CMS Seeking Comment on Durable Medical Equipment Interim Final Rule

CMS is seeking comments on an interim final rule that increases payments to suppliers for some DME and enteral nutrition in areas of the country that are not subject to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DEMPOS) Competitive Bidding Process (CBP). These include rural areas, and Alaska, Hawaii and the territories. From June 1 through December 31, 2018, payments will return to the blended rates that were in effect in 2016. 

The change is in response to stakeholder concerns about significant financial challenges created by the current rates for suppliers, as well as concerns that the number of suppliers in certain areas continues to decline. It is projected to result in a $70 million dollar Medicare cost-sharing increase to beneficiaries. This increase may be covered by supplemental insurance programs like Medigap, and for dual eligible beneficiaries, Medicaid pays the cost sharing. However, beneficiaries who do not have supplemental insurance or who are not dual eligible will have increased cost sharing.

For more information on Durable Medical Equipment Fee Schedule, Adjustments to Resume the Transitional 50/50 Blended Rates to Provide Relief in Rural Areas and Non-Contiguous Areas (CMS-1687-IFC) or to submit a comment on or before July 9, 2018, please visit Regulations..

 Self-Determination Network News:

May 2018

Connect | Share | Learn | http://sdnetworkwi.org/  

Supported Decision-Making Webinar May 21

Register now for a webinar about supported decision making on Monday May 21st.   Governor Walker recently signed a supported decision-making bill into law that gives people with disabilities and older adults options beyond guardianship for getting help with important decisions in their lives.  Attend this webinar sponsored by The Arc of Wisconsin to learn what the law in Wisconsin does and how you might use it in your life or to support a family member.

Join the Discussion!

The Self-Determination Network posts a discussion question related to self-determination/self-direction every month in hopes that we can share experiences and learn from each other.  Last month, we had a discussion about community employment for people with disabilities.  We're switching gears a little bit in May and talking about how self-direction has impacted our lives.   How has self-direction impacted your life?  What words of advice do you have for others just beginning to use self-direction?  Join the Discussion!

Registration is open for the 5^th annual Aging Empowerment Conference: Living a Self-Determined Life!

Join InControl Wisconsin and our sponsors as we welcome international empowerment expert, Dr. Simon Duffy. We’ll learn highlights of global developments in the field of aging and discuss the movement toward self-determination and self-direction. Friday’s Advocacy Summit will be a strategic planning session focusing on Building Strong Moments for Change, in Wisconsin and beyond.

Keynote Address: Are older people still citizens?

A test of any decent society is how it respects the older generation. Are older people at the center of family and community life, or are they isolated or institutionalized? Can people set their own path, even when they need extra help, or are they forced to do what others think is best for them? While people with disabilities have demanded equal rights and self-determination, older people are often forced to accept lower standards. Dr Simon Duffy is both a philosopher and practitioner, who has worked for 30 years to develop ideas and systems to advance equal citizenship for all. Simon will explain what is happening around the world to enable people to be true citizens at any age, and whatever their needs. Simon will also explore how the idea of citizenship - which connects ancient Greece to the civil rights movement - must be central to solving the problems - and seizing the opportunities - ahead of us.

Know an older adult who would be interested in attending? Register for the conference, bring an older adult for free!

*Conference attendance is an activity that fulfills advocacy related goals for county and tribal aging units in your next three-year aging service plan!

For more information, visit :  incontrolwi.org

The Self-Determination Network includes some very talented members and we want to help you to get to know each other a little better. Member Spotlight is a great way for us to get to know each other better.

For May, we shine the spotlight on, Tyler, a junior at UW-Whitewater . As if he isn't busy enough double majoring in Accounting and Economics, he also self-directs all of his own supports.  He encourages people not to settle and not to let the logistics stop you from achieving your dreams.  Stop by this month's Member Spotlight to get to know Tyler.

 Stacy’s Journal

“If it works, don’t fix it.” While it’s human nature for people to want to make things better, sometimes people forget to consider the repercussions of changing things will have on others. Change is hard for everyone. In this month's entry, Stacy discusses while most of the time change is for the better, sometimes with all repercussions of the change, it can do more harm than good.  We encourage you to share your thoughts and experiences as well.

Take five minutes to check out what's happening on the Self-Determination Network:

• Social Security Protections:  Thanks to a new law, people who handle Social Security payments for those with disabilities will be more closely monitored.  Read about how this law will more protect beneficiaries.
• Housing Voucher Opportunity: The U.S. Department of Housing and Urban Development (HUD) has announced a notice of funding availability for Mainstream Vouchers. Learn how these can help people with disabilities.
• Wisconsin Named Leader in Self-Direction:  In a recent report by AARP, Wisconsin was highlighted for being a leader in self-direction.  Find out why.
• Care Facilities Reviews:  People often don't know where to start when it comes time to look for nursing homes or assisted living centers.  Learn about how Yelp reviewers are looking at different aspects of care than the government reviews.
• Care Worker Shortage:  A recent study finds that Wisconsin's care worker shortage continues to grow.   Find out why this is and what's being done to address it.   
• Public Comment on Family Care Amendment:  The Department of Health Services is taking  public comment on an amendment to the Family Care Wavier.  Learn what changes are being proposed.  Public comment closes May 30th.
• Caregiver Survey: To better understand the challenges employers experience as they address the needs of employees with caregiving responsibilities, the Wisconsin Women’s Council in partnership with the Wisconsin Family and Caregiver Support Alliance is looking for employers of all sizes to participate in a first annual survey on caregiving.  The survey closes on May 30th.

 Upcoming Events                                    

Here's a sample of upcoming events listed on the Self-Determination Network:

• WI FACETS Self-Advocacy Workshop: Self-Advocacy Spotlight:  May 21st, 6p.m. to 8p.m., WI FACETS, Milwaukee WI
• Webinar: Training On Wisconsin’s New Supported Decision-Making Law:  May 21st, 6:30p.m. to 8p.m., Online 
  
• 2018 Employment First Conference:  May 22nd, Kalahari Resort, Wisconsin Dells WI
• 2018 Aging Empowerment Conference: June 14th-15th, Crowne Plaza Hotel and Conference Center, Madison WI

Post your event on the Self-Determination Network and it can be included in future Network News emails to members! Questions? Suggestions?  Contact Stacy Ellingen. 

The Self-Determination Network is powered by InControl Wisconsin and supported financially by our members and Sponsors. We couldn't keep this Network going with you!  Find out how you can help support the Network.

New Wisconsin Employer Survey on Employees & Caregiving

The Wisconsin Women’s Council (appointed by the Governor and the State Legislature) in partnership with the Wisconsin Family and Caregiver Support Alliance is looking for employers of all sizes to participate in a first annual survey on caregiving.  We seek to better understand the challenges employers experience as they address the needs of employees with caregiving responsibilities.  The intent of this survey is to improve information and other resources available to Wisconsin employers as they supportcaregivers on the job.

Survey Link:  https://www.surveymonkey.com/r/WICaregiving 

The survey will take less than 10 minutes to complete.  Deadline to participate: May 31

For purposes of this survey, caregiving is defined as support provided to a family member (beyond typical care for a minor child) who may be an older adult or person with a disability. Individual survey responses will remain confidential.  Survey results will be shared with participating employers.

About Us

• Wisconsin Women’s Council: http://womenscouncil.wi.gov/
• Wisconsin Family and Caregiver Support Alliance: http://wisconsincaregiver.org/alliance

If you have questions about the survey contact Christine Lidbury, Executive Director, Wisconsin Women’s Council Christine.Lidbury@wisconsin.gov  or Lisa Pugh, Co-chair, Wisconsin Family and Caregiver Support Alliance: Pugh@thearc.org.

Thank you for your participation.

A recent study finds that Wisconsin's care  worker shortage continues to grow.  The report found that 1-in-5 caregiver positions in the state are unfilled.  This is up from 1-in-7 in 2016.  Inadequate wages are believed to be turning people away from the field.  Due to the shortage, facilities are cutting back services despite up growing demand for long-term care.  The low Medicaid reimbursement rate plays a big factor in  this.  Initiatives such as the WisCaregiver Career Program, which recruits, tests, and trains 3000 certified nursing assistants, are trying to address this issue.

Read more

Registration is open for the 5^th annual Aging Empowerment Conference: Living a Self-Determined Life!

Join InControl Wisconsin and our sponsors as we welcome international empowerment expert, Dr. Simon Duffy. We’ll learn highlights of global developments in the field of aging and discuss the movement toward self-determination and self-direction. Friday’s Advocacy Summit will be a strategic planning session focusing on Building Strong Moments for Change, in Wisconsin and beyond.

Keynote Address: Are older people still citizens?

A test of any decent society is how it respects the older generation. Are older people at the center of family and community life, or are they isolated or institutionalized? Can people set their own path, even when they need extra help, or are they forced to do what others think is best for them? While people with disabilities have demanded equal rights and self-determination, older people are often forced to accept lower standards. Dr Simon Duffy is both a philosopher and practitioner, who has worked for 30 years to develop ideas and systems to advance equal citizenship for all. Simon will explain what is happening around the world to enable people to be true citizens at any age, and whatever their needs. Simon will also explore how the idea of citizenship - which connects ancient Greece to the civil rights movement - must be central to solving the problems - and seizing the opportunities - ahead of us.

Know an older adult who would be interested in attending? Register for the conference, bring an older adult for free!

*Conference attendance is an activity that fulfills advocacy related goals for county and tribal aging units in your next three-year aging service plan!

For more information, visit :  incontrolwi.org

People often don't know where to start when it comes time to look for nursing homes or assisted living centers..  Yelp reviewers are looking at different aspects of care than the government reviews. People want to know: How homey is it? How nice is it inside? Researchers evaluated 264 Yelp reviews of California facilities and grouped them into 5 categories: the quality of staff care and staffing, physical building and setting, resident safety and security, clinical care quality and financial issues.

Read more

Meet Tyler.  As if he isn't busy enough double majoring in Accounting and Economics at UW-Whitewater, he also self-directs all of his own supports.  He has developed a website to help others gain their independence.  Tyler encourages people not to settle and not to let the logistics stop you from achieving your dreams.  We’re so fortunate to have him as a member of the Self-Determination Network.

How are you involved with self-determination? Why did you join the SD Network?

Tyler’s involvement with self-determination is a result of him having to plan all his care needs while still going to school. He joined the SD Network in an effort to share his experiences as well as learn from others. 

Tell us some good news - what's the most exciting thing happening for you (or in Wisconsin) in terms self-determination?

Tyler shared that recently he met with an organization on campus to begin the process of looking for jobs. This involved preparing his resume and looking for careers in the area. He’s also excited that recently hired a new caregiver. 

What tip or resource would you like to share with people who want to be more self-determined?

Tyler has some great recommendations who would like to become self-determined and more independent. First, be willing to ask for help. He explains that there are several people willing to help you with your needs, you just need to reach out and ask. You’ve already taken a big step towards this by joining this network, but if you still have questions that need answering don’t be afraid to ask. Second, be willing to go outside your comfort zone. He says that he considers himself to be a very shy person, but he knew that if he wanted to pursue independence, he would need to come out of his shell a little bit. Third, h encourages people to look for resources in your area. Your local ADRC is a great place to start. Finally, make a set of goals and work to achieve those goals. Everyone is different, and what is Independence for one person may not be the same as independence for another. You should set goals for yourself and do your best to achieve those goals. He also has advice on his website www.transition2collegewi.com.

What message would you like to share with the members of the SD Network?

A message that Tyler would like to share with everyone is don’t settle. He says, “achieve you goals and dreams so you don’t have any regrets. Don’t let logistics get in the way of achieving your goals!” 

What are some of your hobbies?

When Tyler isn’t busy studying, he enjoys watching Netflix and playing board and tabletop games.

***We love hearing the views and opinions of Network members. We need to mention that the views and opinions expressed on this site are those of the person who is sharing them. They do not necessarily reflect InControl Wisconsin or any of our supporters and funders.

As the saying goes, “if it works, don’t fix it.”   In today’s world, where it often seems like we’re trying to improve everything for one reason or another, that saying is frequently forgotten or ignored.  While it’s human nature for people to want to make things better, sometimes people forget to consider the repercussions of changing things will have on others.  Change is hard for everyone.  Due to a variety of reasons, people with disabilities often struggle with change.  Whether it be a change in a material good or a change in an essential service, changes affect all of us.

I’m the first to admit that I don’t do well with change.  I’m convinced a big reason for this is because I live such a scheduled life.  As I’ve shared in a previous entry, due to having drop-in cares, my whole day is scheduled—everything from the time I get up in the morning, to the times I use the restroom and eat meals, to the time I go to bed at night, everything has a set time.  When I’m out of my routine, my body often starts to react in weird ways.

Changes in material goods often have mixed effects on people with disabilities too.  Many times, when material things are improved or upgraded, it often makes life easier for everyone.  However, sometimes when things changed, people don’t realize how it will affect others.  Recently, I read an article online about how the United Kingdom is trying to ban disposable plastic straws because they’re not environmentally friendly.  The article explained why this wouldn’t be good for people with disabilities.  To the average person, this probably doesn’t make a lot of sense.  Why wouldn’t banning plastic straws have such a negative impact on people with disabilities?  For me, personally, being able to drink from a straw “independently” didn’t come easy.  For many years, I either had to drink directly from a cup (someone had to pour liquid directly into my mouth) or someone had to literally hold my lips closed on a straw so I could suck the liquid up.  I think it was nearly college before I was able to use a plastic bendable straw by myself (meaning I’m able to suck liquid through a straw without somebody having to hold my lips shut).  It’s much more socially appropriate to independently drink from a straw than to have somebody pour liquid into your mouth or having someone hold your lips shut on a straw.  Having said that, most hard reusable straws aren't feasible for me (I don't have the ability to get enough suction to get the liquid up with hard straws). Lots of hard straws aren’t bendable either which poses another problem.  Some people, like myself, have a hard time positioning himself/herself to access a regular stick straw; bendable disposable plastic straws are often easier to get at.  Paper straws often aren’t a realistic option for some people with disabilities either.  In my case, because of the way I latch onto the straw, I’d ruin a paper straw even being able to try to suck on it.  Many of my friends with cp have the same issues with straws.  While I’m all for being environmentally friendly, I’m not sure eliminating disposable plastic straws would do much good.

Advancements in technology have made a huge positive impact on lives of people with disabilities.  However, advancements sometimes bring on more challenges that people don’t often think about.  For example, flat screen TVs have become the norm.  While they save a lot of space and are neat, the one thing they normally don’t have are controls on the front of the TV.  Most people wouldn’t even think about this; however, for me, having to use a remote to control the TV presents some challenges.  Due to my fine motor limitations, I can’t just grab the remote and press a button to turn TV on.  In order for me to work a TV remote, it has to be on a hard surface (like a table) and aimed at the TV.  Depending on the setup, the remote often has to be velcroed to the table so it doesn’t fall off when I try to hit the buttons.  Before when buttons were on front of TVs, I could just press them on the TV itself.  Another example of how technological improvements have made some additional hurdles for me is with the adaptive keyboard I use.  Since I was really young, I’ve used enlarged keyboards with mouse functions built-in (meaning I control the mouse by pressing buttons on the keyboard).  I’ve used the same brand of keyboard for over 15 years.  These keyboards wear out because of just over usage.  A few years ago, it was time to get a new computer and It was then I realized that the keyboard I’ve been using hard been discontinued.  I had an assistive tech evaluation done to see if there was anything similar out there.  Unfortunately, to my surprise, there isn’t another enlarged keyboard that has a built-in mouse on the market.  Luckily, the discontinued keyboard still works computers with newer operating systems, so we bought quite a few used keyboards off eBay.  I’ll use those until another keyboard with a built-in mouse is developed.  I can only guess that the keyboard was discontinued due to more advanced products being developed; however, before something is discontinued, there should be something similar made to replace it.

Some home products are often adapted to be made “handicapped accessible.”  Most of the time, these accessible products make life easier for people with disabilities.  There have been times, however, where I’ve found it’s actually more difficult to use adapted products.  One example that comes to mind is when the housing authority tried installing a high-rise toilet in the bathroom in my apartment.  While I can normally use high-rise toilets, because of the way my bathroom is setup, I would have had a much harder time using a high-rise toilet.  Fortunately, the housing authority eventually listened to me and let me keep the regular toilet.  That’s just one example of where an adapted product didn’t work in my favor.

People say change is good, and I agree most of the time that it is.  However, sometimes with all repercussions of the change, it can do more harm than good.  We, as a society, just have to remember to consider how it will affect everybody involved when making a change! 

***The views expressed here are strictly those of the author and do not necessarily reflect those of InControl Wisconsin, the Network or any of our sponsors.

The Centers for Medicare & Medicaid Services (CMS) is requesting input to help develop a potential mode for direct provider contracting.

A direct provider contract model would allow providers to take further accountability for the cost and quality of a designated population in order to achieve better beneficiary outcomes. Such a model would have the potential to enhance the doctor-patient relationship by eliminating administrative burden for clinicians and providing increased flexibility to give the high-quality care that is most appropriate for their patients, thus improving quality while reducing expenditures.

Please submit comments to the CMS Innovation Center at DPC@cms.hhs.gov by 11:59 pm EDT, May 25, 2018.

View more details about this request for information.