[Congressional Record Volume 148, Number 105 (Monday, July 29, 2002)]
[Extensions of Remarks]
[Pages E1469-E1470]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 SUPPORT FOR H.R. 3612, THE MEDICAID COMMUNITY ATTENDANT SERVICES AND 
 SUPPORTS ACT (MiCASSA) ON THE 12TH ANNIVERSARY OF THE AMERICANS WITH 
                            DISABILITIES ACT

                                 ______
                                 

                          HON. DANNY K. DAVIS

                              of illinois

                    in the house of representatives

                         Friday, July 26, 2002

  Mr. DAVIS of Illinois. Mr. Speaker, I rise to recognize the 12th 
anniversary of the Americans with Disabilities Act and to request 
support for H.R. 3612, the Medicaid Community-Based Attendant Services 
and Supports Act, also known as MiCASSA. It is fitting that we give 
special attention to the merits of this important bill as we recognize 
the twelfth anniversary of the Americans with Disabilities Act. On July 
26, 1990 President George Bush signed the Americans with Disabilities 
Act into law. This landmark civil rights legislation ushered in a new 
era of promise for a segment of our population whose talents and rights 
as American citizens have been too long ignored. It established a new 
social compact that seeks to end the paternalistic patterns of the past 
that take away our rights if we become disabled. It says that people 
with disabilities have the right to be active participants integrated 
into the everyday life of society.
  Much like the promise of the 1965 Civil Rights Act, however, the 
promise cannot become a reality until we roll up our sleeves and do the 
work necessary to eliminate the barriers, which still hinder its full 
implementation. While some recent decisions of the Supreme Court have 
threatened the scope of the ADA, I would like to call our attention to 
a Supreme Court ruling that reaffirms the fundamental principle that 
people with disabilities have the right to be active participants 
integrated into the everyday life of society. In 1999, the Court ruled 
in the Olmstead case that states violate the Americans with 
Disabilities Act when they unnecessarily put people with disabilities 
in institutions. The problem is that our Federal-State Medicaid Program 
has not been updated and has a built-in bias that results in the 
unnecessary isolation and segregation of many of our senior citizens 
and younger adults in institutions.
  In the case of Medicaid beneficiaries who need long-term support 
services, the only option currently guaranteed by Federal law in every 
State is nursing home care. Too often decisions relating to the 
provision of long-term services and supports are influenced by what is 
reimbursable under Federal and State Medicaid policy rather than by 
what individuals need and deserve. Research has revealed a significant 
bias in the Medicaid program toward reimbursing services provided in 
institutions over services provided in home and community settings. 
Other options have existed for decades but their spread has been 
fiscally choked off by the fact that 75% of our long term care dollars 
go to institutional settings, in spite of the fact that studies show 
that many people do better in home and community settings.
  Only 27 States have adopted the benefit option of providing personal 
care services under the Medicaid program. Although every State has 
chosen to provide certain services under home- and community-based 
waivers, these

[[Page E1470]]

services are unevenly distributed within and across the States, and 
reach just a small percentage of eligible individuals. In the words of 
Howard Dean, the Governor of Vermont who also happens to be a physician 
and who recently testified on Capitol Hill on behalf of the National 
Governors Association, ``We can provide a higher quality of life by 
avoiding institutional services whenever possible. . . . We will still 
need quality nursing home care for the foreseeable future, but we can 
maintain the necessary level of needed nursing home care while growing 
home and community based services if Congress will give the States the 
tools.''
  The MiCASSA bill is precisely the tool both the States and consumers 
need to obtain more cost effective long-term services in the most 
appropriate setting for the individual. Instead of creating a new 
entitlement, MiCASSA makes the existing entitlement more flexible. It 
amends Title 19 of the Social Security Act and creates an alternative 
service called Community Attendant Services and Supports. This allows 
individuals eligible for Nursing Facility Services or Intermediate Care 
Facility Services for the Mentally Retarded, regardless of age or 
disability, the choice to use these dollars for ``Community Attendant 
Services and Supports.''
  These attendant services and supports range from assisting with 
activities of daily living, such as eating, toileting, grooming, 
dressing, bathing and transferring, as well as other activities 
including meal planning and preparation, managing finances, shopping 
and household chores.
  Quality assurance programs, which promote consumer control and 
satisfaction, are also included in this bill. The provision of services 
must be based on an assessment of functional need and according to a 
service plan approved by the consumer. It also allows consumers to 
choose among various service delivery models including vouchers, direct 
cash payments, fiscal agents and agency providers.
  Some have argued that such a flexible and consumer friendly option 
would bring people who need these services ``out of the woodwork'' and 
make our Medicaid costs skyrocket. This bill has been put together 
based on what we have learned from pilot programs and best practices 
throughout the States. Oregon and Kansas have data to show that fear of 
skyrocketing costs is blown out of proportion. While there may be some 
increase in the number of people who use this option at first, savings 
will be made on the less costly community based services and supports, 
as well as the decrease in the number of people going into 
institutions. The bill also allows states to limit the total amount 
spent on long-term care in a year to what the state would have spent on 
institutional services.
  Whether a child is born with a disability, an adult has a traumatic 
injury or a person becomes disabled through the aging process, we can 
and must do better in offering our citizens the kind of long term care 
services they need and deserve. I can think of no better way to honor 
the memory of our departed disability rights leader, Justin Dart, who 
died on June 22nd and was known by many as the father of the Americans 
with Disabilities Act than to support passage of H.R. 3612.

                          ____________________