By George S. Holliday, Chair
The 2015 Legislative Seminar of the American Council of the Blind, (ACB) was held on Monday, February 23, and concluded on Tuesday, February 24, with visits to Congressional offices. Seven members attended on behalf of Pennsylvania.
Remarks from ACB President, Kim Charlson opened the 2015 ACB Legislative Seminar. After the introduction of seminar attendees, the following topics were addressed:
- What’s New in the Land of Video Description and Accessible Emergency Alerts Compliance
- The Good, the Grief, and the Regulatory Agenda for 2015 at the S. Department of Transportation
- The Do’s and Don’ts of Meeting with Members of Congress and Their Staff
- The Universe of Policy Issues that Employers of People Who are Blind are Working on
This year’s seminar focused on three legislative imperatives: Medicare Demonstration of Coverage for Low Vision Devices Act of 2015, The Alice Cogswell and Anne Sullivan Macy Act, and the Marrakesh Treaty for the Blind, and the need for the U.S. Senate to ratify it. I encourage all PCB members to broaden their understanding of these issues by taking the time to download and listen to these presentations. The archives of the seminar can be found on the ACB website at http://acbradio.org/node/90.
Since PCB President Tony Swartz has described the Marrakesh Treaty for the Blind in his President’s Message earlier in this publication, I will focus my efforts on sharing with you the ACB’s information stating the case for the remaining two imperatives.
Imperative I: H.R. 729, Medicare Demonstration of Coverage for Low Vision Devices Act of 2015
You can also find this on the ACB website at: http://acb.org/LILVdevice
In November 2008, the Centers for Medicare and Medicaid Services (CMS) promulgated a regulation that has had a detrimental impact on the lives of countless individuals who are blind or visually impaired.
To the dismay of the blind community, the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Acquisition Rule contains a provision entitled “Low Vision Aid Exclusion” which states that all devices “irrespective of their size, form, or technological features that use one or more lens to aid vision or provide magnification of images for impaired vision” are excluded from Medicare coverage based on the statutory “eyeglass” exclusion. ACB is well aware that this extremely restrictive reading of the “eyeglass” exclusion has resulted in the denial of vital assistive devices for seniors and other Medicare beneficiaries who may have disabilities, particularly those with vision loss, who need to use such devices to live healthy, safe and independent lives.
This proposal has had a significant impact on beneficiaries with vision impairment who depend on assistive technology that incorporates one or more lenses to aid in their vision. The expansion of the eyeglass exclusion has prevented access to devices such as hand-held magnifiers, video monitors, and other technologies that utilize lenses to enhance vision. These tools are often essential for individuals with low vision who, without the aid of assistive technology, cannot read prescriptions, medicine bottles, and other important materials containing content that is vital to their personal health and safety.
In short, these devices allow individuals with low vision to live independently and safely and to perform activities of daily living.
Without the aid of such assistive devices, many more individuals will be forced into care facilities as our population ages. Seniors on fixed incomes often find the cost of such devices burdensome and therefore are unlikely to be able to afford to purchase them on their own.
The initial impact of this unreasonably narrow interpretation of the eyeglass exclusion has meant a decrease in access to current devices, since prior to this rule change, it was not uncommon for administrative law judges to require Medicare to provide them to beneficiaries who had visual impairments and could demonstrate the requisite necessity. We believe the proposal will have an even more detrimental impact in the long term. The expansion of the statutory eyeglass exclusion to include any technology that uses “one or more lens for the primary purpose of aiding vision,” serves as a pre-emptive and unwarranted coverage denial for any new technology designed to assist individuals with vision loss.
ACB believes that this pre-emptive coverage denial is particularly harmful because it serves as a tremendous disincentive to innovators and researchers to develop new and progressive vision technology. Medicare coverage policies often drive the coverage policies of private health plans, which are influential when it comes to investments in research and development. If Medicare continues to maintain this coverage exclusion for low-vision aids, we will undoubtedly see a decrease in innovation in this area.
ACB urges the House of Representatives to promptly pass H.R. 729, the Medicare Demonstration of Coverage for Low Vision Devices Act of 2015. This legislation would evaluate, through a five-year national demonstration project administered by the Department of Health and Human Services, the fiscal impact of a permanent change to the Social Security Act. This legislation would allow reimbursement for certain low-vision devices that are the most function-rich, most powerful, and most expensive. The devices would be considered durable medical equipment. Individuals will be eligible to participate in the demonstration project only after completing a clinical evaluation performed by an ophthalmologist or optometrist who would then deem a low-vision device as medically necessary. The national demonstration project is designed to provide a rich, well-structured and defined data set that can yield Medicare-program-wide evidence-based conclusions using appropriate statistical methods.
Imperative II: The Reintroduction of the Alice Cogswell and Anne Sullivan Macy Act
You can also find this on the ACB website at: http://acb.org/LICogswellMacy
Since 1975, Public Law 94-142, now the Individuals with Disabilities Education Act (IDEA), has revolutionized educational opportunity for all children and youth with disabilities. However, without key improvements, our national special education system cannot fully keep IDEA’s promise of a truly appropriate education for students who are blind or visually impaired. The Alice Cogswell and Anne Sullivan Macy Act is intended to do just that — to improve the delivery of appropriate special education and related services to all students who are blind or visually impaired, deaf or hard of hearing, or deaf-blind, including students who may have additional disabilities. Once enacted, the legislation will ensure that properly designed and individually tailored services are in fact provided, meeting the unique learning needs of students who are blind or visually impaired, and that the educators who serve them are prepared and supported to do their jobs well, based on evidence-driven best practice.
During the next two years, the U.S. Congress may review and amend IDEA as part of its periodic reauthorization of the law. The Alice Cogswell and Anne Sullivan Macy Act can be passed by Congress at any time in advance of IDEA reauthorization, or it can be incorporated, in whole or in part, into reauthorization itself.
ACB encourages members of the House of Representatives to sign a “Dear Colleague” letter that Rep. Matt Cartwright (D-Pa.) is actively circulating to gain support in advance of the bill’s imminent reintroduction.
This legislation will:
- Ensure that every student with vision loss is properly identified, regardless of formal disability category or classification so that all students who are blind or visually impaired, including those with additional disabilities, are counted and properly served.
- Expand knowledge about the scope and quality of special education and related services provided to students who are blind or visually impaired through refined data collection that tracks all students with vision loss, regardless of formal disability category or classification.
- Expect states to conduct strategic planning, and commit such planning to writing, to guarantee that all students who are blind or visually impaired within each state receive all specialized instruction and services needed by students with vision loss, provided by properly trained personnel.
- Clarify that proper evaluation of students who are blind or visually impaired includes evaluation for students’ needs for instruction in communication and productivity (including braille instruction and assistive technology proficiency inclusive of low-vision devices where appropriate); self-sufficiency and interaction (including orientation and mobility, self-determination, sensory efficiency, socialization, recreation and fitness, and independent living skills); and age-appropriate career education. Such instruction and services constitute the Expanded Core Curriculum, the body of services which teachers of students with visual impairments and related professions are expertly trained to provide.
- Ramp up U.S. Department of Education responsibilities to monitor and report on states’ compliance with their obligations with respect to instruction and services specifically provided to students who are blind or visually impaired.
- Assist parents and educators of students who are blind or visually impaired through regular and up-to-date written policy guidance from the U.S. Department of Education.
- Establish a national collaborative organizational resource, the Anne Sullivan Macy Center on Vision Loss and Educational Excellence, to proliferate evidence-based practices in the education of students who are blind or visually impaired, to keep special educators current with the latest instructional methods, and to supplement state and local educational agency provision of the instruction and services constituting the Expanded Core Curriculum.
What Will It Cost?
Currently, the federal government spends nearly $12 billion a year to help states offer special education to students with disabilities. While this is a significant investment, it represents only about 16% of the total national cost of special education. The Cogswell/Macy Act does not add to these costs, but rather puts safeguards in place to ensure that funds spent on students with sensory disabilities are maximized and used for the most effective services. Without the Cogswell/Macy Act, both federal and state dollars can be misdirected to services that are ineffective because they do not meet the unique educational needs of students with sensory disabilities. In addition, the Cogswell/Macy Act establishes a national resource center, not unlike such resources currently serving the deaf and deaf-blind communities, to strengthen the capacity of the vision loss community to provide effective special education and related services. This center would be supported through a federal investment of $22 million per year, a cost that represents about 0.02% of all federal special education spending.
I encourage everyone reading this article to get involved. The above imperatives affect us all. As you read above, seven PCB members attended the ACB legislative seminar and visited Congress to discuss the imperatives and encouraged the sponsoring of the bills.
The PCB Advocacy & Governmental Affairs Committee (AGAC) encourages ALL CHAPTER PRESIDENTS to establish an Advocacy committee or appoint someone to address advocacy issues within your chapter. Once this advocacy effort is established, contact information should be sent to George Holliday at firstname.lastname@example.org or via telephone at 215-796-9813.
Also, the AGAC is planning two state-wide call-in-days to be announced at a later date. These days are designated for everyone — and I mean everyone — reading this article to encourage chapter members, family and friends to telephone their Congressperson to support and sponsor the above bills.
Last year, President Swartz issued an advocacy challenge to every member of our organization to coordinate our efforts through our Advocacy and Governmental Affairs Committee so that we might meet the advocacy challenge. Are you up for the challenge for 2015? The PCB Advocacy and Governmental Affairs committee is up for the challenge, but we can’t do it without your assistance. So, let us hear from you. Find out how you can get involved. Let’s continue working together for a better tomorrow.