A Federal Commission charged with recommending ways to keep the Medicaid system solvent in the face of prospective budget shortfalls has issued its report to Congress. The Commission made a number of recommendations, including expanding the number of Medicare recipients who can be charged co-pays for prescription drugs and restricting the ability of Medicaid beneficiaries to transfer assets to avoid paying for long-term care.

To read more about the Commission’s proposed changes to the Medicaid system:
http://www.medilexicon.com/medicalnews.php?newsid=30129

2. State’s Medicaid Cuts Take Effect Thursday

Missouri joined the growing list of states drastically cutting Medicaid spending recently. The state’s Medicaid system will no longer pay for durable medical equipment, including wheelchairs, feeding tubes and other equipment often needed by people with physical disabilities. The state will make an exception for pregnant women, children and people living in nursing homes.

To read more about the cuts in Missouri’s Medicaid system on the “St. Louis Today” website:
http://www.stltoday.com/stltoday/neighborhoods/stories.nsf/news/story/8FABE3CCE873F7598625706D005FE82E?OpenDocument

The U.S. Court of Appeals for the 7th Circuit has reversed a lower court decision that had granted a judgment without trial on behalf of Sears Roebuck. Now the case will have to go back to the District Court to be heard.

The controversy arose when Sears allegedly discriminated against a saleswoman by refusing her any accommodations despite the fact that she could only walk short distances due to a medical condition. She subsequently had to quit her job.

“In the new 32 page opinion by Chief Judge Joel M. Flaum, again reversing the judgment and sending the case once more back to the District Court, the Seventh Circuit paved the way for the trial of the case before a jury: ‘Our task has not been to determine whether Keane was disabled when she worked at Sears, whether Sears was aware of her disability, whether Sears reasonably accommodated Keane's disability, or which party caused the break-down of the interactive process.’”

To read the full announcement, use the following link:
http://eeoc.gov/press/8-11-05a.html

A Washington, D.C., jury has awarded $3 million to Lisa Bremer who has multiple sclerosis and was not provided reasonable accommodation at her job with the Commerce Department.

Due to her disability, Lisa Bremer is unable to walk and was mostly working from home, traveling to the office twice a week. After a change in job duties, she was informed she would have to come to the office five days a week.

Both Ms. Bremer and her doctor informed the Department of Commerce that she would be unable to do so. She eventually had to retire on federal disability, and filed a suit under the Americans with Disabilities Act claiming that her employer did not make reasonable accommodations for her to telecommute.

“The U.S. government has been pushing to allow federal employees opportunities to telecommute since 2001. Last year, Congress withheld $5 million in spending from agencies that weren't doing enough to promote telecommuting.”

The jury award of $3 million will be reduced to $300,000 due to a cap on compensatory damages under the Rehabilitation Act.

To read the article in its entirety, use this link:
http://www.wpherald.com/storyview.php?StoryID=20050819-101631-2169r

Jo Anne Barnhart, Commissioner of Social Security, today announced that Social Security will publish a proposed regulation to improve the disability determination process. The improvements, which build upon Social Security's
new electronic disability claims process, would shorten decision times and pay benefits to people who are obviously disabled much earlier in the process.

"In developing a new disability determination process, I have been guided by three questions President Bush asked me during a meeting to discuss disability programs," Commissioner Barnhart said. "'Why does it take so long to make a disability decision? Why can't people who are obviously disabled get a decision immediately? and Why would anyone risk going back to work after going through such a long process to receive benefits?' My goal was to address the President's questions and ensure that we make the correct decision as early in the process as possible. The regulation we are proposing would allow us to do that."

The proposed regulation:

• Establishes a quick disability determination process for those who are obviously disabled. Appropriate claims would be identified and referred directly to special units in the State agencies for expedited action. 
• Establishes a Federal Expert Unit comprised of State and Federal experts to provide medical and vocational expertise for adjudicators at each level of the disability determination process.
• Eliminates the reconsideration step of the appeals process and establishes a Federal Reviewing Official level of review. The Reviewing Official would review initial State agency denials if the claimant requested such review. The Reviewing Official would not conduct a hearing but would issue a decision based on a review of the record. 
• Retains the de novo hearing before the Administrative Law Judge (ALJ). The ALJs would be required to explain in their decisions why they agree or disagree with the rationale of the written decision of the Reviewing Officials.
• Closes the record after the ALJ issues a decision. However, new and material evidence would be considered after a decision is issued under certain limited circumstances.
• Establishes a Decision Review Board (DRB) to select and review both favorable and unfavorable ALJ decisions and to handle dismissals. Other review functions currently performed by the Appeals Council would eventually shift to the DRB when the new process is phased in. 
• Strengthens in-line and end-of-line quality review mechanisms at the state agency, Federal Reviewing Official, hearings and DRB levels of the disability determination process. Pre-effectuation review at the initial claims level would continue while quick disability decisions would be subject to expedited pre-effectuation review as well. The current Disability Quality Branch review of State agency claims would be replaced with a new centrally-managed quality assurance system that would perform independent end-of-line reviews of targeted cases, perform a random sample of all cases, and provide for an in-line quality process performed by State agencies. 
• Provides that Social Security plans to implement the new disability determination process on a phased-in basis, allowing the Agency to make adjustments as necessary.

"None of the changes we are proposing would require legislative action," noted Commissioner Barnhart. "Nor would they adversely affect the employment status of current Social Security or state agency employees."

In conjunction with the changes in the disability determination process, Social Security also plans to conduct several demonstration projects aimed at helping people with disabilities return to work. These projects support the President's New Freedom Initiative and provide for work incentives and opportunities earlier in the process. In these demonstrations, the Agency will test providing cash supports, various forms of medical benefits, and employment supports such as transportation assistance. Social Security will look at how making these available will help people with disabilities successfully work.

The proposed regulation provides for a 90 day comment period and is the result of collaborative discussions that have been underway since Commissioner Barnhart first presented her approach for improving the disability determination process at a hearing before the House Ways and Means Subcommittee on Social Security in September 2003.  Commissioner Barnhart personally held meetings with over 60 professional organizations, advocates, Members of Congress and congressional staff, and Social Security and State employee groups.

"I sincerely believe that the new disability determination process is a system that responds to the challenge inherent in the President's questions," Commissioner Barnhart said. "We have looked beyond the status quo to the possibility of what can be. I believe the proposed regulation will help Social Security provide more accurate and timely service for  the American people. And that's what we are all about."