A n A N C O R p u b l i c a t i o n o f p r i v a t e p r o v i d e r p r a c t i c e a n d f e d e r a l p o l i c y i s s u e s

A p r i l 2 0 1 0 • V o l u m e 4 1 • N u m b e r 4 • w w w . a n c o r . o r g

L INKS

Last year, 2009, was definitely a tough year. To help providers weather the storm, Quint Studer, ANCOR keynote and leadership specialist, has a suggestion: Make 2010 the year you focus on leadership. Not leaders, mind you – leadership.

Products and services change with the demands of the market. Individual leaders

come and go. The key is to create an organi-zational culture that ensures great leadership today and tomorrow.

In other words, you need a long-term fix, not a magic bullet or a trendy program du jour or a charismatic leader. You need a culture built on good, solid, time-tested leadership principles. Studer urges organizations to institute proven across-the-board behaviors that don’t depend on particular individuals. The tried and true “best practices” he shares with his health and human services clients– collectively called evidence-based leadership – enable companies of all types to create results that last.

These practices are not complicated. They’re simple, commonsense tactics that leaders can get their hands around and start doing right away. In fact, Studer says if you imple-ment these five “biggies” you’ll see dramatic changes by the end of 2010:

Get rid of low performers. Now. Yes, despite the layoff ax so many companies have wielded during the past year, low performers still work inside many organizations. And they are caus-ing big problems. Let’s say your employee Car-ol consistently comes in late, gets “headaches” every other (non-payday) Friday, and spends more time cheerily chatting up coworkers than she does working. Others will notice – and they will be resentful. But worse than merely caus-ing contention in the ranks, turning a blind eye to the “Carols” in your organization squelches profitability. Why? Because middle performers

get pulled down to the low-performer level, while high performers either a) disengage or b) leave.

“Too many of us give low performers a pass,” says Studer, whose remedy involves imple-menting a structured series of high-middle-low performer conversations. “It’s easier not to confront low performers, and trust me, a leader can find a thousand other things to do instead. But until you move them either up or out, your company will never advance beyond short-term gains. The low performer is an anchor holding everyone else back. Make this year the year you quit looking the other way.”

Accentuate the positive. The next time you’re having lunch in a restaurant, listen in on the conversations at nearby tables. Chances are, you’ll hear people griping about their work-loads, difficult clients, annoying coworkers, or the ridiculousness of corporate policy. Every-one does it, but if they realized how harmful it is to their company, perhaps they’d think twice. The solution, says Studer, is to hone the fine art of managing up.

“Managing up means positioning your people, products, or company in a positive light,” says Studer. “Managing up doesn’t just happen; you have to make it happen in a systematic way. Help employees understand what can happen when negativity is allowed to breed – good people quit and customers leave – and they’ll be more likely to stop doing it.”

Make a real connection with employees – every day. Studer is a big proponent of what he calls “rounding for outcomes.” Like many of his tactics, this critical leader behavior reveals his health care industry roots. Rounding helps you communicate openly with your employ-ees, allowing you to regularly find out what is going well and what isn’t going well for them

Inside this issue of LINKS

A DSP Making a Difference, p. 8.

New Partnerships Provide Services, Save Money, p. 9.

State Association View: Where are Disability Services Heading? p. 23.

ANCOR and Health Care Reform, a 40 Year Journey, p. 29.

Five Leadership Tactics That Will Make 2010 A Pivotal Business Year

at the company. But remember, says Studer, it’s not just empty “face time” – it’s rounding for outcomes, which means the process has a serious purpose.

“In the business world, a CEO, VP, or depart-ment manager makes the rounds daily to check on the status of his employees,” explains Studer. “Basically, you take an hour a day to touch base with employees, make a personal connection, recognize success, find out what’s going well, and determine what improvements can be made. Rounding is the heart and soul of building an emotional bank account with your employees, because it shows them day in and day out that you care.”

Say thanks. In fact, put it in writing. Studer is a big advocate of sending thank-you notes to employees who do an excellent job. But that doesn’t mean just sending the occasional note when someone goes far above the call of duty. It means literally mandating a specific

See Leadership, page 5.

Reneé Pietrangelo

LINKS April 20102

making to determine and implement aggressive strategies that help assure ANCOR’s relevance and value-added into the future. Within the past month, we disseminated a multidimensional marketing survey to each member organization, the responses to which will help provide clarity around ANCOR value-added and priorities.

2. Protect the core. Financial constraints often mean not being able to pursue all our usual activities. Rather than making across-the-board cuts, however, we should prioritize our core activities. The same should be said for state governments as they try to cover budget shortfalls. Funding should be cut to less criti-cal activities. To act on this advice, however, leaders and board members must answer two questions: What activities and beneficiaries define the essence of our organization? And what do these core services cost? It’s key that we have a crystal clear understanding of the ROI of each of our programs, services and activities. Through the Management Practices Conference and the SRPN, ANCOR is making consulting resources for assessing ROI avail-

CEO PerspectiveSeven Healthy Habits for Surviving the Economic Downturn

ANCOR’s VisionAdvancing excellence in supports and services ~ Leading the way to

communities of choice.

ANCOR’s MissionTo inform, educate and network service providers to safeguard, develop, grow and extend their

capacity to support the choices of people with disabilities.

2 CEO Perspective 3 President’s Corner

2010 Management Practices Conference

14 Trade Show Exhibitors

General

1 Five Leadership Tactics That Will Make 2010 A Pivotal Business Year 8 DSP Chronicles: Nancy Beatty 9 New Partnerships Announced13 Free Medicaid Webinars14 2nd Annual ANCOR Technology Summit22 Stronger Association, Stronger Voice: Earn Up to $1500 for Your Organization29 ANCOR Shapes Important Health Reform

ANCOR Foundation

23 Legacy Leaders Project

ANCOR 40th Anniversary19 Send ANCOR an Anniversary Greeting25 ANCOR: The Beginning, Part II

by Renee Pietrangelo

Recessions are endurance events. Alan Tuck and Don Howard of the Bridgespan Group

surveyed 100 nonprofit executives across the U.S. at six-month intervals to assess eco-nomic status and strategies for coping with the downturn. A full 93 percent said that they were feeling the effects of the downturn; 80 percent having experienced funding cuts.Many were also adopting healthy habits that not only support survival in the current reces-sion, but also may support their success into the future.

1. Act quickly yet thoughtfully. It’s easy to revert to unthinking activity when economic stresses and fear paralyze us. As leaders, we must be both thoughtful in our decision-making and fleet-footed in our implementation. And that means planning for the worst. ANCOR has been working with Tecker Consultants to care-fully assess current activities (programs and services) and apply knowledge-based decision-

Government Relations

10 What Does Reconciliation Mean and Will it Likely Lead to “Restoration of Harmony”

NAC Central

18 Hill Happenings, DSP Wage Study

State Association View

23 Where Are Disability Services Headed?

Wage and Hour Guidelines

28 Fiscal Intermediaries, Thos Hiring Contractors Must Be Aware of IRS Responsibilities

From Our Partners

11 Aflac: Why Voluntary Insurance?13 Philadelphia Insurance - Financially Stable21 Broader HR Advisory Role of Employee Benefit

Brokers

ContentsInside This Issue of LINKS

See CEO, page 5.

3 April 2010 LINKS

by Peter Kowalski

The “new normal” is this year’s buzz word, you can’t avoid it. Starting out as the name

of a book it has become a label slapped onto everyone’s version of the future. The connota-tion implying things won’t be the same after the economy recovers. Well hello! Is anything the same or different from economic cycle to cycle? The implications being that if you do not change and adapt to the new economic situation you will cease to exist. Not much of a revelation.

Is there however something fundamentally dif-ferent or game changing about this economic cycle that would warn us that a fundamental shift has taken place in our world view? I don’t see it- right now it feels like the malaise of the 70’s and looks like it might last as long or until the next “new” thing comes along. Others use the term to “justify” their vision of the future. The New normal will be 10% unemployment, long term debt, the end of US supremacy etc. However the one thing I know is that predications of the future like sure bets seldom come true.

That said, there is a relevant role looking into

the future and also with the New Normal’s premise that there is great opportunity to be had in bad times. In fact many of our richest became so by seeing the opportunity when others saw only despair. Not a new concept but one that needs to be remembered.

ANCOR worked with a futurist a few years back, a man named Ed Barrlow. Ed taught us that futurists don’t predict the future rather they looked at trends that influenced the fu-ture. From population changes to technology changes following these trends should give us that insight about tomorrow (the basis of environmental scanning).

The trends we have seen have been negative, at first glance. As revenue shrank in our states our funds have been cut. Scholars and gurus will argue for a long time about whether that was a good thing. I do know, however, that I never heard a provider tell me that they had too much money. Funding has never been adequate.

So is there anything different here? I don’t know. I guess it depends on how we respond. I think we have responded well over time because our services are still here. The crash

Peter Kowalski

The American Network of Community Options and Resources (ANCOR) was founded in 1970 to provide national advocacy, resources, services and networking

opportunities to providers of private supports and services. LINKS provides a nexus for the exchange

of information, ideas and opinions among key stakeholders.

National Office StaffReneé L. PietrangeloChief Executive Officer703.535.7850, ext. 105rpietrangelo@ancor.org

Cindy Allen de RamosFinance Manager

703.535.7850, ext. 102cramos@ancor.org

Kari AmidonEducation and Foundation Director

703.535.7850, ext 115kamidon@ncor.org

Jessica Sayers BarkerAssociate Director, Public Policy Initiatives

703.535.7850, ext. jbarker@ancor.org

Jocelyn BreelandDirector, Communications and Marketing

703.535.7850, ext. 111jbreeland@ancor.org

Dana CalisiOffice/Data Entry Coordinator

703.535.7850, ext. 101dcalisi@ancor.org

Suellen GalbraithDirector for Government Relations

703.535.7850, ext. 103sgalbraith@ancor.org

Mary Pauline JonesGovernment Relations Assistant

703.535.7850, ext. 108mpjones@ancor.org

Jerri McCandlessDirector of Member Relations and

Board Development703.535.7850, ext. 107jmccandless@ancor.org

Marsha PatrickDirector of Resource and Revenue Development703.535.7850, ext. 110

mpatrick@ancor.org

Jessica SadowskyAssociate Director, Government Relations

703.535.7850, ext. 104jsadowsky@ancor.org

Tony YuDirector of Web and Information Technology

703.535.7850, ext. 109tyu@ancor.org

President’s CornerThe Future

See President, page 6.

of the housing bubble is credited with the mess we are in or at least the policies that led to it. However, as is true with most economic data, what’s good for some is bad for others. Cer-tainly people got hurt speculating on an ever increasing value of real estate. On the other hand the rapid rise in real estate was not a good thing. Housing was getting unaffordable, as were land prices. A return to something closer to “normal” in the cost of real estate will be

LINKS April 20104

5 April 2010 LINKS

Leadership, from page 1.

on-one meetings, the first at 30 days and the second at 90 days, has an enormous impact on retention that directly turns into savings for your organization.

“If these meetings are handled successfully, new employee turnover is reduced by 66 percent,” says Studer. “You can be certain that your new employee is comparing her first few weeks of work with your company to her last week at her previous job – which was filled with well wishes, tearful good-byes, and probably a going-away party. Clearly, your company will get the short end of an unfavor-able comparison. These meetings will help you shore up an otherwise tenuous relationship.”Once you start implementing these tactics, results quickly follow. Your employees will see that you care about them, which boosts morale, which improves performance, which leads to happier consumers and families. Studer says creating satisfied employees is of critical im-portance, especially right now.

“When things aren’t going so well, a lot of leaders panic and start doing things that make employees less satisfied,” he notes. “Don’t make that mistake. Your leaders’ job is to cre-ate happy, loyal, productive employees. They, in turn, will create happy, loyal consumers and families. They are two sides of the same coin – and that coin is the currency that buys you results that last.”

able at a preferred rate to each of our member organizations.

3. Fortify the best people. In good times, ev-ery organization needs good people; in tough times, they need great people. Every organiza-tion has a smaller cadre of staff, board mem-bers and volunteers that propels its success. We need to consider which people are central to the long-term health of the organization and dedicate the lion’s share of our attention and resources to them.

4. Draw funders in. By working with funders as partners, we may be able to change funding priorities. Level with funders about your organization’s financial situation and planned responses. This applies to donors as well, which may open up new funding op-portunities.

5. Shape up. During lean times, organiza-tions should make low- or no-cost improve-ments to internal operations that make it easier for people to work smarter. Clarifying roles and work processes will allow everyone to

number of thank-you notes for leaders to send to the people they supervise. “Thank-you notes don’t just happen,” says Studer. “If they aren’t hardwired into an organization, they don’t get written. And a thank-you note is just too pow-erful a tool not to use. People love receiving thank-you notes. They cherish them.”

He explains that the best thank-you notes are:* Specific, not general. A thank-you note that focuses on something specific the recipient has done is far more effective than one that reads, “Hey, nice job!”* Handwritten, if possible. Most people would rather receive a three-sentence hand-written note than a two-page typed letter. It’s more authentic and special.* Sent to the employee’s home. When an employee receives a thank-you note at home, it feels more personal than one laid on her desk along with a stack of reports and memos.

Don’t just recruit great employees. Re-recruit them. If you plan to hire in 2010 – and as the recovery (hopefully) picks up steam, many will – here’s a relatively easy step you can take that will pay off in a big way. We all know employee turnover is expensive. But did you know that more than 25 percent of employees who leave positions do so in the first 90 days of employment? To retain a new team member, the leader needs to build a relationship. Studer Group has found that scheduling two one-

Quint Studer is the author of BusinessWeek bestseller Hardwiring Excellence: Purpose, Worthwhile Work, Making a Difference; 101 Answers to Questions Leaders Ask; and Wall Street Journal bestseller Results That Last: Hardwiring Behaviors That Will Take Your Company to the Top.

Quint can be reached at quint@studergroup.com.

Article adapted from this original, which can also be found here.

Free resources: Attendees at ANCOR’s 2010 Management Practices Conference and Trade Show auto-matically received a free copy of Quint’s latest book, Straight A Leadership: Alignment, Ac-tion, Accountability.

Click here to access tools and assessments related to Straight A Leadership: Alignment, Action, Accountability so you can implement them in your organization today!

To obtain a complimentary organizational assessment, to see how your organization is aligned with the current economic climate, go here.

work more productively. This may also be the time to include people with different and broader skills as staff openings become avail-able.

6. Bring in the Board. In times of crisis, ev-eryone must be expected to step up to the plate. Board members bring expertise from other domains, test an organization’s assumptions and plans, and help raise funds. They may also be able to complement staff efforts.

7. Communicate openly and often. People need to know that their leaders have a handle on the situation and a plan for weathering the challenges the economic downturn poses. They want to know where they stand and what the organization’s prospects are. They also need to know when and how those prospects change, and what they can do to help. In addition, staff members more than ever appreciate small ges-tures from their leaders, such as frequent praise when they redouble their efforts or tighten belts. Staff members may also welcome extra help on the front line from their leaders. They admire and trust not just strategic commitment,

but operating commitment.

Our actions as leaders will make all the dif-ference in whether---and in what shape---our organizations cross the starting line into the post-recession future.

CEO, from page 2.

It was ability that mattered, not disability, which is a word I’m not crazy about using.

--Marlee Matlin

LINKS April 20106

good for most of us. Likewise high unemploy-ment has been good for most of us. Can you image the real impact on our programs if they were cut as badly as we have been during a time of low unemployment? The new normal folks tell us things won’t go back to the way it was before the crash when the economy recovers, and I hope they are right. Will a new morality evolve about frivolous spending and unending greed? Is this a new normal ex-pectation? Sounds like what we all said in the sixties, and what countless other generations through the ages back to our distant past have all said. What can we predict? I don’t know but here are a few of mine.

We have talked about energy independence for years. Will we see a solution? I think we will but it might not be what some see. The answer is not one thing but many: we are seeing ad-vances in photo-voltaic technologies, a return to nuclear, there are some new breakthroughs being made in fuel cell technology and new thinking about oil. (It’s pretty startling and will, if true, really shake things up. Essentially oil may not be a “fossil fuel,” rather it is con-tinuously created as a result of plate tectonics.) And of course the thing that will really change energy use is the thing around the corner that we don’t see now.

Our economy has soared or crashed on cheap energy or the lack there of. Major innovation here will have profound and unexpected im-pacts on our economy. For those that say there will never be a golden time again and we are doomed to have to settle for less- I don’t buy it. Health care dominates the discussion- forget what side you are on, the fact of the matter is that health care is very expensive and everyone wants the best.

There are those who say the new normal is to accept that we can’t have it all and we can’t have the best. Again, I don’t buy it. I think we are on the cusp of a health care revolu-tion- not over Congressional action, but rather in innovation. We are about to see a quantum shift in health care as our understanding of the human genome continues at an accelerating pace. Drugs designed for us as individuals, genetic manipulation and the like will replace the system of health care we now have in, I believe, a relatively short time.

Unemployment will not remain high for the foreseeable future. Even without the above ad-vances the retirement of the baby boom genera-tion will in fact continue (support the NAC!!). What about our funding? My predication is that it will never be enough. However, look at the advances we have made. I just don’t think we will fall that far backwards. Look at your

own programs over time. The people coming in to our services have much better skills than they did 20 years ago and that impacts the cost dramatically.

I am amazed at the work my staff does with kids with autism. There will be a generation of kids that don’t develop severe behavioral disorders. What a funding difference! Early intervention works. Look at the technology changes that Braddock tracks and how they can be employed. We will look different but will we really? Survival in this “new normal” goes to those who see the opportunity and we are in good shape, since that is what we have all been doing. None of us have stayed stagnant, despite the feelings of the purveyors of today’s latest fad. We have constantly had to find the way; we have lived under continuous paradigm shifts for the 26 years I have been here, so if anyone can do it we can.

I obviously don’t know how the future will shake out. I only hope to see it. However, I am more confident than some that we have the skills to move forward. Will we change? Of course, but we continuously change. The new normal is not something to be afraid of or to be enamored with. Personally, I stay with proverbs: The more things change the more they stay the same.

President, from page 3.

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Features that add value & make your operation run leanBills in daily billing units, hour, ½ hour, ¼ hour, or unit to appropriate funding • sourcePasses hours to payroll for processing and payment to staff • Pinpoints over-/under-uti lizati on of service• Receivables package processes payments and rejecti ons• Outstanding bills reports and receivables management tools• Submit bills electronically or hard copy (plain paper or lett erhead)• Resubmission or write-off of rejecti ons without re-entry• Contract Uti lizati on features identi fy what has been billed versus what could be • billedStandard reports list clients with expired Prior Authorizati ons and Prior • Authorizati ons coming dueSystem checks for common data entry errors like duplicate ti me slips, • overlapping service periods, and incorrect service rati os

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7 April 2010 LINKS

LINKS April 20108

The DSP Chronicles: Nancy Beatty A DSP Who Is Making a Difference at ACT

By Tom King

“I don’t know that there is anything challeng-ing -- if you love to do it.’’

“Who I am makes a difference.”

That is Nancy Beatty’s approach to her role as a Direct Support Professional and

as a person. Meet Nancy, a Direct Support Professional (DSP) for 14 years at Alternative Community Training Inc. (ACT) in Columbia, MO. For the past three she years she has been a DSP in ACT’s Community Integration day program and helps support 100 people at a ratio of four a day. And ACT counts itself as a proud member of ANCOR.

The spirit and soul are significant characteristics of an effective and talented DSP and that’s why Nancy is featured in this month’s College of Direct Support’s “The DSP Chronicles.” Here is how she describes her approach to work – and to life.

“I have a philosophy that guides me daily and it is this saying: ‘Who I am makes a differ-ence.’ That’s true for me and it’s true for all of the people I support and for everyone as well. It’s really important in all of the things we do.”

When you ask Nancy to describe the most enjoyable part of her work, her spirit and soul shine brightly again. “I love being here with my friends, the people I support. I like to see

them complete their goals and share that suc-cess with them. It fills my day. I don’t think it is a challenge to support people.”

When you ask Nancy to describe the most enjoyable part of her work, her spirit and soul shine brightly yet again.

“Those I support, of course! You would be surprised how many hugs I get every morning. I enjoy working for ACT. I enjoy the people we support, my coworkers, my bosses,” Nancy says. “I look forward to coming to work every day to visit and to make a difference. That is why I love this job and working here at ACT.”

What got her interested in be-ing a DSP in the first place? Her answer: “When I came to work at ACT, I needed a job and thought that this was just a place to stop off for a while. I started to see that I enjoyed

coming to work and the people I

support are my friends. That is why I can’t leave here!”

Before coming to ACT she was a factory work-er and a housekeeper at a hospital. Her years at ACT began in 1996 as a production worker, working alongside individuals with disabilities, taking labels off tapes and sorting floppy discs. Nancy was then promoted to Team Leader for employees and a Training Specialist for persons supported. She continued in that role for about eight years.

Then she was offered another position within the warehouse where she would pull products, packing products and mailing them to various locations. Nancy was in this position for about a year and then this position ended. Nancy returned to the Team Leader position until she accepted a position in ACT’s Community Integration program. Michelle Saunders, the Program Director for the day program, says that Nancy spends her days taking care of consumer needs, integrating the persons she supports into the community, doing volunteer work and other fun activities that are meaningful and productive.

Nancy says her growth as a DSP has blossomed in the last 15 or so months. “We changed how we deliver services, so each consumer chooses their activities of choice on a daily basis. This means that the people I support each day changes,” she explained. “This is exciting and makes each day a new experience. I also think the College of Direct Support (CDS) has helped me look at a different perspective of how I do my job. I tell all new employees at ACT to go through the CDS courses because they have helped me so much in my position.”

She says that the CDS courses taught her one major thing. “I have really learned how to be a much more effective advocate for the people I support and for our employees. The CDS opened my eyes and helped me grow as a DSP and I’m so glad I took them.”

Saunders adds that “Nancy was good before the CDS courses, but it seemed to tie it all together in her head when she went through the CDS.”

Author Link: Tom King is Director of Com-munications for the College of Direct Support. You can contact him at 1-877-353-2767 (toll free) or via email at tking@collegeofdirectsup-port.com.

To find out about the ANCOR Foundation partnership with the College of Direct Support and the ANCOR Member Buying Pool, contact Bill Tapp at 1-877-353-2767 (toll free) or email him at Bill@collegeofdirectsupport.com.

Nancy Beatty

Left to right: Mike, Robert, and Alisa enjoying time at the mall with Nancy Beatty

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New Partnerships AnnouncedEssential Learning Becomes Newest SRPN Partner

ANCOR is pleased to announce Essen-tial Learning as the newest partner in

ANCOR’s Shared Resources Purchasing Network. “I’m sure that ANCOR members will be surprised at the many options and learning opportunities Essential Learning of-fers” said Ms. Sue Erskine, CEO of Essential Learning.

“Essential Learning is an educational company that is known to many members,” said ANCOR CEO Renee Pietrangelo, “and letting all of our members know their employees can reach for clinical and compli-ance courses through Essential Learning is extremely important. Having Essential Learning on board is a significant value-added for our member organizations and their staff.” ANCOR members will receive a 10% discount on all courses. For more infor-

mation, click here or contact Marsha Patrick, ANCOR’s Development Director at mpatrick@ancor.org.

ANCOR Foundation Partners with AMAZON.com

The ANCOR Foundation is proud to an-nounce its new partnership with Amazon.

com. Any purchases made through Amazon.com will return up to 6% of your purchase price back to The ANCOR Foundation, at no cost to you. Here’s how it works: Click on Amazon.com to access the link that supports this new partnership. And your payment will credit The ANCOR Foundation upon checkout. Tell your co-workers, family and friends! It’s quick and easy to start your shopping. And, for your convenience, you can even click on the Amazon.com button on the ANCOR home page. Thanks to you, the ANCOR Foundation will be able to gain necessary funds to support programs related to leadership development and disaster relief, among others. Click on the link today. Such small but important efforts will help the foundation continue building strong communities committed to inclusion!

ANCOR Partners with Employee Benefits, Risk Advisory Services Provider

ANCOR is pleased to announce a part-nership with Cook, Hall & Hyde, Inc.

to bring services that specifically focus on ANCOR members’ individual health care pro-grams for their employees. “This partnership is very timely for our members who continue to look for value and benefits in the health care arena. This partnership will help them evaluate their current programs” stated ANCOR CEO Renee Pietrangelo.

Kevin Arnstein, CHC, MPH, Managing Direc-tor, Employee Benefits at Cook, Hall & Hyde, Inc. will work with ANCOR members and pro-vide an objective review and analysis of their health care programs to determine their cost/need effectiveness and include funding alterna-tives. The company is a leading provider of commercial and personal insurance, employee benefits and risk management services. Kevin can be reached at karnstein@chhins.com.

LINKS April 201010

Governmental Relations What Does Reconciliation Mean and Will It Likely Lead to “Restoration of Harmony”

With the drive to complete passage of comprehensive health reform in 2010,

the Congressional term “reconciliation” has raised considerable attention and much confu-sion.

Generally, the Congressional terms “reconcil-ing” or “to reconcile” a bill is more frequently understood in connection with the usual pro-cedure to pass different versions of House and Senate authorizing or appropriations bills. The two versions must be “reconciled” by a confer-ence committee of appointed House and Senate conferees to iron out the differences so that the same version (a conference report) of a bill can then be voted upon by both chambers before it is sent to the President for his signature.

The chief purpose of the reconciliation process is to enhance Congress’s ability to change cur-rent law in order to bring revenue, spending, and debt-limit levels into conformity with the policies of the budget resolution. Accordingly, reconciliation can be a potent budget enforce-ment tool for a large portion of the budget.

--Congressional Research Service, Report RL33030, August 10, 2005.

According to the nonpartisan Congressional Research Service (CRS), the reconciliation procedure has been used 22 times by both Republicans and Democrats for a variety of tax and spending changes in the past 35 years, with the majority of the time used when Republi-cans held the working majority in the Senate. Reconciliation actually means “restoration of harmony.”

The Congressional Budget Act of 1974 pro-vides for the annual adoption of a concurrent House and Senate budget resolution by a target date of April 15th —an agreement between the two chambers on a budget plan for the upcom-ing fiscal year and at least the following four fiscal years. The concurrent resolution is not submitted to the President for his signature, is non-binding, and does not have the force of law. However, the budget resolution may include “reconciliation instructions” that direct one or more committees to produce legisla-tive changes by a specified date to meet direct spending, revenue levels (taxes), and deficit changes.

Reconciliation, which was first used by the House and Senate in 1980, is an optional procedure. The principal focus in the reconcili-ation process has been deficit reduction, but in some years reconciliation has involved revenue

reduction generally and spending increases in selected areas. Although reconciliation is an optional procedure, it has been used most years since its first use in 1980 (19 reconciliation bills have been enacted into law and three have been vetoed).

Reconciliation Is a Two-Step Process and Expedites ConsiderationWhen Congress decides to use the reconcili-ation process, language known as a “recon-ciliation directive” must be included in the budget resolution. Congress may use only one reconciliation measure per annual session. • Under the first step, reconciliation instruc-

tions are included in the budget resolu-tion, directing one or more committees in each chamber to develop legislation that changes spending or revenues (or both) by the amounts specified in the budget resolution. If more than one commit-tee in each chamber is given instruc-tions, each instructed committee submits reconciliation legislation to its respective Budget Committee, which incorporates all submissions, without any substantive revision, into a single, omnibus budget reconciliation measure.

• Under the second step, the omnibus bud-get reconciliation measure is considered in the House and Senate under expedited procedures. The process culminates with enactment of the measure, thus putting the policies of the budget resolution into effect.

The reconciliation procedure allows for ex-pedited consideration of legislation affecting mandatory spending programs (e.g. entitle-ment programs such as Medicaid, Medicare) or taxes. While the reconciliation procedure applies in both the House and Senate, it is especially important in the Senate. Under the law, the expedited consideration means a bill is considered in the Senate under a 20-hour time-limited debate period with passage requiring only a simple majority vote—51 votes instead of a supermajority of 60 votes to overcome a filibuster. While time limits for reconciliation also apply in the House, the House generally imposes time limits on the consideration of important legislation, anyway.

The ability of a party to push through con-troversial legislation with only a 51 vote in

the Senate—including the tie-breaking vote provided by the U.S. Vice President, if neces-sary—is an important tool for the majority. For three decades, the reconciliation process has been used by both parties to avoid the strictures of Senate filibusters which require a superma-jority 60-vote count to end debate to move to a vote instead of moving directly to the “simple 51 majority” to complete a final vote.

Procedural and Political Hurdles to ReconciliationWhile reconciliation enables Congress to bundle together several different provisions affecting a broad range of programs, it faces one major constraint: the “Byrd rule,” named after Senator Byrd (D-WV). This Senate rule makes any provision of (or amendment to) the reconciliation bill that is deemed “extrane-ous” (matters that often provoke controversy without aiding deficit reduction efforts) subject to a “point of order” and is also intended to preserve the deliberative character of the Sen-ate (by excluding from consideration under expedited procedures legislative matters not central to deficit reduction that should be debated under regular procedures). If a point of order is raised under the Byrd rule, the offend-ing provision is automatically stripped from the bill unless at least 60 senators vote to waive the rule. This makes it difficult, for example, to in-clude any policy changes in the reconciliation bill unless they have direct fiscal implications.

While anyone can question a provision under the “Byrd rule,” the Senate parliamentarian—who has considerable sway over questions of the budget impact of specific provisions—could declare that the provision is not “ger-mane.” The U.S. Vice-President can overrule the parliamentarian, waive the point of order, and deem the provision “germane.”

While reconciliation in the Senate limits debate to 20 hours, there is no limit to amendments following the debate. This sets up the pos-sibility of endless amendments and votes on amendments by opponents. Republicans have stated they intend to use this strategy. The par-liamentarian or Vice-President could, at some point, move to end amendments.

See Reconciliation, page 16.

VIEWPOINT

AFLAC / / V IEWPOINTAFLAC / / V IEWPOINT

The real question is, why not? Voluntary insurance plans can resolve a bevy of market pressures faced by HR and benefits managers today, at no cost to their companies. As a unique opportunity to satisfy competing priorities, voluntary insurance programs accomplish the seemingly impossible—help create robust, affordable benefits packages in the face of diminishing budgets, rising healthcare costs, and a heated competition for talent.

Voluntary insurance is offered to employees by their employers and is 100% employee-paid through payroll deduction. It can include policies for accident, cancer/specified-disease, dental, life, short-term disability, specified health event, hospital intensive care, lump sum critical illness, and vision. It is traditionally viewed as coverage that exceeds core benefits packages, yet as many companies are cutting back on health care coverage to curb rising costs, the need for voluntary insurance has become essential to many businesses.

WHY VOLUNTARY INSURANCE?

Employers perceive healthcare costs as the number one challenge to achieving short-term success in todayʼs economic uncertainty.1

Since 1999, family premiums for employer sponsored insurance have increased 120% while wages have gone up 44% and inflation has risen 29%.2

Voluntary insurance supplements core packages at no direct cost to employers, and may reduce corporate taxes by cutting FICA tax contributions.

Rising healthcare costs

EMPLOYER IMPACT EMPLOYEE IMPACT SOLUTION

Controlling health and medical insurance costs is the second highest priority among companies today.3

The average annual family premium increased 27 percent since 2004 to $12,680 in 2008.4

Voluntary insurance policies can help employees manage rising health care costs by providing them with cash benefits for out-of pocket medical expenses.

Pressure to contain expenses means shifting many coststo employees

About 25% of U.S. employees report they suffer from serious financial distress, and up to 80%report their job performance is affected by financial problems.5

Among workers whose illnesses led to bankruptcy, out-of-pocket costs alone averaged $11,854.11.6

Employees with voluntary insurance coverage are less concerned overall with medical finances issues than those without voluntary insurance.7

Growing financial stress among employees can decrease morale,satisfaction and productivity

Nearly one-quarter of employers believe they are more likely to lose employees to competitors with better benefits packages.7

Employees feel that no other workplace benefit comes close in terms of importance.8

Among employers who currently or previously provided voluntary insurance, the top reasons are to: • Retain employees (23%).• Increase job satisfaction (20%).9

A company’s benefitsofferings affects its abilities to recruit and retain top talent

1 2009 Top Five Total Rewards Priorities Survey, Deloitte, LLC 2009. 2(Aflac/Accelerant “Why Supplemental” Survey, 2009), 3(Employer Health Benefits Survey, Kaiser Family Foundation/ KRET, 2008), 4(Pierson, B. “Simply Put, It’s Good Financial Planning,” Supplemental Disability Insurance, Aug. 2007), 5(Himmelstein, D., et al., “Illness and Injury as Contributors to Bankruptcy,” Harvard Study, February 2005), 6(Aflac/Accelerant “Consumer Now More Than Ever Survey, 2009), 7(Small Business “Now More Than Ever” Aflac, Acceler-PULSE™, 2009), 8(“HR Trends and Challenges,” LIMRA International, 2007.), 9(Market Structure: Decision-Makers,” TNS Taylor Nelson Sofres, 2006.)

Numerous Challenges — One Solution

The following Viewpoint was submitted by ANCOR partner Aflac. Aflac offers ANCOR members a wide range of supplemental insurance products. Aflac’s plans are 100 percent employee-paid and pre-tax dollars cover certain benefit costs, resulting in lower employee taxable income and savings on FICA and FUTA taxes.Visit www.chooseaflac.com/ancorlead or contact Ross Setlow at Aflac4ancor@aflacny.com or (800) 595-9768 for more information.

11 April 2010 LINKS

Advertisement

AFLAC / / V IEWPOINT

More than half of the countryʼs employers provide voluntary insurance, tapping into a remarkably easy way to look after the well-being of its workforce through:

CUSTOMIZED BENEFITS PACKAGES Ð employees can select coverage relevant to their circumstances and build a benefits plan tailored to their specific needs.

CASH BENEFITS Ð voluntary insurance policies pay benefits regardless of any other health coverage, helping cover deductibles, copayments, and other unexpected expenses.

MAKE BENEFITS MORE ACCESSIBLE

The cost of health care continues to outpace inflation and household earnings at a pace greater than 2 to 11.1 To reduce the burden on corporate bottom lines, benefits decision-makers are often forced to pass larger portions of these increases onto their workforce.

The result, however, is that employees are now faced with some tough decisions, with many resorting to drawing frompersonal savings, dipping into retirement accounts, and increasing use of creditÐall of which can lead to personal bankruptcy. When an employee faces financial difficulties, an employer feels the impact as well in the form of decreased job performance, absenteeism and dissatisfaction. At the same time, HR managers remain tasked with attracting and retaining the best employees.

Market conditions have created a need for voluntary insurance. Businesses of all sizes and across all industries have adopted voluntary insurance policies because they help to bring resolution to every component of this complex cycle. So the question really isnʼt, why voluntary insurance? The question is, why not?

For more information, call your Aflac agent or visit www.aflacforbusiness.com.

1“Health care costs outpace Inflation 2 to 1.” The News Journal, June 18, 2008. 2Accelerant/Aflac,”Consumer Now More Than Ever,” 2009. *Some businesses may have indirect administrative or other costs. 3Stuckey, M. “When Staying Alive Equals Bankruptcy,” msnbc.com, August 2007.

Breaking the CycleEmployees in 25 states with financial worries were not only more stressed and absent more often than others, but they spend 20 hours of work time per month dealing with money problems.3

Breaking the CycleEmployees without voluntary insurance are nearly twice as likely to skip needed medical tests of procedures as those with voluntary insurance coverage.2

Voluntary insurance policies help ensure a healthy workforce and a healthy bottom line

Breaking the CycleVoluntary insurance pays employees cash benefits to defray rising out-of-pocket costs, unexpected expenses.

Breaking an Unhealthy Cycle

Absenteeism from work, decrease in job

performance

Rising healthcare costs

Negative impact on companyÕs ability

to compete in the marketplace, and compete for talent

Employees experience financial distress or choose to forego needed

healthcare

Increase employeeshare of premiums,

higher deductibles andout-of-pocket costs

Breaking the CycleVoluntary insurance is no cost* to employers and can reduceFICA taxes.

LINKS April 201012

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13 April 2010 LINKS

by Rick LaClair

As we approach the upcoming year, we now know the importance of long term stabil-

ity and experience in the industries one serves. In 2010, ANCOR will celebrate 40 years as an association. We at Philadelphia Insurance Companies are proud to partner with ANCOR and recognize their long standing involvement of improving the services provided to indi-viduals with intellectual and developmental disabilities.

In the coming year, it will be increasingly im-portant to align with financially stable partners who not only are positioned to continue to offer quality services, but also have a strong history of experience in the areas they serve.

Some key aspects one should consider when selecting an insurance program include:

Financial standing of your insurance carrier. There are several sources one should review to obtain the information needed to make an evaluation of financial stability. These include:

1. Insurance carrier’s most recent annual financial report

2. A.M. Best Financial Strength Rating (www.ambest.com) – this will provide an independent opinion of an insurer’s financial strength and ability to meet its ongoing contract obligations. Philadel-phia Insurance Companies continues to be assigned an A+/Excellent rating.

3. Standard & Poor’s Ratings (www.stan-dardandpoors.com) another independent source that analyzes financial capacity to meet insurance obligations. S&P uses a letter grade scale that ranges from AAA (highest) to R (lowest). For example,

Philadelphia Insurance Companies have been assigned an AA- rating.

4. Ward Group analysis (www.wardinc.com) – analyzes best practices and financial performance of over 3,100 property casualty insurance companies. Philadel-phia Insurance Companies have remained in Ward’s grouping of the top fifty for several years.

Underwriting and claims experience the insurance carrier has in the Human Services Industry due to the unique exposures faced and expertise needed in both underwriting and claims settlement. Philadelphia Insurance has over 20 years experience insuring social service organizations and is recognized as a leading insurer in this industry.

One last area to consider is whether your in-surance carrier is admitted vs. non-admitted. An admitted carrier follows the guidelines set forth by individual state’s department of insur-ance. This allows access to state guarantee funds which provides protection for policy-holders should the insurance carrier become insolvent. Non-admitted carriers are not subject to rate and form filings with state departments of insurance and therefore, their policyholders may not have protection from state guarantee funds in the event of insolvency. Regardless of whether a carrier is admitted or non-admitted, it is best to use the tools noted above in analyz-ing the financial strength of your insurance carrier.

In addition to the analyses of the insurance car-rier, it is also important to align yourself with an independent insurance agent who under-stands your needs and has the experience and resources to partner with you for the long haul. Some of the considerations here should include but are not limited to:

1. experience developing insurance programs for social service entities

2. insurance carriers represented and rela-tionships they maintain with these carriers

3. in house expertise in areas such as claims, loss control, etc

As you can see, moving forward and prosper-ing in the years ahead will require partnering with strong and reliable partners. ANCOR and Philadelphia Insurance Companies have earned a reputation of being a truly valued partner of those they serve and will continue to do so in the years ahead.

Author Link: Rick LaClair is a Regional Sales Manager for Philadelphia Insurance Compa-nies. Philadelphia and Rick specialize in the non-profit insurance industry…specifically for ANCOR members. Each policy is custom tailored to address each insured’s unique exposures. Philadelphia Insurance Companies is a preferred ANCOR Services Corporation partner and provides its ANCOR clients with property/casualty insurance policies for prop-erty, general liability, automobile, professional liability and umbrella insurance coverage. For more information on this special marketing agreement and/or to take advantage of its sav-ings, call 1-800-873-4552 and let them know that you are an ANCOR member. You may also visit www.phly.com

Philadelphia Insurance - Financially StableKey Areas To Consider When Selecting An Insurance Program

Advertisement

Free Webinars: How to use the Medicaid Reference Desk

To learn about Medicaid services for people with disabilities. Choose a time and date

that work for you. (All the Webinars on this list are the same.) Check the website for ad-ditional dates in the future. The Medicaid Reference Desk, thedesk.info, is committed to offering accessible, compre-hensive, understandable information about Medicaid services for people with disabilities. They are conducting Webinars to show people how to find the information they need on our website. To join, please choose one of the dates and times below and then register on line at www.thedesk.info/teleconf.

Friday, April 1611:00 a.m. Eastern10:00 a.m. Central9:00 a.m. Mountain8:00 a.m. Pacific

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in association with

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Navigate regulations, guide employees, develop systems that work, andmost importantly, provide positive outcomes for people with disabilities.

To order this publication, contact

ANCOR1101 King Street, Suite 380Alexandria, VA 22314-2944

Phone: (703) 535-7850 Fax: (703) 535-7860www.ancor.org • tyu@ancor.org

15% discount for mulltiple copy sales of 10 or more.To receive this special discount, please mail or FAX order to ANCOR.

Consulting & TrainingDisability Supports and Services

www.hwisolutions.com

POSITIVE OUTCOMES:A Provider’s Guide to Active Outcomes

Presents

LINKS April 201014

The American Network of Community Options and Resources (ANCOR) and the National Council for Community Behavioral

Healthcare (NCCBH) will hold the 2nd annual Technology Leadership Summit at the Westin Westminster Hotel in Westminster, Colorado on Fri-day, October 22, 2010, immediately following the Tenth Annucal Coleman Institute on Cognitive Disabilities Conference, held October 21.

The day-long event will provide CEOs/Executive Directors and technolo-gy-focused professionals with the opportunity to discuss key technological challenges they face, brainstorm solutions and hear about the latest inno-vations in the service arena. ANCOR is pleased to partner with NCCBH for this year’s event, which will allow us to focus on how techology can lead to more responsive supports to individuals with I/DD, mental health and addiction disorders.

Space will be limited to 150 participants.

The NCCBH is a national trade association representing over 1,600 orga-nizations supporting 6 million adults and children with mental illess and addiction disorders.

Be on the lookout for further details in the near future!

2nd Annual ANCOR Technology Leadership Summit

October 21, 2010 - Save the Date

ANCOR is pleased to have the thirty-nine exhibitors at the Management Practices

Conference and Trade Show, scheduled April 11-13, at the Sheraton New Orleans Hotel. Conference attendees are encouraged to take advantage of the opportunity to visit the exhibi-tors, learn about their products and services and thank them for their support and confidence in ANCOR providers.

In addition, the Trade Show will feature a Shared Resources Purchasing Network (SRPN)Section comprised of several partners in this special program. The SRPN was developed in response to the funding challenges many ANCOR members face. A special break-out session titled “Maximizing Your ANCOR Membership: Programs to Support the En-tire Agency” featuring a provider panel dis-cussion on the SRPN, among other benefits, is scheduled for Monday afternoon, April 12 at 3:30 during the conference.

Make your plans now to attend so that you’ll be among the possible winners of several great

gift money cards being contributed by SRPN partners.

The Management Practices Conference Exhibitors include:

Aflac 4 ANCOR/SEFCU Insurance Agency Bethesda Lutheran Communities Inc BCS Recycling Specialists CaraSolva, Inc CareTracker by Resource SystemsCARF International College of Direct SupportCook, Hall & Hyde, Inc.Community Services Analysis LLC Deyta LLCEssential LearningFoothold TechnologyFurniture ConceptsHuman Services CompanyHuman Service ConnectionIrwin Siegel Agency, Inc.Keystone Human Services InternationalLabor Relations Alternatives Manager Development Services

Medline Healthcare CompanyMITCNational DataCare CorporationOdyssey SoftwarePartners 31Philadelphia Insurance CompaniesPractical Health Systems, Inc. PrecisionCare SoftwareRest Assured, LLCSciotoSears CommercialSequestSleeping Dog Software, LLCSocial SolutionsSolana, formerly MRDD SolutionsSteadyCare, LLC The Braff GroupThe Nonprofit TrustTherap ServicesVertex Systems, Inc.

2010 Management Practices Conference and Trade Show Exhibitors

Higher quality services, in less time, with fewer

write-offs.

Social Solutions is helping organizations save time, improve the quality of their services, and reduce their write-off rates with our award-winning Efforts to Outcomes (ETO™) software. Through our Platinum partnership with ANCOR, member organizations receive special rates and benefit immediately when using this industry-leading product. Features of this software include:

� Completely integrated case management, performance management, billing, and reimbursement

� Flexible intake and assessment � On-the-fly configuration to meet virtually any program or reporting need � Diverse standard reports which greatly ease reporting, compliance, and

reimbursement processes

Our customers tell us that when they use ETO, they are able to provide higher quality services, in less time, with fewer write-offs. ANCOR member organizations will have the added benefit of being able to participate in the nationally recognized Performance Excellence Initiative benchmarking project, through pre-defined templates and reports, without any additional overhead.

About Social Solutions:

Social Solutions, Inc. is the leading provider of performance management software for the human service sector. Thousands of organizations use our Efforts to Outcomes (ETO™) software to assist over four million participants with youth service, workforce development, family service, health, and other critical human service needs.

To Learn More About this Program:

Please email ancor@socialsolutions.com or visit www.socialsolutions.com/ancor

P R O U D P A R T N E R

PLATINUM PARTNER

15 April 2010 LINKS

Rest Assured®

877.338.9193Ext. 345

877.338.9193 www.RestAssuredSystem.com

2000 Greenbush StreetLafayette, IN 47904

Free Webinar!Learn how the Web and wireless technology is already providing safety and independence to individuals with developmental disabilities without the presence of a caregiver.

Title: Rest Assured Presentation

Thursday, April 292 - 3 p.m.

Join us for a demonstration of the Rest Assured® Telecare support system, including:

• Two-way audio and visual communication

• Personal Emergency Response System (PERS)

• Carbon monoxide and smoke sensors

• Door and glass break sensors

• 24 hour remote monitoring

• Third party access for loved ones

https://www1.gotomeeting.com/register/692477985Register now! Space is limited.

*After registering you will receive a confirmation email containing information about joining the Webinar.

LINKS April 201016

Decision to Use Back-up Reconciliation Procedure to Address Health ReformCongress included the reconciliation option in the 2010 budget resolution last year. The in-structions provided directives to multiple com-mittees of jurisdiction in the House and Senate on both health care and student education loans. However, the President and Democratic leaders expected to pass comprehensive health reform in 2009. With the Senate passage of health reform bill on Christmas Eve and the House health reform bill passed earlier in the fall, the Democratic leadership expected to return in January to appoint conferees to a joint committee to iron out the differences in the two versions of health reform, thus, complet-ing final passage of health reform in early 2010 instead of by the end of 2009.

However, following the election of Senator Brown (R-MA) to the seat previously held by Senator Kennedy, Democratic leadership be-lieved that the new 59 vote majority would be insufficient to withstand the 60 votes needed to end Republican opposition and withstand Senate filibusters.

Following the February Health Care Summit with President Obama and Republican and Senate leaders, the President released his health care proposal summary on February 22nd and then a March 2nd letter to House and Senate Democratic and Republican leaders suggesting inclusion of four additional Republican priori-ties. These efforts were undertaken to gain Republican support.

When Republican leaders responded by calling for Congress to scrap the efforts to date and begin anew with health reform legislation and stating that they would “do anything to stop this legislation” based on objections to both substance and procedure. Democratic leaders decided in early March to address comprehen-sive health legislation as well as student loans through the reconciliation procedure this year.

Democratic leaders said they would move forward on passing comprehensive health reform as the nation had waited for more than 60 years for comprehensive reform. They said their approach would not only expand cover-age to more 30 million uninsured Americans, take steps to control costs, and was paid for, but it would also reduce the federal deficit and promote job creation. The plan calls for House

Reconciliation, from page 10.

passage of the Senate-passed health reform bill and passage of a “side-car” reconciliation package (with changes or fixes to the underly-ing Senate bill that incorporate Democratic House and Senate, and Administration agreed-upon provisions).

Although the reconciliation procedure has been used many times by both Republicans and Democrats, it is doubtful that this procedure to “restore harmony” will lead to increased bipartisanship throughout the remainder of the year. Republicans have stated that usage of reconciliation will halt bipartisanship efforts on other initiatives such as immigration. And with mid-term elections looming in November, both parties will seek to advance their own agendas. It seems unlikely that harmony will be restored.

ANCOR has supported passage of health reform that expands coverage and includes im-provements to long-term supports and services. The Senate bill includes measures that help ad-vance health coverage for many direct support professionals; important insurance reforms that protect individuals with disabilities and

See Reconciliation, page 17.

What are you doing to minimize your health care increases? We can provide:

• Benefit Audits

• Wellness Initiatives

• Partnering

Kevin M. Arnstein, MPH Benefits Consultant

karnstein@chhins.com631.390.9788

17 April 2010 LINKS

ANCOR Board of Directors Adopts 2010 Government Relations PrioritiesIn its March conference call, the ANCOR Board of Directors adopted the 2010 Govern-ment Relations Priorities. These priorities serve as guidance to Government Relations staff and volunteers for their work in 2010.

ANCOR’s Government Relations Committee and Subcommittees developed the priorities, which include Medicaid, labor and employee benefits, health care, housing and employ-ment of individuals with disabilities. These broad categories include short term strategies and issues of immediate concern to ANCOR members, such as focus on the extension of the Recovery Act FMAP enhancement.

ANCOR’s National Advocacy Campaign was added to the 2010 priorities, reflecting its move to Government Relations. While Government Relations has always worked closely with the NAC and been part of the NAC legislative efforts, this move ensures a dedicated ANCOR staff member, Jessica Sayers Barker, as the key

chronic conditions such as current exclusions in the private market due to pre-existing condi-tions and lifetime and annual caps to coverage; provisions that establish a national long-term supports insurance program that reduces the burden on Medicaid long-term supports and saves federal and state Medicaid funds, while adding a new private source of funding for providers; improvements to Medicaid; some as-sistance in addressing the crisis in recruitment and retention of DSPs; and specific provisions that create incentives to expand home and com-munity services and provide increased federal funding to states. While building upon existing public and private health care structures, AN-COR believes that the Senate-passed legisla-tion also contains more favorable employer requirements.

Reforms to health care generally come in 20-year cycles. It is quite possible that failure this year will mean efforts to reform health care may await many more years. Congress should complete passage of the Senate-passed bill and changes that improve the bill now.

staffer responsible for implementing this multi-faceted campaign.

The Board of Directors and Government Rela-tions work together to meet ANCOR’s strategic outcomes and to be a national leader in public policy important to ANCOR members. If you are interested in learning more about or becoming involved in ANCOR’s Government Relations activities, please contact Jessica Sadowsky (jsadowsky@ancor.org). There is a place for you at the table!

Reconciliation, from page 16.

The good we secure for ourselves is precarious and uncertain until it is secured for all of us and incorpo-rated into our common life.

--Jane Addams

LINKS April 201018

Hill HappeningsIn an effort to help sustain the direct support workforce, the NAC has encouraged its network to urge passage of the American Workers, State, and Business Relief Act of 2010 (H.R. 4213). This bill contains

an additional estimated $25.5 billion in federal Medicaid (FMAP) and an additional $1.2 billion in adjustments to help states with the Medicare Part D payments states are required to make to the federal government. (See related article in this month’s issue.) Although the Sen-ate passed HR 4213 on March 10th, as LINKS goes to print, the bill will be conferenced with a version the House passed in December. Thank you to everyone who reached out to their Senators and urged passage of this bill.

In March, ANCOR staff updated and discussed future activities around the workforce crisis with Representatives Capps (D-CA) and Terry (R-NE), the co-sponsors of the workforce bill (HR 868). Capps and Terry reiterated their support for ANCOR’s efforts on H.R. 868. Al-though ANCOR members have been working hard to add additional co-sponsors, the senti-ment of our bill’s champions is that health care

reform has brought Congress to a grinding halt, with little room for work on other important issues, like H.R. 868. The currently has 58 co-sponsors, so if you have not already contacted your Representative, please do so. You can use ANCOR’s Action Center to contact your U.S. Representative and urge them to co-sponsor H.R. 868!

Direct Support Professionals Wage StudyIn partnership with the Mosaic Collaborative for Public Policy and Practice, ANCOR has again commissioned a national study compar-ing entry level and average wages for DSPs.

The purpose of the survey and study is to gain credible data related to growing wage dispari-ties to illustrate how that impacts high turnover rates and the overall workforce shortage.

Initial analysis of survey results substantiates our claims of a stark disparity between state and private DSP wages, and strengthens the statistical data for our work to increase DSP wages, training, and technology. Results of the study will be available online soon. Be sure to visit www.ancor.org for more information.

NAC CentralHeritage Christian Services opened two new group homes in January of 2010. We were very pleased to be able to use the Shared Resources Purchas-ing Network partnership with SEARS. It took one phone call to set up the user account with the SEARS staff and we were able to purchase all of the ap-pliances and bedding needed to open these two homes. The order was delivered promptly within 3 days and the pricing is below the best sale price offered on these products throughout the year.

--Dan StewartDirector of Facilities,Heritage Christian Services

19 April 2010 LINKS

Join the Celebration!Send ANCOR an Anniversary Greeting

It’s Our Anniversary; Send us a CardThat’s right. As you should all know by now, in 2010 ANCOR celebrates 40 years as the association of community providers of supports and services to people with disabilities.

We’re looking forward to a year of celebra-tion, including the kick off at the Management Practices Conference and Trade Show next week and the gala celebration planned for the fall (details on that will come later.)

Right now, we’d like to get all our members in on the act by inviting you to send ANCOR birthday greetings.

We’ll be using the new ANCOR Connected Community (ACC) to collect your well wishes.

Simply go to http://ancor.connectedcommunity.org.

If you are not already logged in to the ANCOR Connected Community, you’ll see a screen that looks like this:

Simply enter your email address and pass-word.*

**Float your cursor over “Discussions” in the top navigation bar to release the drop down menu. Select “Discussions Home.”

Find “ANCOR 40th Anniversary under the “Member Created Groups” section. Follow straight across to where you see “info digest post.”

Select “post.” If you are not already a sub-scriber to the group, you will first be asked to subscribe by indicating how often you wish to be notified of message activity. (Most folks probably want “daily digest.”)

After you select, you will be taken to a post message screen. ANCOR 40th Anniversary should already be included in the drop down menu after “To.” If not, select it an proceed to draft your message.

Enter your message and hit “Send” at the bot-tom.

Notes on Using the ACC*The email and password combination for access is the same one you use to access members-only portions of the ANCOR website. If you don’t yet have a password, click here to get one.

**The first time you log on to the ACC you’ll have to agree to our site rules of etiquette. Just scroll down to the bottom of the page and select the correct button.

Then you’ll be taken to the main page of the ACC. From there you can follow these instruc-tions to leave an anniversary greeting. You’ll also want to update your profile, subscribe to discussions, and more.

We invite you to take a look around.

Here are some instructions on how to use various parts of the site. (Once you’re in the ACC, all of these documents are available in the library called “ANCOR Connected Com-munity.”)

Here’s a guide to getting started and setting up your profile.

Here’s a guide to joining in discussions.

Here’s a guide to finding contacts in the com-munity.

Here’s a guide to sharing documents in the community.

Look for more LINKS articles and emails in the future telling you how you can get involved in celebrating ANCOR’s 40th anniversary, and how you can use the ANCOR Connected Community to get greater value out of your ANCOR membership. Enjoy!

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LINKS April 201020

21 April 2010 LINKS

by Kevin Arnstwin

Businesses of all sizes have long relied on trusted advisors to assist their organiza-

tions in a wide range of operational areas. In some instances, an advisor’s role is narrowly focused, while in other cases, it encompasses many aspects of a company’s operations. Lawyers, for example, primarily focus on legal matters whether relating to contracts, intellectual property, employee relations, real estate investments, etc. The business advice accountants provide, on the other hand, often extends beyond matters of finance and taxation and into diverse areas ranging from strategic business and succession planning, to mergers and acquisitions, litigation consult-ing, systems consulting, materials handling, inventory management, etc. Insurance brokers too are filling a much broader role than their titles would suggest. For human resource ex-ecutives, knowing what their brokers’ broader consultative role can and should encompass, particularly as it relates to the employee health care benefits, affords significant value-add beyond the benefit packages they provide.

Beyond The Traditional Broker’s Role To begin with, HR executives should expect a level of service from their health care benefits broker that starts with assistance in select-ing and designing the optimum employee benefit plan and includes advice regarding how best to fund that plan. In addition, a proactive benefits broker will assume a major role in helping the HR executive secure the best policy at the best price. This means the broker should be willing to provide options and assist in conducting a thorough, compara-tive cost analysis of the various plans. Once a plan is selected, the broker should be a strong advocate for the company in negotiating the optimum price.

From this point on, the broker’s role is to assure the ease and seamless administra-tion of the plan. The HR executive and staff members should be able to easily access information, address concerns, and coordinate additional value-added services.

Employee Benefit Plan Re-view Also encompassed within the traditional role of the broker is assistance in overseeing health insurance claims. The broker should periodically review the company’s claim history and trends to make certain that the current health care plan and options are still

in the best interest of the company and its employees. Also regarding claims manage-ment, the broker should be abreast of how claims are being handled to make sure that an expeditious, courteous service is being provided to the company’s employees. When and if serious disputes arise or appeals must be made, the broker should serve as the voice of reason, almost in the role of ombudsman between the insured and the insurance com-pany. Here is where the role of the benefits broker is already starting to expand into the HR advisory area.

Employee Communications Typically, communicating information regarding benefits to employees is handled by a company’s HR department. A broker serving in a broader HR advisory capacity, however, will play a major role in this area. He or she will provide guidance as to how communications should be crafted, what information should be left in and what should not be included, and how often employ-ees should receive information about their benefits. To elaborate, the broker can share insight with the HR professional regarding how much more robust the company’s plan may be in comparison to other companies; information which should be shared with employees to create goodwill and bolster employer-employee relations. The broker also might provide statistics that help demonstrate to employees how various healthy behaviors reduce illness and subsequent claims and help keep health insurance premiums down-a goal of every employer/plan sponsor. Even with respect to formatting of employee benefit communications, the broker can provide valu-able guidance which encourages employees to read the communication, understand and retain it, as well as act on important informa-tion.

Another area in which brokers can assume a key role is in measuring and benchmarking employee satisfaction with their benefits. They can assist in the development of blind surveys to elicit candid responses. These surveys can be useful tools in determining whether the benefits meet the employees’ needs, whether employees fully understand their benefits and related value, and whether management is doing a good job of effective-ly communicating benefit information.

Worksite Programs Often employee benefit programs receive the recognition and value they deserve from employees through the use of worksite

programs. A proactive benefits broker will help develop a meaningful worksite program that educates employees about their benefit options, instructs them on how to file claims, and helps them understand their benefits’ true value. This information is perceived to have more credibility when conveyed by a third-party rather than company management.

Policies And Procedures A true “Best in Class” benefits broker will also assist the HR department in establishing employee policies relating to the benefit plan. These policies and procedures would provide direction relating to the chain of command that should be follow when inquiring about benefits, changing benefits of those covered and/or beneficiaries, privacy issues, COBRA-related issues, problems with claims, etc.

Closing Remarks Based on findings from the “National Com-pensation Survey: Employee Benefits in the United States,” reported by the Department of Labor’s Bureau of Statistics, 60 percent of businesses in private industry offer medical care benefits to their employees. A Hewitt Associates survey in January 2009 of 340 large employers representing more than five million employees found that 52 percent of these companies expect the economic down-turn to have an impact on their 2010 health care programs. The survey goes on to say that they do not plan to make drastic changes, but will be relying on traditional and progressive strategies to address health care costs with 65 percent saying they would be shifting more costs to employees.

Regardless of how health care reform in America shapes up, employee benefits will continue to be a part of the employer-employ-ee rela¬tionship. Utilizing all resources avail-able to optimize how benefits are positioned with employees is a sound HR strategy. Relying on a proactive broker who serves in a broad HR consultative capacity is an integral component to this strategy.

Author Link: Kevin Arnstein, CHC, MPH, is Managing Director, Employee Benefits at Cook, Hall & Hyde, Inc. They are a provider of commercial and personal insurance, employee benefits and risk management services. ANCOR has partnered with Cook, Hall & Hyde to have Kevin bring services that specifically focus on ANCOR members’ health care programs for their employees. He can be reached at karnstein@chhins.com.

The Broader HR Advisory Role of Employee Benefit Brokers

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LINKS April 201022

A Stronger Association, A Stronger Voice Your Association Needs You ~ And We’re Offering A Reward

ANCOR needs your help with recruitment in 2010, and we’re offering a sweet incen-

tive – up to $1,500 for your agency - to those of you who demonstrate your powers of per-suasion by recruiting new ANCOR members.

As a member, you are in a unique position to share with other providers the benefits you’ve realized as a part of our community of com-munity providers. Studies indicate this kind of one-on-one approach can be much more effec-tive than even the most energetic membership campaign by staff.

And ANCOR is ready to support and encour-age you in two important ways.

First, we’re offering incentive bonuses to any member who recruits another member.

• Recruit one member, and ANCOR will send you a check for $250.

• Recruit a second member and ANCOR will send you a check for $500.

• Recruit a third member and ANCOR will send you a check for $750.

Do the math! By simply recruiting three mem-bers from your community, you could earn an extra $1500. Think of the things you could do with that money. Here are a few suggestions.

• Replace a line item you’ve cut from your budget

• Invest in technology to help you improve quality and efficiency

• Reward the person who did the recruiting• Take the people you serve on a special

outing• Hold an event to thank your community

Second, we’re going to provide you all the tools you need to be a successful recruiter.

What do I say? Want to recruit, but don’t know what to say? We’ve got a set of talking points you can use. You got a copy by mail; email us if you need another.

What do I do? Looking for ideas? We’ve started a list and again, we mailed you a copy and will send another on request.

Anything else? Of course. We’ve prepared an ANCOR Stronger Voices Recruitment Kit, including:

• ANCOR Video. A picture says a thousand words. Share this video.

• ANCOR Brochures – one general over-view, one with a dozen reasons to join

• Copies of past LINKS (limited quanti-ties, while supplies last). March, April, September, October

The original mailing included a reply post-card for recruitment kits. If you’ve misplaced

yours, just email a request and we’ll get your supplies in the mail to you.Important: To receive credit for your recruit-ment, the new member must supply your name and agency on page 4 of the application form.

(Note: In the event a recruit credits two or more agencies, we’ll split the check!)

Keep this in mind.

The point of this exercise is to help ANCOR, while helping your own agency. It’s important business, but we want you to have fun while you’re at it. Meanwhile, if it’s recognition you crave, we’ll be announcing your success in LINKS and, if you’re part of the ANCOR Connected Community, you’ll have the Star Recruiter badge to add to your profile. (Note: The ANCOR Connected Community is new, and the subject of separate emails from AN-COR.)

If you have questions about the Stronger Association, Stronger Voices Campaign, please contact a member of the ANCOR membership team.

Jocelyn Breeland jbreeland@ancor.orgJerri McCandless jmccandless@ancor.orgMarsha Patrick mpatrick@ancor.org

Good Luck!

23 April 2010 LINKS

by Diane McCombANCOR Liaison to State Association Execu-tives

Disability leaders around the country are universally embroiled in state budget

battles. Indeed, this year’s legislative sessions are grim for many providers of services and supports for people with disabilities. Associa-tions are using multiple strategies to offset the onslaught of funding attacks. At the national level, things are little better as the battle for health reforms rages.

Multiple states have deeply cut human services across the board with dire consequences loom-ing. Associations and providers are responding with litigation, seeking injunctions against the cuts, and in some instances finding support from the US Justice Department (North Caro-lina). Some are advancing support through cross-disciplinary coalitions to increase taxes on liquor (Kansas, Maryland) and cigarettes. The extension of FMAP federal funds will likely forego the necessity of deeper cuts in multiple states where governors built budgets contingent on its passage.

By now everyone realizes this recession is historic and life-changing. When it subsides, the landscape of providing services and sup-ports to people with disabilities will most likely be dramatically different than it was prior to the onset. What preparations are important to emerge intact?

Guiding principles are easy to get lost in times of duress, yet they are needed the most right now. Guiding principles espouse a group’s values -- saying to the public what the group stands for. While most disability coalitions are embroiled in budget warfare, it’s easy to lose sight of everything else.

Eventually, economic indicators will turn around. Within the next few years, states will slowly start to see jobs added and revenues return to the positive side of the ledger; how-ever, everywhere there are signs of caution that increases of the size seen in the recovery of the 90s will not occur in this recovery. State bud-gets may grow modestly by 1% to 3% - hardly enough to return to doing business as usual.

It is critical to take stock of what this field offers to people with disabilities and their families and measure that against the avail-able financial resources and manpower. If the resources are no longer available or available at the same level to do what’s been done for years, consideration of alternative ways of sup-porting people may be necessary.

Some are saying that larger, congregate settings are more cost effective and that smaller, indi-vidually tailored supports are cost prohibitive, yet experience doesn’t bear that out. Individual and family supports can be much more cost effective, and not just because the per capita funding is lower. Allowing people with dis-abilities and their families to design their own package of supports can create greater levels of consumer satisfaction and manage expectations at the same time.

Collecting data on consumer satisfaction, program quality and staff stability (i.e., the opposite of turnover) will become even more critical than it is today. Being able to measure outcomes will become a crucial, deciding fac-tor for funders and consumers alike. Providers that survive into the future will do so by oper-ating with leaner overhead and by responding to what people with disabilities are saying they want in the way of supports.

It’s very likely that the resources once ear-marked for disabilities will not be available at the same levels in the future. At the same time

advocating for a strong system of community supports will always be important; and, if we listen to people with disabilities and their families, we just might get another chance to get it right.

Author Link: Diane can be reached at dmc-comb@ancor.org.

State Association ViewWhere Are Disability Services Headed?

Diane McComb

“I know not what the future holds, but I know it is leaders who hold the future.”

The ANCOR Foundation has initiated the Legacy Leaders Project, a special recogni-

tion effort designed to celebrate the accom-plishments of the men and women who have paved the way in making ANCOR the premier trade association representing more than 800 private providers for nearly 500,000 Americans with disabilities.

Nominations can come from a variety of sources, including:

Self-nominationAgency board of directorsAgency personnelFamily MemberColleague

Cost to nominate someone is a minimum of $1,000. Contributions made to this spe-cial fund will be used to create training and development programs for future leaders in the disabilities field.

Click here to access the nomination form.

Please note: The ANCOR Foundation is a 501(c) 3 charitable organizations.

Contributions made to the foundation are tax-deductible.

Legacy Leaders Recognition Project

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LINKS April 201024

25 April 2010 LINKS

By Joni Fritz

As private providers met informally through the newly formed National Association of

Private Residential Facilities for the Mentally Retarded (NAPRFMR) they developed friend-ships, and ideas articulated by smaller agencies - that had been resisted by many providers of private institutions - began to arouse interest.

Early Board members included people who op-erated small family residences like Jewell Kay and her daughter Marcene Shaw, who were active members and officers of the California Association of Residences for the Retarded. Both of these women lived in their homes, which were licensed as foster care facilities for six infants and children with severe intellectual disabilities and multiple physical disabilities.

Another person who supported infants and young children with multiple, severe challeng-es was Virginia Franks from North Carolina who also used an existing home in the com-munity to support six children. Mary Wagner constructed large group homes in Michigan for

young adults using the Department of Hous-ing and Urban Development’s Section 202/8 program that was designed to develop housing for people who were elderly and disabled.

Other innovative new members in those first years included Terry Allen Perl from Mary-land, Peter “Skip” Sajevic from Minnesota and Stephen Bennett from California (all of whom later served as President of the association). They operated agencies that had one or more larger residences but were in the process of de-

ANCOR: The BeginningANCOR: Early Inside Resources

veloping multiple small community residences

Members of NAPRFMR who first questioned the viability of small living arrangements were curious and asked these providers to tell them more about their agencies. They spoke at AAMD (American Association on Mental Deficiency, now AAIDD, the American As-sociation on Intellectual and developmental Disabilities) conferences and described the way their systems operated and the effect on the

See Resources, page 26.

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people who lived in this housing. Other mem-bers of NAPRFMR liked and respected these providers. They trusted their judgment. These weren’t “off-the-wall parents” or advocates who espoused some “pie-in-the-sky” philo-sophical position, but providers, (also some-times parents of children with disabilities) who knew what it was to work with state agencies to obtain funding and to perform the day-to-day operations of an agency that had 24-hour-a-day, 365-day-a-year responsibility for the lives of people who required supports.

It wasn’t long before many other member agen-cies were experimenting with group homes – largely due to the influence of providers like these. Some used existing housing in their local communities, others constructed new housing for up to 15 people – a number chosen at the time because fire safety requirements permit-ted non-institutional life-safety construction features in homes up to this size. These provid-ers spoke about the success achieved in small homes.

At first there was a general belief that the larger group homes were the most appropriate for people who were leaving institutional settings – both public and private. These were often referred to as “transitional housing” and some believed that it was most effective to move people from institutions to smaller and smaller

housing in a “continuum of care.” That didn’t last long, however. It eventually became appar-ent that those people who moved directly from institutions to smaller settings quickly became more self-sufficient.

Newly formed agencies skipped the institution-al beginnings and began supporting children and adults in homes that blended into their neighborhoods. They too joined NAPRFMR. Perhaps the most important lesson learned was that no single living arrangement provided the optimum setting for all individuals. Adult foster care provides the best environment for some people, while others prefer to live by themselves with periodic drop-in support. Some have roommates of their own choosing, and others prefer to live in apartments or small group homes.

While NAPRFMR continued to meet in conjunction with the annual conference of the AAMD, during the 1970s the association also began holding its own free-standing conferenc-es targeted at the interests of the private sector.

This article is the second in a special 40th An-niversary Series that looks back at the history of the association. The author is a former ANCOR CEO.

Resources, from page 25.

The 2010 Summer Leadership Institute will be held at the University of Delaware July 11th – 16th 2010.

This week-long, intensive leadership development program is designed for cur-rent executive-level leaders and emerging leaders. Participants may work in areas of management or program leadership in organizations that provide, advocate for, or fund supports for people with developmen-tal disabilities and their families.

The focus of the Leadership Institute is on assessing and strengthening leadership skills, setting organizational direction, and understanding the future of the developmen-tal disabilities field. Institute participants come away with demonstrated leadership ability and a firm grasp of the skills and values critical for quality, individualized supports.

Apply now online at www.nlcdd.orgApplications are due by April 12, 2010.For questions e-mail Nancy Weiss at: nweiss@udel.edu.

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27 April 2010 LINKS

LINKS April 201028

Joni Fritz

By Joni Fritz, Labor Standards Specialist

As reported earlier, the Internal Revenue Service announced in the fall of 2009

that it will conduct random audits of 6,000 employers during 2010 to determine how many misclassify workers as independent contractors.

Respite Workers and Companions Among Those Being InvestigatedFederal rules for the companionship exemp-tion clearly label companions as employees. It is not always clear, however, who stands in the capacity of employer. Sometimes workers who might meet the definition of companion are identified instead as respite workers. Both come under the U.S. Department of Labor defi-nition of domestic service employees. It is not uncommon for these workers to be considered self-employed contractors. In other cases they are considered to be foster care providers even though the children or adults with disabilities do not live in their homes on a permanent basis, and they therefore do not meet the definition of a foster provider and owe taxes on the money they receive (as discussed in earlier

editions of this column).

In some situations families identify and con-tract with respite providers/companions them-selves, so agencies are less likely to be found out of compliance with federal employment requirements. If families conduct background checks and provide training, using standards developed by local government entities, and actually pay the workers, the families are likely to be considered employers with all of the responsibilities that entails. This writer would like to see private agencies assume a greater role in educating individuals and families with whom they work about applicable tax and labor law.

Respite/companion workers, particularly those who provide supports to more than one family, and who advertise their services to the public at large should be able to establish themselves as self-employed businesses. However, if they are not paying taxes and Social Security, they or the families whom they support may be required to pay back taxes, Social Security and perhaps even penalties. Here again we see a role for the private sector in educating and training small self-employed workers about tax

and labor requirements.

Agencies that serve as a fiscal intermediary, paying respite/companion providers, based on documentation from families or individu-als that supports were provided consistent with the number of hours available to each person served, also have to meet IRS re-quirements. It is likely inadequate merely to issue these providers a 1099 form each year so they can file appropriate taxes them-selves. Knowledge of complex tax law is

FEDERAL WAGE AND HOUR GUIDANCEFiscal Intermediaries and Those Hiring Contractors Must Be Aware of IRS Responsibilities

See Wage and Hour, page 29.

29 April 2010 LINKS

essential for private providers who assume the role of fiscal intermediary.

Research Essential Before Embarking Upon Fiscal Intermediary ResponsibilitiesUnfortunately, ANCOR recommendations are sometimes overlooked. On at least two occasions in the past, ANCOR has recom-mended that members obtain a copy of an extensive publication entitled: Developing and Implementing Self-Direction Programs and Policies: A Handbook. Published in Febru-ary 2009 in a combined effort by the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation, the Administration on Aging, and the Robert Wood Johnson Foundation, this 296-page handbook is available free, online at www.cashandcounseling.org/resources/handbook. It has four principal authors and 10 co-authors and provides in-depth informa-tion for providers, state staff, policymakers, program participants and other stakeholders as a single, comprehensive source of information about self-direction programs and policies. It describes several statutory authorities for the delivery of Medicaid-funded Home and Community-Based Services Waiver programs; and discusses everything from involving people in program design, implementation and

evaluation to enrollment; individual budgeting; counseling; and quality management. It also refers readers to additional useful publications and resources.

Perhaps most important in the context of this article is chapter seven, which discusses “Fiscal/Employer Agent Services.” This 34-page chapter describes the key features of five financial management service models and focuses on the issues and challenges related to two in particular: the Government and Vendor Fiscal/Employer Agent models. Under these models a state, local government or private vendor must apply for and obtain authoriza-tion from the IRS to act as an employer agent for each person it represents. The Handbook cites the IRS provisions and forms that must be used. It discusses advantages and challenges for these programs, and includes discussions of agency reimbursement rates, workers’ compen-sation, health insurance and other benefits for direct support professionals.

There are additional resources that should be obtained by agencies that question their respon-sibility regarding payments to respite/compan-ion workers on behalf of others. Among these are:

• IRS Revenue Procedure 80-4, 1980-1 CB 581, which sets forth procedures to be followed by agencies involved with the payment of public funds to employees of

people with disabilities or other “welfare recipients” who receive in-home services.

• IRS Private Ruling 9209002, a “Technical Advice Memorandum” dated October 3, 1991.

• Notice 2003-70, IRB 2003-43, dated Octo-ber 3, 2003, a proposed revenue procedure updating guidance contained in Revenue Procedure 80-4 (cited above).

These publications have been distributed by IRS investigators within the past year to provide guidance to agencies serving as fiscal intermediaries.

The Handbook is a must for any agency that is interested in serving as fiscal intermediary under a Medicaid Waiver program. It should be used in consultation with IRS documents and an attorney who is familiar with both IRS and federal, state and local labor law.

AUTHOR LINK: Joni Fritz is a Labor Stan-dards Specialist whose guidance is free to ANCOR members and to those who attend a Wage and Hour Workshop or participate in a teleconference that she has conducted. Any ANCOR member who wishes to make arrange-ments for consultation or workshops with Joni must first contact Jessica Sadowsky, ANCOR Associate Director, Government Relations, for a referral at (703)535-7850 or jsadowsky@ancor.org.

Wage and Hour, from page 28

See Reform, page 30.

Protection and Affordable Care Act and a pack-age of fixes or improvements to the Senate bill in The American Health Reform and Education Affordability Act of 2010.

Comprehensive Health Reform Signed into Law by President ObamaOver the past 40 years, ANCOR’s governmen-tal relations’ expertise, presence, and influence has grown in Washington, D.C.—including the relationships built in working directly with The White House and administrations, Members of Congress and their staff, and expanded col-laborations and alliances with new provider, disability, and aging national organizations. In those 40 years, not only has our name changed, but also our vision, mission and focus. AN-COR has expanded our federal advocacy on behalf of providers of supports to individuals with disabilities and individuals with dis-abilities of all ages all aging and lead the way on increasing opportunities for choice and the financing of individualized, person-centered home and community services.

For the past two years, ANCOR’s expertise, presence, and influence has been called upon

by The White House and administration, Congressional members and committees, and other national organizations to improve health care and long-term supports for individuals with disabilities, their families, and the private providers and direct support professionals who daily make a difference in the lives of millions of individuals of all ages throughout the na-tion. The government relations recommendations for the past two years that the ANCOR Board of Directors adopted in 2009 and 2010 included a priority on health reform for all Americans.

President Obama signed into law March 23rd and March 30th, two pieces of comprehensive health reform passed a week apart by both chambers of Congress: the underlying Senate bill passed on December 24, 2009, The Patient

What a Difference 40 Years Makes! ANCOR Shapes Important Health Reform for Individuals with Disabilities

“…we have now just enshrined, as soon as I sign this bill, the core principle that everybody should have some basic security when it comes to their health care. And it is an extraordinary achievement that has happened because of all of you and all the advocates all across the country. According to the independent and non-partisan Congressional Budget Office, people who get coverage through their employer today will likely see lower premi-ums. And remember, the cost of doing nothing is high. In ten years, health care spending for each employee at an average big company will be $28,530.”

--President Obama upon signing the bill on March 23rd

LINKS April 201030

The comprehensive legislation makes the most significant changes to America’s health care de-livery system since the enactment of Medicare and Medicaid in 1965. In general, the legisla-tion extends coverage to 32 million uninsured individuals; requires most U.S. citizens and legal residents to have health insurance; creates state-based health benefit exchanges through which individuals and small businesses can purchase cover-age; requires employers to pay penalties for uninsured em-ployees or who elect to receive tax credits for health insur-ance through the exchanges, with excep-tions for small employers; expands Med-icaid coverage to new populations and provides increased federal matching funds to states for expansions; includes habilitation and rehabilitation in basic health plans; extends coverage until age 26 in the case of dependent coverage; and prohib-its insurers from denying coverage based on pre-existing conditions, from revoking cover-age when individual becomes sick, and from applying life-time and annual caps. It makes major changes in long-term services through The CLASS Act and significant improvements to Medicaid home and community long-term services (through, for example, Community First Choice, Rebalancing Act, and Medicaid section 1915 (i) HCBS state plan option). Ef-fective dates of implementation vary from 2010 to 2018, with employer requirements beginning in 2014.

The legislation provides an additional $434 billion over 10 years in new federal FMAP spending and an additional $20 billion in new federal Medicaid as-sistance to states. The combined $454 billion is above current baseline spending for Medicaid. The combined additional federal Medicaid funding to states over the next decade will enable states to bet-ter address their residents’ health needs, eliminating current state-only spending on health care and high-risk insurance pools. The cost of expanding coverage for 32 million Americans is split between this additional Medicaid funding to states and purchase of insurance through new State Exchanges.

The Congressional Budget Office (CBO) scores the cost of spending of the two

pieces of legislation at $940 billion over 10 years. CBO estimates the proposal will reduce the deficit by $143 billion over ten years and $1.3 trillion over the next decade. The size of the deficit reduction is cited as representing the largest deficit reduction effort since 1993. The legislation is cited as creating 400,000 new jobs annually upon implementation.

This issue of LINKS went to press as the President signed the legislation. ANCOR was just beginning analysis of the comprehensive

reform. Due to the inter-relation-ships of multiple public and private provi-sions, changes to Medicaid, variations in state

Medicaid programs, different

current employer coverage, and variations in state health care individual and employer re-quirements, it is not possible to predict precise impacts on every individual or employer.

For more information: ANCOR has completed three Issue Briefs distributed to members on general overview of provisions, Medicaid coverage expansions, and long-term services and supports. Additional Issue Briefs detailing specific provisions will become available. AN-COR also held the first in a series of webinars on reform in late April. For continued updates, see ANCOR Washington Insiders Club Updates and visit ANCOR’s health care website.

President Obama signs the bill, March 23, 2010

eform, from page 29.Celebrating 40 Years Working with Senator Ted KennedyANCOR Congressional Lifetime Achievement Award Presented by ADDP to Ted, Jr.Throughout ANCOR’s 40 years representing individuals with disabilities, their families, and providers and direct support professionals who support them, ANCOR worked with Senator Ted Kennedy (D-MA) and his staff on multiple federal issues. With his failing health, ANCOR decided last summer to honor Senator Kennedy by creating a new Congressional Award –The ANCOR Congressional Lifetime Achieve-ment Award. The new award category was created with Senator Kennedy in mind prior to his death and was to be presented to him at ANCOR’s 2009 Governmental Activities Seminar. ANCOR member Gary Blumenthal, ADDP Executive Director and other ANCOR members from ADDP were expected to pres-ent the award. Instead, ANCOR announced this special award at the Seminar, reading the inscription, at which time the Seminar partici-pants were moved to a standing ovation. Gary and other Massachusetts’ members were asked to present the award to family members at a later date.

The ANCOR award was presented on March 26th, the end of a historic week when both the House and Senate passed comprehensive health reform legislation. It followed on the heels of a Senate defeat of an amendment to the reconcili-ation bill that would have stripped The CLASS Act from health reform—the Kennedy legacy new long-term supports program. Blumenthal commented that the award could not have been presented at a more timely point given Senator Kennedy’s life-long commitment to health care for all Americans, people with disabilities, and social justice. The inscription on the award

read:

ANCOR Congressional Lifetime Achievement Award

Presented to Senator Ted KennedySeptember 2009

The American Network of Com-munity Options and Resources

honors and recognizes his distinguished career and lifelong

dedication to health care, education, civil rights and equal

justice for individuals with disabilities and America’s other forgotten voices

ANCOR members Bob Richards and Nancy Silver Hargreaves present ANCOR Congressional Lifetime Achievement Award honoring Senator Ted Kennedy of Massachusetts to Ted Ken-nedy, Jr. at ADDP conference.