Recommendations for Affordable Health Choices Act

AUCD enthusiastically supports the Affordable Health Choices Act. In particular, we applaud the inclusion of long-term services and supports (CLASS Act) and provisions which will promote wellness of individuals with disabilities, training of health professionals in disabilities, and reduction of health disparities for individuals with disabilities. The following are mostly minor insertions to language in the bill that we feel could strengthen provisions for individuals with disabilities.

Recommendations

  • The paradigm of prevention of secondary conditions is important to individuals with disabilities. However, this sometimes is lost within chronic disease prevention. In order to highlight this could add language on “prevention of secondary conditions” within Section 321 Community Transformation Grants.
  • Page 382, lines 16-19, modify to read:

“…in order to reduce chronic disease rates, prevent development of secondary conditions, address health disparities, and develop a stronger evidence-base of effective prevention programming.

  • Page 387, line 7-8, modify to read:

“…effective strategies for the prevention and control of chronic disease, including prevention of secondary conditions for individuals with disabilities.”

  • While the activities of the Community Transformation Grants include “addressing the needs of special populations, including all age groups and individuals with disabilities,” additional attention could be given to health disparities for individuals with disabilities.
  • Page 384, lines 21-23, modify to read:

“prioritizing strategies to reduce racial and ethnic disparitiesdisparities based on race, ethnicity, or disability, including social determinants of health

  • There are a couple places where elevating role and involvement of the Office on Disability might be considered.
  • Within Section 322 Healthy Aging, Living Well, page 389, lines 11-15, modify to read:

“…collaborate with the Centers for Disease Control and Prevention, the Office on Disability, the Administration on Aging, and relevant local agencies and organizations.”

  • Within Section 3301 Data Collection, Analysis, and Quality, page 412, line 20, insert “the Office on Disability” as C within the list of offices to which data concerning health disparities must be disseminated and reported to.
  • Could consider expanding the CDC State Disability & Health grants from 16 states to every state and US territory under Section 323 Wellness for Individuals with Disabilities and provide “such sums as necessary.” A new CDC program “Healthy Aging, Living Well” is authorized for the 55-64 year-old population, so this would complement that and formalize perhaps the only existing program on disability and health.
  • While disability status is included within data collection on health disparities along with race and ethnicity (Section 3301), could consider adding language on subgroups similar to what is done for racial and ethnic subgroups. At a minimum this might include such categories as developmental, physical, sensory, and mental disabilities (similar to recommendations provided to the Finance Committee). Could modify page 411, lines 1-4 to read:

“(D) if practicable, data by racial, ethnic, and disability subgroups for applicants, recipients or beneficiaries using, if needed, statistical oversamples of these subpopulations.”

  • Within Title IV Health Care Work Force the definition of “health disparity population” could be problematic. This may refer to Section 485E of the Public Health Services Act and the Minority Health and Health Disparities Research and Education Act. This needs modified to include individuals with disabilities. However, rather than modifying the definition for this Title only, it would be better to modify the original definition. This would be a significant advance in achieving the goal of including disability along with race and ethnic when considering health disparities (Barbara Kornbau from Special Olympics and a small coalition of others are attempting to work on better language).
  • Within Section 411 National Health Care Workforce Commission could more explicitly include individuals with disabilities by modifying page 439 lines 3-9 to read:

“(D) the health care workforce needs of special populations, such as minorities, individuals with disabilities,rural populations, medically underserved population, gender specific needs, and geriatric and pediatric populations with recommendations for new Federal policies to meet the needs of these populations.”

  • Within Section 432 Training Opportunities for Direct Care Workers language could be more inclusive of all direct care workers, particularly workers in home and community-based settings and workers providing long-term services and supports across the age spectrum.
  • On page 500, modify lines 6-10 to read:

“…such as nursing homes, intermediate care facilities for persons with mental retardation, assisted living facilities, community group homes, home care settings, long-term care recipients’ own homes, and any other setting the Secretary determines to be appropriate.”

  • On page 500, modify lines 20-23 to read:

“(B) has established a public-private educational partnership with a nursing home, home health agencies, community service agency for persons with disabilities, or other long-term care provider; and”

  • On page 501, modify lines 1-5 to read:

“(c) Use of funds.- An eligible entity shall use amounts awarded under a grant under this section to provide assistance to eligible individuals to offset the cost of tuition andrequired fees in academictraining programs provided by such entity.” (The term “training” can include an “academic” program, but academic program could be interpreted as only degree granting programs at the AA level or above.)

  • On Page 501, modify lines 12-18 to read:

“(2) Condition of Assistance.-As a condition of receiving assistance under this section, an individual shall agree that, following completion of the assistance period, the individual will work in the field of geriatrics, disability services, long-term care, or chronic care management for a minimum of 2 years under guidelines set by the Secretary.”

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