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Background on ADAPT [American Disabled for Attendant Programs Today] Meeting 6/25/97
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Background on ADAPT [American Disabled for Attendant Programs Today] Meeting 6/25/97
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FOIA Number: 2007-0143-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Public Liaison
Series/Staff Member:
Maria Echaveste
Subseries:
OA/ID Number:
11491
FolderID:
Folder Title:
Background on ADAPT [American Disabled for Attendant Programs Today] Meeting 6/25/97
Stack:
Row:
Section:
Shelf:
Position:
S
30
6
11
1
June 24, 1997
TO:
MARIA ECHAVESTE
FROM:
BILL WHITE - OPL
SUBJECT:
BACKGROUND ON ADAPT MEETING
DATE/TIME:
Wednesday, June 25, 1997
3:00 - 4:00 PM
LOCATION:
OEOB - Room 180
PURPOSE:
To attempt to begin a dialogue on personal assistant services with
ADAPT.
OUTLINE:
Welcome & Opening
Maria Echaveste
Introductory Remarks
Chris Jennings
CASA Overview
Michael Oxford
ADAPT
Administration Proposals
Administrator Bruce Vladek
Health Care Financing Admin.
Close & Next Steps
Maria Echaveste
BACKGROUND:
ADAPT is a grassroots civil rights organization that is committed to
changing the long term services system. They believe that the current
system confines 2 million people with disabilities in nursing homes.
ADAPT wants health dollars redirected SO that people with disabilities,
with the assistance of personal attendants, can live independently within
their communities. While ADAPT claims their proposal will save money,
HHS disagrees and is concerned with the enormous risk of abuse in such a
system. The nursing home industry would also object.
ADAPT is in DC (June 14 - 26) to push for a national attendant services
Bared at for
balks
program. Famous for their acts of civil disobedience, this week ADAPT
MS
has "visited" the Department of Labor, Transportation, the Greyhond Bus
Company (b/c of inaccessible buses) and Gingrich's office. Gingrich, at
ADAPT's urging, has introduced legislation (HR 2020, a.k.a. the CASA
Michalogford
Bill) on this issue on Monday, June 23rd. HHS is in the process of
reviewing this legislation.
In your introduction, you should set a tone about how this process must
Administra
work if it is to be productive. You should recognize that although we
failed to get a meeting in the first quarter (as we stated), it wasn't for lack
of trying. (Like the first term, you are coordinating policy level
discussions with the President and key constituency groups, including the
will to
disability community.) You need to make clear that the meeting with the
Tior
President on September 10 is not ADAPT's meeting, but the President's
meeting with leaders of the disability community to discuss issues
change folksiven Dready
important to people with disabilities, including personal assistance
2
policy 1/1/98 be budget
services. We would like to include representatives of ADAPT in that
meeting. (In jest, you might say that because ADAPT has not responded
"in writing" to your letter of June 16 inviting them to participate, your not
sure if they plan to attend!) You should state that our discussions should
be about the future, not the past; and focus on substance, and not
posturing.
use consumer protection folks - quality checkers
neutral deoped hougron 1095.00
After your opening comments, you will introduce Chris Jennings (the
President's senior health policy advisor and Deputy Assistant to the
President for Domestic Policy). Chris will talk about the importance of
the issue, review the Administration's accomplishments, state that the
Administration recognizes that more needs to be done, and that we look
bady
Geramine Medicaid being all home carel new
forward
to
their
ideas.
I
Buel
Awantrodoth's
will
set
ASAP
& Sord
to
You will then invite ADAPT member Mike Oxford to make a
presentation. HCFA Administrator Bruce Vladek will respond to ADAPT
and present a number of policy initiatives aimed at addressing the issue
Dias inst lise VS there work a smeothis uses
(attached).
pot
want
One of the proposals will be to create a working group to develop action
we
plan to expand access to consumer directed personnel assistance services,
delinking this
which would include a representative from ADAPT. You should close
the be announcing the next step, which would be the first meeting of the
a
working group. You should propose to ADAPT the dates of July 28-31
4 Redicare eliminate of delicared
for the first meeting.
Finally, keep in mind that while this may not be your most fun meeting
here at the White House, it may be your most memorable. P.S. Don't
forget to bring your issue, cutters if they decide to chain themselves in room 180.
5
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and there are needs
PARTICIPANTS:
Cassie James
ADAPT
Andres Pete Duran
ADAPT
Michael Oxford
ADAPT
Michael Auberger
ADAPT
Kevin Grivine
ADAPT
Linda Anthony
ADAPT
Kathleen Kliemann
ADAPT -PA
Pamela Burkley
ADAPT
Barbara Toomer
ADAPT
Kevin Burrison
ADAPT
profwillians. Cannon
Compets from Buuce Vladek
W onler owned conporation in Bronx -
KattleenKleinam - suys the ewaivers have become a problem because
it is new fragmented
Cassie James become - providers developing di sabled to - may also he
Qualityofife cheaper is inproved, leading to better healthcare
Consumer - Denonstration
Reaction <> to CASA Hrz 2020 accurate welds so you work car
Chis
Jenning estimate need costs more to make case real this ustimeles will
better and checked to set headis is or
Denonotictions model impeopes would were out
elderly Average person who take aren' advantage + recessary of baefits sand of for Job disalled
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Assistmed but for ADAPT
OMB CBO
JUN-24-1997 16:18
¿CFA-OLIGA
2026908168 P.02
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PROPOSAL FOR DISCUSSION WITH ADAPT
-LoH
I. Overview
The Administration recognizes that we must make greater efforts to support the ability of people
with disabilities to live in the community and to engage in productive activity in accordance with
their individual choices and circumstances. To that end, we will work over the next two years to
identify and reduce the barriers and disincentives in our health care financing programs to living in
the community and engaging in socially productive activity including employment. Specifically,
we will continue and expand our efforts to:
Reduce the institutional bias and, where appropriate, the medical orientation
of public long-term care financing;
Promote consumer directed services for individuals with disabilities who
want and need them;
Expand the supply of well-trained personal attendants;
Remove other barriers in our health care financing programs that impede
people with disabilities from participating in the work force.
IL Action Steps
1. Expedite final rule making for the HCFA regulation on the coverage of personal care
services. This rule will permit personal care to be provided in settings other than a person's own
home, at state option, and without the supervision of a registered nurse as long as authorized by a
physician in accordance with a plan of treatment
This new rule will remove some of the key barriers to consumer directed services within the
Medicaid personal care option.
2. Work with States on HCFA solicitations for consumer-directed DME and for dually
eligible beneficiaries:
HCFA is preparing an initiative that would solicit applications from Centers for
Independent Living to develop and implement demonstration projects on
Consumer-Directed Durable Medical Equipment. The demonstration will establish service
delivery models to facilitate beneficiary access to wheeled mobility equipment through
partnerships with sponsoring organizations Sponsors would facilitate the provision of
assistive technology information, assessment and case management activities, prior
authorization of equipment, beneficiary credit accounts for increased equipment
purchasing flexibility, and other activities as may be approved. State Medicaid and other
payor participation also will be encouraged. HCFA anticipates the release of a special
solicitation in the near future.
JUN-24-1997 16:18
¿CFA-OLIGA
2026908168
P.03
HCFA has released a solicitation to States and other interested parties that would work
collaboratively with States to develop more effective strategies to meet the diverse and
complex needs of the dually eligible Medicare and Medicaid beneficiaries. The
solicitation, entitled "Reforming Service Delivery for Dually Eligible Beneficiaries," seeks
applications that foster a more integrated and flexible service delivery systems and
strengthens Federal and State capabilities to address the problems and challenges that
confront these beneficiaries. The closing date for applications has been extended until
August 29, 1997.
3. Plan and Implement a New Technical Assistance Strategy to Support State Programs of
Consumer Directed Services. HCFA, the Administration on Aging and the Administration for
Development Disabilities will develop a new technical assistance program to help states design
and implement consumer directed services approaches under the Medicaid personal care option,
the Home and Community based waiver program and the Older Americans Act Title III
programs. As an initial step, HCFA is drafting a letter to State Medicaid Directors urging them to
make home and community-based services (HCBS)waivers available to all persons currently
institutionalized or at risk of institutionalization and requesting them to consider incorporating
consumer directed services principals into their programs.
4. Create a Working Group to Develop Action Plan to Expand Access to Consumer
Directed Personnel Assistance Services. A work group would be appointed of senior HHS staff,
State Officials and representatives from the disability community, with participation from OMB
and the White House to develop an action plan for expanding and promoting consumer directed
services strategies. The work group would consider a number of options including:
A)
Convening a National Conference on Consumer Directed Services. The conference
would bring together people with disabilities, State officials, federal policy makers and
technical experts to draw attention to the current institutional emphasis of Medicaid long-
term care financing, identify barriers to consumer directed services and to recommend
strategies for promoting consumer directed services strategies in public financing
programs.
B)
Establishing a New Mayor National Demonstration Program to Operationalize the
Principals of CASA. The new demonstration would be directed at working age adults
with disabilities who require attendant services and would be implemented as a 6-10 states
experiment with a rigorous evaluation design to test impacts on consumer economic and
social self-sufficiency, satisfaction and costs.
C)
Encouraging the Removal of Barriers to Consumer Directed Services in Nurse
Practice Acts. HCFA, AOA, and ADD would work with the disability community and
states to identify barriers within Nurse Practice Acts that inhibit the use of consumer
directed services and strategies for overcoming these barriers including the creation and
implementation of model guidelines that support consumer directed services within a
framework that addresses health and safety issues for vulnerable persons.
JUN-24-1997 16:19
oCFA-OLIGA
2026908168 P.04
D)
Expanding the Supply of Personal Care Attendants in Conjunction with State
Welfare Reform Strategies. In partnership with States, ACF and HCFA with the Office
of the Secretary would support the development of job training and placement programs
which encourage welfare recipients to become personal care attendants
5. Advocate for Administration's Work Incentive for People with Disabilities. The
President proposed a work incentive to encourage SSI beneficiaries to return to work. The
President's proposal would allow States to permit SSI beneficiaries to buy into Medicaid after
they exceed the 1619 income threshold. The Senate Finance Committee bill has included a
provision to give States the option of permitting SSI beneficiaries with income up to 250 percent
of poverty to buy into Medicaid. The Administration recently wrote a letter to Senator Trent Lott
urging inclusion of the President's proposal that would not limit eligibility for this program to
people whose earnings are below 250 percent of poverty. We will continue to work with
Members to have the income cap removed during conference.
TOTAL P.04
THE WHITE HOUSE
WASHINGTON
June 16, 1997
Michael Oxford
ADAPT
P.O. Box 9598
Denver, CO 80209
Dear Michael:
The President has scheduled a meeting with leaders of the disability community for
September 10, 1997 to discuss issues important to people with disabilities, including personal
assistance services. We would like to include representatives of ADAPT in that meeting.
As you know, the Office of Public Liaison has been actively pursuing the scheduling of a
meeting between the President and leaders of the disability community. Prior to the meeting
with the President, the White House will continue its consultative process with ADAPT and, in
particular, begin a policy discussion regarding the issue of personal assistance services. The
Administration will be represented by the White House Office of Public Liaison, Domestic
Policy Council, National Economic Council, and the Department of Health and Human Services
during the policy discussions with ADAPT.
We are ready to begin the substantive policy discussions immediately and are waiting for
ADAPT to propose dates for the first meeting. Please contact Bill White at (202) 456-7032 to
coordinate the first meeting.
Sincerely,
Maria Echaveste
Assistant to the President
Office of Public Liaison
Date: 06/18/97 Time: 09:13
bDisabilities Group Protests at DOL; Gains Meeting with Clinton
To: National Desk, Health Care Writer
Contact: Mike Auberger, 202-289-5959,
Jennifer Burnett, 202-842-4466, or
Joe Ehman, 202-842-4466, all of the American Disabled
for Attendant Programs Today
WASHINGTON, June 18 /U.S. Newswire/ -- Members of a national
disability rights organization, ADAPT, held a protest at the
Department of Labor, forcing the White House to keep its promise
made November 1996.
Three hundred members of ADAPT occupied the building while ADAPT
representatives negotiated with White House staff, forcing a
meeting with the president scheduled for Sept. 10.
The protest was a result of a Clinton Administration promise. In
November 1996 a letter was sent to ADAPT by Assistant to the
President Alexis Herman, promising a meeting between ADAPT and the
president in the first quarter of 1997. The meeting never took
place. Alexis Herman is now Secretary of Labor, and ADAPT went to
her office to demand accountability for the promise.
The protest caused an immediate reaction from the president's
office. The current Assistant to the President Maria Eschaveste and
ADAPT member Bob Kafka negotiated an agreement over the telephone.
She then faxed a confirmation to ADAPT at the Department of Labor,
verifying that the White House Office of Public Liaison had not
only arranged the meeting with the president but would also
coordinate a policy meeting on Wednesday, June 25. This policy
IT ing will include Secretary of Health and Human Services Donna
≤ ala, the heads of Domestic Policy Council, National Economic
Council, the Office of Public Liaison and ADAPT.
In a letter to ADAPT dated June 16, Echaveste wrote, "We are
ready to begin substantive policy discussions immediately and are
waiting for ADAPT to propose dates for the first meeting.
ADAPT is in Washington to support the passage of CASA, The
Community Attendant Services Act, which is expected to be
introduced next week by Speaker of the House Newt Gingrich. This
legislation will redirect Medicaid's long term care funding from
nursing homes to home and community-based services. It will allow
people to live in their own homes by providing services in the
community instead of in nursing homes and other institutions.
ADAPT spent the afternoon surrounding the Bus Terminal stopping
buses in downtown D.C., sending a message to Greyhound that access
is a civil right. Last year Greyhound maneuvered a delay in the
development of ADA regulations regarding over the road coaches.
With this delay in place, Greyhound is planning to purchase new
inaccessible buses.
-0-
/U.S. Newswire 202-347-2770/
APNP-06-18-97 0929EDT
*ASPE/HCFA looh@this
November 4, 1996
CC ChrisJ Vladeek Bruce (fax Min
Mr. Michael Oxford
ADAPT
835 800 East Road
Lawrence, Kansas 66047
From Diana Fortune
Nancy Ann 5-728
Dear Michael:
The President is proud of his record on disability rights issues. President Clinton's
administration has continued to build policies based on the three simple creeds: inclusion,
independence, and empowerment. Last year the President vetoed legislation that would have
eliminated the Medicaid guarantee of health care and independence so important to
individuals with disabilities. His administration has vigorously enforced the Americans With
Disabilities Act, the Individuals With Disabilities Education Act, and other civil rights laws.
To this end we will convene a meeting with the President, ADAPT, and other disability rights
leaders to discuss what we can do together to further our efforts on such issues as personal
attendant, home and community bases services, and other issues that are important to people
with disabilities. Provided the President is re-elected, we will convene this meeting in the
first quarter of next year. I will be in touch with you directly to discuss the appropriate
arrangements for this meeting.
Sincerely
Alexis Herman.
Assistant to the President / Director of Public Liaison
Clinton
Gore
Statement of Governor Clinton on Personal Assistance Services
I support efforts to make affordable personal assistance services available to
Americans with disabilities. We must ensure that all people have the opportunity to live
independent lives. People who have disabilities and have a need for personal assistance
services should have maximum control over the care they receive. Personal assistance
services must be consumer-driven -- they must meet the needs and desires of the user,
not the dictates of the supplier.
I believe that personal assistance services are of the utmost importance. I
understand that every person has different needs. For this reason, I believe that every
individual has a right to personal care.
I believe that personal assistance services should be provided by a wide range of
qualified individuals. In my proposal for a National Service Trust Fund, I have suggested
that young men and women who go to college can pay for their education by spending
two years working in jobs which serve our community .. teaching our children, policing
our streets, rebuilding our infrastructure. Employment in personal assistance services
should be an option in this program, and I hope thousands of men and women choose it.
This is only one of many ways in which we can expand the scope of available services.
Personal assistance services should be a part of any comprehensive health care
reform plan. For this reason, I intend to appoint a task force, including individuals with
disabilities, on the role of personal assistance services and long term care in health care
reform. I have promised to submit a reform package to Congress in the first 100 days of
my Administration. The task force will submit recommendations on reform in that time
period.
It is time for America to realize that silence on issues of concern to people with
disabilities is as damaging as prejudice. As President, I will work with individuals with
disabilities to empower people to live independently. I will bring people together and
make this plan a reality.
October 16, 1992
National Campaign Headquarters
P.O. Box 615
Little Rock. Arkansas 72203
Telephone (501) 372-1992
FAX (501) 372-2292
Psid
William H. White Jr.
06/25/97 01:34:13 PM
Record Type:
Record
To:
See the distribution list at the bottom of this message
CC:
Subject: Background on CASA from ADAPT
FOR IMMEDIATE RELEASE
June 23,1997
Contact: Mike Auberger/Bob Kafka (202) 289-5959
Joe Ehman (202) 842-4466
Missy Jenkins, aide to Newt Gingrich (202)225-4501
Washington DC - ADAPT HAS 20/20 VISION!! A bill,HR 2020, the Medicaid
Community Attendant Services Act, also known as CASA, was introduced
today by Speaker of the House Newt Gingrich.
HR 2020 states that any individual who is entitled to nursing home or
other institutional services will now have the choice where and how these
services are provided. The vision of OUR HOMES NOT NURSING HOMES will
finally become a reality for many of the two million Americans currently
residing in nursing homes.
HR 2020 will clearly free disabled and elderly people by the thousands
from nursing homes and other institutions. Currently, the United States
spends 80% of Medicaid dollars in nursing homes. HR 2020 will allow the
money to follow the individual into the community. "This historic
legislation is consistent with America's goal of empowerment and liberty
for all-including disabled people," said Mike Auberger, ADAPT organizer.
Attendant services provided in disabled peoples' homes include help with
dressing, bathing, eating, toiletting, and ventilator care. There is no
known medical reason why these services have to be provided in an
institutional setting. With HR 2020, the consumer will control the
delivery of these everyday services.
HR 2020 will forever change the way America views disabled people. For
the first time, all Americans with disabilities will truly be free to
pursue the American dream.
Message Sent To:
William H. White Jr.
06/25/97 01:34:13 PM
Record Type:
Record
To:
See the distribution list at the bottom of this message
cc:
Subject: Background on CASA from ADAPT
FOR IMMEDIATE RELEASE
June 23, 1997
Contact: Mike Auberger/Bob Kafka (202) 289-5959
Joe Ehman (202) 842-4466
Missy Jenkins, aide to Newt Gingrich (202)225-4501
Washington DC - ADAPT HAS 20/20 VISION!! A bill,HR 2020, the Medicaid
Community Attendant Services Act, also known as CASA, was introduced
today by Speaker of the House Newt Gingrich.
HR 2020 states that any individual who is entitled to nursing home or
other institutional services will now have the choice where and how these
services are provided. The vision of OUR HOMES NOT NURSING HOMES will
finally become a reality for many of the two million Americans currently
residing in nursing homes.
HR 2020 will clearly free disabled and elderly people by the thousands
from nursing homes and other institutions. Currently, the United States
spends 80% of Medicaid dollars in nursing homes. HR 2020 will allow the
money to follow the individual into the community. "This historic
legislation is consistent with America's goal of empowerment and liberty
for all-including disabled people," said Mike Auberger, ADAPT organizer.
Attendant services provided in disabled peoples' homes include help with
dressing, bathing, eating, toiletting, and ventilator care. There is no
known medical reason why these services have to be provided in an
institutional setting. With HR 2020, the consumer will control the
delivery of these everyday services.
HR 2020 will forever change the way America views disabled people. For
the first time, all Americans with disabilities will truly be free to
pursue the American dream.
Message Sent To: