, HHS, Education, Related Agencies Appropriations Bill, 2018 (Part 6 of 10)

WASHINGTON, July 27 -- The House Appropriations Committee issued a report (H.Rpt. 115-244) on legislation (H.R. 3358) in explanation of the accompanying bill making appropriations for the Departments of Labor, Health and Human Services (except the Food and Drug Administration, the Agency for Toxic Substances and Disease Registry and the Indian Health Service), Education, Committee for Purchase from People Who Are Blind or Severely Disabled, Corporation for National and Community Service, Corporation for Public Broadcasting, Federal Mediation and Conciliation Service, Federal Mine Safety and Health Review Commission, Institute of Museum and Library Services, Medicaid and CHIP Payment and Access Commission, Medicare Payment Advisory Commission, National Council on Disability, National Labor Relations Board, National Mediation Board, Occupational Safety and Health Review Commission, Railroad Retirement Board, and the Social Security Administration for the fiscal year ending September 30, 2018. The report was advanced by Rep. Tom Cole, R-Okla., on July 24.

Program Operations

The Committee recommends $2,341,274,000 for Program Operations to support activities used to administer the Medicare program, fund beneficiary outreach and education, maintain information technology (IT) infrastructure needed to support various claims processing systems, and continue programmatic improvements.

Adult Immunization Quality Measures.--The Committee is aware that the Centers for Medicare & Medicaid Servies (CMS) is working to close gaps in quality measures to improve care delivery and patient outcomes, including reducing racial and ethnic health disparities. Adult immunization quality measures are one area where more work is needed, as noted in a 2014 National Quality Forum (NQF) report entitled Priority Setting for Healthcare Performance Measurement: Addressing Performance Measure Gaps for Adult Immunization. The Committee recommends CMS work with relevant partners, such as NQF, to address the current gaps in adult immunization quality measures and ensure the quality measures reflect current immunization practice standards as well as the Advisory Committee on Immunization Practice recommendations for adult immunization. The Committee requests a report from CMS no later than 12 months following enactment of this Act on the steps the agency has taken to improve quality measures applicable to adult immunization under Medicare and Medicaid, including an action plan to enable widespread adoption across healthcare settings.

Agents Used for Cosmetic Purposes or Hair Growth.--The Committee recognizes that recently passed legislation eliminated Federal Medicaid matching funds for prescription drugs used for cosmetic purposes or hair growth unless they are determined to be medically necessary. The Committee encourages CMS to include autoimmune conditions that cause hair loss, such as alopecia areata and thyroid disease, within these medically necessary coverage criteria.

Ambulatory Surgical Centers.--CMS is directed to submit a report to the Committees on Appropriations of the House of Representatives and Senate, and the authorizing committees of jurisdiction, on any increased cost to the Medicare program and its beneficiaries due to the migration of procedures from ambulatory surgical centers (ASCs) to higher cost settings. The report will evaluate volume changes over the past ten years to identify procedures that are migrating from ASCs to higher cost settings and make specific recommendations that CMS can implement to reverse this trend.

Chronic Obstructive Pulmonary Disease.--Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death and fourth most costly condition with respect to hospital readmissions. Respiratory therapists are educated and trained in all aspects of pulmonary medicine and play a critical role in the treatment of COPD patients. The Committee encourages CMS to conduct an analysis of the most recent claims data of services provided to Medicare beneficiaries with COPD in the emergency department, inpatient and physician office settings, and long-term care facilities to determine the role of respiratory therapists in improved health outcomes, reduced readmissions, and potential cost savings. The Committee requests an update on this effort in the fiscal year 2019 Congressional Justification.

Colorectal Cancer Screening.--The Committee recognizes the inequity in beneficiary cost sharing for screening colonoscopies. The Committee urges CMS to align its interpretation of the colorectal cancer screening cost-sharing requirements for Medicare beneficiaries with the policy of colorectal cancer cost-sharing requirements for other Federally funded health programs. The Committee encourages CMS to conduct an analysis of recent scientific literature on the efficacy of colorectal cancer screening. The Committee requests an update on this topic in the fiscal year 2019 Congressional Justification.

Critical Access Hospitals.--The Committee continues to note concerns about the proposal to eliminate Critical Access Hospitals (CAH) status from facilities located less than 10 miles from another hospital and reducing the reimbursement rate from 101 to 100 percent. Changes to the reimbursement for CAH can affect their ability to provide proper care to local residents. The Committee supports efforts by CMS to address concerns from CAH.

Diabetic Retinal Exams.--According to the CDC, diabetes- related blindness costs the nation about $500 million annually. The Committee recognizes that as more Medicare beneficiaries are diagnosed with diabetes, diabetic retinopathy remains a concern. Experts recommend that all individuals diagnosed with diabetes should be examined for eye health yet failure to receive annual diabetic retinal exams (DREs) is prevalent due to a variety of reasons. The Committee urges CMS to update its policy to make DREs more accessible to diabetic patients in primary care settings.

Electrodiagnostic (EDX) Patient Care.--The Committee thanks CMS for providing additional guidance on actions taken in response to the recommendations in the 2014 OIG Report: Questionable Billing for Medicare Electrodiagnostic Tests. The Committee notes that utilization of the codes for EDX testing continue to increase and that identified efforts to curb rampant fraud and abuse are exclusively focused on physicians with high utilization rates, and do not capture the full scope of the problem. The Committee remains interested in comprehensive solutions from CMS that advance quality care and cost savings by ensuring patients do not receive inadequate or unnecessary EDX tests.

Evaluation and Management Codes.--Over 90 percent of the care provided by infectious disease (ID) physicians is considered evaluation and management (E&M;). These face-to-face encounters continue to be undervalued by current payment systems that much more generously reward procedures. This has created a significant compensation disparity between ID physicians and specialists who provide more procedure-based care, as well as primary care physicians who provide similar or identical E&M; services but who have received payment increases simply because their specialty enrollment designations as "primary care physicians." The Committee requests CMS, as part of its ongoing effort to improve valuation and payment accuracy, research the necessary documentation that would more precisely describe the cognitive work in the office visits of ID physicians. The Committee requests an update on this topic in the fiscal year 2019 Congressional Justification.

Home Health Care.--The Committee is aware that the current requirement that home health plans be certified solely by a physician has resulted in problems with access to home health care. The Committee acknowledges CMS' efforts to limit the requirements placed on the certifying physician. The Committee requests an update in the fiscal year 2019 Congressional Justification on the face-to-face encounter performed by an allowed non-physician practitioner (working in collaboration with/under the supervision of the certifying physician or the acute/post-acute-care physician).

Hospital Rating System.--The Committee is concerned with the implementation of CMS's Hospital Star Rating System. While the Committee supports the goals of transparency for patients, it is concerned with how CMS measures factors in determining these ratings. The Committee requests CMS provide details on the methodology used to determine the ratings in the fiscal year 2019 budget request. The Committee encourages CMS to solicit feedback from the stakeholder community regarding the methodology and factors used to determine ratings.

Long Term Care Hospitals.--The Committee recognizes the challenges faced by Long Term Care Hospitals (LTCHs). The Committee encourages continued discussion and analysis on payment methodologies that permit flexibility for LTCHs to meet the needs of their patients and community.

Medication Diversion.--The Committee understands the important role of medication-assisted treatment for beneficiaries with opioid use disorder. At the same time, there are reports from several authorities of rising rates of diversion of these Food and Drug Administration-approved medications. The Committee directs CMS to evaluate diversion data from the Drug Enforcement Administration and State sources to determine the scope of this problem and to include in the fiscal year 2019 Congressional Justification options to reduce diversion.

National Health Expenditures.--The Committee requests CMS include information in its fiscal year 2019 Congressional Justification explaining the methodology for including data in the National Health Expenditure (NHE) database. In addition, the Committee requests an analysis of how CMS-published data compares to other comparable information on health expenditures, such as industry surveys.

Out of Network Emergency Care.--The Committee is concerned the Center for Consumer Information and Insurance Oversight (CCIIO) has not provided sufficient clarity on how to determine the "Usual, Customary & Reasonable" (UCR) amount in its final rule for patient protections (80 Fed. Reg. 72191). Therefore, the Committee requests CCIIO publish guidance, which may come in the form of Frequently Asked Questions, clarifying what constitutes the UCR amount using a transparent and fair standard, such as an independent unbiased charge database.

Patient Matching.--The Committee recognizes that a lack of a patient matching system for Medicare beneficiaries results in duplicate procedures and poses a significant patient safety risk. The Committee is aware that a number of patient matching systems are currently being used in the commercial sector, but one has yet to be adopted in Medicare. The Committee requests a report not less than 12 months after the date of enactment of this Act on the impact on care improvement, reduction in costs, estimated saved lives or reduction in errors, and improvements in patient safety if hospitals were required to use a patient matching system as a requirement for participation in the Medicare program.

Readmission Rates.--The Committee continues to support CMS efforts to reduce readmission rates among high-risk seniors living in communities challenged by poverty, poor health literacy, health disparities or non-compliance with treatment regimens. In particular, flexible, community-based multi-payer arrangements have encouraged health and social service providers to combine efforts in tailoring services to these at- risk populations. The Committee continues to encourage CMS to work with community-based organizations to help identify best practices and transition them to Medicare's value-based purchasing initiatives. Recovery Audit Contractors.--The Committee values the role played by Recovery Audit Contractors (RACs) in the identification and prevention of improper Medicare payments. However, some audit processes have resulted in prolonged delays in payment to providers. The Committee encourages efforts by CMS to provide oversight to ensure RACs are operating consistent with CMS issued guidance.

Risk Corridors.--The Committee continues bill language prohibiting use of the Program Management appropriation from being available for risk corridor payments.

Rural Health Clinics.--The Committee encourages CMS to engage States and other stakeholders on outstanding issues of payment recoupment, as it relates to CMS-designated Rural Health Clinics. The Committee also requests an update in the fiscal year 2019 Congressional Justification on the study requested in House Report 114-699 under this heading.

Therapeutic Foster Care Services.--The Committee remains concerned about the lack of a uniform definition within the Medicaid program for therapeutic foster care (TFC) services. A uniform definition would improve the ability for more consistent care and treatment. The Committee requests an update in the fiscal year 2019 Congressional Justification on the study requested in House Report 114-699 under this heading.

Transparency in Hospital Reimbursement.--The Committee requests CMS provide information in the fiscal year 2019 Congressional Justification identifying all pass-through payments reimbursed from the Hospital Insurance Trust Fund. The Committee expects CMS to address pass-through payments for hospital-based nursing programs, as well as the oversight function CMS performs to ensure such programs are fully accredited.

Federal Administration

The Committee recommends $712,533,000 for Federal Administration activities related to the Medicare and Medicaid programs, which is $20,000,000 below the fiscal year 2017 enacted level and $10,000,000 below the fiscal year 2018 budget request. The Federal Administration funding supports CMS staff, along with operating and administrative expenses for planning, developing, managing, and evaluating healthcare financing programs and policies.

Health Insurance Exchange Transparency.--The Committee continues to include bill language requiring CMS to provide cost information for the following categories: Federal Payroll and Other Administrative Costs; Exchange related Information Technology (IT); Non IT Program Costs, including Health Plan Bid Review, Management and Oversight; Payment and Financial Management; Eligibility and Enrollment; Consumer Information and Outreach, including the Call Center, Navigator Grants, and Consumer Education and Outreach; Exchange Quality Review; Small Business Health Options Program and Employer Activities; and Other Marketplace Activities. Cost information should be provided for each fiscal year since the enactment of the Patient Protection and Affordable Care Act (Public Law 111- 148). CMS is also required to include the estimated costs for fiscal year 2019.

HEALTH CARE FRAUD AND ABUSE CONTROL ACCOUNT

The Committee provides $745,000,000 to the Health Care Fraud and Abuse Control Account (HCFAC). This includes a base amount of $311,000,000 and an additional $434,000,000 through a discretionary budget cap adjustment authorized under section 251(b) of the Balanced Budget and Emergency Deficit Control Act of 1985. The HCFAC funds support activities conducted by CMS, the HHS Office of Inspector General, and the Department of Justice. This level is $20,000,000 above the fiscal year 2017 enacted level and $6,000,000 below the fiscal year 2018 budget request.

This funding is in addition to other mandatory funding provided through authorizing legislation. The funding will provide resources to continue efforts for Medicaid program integrity activities, for safeguarding the Medicare prescription drug benefit and the Medicare Advantage program, and for program integrity efforts carried out by the Department of Justice.

The Committee continues to include bill language to ensure the Secretary funds the Senior Medicare Patrol Program administered by the Administration for Community Living from funds provided to this account.

The Committee expects all recipients of funds from the Health Care Fraud and Abuse Control Account, the Centers for Medicare & Medicaid Services, the Department of Health and Human Services Office of Inspector General, and the Department of Justice, to use funds for efforts to address fraud and abuse as described in section 1128C of the Social Security Act.

Administration for Children and Families

PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT PROGRAMS

The Committee recommends $2,995,400,000 for the Child Support Enforcement and Family Support programs, which is $15,231,000 below the fiscal year 2017 enacted level and the same as the fiscal year 2018 budget request. The Committee also recommends $1,400,000,000 in advance funding, as requested, for the first quarter of fiscal year 2019 to ensure timely payments for Child Support Enforcement programs. These programs support State-administered programs of financial assistance and services for low-income families to promote their economic security and self-sufficiency.

LOW INCOME HOME ENERGY ASSISTANCE

The Committee recommends $3,390,304,000 for the Low Income Home Energy Assistance Program, which is the same as the fiscal year 2017 enacted level and $3,390,304,000 above the fiscal year 2018 budget request. Within the amount available for formula grants, the Committee recommends up to $2,988,000 for technical assistance, training, and monitoring of program activities.

REFUGEE AND ENTRANT ASSISTANCE

The Committee recommends $1,022,811,000 for Refugee and Entrant Assistance programs, which is $651,880,000 below the fiscal year 2017 enacted level and $433,944,000 below the fiscal year 2018 budget request.

The Office of Refugee Resettlement (ORR) programs are designed to help refugees, asylees, Cuban and Haitian entrants, and trafficking victims become employed and self-sufficient. These programs also provide for care of unaccompanied immigrant children in Federal custody and victims of torture.

The Committee recognizes the responsibilities of the Federal government for the care of unaccompanied children while in Federal custody. The Committee supports policies that are in the best interest of the child while in the custody of the U.S. Department of Homeland Security and when subsequently transferred to the Department of Health and Human Service's Office of Refugee Resettlement (ORR). The Committee expects ORR to coordinate closely with U.S. Immigration and Customs Enforcement (ICE) on the transfer to ICE of unaccompanied children who turn 18 while in ORR custody.

Within the total, the Committee recommends the following:

Budget Activity.................... FY 2018 Committee

Transitional and Medical Services.................... $320,000,000

Victims of Trafficking............................... 18,755,000

Refugee Support Services............................. 175,321,000

Unaccompanied Children............................... 498,000,000

Victims of Torture................................... 10,735,000

Healthcare Costs Related to Illegal Immigration.--The Committee requests an update to the report submitted to Congress by the Department of Health and Human Services pursuant to this heading as it appeared in the explanatory statement accompanying division H of the Consolidated Appropriations Act, 2016 (P.L. 114-113).

National Human Trafficking Training and Assistance Center.--The Committee directs the Administration for Children and Families to increase funding for the National Human Trafficking Hotline.

PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT BLOCK GRANT

The Committee recommends $2,860,000,000 for the discretionary portion of the Child Care and Development Fund, the Child Care and Development Block Grant, which is $4,000,000 above the fiscal year 2017 enacted level and $99,000,000 above the fiscal year 2018 budget request. The Child Care and Development Block Grant provides funds according to a formula to States, territories, and Tribes to provide financial assistance to help low-income working families and families engaged in training or education activities access child care and to improve the quality of child care for all children.

SOCIAL SERVICES BLOCK GRANT

The Committee recommends $1,700,000,000 for the Social Services Block Grant, which is the same as the fiscal year 2017 enacted level and $1,700,000,000 above the fiscal year 2018 budget request. States receive grants by formula. States have the flexibility to determine what services and activities are supported, provided they are targeted at a broad set of goals, including reducing or eliminating poverty, achieving or maintaining self-sufficiency, and preventing neglect, abuse, or exploitation of children and adults.

CHILDREN AND FAMILIES SERVICES PROGRAMS

The Committee recommends $11,181,500,000 for Children and Families Services programs, which is $112,868,000 below the fiscal year 2017 enacted level and $977,207,000 above the fiscal year 2018 budget request. The Children and Families Services programs fund activities serving children, youth, families, the developmentally disabled, Native Americans, victims of child abuse and neglect and domestic violence, and other vulnerable populations.

The Committee recommends the following amounts:

Budget Activity.................... FY 2018 Committee

Programs for Children, Youth, and Families:

Head Start........................................... $9,275,000,000

Preschool Development Grants......................... 250,000,000

Runaway/Homeless Youth............................... 101,980,000

Abuse of Runaway Youth Prevention.................... 17,141,000

State Child Abuse Prevention......................... 25,310,000

Discretionary Child Abuse Prevention................. 33,000,000

Community-based Child Abuse Prevention............... 39,764,000

Child Welfare Services............................... 268,735,000

Child Welfare Training............................... 17,984,000

Adoption Opportunities............................... 39,100,000

Adoption Incentives.................................. 37,943,000

Social Services/Income Maintenance Research.......... 6,512,000

Native American Programs............................. 52,050,000

Community Services:

Community Services Block Grant................... 600,000,000

Community Economic Development................... 10,000,000

Rural Community Facilities....................... 7,500,000

Domestic Violence Hotline............................ 8,750,000

Family Violence/Battered Women's Shelters............ 151,000,000

Independent Living Training Vouchers................. 43,257,000

Disaster Human Services Case Management.............. 1,864,000

Program Direction.................................... 194,610,000

Head Start

The Committee recommends $9,275,000,000 for the Head Start program, which is $21,905,000 above the fiscal year 2017 enacted level and $106,905,000 above the fiscal year 2018 budget request. Within the total for Head Start, the Committee recommends a cost-of-living adjustment and includes $25,000,000 for the Designation Renewal System. Within the total for Head Start, the Committee recommends $640,000,000 for Early Head Start-Child Care Partnership grants, which is the same as the fiscal year 2017 enacted level and $5,000,000 above the fiscal year 2018 budget request.

The Committee is concerned about closures and consolidations of Head Start centers that have resulted from a number of re-competitions across the country in recent years. The Committee strongly encourages HHS to consider the consequences of Head Start program closures, reductions, and consolidations have on the ability of children and families to access Head Start services, particularly in rural areas. Transportation barriers can lead to increased absenteeism and missed work for families. In the event of a Head Start center closure, reduction, or consolidation, the Committee encourages the Office of Head Start to work with the local grantees to consider the impact on children, and encourage grantees to provide transportation for children who are displaced to a new Head Start center that is more than 15 miles from the center in which they were enrolled during the previous school year.

Preschool Development Grants

The Committee recommends $250,000,000 for Preschool Development Grants, which is the same as the fiscal year 2017 enacted level and $250,000,000 above the fiscal year 2018 budget request. This program provides grants to States to build State and local capacity to provide preschool for 4-year-olds from low-and moderate-income families. Research confirms that high-quality preschool improves school readiness and long-term academic success of children by supporting their academic and social-emotional skills. Support for this grant is an important step to building a globally competitive 21st century workforce.

Child Abuse Discretionary Activities

Infant-Toddler Court Teams.--The Committee continues funding to for a National resource center to preserve, disseminate, and amplify the work of the Quality Improvement Center (QIC) for Research-based Infant-Toddler Court Teams by providing training and technical assistance in support of such court teams' efforts across the country. This funding should help to build upon and continue the work of sites established through the QIC initiative, which have brought together the court system, child welfare agencies, health professionals, and community leaders to improve current practices in the child welfare system and make better-informed decisions on behalf of the child.

Native American Programs

The Committee recommends $52,050,000 for Native American Programs, which is the same as the fiscal year 2017 enacted level and $2,145,000 above the fiscal year 2018 budget request.

Within the total, the Committee recommendation includes $12,000,000 for Native American language preservation activities, including the requested $3,000,000 for Generation Indigenous, which focuses on improving Native American language instruction across the educational continuum. The Committee provides not less than $4,000,000 for language immersion programs as authorized by section 803C(b)(7)(A)-(C) of the Native American Programs Act, as amended by the Esther Martinez Native American Language Preservation Act of2006. The Committee strongly encourages the Administration for Children and Families (ACF) to give priority to grantees with rigorous immersion programs.

Community Services Programs

Community Services Block Grant.--The Committee recommends $600,000,000 for the Community Services Block Grant, which is $115,000,000 below the fiscal year 2017 enacted level and $600,000,000 more than the fiscal year 2018 budget request.

Community Economic Development.--The Committee provides $10,000,000 for Community Economic Development grants, which is $9,883,000 below the fiscal year 2017 enacted level and $10,000,000 above the fiscal year 2018 budget request. Community Economic Development is a Federal grant program funding Community Development Corporations that address the economic needs of individuals and families with low income through the creation of sustainable business development and employment opportunities. CED awards funds to private, non- profit organizations that are community development corporations, including faith-based organizations, and Tribal and Alaskan Native organizations. The Committee directs the Administration for Children and Families to issue a funding opportunity announcement prioritizing applications from rural areas with high rates of poverty, unemployment, and substance abuse.

Rural Community Facilities.--The Committee recommends $7,500,000 for the Rural Community Facilities program, which is the same as the fiscal year 2017 enacted level, and $7,500,000 more than the fiscal year 2017 budget request. Grantees work with small communities on drinking water and wastewater issues.

Family Violence Prevention and Battered Women's Shelters

The Committee recommends $151,000,000 for the Family Violence Prevention and Battered Women's Shelters programs, which is the same as the fiscal year 2017 enacted level and the fiscal year 2018 budget request. The Family Violence Prevention and Services Act programs provide funding to support the prevention of incidents of family violence, domestic violence, and dating violence, and provide the immediate shelter and supportive services for adult and youth victims (and their dependents).

PROMOTING SAFE AND STABLE FAMILIES

The Committee recommends $325,000,000 in mandatory funds for the Promoting Safe and Stable Families program, which is the same as the fiscal year 2017 enacted level and $20,000,000 below the fiscal year 2018 budget request. The Committee also recommends $59,765,000 in discretionary funds for this program, which is the same as the fiscal year 2017 enacted level and the fiscal year 2018 budget request. This program enables each State to operate a coordinated program of family preservation services, community-based family support services, time-limited reunification services, and adoption promotion and support services. States receive funds based on their share of children in all States receiving food stamp benefits.

PAYMENTS FOR FOSTER CARE AND PERMANENCY

The Committee recommends $6,225,000,000 for payments to States for foster care and adoption assistance, which is $461,000,000 more than the fiscal year 2017 enacted level and the same as the fiscal year 2018 budget request. The Committee also recommends an advance appropriation of $2,700,000,000 for the first quarter of fiscal year 2018 to ensure timely completion of first quarter grant awards.

Within the total, the Committee recommends $5,537,000,000 for the Foster Care program, which is $545,000,000 above the fiscal year 2017 enacted level and the same as the fiscal year 2018 budget request. This program provides funds to States for foster care maintenance payments for children living in foster care. These funds also reimburse States for administrative costs to manage the program and training for staff and parents.

Within the total, the Committee recommends $2,867,000,000 for Adoption Assistance, which is $87,000,000 more than the fiscal year 2017 enacted level and the same as the fiscal year 2018 budget request. This program provides funds to States to subsidize families who adopt children with special needs, such as older children, a member of a minority or sibling group, or children with physical, mental, and emotional disabilities. In addition, the program provides training for adoptive parents and State administrative staff. This annually appropriated entitlement provides alternatives to long, inappropriate stays in foster care by developing permanent placements with families.

Within the total, the Committee recommends $181,000,000 for the Kinship Guardianship Assistance program, which is $29,000,000 more than the fiscal year 2017 enacted level and the same as the fiscal year 2018 budget request. This program provides subsidies to a relative taking legal guardianship of a child for whom being returned home or adoption are not appropriate permanency options.

Finally, within the total, the Committee recommends $140,000,000 for the Independent Living program, which is the same as the fiscal year 2017 enacted level and the fiscal year 2018 budget request. This program assists foster children age 16 or older make successful transitions to independence. Funds support a variety of services, including educational assistance, career exploration, vocational training, job placement, life skills training, home management, health services, substance abuse prevention, preventive health activities, and room and board. Each State receives funds based on the number of children on whose behalf the State receives Federal Foster Care Payments.

Administration for Community Living

AGING AND DISABILITY SERVICES PROGRAMS

The Committee recommends a total program level of $2,237,224,000 for the Administration for Community Living (ACL), which is $243,409,000 above the fiscal year 2017 enacted program level and $385,774,000 above the fiscal year 2018 budget request. The Committee recommends funding for the Senior Medicare Patrol Program, and provides this funding under the Health Care Fraud and Control Abuse Account.

Home and Community-Based Supportive Services

The Committee recommends $350,224,000 for Home and Community-Based Supportive Services, which is the same as the fiscal year 2017 enacted level and $3,161,000 above the fiscal year 2018 budget request. This program provides formula grants to States and territories to fund a wide range of social services that enable seniors to remain independent in their homes for as long as possible.

Preventive Health Services

The Committee recommends $19,848,000 for Preventive Health Services, which is the same as the fiscal year 2017 enacted level and $38,000 above the fiscal year 2018 budget request. This program funds activities that help seniors remain healthy and avoid chronic diseases.

Protection of Vulnerable Older Americans

The Committee recommends $20,658,000 for activities to protect vulnerable older Americans, which is the same as the fiscal year 2017 enacted level and $39,000 above the fiscal year 2018 budget request. These programs provide grants to States for protection of vulnerable older Americans through the Long-Term Care Ombudsman and Prevention of Elder Abuse and Neglect programs.

Family Caregiver Support Services

The Committee recommends $150,586,000 for the National Caregiver Support program, which is the same as the fiscal year 2017 enacted level and $286,000 above the fiscal year 2018 budget request. This program supports a multifaceted support system in each State for family caregivers.

Native American Caregiver Support Services

The Committee recommends $7,556,000 for the Native American Caregiver Support program, which is the same as the fiscal year 2017 enacted level and $39,000 above the fiscal year 2018 budget request. This program provides grants to tribes for the support of American Indian, Alaskan Native, and Native Hawaiian families caring for older relatives with chronic illness or disabilities.

Congregate and Home-Delivered Nutrition Services

The Committee recommends a total of $837,753,000 for senior nutrition. The Committee recommends $450,342,000 for Congregate Nutrition Services, which is the same as the fiscal year 2017 enacted level and $2,852,000 above the fiscal year 2018 budget request. The Committee recommends $227,342,000 for Home- Delivered Meal Services, which is the same as the fiscal year 2017 enacted level and $1,430,000 above the fiscal year 2018 budget request. The Committee recommends $160,069,000 for the Nutrition Services Incentives program, which is the same as the fiscal year 2017 enacted level and $304,000 above the fiscal year 2018 budget request. These programs help older Americans remain healthy and independent in their communities by providing meals and related services in a variety of settings (including congregate facilities such as senior centers) and via home-delivery to older adults who are homebound due to illness, disability, or geographic isolation.

Native American Nutrition and Supportive Services

The Committee recommends $31,208,000 for Native American Nutrition and Supportive Services, which is the same as the fiscal year 2017 enacted level and $109,000 above the fiscal year 2018 budget request. This program provides grants to Tribes to promote the delivery of nutrition and home and community-based supportive services to Native American, Alaskan Native, and Native Hawaiian elders.

Aging Network Support Activities

The Committee recommends $9,961,000 for the Aging Network Support Activities, which is the same as the fiscal year 2017 enacted level and $19,000 above the fiscal year 2018 budget request. This program supports activities that expand public understanding of aging and the aging process.

Holocaust Survivor's Assistance.--Within funding for the Aging Network Support Activities, the Committee provides not less than $3,000,000 for Holocaust Survivor's Assistance. This program provides supportive services for aging Holocaust survivors living in the United States.

Alzheimer's Disease Services

The Committee recommends $19,500,000 for the Alzheimer's Disease Services programs, which is the same as the 2016 enacted program level and $10,000 above the fiscal year 2018 budget request. These programs provide competitive matching grants to a limited number of States to encourage program innovation and coordination of public and private services for people with Alzheimer's disease and their families.

The Committee accepts the Administration's proposal to consolidate funding for Alzheimer's disease programs into one more flexible program authorized under Title IV of the Older Americans Act.

Lifespan Respite Care

The Committee recommends $3,360,000 for Lifespan Respite Care, which is the same as the fiscal year 2017 enacted level and $6,000 above the fiscal year 2018 budget request. The program focuses on easing the burdens of caregiving by providing grants to eligible State organizations to improve the quality of, and access to, respite care for family caregivers.

Elder Falls

The Committee recommends $5,000,000 for the Elder Falls program, which is the same as the fiscal year 2017 enacted level and the fiscal year 2018 budget request. Fall prevention grants support the promotion and dissemination of prevention tools delivered in community settings.

Chronic Disease Self-Management Program

The Committee recommends $5,000,000 for Chronic Disease Self-Management program, which is $3,000 below the fiscal year 2017 enacted level and the same as the fiscal year 2018 budget request. This program supports grants to States for low-cost, evidence-based prevention models that use state-of-the-art techniques to help those with chronic conditions address issues related to the management of their disease.

Elder Rights Support Activities

The Committee recommends $11,874,000 for Elder Rights Support Activities, which is $2,000,000 below the fiscal year 2017 enacted level and $23,000 above the fiscal year 2018 budget request. This program supports efforts that provide information, training, and technical assistance to legal and aging services organizations towards the end of preventing and detecting elder abuse and neglect.

Aging and Disability Resource Centers

The Committee recommends $6,119,000 for Aging and Disability Resource Centers, which is the same as the fiscal year 2017 enacted level and $12,000 above the fiscal year 2018 budget request. These centers provide information, counseling and access for individuals to learn about the services and support options available to seniors and the disabled so they may retain their independence.

Senior Community Service Employment Program

The Committee transfers the Senior Community Service Employment Program (SCSEP) from the Department of Labor to the Administration for Community Living. The Committee recommends $300,000,000 for the administrative and operational costs of SCSEP, which is $100,000,000 below the fiscal year 2017 enacted level and $300,000,000 above the fiscal year 2018 budget request. This program supports low-income seniors in community service positions.

State Health Insurance Program

Due to funding constraints, the Committee recommends no funding for the State Health Insurance program, which is $47,115,000 below the fiscal year 2017 enacted level and the same as the fiscal year 2018 budget request. Other Federal programs provide similar services.

Paralysis Resource Center

The Committee recommends $6,700,000 for the Paralysis Resource Center, which is the same as the fiscal year 2017 enacted level and $6,700,000 above the fiscal year 2018 budget request. The Paralysis Resource Center offers activities and services aimed at increasing independent living for people with paralysis and related mobility impairments, and supporting integration into the physical and cultural communities in which they live.

Limb Loss Resource Center

The Committee recommends $2,500,000 for the Limb Loss Resource Center, which is the same as the fiscal year 2017 enacted level and $2,500,000 above the fiscal year 2018 budget request. The Limb Loss Resource Center supports a variety of programs and services for those living with limb loss, including a national peer support program, educational events, training for consumers and healthcare professionals, and information and referral services.

Traumatic Brain Injury

The Committee recommends $9,321,000 for the Traumatic Brain Injury program, which is the same as the fiscal year 2017 enacted level and $6,159,000 above the fiscal year 2017 budget request. The program provides grants to States for the development of a comprehensive, coordinated family and person- centered service system at the state and community level for individuals who sustain a traumatic brain injury.

Developmental Disabilities State Councils

The Committee recommends $73,000,000 for State Councils on Developmental Disabilities, which is the same as the fiscal year 2017 enacted level and $73,000,000 above the fiscal year 2018 budget request. The State Councils work to develop, improve and expand the system of services and supports for people with developmental disabilities.

Partnerships for Innovation, Inclusion, and Independence

The Committee does not consolidate the State Councils on Developmental Disabilities, State Independent Living Councils, and State Advisory Boards on Traumatic Brain Injury. The Committee recognizes the unique role played by each program and believes consolidation into one program will not serve the needs of people living with a disability.

Developmental Disabilities Protection and Advocacy

The Committee recommends $38,734,000 for Developmental Disabilities Protection and Advocacy, which is the same as the 2017 enacted level and $74,000 above the fiscal year 2018 budget request. This formula grant program provides funding to States to establish and maintain protection and advocacy systems to protect the legal rights of persons with developmental disabilities.

The Committee recognizes that the Americans with Disabilities Act (ADA) encourages states to administer services for people with intellectual/developmental disabilities (I/DD) "in the most integrated setting appropriate to the needs of qualified individuals with disabilities." As a result of enactment of the ADA and the Supreme Court decision in Olmstead v. L.C. (1999), there has been a National trend towards deinstitutionalization, whereby individuals have been encouraged to move out of State-run and other Federally-funded, certified facilities and into residential settings in their respective communities. However, the Committee is aware that many family members and legal guardians of individuals residing in these facilities have been pressured to move their loved ones into the community against their wishes. The Committee is concerned about the adequacy of community-based housing and the lack of specialized care and support services available in them, the pace of transfer, higher rates of abuse and mortality in community settings, and the adequacy of opportunities for residents to express views and preferences throughout the process.

The Committee fully supports the ADA's goal of enabling people with I/DD to receive services "in the most integrated setting appropriate to the[ir] needs." However, the Committee also notes that Olmstead held that the ADA does not condone or require removing individuals from institutional settings when they are unable to handle or benefit from a community-based setting and that the ADA does not require the imposition of community-based treatment on patients who do not desire it. Congress endorsed the same principle in the Developmental Disabilities (DD) Act of 2000. The Committee strongly urges the DD Act programs (state developmental disabilities councils, protection and advocacy systems and university centers for excellence in developmental disabilities) to continually consult with parents and guardians of those individuals within these facilities. The Committee urges the Administration on Community Living to monitor this matter and to include an update on the efforts to ensure compliance with bill language requiring notification in the fiscal year 2019 Congressional Justification.

The Committee strongly urges the Department to ensure that DD Act programs properly account for the needs and desires of patients, their families, and caregivers, and the importance of affording patients the proper setting for their care, into their enforcement of the ADA.

Voting Access for Individuals with Disabilities

The Committee recommends $4,963,000 for Voting Access for Individuals with Disabilities program, which is the same as the fiscal year 2017 enacted level and $9,000 above the fiscal year 2018 budget request.

The Voting Access for Individuals with Disabilities program authorized by the Help America Vote Act provides formula grants to ensure full participation in the electoral process for individuals with disabilities, including registering to vote, casting a vote, and accessing polling places.

Developmental Disabilities Projects of National Significance

The Committee recommends $7,600,000 for Developmental Disabilities Projects of National Significance, which is $2,400,000 below the fiscal year 2017 enacted level and the same as the fiscal year 2018 budget request. This program funds grants and contracts that develop new technologies and demonstrate innovative methods to support the independence, productivity, and integration of the disabled into the community.

University Centers for Excellence in Developmental Disabilities

The Committee recommends $38,619,000 for University Centers for Excellence in Developmental Disabilities, which is the same as the fiscal year 2017 enacted level and $73,000 above the fiscal year 2018 budget request.

Independent Living

The Committee recommends $101,183,000 for the Independent Living program, of which $22,878,000 is for the Independent Living State Grants program and $78,305,000 is for the Centers for Independent Living program. This funding level is the same as the fiscal year 2017 enacted level and $23,027,000 above the fiscal year 2018 budget request. Independent Living programs maximize the leadership, empowerment, independence and productivity of individuals with disabilities.

National Institute on Disability, Independent Living, and Rehabilitation Research

The Committee recommends $103,970,000 for the National Institute on Disability, Independent Living, and Rehabilitation Research, which is the same as the fiscal year 2017 enacted level and $8,843,000 above the fiscal year 2018 budget request. The National Institute on Disability, Independent Living, and Rehabilitation Research serves to generate knowledge and promote its effective use to enhance the abilities of people with disabilities to perform activities of their choice in the community and to expand society's capacity to provide full opportunities for its citizens with disabilities.

Assistive Technology

The Committee recommends $34,000,000 for Assistive Technology, which is the same as the fiscal year 2017 enacted level and $2,061,000 above the fiscal year 2018 budget request. Of this amount, the Committee provides $2,000,000 for competitive grants to support existing and new alternative financing programs that provide for the purchase of assistive technology (AT) devices. The Committee intends for this funding to support the expansion of existing programs and the creation of new programs that allow greater access to affordable financing to help people with disabilities purchase the specialized technologies required to live independently, to succeed at school and work and to live active and productive lives. Programs that have previously received funding are eligible to compete but must report on how the prior funding has been used, including the number of loans extended and individuals served, funding leveraged, and asset development programs created. The Committee intends for applicants to incorporate credit-building activities into their programs, including financial education and information about other possible funding sources. Successful applicants must emphasize consumer choice and control and build programs that will provide financing for the full array of AT devices and services and ensure that all people, regardless of type of disability or health condition, age, level of income, and residence have access to the program. Assistive Technology programs maximize the ability of individuals with disabilities of all ages and their family members, guardians, advocates, and authorized representatives to obtain AT devices and AT services.

Program Administration

The Committee recommends $37,987,000 for Program Administration, which is $2,076,000 below the fiscal year 2017 enacted level and the same as the fiscal year 2018 budget request. This funding supports Federal administrative costs associated with administering ACL programs.

Continues with Part 7 of 10

Myron Struck, editor, Targeted News Service, Springfield, Va., 703/304-1897; [email protected]; http://www.targetednews.com