MARGARET HATHAWAY

Labor-HHS-Education and Related Agencies appropriations bill-- for additional administrative funding for the Social Security Admininstration in order to reduce the tragic backlogs in Social Security disability applications and for support of many social service programs in appropriations. (continued) As yet to be introduced legislation that may be in Budget/Appropriations or may be in another bill regarding possible terms of extending deadline for Amtrak obligation to make all stations accessible to people with disabilities past original deadline of July 26, 2010. Supported funding for new Vocational Rehabilitation and employment programs for people with disabilities including new competitive grant program to expand supported employment for youth with disabilities as they transition from school to the workforce, Projects with Industry, Supported Employment State Grant Program, Supported Employment Extended Services for Youth Grant Program, Workforce Innovation Fund, Model Transition Program for Students with Intellectual Disabilities into Higher Education, and Agribility. Supported inclusion of appropriate funding levels to support VA research programs in FY 2011 Military Consruction-VA Appropriations (House and Senate). Opposed proposed cuts to Section 811 and Section 202 HUD housing programs in President's proposed budget for FY 2011 as these programs help provide affordable and accessible housing to people with disabilities. Supported inclusion of funding in the Fiscal 2011 Defense Appropriation legislation (House and Senate) for conducting multiple sclerosis research under the Congressionally Directed Medical Research Programs of the Department of Defense. Supported the inclusion of $22 million for FY 2011 to fund programs authorized by the Traumatic Brain Injury Act Amendments of 2008 under the Department of Health and Human Services and $11 million for the National Institute on Disability and Rehabilitation Research TBI Model Systems administered by the Department of Education. Supported funding for new Agent Orange presumptive VA benefits claims as part of the Supplemental Appropriations Act of 2010 (H.R. 4899). Supported an effort for $10 million to be appropriated for Family to Family Health Information Centers for children with special health care needs. The funding that they receive now is barely enough to keep the centers open with one or two staff per state. Funding letter Soc Sec to Chairs and Ranking members of Senate and House Appropriations Committees and Subcomms on Labor HHS-Education and Related Agencies calling for enactment of FY 2011 appropriations for Social Security at the full amount in the Presidents budget in order to help decrease rather than increase the disability determination backlog. $12.548B. Supported the Able Act H.R. 1205 would provide individuals with disabilities and their families with a savings instrument for specified education, medical and community-based services, including housing, transportation, employment training, and supports for their child without disqualifying that child from receipt of funds from entitlement programs which are vital in ensuring their quality of life.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratoriumon Medicare therapy caps. Supported HR 4213 to extend federal FMAP assistance to the states until June 2011. Opposed HR 1255, a bill that would make it more difficult for the Protection and Advocacy System to file suits on behalf of people who are confined to institutions. See also Health.

Stem Cell Research Improvement Act of 2009 allows for federal funding of embryonic stem cell research provided that certain ethical requirements are met (HR 873 and S 487). Supported the Cord Blood Education and Awareness Acts (H.R. 2107) inclusion in legislation being drafted to reauthorize the C.W. Young Cell Transplantation Program. H.R. 2107 would require uniform and medically accurate information to be developed by the Department of Health and Human Services and disseminated by maternal healthcare providers. Supported HR 1362 for MS and Parkinsons research.

Frank Melville Supportive Housing Investment Act of 2009, HR 1675, to make significant changes and improvements to the Section 811 Supportive Housing for Persons with Disabilities program and authorize a demonstration program that fulfills the promise of true community integration as envisioned by the Americans with Disabilities Act, to advance housing accessibility by filling in gaps of Fair Housing Act & Sec 504 of the Rehabilitation Act. Support HR 1408 Inclusive Home Design Act which requires all newly constructed, federally assisted, single-family houses and town houses to meet minimum standards of visitability for persons with disabilities

Frank Melville Supportive Housing Investment Act of 2009, HR 1675, to make significant changes and improvements to the Section 811 Supportive Housing for Persons with Disabilities program and authorize a demonstration program that fulfills the promise of true community integration as envisioned by the Americans with Disabilities Act, to advance housing accessibility by filling in gaps of Fair Housing Act & Sec 504 of the Rehabilitation Act. Support HR 1408 Inclusive Home Design Act which requires all newly constructed, federally assisted, single-family houses and town houses to meet minimum standards of visitability for persons with disabilities

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. Met with senior HHS officials to talk about implementation of health reform. See also Medicare and Medicaid.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratorium on Medicare therapy caps. See also Health.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. See also Medicare and Medicaid.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratoriumon Medicare therapy caps. Supported HR 4213 to extend federal FMAP assistance to the states until June 2011. Opposed HR 1255, a bill that would make it more difficult for the Protection and Advocacy System to file suits on behalf of people who are confined to institutions. See also Health.

Frank Melville Supportive Housing Investment Act of 2009, HR 1675, to make significant changes and improvements to the Section 811 Supportive Housing for Persons with Disabilities program and authorize a demonstration program that fulfills the promise of true community integration as envisioned by the Americans with Disabilities Act, to advance housing accessibility by filling in gaps of Fair Housing Act & Sec 504 of the Rehabilitation Act. Support HR 1408 Inclusive Home Design Act which requires all newly constructed, federally assisted, single-family houses and town houses to meet minimum standards of visitability for persons with disabilities

Frank Melville Supportive Housing Investment Act of 2009, HR 1675, to make significant changes and improvements to the Section 811 Supportive Housing for Persons with Disabilities program and authorize a demonstration program that fulfills the promise of true community integration as envisioned by the Americans with Disabilities Act, to advance housing accessibility by filling in gaps of Fair Housing Act & Sec 504 of the Rehabilitation Act. Support HR 1408 Inclusive Home Design Act which requires all newly constructed, federally assisted, single-family houses and town houses to meet minimum standards of visitability for persons with disabilities

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. Met with senior HHS officials to talk about implementation of health reform. See also Medicare and Medicaid.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratoriumon Medicare therapy caps. Supported HR 4213 to extend federal FMAP assistance to the states until June 2011. Opposed HR 1255, a bill that would make it more difficult for the Protection and Advocacy System to file suits on behalf of people who are confined to institutions. See also Health.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratorium on Medicare therapy caps. See also Health.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. See also Medicare and Medicaid.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. Met with senior HHS officials to talk about implementation of health reform. See also Medicare and Medicaid.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. See also Medicare and Medicaid.

Stem Cell Research Improvement Act of 2009 allows for federal funding of embryonic stem cell research provided that certain ethical requirements are met (HR 873 and S 487). Supported the Cord Blood Education and Awareness Acts (H.R. 2107) inclusion in legislation being drafted to reauthorize the C.W. Young Cell Transplantation Program. H.R. 2107 would require uniform and medically accurate information to be developed by the Department of Health and Human Services and disseminated by maternal healthcare providers. Supported HR 1362 for MS and Parkinsons research.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratoriumon Medicare therapy caps. Supported HR 4213 to extend federal FMAP assistance to the states until June 2011. Opposed HR 1255, a bill that would make it more difficult for the Protection and Advocacy System to file suits on behalf of people who are confined to institutions. See also Health.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratorium on Medicare therapy caps. See also Health.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. Met with senior HHS officials to talk about implementation of health reform. See also Medicare and Medicaid.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. See also Medicare and Medicaid.

Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. In health care reform HR 3590. Advocated for health insurance parity for coverage of prosthetic and orthotics devices, components and benefits for other medical and surgical services: under ERISA and HR 2575 for group health plans and group health insurance Social Security: HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions would have expired without reauthorization. Met with senior Senior SSA officials, as well as Senate and House staff regarding policies and possible legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities, electronic filing of disabilty applications and electronic authorizations for SSA to obtain medical records in connection with disabilities claims. - Met with SSA senior staff regarding draft report of SSA's Occupational Information Development Advisory Panel (OIDAP) that recommends dramatically different procedures to determine eligibility fordisability benefits under both Title II and Title XVI programs. -- Commented on on disabilty determinations for people with drug addiction and/or alcoholism. Supported HR 4532 to renew SSAs demonstration authority and to make permanent a successful demonstration that enables both attorneys and non-attorneys (who meet certain qualifications) representing Social Security disability claimants to be paid reasonable fees out of retroactive benefits. This practice enables many claimants (including those with mental illnesses and conditions such as post-traumatic stress disorder) to have good representation rather than to navigate the esoteric and complex application process on their own (often to be denied for procedural rather than substantive reasons). - Supported President's Budget proposal for SSA Limitation on Administrative expenses because the increased funding will help cut the backlog and delays in both the initial and hearing level disability determinations, thus providing disability benefits with less delay to people who meet SSA's strict eligibility requirements.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. See also Medicare and Medicaid.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. Met with senior HHS officials to talk about implementation of health reform. See also Medicare and Medicaid.

Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. In health care reform HR 3590. Advocated for health insurance parity for coverage of prosthetic and orthotics devices, components and benefits for other medical and surgical services: under ERISA and HR 2575 for group health plans and group health insurance Supported HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration Supported HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions would have expired without reauthorization. Met with senior Senior SSA officials, as well as Senate and House staff regarding policies and possible legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities, electronic filing of disabilty applications and electronic authorizations for SSA to obtain medical records in connection with disabilities claims. Submitted comments (in response to an SSA request) on complicated medical evidence issues when Social Security disability applicants have a co-occurring alcohol or substance use diagnosis and a serious mental illness. Supported HR 4532 to renew SSAs demonstration authority and to make permanent a successful demonstration that enables both attorneys and non-attorneys (who meet certain qualifications) representing Social Security disability claimants to be paid reasonable fees out of retroactive benefits. This practice enables many claimants (including those with mental illnesses and conditions such as post-traumatic stress disorder) to have good representation rather than to navigate the esoteric and complex application process on their own (often to be denied for procedural rather than substantive reasons). Supported President's Budget proposal for SSA Limitation on Administrative expenses because the increased funding will help cut the backlog and delays in both the initial and hearing level disability determinations, thus providing disability benefits with less delay to people who meet SSA's strict eligibility requirements. Asked HHS to ensure that lifetime caps are prohibited as of September 2010. Health insurance companies are arguing that they can keep lifetime caps on health insurance for up to another year. Met with senior HHS officials to talk about the future of the CLASS Act as well as health reform implementation. Supported the Prosthetic and Custom Orthotic Parity Act of 2010 (HR 2575/S 3220). The legislation would ensure that there that insurance provide equal coverage for prosthetics and orthotics that it does for other medical treatment. Met with senior House and Senate Hill staff to strategize on obtaining sufficient appropriations for the Social Security Administration to reduce the backlog in disability determinations and otherwise better serve people with disabilities. Met with senior SSA officials regarding SSAs new proposal for work incentives under SSDI and other Title II disability

Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. In health care reform HR 3590. Advocated for health insurance parity for coverage of prosthetic and orthotics devices, components and benefits for other medical and surgical services: under ERISA and HR 2575 for group health plans and group health insurance Social Security: HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions would have expired without reauthorization. Met with senior Senior SSA officials, as well as Senate and House staff regarding policies and possible legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities, electronic filing of disabilty applications and electronic authorizations for SSA to obtain medical records in connection with disabilities claims. - Met with SSA senior staff regarding draft report of SSA's Occupational Information Development Advisory Panel (OIDAP) that recommends dramatically different procedures to determine eligibility fordisability benefits under both Title II and Title XVI programs. -- Commented on on disabilty determinations for people with drug addiction and/or alcoholism. Supported HR 4532 to renew SSAs demonstration authority and to make permanent a successful demonstration that enables both attorneys and non-attorneys (who meet certain qualifications) representing Social Security disability claimants to be paid reasonable fees out of retroactive benefits. This practice enables many claimants (including those with mental illnesses and conditions such as post-traumatic stress disorder) to have good representation rather than to navigate the esoteric and complex application process on their own (often to be denied for procedural rather than substantive reasons). - Supported President's Budget proposal for SSA Limitation on Administrative expenses because the increased funding will help cut the backlog and delays in both the initial and hearing level disability determinations, thus providing disability benefits with less delay to people who meet SSA's strict eligibility requirements.

Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. In health care reform HR 3590. Advocated for health insurance parity for coverage of prosthetic and orthotics devices, components and benefits for other medical and surgical services: under ERISA and HR 2575 for group health plans and group health insurance Supported HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration Supported HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions would have expired without reauthorization. Met with senior Senior SSA officials, as well as Senate and House staff regarding policies and possible legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities, electronic filing of disabilty applications and electronic authorizations for SSA to obtain medical records in connection with disabilities claims. Submitted comments (in response to an SSA request) on complicated medical evidence issues when Social Security disability applicants have a co-occurring alcohol or substance use diagnosis and a serious mental illness. Supported HR 4532 to renew SSAs demonstration authority and to make permanent a successful demonstration that enables both attorneys and non-attorneys (who meet certain qualifications) representing Social Security disability claimants to be paid reasonable fees out of retroactive benefits. This practice enables many claimants (including those with mental illnesses and conditions such as post-traumatic stress disorder) to have good representation rather than to navigate the esoteric and complex application process on their own (often to be denied for procedural rather than substantive reasons). Supported President's Budget proposal for SSA Limitation on Administrative expenses because the increased funding will help cut the backlog and delays in both the initial and hearing level disability determinations, thus providing disability benefits with less delay to people who meet SSA's strict eligibility requirements. Asked HHS to ensure that lifetime caps are prohibited as of September 2010. Health insurance companies are arguing that they can keep lifetime caps on health insurance for up to another year. Met with senior HHS officials to talk about the future of the CLASS Act as well as health reform implementation. Supported the Prosthetic and Custom Orthotic Parity Act of 2010 (HR 2575/S 3220). The legislation would ensure that there that insurance provide equal coverage for prosthetics and orthotics that it does for other medical treatment. Met with senior House and Senate Hill staff to strategize on obtaining sufficient appropriations for the Social Security Administration to reduce the backlog in disability determinations and otherwise better serve people with disabilities. Met with senior SSA officials regarding SSAs new proposal for work incentives under SSDI and other Title II disability

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratoriumon Medicare therapy caps. Supported HR 4213 to extend federal FMAP assistance to the states until June 2011. Opposed HR 1255, a bill that would make it more difficult for the Protection and Advocacy System to file suits on behalf of people who are confined to institutions. See also Health.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratorium on Medicare therapy caps. See also Health.

Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. In health care reform HR 3590. Advocated for health insurance parity for coverage of prosthetic and orthotics devices, components and benefits for other medical and surgical services: under ERISA and HR 2575 for group health plans and group health insurance Supported HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration Supported HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions would have expired without reauthorization. Met with senior Senior SSA officials, as well as Senate and House staff regarding policies and possible legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities, electronic filing of disabilty applications and electronic authorizations for SSA to obtain medical records in connection with disabilities claims. Submitted comments (in response to an SSA request) on complicated medical evidence issues when Social Security disability applicants have a co-occurring alcohol or substance use diagnosis and a serious mental illness. Supported HR 4532 to renew SSAs demonstration authority and to make permanent a successful demonstration that enables both attorneys and non-attorneys (who meet certain qualifications) representing Social Security disability claimants to be paid reasonable fees out of retroactive benefits. This practice enables many claimants (including those with mental illnesses and conditions such as post-traumatic stress disorder) to have good representation rather than to navigate the esoteric and complex application process on their own (often to be denied for procedural rather than substantive reasons). Supported President's Budget proposal for SSA Limitation on Administrative expenses because the increased funding will help cut the backlog and delays in both the initial and hearing level disability determinations, thus providing disability benefits with less delay to people who meet SSA's strict eligibility requirements. Asked HHS to ensure that lifetime caps are prohibited as of September 2010. Health insurance companies are arguing that they can keep lifetime caps on health insurance for up to another year. Met with senior HHS officials to talk about the future of the CLASS Act as well as health reform implementation. Supported the Prosthetic and Custom Orthotic Parity Act of 2010 (HR 2575/S 3220). The legislation would ensure that there that insurance provide equal coverage for prosthetics and orthotics that it does for other medical treatment. Met with senior House and Senate Hill staff to strategize on obtaining sufficient appropriations for the Social Security Administration to reduce the backlog in disability determinations and otherwise better serve people with disabilities. Met with senior SSA officials regarding SSAs new proposal for work incentives under SSDI and other Title II disability

Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. In health care reform HR 3590. Advocated for health insurance parity for coverage of prosthetic and orthotics devices, components and benefits for other medical and surgical services: under ERISA and HR 2575 for group health plans and group health insurance Social Security: HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions would have expired without reauthorization. Met with senior Senior SSA officials, as well as Senate and House staff regarding policies and possible legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities, electronic filing of disabilty applications and electronic authorizations for SSA to obtain medical records in connection with disabilities claims. - Met with SSA senior staff regarding draft report of SSA's Occupational Information Development Advisory Panel (OIDAP) that recommends dramatically different procedures to determine eligibility fordisability benefits under both Title II and Title XVI programs. -- Commented on on disabilty determinations for people with drug addiction and/or alcoholism. Supported HR 4532 to renew SSAs demonstration authority and to make permanent a successful demonstration that enables both attorneys and non-attorneys (who meet certain qualifications) representing Social Security disability claimants to be paid reasonable fees out of retroactive benefits. This practice enables many claimants (including those with mental illnesses and conditions such as post-traumatic stress disorder) to have good representation rather than to navigate the esoteric and complex application process on their own (often to be denied for procedural rather than substantive reasons). - Supported President's Budget proposal for SSA Limitation on Administrative expenses because the increased funding will help cut the backlog and delays in both the initial and hearing level disability determinations, thus providing disability benefits with less delay to people who meet SSA's strict eligibility requirements.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratorium on Medicare therapy caps. See also Health.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratoriumon Medicare therapy caps. Supported HR 4213 to extend federal FMAP assistance to the states until June 2011. Opposed HR 1255, a bill that would make it more difficult for the Protection and Advocacy System to file suits on behalf of people who are confined to institutions. See also Health.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratorium on Medicare therapy caps. See also Health.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratoriumon Medicare therapy caps. Supported HR 4213 to extend federal FMAP assistance to the states until June 2011. Opposed HR 1255, a bill that would make it more difficult for the Protection and Advocacy System to file suits on behalf of people who are confined to institutions. See also Health.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratorium on Medicare therapy caps. See also Health.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratoriumon Medicare therapy caps. Supported HR 4213 to extend federal FMAP assistance to the states until June 2011. Opposed HR 1255, a bill that would make it more difficult for the Protection and Advocacy System to file suits on behalf of people who are confined to institutions. See also Health.

Supported HR 4247 and S 2860 the Preventing Harmful Restraint and Seclusion in Schools Act.

Supported HR 4247 and S 2860 the Preventing Harmful Restraint and Seclusion in Schools Act.

Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. In health care reform HR 3590. Advocated for health insurance parity for coverage of prosthetic and orthotics devices, components and benefits for other medical and surgical services: under ERISA and HR 2575 for group health plans and group health insurance Social Security: HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions would have expired without reauthorization. Met with senior Senior SSA officials, as well as Senate and House staff regarding policies and possible legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities, electronic filing of disabilty applications and electronic authorizations for SSA to obtain medical records in connection with disabilities claims. - Met with SSA senior staff regarding draft report of SSA's Occupational Information Development Advisory Panel (OIDAP) that recommends dramatically different procedures to determine eligibility fordisability benefits under both Title II and Title XVI programs. -- Commented on on disabilty determinations for people with drug addiction and/or alcoholism. Supported HR 4532 to renew SSAs demonstration authority and to make permanent a successful demonstration that enables both attorneys and non-attorneys (who meet certain qualifications) representing Social Security disability claimants to be paid reasonable fees out of retroactive benefits. This practice enables many claimants (including those with mental illnesses and conditions such as post-traumatic stress disorder) to have good representation rather than to navigate the esoteric and complex application process on their own (often to be denied for procedural rather than substantive reasons). - Supported President's Budget proposal for SSA Limitation on Administrative expenses because the increased funding will help cut the backlog and delays in both the initial and hearing level disability determinations, thus providing disability benefits with less delay to people who meet SSA's strict eligibility requirements.

Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. In health care reform HR 3590. Advocated for health insurance parity for coverage of prosthetic and orthotics devices, components and benefits for other medical and surgical services: under ERISA and HR 2575 for group health plans and group health insurance Supported HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration Supported HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions would have expired without reauthorization. Met with senior Senior SSA officials, as well as Senate and House staff regarding policies and possible legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities, electronic filing of disabilty applications and electronic authorizations for SSA to obtain medical records in connection with disabilities claims. Submitted comments (in response to an SSA request) on complicated medical evidence issues when Social Security disability applicants have a co-occurring alcohol or substance use diagnosis and a serious mental illness. Supported HR 4532 to renew SSAs demonstration authority and to make permanent a successful demonstration that enables both attorneys and non-attorneys (who meet certain qualifications) representing Social Security disability claimants to be paid reasonable fees out of retroactive benefits. This practice enables many claimants (including those with mental illnesses and conditions such as post-traumatic stress disorder) to have good representation rather than to navigate the esoteric and complex application process on their own (often to be denied for procedural rather than substantive reasons). Supported President's Budget proposal for SSA Limitation on Administrative expenses because the increased funding will help cut the backlog and delays in both the initial and hearing level disability determinations, thus providing disability benefits with less delay to people who meet SSA's strict eligibility requirements. Asked HHS to ensure that lifetime caps are prohibited as of September 2010. Health insurance companies are arguing that they can keep lifetime caps on health insurance for up to another year. Met with senior HHS officials to talk about the future of the CLASS Act as well as health reform implementation. Supported the Prosthetic and Custom Orthotic Parity Act of 2010 (HR 2575/S 3220). The legislation would ensure that there that insurance provide equal coverage for prosthetics and orthotics that it does for other medical treatment. Met with senior House and Senate Hill staff to strategize on obtaining sufficient appropriations for the Social Security Administration to reduce the backlog in disability determinations and otherwise better serve people with disabilities. Met with senior SSA officials regarding SSAs new proposal for work incentives under SSDI and other Title II disability

Stem Cell Research Improvement Act of 2009 allows for federal funding of embryonic stem cell research provided that certain ethical requirements are met (HR 873 and S 487). Supported the Cord Blood Education and Awareness Acts (H.R. 2107) inclusion in legislation being drafted to reauthorize the C.W. Young Cell Transplantation Program. H.R. 2107 would require uniform and medically accurate information to be developed by the Department of Health and Human Services and disseminated by maternal healthcare providers. Supported HR 1362 for MS and Parkinsons research.

Stem Cell Research Improvement Act of 2009 allows for federal funding of embryonic stem cell research provided that certain ethical requirements are met (HR 873 and S 487).

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. See also Medicare and Medicaid.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. Met with senior HHS officials to talk about implementation of health reform. See also Medicare and Medicaid.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratoriumon Medicare therapy caps. Supported HR 4213 to extend federal FMAP assistance to the states until June 2011. Opposed HR 1255, a bill that would make it more difficult for the Protection and Advocacy System to file suits on behalf of people who are confined to institutions. See also Health.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratorium on Medicare therapy caps. See also Health.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. See also Medicare and Medicaid.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. Met with senior HHS officials to talk about implementation of health reform. See also Medicare and Medicaid.

Supported HR 4247 and S 2860 the Preventing Harmful Restraint and Seclusion in Schools Act.

Supported HR 4247 and S 2860 the Preventing Harmful Restraint and Seclusion in Schools Act.

Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. In health care reform HR 3590. Advocated for health insurance parity for coverage of prosthetic and orthotics devices, components and benefits for other medical and surgical services: under ERISA and HR 2575 for group health plans and group health insurance Supported HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration Supported HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions would have expired without reauthorization. Met with senior Senior SSA officials, as well as Senate and House staff regarding policies and possible legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities, electronic filing of disabilty applications and electronic authorizations for SSA to obtain medical records in connection with disabilities claims. Submitted comments (in response to an SSA request) on complicated medical evidence issues when Social Security disability applicants have a co-occurring alcohol or substance use diagnosis and a serious mental illness. Supported HR 4532 to renew SSAs demonstration authority and to make permanent a successful demonstration that enables both attorneys and non-attorneys (who meet certain qualifications) representing Social Security disability claimants to be paid reasonable fees out of retroactive benefits. This practice enables many claimants (including those with mental illnesses and conditions such as post-traumatic stress disorder) to have good representation rather than to navigate the esoteric and complex application process on their own (often to be denied for procedural rather than substantive reasons). Supported President's Budget proposal for SSA Limitation on Administrative expenses because the increased funding will help cut the backlog and delays in both the initial and hearing level disability determinations, thus providing disability benefits with less delay to people who meet SSA's strict eligibility requirements. Asked HHS to ensure that lifetime caps are prohibited as of September 2010. Health insurance companies are arguing that they can keep lifetime caps on health insurance for up to another year. Met with senior HHS officials to talk about the future of the CLASS Act as well as health reform implementation. Supported the Prosthetic and Custom Orthotic Parity Act of 2010 (HR 2575/S 3220). The legislation would ensure that there that insurance provide equal coverage for prosthetics and orthotics that it does for other medical treatment. Met with senior House and Senate Hill staff to strategize on obtaining sufficient appropriations for the Social Security Administration to reduce the backlog in disability determinations and otherwise better serve people with disabilities. Met with senior SSA officials regarding SSAs new proposal for work incentives under SSDI and other Title II disability

Stem Cell Research Improvement Act of 2009 allows for federal funding of embryonic stem cell research provided that certain ethical requirements are met (HR 873 and S 487). Supported the Cord Blood Education and Awareness Acts (H.R. 2107) inclusion in legislation being drafted to reauthorize the C.W. Young Cell Transplantation Program. H.R. 2107 would require uniform and medically accurate information to be developed by the Department of Health and Human Services and disseminated by maternal healthcare providers. Supported HR 1362 for MS and Parkinsons research.

Stem Cell Research Improvement Act of 2009 allows for federal funding of embryonic stem cell research provided that certain ethical requirements are met (HR 873 and S 487).

Support HR 1205/S. 493, the Achieving a Better Life Experience Act of 2009 (ABLE Act). This legislation will allow individuals with disabilities to have access to the same type of savings instruments that other Americans use through the use of 401K, IRA and College Savings Account Families could establish savings accounts for specified education, medical and community-based services, including housing, transportation, employment training, and supports without jeopardizing other benefits vital to beneficiaries.

Support HR 1205/S. 493, the Achieving a Better Life Experience Act of 2009 (ABLE Act). This legislation will allow individuals with disabilities to have access to the same type of savings instruments that other Americans use through the use of 401K, IRA and College Savings Account Families could establish savings accounts for specified education, medical and community-based services, including housing, transportation, employment training, and supports without jeopardizing other benefits vital to beneficiaries.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratoriumon Medicare therapy caps. Supported HR 4213 to extend federal FMAP assistance to the states until June 2011. Opposed HR 1255, a bill that would make it more difficult for the Protection and Advocacy System to file suits on behalf of people who are confined to institutions. See also Health.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratorium on Medicare therapy caps. See also Health.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. Met with senior HHS officials to talk about implementation of health reform. See also Medicare and Medicaid.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. See also Medicare and Medicaid.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. Met with senior HHS officials to talk about implementation of health reform. See also Medicare and Medicaid.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. See also Medicare and Medicaid.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratoriumon Medicare therapy caps. Supported HR 4213 to extend federal FMAP assistance to the states until June 2011. Opposed HR 1255, a bill that would make it more difficult for the Protection and Advocacy System to file suits on behalf of people who are confined to institutions. See also Health.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. See also Medicare and Medicaid.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. Met with senior HHS officials to talk about implementation of health reform. See also Medicare and Medicaid.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratorium on Medicare therapy caps. See also Health.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. See also Medicare and Medicaid.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. Met with senior HHS officials to talk about implementation of health reform. See also Medicare and Medicaid.

Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. In health care reform HR 3590. Advocated for health insurance parity for coverage of prosthetic and orthotics devices, components and benefits for other medical and surgical services: under ERISA and HR 2575 for group health plans and group health insurance Supported HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration Supported HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions would have expired without reauthorization. Met with senior Senior SSA officials, as well as Senate and House staff regarding policies and possible legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities, electronic filing of disabilty applications and electronic authorizations for SSA to obtain medical records in connection with disabilities claims. Submitted comments (in response to an SSA request) on complicated medical evidence issues when Social Security disability applicants have a co-occurring alcohol or substance use diagnosis and a serious mental illness. Supported HR 4532 to renew SSAs demonstration authority and to make permanent a successful demonstration that enables both attorneys and non-attorneys (who meet certain qualifications) representing Social Security disability claimants to be paid reasonable fees out of retroactive benefits. This practice enables many claimants (including those with mental illnesses and conditions such as post-traumatic stress disorder) to have good representation rather than to navigate the esoteric and complex application process on their own (often to be denied for procedural rather than substantive reasons). Supported President's Budget proposal for SSA Limitation on Administrative expenses because the increased funding will help cut the backlog and delays in both the initial and hearing level disability determinations, thus providing disability benefits with less delay to people who meet SSA's strict eligibility requirements. Asked HHS to ensure that lifetime caps are prohibited as of September 2010. Health insurance companies are arguing that they can keep lifetime caps on health insurance for up to another year. Met with senior HHS officials to talk about the future of the CLASS Act as well as health reform implementation. Supported the Prosthetic and Custom Orthotic Parity Act of 2010 (HR 2575/S 3220). The legislation would ensure that there that insurance provide equal coverage for prosthetics and orthotics that it does for other medical treatment. Met with senior House and Senate Hill staff to strategize on obtaining sufficient appropriations for the Social Security Administration to reduce the backlog in disability determinations and otherwise better serve people with disabilities. Met with senior SSA officials regarding SSAs new proposal for work incentives under SSDI and other Title II disability

Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. In health care reform HR 3590. Advocated for health insurance parity for coverage of prosthetic and orthotics devices, components and benefits for other medical and surgical services: under ERISA and HR 2575 for group health plans and group health insurance Social Security: HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions would have expired without reauthorization. Met with senior Senior SSA officials, as well as Senate and House staff regarding policies and possible legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities, electronic filing of disabilty applications and electronic authorizations for SSA to obtain medical records in connection with disabilities claims. - Met with SSA senior staff regarding draft report of SSA's Occupational Information Development Advisory Panel (OIDAP) that recommends dramatically different procedures to determine eligibility fordisability benefits under both Title II and Title XVI programs. -- Commented on on disabilty determinations for people with drug addiction and/or alcoholism. Supported HR 4532 to renew SSAs demonstration authority and to make permanent a successful demonstration that enables both attorneys and non-attorneys (who meet certain qualifications) representing Social Security disability claimants to be paid reasonable fees out of retroactive benefits. This practice enables many claimants (including those with mental illnesses and conditions such as post-traumatic stress disorder) to have good representation rather than to navigate the esoteric and complex application process on their own (often to be denied for procedural rather than substantive reasons). - Supported President's Budget proposal for SSA Limitation on Administrative expenses because the increased funding will help cut the backlog and delays in both the initial and hearing level disability determinations, thus providing disability benefits with less delay to people who meet SSA's strict eligibility requirements.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. See also Medicare and Medicaid.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. Met with senior HHS officials to talk about implementation of health reform. See also Medicare and Medicaid.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratoriumon Medicare therapy caps. Supported HR 4213 to extend federal FMAP assistance to the states until June 2011. Opposed HR 1255, a bill that would make it more difficult for the Protection and Advocacy System to file suits on behalf of people who are confined to institutions. See also Health.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. See also Medicare and Medicaid.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. Met with senior HHS officials to talk about implementation of health reform. See also Medicare and Medicaid.

Funding for Social Security administrative expenses (SSA-LAE) to enable the Social Security Administration (SSA) to reduce the tragic backlog in disability determinations. Contact with both House and Senate and with covered executive branch officials of SSA to discuss a number of policy positions including privacy rights and other issues in processing disability applications (including SSA proposal for expedited record review); necessity for increased program integrity activities; electronic disability folders; cont expanding internet access for those representing claimants for disability benefits; use of video hearings; increased time for hearing notice; new screening initiatives including Quick Disability determinations and Compassionate Allowances; improved development of evidence earlier in the application and appeals processes; because it helps claimants to be well represented in the complex appeals and hearing process increasing and indexing the fee cap for representatives (HR 1093) and extending or making permanent the demonstrations for (i) voluntary Title II attorney fee withholding and direct payment procedures to Title XVI and (ii) allowing non-attorney representatives to qualify for fee withholding and direct payment provided that they meet certain requirements; evaluation of the effectiveness of the Ticket to Work and Work Incentives Improvement Act (TWWIIA) and extension of expired/expiring provisions; and the necessity for better processing of reported earnings and prompt adjustment of monthly benefits in order to minimize the serious problems created by overpayments to beneficiaries. Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program to be financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits.

Funding for Social Security administrative expenses (SSA-LAE) to enable the Social Security Administration (SSA) to reduce the tragic backlog in disability determinations. Contact with both House and Senate and with covered executive branch officials of SSA to discuss a number of policy positions including privacy rights and other issues in processing disability applications (including SSA proposal for expedited record review); necessity for increased program integrity activities; electronic disability folders; cont expanding internet access for those representing claimants for disability benefits; use of video hearings; increased time for hearing notice; new screening initiatives including Quick Disability determinations and Compassionate Allowances; improved development of evidence earlier in the application and appeals processes; because it helps claimants to be well represented in the complex appeals and hearing process increasing and indexing the fee cap for representatives (HR 1093) and extending or making permanent the demonstrations for (i) voluntary Title II attorney fee withholding and direct payment procedures to Title XVI and (ii) allowing non-attorney representatives to qualify for fee withholding and direct payment provided that they meet certain requirements; evaluation of the effectiveness of the Ticket to Work and Work Incentives Improvement Act (TWWIIA) and extension of expired/expiring provisions; and the necessity for better processing of reported earnings and prompt adjustment of monthly benefits in order to minimize the serious problems created by overpayments to beneficiaries. Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program to be financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits.

Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program to be financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. Included in Senate Affordable Health Choices Act. see also Social Security - next page. Social Security HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions will expire without reauthorization. Met with senior SSA officials and Hill staff regarding proposed legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities.

Increased funding for Social Security administrative expenses (SSA-LAE), for National Computer Center, for $250 stimulus payment to Title II and Title XVI beneficiaries -- to enable SSA to reduce the tragic backlogs at all stages of the disability determination process. Contact with both House and Senate and with covered executive branch officials of SSA to discuss a number of policy positions including privacy rights and other issues continued in processing of disability applications (including SSA proposal for expedited record review); necessity for increased program integrity activities; electronic disability folders; expanding internet access for those representing claimants for disability benefits; use of video hearings; increased time for hearing notice; new screening initiatives including Quick Disability Determinations and Compassionate Allowances; improved development of evidence earlier in the application and appeals processes; because it helps claimants to be well represented in the complex appeals and hearing process -- increasing and indexing the fee cap for representatives (HR 1093) and extending or making permanent the demonstrations for (i) voluntary Title II attorney fee withholding and direct payment procedures to Title XVI and (ii) allowing non-attorney representatives to qualify for fee withholding and direct payment provided that they meet certain requirements; evaluation of the effectiveness of the Ticket to Work and Work Incentives Improvement Act (TWWIIA) and extension of expired/expiring provisions; and the necessity for better processing of reported earnings and prompt adjustment of monthly benefits in order to minimize the serious problems caused to beneficiaries by overpayments. Community Living Assistance Services and Supports Act (CLASS Act) to create a national insurance program to be financed by payroll deductions to provide services to assist people with activities of daily living to stay in their homes and communities if they become disabled. People would not be required to impoverish themselves in order to qualify for benefits; S 697/H.R. 1721.

Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program to be financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. Included in Senate Affordable Health Choices Act. see also Social Security - next page. Social Security HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions will expire without reauthorization. Met with senior SSA officials and Hill staff regarding proposed legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities.

Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. HR 1721, S.697, HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill). Social Security: HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions would have expired without reauthorization. Met with senior SSA officials, as well as Senators, Representatives and staff regarding policies and possible legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities. Supported proposed legislation to provide an additional stimulus payment in 2010 for people receiving Social Security retirement and disability benefits and participated in call with representative of White House Council of Economic Advisors on this proposal. Supported proposed legislation to renew the Social Security Administrations demonstration authority and to make permanent a successful demonstration that enables both attorneys and non-attorneys (who meet certain qualifications) representing Social Security disability claimants to be paid reasonable fees out of retroactive benefits. This practice enables many claimants (including those with mental illnesses and conditions such as post-traumatic stress disorder) to have good representation rather than to navigate the esoteric and complex application process on their own (often to be denied for procedural rather than substantive reasons). Letter to Peter Orzag, Director of the Office of Management and Budget, urging sufficient administrative funding in FT 2010 for the Social Security Administration to continue reducing the tragic backlog in disability applications notwithstanding the recent unexpected surge in applications for both retirement and disability benefits.

Support HR 1205/S. 493, the Achieving a Better Life Experience Act of 2009 (ABLE Act). This legislation will allow individuals with disabilities to have access to the same type of savings instruments that other Americans use through the use of 401K, IRA and College Savings Account Families could establish savings accounts for specified education, medical and community-based services, including housing, transportation, employment training, and supports without jeopardizing other benefits vital to beneficiaries.

Comprehensive health care reform and the related goals of reducing costs, improving quality and expanding health care coverage for all Americans (including those who lack health insurance) including: providing for home and community-based services/long-term services and supports for people with disabilities and chronic conditions; comparative effectiveness research and use of information; prevention and wellness (including accessible medical equipment); health coverage that adequately meets the needs of people cont with disabilities and chronic conditions including having durable medical equipment that meets their individual needs, enables them to be as independent as possibile, to live in their homes and participate in the community, and to be employed without fear of losing the health care/services and supports they need. Comprehensive health care reform is also expected to make changes in Medicare, Medicaid and the State Childrens Health Insurance Program (SCHIP). S 4 is the placeholder bill in the Senate. No House bill yet. Medical Device Safety Act (S. 540/H.R. 1346) would prevent state preemption regarding liability for safety of medical devices H.R. 868 Direct Support Professionals (HR 868, no Senate bill yet) would secure federal funding to help states address issues regarding direct workforce professionals who provide services. Requested introduction of the Prosthetic and Orthotic Parity Act. No bill yet. See also Medicare/Medicaid

See next page Support comprehensive health care reform and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and all Americans (including those who lack health insurance). We hope that comprehensive health care reform will: Provide for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) Act* and the Community Choice Act.* Provide for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Provide for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry on how to treat individuals with disabilities; Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs -- that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits. Provide for insurance market reforms, such as those included in the Senates Affordable Health Choices Act and the Houses Americas Affordable Health Choices Act that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting lifetime caps on coverage. Currently many insurance companies have a lifetime benefit of $1 million. People with serious injuries or conditions often quickly exceed this cap due to lengthy hospital stays or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. *Pursued both independently and as part of health care reform: CLASS Act* -- S. 697/H.R. 1721 included in the Senates Affordable Health Choices Act. Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS Act will bring billions into the federal treasury and save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. HR 1346/S 540 * Support legislation to prohibit immunity from state laws for companies that have products that are approved medical devices but that cause harm. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services.

See next page Support comprehensive health care reform and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and all Americans (including those who lack health insurance). We hope that comprehensive health care reform will: Provide for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) Act* and the Community Choice Act.* Provide for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Provide for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry on how to treat individuals with disabilities; Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs -- that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits. Provide for insurance market reforms, such as those included in the Senates Affordable Health Choices Act and the Houses Americas Affordable Health Choices Act that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting lifetime caps on coverage. Currently many insurance companies have a lifetime benefit of $1 million. People with serious injuries or conditions often quickly exceed this cap due to lengthy hospital stays or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. *Pursued both independently and as part of health care reform: CLASS Act* -- S. 697/H.R. 1721 included in the Senates Affordable Health Choices Act. Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS Act will bring billions into the federal treasury and save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. HR 1346/S 540 * Support legislation to prohibit immunity from state laws for companies that have products that are approved medical devices but that cause harm. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. HR 3200 in House, Americas Healthy Future Act (Senate Finance Committee) and Affordable Health Choices Act (Senate HELP Committee) - no Senate bill numbers yet. Support health care reform legislation and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and all Americans (including those who lack health insurance). Issues with asterisks indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for insurance market reforms, such as those included in the Senates Affordable Health Choices Act and the Houses Americas Affordable Health Choices Act that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: oRequiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. oProhibiting annual and lifetime caps on coverage. Currently many insurance companies have a lifetime benefit of $1 million. People with serious injuries or conditions often quickly exceed this cap due to lengthy hospital stays or extensive rehabilitation oRequiring health insurance to cover rehabilitation and habilitative services and durable medical equipment, prosthetics and orthodics. oStop or limit copays for preventive care. Provide for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) Act* and the Community Choice Act.* Provide for comparative effectiveness research and using the resulting information in ways that respects that what works for many people will not work for all; Provide for prevention and wellness including oDeveloping standards for accessible medical equipment; oAuthorizing funds to establish a Prevention and Public Health Investment Fund; oProviding for community Transformation Grants that include focus on the needs of people with disabilities; oIncluding disability status within data collection on health disparities; oProviding training programs for primary care providers and dentistry on how to treat individuals with disabilities; Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including oCovering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs -- that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits. CLASS Act* -- S. 697/H.R. 1721 included in the Senates Affordable Health Choices Act. legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living, remain in their homes and off of the Medicaid program. CBO estimates that the CLASS Act will bring billions into the federal treasury and save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670) make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. End Medicares 24-month waiting period* - S 700/HR 1708 -- end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* create non-government independent entities to study the comparative effectiveness of treatments in health care. HR 1346/S 540 * regarding immunity from state laws for companies that have products that are approved medical devices but that cause harm. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Urged legislation to clarify that state Medicaid plans must ensure the provision of mandated care and Services to needy individuals not simply reimburse them, if they manage to obtain such services. (HR 3200 s. 1781(e) (page 826)) Without such a clarifying provision, current trends in the courts could significantly contract the availability of health services to underserved individuals and groups. First month purchase option Maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use so people with long term need will get the wheelchair that they need. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported language in HR 3200 and Senate Finance health bill that would exempt Class III and higher power wheel chairs from the rental period. Community First Choice Option in Americas Healthy Future Act -- allow states to create Medicaid plans that would reverse the institutional bias in Medicaid and provided 6% increase in FMAP matching funds to states. H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. HR 3200 in House, Americas Healthy Future Act (Senate Finance Committee) and Affordable Health Choices Act (Senate HELP Committee) - no Senate bill numbers yet. Support health care reform legislation and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and all Americans (including those who lack health insurance). Issues with asterisks indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for insurance market reforms, such as those included in the Senates Affordable Health Choices Act and the Houses Americas Affordable Health Choices Act that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: oRequiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. oProhibiting annual and lifetime caps on coverage. Currently many insurance companies have a lifetime benefit of $1 million. People with serious injuries or conditions often quickly exceed this cap due to lengthy hospital stays or extensive rehabilitation oRequiring health insurance to cover rehabilitation and habilitative services and durable medical equipment, prosthetics and orthodics. oStop or limit copays for preventive care. Provide for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) Act* and the Community Choice Act.* Provide for comparative effectiveness research and using the resulting information in ways that respects that what works for many people will not work for all; Provide for prevention and wellness including oDeveloping standards for accessible medical equipment; oAuthorizing funds to establish a Prevention and Public Health Investment Fund; oProviding for community Transformation Grants that include focus on the needs of people with disabilities; oIncluding disability status within data collection on health disparities; oProviding training programs for primary care providers and dentistry on how to treat individuals with disabilities; Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including oCovering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs -- that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits. CLASS Act* -- S. 697/H.R. 1721 included in the Senates Affordable Health Choices Act. legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living, remain in their homes and off of the Medicaid program. CBO estimates that the CLASS Act will bring billions into the federal treasury and save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670) make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. End Medicares 24-month waiting period* - S 700/HR 1708 -- end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* create non-government independent entities to study the comparative effectiveness of treatments in health care. HR 1346/S 540 * regarding immunity from state laws for companies that have products that are approved medical devices but that cause harm. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Urged legislation to clarify that state Medicaid plans must ensure the provision of mandated care and Services to needy individuals not simply reimburse them, if they manage to obtain such services. (HR 3200 s. 1781(e) (page 826)) Without such a clarifying provision, current trends in the courts could significantly contract the availability of health services to underserved individuals and groups. First month purchase option Maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use so people with long term need will get the wheelchair that they need. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported language in HR 3200 and Senate Finance health bill that would exempt Class III and higher power wheel chairs from the rental period. Community First Choice Option in Americas Healthy Future Act -- allow states to create Medicaid plans that would reverse the institutional bias in Medicaid and provided 6% increase in FMAP matching funds to states. H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services.

Frank Melville Supportive Housing Investment Act of 2009, HR 1675, to make significant changes and improvements to the Section 811 Supportive Housing for Persons with Disabilities program and authorize a demonstration program that fulfills the promise of true community integration as envisioned by the Americans with Disabilities Act. Support Inclusive Home Design Act, HR 2353, to advance housing accessibility by filling in gaps of Fair Housing Act & Sec 504 of the Rehabilitation Act. Support HR 1408 - which requires all newly constructed, federally assisted, single-family houses and town houses to meet minimum standards of visitability for persons with disabilities Support the Preserving Homes and Community Act (HR 3766 and S 1731) which would use TARP funds for mortgage relief and making rent more affordable

See next page Support comprehensive health care reform and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and all Americans (including those who lack health insurance). We hope that comprehensive health care reform will: Provide for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) Act* and the Community Choice Act.* Provide for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Provide for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry on how to treat individuals with disabilities; Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs -- that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits. Provide for insurance market reforms, such as those included in the Senates Affordable Health Choices Act and the Houses Americas Affordable Health Choices Act that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting lifetime caps on coverage. Currently many insurance companies have a lifetime benefit of $1 million. People with serious injuries or conditions often quickly exceed this cap due to lengthy hospital stays or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. *Pursued both independently and as part of health care reform: CLASS Act* -- S. 697/H.R. 1721 included in the Senates Affordable Health Choices Act. Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS Act will bring billions into the federal treasury and save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. HR 1346/S 540 * Support legislation to prohibit immunity from state laws for companies that have products that are approved medical devices but that cause harm. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services.

See next page and see also HCR - Health Care Issues. Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform bills ) end the institutional bias in Medicaid; amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with and communicated with the Medicare Ombudsman office to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance. HR 3631 Medicare Premium Fairness Act Makes premiums for Medicare Part B and the related monthly actuarial rate the same as those for 2009 for all Medicare enrollees, notwithstanding no COLAs (Cost of Living Adjustments). Urged legislation to clarify that state Medicaid plans must ensure the provision of mandated care and Services to needy individuals not simply reimburse them, if they manage to obtain such services. (HR 3200 s. 1781(e) (page 826)) Without such a clarifying provision, current trends in the courts could significantly contract the availability of health services to underserved individuals and groups, just as

See next page and see also HCR - Health Care Issues. Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform bills ) end the institutional bias in Medicaid; amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with and communicated with the Medicare Ombudsman office to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance. HR 3631 Medicare Premium Fairness Act Makes premiums for Medicare Part B and the related monthly actuarial rate the same as those for 2009 for all Medicare enrollees, notwithstanding no COLAs (Cost of Living Adjustments). Urged legislation to clarify that state Medicaid plans must ensure the provision of mandated care and Services to needy individuals not simply reimburse them, if they manage to obtain such services. (HR 3200 s. 1781(e) (page 826)) Without such a clarifying provision, current trends in the courts could significantly contract the availability of health services to underserved individuals and groups.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. In the House, HR 3962 (Affordable Care for America Act) and in the Senate HR 3590 (Patient Protection and Affordable Care Act) and Americas Healthy Future Act (Senate Finance Committee) and Affordable Health Choices Act (Senate HELP Committee). Support health care reform legislation and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits. Provide for insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the medical device excise tax that is proposed in both the House and Senate bills. The excise tax on manufacturers would increase their costs and could potentially increase costs for medical equipment for people with disabilities and chronic conditions who depend on them. Provide for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Provide for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Provide for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 150% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. continued on next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. See also Medicare and Medicaid.

Reauthorization of the State Childrens Health Insurance Program (SCHIP); H.R. 2/S. 275. Ending the Medicare Disability Waiting Period Act of 2009 to phase out the 24-month waiting period for Medicare for disabled individuals who become eligible for Title II Social Security benefits for Medicare benefits, to eliminate the waiting period for individuals with life-threatening conditions; S. 700/H.R. 1708. continued Community Choice Act to reverse the institutional bias in Medicaid and allow people with disabilities to stay in their homes and communities rather than be forced into institutions to receive needed services; S. 683/H.R. 1670. Community Living Assistance Services and Supports Act (CLASS Act) to create a national insurance program to be financed by payroll deductions to provide services to assist people with activities of daily living to stay in their homes and communities if they become disabled. People would not be required to impoverish themselves in order to qualify for benefits; S 697/H.R. 1721. S. 434 - to improve the State plan amendment option for providing home and community-based services under the Medicaid program. No House bill yet. Empowered at Home Act - to amend the Medicaid program to improve the home and community-based services (HCBS) option to encourage more states to provide the services to eligible people. The bill builds on the state option created by the Medicare Modernization Act whereby states were able to have HCBS as part of a state plan rather than as a Medicaid waiver program; S. 434. Requested introduction of legislation to reverse misguided Medicare regulations that pay for wheelchairs only as needed in the home, rather than as needed to be independent, to be employed and to participate in the community. No bill yet. Requested introduction of legislation to allow in-home care under Medicare for beneficiaries who need it, rather than just for those who do not leave their homes except in very limited circumstances. No bill yet. Requested introduction of the Prosthetic and Orthotic Parity Act. No bill yet. In letter to administration and CMS on Medicare Part D prescription drug coverage outlined concerns about protected drug classes, comparative effectiveness, and off label use of prescriptions.

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. See also Health.

See next page Support comprehensive health care reform and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and all Americans (including those who lack health insurance). We hope that comprehensive health care reform will: Provide for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) Act* and the Community Choice Act.* Provide for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Provide for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry on how to treat individuals with disabilities; Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs -- that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits. Provide for insurance market reforms, such as those included in the Senates Affordable Health Choices Act and the Houses Americas Affordable Health Choices Act that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting lifetime caps on coverage. Currently many insurance companies have a lifetime benefit of $1 million. People with serious injuries or conditions often quickly exceed this cap due to lengthy hospital stays or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. *Pursued both independently and as part of health care reform: CLASS Act* -- S. 697/H.R. 1721 included in the Senates Affordable Health Choices Act. Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS Act will bring billions into the federal treasury and save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. HR 1346/S 540 * Support legislation to prohibit immunity from state laws for companies that have products that are approved medical devices but that cause harm. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services.