Policy Corner: May 10, 2019

House Appropriators Increase TBI Funding

The House Appropriations Committee marked up the Labor, Health and Human Services (HHS), Education, and Related Agencies spending bill for fiscal year 2020, beginning Oct. 1, on Wednesday. The bill includes an additional $1 million for a total of $12.321 million for the HHS’ Administration for Community Living’s (ACL) Traumatic Brain Injury (TBI) Program. The additional funding is appropriated to the Protection & Advocacy (P&A) and the state grant programs combined. The President’s budget called for a $2 million cut for the program. The committee recommended level funding for the ACL National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), which funds the TBI Model Systems. The President recommended that that program be reduced by $19 million. The committee also recommended a $1 million increase for the ACL Assistive Technology Act program and $5 million (level funding) for the ACL falls prevention program for older adults. The President’s budget eliminated funding for the ACL falls prevention program.

The bill proposes $700 million for the Centers for Disease Control and Prevention’s (CDC) Injury Center. While the Injury Center’s TBI program is level funded, some of the other Injury Center programs received increases or were at least level funded, avoiding elimination as proposed by the President’s budget. The bill included an additional $2 million for the Injury Control Research Centers for a total of $11 million, an additional $1 million for the elderly falls prevention program for a total of $3.05 million, and $25 million for firearm injury and mortality prevention research.

Overall, the bill provided $99 billion for HHS, an increase of $8.5 billion above the 2019 enacted level and $20.9 billion above the President’s budget request. This includes an increase of $2 billion for the National Institutes of Health (NIH), for a total of $4.1.1 billion, and $115 billion additional funding for the Substance Abuse and Mental Health Services Administration (SAMHSA). Funding is increased for substance use treatment by $14 million, including continued funding for opioid prevention and treatment and three new behavioral health programs to enhance treatment efforts. With regard to CDC’s budget, the bill provides $921 million above current spending level, $854 million in transfers from the Prevention and Public Health Fund, and $225 million in transfers from the HHS Nonrecurring Expenses Fund for a new research support building and campus infrastructure improvements.

The Appropriations Subcommittee had recommended $300,000 to establish a Disabled Veterans Program within the Department of Labor (DOL). The purpose is to address the high unemployment and low labor force participation rate of veterans with service-connected and non-service-connected disabilities.

House Passes Bill Protecting Preexisting Conditions

The House of Representatives passed H.R. 986, the Protecting Americans with Preexisting Conditions Act of 2019, this week. The purpose of the bill is to correct the Administration’s efforts to abolish the Affordable Care Act (ACA) by nullifying the U.S. Department of the Treasury and the U.S. Department of Health and Human Services guidance, “State Relief and Empowerment Waivers,” published Oct. 24, 2018. The guidance pertains to Section 1332 waivers, known as State Innovation Waivers or State Relief and Empowerment Waivers, which allow states to forego certain requirements of the ACA in order to implement experimental plans for health care coverage as long as the resulting coverage meets certain statutory criteria. For example, the guidance (1) redefines acceptable coverage under such waivers to include short-term, limited-duration insurance and association health plans; (2) allows the comprehensiveness and affordability of coverage under such waivers to be assessed based on projected availability, rather than enrollment; and (3) allows the level of coverage to be assessed based on the effects over the entire course of the waiver, rather than per year.

Senators Introduce Bill on Fitness Facilities Accessibility for People with Disabilities

To coincide with the 41st anniversary of the end of the historic protests of the disability community in San Francisco and Washington, D.C. in 1977, resulting in implementation of Section 504 of the Rehabilitation Act disability rights law, Senators Tammy Duckworth (D-Ill.), Bob Casey (D-Pa) and Richard Blumenthal (D-Conn.) re-introduced legislation to make fitness facilities across America more accessible for persons with disabilities. The Exercise and Fitness for All Act would establish new federal guidelines to help ensure people with disabilities have the same opportunity to use fitness facilities as their able-bodied peers, and it would allow small businesses to use the Disabled Access Tax Credit to help cover the purchase of accessible exercise equipment.

According to the CDC, adults living with a disability experience far higher rates of obesity and chronic disease than those without a disability. The CDC also found that the inaccessibility of many fitness facilities creates barriers for those will a disability to exercise due to the lack of accessible space and equipment.

Section 504 of the Rehabilitation Act was signed into law in 1973, but the former U.S. Department of Health, Education, and Welfare (HEW) had refused to implement the new rules until the protests occurred.

NCMRR is Updating Its Research Plan

NIH’s National Center for Medical Rehabilitation Research (NCMRR) is beginning the process of updating its trans-NIH Rehabilitation Research plan. This is required by the 21st Century Cures Act. The plan was last published in 2016. The update is scheduled for publication in 2021, but the agency has released a Request for Information asking the public for commentary on suggested priorities for the plan, specifically including:

• The community’s perception of progress towards achieving the priorities specified in the research plan,
• Potential priorities or areas of research to consider in the update of the research plan,
• Current priorities that should be retained and continued,
• Emerging areas of science that will impact the research plan on rehabilitation,
• Potential focus areas for concentrated work in medical rehabilitation research.

The deadline for comment is June 17, 2019. Click here for more information.

ACL Publishes Reorganization Plan

ACL published an updated Statement of Organization, Functions, and Delegations of Authority in the Federal Register yesterday. Programs administered by ACL are organized under the Administration on Aging, the Administration on Disabilities, and NIDILRR. ACL is also administering the Center for Regional Operations (CRO) to serve as the liaison, advocate, and representative for the agency regionally across the U.S. for all ACL’s programs areas. Programs under the Administration on Disabilities have been reorganized within these offices:

• Office of the Commissioner on Disabilities
• Office of Intellectual and Developmental Disability Programs
• President’s Committee for People with Intellectual Disabilities
• Office of Independent Living Programs
• Office of Disability Innovation

The TBI program (P&A and state grant programs) is located in the Office of Disability Innovation. In addition to the P&A TBI grant program, the Office will administer the P&A programs authorized by the Developmental Disabilities (DD) Act, Section 292 of the Help America Voter Act (HACA), and Section 5 of the Assistive Technology Act. The office is also responsible for the coordination, oversight, management and evaluation of the Projects of National Significance program authorized by the DD Act. The Office ensures the dissemination of grantee results in coordination with the Office of Intellectual and Developmental Disability Programs, the Office of Independent Living Programs, and the Office of the Commissioner on Disabilities. The Office coordinates information sharing and other activities related to national program trends and studies and reviews and analyzes other federal programs providing services applicable to persons with disabilities for the purpose of integrating and coordinating program efforts.

BIAA gratefully acknowledges the Centre for Neuro Skills and Avanir Pharmaceuticals for their support for legislative action.