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News from Disability Rights Ohio is the monthly newsletter from the Disability Rights Ohio providing information and updates about case work and activities of Disability Rights Ohio, and other disability-related news.

In this issue:

Disability Rights Ohio committed to helping people with communication disabilities get speech-generating devices

Gov. Kasich signs into law H.B. 27, the Adult Guardianship and Protective Proceedings Jurisdiction Act

New on our website: Frequently Asked Questions about Medicaid

2013 brings some healthcare reforms under the Affordable Care Act (ACA)

Action and results: Case summaries - Disability Rights Ohio fights for housing rights

 

Disability Rights Ohio committed to helping people with communication disabilities get speech-generating devices

Speech-generating devices (SGDs) can be life-changing to individuals with communication disabilities. Thanks to this kind of assistive technology, SGD users can create sentences or select from pre-set messages to talk with others. The device then “speaks” for the person, giving them a voice to communicate their wants, needs, and other thoughts. SGDs range from relatively low-tech devices with a few pre-programmed messages, to high-tech devices that allow users to create their own, novel messages.

Disability Rights Ohio has been involved in making SGDs available to individuals with disabilities for many years, including working on the original rule that set criteria for Medicaid funding of SGDs. Over the past few years, Disability Rights Ohio has assisted dozens of individuals whose requests for prior authorization for SGDs had been denied by Ohio Medicaid or a managed care plan.  In some cases, Disability Rights Ohio worked with the individual’s speech therapist and device vendor to ensure that they were submitting the necessary information.  In cases where the necessary information had been submitted but Medicaid continued to deny the prior authorization request, Disability Rights Ohio has represented individuals in the Medicaid state hearing and administrative appeal process. In many of those cases, the denial has been overturned, and the individual has received the SGD.

Earlier this year, Disability Rights Ohio submitted comments to the Ohio Department of Job and Family Services (ODJFS) during the agency’s process of overhauling the SGD funding rule. Since the rule was revised, Disability Rights Ohio has seen a decrease in the overall number of requests for assistance related to SGD denials, but a significant increase in denials by managed care organizations.  Many of these denials are attempts to restrict individuals to low-tech devices that cannot be used to create novel messages; in most cases, the managed care organization relies on reports by “independent reviewers,” who recommend lower-cost devices or iPads, which are generally not funded by Medicaid as SGDs.

In recent months, Disability Rights Ohio has represented four individuals whose managed care organizations denied prior authorization for SGDs. In each case, the managed care organization’s “independent reviewer” recommended alternative low-tech devices despite substantial information from the individual’s speech therapist that the individual needed a higher-tech device to fully communicate with his or her family and peers. All four appeals were sustained, which means that the hearing officer found that the managed care organization’s denial was not correct.

SGDs are critical pieces of equipment that allow individuals to communicate with their family and friends at home, school, work and in the community, but Medicaid and other insurers try to restrict their availability because of their cost. Disability Rights Ohio is committed to helping individuals with disabilities get the assistive technology they need. If you have been denied coverage for a SGD or other assistive technology, contact Disability Rights Ohio for assistance at 614-466-7264 or 800-282-9181 or (TTY) 614-728-2553 or 800-858-3542.

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Gov. Kasich signs into law H.B. 27, the Adult Guardianship and Protective Proceedings Jurisdiction Act

In January 2011, Representatives Peter Stautberg and Tom Letson introduced H.B. 27, a legislative measure authorizing the state of Ohio to adopt the Adult Guardianship and Protective Proceedings Jurisdiction Act. After numerous stakeholder meetings, policy discussions, amendment drafting sessions, and a final series of committee hearings, the bill passed the Ohio House of Representatives and Senate and was signed into law by Governor Kasich on December 20, 2012. Ohio’s adoption of the bill makes it the 37th state to adopt such a law, aimed at establishing common rules amongst states for addressing jurisdictional, transfer, communication and enforcement issues of adult guardianship matters. This will make it easier for Ohio courts to communicate with courts in states that have also adopted this language about issues of guardianship for adults. 

While Disability Rights Ohio ultimately supported the changes proposed in H.B. 27, the organization did initially voice concerns about potential impact the legislation could have on clients’ due process and civil rights protections under current state guardianship law. Indeed, Disability Rights Ohio participated in the legislative process by reaching out to policy makers and other stakeholders to educate and inform them of our clients’ interests and concerns with the bill. In addition, Disability Rights Ohio staff participated in a series of Interested Party meetings, hosted by the bill’s sponsors to improve the bill and discuss outstanding concerns. The other stakeholders involved in the meetings were representatives from the Ohio State Bar Association, the Ohio Judicial Conference and the Ohio Alzheimer’s Association. As a result of the meetings and policy discussions, an agreement was reached on a few key amendments to H.B. 27 so that it could be moved through the legislative process. Disability Rights Ohio’s efforts focused on including language that would ensure due process protections for wards and other persons subject to guardianship orders or other jurisdictional proceedings. 

H.B. 27 will become effective 90 days after the Governor signed the bill into law.

Additional Disability Rights Ohio resources on adult guardianship matters or alternatives to guardianships can be found in our Guardianship Frequently Asked Questions.

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New on our website: Frequently Asked Questions about Medicaid

Navigating Ohio's Medicaid program can be very complicated and confusing. To help answer some of the most common questions, Disability Rights Ohio has created a Frequently Asked Questions guide about Medicaid

We encourage you to use it as a reference and forward it to people you know who would find it helpful.

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2013 brings some healthcare reforms under the Affordable Care Act (ACA)

In March of 2010, Congress enacted and the President signed into law a legislative measure aimed at reforming the healthcare insurance system, the Affordable Care Act (ACA). The comprehensive reforms are to be implemented over a series of years. Some of the more popular reforms implemented so far have included tax credits for small businesses to provide employer-sponsored healthcare; allowing young adults to maintain coverage on their parents health plan up to age 26; providing additional federal matching funds to states to encourage expanded health coverage through Medicaid; requiring preventative healthcare services be covered by insurance plans at no charge; preventing insurance companies from rescinding coverage and prohibiting insurance companies from denying coverage to children under the age of 19 for a pre-existing condition; regulating proposed premium increases; promoting and supporting community health centers and rural healthcare providers; increasing prescription drug discounts for seniors; and promoting home-and community-based services over institutional care.

Though the most significant policy changes won’t happen until 2014, a few policies will be enacted in 2013. Below is a summary of the major scheduled policy changes.

Improving Preventive Health Coverage To increase the number of consumers obtaining preventive care, the law provides new additional funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost. Effective January 1, 2013.

Expanding Quality and Coordination of Healthcare Services through Bundled Payments The law establishes a national pilot program called “Payment Bundling” to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care. Effective no later than January 1, 2013.

Supporting and Promoting Primary Care Doctors with Enhanced Payments In preparation for the scheduled expansion of the Medicaid program in 2014 and the expected large increase in patients seeking care, the law requires states to enhance Medicaid reimbursements to primary care physicians. The enhanced payments should match the Medicare payment rates for primary care services. The increase is fully funded by the federal government. Effective January 1, 2013.

Medicaid Disproportionate Share Hospital Payments In anticipation of Medicaid expansion and greater coverage for many people who previously would have been without any health insurance, the law reduces states’ Medicaid Disproportionate Share Hospital (DSH) allotments and requires the Secretary to develop a methodology for distributing the DSH reductions. Effective October 1, 2013

Providing Additional Funding for the Children’s Health Insurance Program Under the new law, states will receive two more years of funding to continue coverage for the Children’s Health Insurance Program (CHIP), an expansion of Medicaid to cover children not eligible under a state’s traditional Medicaid program. In Ohio, the CHIP program is not a separate healthcare program but is included and administered as an expansion of the general Medicaid program. Ohio expanded its Medicaid program to cover more children under its Medicaid program in 1998 and then again in 2000. Effective October 1, 2013.

Limits on Flexible Spending Accounts (FSAs) In 2013, the most you can set aside tax-free for medical expenses not covered by insurance will be $2,500, with the limit increasing by the annual inflation rate in subsequent years. Also of note is the elimination of the use of FSAs to pay for over-the-counter drugs, unless you have a doctor’s prescription. The new limits take effect January 1, 2013. For consumers with 2012-2013 healthcare plans that run on a fiscal (rather than calendar) year, the new FSA limits become effective on July 1, 2013.

Increased Threshold for Itemized Deductions on Unreimbursed Medical Expenses The itemized tax deduction for unreimbursed medical expenses will increase this year from 7.5% of adjusted gross income to 10% of adjusted gross income. This particular provision also waives the increase for individuals age 65 and older for tax years 2013 through 2016. Effective January 1, 2013

For more information on the ACA or federal health reform, see the following resources [LINKS]:

The U.S. government's healthcare website, healthcare.gov

Consumer Reports' update on healthcare reform

The Governor's Office on Health Transformation website 

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Action and results: Case summaries

Disability Rights Ohio fights for housing rights

As Ohio’s federally designated protection and advocacy agency for persons with disabilities, Disability Rights Ohio assists clients with a variety of disability-related housing issues.

Architectural barriers, bad policies and discriminatory acts can deprive persons with disabilities of the equal use and enjoyment of their housing – or deprive them of housing altogether. The Fair Housing Act and other federal and state laws require landlords to reasonably accommodate the needs of persons with disabilities upon request, and prohibit housing discrimination based on disability status. 

Among other cases, Disability Rights Ohio has recently helped tenants with disabilities obtain wheelchair-accessible parking spaces, helped a tenant get permission to have a wheelchair ramp installed, and assisted tenants facing disability-related terminations from low-income housing programs. Where possible, solutions that address recurring problems affecting broad groups of individuals are preferred. Two recent instances where Disability Rights Ohio helped improve the quality of life for tenants with disabilities are described in more detail below.

 

Disability Rights Ohio assists individual after rental manager threatens to evict; manager replaced

Our client, a man who has developmental disabilities, lives in federally subsidized housing, in a building owned by a corporation. A county-paid service provider comes to his apartment to give him needed assistance with daily living. She contacted Disability Rights Ohio after the manager for the client’s building sent our client a letter threatening to evict him. The service provider had complained to rental management and governmental authorities about conditions in the apartment building, and had also questioned whether the client’s rental account was correct. The letter from the rental manager threatened to evict our client for purportedly “failing to control his guest” – the person providing him essential services under a contract with the county.

A Disability Rights Ohio attorney immediately contacted the landlord’s corporate office and made it clear this threat letter violated the law. Ohio’s Landlord-Tenant Act prohibits a landlord from retaliating for complaints about conditions. In this case, the eviction threat also amounted to unlawful discrimination against the client based on his disability. The client’s service provider was not a “guest,” but a paid contractor providing assistance to our client on account of his disability. Threatening to evict him over her complaints was inappropriate and intolerable.

The corporation responded promptly, in a constructive way. They immediately replaced the rental manager who sent the eviction threat. A supervisor met with our client and his service provider. They promised to hire a social worker to serve the tenants with disabilities in the building. Our client reports that he is very pleased with this outcome.

 

Disability Rights Ohio sends letter to client's landlord over trash removal discrimination; building policy changed 

Disability Rights Ohio was contacted by a client who is wheelchair-dependent, has limited use of her arms, and lives in a private high-rise apartment building. She told us that a large number of other tenants in the high-rise also have disabilities.  Her landlord had closed the building’s trash chute, which tenants had used for years, and told tenants they had to use an outside dumpster. Just getting to the dumpster meant that tenants either had to go down steps or circle the building and cross a sloped parking lot. Even if our client could get her trash bags to the outside dumpster, she had no way to stand with the trash bag, lift the lid and deposit her trash. The practical effect was that she had to pay someone to remove her trash, which tenants who could use the dumpster did not have to do. 

A Disability Rights Ohio attorney sent a the landlord a request for a reasonable accommodation of the client’s disability, with a strong supporting statement from the client’s doctor. The letter noted that the Fair Housing Act provides that persons with disabilities must be afforded an equal opportunity to use and enjoy a dwelling, and it is illegal to treat persons with disabilities less favorably than others because of their disability, as this landlord was doing. After a follow up letter and discussions with the landlord’s attorney, the landlord agreed to allow this client and some other tenants with disabilities to leave their trash in accessible rooms on the tenants’ own floors, resolving the client’s problem.

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