My Medicaid Matters

My Medicaid Matters –

On Wednesday, September 21, 2011 at noon on the Capital Hill

In Washington, D.C. there will be a national “My Medicaid Matters” rally.

This is a very critical time for all disabled and elderly people who need and depend on Medicaid to survive. As you know, Congress has established a “super Committee” to decide about the deficit and need to control federal spending. So far, the public conversation has almost solely focused on the deficient reduction and controlling the cost of Medicaid

On Tuesday, August 30, 2011, a number of Governors issued a statement directed to the Congressional “super Committee,” telling this Committee to loosen Medicaid restrictions on how states spend the federal money on health care for persons on SSI, other low-income persons, disabled and elderly Americans. The Governors want to receive a lump sum payment from the federal government and then want to be free to design their own state-by-state Medicaid program.

If you thought the past Medicaid struggles -- over waiver “caps,” limitation of hours for Personal Assistance Service, institutional bias, hospital stays, covered services – were tough, just wait until there are no federal minimums! That’s right, no federal minimums that could even enforced in federal courts.

If you thought in the past Medicaid providers of nursing homes, ICF-MRs, Assisted Living had lot’s of power as political players because they contributed to your Governor’s and other elected officials Political Action Committees, just wait and you’ll really see institutional power and biases! These providers are in business for a profit and people with disabilities and the elderly are their cash-cows.

If you thought families with and parents of disabled in the past had to struggle to receive Medicaid services to obtain minimally needed services, just wait. Welcome back the 1950s! Most folks do not remember how bad it was.

If you thought your state Medicaid folks in the past did not respect or implement the Olmstead decision that found unnecessary institutionalization as discrimination under the ADA, just wait and you’ll be kissing goodbye your ADA rights.

The Governors plan to come to Washington in October to push for their Medicaid. They do not care Medicaid provides vital home and community-based services that allow seniors and younger people with disabilities to live independently in the community. They care only about money.

In the general public, few people understand what Medicaid is or the impact that Medicaid’s federal funding has on the lives of people with disabilities, seniors, their families and those people who work to support them.

Disability, aging and civil rights organizations have banded together to organize a national rally on Capitol Hill to show Congress that My Medicaid Matters!

September 21st and will kick off organizing efforts in all 50 states to show that My Medicaid Matters!

Rally National Sponsors include:

o ADAPT

o AFSME

o American Association of People with Disabilities

o American Network of Community Options and Resources

o The Association of Programs for Rural Independent Living

o The Autistic Self Advocacy Network

o The Caring Across Generation Campaign

o The Center for Self-Determination

o Coalition for Community Integration

o The Disability Rights Education and Defense Fund

o Easter Seals

o Hand in Hand: The Domestic Employers Association

o Jews for Racial and Economic Justice

o The Leadership Conference on Civil and Human Rights

o National Council on Independent Living

o National Disability Rights Network

o National Hispanic Council on Aging

o Not Dead Yet

o Self Advocates Becoming Empowered

o Service Employees International Union

o Services and Advocacy for GLBT Elders (SAGE)

o United Cerebral Palsy

o United Spinal Association

How You Can Help

Join us! Rally organizers are looking for members of Congress who are willing to talk about the importance of Medicaid to low and middle income Americans, older Americans and Americans with disabilities.

Help us show that My Medicaid Matters!

Additional Information

For more information, and the most updated list of sponsoring organizations, go to: http://ly.adapt.org/rally

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com

with a searchable Archive at this site divided into different subjects.

As of August, 2010, Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/

To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100.

Have 1,000 People Transitioned Out of Institutions With Mainstream Category 2 Vouchers?

Have 1,000 People Transitioned Out of Institutions With Mainstream Category 2 Vouchers? Information Bulletin #335 (7/2011).

It’s been about seven months since HUD awarded its Mainstream Category 2 Vouchers. These were the special vouchers that were intended to be used solely for people with disabilities to transition from institutions to the community. Housing Authorities and other public entities had to apply for these vouchers, and HUD awarded them on a competitive basis.

We know there were a lot of advocates for individuals with disabilities who were very disappointed that their Housing Authorities had not been awarded these vouchers. This was particularly so, after advocates had worked with and encouraged their Housing Authorities to apply.

Okay folks - now is the time to check out if the “winning” Housing Authorities have actually used these Category 2 Vouchers as they were intended - to help people to leave institutions.

Has your State Medicaid agency been actively involved? Has it helped identify people who want to transition out? How has the Housing Authority identified the person who was institutionalized?

Has there been any press regarding the successful transitions? If we want additional vouchers to be similarly targeted in the future, let’s make sure at the least that the 1,000 Category 2 vouchers have worked properly.

If you reside in one of the following 28 locales, please contact the recipient. If you find out, let us know.

Below find, by State, the 28 recipients and the number of Category 2 Vouchers awarded to each winner.

ARIZONA - Pima County c/o City of Tucson	25
CALIFORNIA - Housing Authority of the County of Alameda	10
CALIFORNIA - Housing Authority of the County of Santa Barbara	25
CALIFORNIA -Housing Authority of the County of Santa Clara	10
CALIFORNIA - Orange County Housing Authority	50
CALIFORNIA- Pasadena Community Development Commission	40
FLORIDA - Collier County Housing Authority	25
GEORGIA - Housing Authority of the City of Decatur, Georgia	35
ILLINOIS - Housing Authority of the Village of Oak Park	15
ILLINOIS - Springfield Housing Authority	10
MASSACHUSETTS - Lynn Housing Authority & Neighborhood Development	35
MARYLAND - Baltimore County Department of Social Services Housing Office	50
MARYLAND - Housing Authority of Baltimore City	40
MARYLAND - Howard County Housing Commission	10
MARYLAND - Maryland Department of Housing and Community Development	12
MICHIGAN - Traverse City Housing Commission	10
NORTH CAROLINA - Housing Authority of the City of Wilmington, N. C.	5
NEW JERSY - New Jersey Department of Community Affairs	100
NEW YORK - Belmont Shelter Corp. as agent for Erie County PHA Consortium	20
OHIO - Cincinnati Metropolitan Housing Authority	100
OHIO - Lucas Metropolitan Housing Authority	60
PENNSYLVANIA - Housing Authority of the County of Dauphin	10
TEXAS - Housing Authority of the City of Austin	36
WASHINGTON - Housing Authority of Snohomish County	50
WASHINGTON - Housing Authority of the City of Longview	35
WASHINGTON - Housing Authority of the City of Yakima	15
WASHINGTON - Housing Authority of the County of Clallam	15
WASHINGTON -Housing Authority of the City of Tacoma	100

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com

with a searchable Archive at this site divided into different subjects.

As of August, 2010, Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/

To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

DOJ and Enforcement of Integration Mandate in ADA/Olmstead

DOJ and Enforcement of Integration Mandate in ADA/Olmstead. Information Bulletin # 334 (7/2011).

In recognition of the 12^th anniversary of the Supreme Court’s Olmstead decision, the United States Department of Justice issued an extremely important and comprehensive “Statement … on Enforcement of the Integration Mandate” of the ADA and Olmstead.

This is DOJ’s “technical assistance guide.” All advocates should download it and use it in your advocacy efforts. Quote it in your briefs in Court. Quote it in your meetings with government officials. Cite it in your letters to the editor and opinion editorials. This document represents the official position of the highest law enforcement agency in the country. http://www.ada.gov/olmstead/q&a_olmstead.htm

This Information Bulletin is intended only to wet your appetite. Please read the entire document. We’ll summarily quote as much as possible. In the original, there are 18 questions. We’ve added (arbitrarily) emphases.

DOJ stated: The “goal of the integration mandate – to provide individuals with disabilities opportunities to live their lives like individuals without disability – has yet to be fully realized…. Many people who could and want to live, work and receive services in integrated settings are still waiting for the promise of Olmstead to be fulfilled.”

1. What is the most integrated setting?

“Integrated settings are those that provide … opportunities to live, work, and receive services in the greater community, like individuals without disabilities. Integrated settings are located in mainstream society; offer access to community activities and opportunities at times, frequencies and with persons of an individual’s choosing; provide the opportunity to interact with nondisabled persons to the fullest extent possible…. Segregated settings include, but are not limited to: congregate settings populated exclusively or primarily with individuals with disabilities….”

2. When is the ADA’s integration mandate implicated?

Anytime a “public entity administers its programs in a manner that results in unjustified segregation” whether by operating segregating programs, or financing them in private facilities, or “funding choices or service implementation practices that promotes or relies upon the segregation in private facilities or programs.”

3. What factors are relevant in determining whether an individual does not oppose an integrated setting?

“Public entities must take affirmative steps to remedy this history of segregation and prejudice in order to insure that individuals have an opportunity to make an informed choice. Such steps include providing information about the benefits of integrated settings, facilitating visits in such settings, and offering opportunities to meet with individuals with disabilities living in integrated settings.

4. Does ADA apply to persons at serious risk of segregation?

“Yes… People need not wait unit the harm of institutionalization or segregation occurs or is imminent.” Persons can show such risk “if a public entity’s failure to provide community services or its cut to such services will likely cause a decline in health, safety, or welfare that would lead to the individual’s eventual placement in an institution or segregation.”

5. May the ADA require a State to provide additional services than are provided in their Medicaid program?

“A state’s obligations under the ADA are independent from the requirements of the Medicaid program. The ADA may require states to provide services beyond what a state currently provides under Medicaid.” “Caps… do not exempt state from serving additional people in the community by seeking a modification of a waiver to remove the cap.”

6. Can budget cuts violate the ADA?

“Yes, budgets cuts can violate ADA when significant funding cuts to community services create a risk of institutionalization or segregation…. In making budget cuts, public entities have a duty to take all reasonable steps to avoid placing individuals at risk of institutionalization or segregation… including making exceptions to the service reductions or to provide alternative services to individuals who would be forced into institutions as a result of such cuts.”

7. What budgetary resources are relevant?

“All money the public entity allots, spends, receives, or could receive if it applied for available federal funding to provide services. All relevant costs, not simply those funded by the single agency that operates or funds the segregated or integrated settings.”

8. What about an Olmstead Plan?

It must do more than provide vague assurances of future. Must contain concrete and reliable commitments to expand integrated opportunities. Must include commitments for each group of persons who are unnecessarily segregated. Must address the needless segregation of the group at issue in the case.

9. What about budgetary shortages?

“Even in times of budgetary constraints, public entities can often reasonably modify their programs by re-allocating funding from expensive segregated settings to cost-effective integrated settings. Whether the public entity has sought additional federal resources available to support the provision of services in integaated settings – such as Medicaid, MFP and federal housing vouchers.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com

with a searchable Archive at this site divided into different subjects.

As of August, 2010, Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/

To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

Medicare, CMS, Hospitals, and Unnecessarily Institutionalization.

Medicare, CMS, Hospitals, and Unnecessarily Institutionalization. Information Bulletin # 334 (6/2011).

There’s been a number of news articles recently stating that CMS will track hospital spending for Medicare recipients and will reward hospitals that keep costs down and penalize hospitals for costs incurred within 90 days after the person leaves the hospital.

It’s a “Medicare spending per beneficiary” device to measure hospital performance. For example, we have national data for infections occurring after surgery and/or as a result of just being in a hospital. Hospitals with much higher rates will be penalized. Similarly, there’s national data for heart attack mortality rates against which hospitals can be compared, rated, and then rewarded or penalized.

Obviously, besides improving medical care, rewards/penalties are an important strategy to control health costs, something everyone agrees is necessary.

We have a simple suggestion for CMS.

How about CMS including in its “Medicare spending per beneficiary” the measure of placement in nursing homes directly from acute care hospitals? This could actually be easily implemented because CMS could actually enforce its own federal regulations which require hospitals to do real and meaningful “discharge planning”?

CMS has national data by hospital. The federal “discharge planning” regulations require hospitals to identify at an “early stage of hospitalization” people likely to need post-hospital services. Discharge plans must include “appropriate arrangements for post-hospital care ... before discharge.”

Here’s a radical idea - save federal funds, both Medicare and Medicaid, by using the existing regulations to reward and penalize hospitals which do not arrange for home and community-based services and which have higher rates of nursing home placement.

Yes, stop the dumping of people from hospitals to nursing homes. It is outrageous, let alone unnecessarily expensive, that more than 60% of people in nursing homes come directly from acute care hospitals.

It’s no secret that hospital discharge planning does not take home and community-based services seriously. It’s no secret that a primary goal of the hospital is to save money, especially if its nonreimburseable. Therefore, hospitals will do everything to get the person “out of the hospital” as soon as the reimbursements will likely cease, even if it means dumping the person in a nursing home.

CMS - you have a financial interest, the regulatory authority, as well as an interest in the ADA’s mandate that services be provided “in the most integrated setting appropriate,” to address hospital dumping.

Include in the “Medicare spending per beneficiary” plan a measure of post-hospital placements. Reward hospitals that place people in the community with services and penalize hospitals with the worst dumping scores.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. Information Bulletins are also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

180,000 Housing Voucher Turnovers and Transitioning People Out of Institutions.

180,000 Housing Voucher Turnovers and Transitioning People Out of Institutions. Information Bulletin - # 334 (6/2011)

Nationally, in 2010, about 9 percent of nearly 2 million Housing Choice Vouchers (a/k/a Section 8 vouchers) are “turned over” each year. In HUD parlance, these are classified as an“attrition rate.”

Public Housing Authorities throughout the country, therefore, have “turned over” Housing Choice Vouchers available to issueto people who have previously applied for vouchers but were placed on a “waiting list.”

Please be aware that some Housing Authorities may not be able to immediately reissue all vouchers as they turnover. PHAs must manage their program withing the funding that is available, which may preclude them from immediately reissuing all vouchers upon turnover.

As you know, because there are long “waiting lists” for these vouchers, many advocates understandably are discouraged with the length of time people must wait until a voucher becomes available.

However, it’s very important to remember that these “waiting lists” do move nationally by about 9 percent a year. Some Housing Authorities had 20 - 40 % turnover rate. (Please note turnover data was not available for about 25 “Moving to Work” Housing Authorities, many of which are the large Housing Authorities.)

But a 9% turnover rate means, nationally, there are at least (remember the big MTW authorities are not even included) about 180,000 vouchers potentially available to be issued to people who are on a waiting lists.

If you want to see what the “attrition rate”/ “turnover rate” was for you Housing Authority and if you have excel on your computer, go to the following link: http://www.stevegoldada.com/2010_pha_avail_attr.xls or go to http://www.stevegoldada.com/2010_pha_avail_attr.csv The Housing Authorities are by State and the column “units” mean vouchers. If your Housing Authority is not listed, it means either it is one of the 25 MTW authorities or it does not administer any Housing Choice Vouchers.

It’s also important to remember that each Housing Authority may establish preferences for admission to their voucher program. If they do so, they must list the “preferences” for their vouchers in their Section 8 Administrative Plan, which is publicly available. “Preferences” mean exactly what you think. Some categories of people go to the top of the waiting list and others do not.

“Preferences” are supposed to reflect housing “needs” in your community.

In Information Bulletin # 329 (4/4/2011), we summarized the national HUD report entitled “Worst Case Housing Needs of People with Disabilities.” Here is the web link http://www.huduser.org/Publications/pdf/WorstCaseDisabilities03_2011.pdf

This Worst Case report does not include persons who are institutionalized in nursing homes, ICFs or Mental Institutions. Advocates know there are many people institutionalized solely because they cannot afford to pay for housing in the community. The nursing home is the Poorhouse of the 21st Century.

What advocates should do:

Advocates for older and disabled Americans should use the HUD “Worst Case” report as a basis for establishing your local “Worst Case Housing Needs of People with Disabilities” in your specific county or city.

Obviously, you must include people who are institutionalized to show that persons in institutions are the Worst of the Worst Cases.

You can now approach your Housing Authorities, persuade them that institutionalized people must be give the highest Preference or at the least a certain number of new admissions each year that will be given preference.

Demand that a certain number of Housing Voucher “turn overs”/ “attrition rates” be used to transition people out of these institutions.

Remember, that annually Housing Authorities must write an Annual Plan which is then submitted as part of a Consolidated Plan. These are supposed to reflect housing needs.

Does your Housing Authority (including the 25 MTW authorities) give a “preference” for persons with disabilities who are in institutionalized because they cannot afford to live in the community? Does it even list these people as having a “need.”? Have you met with your Housing Authority officials to discuss revising their Voucher “preferences” so that people with disabilities in institutions become a high preference? Have you discussed potentially use these Vouchers so that people with disabilities could leave the institution?

What about discussing this option with your State Money Follows the Person officials? With your Medicaid officials? With your Governor’s office which wants desperately to save general revenue funds?

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at
http://www.stevegoldada.com with a searchable Archive at this site
divided into different subjects. As of August, 2010, Information Bulletins
will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada@cs.com or
call 215-627-7100.

Medicaid Bed Taxes and Institutional Bias.

Medicaid Bed Taxes and Institutional Bias. Information Bulletin #333 (5/20111)

In FY 2010, nearly $13.5 billion dollars were generated in 37 States as Medicaid “Provider Taxes,” a/k/a, Bed Taxes, Fees, and/or Assessments. At a minimum, these bed taxes generated another $13.5 billion federal match and more that States received.

What are Medicaid Bed Taxes and why should advocates for older and disabled Americans care?

37 States levy Medicaid provider/bed taxes against nursing homes (they can also be levied on hospitals or ICF beds). The $13.5 billion broken at the end of this Bulletin does not distinguish among NH, ICF or hospitals.

Often, bed taxes are based on, for example, the total number of nursing home beds in a nursing home. That is, a State requires each nursing home to pay the State a specific amount of money for each nursing home bed per day. We heard recently that one State taxed nursing homes $10 per nursing home bed per day whether or not the bed was even occupied.

The State then uses revenues generated from these “bed taxes” to bring down federal Medicaid funds, i.e., the federal match.

Here’s what happens over time. After a few years of these bed taxes, the federal reimbursement generated from nursing home bed taxes are then used to draw down more federal funds. (A type of Ponzi scheme?)

Obviously, State legislatures like bed taxes because the income generated means that less general State revenue funds need to be allocated to draw down free federal Medicaid funds. States that have provider/bed taxes therefore save State general revenue expenditures because States use the provider tax – not State general revenue funds - to generate the federal reimbursements. (No idea what’s in it for the federal government.)

It is quite important for advocates for older and disabled Americans to understand that bed taxes directly impact on your State’s Medicaid long-term, home and community-based versus institutional policy.

As the National Conference of State Legislatures recently wrote, “the rate of taxation and the allocation or earmarking of the revenue can have far-reaching impacts on state health programs and on overall state budgets.” “Earmarking” means where the federal funds that the bed taxes draw down are then used. “Far-reaching impacts” mean that institutional versus community-based services is dictated not by the ADA but where the bed-taxes come from and where they are used.

No one should be naïve. Nursing homes and other institutions do not voluntarily agree to pay these bed taxes without getting something in return.

Did you ever wonder why nursing homes receive, often annually, increased nursing home Medicaid per diem rates, while home and community-based service programs do not receive similar increases (and/or are actually reduced)? Look at how your State uses its Provider Taxes. Of course, these taxes could be used for any and all Medicaid programs, including HCBS, but as NCSL notes above they are “earmarked” for specific programs.

The National Conference of State Legislature report stated that “in a majority of cases, the cost of the tax is promised back to providers through an increase in the Medicaid reimbursement rate.” Yup, Medicaid nursing home reimbursement rates are increased as part of the sweet deal with nursing homes paying bed taxes: from the nursing homes as bed taxes back to the nursing homes as increased per diem reimbursements. Anyone want to wager whether the nursing homes make a profit on this scheme?

Advocates should find out which institutions in the 37 States pay these taxes and where the generated federal match is “earmarked.” If these funds are earmarked to keep institutions operating, they are not distributed “even handed” so home and community-based services receive a reasonable amount. Hmm, the Olmstead decision assumed “even handed” expenditures.

Here are the 2010 Bed Taxes for the 37 States that use them. This information was obtained via a FOIA request. If your State is not listed, it did not have a bed tax.

Arkansas..................... $65 .1m
California................... $412.9m
Connecticut................. $3.2m
Florida........................ $489.4m
Georgia....................... $194.9
Illinois......................... $1.501 b
Indiana........................ $86.7m
Iowa............................ $38.3m
Kansas........................ $32.7 m
Kentucky.................... $311.3m
Louisiana.................... $110.5m
Maine.......................... $138.3m
Maryland.................... $0.7m
Massachus.................. $601.9m
Michigan..................... $757.2m
Minnesota................... $711.6m
Mississippi.................. $272m
Missouri...................... $1.134b
Montana...................... $31m
Nebraska..................... $1m
Nevada........................ $29.6m
New Hampshire.......... $36.4m
New York .................. $3.549 b
North Carolina............ $133.5
North Dakota.............. $4.5 m
Ohio............................ $1.067b
Oklahoma................... $51.6m
Oregon....................... $35.5m
Pennsylvania............... $596.6m
Rhode Island............... $40.4m
South Carolina............ $66.5m
Tennessee................... $414.3m
Texas......................... $48.6m
Washington ................ $38.1m
West Virginia.............. $157,9m
Wisconsin .................. $74.4m
Wyoming ................... $4.7m

National ..................... $13.425 billion

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com
with a searchable Archive at this site divided into different subjects.
As of August, 2010, Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

The Nursing Practice Act and the ADA/Section 504.

The Nursing Practice Act and the ADA/Section 504. Information Bulletin #332 (May 2011)

The U.S. Department of Justice recently filed an amicus curiae brief in the California Supreme Court arguing in an IDEA/ “free appropriate public education” case (American Nurses Association v. Jack O’Connell) that the state’s Nursing Practice Act was preempted by the federal disabilities laws. Preemption means that the federal law - ADA, IDEA, 504, Federal Housing Act - trumped a state law that conflicts with the federal law..

The DOJ was quite emphatic that it’s position was limited to the facts in that case, i.e., where the California Dept of Education would permit a trained but unlicensed school employee to administer insulin per a doctor’s orders, but only if the other authorized/delegated persons were unavailable.

DOJ argued that the State law was preempted by the federal ADA and Section 504, because the State law presented obstacles to compliance with the IDEA and FAPE. It noted that the evidence established that because there were so few school nurses or other authorized persons available, “some students [who required insulin] have been deprived of their right to a FAPE.”

DOJ cited a number of cases that emphasized that disability rights laws required reasonable accommodations and that a “proposed accommodation under the ADA [or 504 or the Fair Housing Act] was not unreasonable simply because it might require defendants to violate state law.”

Advocates have faced the Nursing Practice Act restrictions in a number of contexts well beyond the IDEA and FAPE

How about integrating persons with disabilities into the community to comply with the ADA and the Olmstead decision.. Advocates have confronted the Nursing Practice Act when we have represented persons who use ventilators, who require suctioning, who need catheters changed, or who need to take medications but do not have the manual dexterity to take the meds themselves.
We have had States deny Medicaid Waiver services to these people because the States argue their Nursing Practice Act requires a nurse to provide the services. Then the States argue that, because more nursing services are required than the waiver offers, the persons are denied Waiver services and must remain institutionalized.

The above DOJ rationale would apply in the above vent, suctioning, etc., situations, all of which are non-IDEA. That is, if your State’s Nursing Practice Act requires a licensed nurse to provide any of the specific services listed in the preceding paragraph, this requirement should not be an obstacle or barrier to comply with “the most integrated” mandate of the ADA and the Olmstead decision. Reasonable accommodations are available.

States should either pay for the nurses in the community or permit people to have a reasonable accommodation of other people performing these tasks. But in no circumstance should the State be allowed to use the Nursing Practice Act as an obstacle to deny a person the ADA right to live in an integrated community.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. Information Bulletins are also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.