In this policy round up:
- Input Needed
- DOJ proposed rule on accessible medical diagnostic equipment under Title II of the ADA (Comments due 2/12)
- HUD proposes “30-Day Notice” rule for nonpayment of rent (Comments due 1/30)
- CMS issues proposed rule that would establish appeal rules for hospital observation status (Comments due 2/26)
- OMB accessibility guidance for government technology
- Report on waiting lists for Medicaid HCBS services
- New CMS health equity briefs on Medicaid and CHIP
- New paper on Social Security’s Retirement Earnings Test and shifting retirement paths
- HHS and Ed update resource on inclusion in early childhood programs
- EEOC publishes article on workplace accessibility
Input Needed by 2/12: DOJ proposed rule on accessible medical diagnostic equipment under Title II of the ADA
The Department of Justice is seeking comments on a proposed rule that seeks to improve access to medical diagnostic equipment (MDE) for people with disabilities. Examples of MDE include examination tables, dental chairs, and mammography and x-ray equipment. The Notice of Proposed Rulemaking clarifies how public entities such as hospitals and health care clinics operated by state or local governments can meet their obligations under the Title II of the Americans with Disabilities Act (ADA).
The proposed technical standards for MDE are based on standards developed by the Access Board and used in HHS’ recent proposed rule implementing Section 504 of the Rehabilitation Act. The HHS Sec. 504 proposed rule applies to entities that receive federal funding or assistance while the DOJ Title II proposed rule applies to public entities (i.e., state and local governments).
You can submit comment online, by mail, or in person by February 12, 2024.
For more on this proposed rule, see DOJ’s fact sheet and press release. Visit ACL’s Disability Rules page to learn about and track the many upcoming, proposed, and final rules from across the federal government that seek to protect the rights of people with disabilities.
Input Needed by 1/30: HUD proposes “30-Day Notice” rule for nonpayment of rent
The Department of Housing and Urban Development (HUD) is seeking comments on a proposed rule that would require tenants of certain HUD-funded housing to receive 30-day advance notice before an eviction due to nonpayment of rent is filed in court. The proposed rule would apply to public housing agencies with tenants in public housing and owners of properties participating in HUD Multifamily project-based rental assistance programs.
It would also require the 30-day notice to include instructions on how tenants can correct lease violations for nonpayment of rent as well as information on how to recertify their income and request a minimum rent hardship exemption, if applicable, to avoid eviction.
Under the proposed rule, notice must be provided in formats that are accessible to people with disabilities and provide meaningful access for people with limited English proficiency.
Comments can be submitted online or by mail until January 30.
Input Needed by 2/26: CMS issues proposed rule that would establish appeal rules for hospital observation status
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule to establish appeals processes for certain Medicare beneficiaries who are initially admitted as hospital inpatients under Medicare Part A but are later reclassified as outpatients receiving observation services under Medicare Part B during their hospital stay.
Medicare Part B, which covers outpatient hospital care, has different cost-sharing rules than Medicare Part A for inpatient hospital care. Beneficiaries whose hospitalization is covered under Part B may have to pay greater cost-sharing amounts. Additionally, a person’s classification can affect coverage eligibility for care in a skilled nursing facility or rehabilitation hospital if needed after hospitalization. To receive the post-hospital skilled care, a beneficiary must have stayed at the hospital as an inpatient for three or more consecutive days.
In most cases, beneficiaries who are found ineligible for post-hospital care because they were in outpatient status and didn’t meet the three-day requirement must either pay out-of-pocket for the skilled care or forego the necessary care. In some cases, a beneficiary may receive skilled services under the Medicare home health benefit, however, Medicare does not provide the same level of care in the home as in an institutional setting. This could impact a beneficiary’s ability to recover.
The proposed rule would establish an expedited appeals process, a standard appeals process, and a retrospective appeals process to appeal a hospital’s decision reclassifying their status from inpatient to outpatient receiving observation services.
- The expedited appeals process is for eligible beneficiaries while they are still in the hospital.
- The standard appeals process is for eligible beneficiaries who do not file an expedited appeal while in the hospital.
- The retrospective appeals process would apply to beneficiaries hospitalized between January 1, 2009 and the implementation of the appeals processes discussed above.
The proposed rule is in response to litigation and serves to implement the terms of a settlement in a federal court case.
Comments can be submitted online or by mail until February 26.
For more on the proposed rule see this fact sheet.
OMB accessibility guidance for government technology
OMB recently released guidance to help federal agencies advance digital accessibility. The guidance requires agencies to establish an agency-wide Section 508 program with appropriate resources (including staff, technology, and tools) and appoint a Section 508 program manager.
Section 508 of the Rehabilitation Act is the federal law that requires government agencies to provide people with disabilities with equal access to electronic information and data.
The guidance:
- requires each agency to maintain a plain language digital accessibility statement on its website.
- requires agencies to comply with accessibility standards when designing or developing information and communication technology (ICT), unless an exception applies.
- encourages agencies to establish agency-wide policies and procedures to manage the accessibility of ICT
- provides recommendations for acquiring accessible ICT.
- provides recommendations to help agencies create and publish online and electronic content that is inclusive and accessible for users.
- provides strategies for agencies to manage and maintain digital accessibility.
Report on Waiting Lists for Medicaid HCBS Services
KFF has published a new report, A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2023. The report provides insight into one important measure of unmet need for home and community-based services (HCBS) across states.
A few highlights from the report include:
- The number of states with waiting lists hasn’t changed significantly over time. Currently, 38 states have them.
- As of 2023, there are over 692,000 people on waiting or interest lists for HCBS services.
- Most people on waiting or interest lists for HCBS live in states that do not screen for eligibility before adding people to lists.
- Most people on waiting or interest lists are eligible for other HCBS services, but those services may not fully meet their needs.
New CMS health equity briefs on Medicaid and CHIP
CMS released a set of health equity data briefs on Medicaid and the Children’s Health Insurance Program (CHIP). The briefs cover Mental Health/Substance Use Disorder Services, the Section 1915(c) Waiver Program, and Well-Child Visits.
Highlights from the new data briefs include:
- Nearly all states operate a 1915(c) waiver program that provides access to critical long-term services in home or community-based care settings. Compared to Medicaid beneficiaries not in a waiver program, the population participating in these waiver programs tend to be older adults (ages 65+) and non-Hispanic White.
- 93% of children under the age of one received a well-child visit paid for by Medicaid or CHIP in 2020.
- Nearly a quarter of enrollees between the ages of 21 to 64 received a behavioral health service paid for by Medicaid or CHIP in 2020.
- Asian/Pacific Islander (API) and Hispanic enrollees receive behavioral health services at lower rates than other racial and ethnic groups. API enrollees receive services at nearly one third the rate of other racial and ethnic groups.
- Over 40% of enrollees who were eligible for Medicaid based on disability received services for a behavioral health condition—nearly double the rate for other adult eligibility categories.
CMS has previously released health equity data briefs that we discussed here.
New paper on Social Security’s Retirement Earnings Test and shifting retirement paths
The Social Security Advisory Board released a paper examining different retirement paths in the context of Social Security’s retirement earnings test (RET). The RET temporarily withholds or reduces Security retirement benefits of people who are below full retirement age and whose earned income is above a certain threshold.
Most people don’t fully understand how RET works. It is important for older workers and their families to understand RET as they make decisions about work and retirement, particularly as more people are choose non-traditional retirement paths, such as partially retiring or returning to work after retirement.
While the Social Security Administration has a webpage, brochure, and online RET calculator, the paper recommends SSA improve those resources by:
- using plain language,
- ensuring information is consistent and accurate across resources,
- making tools such as the RET calculator easier to find and use, and
- considering reminding workers how the RET operates at various points during their careers.
HHS and Ed update resource on inclusion in early childhood programs
The Departments of Health and Human Services and Education recently released an updated joint policy statement on supporting the inclusion of children with disabilities in early childhood programs.
The policy statement reiterates expectations for inclusive early childhood settings and updates recommendations for state and local agencies that implement Individuals with Disabilities Education Act, Head Start, child care, home visit, preschool, and public school programs to increase inclusive early learning opportunities for all children. It also includes evidence-based models and examples of inclusion, as well as resources to support high-quality individualized programming and inclusion of children with disabilities in early childhood programs.
EEOC publishes article on workplace accessibility
The EEOC released an article that provides an overview of the laws that federal agencies must comply with to provide people with disabilities access to accommodations to ensure they are able to participate fully in the workplace
The article focuses on accommodations that improve access to job facilities, physical spaces, and information technology. These include accommodations like automated doors, handrails and stair treads, accessible parking spaces, and adaptive computer hardware and software, providing ASL interpreters, and providing written materials in large print or Braille
It also provides information about where agencies can find additional resources to help them comply with anti-discrimination and accessibility laws, including resources from the Access Board, DOJ, ODEP, and more.