Represent

Lobbying
Lobbying by UNITED SPINAL ASSOCIATION

Lobbying Relationship

Client

UNITED SPINAL ASSOCIATION

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Lobbying firm

United Spinal Association

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United Spinal supports Increased funding for SCI Model Systems. This program is long overdue for a significant funding increase that considers inflation and the approximate 50% growth in the SCI population since 2000 (from approximately 200,000 to more than 300,000) - $16.8 million. Increased funding for the National Spinal Cord Injury Statistical Center (NSCISC), which serves as the premier source of spinal cord injury-related statistical data in the United States - $1.8 million. Increased funding for the Model Systems Knowledge Translation Center (MSKTC), the MSKTC works with the NSCISC and the SCI Model Systems on research and translating the data into useful fact sheets on various topics related to spinal cord injury that are used not only in the United States but globally - $2.1 million. United Spinal staff met with staff with the Senate Aging Committee to provide information for an appropriations support letter for the National Institute on Disability, Independent Living, and Rehabilitation Research. United Spinal endorsed comments on the Medicare Advantage proposed rule as a Steering Committee member of the Coalition to Preserve Rehabilitation and United Spinal endorsed comments on the Notice of Benefit and Payment Parameters proposed rule as a Steering Committee member of the Independence Through Enhancement of Medicare and Medicaid Coalition.
United Spinal staff participated in a quarterly call with Amtrak along with other representatives from disability organizations. United Spinal staff participated in a meeting with Amtrak to review their plans for their replacement long-distance trainsets. United Spinal staff met with DOT staff to provide information about the results of United Spinals data gathering efforts regarding the availability of accessible parking spaces in different states and urging DOT to support updating the current ADA minimum standards for the number of accessible parking spaces required in lots and garages. House Senate United Spinal supported the accessibility provisions in, H.R. 7126, the Autonomous Vehicle Accessibility Act, introduced by Representative Greg Stanton (D-AZ-4). https://www.congress.gov/bill/118th-congress/house-bill/7126/all-info?s=1&r=3 Department of Labor Department of Transportation United Spinal contributed comments and responded to comments of others in an IdeaScale: Dialogue about Exploring the Future of Public Transportation Research: A National Online Dialogue Comments in part included topic about research keeping pace with the continuing development of technologies that could improve accessibility for people with disabilities. Department of Transportation United Spinal supported the Department of Transportations future initiative to address the substantive issues involved with the service animal rule. The comments read in part, We request that as soon as possible you also convene meetings and conduct outreach throughout the disability community ,including wheelchair users, to address issues specific to the usefulness of the form, its role in the equitable air travel rights and responsibilities of passengers with disabilities as well as evaluating how well the current regulatory environment assist individuals using service animals in air travel. Department of Transportation United Spinal, along with numerous other disability organizations, as members of the Consortium for Constituents with Disabilities (CCD) Transportation Task Force signed on to comments on the Department of Transportations request for information (RFI) on accessibility improvements for transportation facilities, Docket No: DOT-OST-2023-0166. United Spinal submitted our own comments to the U. S. Department of Transportations (DOT) request for information on accessibility improvements for transportation facilities, Docket No: DOT-OST-2023-0166. The comments read in part: United Spinal contributed to and wholeheartedly supports the comments submitted by the Consortium for Constituents with Disabilities (CCD) in response to this RFI. We wish to further comment on some topics specifically from the perspective of the wheelchair user. Department of Transportation United Spinal, as a member of the SecureRide Coalition, helped draft and signed a letter to Tool, Inc., a company that has submitted an application for a Department of Transportation Small Business Innovation Research (SBIR) Program 24-NH4 Phase I Pre-Offer, Re: 24-NH4: Lightweight Universal Docking Interface Geometry Manual Wheelchair Attachment. The letter read in part: The SecureRide Coalition strongly supports Tool, Inc.s application for the U. S. Department of Transportations (DOT) Phase I Small Business Innovation Research (SBIR) 24-NH4: Lightweight Universal Docking Interface Geometry Manual Wheelchair Attachment. Due to the obvious efficiencies that can be achieved by employing integrated research, design and development methodologies with the two essential components of a wheelchair securement system, SecureRide also fully supports Tool., Inc.s SBIR application, 24-NH6: Anchor Design for Universal Docking Interface Geometry. National Highway Traffic Safety Administration United Spinal, as a member of SecureRide, met with National Highway TrafficSafety Administration officials in the Human Factors/Engineering Integration Division to discuss coordination of development of safe wheelchair securement standards. United Spinal Association appreciated the opportunity to provide comments on the Department of Transportations (DOT) renewal of the Service Animal Behavior and Health Attestation Form and supported the Department of Transportations future initiative to address the substantive issues involved with the service animal rule. The comments read in part, We request that as soon as possible you also convene meetings and conduct outreach throughout the disability community, including wheelchair users, to address issues specific to the usefulness of the form, its role in the equitable air travel rights and responsibilities of passengers with disabilities as well as evaluating how well the current regulatory environment assist individuals using service animals in air travel.
United Spinal supports the accessibility provisions in, H.R. 7351 / S. 3747, Removing Access Barriers to Running for Elected Office for People with Disabilities Act, introduced by Representative Madeleine Dean (D-PA-4) and Senator Robert P. Casey, Jr. (D-PA). United Spinal supported the accessibility provisions in H.R. 7389 / S. 3748, Accessible Voting Act of 2024, introduced respectively by Representative Mary Gay Scanlon (D-PA-5) and Senator Robert P. Casey, Jr. (D-PA). United Spinal supports the accessibility provisions in H.R. 7350 / S. 3749, The Accessibility and Inclusion to Diversity Local Government Leadership Act (the AID Local Government Act) introduced by Representative Madeleine Dean (D-PA-4) and Senator Robert P. Casey, Jr. (D-PA). United Spinal participated in White House Office of Public Engagement Aging and Disability Communities Calls on 2.29.24, 3/7/2024, 3/21/24. United Spinal, as a member of the Consortium for Constituents with Disabilities (CCD), signed on to comments the CCD submitted in response to the Department of Justices request, Nondiscrimination on the Basis of Disability: Accessibility of Medical Diagnostic Equipment of State and Local Government Entities (DOJ-CRT-2024-0001). United Spinal also submitted our own comments on the above opportunity, DOJ-CRT-2024-0001-0001. The comments read in part, United Spinal Association supports DOJs efforts to apply specific requirements to accessible medical equipment. Inaccessible MDE effectively excludes certain people with disabilities from accessing routine examinations and specialized medical care. United Spinal participated in the National Council on Disabilitys virtual discussion about ground transportation for wheelchair users, sharing our lived experiences with the barriers commonly encountered. United Spinal staff led a delegation of disability organizations in a meeting with Assistant Attorney General Kristen Clarke and Civil Rights Division section leaders to discuss many critical issues facing the disability community.
United Spinal participated in a quarterly meeting of the Disability Community Advisory Group with DC Homeland Security Emergency Management Agency.
United Spinal supported the accessibility provisions in H.R. 6373, the Veterans STAND Act of 2023, introduced by Representative Jack Bergman (R-MI-1). House Senate United Spinal, as a member of the, Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition, signed onto a letter of support to the sponsors of H.R. 6373, the Veterans Spinal Trauma Access to New Devices (STAND) Act of 2023.
United Spinal Association supports: H.R. 3935/S. 1939 Securing Growth and Robust Leadership in American Aviation Act/FAA Reauthorization Act of 2023 United Spinal Association supports full inclusion of all of the provisions contained in H.R. 1267/ S. 545, the Air Carrier Access Amendments Act (ACAAA) and H.R. 1499 / S. 753, the Good Jobs for Good Airports (GJGA) Act. As one of the Air Carrier Access Act (ACAA) Advisory Committee recommendations: a U.S. Department of Transportation (DOT) Public Awareness Campaign to Ensure Air Travelers with Disabilities Know Their Rights - United Spinal partcipated and provided recommendations. United Spinal Association supported is participating in the U.S. Department of Transportation's Office of Aviation Consumer Protection (OACP) ongoing efforts to launch a new database, Aviation Complaint, Enforcement, and Reporting System (ACERS). In support of Democratic Committee Members of the U.S. House Committee on Transportation and Infrastructure letter sent to Airlines for America (A4A) President and CEO Nicholas Calio expressing concern and dismay regarding the continued trend of mishandled wheelchairs and scooters.
United Spinal responded to the Federal Communications Commissions The Reinstatement of Net Neutrality Rules (Docket No. 23-320) with comments. Which reads in part, Unfortunately, for the millions of people whom United Spinal represents, in too short a timeframe, the FCC has opined and acted on the need for dramatically more and dramatically less regulation with diametrically opposed voices. United Spinal supports H.R. 6929, The Affordable Connectivity Program Extension Act, introduced by Representative Yvette D. Clarke (D-NY-9). The bill would provide $7 billion to fund the ACP through FY24.
H.R. 5408 / S. 2767 - Introduced by Representative Brian Higgins (D- NY-26) and Senator Sherrod Brown (D-OH) SSI Savings Penalty Elimination Act. United Spinal, along with numerous other disability organizations, as members of the Consortium for Constituents with Disabilities (CCD), including CCDs Social Security Task Force (SSTF) and Housing Task Force (HTF), submitted comments to the Social Security Administrations Administrator in response to its Notice of Proposed Rulemaking: Docket No. SSA-2023-0010 Expansion of Rental Subsidy Policy for SSI. United Spinal, along with numerous other disability organizations, as members of the Social Security Task Force of the Consortium for Citizens with Disabilities (CCD) submitted comments about the proposed expansion of the definition of public assistance household in the Supplemental Security Income program (SSI), Docket No. SSA-2023-0015. United Spinal, along with numerous other disability organizations, as members of the Social Security Task Force of the Consortium for Citizens with Disabilities (CCD) submitted comments about the proposed Intermediate Improvement to the Disability Adjudication Process: Including How We Consider Past Work, Docket No. SSA-2023-0024.
Urge CMS to lift 'in the home' restriction under Medicare and Social Security Act language for wheelchairs. Support Medicare coverage for standing systems wheelchairs. Seek FY25 Appropriations programmatic report language: Medicare should provide coverage for individuals to obtain wheelchairs that allow them to integrate safely in both their communities and their homes. The Committee directs CMS to update the 2005 National Coverage Determination under Medicare for Mobility Assistive Equipment (MAE) by adding, and/or in the community" after "in the home. And urge the Centers for Medicare and Medicaid Services to provide Medicare coverage for standing systems in power wheelchairs to facilitate increased options for independent and community living for all wheelchair users. Centers for Medicare and Medicaid Services United Spinal, along with numerous other disability and disability related organizations, as members of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition and other supporting organizations that endorsed our original request in 2020 for the Centers for Medicare and Medicaid Services (CMS) to conduct a National Coverage Analysis (NCA) for Medicare coverage of seat elevation and standing systems in power wheelchairs, we write to reaffirm our request for CMS to expeditiously open an NCA for standing systems in Group 3 power wheelchairs, which are classified by Medicare as complex rehabilitative technology (CRT) wheelchair.
United Spinal supports H.R.7138, Supplemental Security Income Restoration Act of 2024, introduced by Raul M. Grijalva (D-AZ-7). The bill increases income disregard amounts that have not changed since 1974. Social Security Administration (SSA) currently reduces benefit amounts based on these out-of-date amounts and updates the asset limit to $10,000 / $20,000 for an eligible couple, so people are not excluded for responsibly saving money. United Spinal supports H.R. 5408 / S. 2767, the SSI Savings Penalty Elimination Act, introduced by Representative Brian Higgins (D- NY-26) and Senator Sherrod Brown (D-OH). United Spinal signed on to a Consortium for Constituents with Disabilities Social Security Task Force transition memo to the Honorable Martin OMalley, Commissioner, Social Security Administration. The comments in part read, We use our collective expertise to offer recommendations on a wide range of legislative and administrative issues impacting people with disabilities.

Duration: January 1, 2008 to present

General Issues: Health Issues, Transportation, Civil Rights/Civil Liberties, District of Columbia, Veterans, Aviation/Aircraft/Airlines, Telecommunications, Insurance, Medicare/Medicaid, Government Issues, Medical/Disease Research/Clinical Labs, Labor Issues/Antitrust/Workplace, Natural Resources, Defense, Disaster Planning/Emergencies, Housing, Education, Financial Institutions/Investments/Securities, Immigration, Science/Technology, Taxation/Internal Revenue Code, Communications/Broadcasting/Radio/TV, Budget/Appropriations, Postal, Roads/Highway, Environmental/Superfund, Computer Industry, Pharmacy, Homeland Security, Agriculture, Railroads, Constitution, Automotive Industry, Foreign Relations, Aerospace, Firearms/Guns/Ammunition, Marine/Maritime/Boating/Fisheries, Law Enforcement/Crime/Criminal Justice, Consumer Issues/Safety/Protection, Economics/Economic Development, Indian/Native American Affairs

Spending: about $5,270,000 (But it's complicated. Here's why.)

Agencies lobbied since 2008: U.S. Senate, House of Representatives, AMTRAK - Natl Railroad Passenger Corporation, Transportation - Dept of (DOT), Natl Highway Traffic Safety Administration (NHTSA), Architectural & Transportation Barriers Compliance Board, White House Office, Justice - Dept of (DOJ), Natl Council on Disability, Federal Communications Commission (FCC), Social Security Administration (SSA), Centers For Medicare and Medicaid Services (CMS), Health & Human Services - Dept of (HHS), Natl Institutes of Health (NIH), U.S. Access Board - Architectural & Transportation Barriers Compliance Board, Bureau of the Census, Centers For Disease Control & Prevention (CDC), Government Accountability Office (GAO), Natl Park Service (NPS), Veterans Affairs - Dept of (VA), Natl Telecommunications & Information Administration (NTIA), Labor - Dept of (DOL), Transportation Security Administration (TSA), Education - Dept of, Agency for Healthcare Research & Quality (AHRQ), Homeland Security - Dept of (DHS), Defense - Dept of (DOD), Office of Management & Budget (OMB), Federal Transit Administration (FTA), Federal Aviation Administration (FAA), Housing & Urban Development - Dept of (HUD), Equal Employment Opportunity Commission (EEOC), Food & Drug Administration (FDA), Vice President of the U.S., Postal Regulatory Commission, U.S. Commission on Civil Rights, Consumer Financial Protection Bureau (CFPB), Agriculture - Dept of (USDA), Federal Emergency Management Agency (FEMA), Medicare Payment Advisory Commission (MedPAC), Election Assistance Commission (EAC), State - Dept of (DOS), U.S. Coast Guard (USCG), Health & Human Services - Dept of (HHS), Defense - Dept of (DOD), Office of Personnel Management (OPM), Centers For Medicare and Medicaid Services (CMS), Transportation - Dept of (DOT),, Justice - Dept of (DOJ), Homeland Security - Dept of (DHS), U.S. Senate,, House of Representatives,, Equal Employment Opportunity Commission (EEOC),, Justice - Dept of (DOJ),, Labor - Dept of (DOL),, Housing & Urban Development - Dept of (HUD),, Centers For Medicare and Medicaid Services (CMS),, President of the U.S., Veterans Affairs - Dept of (VA),, Social Security Administration (SSA),, Health & Human Services - Dept of (HHS),, Executive Office of the President (EOP), Treasury - Dept of

Bills mentioned

H.R.620: ADA Education and Reform Act of 2017

Sponsor: Ted Poe (R-Texas)

S.910: Disability Integration Act of 2017

Sponsor: Charles E. Schumer (D-N.Y.)

H.R.2472: Disability Integration Act of 2017

Sponsor: F. James Sensenbrenner (R-Wis.)

H.CON.RES.80: Expressing the sense of the Congress that assisted suicide (sometimes...

Sponsor: Brad Wenstrup (R-Ohio)

H.R.1259: VA Accountability First Act of 2017

Sponsor: Phil Roe (R-Tenn.)

H.R.2123: VETS Act of 2017

Sponsor: Glenn Thompson (R-Pa.)

S.925: VETS Act of 2017

Sponsor: Joni Ernst (R-Iowa)

S.1318: Air Carrier Access Amendments Act of 2017

Sponsor: Tammy Baldwin (D-Wis.)

H.R.750: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2017

Sponsor: F. James Sensenbrenner (R-Wis.)

H.R.3730: To amend title XVIII of the Social Security Act to provide for the...

Sponsor: Lee Zeldin (R-N.Y.)

H.R.3635: Local Coverage Determination Clarification Act of 2018

Sponsor: Lynn Jenkins (R-Kan.)

S.794: Local Coverage Determination Clarification Act of 2017

Sponsor: Johnny Isakson (R-Ga.)

H.R.3178: Medicare Part B Improvement Act of 2017

Sponsor: Kevin Brady (R-Texas)

H.R.1361: To amend title XVIII of the Social Security Act to provide for the...

Sponsor: Lee Zeldin (R-N.Y.)

S.486: Protecting Beneficiary Access to Complex Rehab Technology Act of 2017

Sponsor: Bob Casey (D-Pa.)

H.R.292: HOT-R Act

Sponsor: Don Young (R-Alaska)

S.849: Strengthening Mosquito Abatement for Safety and Health Act

Sponsor: Angus King (ID-Maine)

H.R.807: Medicare Access to Rehabilitation Services Act of 2017

Sponsor: Erik Paulsen (R-Minn.)

S.253: Medicare Access to Rehabilitation Services Act of 2017

Sponsor: Benjamin L. Cardin (D-Md.)

H.R.1628: American Health Care Act of 2017

Sponsor: Diane Black (R-Tenn.)

H.R.634: Election Assistance Commission Termination Act

Sponsor: Gregg Harper (R-Miss.)

H.R.1394: To amend title XIX of the Social Security Act to provide States with...

Sponsor: Susan Brooks (R-Ind.)

H.R.1659: Stop Taxing Death and Disability Act

Sponsor: Peter Roskam (R-Ill.)

S.405: Stop Taxing Death and Disability Act

Sponsor: Christopher A. Coons (D-Del.)

H.R.1618: S.O.S. Veterans Caregivers Act

Sponsor: Raul Ruiz (D-Calif.)

H.R.523: Debt Transparency and Accountability Act

Sponsor: Kenny Marchant (R-Texas)

H.R.2050: Medicare Demonstration of Coverage for Low Vision Devices Act of 2017

Sponsor: Carolyn B. Maloney (D-N.Y.)

H.R.2465: Steve Gleason Enduring Voices Act of 2017

Sponsor: Cathy McMorris Rodgers (R-Wash.)

S.1132: Steve Gleason Act of 2017

Sponsor: Bill Cassidy (R-La.)

H.R.1215: Protecting Access to Care Act of 2017

Sponsor: Steve King (R-Iowa)

H.R.4441: Safe and Secure Decommissioning Act of 2017

Sponsor: Nita M. Lowey (D-N.Y.)

S.984: Creating Pathways for Youth Employment Act

Sponsor: Richard J. Durbin (D-Ill.)

H.R.6: 21st Century Cures Act

Sponsor: Fred Upton (R-Mich.)

H.R.34: 21st Century Cures Act

Sponsor: Suzanne Bonamici (D-Ore.)

S.849: Advancing Research for Neurological Diseases Act of 2016

Sponsor: Johnny Isakson (R-Ga.)

S.800: Enhancing the Stature and Visibility of Medical Rehabilitation Research...

Sponsor: Mark Steven Kirk (R-Ill.)

H.R.1631: Enhancing the Stature and Visibility of Medical Rehabilitation Research...

Sponsor: Jim Langevin (D-R.I.)

S.3252: Automatic Voter Registration Act of 2016

Sponsor: Patrick J. Leahy (D-Vt.)

H.R.5779: Automatic Voter Registration Act of 2016

Sponsor: Robert A. Brady (D-Pa.)

S.2689: REGROW Act

Sponsor: Mark Steven Kirk (R-Ill.)

S.3446: ADA Education and Reform Act of 2016

Sponsor: Jeff Flake (R-Ariz.)

H.R.3765: ADA Education and Reform Act of 2015

Sponsor: Ted Poe (R-Texas)

S.2427: Disability Integration Act of 2015

Sponsor: Charles E. Schumer (D-N.Y.)

H.R.5689: Disability Integration Act of 2016

Sponsor: Chris Gibson (R-N.Y.)

H.R.4719: COMPLI Act

Sponsor: Jerry McNerney (D-Calif.)

H.R.241: ACCESS (ADA Compliance for Customer Entry to Stores and Services) Act of...

Sponsor: Ken Calvert (R-Calif.)

H.R.3229: To amend title XVIII of the Social Security Act to provide for the...

Sponsor: Lee Zeldin (R-N.Y.)

S.2196: A bill to amend title XVIII of the Social Security Act to provide for...

Sponsor: Bob Casey (D-Pa.)

H.R.1516: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015

Sponsor: F. James Sensenbrenner (R-Wis.)

S.1013: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015

Sponsor: Thad Cochran (R-Miss.)

H.R.5721: Local Coverage Determination Clarification Act of 2016

Sponsor: Lynn Jenkins (R-Kan.)

H.R.3298: Medicare Post-Acute Care Value-Based Purchasing Act of 2015

Sponsor: Kevin Brady (R-Texas)

H.R.4909: National Defense Authorization Act for Fiscal Year 2017

Sponsor: William M. Thornberry (R-Texas)

H.R.5620: VA Accountability First and Appeals Modernization Act of 2016

Sponsor: Jeff Miller (R-Fla.)

H.R.5128: Protection and Advocacy for Veterans Act

Sponsor: Martha Roby (R-Ala.)

S.3141: Protection and Advocacy for Veterans Act of 2016

Sponsor: Mike Rounds (R-S.D.)

S.3130: Independence at Home Act of 2016

Sponsor: Edward J. Markey (D-Mass.)

H.R.670: Special Needs Trust Fairness and Medicaid Improvement Act

Sponsor: Glenn Thompson (R-Pa.)

H.R.5903: Transition to Independence Act of 2016

Sponsor: Chris Van Hollen (D-Md.)

H.R.292: Advancing Research for Neurological Diseases Act of 2015

Sponsor: Michael C. Burgess (R-Texas)

H.R.5009: Ensuring Patient Access to Critical Breakthrough Products Act of 2016

Sponsor: Charles Boustany Jr. (R-La.)

H.R.385: DISASTER Act

Sponsor: Scott Peters (D-Calif.)

H.R.3471: Veterans Mobility Safety Act of 2016

Sponsor: Jackie Walorski (R-Ind.)

H.R.3975: Veterans Homebuyer Accessibility Act of 2015

Sponsor: Jim Langevin (D-R.I.)

S.2683: Federal Aviation Administration Veteran Transition Improvement Act of 2016

Sponsor: Mazie K. Hirono (D-Hawaii)

H.R.2577: Military Construction, Veterans Affairs, and Related Agencies...

Sponsor: Mario Diaz-Balart (R-Fla.)

H.R.5210: PADME Act

Sponsor: Tom Price (R-Ga.)

H.R.636: FAA Extension, Safety, and Security Act of 2016

Sponsor: Pat Tiberi (R-Ohio)

H.R.3016: Veterans Employment, Education, and Healthcare Improvement Act

Sponsor: Brad Wenstrup (R-Ohio)

H.R.2264: To amend title 10, United States Code, to establish a space-available...

Sponsor: Gus Bilirakis (R-Fla.)

S.2596: A bill to amend title 10, United States Code, to permit veterans who...

Sponsor: Dean Heller (R-Nev.)

H.R.4683: Fairness for Veterans Act of 2016

Sponsor: Mike Coffman (R-Colo.)

S.2425: Patient Access and Medicare Protection Act

Sponsor: Rob Portman (R-Ohio)

H.R.2646: Helping Families in Mental Health Crisis Act of 2016

Sponsor: Tim Murphy (R-Pa.)

H.R.3516: Social Security Beneficiary 2nd Amendment Rights Protection Act

Sponsor: Sam Johnson (R-Texas)

H.R.1969: Military and Veteran Caregiver Services Improvement Act of 2015

Sponsor: Jim Langevin (D-R.I.)

H.R.3913: Lifespan Respite Care Reauthorization Act of 2015

Sponsor: Jim Langevin (D-R.I.)

S.1085: Military and Veteran Caregiver Services Improvement Act of 2015

Sponsor: Patty Murray (D-Wash.)

S.2141: TRUST IT Act

Sponsor: Bill Cassidy (R-La.)

H.R.353: Veterans' Access to Hearing Health Act of 2015

Sponsor: Sean Duffy (R-Wis.)

H.R.3970: Housing Our Heroes Act

Sponsor: Steve Israel (D-N.Y.)

S.1203: 21st Century Veterans Benefits Delivery and Other Improvements Act

Sponsor: Dean Heller (R-Nev.)

S.1021: Wounded Warrior Workforce Enhancement Act

Sponsor: Richard J. Durbin (D-Ill.)

S.1022: Wounded Warrior Research Enhancement Act

Sponsor: Richard J. Durbin (D-Ill.)

H.R.1987: Coast Guard Authorization Act of 2015

Sponsor: Duncan D. Hunter (R-Calif.)

H.R.188: TIME Act

Sponsor: Gregg Harper (R-Miss.)

S.1604: Transition to Independence Act

Sponsor: Charles E. Grassley (R-Iowa)

H.R.1994: VA Accountability Act of 2015

Sponsor: Jeff Miller (R-Fla.)

H.R.2360: Career-Ready Student Veterans Act

Sponsor: Mark Takano (D-Calif.)

H.R.475: GI Bill Processing Improvement Act of 2015

Sponsor: Brad Wenstrup (R-Ohio)

S.1253: Patient Access to Disposable Medical Technology Act of 2015

Sponsor: Richard M. Burr (R-N.C.)

H.R.1018: Patient Access to Disposable Medical Technology Act of 2015

Sponsor: Renee Ellmers (R-N.C.)

S.1611: Coast Guard Authorization Act of 2015

Sponsor: John Thune (R-S.D.)

H.R.2578: Commerce, Justice, Science, and Related Agencies Appropriations Act, 2016

Sponsor: John Culberson (R-Texas)

H.R.3150: One Social Security Act

Sponsor: Xavier Becerra (D-Calif.)

H.R.9: Innovation Act

Sponsor: Robert W. Goodlatte (R-Va.)

H.R.1735: National Defense Authorization Act for Fiscal Year 2016

Sponsor: William M. Thornberry (R-Texas)

H.R.2894: CARE for All Veterans Act

Sponsor: Elizabeth Esty (D-Conn.)

H.R.1919: Steve Gleason Act of 2015

Sponsor: Cathy McMorris Rodgers (R-Wash.)

H.R.629: Permanent S Corporation Built-in Gain Recognition Period Act of 2015

Sponsor: Dave Reichert (R-Wash.)

S.984: Steve Gleason Act of 2015

Sponsor: David Vitter (R-La.)

H.R.160: Protect Medical Innovation Act of 2015

Sponsor: Erik Paulsen (R-Minn.)

S.705: A bill to amend section 213 of title 23, United States Code, relating to...

Sponsor: Thad Cochran (R-Miss.)

H.R.2071: Safe Streets Act of 2015

Sponsor: Doris Matsui (D-Calif.)

H.R.2530: Friendly Airports for Mothers Act of 2015

Sponsor: Tammy Duckworth (D-Ill.)

H.R.1448: Transit Accessibility Innovation Act of 2015

Sponsor: Jim Langevin (D-R.I.)

H.R.628: Steve Gleason Act of 2015

Sponsor: Cathy McMorris Rodgers (R-Wash.)

H.R.773: Transform Education in America through Choice Act of 2015

Sponsor: Ted Yoho (R-Fla.)

S.539: Medicare Access to Rehabilitation Services Act of 2015

Sponsor: Benjamin L. Cardin (D-Md.)

H.R.729: Medicare Demonstration of Coverage for Low Vision Devices Act of 2015

Sponsor: Carolyn B. Maloney (D-N.Y.)

H.R.2: Medicare Access and CHIP Reauthorization Act of 2015

Sponsor: Michael C. Burgess (R-Texas)

S.2553: Kari's Law Act of 2016

Sponsor: Amy Klobuchar (D-Minn.)

H.R.4994: Veterans Pensions Protection Act of 2016

Sponsor: Alcee L. Hastings (D-Fla.)

H.R.749: Passenger Rail Reform and Investment Act of 2015

Sponsor: Bill Shuster (R-Pa.)

S.499: Social Security Disability Insurance and Unemployment Benefits Double...

Sponsor: Orrin G. Hatch (R-Utah)

H.R.918: Social Security Disability Insurance and Unemployment Benefits Double...

Sponsor: Sam Johnson (R-Texas)

S.343: Reducing Overlapping Payments Act

Sponsor: Jeff Flake (R-Ariz.)

H.R.288: CHAMPVA Children's Protection Act of 2013

Sponsor: Michael H. Michaud (D-Maine)

S.325: A bill to amend title 38, United States Code, to increase the maximum...

Sponsor: Jon Tester (D-Mont.)

H.R.4090: Social Security Fraud and Error Prevention Act of 2014

Sponsor: Xavier Becerra (D-Calif.)

H.R.5260: Stop Disability Fraud Act of 2014

Sponsor: Sam Johnson (R-Texas)

H.R.647: ABLE Act of 2014

Sponsor: Ander Crenshaw (R-Fla.)

S.313: ABLE Act of 2013

Sponsor: Bob Casey (D-Pa.)

S.2035: SPRINT Act

Sponsor: Mark Begich (D-Alaska)

S.153: Mental Health First Aid Act of 2013

Sponsor: Mark Begich (D-Alaska)

H.R.942: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013

Sponsor: Joseph Crowley (D-N.Y.)

S.948: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013

Sponsor: Charles E. Schumer (D-N.Y.)

H.R.4920: Medicare DMEPOS Competitive Bidding Improvement Act of 2014

Sponsor: Pat Tiberi (R-Ohio)

S.1027: A bill to improve, coordinate, and enhance rehabilitation research at...

Sponsor: Mark Steven Kirk (R-Ill.)

H.R.3422: Veterans Homebuyer Accessibility Act of 2013

Sponsor: Jim Langevin (D-R.I.)

H.R.4435: Howard P. "Buck" McKeon National Defense Authorization Act for Fiscal...

Sponsor: Howard P. McKeon (R-Calif.)

S.2410: Carl Levin National Defense Authorization Act for Fiscal Year 2015

Sponsor: Carl Levin (D-Mich.)

H.R.3979: Carl Levin and Howard P. "Buck" McKeon National Defense Authorization...

Sponsor: Lou Barletta (R-Pa.)

S.1659: POST Act of 2013

Sponsor: Richard J. Durbin (D-Ill.)

H.R.4630: Caring for Military Children with Developmental Disabilities Act of 2014

Sponsor: John B. Larson (D-Conn.)

S.2333: Caring for Military Children with Developmental Disabilities Act of 2014

Sponsor: Patty Murray (D-Wash.)

H.R.164: To amend title 10, United States Code, to permit veterans who have a...

Sponsor: Gus Bilirakis (R-Fla.)

H.R.1705: Rehabilitative Therapy Parity for Military Beneficiaries Act

Sponsor: Michael C. Burgess (R-Texas)

S.967: Military Justice Improvement Act of 2013

Sponsor: Kirsten E. Gillibrand (D-N.Y.)

H.R.2249: Disabled Military Child Protection Act of 2013

Sponsor: James P. Moran (D-Va.)

S.1076: Disabled Military Child Protection Act of 2013

Sponsor: Kay Hagan (D-N.C.)

H.R.83: Consolidated and Further Continuing Appropriations Act, 2015

Sponsor: Donna M.C. Christensen (D-Virgin Islands)

H.R.5404: Department of Veterans Affairs Expiring Authorities Act of 2014

Sponsor: Jeffrey Denham (R-Calif.)

H.R.5007: Restoring Accountability in Veterans Access to Health Care Act

Sponsor: Raul Ruiz (D-Calif.)

H.R.4674: Guarantee Housing for Terminally Ill Veterans Act

Sponsor: Julia Brownley (D-Calif.)

S.2009: Rural Veterans Improvement Act of 2014

Sponsor: Tom Udall (D-N.M.)

S.2145: Veteran Voting Support Act

Sponsor: Dianne Feinstein (D-Calif.)

S.2296: Veterans Appeals Improvement Act of 2014

Sponsor: Jeanne Shaheen (D-N.H.)

S.2091: 21st Century Veterans Benefits Delivery Act

Sponsor: Dean Heller (R-Nev.)

S.2316: A bill to require the Inspector General of the Department of Veterans...

Sponsor: John Thune (R-S.D.)

S.2362: A bill to prohibit the payment of performance awards in fiscal year 2015...

Sponsor: Deb Fischer (R-Neb.)

S.2401: Increasing Medical Oversight in the Department of Veterans Affairs Act...

Sponsor: Jon Tester (D-Mont.)

H.R.4810: Veteran Access to Care Act of 2014

Sponsor: Jeff Miller (R-Fla.)

H.R.4037: Improving Veterans' Access to Vocational Rehabilitation and Employment...

Sponsor: Bill Flores (R-Texas)

H.R.2119: Veterans Access to Speedy Review Act

Sponsor: Raul Ruiz (D-Calif.)

H.R.3876: Burial with Dignity for Heroes Act of 2014

Sponsor: Al Green (D-Texas)

S.1584: A bill to amend title 38, United States Code, to provide replacement...

Sponsor: Bernard Sanders (ID-Vt.)

H.R.2088: To direct the Secretary of Veterans Affairs to carry out a pilot program...

Sponsor: Michael H. Michaud (D-Maine)

H.R.2726: Long-Term Care Veterans Choice Act

Sponsor: Jeff Miller (R-Fla.)

S.944: Veterans Health and Benefits Improvement Act of 2013

Sponsor: Bernard Sanders (ID-Vt.)

S.1165: Access to Appropriate Immunizations for Veterans Act of 2013

Sponsor: Jon Tester (D-Mont.)

S.832: Improving the Lives of Children with Spina Bifida Act of 2013

Sponsor: Joe Donnelly (D-Ind.)

H.R.1623: VA Claims Efficiency Through Information Act of 2013

Sponsor: Gloria Negrete McLeod (D-Calif.)

H.R.2189: To improve the processing of disability claims by the Department of...

Sponsor: Jeff Miller (R-Fla.)

H.R.2341: Veterans Pension Protection Act

Sponsor: Tom Rooney (R-Fla.)

H.R.2138: Ending VA Claims Disability Backlog and Accountability Act

Sponsor: Kevin McCarthy (R-Calif.)

H.R.844: VetSuccess Enhancement Act

Sponsor: Mark Takano (D-Calif.)

H.R.894: To amend title 38, United States Code, to improve the supervision of...

Sponsor: Bill Johnson (R-Ohio)

H.R.369: Reducing Barriers to Veterans' Benefits Act

Sponsor: Dan Benishek (R-Mich.)

H.R.733: Access to Veterans Benefits Improvement Act

Sponsor: Jon Runyan (R-N.J.)

S.2834: Protect Veterans Employment and Training Services Act of 2014

Sponsor: Patrick J. Toomey (R-Pa.)

H.R.4977: COVER Act

Sponsor: Gus Bilirakis (R-Fla.)

H.R.5059: Clay Hunt SAV Act

Sponsor: Tim Walz (D-Minn.)

S.2182: Suicide Prevention for American Veterans Act

Sponsor: John Walsh (D-Mont.)

H.R.5484: Toxic Exposure Research Act of 2014

Sponsor: Dan Benishek (R-Mich.)

H.R.5032: Wounded Warrior Employment Improvement Act

Sponsor: Sean Patrick Maloney (D-N.Y.)

H.R.4971: Ask Veterans Act

Sponsor: Beto O'Rourke (D-Texas)

S.2115: American Cures Act

Sponsor: Richard J. Durbin (D-Ill.)

S.2243: Military and Veteran Caregiver Services Improvement Act of 2014

Sponsor: Patty Murray (D-Wash.)

H.R.4892: Military and Veteran Caregiver Services Improvement Act of 2014

Sponsor: Jim Langevin (D-R.I.)

H.R.4247: Disabled Veterans Jobs Opportunity Act

Sponsor: Raul Ruiz (D-Calif.)

H.R.4616: Express Appeals Act

Sponsor: Beto O'Rourke (D-Texas)

H.R.5332: SAVE Act of 2014

Sponsor: Joseph Crowley (D-N.Y.)

S.2450: Veterans' Access to Care through Choice, Accountability, and...

Sponsor: Bernard Sanders (ID-Vt.)

H.R.3230: Veterans Access, Choice, and Accountability Act of 2014

Sponsor: Harold Rogers (R-Ky.)

S.1950: Comprehensive Veterans Health and Benefits and Military Retirement Pay...

Sponsor: Bernard Sanders (ID-Vt.)

S.1982: Comprehensive Veterans Health and Benefits and Military Retirement Pay...

Sponsor: Bernard Sanders (ID-Vt.)

H.R.2527: To amend title 38, United States Code, to provide veterans with...

Sponsor: Dina Titus (D-Nev.)

H.R.2974: To amend title 38, United States Code, to provide for the eligibility...

Sponsor: Jackie Walorski (R-Ind.)

H.R.3958: Healing Our Heroes Act

Sponsor: Paul Broun (R-Ga.)

H.R.4276: Veterans Traumatic Brain Injury Care Improvement Act of 2014

Sponsor: Bill Cassidy (R-La.)

S.2607: Assisted Living Pilot Program for Veterans with Traumatic Brain Injury...

Sponsor: Cory Booker (D-N.J.)

H.R.4234: Ensuring Veterans' Resiliency Act

Sponsor: Larry Bucshon (R-Ind.)

H.R.4150: Veterans Employment and Training Service Longitudinal Study Act of 2014

Sponsor: Paul Cook (R-Calif.)

H.R.4151: Veterans Education Survey Act of 2014

Sponsor: Gus Bilirakis (R-Fla.)

H.R.2018: Honor Those Who Served Act of 2013

Sponsor: Steve Stivers (R-Ohio)

H.R.2529: Veteran Spouses Equal Treatment Act

Sponsor: Dina Titus (D-Nev.)

H.R.3671: To amend title 38, United States Code, to expand the eligibility for a...

Sponsor: Jeff Miller (R-Fla.)

H.R.4095: Veterans' Compensation Cost-of-Living Adjustment Act of 2014

Sponsor: Jon Runyan (R-N.J.)

S.2258: Veterans' Compensation Cost-of-Living Adjustment Act of 2014

Sponsor: Mark Begich (D-Alaska)

H.R.4102: To amend title 38, United States Code, to clarify that the estate of a...

Sponsor: Jeff Miller (R-Fla.)

H.R.4141: To amend title 38, United States Code, to authorize the Secretary of...

Sponsor: Ander Crenshaw (R-Fla.)

S.2311: A bill to amend title 38, United States Code, to include licensed...

Sponsor: Jon Tester (D-Mont.)

H.R.3508: To amend title 38, United States Code, to clarify the qualifications of...

Sponsor: Sean Duffy (R-Wis.)

H.R.3672: S.O.S. Veterans Caregivers Act

Sponsor: Raul Ruiz (D-Calif.)

S.1564: Protecting Those Who Protected Us Act of 2013

Sponsor: Bernard Sanders (ID-Vt.)

H.R.1980: Quicker Veterans Benefits Delivery Act

Sponsor: Tim Walz (D-Minn.)

H.R.4191: Quicker Veterans Benefits Delivery Act

Sponsor: Tim Walz (D-Minn.)

H.R.2797: Homeless Veterans Assistance Fund Act of 2013

Sponsor: Steve Israel (D-N.Y.)

H.R.3330: Veterans' Independent Living Enhancement Act

Sponsor: Michelle Lujan Grisham (D-N.M.)

H.R.570: American Heroes COLA Act

Sponsor: Jon Runyan (R-N.J.)

H.R.602: Veterans 2nd Amendment Protection Act

Sponsor: Jeff Miller (R-Fla.)

H.R.671: Ruth Moore Act of 2013

Sponsor: Chellie Pingree (D-Maine)

H.R.679: Honor America's Guard-Reserve Retirees Act

Sponsor: Tim Walz (D-Minn.)

H.R.1729: VA Claims, Operations, and Records Efficiency Act

Sponsor: Ann Kirkpatrick (D-Ariz.)

H.R.1288: World War II Merchant Mariner Service Act

Sponsor: G. K. Butterfield (D-N.C.)

H.R.1494: Blue Water Navy Ship Accountability Act

Sponsor: Chris Gibson (R-N.Y.)

H.R.2086: Pay As You Rate Act

Sponsor: Dina Titus (D-Nev.)

H.R.1809: To amend title 38, United States Code, to direct the Secretary of...

Sponsor: Beto O'Rourke (D-Texas)

H.R.2382: Prioritizing Urgent Claims for Veterans Act

Sponsor: Paul Cook (R-Calif.)

H.R.2423: Disabled Veterans' Access to Medical Exams Improvement Act

Sponsor: Jon Runyan (R-N.J.)

H.R.813: Putting Veterans Funding First Act of 2013

Sponsor: Jeff Miller (R-Fla.)

S.932: Putting Veterans Funding First Act of 2013

Sponsor: Mark Begich (D-Alaska)

S.522: Wounded Warrior Workforce Enhancement Act

Sponsor: Richard J. Durbin (D-Ill.)

S.877: Veterans Affairs Research Transparency Act of 2013

Sponsor: Mark Begich (D-Alaska)

H.R.1702: Veterans Transportation Service Act

Sponsor: Ron Barber (D-Ariz.)

S.455: A bill to amend title 38, United States Code, to authorize the Secretary...

Sponsor: Jon Tester (D-Mont.)

H.R.33: Audit The Fed Act of 2013

Sponsor: Steve Stockman (R-Texas)

H.R.1591: CAL Undiagnosed Diseases Research and Collaboration Network Act of 2013

Sponsor: John Carter (R-Texas)

H.R.385: HAVEN Act

Sponsor: Al Green (D-Texas)

H.R.3743: HAVEN Act

Sponsor: Al Green (D-Texas)

S.1387: HAVEN Act

Sponsor: Jack Reed (D-R.I.)

H.R.384: Homes for Heroes Act of 2013

Sponsor: Al Green (D-Texas)

H.R.386: Homes for Heroes Act of 2013

Sponsor: Al Green (D-Texas)

S.2889: Universal Home Design Act of 2014

Sponsor: Tom Harkin (D-Iowa)

H.R.2362: Transportation for Heroes Act of 2013

Sponsor: Al Green (D-Texas)

H.R.2637: Supporting Academic Freedom through Regulatory Relief Act

Sponsor: Virginia Foxx (R-N.C.)

H.R.4683: Lifespan Respite Care Reauthorization Act of 2014

Sponsor: Jim Langevin (D-R.I.)

H.R.3077: TELE-MED Act of 2013

Sponsor: Devin Nunes (R-Calif.)

H.R.3749: Medicare Demonstration of Coverage for Low Vision Devices Act of 2013

Sponsor: Carolyn B. Maloney (D-N.Y.)

H.R.713: Medicare Access to Rehabilitation Services Act of 2013

Sponsor: Jim Gerlach (R-Pa.)

S.367: Medicare Access to Rehabilitation Services Act of 2013

Sponsor: Benjamin L. Cardin (D-Md.)

S.2515: Community Integration Act of 2014

Sponsor: Tom Harkin (D-Iowa)

H.R.3383: Caregivers Expansion and Improvement Act of 2013

Sponsor: Elizabeth Esty (D-Conn.)

S.851: Caregivers Expansion and Improvement Act of 2013

Sponsor: Bernard Sanders (ID-Vt.)

H.R.1284: To amend title 38, United States Code, to provide for coverage under the...

Sponsor: Julia Brownley (D-Calif.)

S.633: A bill to amend title 38, United States Code, to provide for coverage...

Sponsor: Jon Tester (D-Mont.)

H.R.1405: To amend title 38, United States Code, to require the Secretary of...

Sponsor: Dina Titus (D-Nev.)

H.R.631: Servicemembers' Choice in Transition Act of 2013

Sponsor: Bill Flores (R-Texas)

S.889: Servicemembers' Choice in Transition Act of 2013

Sponsor: John Boozman (R-Ark.)

H.R.803: Workforce Innovation and Opportunity Act

Sponsor: Virginia Foxx (R-N.C.)

H.R.3978: New Opportunities for Bicycle and Pedestrian Infrastructure Financing...

Sponsor: Albio Sires (D-N.J.)

H.R.3494: To amend title 23, United States Code, with respect to the establishment...

Sponsor: Earl Blumenauer (D-Ore.)

S.1708: A bill to amend title 23, United States Code, with respect to the...

Sponsor: Jeff Merkley (D-Ore.)

H.R.357: GI Bill Tuition Fairness Act of 2014

Sponsor: Jeff Miller (R-Fla.)

S.131: Women Veterans and Other Health Care Improvements Act of 2013

Sponsor: Patty Murray (D-Wash.)

H.R.958: Women Veterans and Other Health Care Improvements Act of 2013

Sponsor: Rick Larsen (D-Wash.)

H.R.183: Veterans Dog Training Therapy Act

Sponsor: Mike Grimm (R-N.Y.)

H.R.4755: Access to Inpatient Rehabilitation Therapy Act of 2014

Sponsor: Glenn Thompson (R-Pa.)

H.R.3620: Local Hire Act

Sponsor: Karen Bass (D-Calif.)

S.308: Protecting and Preserving Social Security Act

Sponsor: Mark Begich (D-Alaska)

S.567: Strengthening Social Security Act of 2013

Sponsor: Tom Harkin (D-Iowa)

H.R.297: Children's Hospital GME Support Reauthorization Act of 2013

Sponsor: Joe Pitts (R-Pa.)

H.R.1717: Medicare DMEPOS Market Pricing Program Act of 2013

Sponsor: Tom Price (R-Ga.)

S.460: Fair Minimum Wage Act of 2013

Sponsor: Tom Harkin (D-Iowa)

H.R.3505: TEACH Act

Sponsor: Tom Petri (R-Wis.)

H.R.994: ACCESS (ADA Compliance for Customer Entry to Stores and Services) Act of...

Sponsor: Ken Calvert (R-Calif.)

H.R.203: Pool SAFE Act

Sponsor: Mick Mulvaney (R-S.C.)

H.R.777: ADA Notification Act of 2013

Sponsor: Duncan D. Hunter (R-Calif.)

H.R.2610: Transportation, Housing and Urban Development, and Related Agencies...

Sponsor: Tom Latham (R-Iowa)

H.R.2216: Military Construction and Veterans Affairs, and Related Agencies...

Sponsor: John Culberson (R-Texas)

H.R.1960: National Defense Authorization Act for Fiscal Year 2014

Sponsor: Howard P. McKeon (R-Calif.)

H.R.3304: National Defense Authorization Act for Fiscal Year 2014

Sponsor: Ted Deutch (D-Fla.)

S.1197: National Defense Authorization Act for Fiscal Year 2014

Sponsor: Carl Levin (D-Mich.)

H.R.2123: Special Needs Trust Fairness Act of 2013

Sponsor: Glenn Thompson (R-Pa.)

H.R.3118: Strengthening Social Security Act of 2013

Sponsor: Linda T. Sánchez (D-Calif.)

H.R.569: Veterans' Compensation Cost-of-Living Adjustment Act of 2013

Sponsor: Jon Runyan (R-N.J.)

H.R.831: Fair Wages for Workers with Disabilities Act of 2013

Sponsor: Gregg Harper (R-Miss.)

H.R.2352: Eleanor Smith Inclusive Home Design Act of 2013

Sponsor: Jan Schakowsky (D-Ill.)

H.R.649: Protecting and Preserving Social Security Act

Sponsor: Ted Deutch (D-Fla.)

H.CON.RES.34: Expressing the sense of the Congress that the Chained Consumer Price...

Sponsor: David Cicilline (D-R.I.)

S.1365: Part D Beneficiary Appeals Fairness Act

Sponsor: Bill Nelson (D-Fla.)

H.R.2827: Part D Beneficiary Appeals Fairness Act

Sponsor: Hank Johnson (D-Ga.)

S.1356: Workforce Investment Act of 2013

Sponsor: Patty Murray (D-Wash.)

H.R.8:

Sponsor: John A. Boehner (R-Ohio)

H.R.4378: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2012

Sponsor: Joseph Crowley (D-N.Y.)

H.R.3613: Part D Beneficiary Appeals Fairness Act

Sponsor: Hank Johnson (D-Ga.)

H.R.1546: Medicare Access to Rehabilitation Services Act of 2011

Sponsor: Jim Gerlach (R-Pa.)

S.829: Medicare Access to Rehabilitation Services Act of 2011

Sponsor: Benjamin L. Cardin (D-Md.)

H.R.6490: Medicare DMEPOS Market Pricing Program Act of 2012

Sponsor: Tom Price (R-Ga.)

H.R.115: CHAMPVA Children's Protection Act of 2011

Sponsor: Bob Filner (D-Calif.)

S.490: A bill to amend title 38, United States Code, to increase the maximum...

Sponsor: Daniel K. Akaka (D-Hawaii)

H.R.2032: To protect the interests of each resident of intermediate care...

Sponsor: Barney Frank (D-Mass.)

H.R.3356: ACCESS (ADA Compliance for Customer Entry to Stores and Services) Act of...

Sponsor: Dan Lungren (R-Calif.)

H.R.4200: To amend the Americans with Disabilities Act of 1990 to prohibit the...

Sponsor: David Schweikert (R-Ariz.)

H.R.4256: Pool Safety and Accessibility for Everyone (Pool SAFE) Act

Sponsor: Mick Mulvaney (R-S.C.)

S.2191: A bill to amend the Americans with Disabilities Act of 1990 to prohibit...

Sponsor: Jim DeMint (R-S.C.)

S.2186: A bill to amend the Americans with Disabilities Act of 1990 to prohibit...

Sponsor: Jim DeMint (R-S.C.)

H.R.6627: Veterans Homebuyer Accessibility Act of 2012

Sponsor: Jim Langevin (D-R.I.)

H.R.4310: National Defense Authorization Act for Fiscal Year 2013

Sponsor: Howard P. McKeon (R-Calif.)

S.67: A bill to amend title 10, United States Code, to permit former members...

Sponsor: Daniel K. Inouye (D-Hawaii)

H.R.4329: Disabled Military Child Protection Act of 2012

Sponsor: James P. Moran (D-Va.)

H.R.2288: Caring for Military Kids with Autism Act

Sponsor: John B. Larson (D-Conn.)

S.2179: Military and Veterans Educational Reform Act of 2012

Sponsor: Jim Webb (D-Va.)

H.R.5326: Commerce, Justice, Science, and Related Agencies Appropriations Act, 2013

Sponsor: Frank R. Wolf (R-Va.)

H.R.5856: Department of Defense Appropriations Act, 2013

Sponsor: C. W. Bill Young (R-Fla.)

S.2241: GI Bill Consumer Awareness Act of 2012

Sponsor: Patty Murray (D-Wash.)

S.1806: A bill to amend the Internal Revenue Code of 1986 to allow taxpayers to...

Sponsor: Barbara Boxer (D-Calif.)

H.R.6527: Women Veterans and Other Health Care Improvements Act of 2012

Sponsor: Rick Larsen (D-Wash.)

S.3313: Women Veterans and Other Health Care Improvements Act of 2012

Sponsor: Patty Murray (D-Wash.)

S.3372: Military Service Integrity Act of 2012

Sponsor: Jim Webb (D-Va.)

H.R.1627: Honoring America's Veterans and Caring for Camp Lejeune Families Act of...

Sponsor: Jeff Miller (R-Fla.)

H.R.2985: Veteran's I.D. Card Act

Sponsor: Todd Akin (R-Mo.)

H.R.3730: Veterans Data Breach Timely Notification Act

Sponsor: Joe Donnelly (D-Ind.)

H.R.4481: Veterans Affairs Employee Accountability Act

Sponsor: Phil Roe (R-Tenn.)

H.R.5948: Veterans Fiduciary Reform and Honoring Noble Service Act

Sponsor: Bill Johnson (R-Ohio)

S.3340: Mental Health ACCESS Act of 2012

Sponsor: Patty Murray (D-Wash.)

S.3270: A bill to amend title 38, United States Code, to require the Secretary...

Sponsor: Ron Wyden (D-Ore.)

S.1755: A bill to amend title 38, United States Code, to provide for coverage...

Sponsor: Jon Tester (D-Mont.)

S.1264: Veteran Voting Support Act of 2011

Sponsor: Dianne Feinstein (D-Calif.)

H.R.4072: Consolidating Veteran Employment Services for Improved Performance Act...

Sponsor: Jeff Miller (R-Fla.)

H.R.674: To amend the Internal Revenue Code of 1986 to repeal the imposition of 3...

Sponsor: Wally Herger (R-Calif.)

H.R.2433: Veterans Opportunity to Work Act of 2011

Sponsor: Jeff Miller (R-Fla.)

S.951: Hiring Heroes Act of 2011

Sponsor: Patty Murray (D-Wash.)

H.R.2559: Helping Homeless Heroes Act of 2011

Sponsor: Ted Deutch (D-Fla.)

H.R.2671: Charles August Long Undiagnosed Diseases Research and Collaboration...

Sponsor: John Carter (R-Texas)

H.R.198: Veterans Dog Training Therapy Act

Sponsor: Mike Grimm (R-N.Y.)

S.1838: A bill to require the Secretary of Veterans Affairs to carry out a pilot...

Sponsor: Max Baucus (D-Mont.)

H.R.2074: Veterans Sexual Assault Prevention and Health Care Enhancement Act

Sponsor: Ann Marie Buerkle (R-N.Y.)

H.R.1154: VETS Dogs Act

Sponsor: John Carter (R-Texas)

S.914: Veterans Programs Improvement Act of 2011

Sponsor: Mark Begich (D-Alaska)

S.769: VETS Dogs Act of 2011

Sponsor: Tom Harkin (D-Iowa)

S.411: Helping Our Homeless Veterans Act of 2011

Sponsor: Amy Klobuchar (D-Minn.)

S.957: Veterans' Traumatic Brain Injury Rehabilitative Services' Improvements...

Sponsor: John Boozman (R-Ark.)

H.R.1133: Helping Our Homeless Veterans Act of 2011

Sponsor: Bob Filner (D-Calif.)

H.R.117: HELP Veterans Act of 2011

Sponsor: Bob Filner (D-Calif.)

H.R.1671: Andrew Connolly Veterans' Housing Act

Sponsor: Bruce Braley (D-Iowa)

H.R.805: To direct the Secretary of Veterans Affairs to educate certain staff of...

Sponsor: Bob Filner (D-Calif.)

H.R.6381: HAVEN Act

Sponsor: Al Green (D-Texas)

S.3614: HAVEN Act

Sponsor: Jack Reed (D-R.I.)

H.R.6361: Vulnerable Veterans Housing Reform Act of 2012

Sponsor: Joe Heck (R-Nev.)

H.R.5781: Inclusive Home Design Act of 2012

Sponsor: Jan Schakowsky (D-Ill.)

H.R.3200: Local Flexibility for Transit Assistance Act

Sponsor: Russ Carnahan (D-Mo.)

S.1950: Commercial Motor Vehicle Safety Enhancement Act of 2011

Sponsor: Frank R. Lautenberg (D-N.J.)

S.1813: MAP-21

Sponsor: Barbara Boxer (D-Calif.)

H.R.7: American Energy and Infrastructure Jobs Act of 2012

Sponsor: John L. Mica (R-Fla.)

H.R.6061: WIPA and PABSS Continuation of Services Act of 2012

Sponsor: Xavier Becerra (D-Calif.)

H.R.4227: Workforce Investment Act of 2012

Sponsor: John F. Tierney (D-Mass.)

H.R.3086: Fair Wages for Workers with Disabilities Act of 2011

Sponsor: Cliff Stearns (R-Fla.)

H.R.881: ADA Notification Act of 2011

Sponsor: Duncan D. Hunter (R-Calif.)

H.R.5428: To suspend temporarily the duty on certain women's footwear.

Sponsor: Tim Huelskamp (R-Kan.)

H.R.1173: Fiscal Responsibility and Retirement Security Act of 2011

Sponsor: Charles Boustany Jr. (R-La.)

H.R.3266: Lifespan Respite Care Reauthorization Act of 2011

Sponsor: Jim Langevin (D-R.I.)

H.R.4323: Consumer Mortgage Choice Act

Sponsor: Bill Huizenga (R-Mich.)

S.1872: ABLE Act of 2011

Sponsor: Bob Casey (D-Pa.)

H.R.3010: Regulatory Accountability Act of 2011

Sponsor: Lamar Smith (R-Texas)

S.1606: Regulatory Accountability Act of 2011

Sponsor: Rob Portman (R-Ohio)

H.R.10: Regulations From the Executive in Need of Scrutiny Act of 2011

Sponsor: Geoff Davis (R-Ky.)

S.299: REINS Act

Sponsor: Rand Paul (R-Ky.)

H.R.1862: Regenerative Medicine Promotion Act of 2011

Sponsor: Brian P. Bilbray (R-Calif.)

H.R.2376: Stem Cell Research Advancement Act of 2011

Sponsor: Diana DeGette (D-Colo.)

H.R.1958: Medicare Orthotics and Prosthetics Improvement Act of 2011

Sponsor: Shelley Berkley (D-Nev.)

H.R.4899: Supplemental Appropriations Act, 2010

Sponsor: David R. Obey (D-Wis.)

H.R.1205: ABLE Act of 2009

Sponsor: Ander Crenshaw (R-Fla.)

H.R.5822: Military Construction and Veterans Affairs and Related Agencies...

Sponsor: Chet Edwards (D-Texas)

H.R.3590: Patient Protection and Affordable Care Act

Sponsor: Charles B. Rangel (D-N.Y.)

H.R.4872: Health Care and Education Reconciliation Act of 2010

Sponsor: John M. Spratt Jr. (D-S.C.)

S.697: Community Living Assistance Services and Supports Act

Sponsor: Edward M. Kennedy (D-Mass.)

H.R.1721: Community Living Assistance Services and Supports Act

Sponsor: Frank Pallone (D-N.J.)

H.R.3962: Preservation of Access to Care for Medicare Beneficiaries and Pension...

Sponsor: John D. Dingell (D-Mich.)

S.683: Community Choice Act of 2009

Sponsor: Tom Harkin (D-Iowa)

H.R.1670: Community Choice Act of 2009

Sponsor: Danny K. Davis (D-Ill.)

S.700: Ending the Medicare Disability Waiting Period Act of 2009

Sponsor: Jeff Bingaman (D-N.M.)

H.R.1708: Ending the Medicare Disability Waiting Period Act of 2009

Sponsor: Gene Green (D-Texas)

H.R.2502: Comparative Effectiveness Research Act of 2009

Sponsor: Kurt Schrader (D-Ore.)

S.1213: Patient-Centered Outcomes Research Act of 2009

Sponsor: Max Baucus (D-Mont.)

S.1136: Mental Illness Chronic Care Improvement Act of 2009

Sponsor: Debbie Stabenow (D-Mich.)

H.R.2575: Prosthetic and Custom Orthotic Parity Act of 2009

Sponsor: Robert E. Andrews (D-N.J.)

H.R.1675: Frank Melville Supportive Housing Investment Act of 2009

Sponsor: Christopher S. Murphy (D-Conn.)

H.R.1408: Inclusive Home Design Act of 2009

Sponsor: Jan Schakowsky (D-Ill.)

H.R.1093: To amend title II of the Social Security Act to provide for an increase...

Sponsor: John Lewis (D-Ga.)

H.R.2829: Recidivism Reduction Act

Sponsor: André Carson (D-Ind.)

H.R.3325: WIPA and PABSS Reauthorization Act of 2009

Sponsor: John Tanner (D-Tenn.)

H.R.4532: Social Security Disability Applicants' Access to Professional...

Sponsor: John Tanner (D-Tenn.)

S.3220: Prosthetics and Custom Orthotics Parity Act of 2010

Sponsor: Olympia J. Snowe (R-Maine)

S.3223: Prosthetics and Custom Orthotics Parity Act of 2010

Sponsor: Olympia J. Snowe (R-Maine)

H.R.873: Stem Cell Research Enhancement Act of 2009

Sponsor: Diana DeGette (D-Colo.)

S.487: Stem Cell Research Enhancement Act of 2009

Sponsor: Tom Harkin (D-Iowa)

H.R.2107: Cord Blood Education and Awareness Act of 2009

Sponsor: Jackie Speier (D-Calif.)

H.R.1362: National Neurological Diseases Surveillance System Act of 2010

Sponsor: Chris Van Hollen (D-Md.)

H.R.3790: To amend title XVIII of the Social Security Act to repeal the Medicare...

Sponsor: Kendrick B. Meek (D-Fla.)

H.R.3184: Medicare Independent Living Act of 2009

Sponsor: Jim Langevin (D-R.I.)

S.1186: Medicare Independent Living Act of 2009

Sponsor: Jeff Bingaman (D-N.M.)

H.R.2390: Guidance, Understanding, and Information for Dual Eligibles (GUIDE) Act

Sponsor: Lucille Roybal-Allard (D-Calif.)

S.1630: Affordable Access to Prescription Medications Act of 2009

Sponsor: John D. Rockefeller IV (D-W.Va.)

H.R.3799: Affordable Access to Prescription Medications Act of 2009

Sponsor: Hank Johnson (D-Ga.)

H.R.3621: Call Center Consumer's Right to Know Act

Sponsor: Jason Altmire (D-Pa.)

H.R.1255: To protect the interests of each resident of intermediate care...

Sponsor: Barney Frank (D-Mass.)

H.R.5549: RAPID Claims Act

Sponsor: Joe Donnelly (D-Ind.)

S.3517: Claims Processing Improvement Act of 2010

Sponsor: Daniel K. Akaka (D-Hawaii)

H.R.1037: Veterans' Benefits Enhancement Act of 2009

Sponsor: Stephanie Herseth Sandlin (D-S.D.)

S.728: Veterans' Benefits Enhancement Act of 2009

Sponsor: Daniel K. Akaka (D-Hawaii)

H.R.116: Robo Calls Off Phones (Robo COP) Act

Sponsor: Virginia Foxx (R-N.C.)

H.R.3813: Veterans Training Act

Sponsor: Joe Sestak (D-Pa.)

H.R.2243: Surviving Spouses' Benefit Improvement Act of 2009

Sponsor: Steve Buyer (R-Ind.)

H.R.775: Military Surviving Spouses Equity Act

Sponsor: Solomon P. Ortiz (D-Texas)

S.53: Nursing School Clinics Act of 2009

Sponsor: Daniel K. Inouye (D-Hawaii)

H.R.5225: iVETS Act

Sponsor: Niki Tsongas (D-Mass.)

H.R.3407: Severely Injured Veterans Benefit Improvement Act of 2009

Sponsor: Steve Buyer (R-Ind.)

S.1237: Homeless Veterans and Other Veterans Health Care Authorities Act of 2010

Sponsor: Patty Murray (D-Wash.)

S.1547: Zero Tolerance for Veterans Homelessness Act of 2009

Sponsor: Jack Reed (D-R.I.)

H.R.4810: End Veteran Homelessness Act of 2010

Sponsor: Bob Filner (D-Calif.)

H.R.2504: To amend title 38, United States Code, to provide for an increase in the...

Sponsor: Harry Teague (D-N.M.)

H.R.2559: Help Our Homeless Veterans Act

Sponsor: Phil Hare (D-Ill.)

H.R.2735: To amend title 38, United States Code, to make certain improvements to...

Sponsor: Ciro D. Rodriguez (D-Texas)

H.R.3906: To amend title 38, United States Code, to authorize appropriations for...

Sponsor: Harry Teague (D-N.M.)

H.R.501: America's Right-to-Eat Rescue Act of 2009

Sponsor: Joe Baca (D-Calif.)

H.R.952: Compensation Owed for Mental Health Based on Activities in Theater...

Sponsor: John Hall (D-N.Y.)

S.3398: Veteran Employment Transition Act of 2010

Sponsor: Max Baucus (D-Mont.)

H.R.5400: Veteran Employment Transition Act of 2010

Sponsor: Tim Walz (D-Minn.)

H.R.2059: To amend title 10, United States Code, to provide for the payment of...

Sponsor: Bill Foster (D-Ill.)

H.R.3219: Veterans' Benefits Act of 2010

Sponsor: Bob Filner (D-Calif.)

H.R.5428: To direct the Secretary of Veterans Affairs to educate certain staff of...

Sponsor: Bob Filner (D-Calif.)

H.R.5953: To direct the Secretary of Veterans Affairs to display in each facility...

Sponsor: Bob Filner (D-Calif.)

S.3447: Post-9/11 Veterans Educational Assistance Improvements Act of 2010

Sponsor: Daniel K. Akaka (D-Hawaii)

H.R.5933: Post-9/11 Veterans Educational Assistance Improvements Act of 2010

Sponsor: Walt Minnick (D-Idaho)

H.R.5360: HELP Veterans Act of 2010

Sponsor: Stephanie Herseth Sandlin (D-S.D.)

H.R.4121: Veterans Appeals Improvement and Modernization Act of 2009

Sponsor: John Hall (D-N.Y.)

H.R.5928: Veterans' Disability Claims Efficiency Act of 2010

Sponsor: Tim Walz (D-Minn.)

H.R.5136: National Defense Authorization Act for Fiscal Year 2011

Sponsor: Ike Skelton (D-Mo.)

S.3280: National Defense Authorization Act for Fiscal Year 2011

Sponsor: Carl Levin (D-Mich.)

H.R.205: Death Tax Repeal Act

Sponsor: William M. Thornberry (R-Texas)

S.493: Achieving a Better Life Experience Act of 2009

Sponsor: Bob Casey (D-Pa.)

H.R.4247: Keeping All Students Safe Act

Sponsor: George Miller (D-Calif.)

S.2860: Preventing Harmful Restraint and Seclusion in Schools Act

Sponsor: Christopher J. Dodd (D-Conn.)

H.R.3101: Twenty-First Century Communications and Video Accessibility Act of 2010

Sponsor: Edward J. Markey (D-Mass.)

S.3304: Twenty-First Century Communications and Video Accessibility Act of 2010

Sponsor: Mark Pryor (D-Ark.)

S.3828: A bill to make technical corrections in the Twenty-First Century...

Sponsor: Mark Pryor (D-Ark.)

H.R.4213: Unemployment Compensation Extension Act of 2010

Sponsor: Charles B. Rangel (D-N.Y.)

S.1963: Caregivers and Veterans Omnibus Health Services Act of 2010

Sponsor: Daniel K. Akaka (D-Hawaii)

H.R.3155: Caregiver Assistance and Resource Enhancement Act

Sponsor: Michael H. Michaud (D-Maine)

H.R.1211: Women Veterans Health Care Improvement Act

Sponsor: Stephanie Herseth Sandlin (D-S.D.)

H.R.1293: Disabled Veterans Home Improvement and Structural Alteration Grant...

Sponsor: Steve Buyer (R-Ind.)

H.R.2770: Veterans Nonprofit Research and Education Corporations Enhancement Act...

Sponsor: Bob Filner (D-Calif.)

S.535: A bill to amend title 10, United States Code, to repeal requirement for...

Sponsor: Bill Nelson (D-Fla.)

H.R.3288: Consolidated Appropriations Act, 2010

Sponsor: John W. Olver (D-Mass.)

H.R.2647: National Defense Authorization Act for Fiscal Year 2010

Sponsor: Ike Skelton (D-Mo.)

H.R.1913: Local Law Enforcement Hate Crimes Prevention Act of 2009

Sponsor: John Conyers Jr. (D-Mich.)

S.909: Matthew Shepard Hate Crimes Prevention Act

Sponsor: Edward M. Kennedy (D-Mass.)

H.R.2353: To require electric utilities to notify electric consumers of the cost...

Sponsor: Jason Chaffetz (R-Utah)

H.R.3766: Main Street TARP Act of 2009

Sponsor: Barney Frank (D-Mass.)

S.1731: Preserving Homes and Communities Act of 2009

Sponsor: Jack Reed (D-R.I.)

H.R.3293: Departments of Labor, Health and Human Services, and Education, and...

Sponsor: David R. Obey (D-Wis.)

H.R.3200: America's Affordable Health Choices Act of 2009

Sponsor: John D. Dingell (D-Mich.)

H.R.1346: Medical Device Safety Act of 2009

Sponsor: Frank Pallone (D-N.J.)

S.540: Medical Device Safety Act of 2009

Sponsor: Edward M. Kennedy (D-Mass.)

S.1781: Reducing Emergency Department Utilization through Coordination and...

Sponsor: Jeanne Shaheen (D-N.H.)

H.R.3631: Medicare Premium Fairness Act

Sponsor: Dina Titus (D-Nev.)

S.1390: National Defense Authorization Act for Fiscal Year 2010

Sponsor: Carl Levin (D-Mich.)

S.678: Juvenile Justice and Delinquency Prevention Reauthorization Act of 2009

Sponsor: Patrick J. Leahy (D-Vt.)

S.801: Caregiver and Veterans Health Services Act of 2009

Sponsor: Daniel K. Akaka (D-Hawaii)

H.R.1: American Recovery and Reinvestment Act of 2009

Sponsor: David R. Obey (D-Wis.)

S.1: American Recovery and Reinvestment Act of 2009

Sponsor: Harry Reid (D-Nev.)

H.R.1105: Omnibus Appropriations Act, 2009

Sponsor: David R. Obey (D-Wis.)

S.22: Omnibus Public Land Management Act of 2009

Sponsor: Jeff Bingaman (D-N.M.)

H.R.146: Omnibus Public Land Management Act of 2009

Sponsor: Rush Holt (D-N.J.)

H.R.307: Christopher and Dana Reeve Paralysis Act

Sponsor: Tammy Baldwin (D-Wis.)

S.4: Comprehensive Health Reform Act of 2009

Sponsor: Harry Reid (D-Nev.)

H.R.868: Direct Support Professionals Fairness and Security Act of 2009

Sponsor: Lois Capps (D-Calif.)

H.R.2: Children's Health Insurance Program Reauthorization Act of 2009

Sponsor: Frank Pallone (D-N.J.)

S.275: Children's Health Insurance Program Reauthorization Act of 2009

Sponsor: Max Baucus (D-Mont.)

S.434: Empowered at Home Act of 2009

Sponsor: John Kerry (D-Mass.)

S.3230: Departments of Labor, Health and Human Services, and Education, and...

Sponsor: Tom Harkin (D-Iowa)

H.R.2638: Consolidated Security, Disaster Assistance, and Continuing...

Sponsor: David E. Price (D-N.C.)

H.R.1424: A bill to provide authority for the Federal Government to purchase and...

Sponsor: Patrick J. Kennedy (D-R.I.)

S.3212: Bipartisan Electronic Voting Reform Act of 2008

Sponsor: Dianne Feinstein (D-Calif.)

H.R.3221: Housing and Economic Recovery Act of 2008

Sponsor: Nancy Pelosi (D-Calif.)

S.3398: Medical Device Safety Act of 2008

Sponsor: Edward M. Kennedy (D-Mass.)

S.3408: Comparative Effectiveness Research Act of 2008

Sponsor: Max Baucus (D-Mont.)

H.R.2683: Pension Security Act of 2007

Sponsor: Michael N. Castle (R-Del.)

S.2101: Medicare Savings Program Improvement Act of 2007

Sponsor: Jeff Bingaman (D-N.M.)

S.24: Perchlorate Monitoring and Right-to-Know Act of 2008

Sponsor: Barbara Boxer (D-Calif.)

H.R.6331: Medicare Improvements for Patients and Providers Act of 2008

Sponsor: Charles B. Rangel (D-N.Y.)

H.R.6252: Medicare DMEPOS Competitive Acquisition Reform Act of 2008

Sponsor: Pete Stark (D-Calif.)

S.3118: Preserving Access to Medicare Act of 2008

Sponsor: Charles E. Grassley (R-Iowa)

S.3327: Empowered at Home Act of 2008

Sponsor: John Kerry (D-Mass.)

H.R.1845: Medicare Durable Medical Equipment Access Act of 2007

Sponsor: John Tanner (D-Tenn.)

H.R.1809: Medicare Independent Living Act of 2007

Sponsor: Jim Langevin (D-R.I.)

S.2103: Medicare Independent Living Act of 2007

Sponsor: Jeff Bingaman (D-N.M.)

H.R.1621: Community Choice Act of 2007

Sponsor: Danny K. Davis (D-Ill.)

S.799: Community Choice Act of 2007

Sponsor: Tom Harkin (D-Iowa)

H.R.1279: Direct Support Professionals Fairness and Security Act of 2007

Sponsor: Lois Capps (D-Calif.)

S.1758: CLASS Act

Sponsor: Edward M. Kennedy (D-Mass.)

H.R.3001: Community Living Assistance Services and Supports Act

Sponsor: Frank Pallone (D-N.J.)

H.R.5613: Protecting the Medicaid Safety Net Act of 2008

Sponsor: John D. Dingell (D-Mich.)

H.R.3195: ADA Amendments Act of 2008

Sponsor: Steny H. Hoyer (D-Md.)

S.1881: Americans with Disabilities Act Restoration Act of 2007

Sponsor: Tom Harkin (D-Iowa)

S.3406: ADA Amendments Act of 2008

Sponsor: Tom Harkin (D-Iowa)

H.R.5772: Frank Melville Supportive Housing Investment Act of 2008

Sponsor: Christopher S. Murphy (D-Conn.)

H.R.6485: Timely Due Process for the Disabled Act of 2008

Sponsor: Kathy Castor (D-Fla.)

H.R.6225: Improving SCRA and USERRA Protections Act of 2008

Sponsor: Stephanie Herseth Sandlin (D-S.D.)

S.3308: Veteran Voting Support Act

Sponsor: Dianne Feinstein (D-Calif.)

H.R.2642: Supplemental Appropriations Act, 2008

Sponsor: Chet Edwards (D-Texas)

H.R.4088: Secure America Through Verification and Enforcement Act of 2007

Sponsor: Heath Shuler (D-N.C.)

H.R.2007: To amend title 5, United States Code, to provide that the National...

Sponsor: Michael R. Turner (R-Ohio)

H.R.3: Stem Cell Research Enhancement Act of 2007

Sponsor: Diana DeGette (D-Colo.)

S.5: Stem Cell Research Enhancement Act of 2007

Sponsor: Harry Reid (D-Nev.)

S.1428: Medicare Durable Medical Equipment Access Act of 2007

Sponsor: Orrin G. Hatch (R-Utah)

S.3144: Medicare DMEPOS Competitive Acquisition Reform Act of 2008

Sponsor: Max Baucus (D-Mont.)

S.1050: Promoting Wellness for Individuals with Disabilities Act of 2007

Sponsor: Tom Harkin (D-Iowa)

S.57: Filipino Veterans Equity Act of 2007

Sponsor: Daniel K. Inouye (D-Hawaii)

H.R.760: Filipino Veterans Equity Act of 2007

Sponsor: Bob Filner (D-Calif.)

S.1315: Veterans' Benefits Enhancement Act of 2008

Sponsor: Daniel K. Akaka (D-Hawaii)

H.R.811: Voter Confidence and Increased Accessibility Act of 2007

Sponsor: Rush Holt (D-N.J.)

S.599: Private Disaster Loans Act of 2007

Sponsor: Olympia J. Snowe (R-Maine)

H.R.1592: Local Law Enforcement Hate Crimes Prevention Act of 2007

Sponsor: John Conyers Jr. (D-Mich.)

H.R.4137: Higher Education Opportunity Act

Sponsor: George Miller (D-Calif.)

S.1642: Higher Education Amendments of 2007

Sponsor: Edward M. Kennedy (D-Mass.)

S.1200: Indian Health Care Improvement Act Amendments of 2008

Sponsor: Byron L. Dorgan (D-N.D.)

H.R.5140: Economic Stimulus Act of 2008

Sponsor: Nancy Pelosi (D-Calif.)

S.2539: A bill to amend the Internal Revenue Code of 1986 to provide a special...

Sponsor: Arlen Specter (D-Pa.)

H.R.3197: PUPPERS Act of 2017

Sponsor: David A. Brat (R-Va.)

S.1405: Federal Aviation Administration Reauthorization Act of 2017

Sponsor: John Thune (R-S.D.)

H.R.323: To amend the Black Lung Benefits Act to provide equity for certain...

Sponsor: Morgan Griffith (R-Va.)

S.1872: TSA Modernization Act

Sponsor: John Thune (R-S.D.)

H.R.1894: To facilitate construction of a bridge on certain property in Christian...

Sponsor: Billy Long (R-Mo.)

S.817: ABLE Age Adjustment Act

Sponsor: Bob Casey (D-Pa.)

H.R.1896: ABLE to Work Act of 2017

Sponsor: Cathy McMorris Rodgers (R-Wash.)

S.818: ABLE to Work Act of 2017

Sponsor: Richard M. Burr (R-N.C.)

H.R.1897: ABLE Financial Planning Act

Sponsor: Cathy McMorris Rodgers (R-Wash.)

S.816: ABLE Financial Planning Act

Sponsor: Bob Casey (D-Pa.)

H.R.3571: Reasonable ADA Compliance Act of 2017

Sponsor: Kathy Castor (D-Fla.)

H.R.1: An Act to provide for reconciliation pursuant to titles II and V of the...

Sponsor: Kevin Brady (R-Texas)

H.R.5004: Air Carrier Access Amendments Act of 2018

Sponsor: Jim Langevin (D-R.I.)

S.2193: Caring for our Veterans Act of 2017

Sponsor: Johnny Isakson (R-Ga.)

S.2184: Veterans Community Care and Access Act of 2017

Sponsor: John McCain (R-Ariz.)

H.R.4508: PROSPER Act

Sponsor: Virginia Foxx (R-N.C.)

H.R.626: Access to Inpatient Rehabilitation Therapy Act of 2017

Sponsor: Glenn Thompson (R-Pa.)

H.R.4: FAA Reauthorization Act of 2018

Sponsor: Bill Shuster (R-Pa.)

H.R.5603: Access to Telehealth Services for Substance Use Disorders Act

Sponsor: Doris Matsui (D-Calif.)

S.2372: VA MISSION Act of 2018

Sponsor: Johnny Isakson (R-Ga.)

H.R.4146: Disabled Veterans Life Insurance Act of 2017

Sponsor: Steve Pearce (R-N.M.)

H.R.5536: Disabled Access Credit Expansion Act

Sponsor: A. Donald McEachin (D-Va.)

H.R.2: Agriculture Improvement Act of 2018

Sponsor: K. Michael Conaway (R-Texas)

S.2227: EMPOWER Care Act

Sponsor: Rob Portman (R-Ohio)

H.R.5306: EMPOWER Care Act

Sponsor: Brett Guthrie (R-Ky.)

H.R.4931: Transition to Independence Act of 2018

Sponsor: Jim Langevin (D-R.I.)

H.R.302: FAA Reauthorization Act of 2018

Sponsor: Brett Guthrie (R-Ky.)

H.R.5609: Water Affordability, Transparency, Equity, and Reliability Act of 2018

Sponsor: Keith Ellison (D-Minn.)

H.R.6042: To amend title XIX of the Social Security Act to delay the reduction in...

Sponsor: Brett Guthrie (R-Ky.)

H.R.5912: To amend title XIX of the Social Security Act to delay the reduction in...

Sponsor: Jim Langevin (D-R.I.)

H.R.5541: Removing Barriers to Allergy Diagnostic Testing Act of 2018

Sponsor: Fred Upton (R-Mich.)

S.2888: Geriatrics Workforce Improvement Act

Sponsor: Susan Collins (R-Maine)

S.3459: Disabled Access Credit Expansion Act

Sponsor: Tammy Duckworth (D-Ill.)

S.3260: Disability Employment Incentive Act

Sponsor: Bob Casey (D-Pa.)

H.R.184: Protect Medical Innovation Act of 2018

Sponsor: Erik Paulsen (R-Minn.)

H.R.1874: ABLE Age Adjustment Act

Sponsor: Tony Cárdenas (D-Calif.)

S.1885: AV START Act

Sponsor: John Thune (R-S.D.)

S.3729: United States Cadet Nurse Corps Service Recognition Act of 2018

Sponsor: Elizabeth Warren (D-Mass.)

H.R.7217: IMPROVE Act

Sponsor: Joe L. Barton (R-Texas)

S.3741: Social Security Disability Protection Act

Sponsor: Bob Casey (D-Pa.)

S.3679: READI for Disaster Act

Sponsor: Bob Casey (D-Pa.)

S.669: Air Carrier Access Amendments Act of 2019

Sponsor: Tammy Baldwin (D-Wis.)

H.R.1549: Air Carrier Access Amendments Act of 2019

Sponsor: Jim Langevin (D-R.I.)

S.679: HAVEN Act

Sponsor: Tammy Baldwin (D-Wis.)

S.30: Chiropractic Health Parity for Military Beneficiaries Act

Sponsor: Tammy Baldwin (D-Wis.)

S.584: Advancing Human Spaceflight Act

Sponsor: John Cornyn (R-Texas)

H.R.1342: EMPOWER Care Act

Sponsor: Debbie Dingell (D-Mich.)

H.R.1839: Medicaid Services Investment and Accountability Act of 2019

Sponsor: Raul Ruiz (D-Calif.)

S.651: ABLE Age Adjustment Act

Sponsor: Bob Casey (D-Pa.)

H.R.1814: ABLE Age Adjustment Act

Sponsor: Tony Cárdenas (D-Calif.)

S.117: Disability Integration Act of 2019

Sponsor: Charles E. Schumer (D-N.Y.)

H.R.555: Disability Integration Act of 2019

Sponsor: F. James Sensenbrenner (R-Wis.)

H.R.302: Child Tax Credit Equity for Puerto Rico Act of 2019

Sponsor: Jenniffer González-Colón (R-Puerto Rico)

H.R.2073: To amend the Internal Revenue Code of 1986 to permanently extend the 7.5...

Sponsor: Katie Porter (D-Calif.)

S.110: Medical Expense Savings Act

Sponsor: Susan Collins (R-Maine)

S.1835: 21st Century Assistive Technology Act

Sponsor: Bob Casey (D-Pa.)

H.R.1301: Mental Health Telemedicine Expansion Act

Sponsor: Suzan K. DelBene (D-Wash.)

H.R.1925: To designate the Manhattan Campus of the New York Harbor Health Care...

Sponsor: Carolyn B. Maloney (D-N.Y.)

S.898: A bill to designate the Manhattan Campus of the New York Harbor Health...

Sponsor: Kirsten E. Gillibrand (D-N.Y.)

H.R.846: Veterans Serving Veterans Act of 2019

Sponsor: Jenniffer González-Colón (R-Puerto Rico)

H.R.2557: Get Veterans a Doctor Now Act

Sponsor: Sean Patrick Maloney (D-N.Y.)

H.R.299: Blue Water Navy Vietnam Veterans Act of 2019

Sponsor: Mark Takano (D-Calif.)

H.R.2293: Protecting Access to Wheelchairs Act

Sponsor: John B. Larson (D-Conn.)

S.1223: Protecting Beneficiary Access to Complex Rehab Technology Act of 2019

Sponsor: Bob Casey (D-Pa.)

H.R.2408: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019

Sponsor: F. James Sensenbrenner (R-Wis.)

H.R.3215: Disaster Relief Medicaid Act

Sponsor: Donna Shalala (D-Fla.)

S.1754: Disaster Relief Medicaid Act

Sponsor: Bob Casey (D-Pa.)

S.260: Transformation to Competitive Employment Act

Sponsor: Bob Casey (D-Pa.)

H.R.873: Transformation to Competitive Employment Act

Sponsor: Robert C. Scott (D-Va.)

H.R.3208: REAADI for Disasters Act

Sponsor: Jim Langevin (D-R.I.)

S.1755: REAADI for Disasters Act

Sponsor: Bob Casey (D-Pa.)

S.RES.329: A resolution designating September 2019 as "National Spinal Cord Injury...

Sponsor: Marco Rubio (R-Fla.)

S.1881: Veterans Expedited TSA Screening Safe Travel Act

Sponsor: Todd Young (R-Ind.)

H.R.3356: Veterans Expedited TSA Screening Safe Travel Act

Sponsor: Paul Gosar (R-Ariz.)

H.R.3867: Violence Against Women Veterans Act

Sponsor: Nydia M. Velázquez (D-N.Y.)

H.R.3504: Ryan Kules and Paul Benne Specially Adaptive Housing Improvement Act of...

Sponsor: Gus Bilirakis (R-Fla.)

S.2022: Paul Benne Specially Adaptive Housing Improvement Act of 2019

Sponsor: Jerry Moran (R-Kan.)

H.R.3107: Improving Seniors' Timely Access to Care Act of 2019

Sponsor: Suzan K. DelBene (D-Wash.)

S.2112: Domestic Workers Bill of Rights Act

Sponsor: Kamala Harris (D-Calif.)

H.R.3760: Domestic Workers Bill of Rights Act

Sponsor: Pramila Jayapal (D-Wash.)

H.R.3992: Disability Employment Incentive Act

Sponsor: Josh Harder (D-Calif.)

H.R.712: VA Medicinal Cannabis Research Act of 2019

Sponsor: J. Luis Correa (D-Calif.)

S.179: VA Medicinal Cannabis Research Act of 2019

Sponsor: Jon Tester (D-Mont.)

H.R.601: Medical Cannabis Research Act of 2019

Sponsor: Matt Gaetz (R-Fla.)

S.2661: National Suicide Hotline Designation Act of 2020

Sponsor: Cory Gardner (R-Colo.)

H.R.4194: National Suicide Hotline Designation Act of 2019

Sponsor: Chris Stewart (R-Utah)

H.R.4589: To make permanent the authority of the Secretary of Veterans Affairs to...

Sponsor: TJ Cox (D-Calif.)

H.R.4588: Modernizing VA’s Records Management Program Act

Sponsor: TJ Cox (D-Calif.)

H.R.4625: Protect the GI Bill Act

Sponsor: Mike Levin (D-Calif.)

H.R.1865: Further Consolidated Appropriations Act, 2020

Sponsor: Bill Pascrell Jr. (D-N.J.)

H.R.4674: College Affordability Act

Sponsor: Robert C. Scott (D-Va.)

S.978: Work Opportunity Tax Credit and Jobs Act

Sponsor: Rob Portman (R-Ohio)

H.R.4280: Supplemental Security Income Restoration Act of 2019

Sponsor: Raúl M. Grijalva (D-Ariz.)

S.2753: Supplemental Security Income Restoration Act of 2019

Sponsor: Sherrod Brown (D-Ohio)

S.255: Disability Employment Incentive Act

Sponsor: Bob Casey (D-Pa.)

H.R.5429: SENIOR CARE Act

Sponsor: Steve Stivers (R-Ohio)

S.3010: Supporting and Empowering the Nation to Improve Outcomes that Reaffirm...

Sponsor: Rob Portman (R-Ohio)

S.3548: CARES Act

Sponsor: Mitch McConnell (R-Ky.)

H.R.748: CARES Act

Sponsor: Joe Courtney (D-Conn.)

S.3544: Coronavirus Relief for Seniors and People with Disabilities Act of 2020

Sponsor: Bob Casey (D-Pa.)

H.R.6305: Coronavirus Relief for Seniors and People with Disabilities Act of 2020

Sponsor: Debbie Dingell (D-Mich.)

H.R.6074: Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020

Sponsor: Nita M. Lowey (D-N.Y.)

S.3206: Accessible Voting Act of 2020

Sponsor: Bob Casey (D-Pa.)

S.3369: Recognizing the Role of Direct Support Professionals Act

Sponsor: Margaret Hassan (D-N.H.)

H.R.6045: Recognizing the Role of Direct Support Professionals Act

Sponsor: Kathleen Rice (D-N.Y.)

H.R.4870: United States Public Health Service Modernization Act of 2019

Sponsor: Michael C. Burgess (R-Texas)

S.2629: United States Public Health Service Modernization Act of 2019

Sponsor: Mike Rounds (R-S.D.)

S.2981: National Oceanic and Atmospheric Administration Commissioned Officer...

Sponsor: Dan Sullivan (R-Alaska)

H.R.2406: National Oceanic and Atmospheric Administration Commissioned Officer...

Sponsor: Ed Case (D-Hawaii)

H.R.5701: Care for the Veteran Caregiver Act

Sponsor: Richard Hudson (R-N.C.)

S.3503: A bill to authorize the Secretary of Veterans Affairs to treat certain...

Sponsor: Jerry Moran (R-Kan.)

H.R.5995: Major Richard Star Act

Sponsor: Gus Bilirakis (R-Fla.)

S.3393: A bill to amend title 10, United States Code, to provide for concurrent...

Sponsor: Jon Tester (D-Mont.)

H.R.6248: Disability Access to Transportation Act

Sponsor: Jim Langevin (D-R.I.)

H.R.4334: Supporting Older Americans Act of 2020

Sponsor: Suzanne Bonamici (D-Ore.)

S.2741: CONNECT for Health Act of 2019

Sponsor: Brian Schatz (D-Hawaii)

H.R.4932: CONNECT for Health Act of 2019

Sponsor: Mike Thompson (D-Calif.)

H.R.6420: All Dependent Children Count Act

Sponsor: Angie Craig (D-Minn.)

S.3652: All Dependents Count Act of 2020

Sponsor: Tina Smith (D-Minn.)

H.R.6680: Strengthening Unemployment Insurance for Coronavirus Impacted Workers...

Sponsor: Dan Kildee (D-Mich.)

S.3740: COVID–19 Recovery for Seniors and People with Disabilities Act of 2020

Sponsor: Bob Casey (D-Pa.)

S.3768: Nursing Home COVID–19 Protection and Prevention Act of 2020

Sponsor: Bob Casey (D-Pa.)

H.R.6957: National Guard COVID–19 Earned Benefits Guarantee Act

Sponsor: Jimmy Panetta (D-Calif.)

H.R.7663: Protecting Access to Post-COVID–19 Telehealth Act of 2020

Sponsor: Mike Thompson (D-Calif.)

H.R.5924: To amend the Public Health Service Act to authorize a loan repayment...

Sponsor: David McKinley (R-W.Va.)

S.4393: TEAM Act of 2020

Sponsor: Thom Tillis (R-N.C.)

S.785: Commander John Scott Hannon Veterans Mental Health Care Improvement Act...

Sponsor: Jon Tester (D-Mont.)

H.R.8247: Veterans COMPACT Act of 2020

Sponsor: Mark Takano (D-Calif.)

H.R.7059: Coronavirus Provider Protection Act

Sponsor: Phil Roe (R-Tenn.)

S.4526: Coronavirus Language Access Act

Sponsor: Mazie K. Hirono (D-Hawaii)

H.R.6881: Emergency Broadband Connections Act of 2020

Sponsor: Marc Veasey (D-Texas)

H.R.7867: Healthy Flights Act of 2020

Sponsor: Peter A. DeFazio (D-Ore.)

H.R.2: Moving Forward Act

Sponsor: Peter A. DeFazio (D-Ore.)

S.2302: America's Transportation Infrastructure Act of 2019

Sponsor: John Barrasso (R-Wyo.)

H.R.8581: Triple A Study Act

Sponsor: G. K. Butterfield (D-N.C.)

S.4343: Triple A Study Act

Sponsor: Marsha Blackburn (R-Tenn.)

H.R.8506: Toxic Exposure in the American Military Act of 2020

Sponsor: Gus Bilirakis (R-Fla.)

H.R.110: To provide an exception to certain mandatory minimum sentence...

Sponsor: Michael C. Burgess (R-Texas)

H.R.7105: Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits...

Sponsor: Mike Levin (D-Calif.)

S.4791: Community-Based Response Act

Sponsor: Chris Van Hollen (D-Md.)

H.R.8478: Online Accessibility Act

Sponsor: Ted Budd (R-N.C.)

S.4049: National Defense Authorization Act for Fiscal Year 2021

Sponsor: James M. Inhofe (R-Okla.)

H.R.6395: William M. (Mac) Thornberry National Defense Authorization Act for...

Sponsor: Adam Smith (D-Wash.)

H.R.1368: Mental Health Justice Act of 2021

Sponsor: Katie Porter (D-Calif.)

S.515: Mental Health Justice Act of 2021

Sponsor: Elizabeth Warren (D-Mass.)

H.R.2168: Expanded Telehealth Access Act

Sponsor: Mikie Sherrill (D-N.J.)

S.927: Toxic Exposure in the American Military Act

Sponsor: Thom Tillis (R-N.C.)

H.R.2127: TEAM Act

Sponsor: Mike Bost (R-Ill.)

H.R.110: Care for the Veteran Caregiver Act

Sponsor: Richard Hudson (R-N.C.)

H.R.1801: CHAMPVA Children’s Care Protection Act of 2021

Sponsor: Julia Brownley (D-Calif.)

S.727: CHAMPVA Children's Care Protection Act of 2021

Sponsor: Sherrod Brown (D-Ohio)

S.444: Advancing Uniform Transportation Opportunities for Veterans Act

Sponsor: Susan Collins (R-Maine)

H.R.1361: AUTO for Veterans Act

Sponsor: Daniel Meuser (R-Pa.)

S.344: Major Richard Star Act

Sponsor: Jon Tester (D-Mont.)

H.R.1282: Major Richard Star Act

Sponsor: Gus Bilirakis (R-Fla.)

H.RES.183: Recommitting the United States to the promotion of disability rights and...

Sponsor: Eleanor Holmes Norton (D-D.C.)

S.RES.86: A resolution recommitting the United States to the promotion of...

Sponsor: Tammy Duckworth (D-Ill.)

S.1: For the People Act of 2021

Sponsor: Jeff Merkley (D-Ore.)

H.R.1697: Disability Access to Transportation Act

Sponsor: Jim Langevin (D-R.I.)

S.642: Air Carrier Access Amendments Act of 2021

Sponsor: Tammy Baldwin (D-Wis.)

H.R.1696: Air Carrier Access Amendments Act of 2021

Sponsor: Jim Langevin (D-R.I.)

S.630: Disability Employment Incentive Act

Sponsor: Bob Casey (D-Pa.)

H.R.1065: Pregnant Workers Fairness Act

Sponsor: Jerrold Nadler (D-N.Y.)

H.R.1219: ABLE Age Adjustment Act

Sponsor: Tony Cárdenas (D-Calif.)

S.331: ABLE Age Adjustment Act

Sponsor: Bob Casey (D-Pa.)

S.1512: CONNECT for Health Act of 2021

Sponsor: Brian Schatz (D-Hawaii)

H.R.2903: Creating Opportunities Now for Necessary and Effective Care Technologies...

Sponsor: Mike Thompson (D-Calif.)

H.R.366: Protecting Access to Post-COVID–19 Telehealth Act of 2021

Sponsor: Mike Thompson (D-Calif.)

H.R.2461: Triple A Study Act

Sponsor: G. K. Butterfield (D-N.C.)

H.R.3967: Honoring our PACT Act of 2022

Sponsor: Mark Takano (D-Calif.)

S.RES.278: A resolution recognizing the 75th anniversary of United Spinal...

Sponsor: Bob Casey (D-Pa.)

S.976: Caring for Survivors Act of 2021

Sponsor: Jon Tester (D-Mont.)

S.458: Veterans Claim Transparency Act of 2021

Sponsor: Jon Tester (D-Mont.)

S.952: Presumptive Benefits for War Fighters Exposed to Burn Pits and Other...

Sponsor: Kirsten E. Gillibrand (D-N.Y.)

S.437: Veterans Burn Pits Exposure Recognition Act of 2021

Sponsor: Dan Sullivan (R-Alaska)

S.2038: Disability Access to Transportation Act

Sponsor: Robert Menendez (D-N.J.)

H.R.1783: Accessible, Affordable Internet for All Act

Sponsor: James E. Clyburn (D-S.C.)

S.745: Accessible, Affordable Internet for All Act

Sponsor: Amy Klobuchar (D-Minn.)

S.167: Community Immunity During COVID–19 Act of 2021

Sponsor: Tina Smith (D-Minn.)

H.R.2974: Military Spouse Hiring Act

Sponsor: Antonio Delgado (D-N.Y.)

H.R.3582: Veteran Employment Recovery Act

Sponsor: Pat Fallon (R-Texas)

H.R.5376: Inflation Reduction Act of 2022

Sponsor: John Yarmuth (D-Ky.)

H.R.3684: Infrastructure Investment and Jobs Act

Sponsor: Peter A. DeFazio (D-Ore.)

H.R.4350: National Defense Authorization Act for Fiscal Year 2022

Sponsor: Adam Smith (D-Wash.)

S.2792: National Defense Authorization Act for Fiscal Year 2022

Sponsor: Jack Reed (D-R.I.)

H.R.3824: Supplemental Security Income Restoration Act of 2021

Sponsor: Raúl M. Grijalva (D-Ariz.)

S.2065: Supplemental Security Income Restoration Act of 2021

Sponsor: Sherrod Brown (D-Ohio)

H.R.2373: Transformation to Competitive Integrated Employment Act

Sponsor: Robert C. Scott (D-Va.)

S.3238: Transformation to Competitive Integrated Employment Act

Sponsor: Bob Casey (D-Pa.)

S.3193: Expanded Telehealth Access Act

Sponsor: Steve Daines (R-Mont.)

H.R.3932: PASTEUR Act of 2021

Sponsor: Mike Doyle (D-Pa.)

S.2076: PASTEUR Act of 2021

Sponsor: Michael Bennet (D-Colo.)

H.R.6641: DRA of 2022

Sponsor: Markwayne Mullin (R-Okla.)

S.3620: Health Data Use and Privacy Commission Act

Sponsor: Bill Cassidy (R-La.)

H.R.944: To amend the Public Health Service Act to authorize a loan repayment...

Sponsor: David McKinley (R-W.Va.)

H.R.2256: Resident Physician Shortage Reduction Act of 2021

Sponsor: Terri Sewell (D-Ala.)

S.834: Resident Physician Shortage Reduction Act of 2021

Sponsor: Robert Menendez (D-N.J.)

H.R.5030: DIVERSE Trials Act

Sponsor: Raul Ruiz (D-Calif.)

S.2706: DIVERSE Trials Act

Sponsor: Robert Menendez (D-N.J.)

S.3575: Stop the Wait Act of 2022

Sponsor: Bob Casey (D-Pa.)

H.R.6583: Stop the Wait Act of 2022

Sponsor: Lloyd Doggett (D-Texas)

H.R.4938: Real Emergency Access for Aging and Disability Inclusion for Disasters Act

Sponsor: Jim Langevin (D-R.I.)

S.2658: REAADI for Disasters Act

Sponsor: Bob Casey (D-Pa.)

H.R.4937: Disaster Relief Medicaid Act

Sponsor: Jimmy Panetta (D-Calif.)

S.2646: Disaster Relief Medicaid Act

Sponsor: Bob Casey (D-Pa.)

H.R.3173: Improving Seniors’ Timely Access to Care Act of 2021

Sponsor: Suzan K. DelBene (D-Wash.)

S.3018: Improving Seniors’ Timely Access to Care Act of 2021

Sponsor: Roger Marshall (R-Kan.)

H.R.3304: CARS for Vets Act

Sponsor: Lizzie Fletcher (D-Texas)

S.910: SAFE Banking Act of 2021

Sponsor: Jeff Merkley (D-Ore.)

H.R.4040: Advancing Telehealth Beyond COVID–19 Act of 2021

Sponsor: Liz Cheney (R-Wyo.)

H.R.8746: Access to Inpatient Rehabilitation Therapy Act of 2022

Sponsor: Joe Courtney (D-Conn.)

H.R.5758: COMFORT Act

Sponsor: Elissa Slotkin (D-Mich.)

S.302: STOP COVID–19 Act

Sponsor: Rick Scott (R-Fla.)

S.684: Connecting America’s Active Transportation System Act

Sponsor: Edward J. Markey (D-Mass.)

H.R.2916: VA Medicinal Cannabis Research Act of 2021

Sponsor: J. Luis Correa (D-Calif.)

S.1467: VA Medicinal Cannabis Research Act of 2021

Sponsor: Jon Tester (D-Mont.)

S.RES.85: A resolution designating March 1, 2023, as "National Assistive...

Sponsor: Bob Casey (D-Pa.)

H.R.1282: Major Richard Star Act

Sponsor: Gus Bilirakis (R-Fla.)

S.344: Major Richard Star Act

Sponsor: Jon Tester (D-Mont.)

S.545: Air Carrier Access Amendments Act of 2023

Sponsor: Tammy Baldwin (D-Wis.)

H.R.1267: Air Carrier Access Amendments Act of 2023

Sponsor: Dina Titus (D-Nev.)

H.R.3845: Disability Access to Transportation Act

Sponsor: Dina Titus (D-Nev.)

S.1813: Disability Access to Transportation Act

Sponsor: Robert Menendez (D-N.J.)

H.R.1445: Prioritizing Accountability and Accessibility for Aviation Consumers Act...

Sponsor: Steve Cohen (D-Tenn.)

S.400: Prioritizing Accountability and Accessibility for Aviation Consumers Act...

Sponsor: Tammy Duckworth (D-Ill.)

H.R.3762: Emergency Vacating of Aircraft Cabin Act

Sponsor: Steve Cohen (D-Tenn.)

S.1765: Emergency Vacating of Aircraft Cabin Act

Sponsor: Tammy Duckworth (D-Ill.)

S.1119: CHAMPVA Children's Care Protection Act of 2023

Sponsor: Sherrod Brown (D-Ohio)

H.R.3802: Precipitation Forecasting for Agriculture Act.

Sponsor: James Baird (R-Ind.)

S.1459: MOBILE Act

Sponsor: Tammy Duckworth (D-Ill.)

H.R.3743: To amend the FAA Reauthorization Act of 2018 to extend the advisory...

Sponsor: Darren Soto (D-Fla.)

H.R.1772: WHEELChairs on Airplanes Act

Sponsor: Dina Titus (D-Nev.)

S.1939: FAA Reauthorization Act of 2024

Sponsor: Maria Cantwell (D-Wash.)

H.R.3935: Securing Growth and Robust Leadership in American Aviation Act

Sponsor: Sam Graves (R-Mo.)

H.R.1499: Good Jobs for Good Airports Act

Sponsor: Jesús García (D-Ill.)

S.753: Good Jobs for Good Airports Act

Sponsor: Edward J. Markey (D-Mass.)

H.R.5308: Rural Telehealth and Education Enhancement Act of 2023

Sponsor: Nick Langworthy (R-N.Y.)

S.2516: Veterans Accessibility Act of 2023

Sponsor: Bob Casey (D-Pa.)

H.R.4858: Communications, Video, and Technology Accessibility Act of 2023

Sponsor: Anna G. Eshoo (D-Calif.)

S.2494: Communications, Video, and Technology Accessibility Act of 2023

Sponsor: Edward J. Markey (D-Mass.)

H.R.5408: SSI Savings Penalty Elimination Act

Sponsor: Brian Higgins (D-N.Y.)

S.2767: SSI Savings Penalty Elimination Act

Sponsor: Sherrod Brown (D-Ohio)

H.R.5371: Choices for Increased Mobility Act of 2023

Sponsor: John Joyce (R-Pa.)

S.1355: PASTEUR Act of 2023

Sponsor: Michael Bennet (D-Colo.)

H.R.2940: Pioneering Antimicrobial Subscriptions To End Upsurging Resistance Act...

Sponsor: A. Drew Ferguson (R-Ga.)

S.1298: Supporting Our Direct Care Workforce and Family Caregivers Act

Sponsor: Tim Kaine (D-Va.)

H.R.547: Better Care Better Jobs Act

Sponsor: Debbie Dingell (D-Mich.)

S.100: Better Care Better Jobs Act

Sponsor: Bob Casey (D-Pa.)

H.R.1493: HCBS Access Act

Sponsor: Debbie Dingell (D-Mich.)

S.762: HCBS Access Act

Sponsor: Bob Casey (D-Pa.)

H.R.5859: Transportation Assistance for Individuals with Disabilities Act

Sponsor: Frederica Wilson (D-Fla.)

S.3120: Disaster Relief Medicaid Act

Sponsor: Bob Casey (D-Pa.)

H.R.6029: Disaster Relief Medicaid Act

Sponsor: Jimmy Panetta (D-Calif.)

S.1049: REAADI for Disasters Act

Sponsor: Bob Casey (D-Pa.)

H.R.2371: Real Emergency Access for Aging and Disability Inclusion for Disasters Act

Sponsor: Debbie Dingell (D-Mich.)

S.3118: HCBS Relief Act of 2023

Sponsor: Bob Casey (D-Pa.)

S.1001: Telehealth Expansion Act of 2023

Sponsor: Steve Daines (R-Mont.)

H.R.1848: To provide for a limitation on availability of funds for Senate, Office...

Sponsor: Andy Biggs (R-Ariz.)

H.R.7126: Autonomous Vehicle Accessibility Act

Sponsor: Greg Stanton (D-Ariz.)

H.R.7351: Removing Access Barriers to Running for Elected Office for People with...

Sponsor: Madeleine Dean (D-Pa.)

S.3747: Removing Access Barriers to Running for Elected Office for People with...

Sponsor: Bob Casey (D-Pa.)

H.R.7389: Accessible Voting Act of 2024

Sponsor: Mary Gay Scanlon (D-Pa.)

S.3748: Accessible Voting Act of 2024

Sponsor: Bob Casey (D-Pa.)

H.R.7350: AID Local Government Leadership Act

Sponsor: Madeleine Dean (D-Pa.)

S.3749: AID Local Government Leadership Act

Sponsor: Bob Casey (D-Pa.)

H.R.6373: Veterans Spinal Trauma Access to New Devices Act

Sponsor: Jack Bergman (R-Mich.)

H.R.6929: Affordable Connectivity Program Extension Act of 2024

Sponsor: Yvette D. Clarke (D-N.Y.)

H.R.7138: Supplemental Security Income Restoration Act of 2024

Sponsor: Raúl M. Grijalva (D-Ariz.)

Show All Mentioned Bills

Lobbyists

Lobbyists named here were listed on a filing related to this lobbying engagement. They may not be working on it now. Occasionally, a single lobbyist whose name is spelled two different ways on filings may be represented twice here.

Lobbyist	Covered positions?
Kent Keyser	Office of Rep. Nick Rahall - Community Relations Assistant, 1977-1984; District Director, 1984-1988; Chief of Staff, 1988-2011; Senior Policy Advisor, 2011-Jan 2015
Alexandra Bennewith	n/a
Jasey Cardenas	n/a
Christopher Neiweem	n/a
Ross Meglathery	n/a
Carol Tyson	n/a
Heather Ansley	n/a
Joseph Isaacs	n/a
Andrew Morris	n/a
James Weisman	n/a
Peggy (Margaret) Hathaway	n/a
Peggy (Margaret v.) Hathaway	n/a
Other without 20% time Others without 20% time	n/a
Peggy (Margaret V) Hathaway	n/a
Others w less than 20% time Others w less than 20% time	n/a
Other w less than 20% time Other w less than 20% time	n/a
Pegg (Margaret) Hathaway	n/a
Others w less thatn 20% time Others w less than 20% time	n/a
Margaret (Peggy) Hathaway	n/a
No one w 20% or more time No one w 20% or more time	n/a
No one w 20% or more time No one w 20% or more time	n/a
Bethany Keirans	n/a
Danielle Corazza	n/a
Danielle Applegate	n/a
Stephen Lieberman	n/a
Alexandra Bennewith United	n/a
Steve Lieberman	n/a
Kenneth Greenberg	n/a
Alexandra Bennewith Vice P	n/a
Rebecca MacTaggart	n/a
Elizabeth Osborn	n/a
Betsy Osborn	n/a

Disclosures Filed

Once a lobbying engagement begins, the lobbyist or firm is required to file updates four times a year. Those updates sometimes change which lobbyists are involved or add new issues being discussed. When lobbyists stop working for a client, the firm is also supposed to file a report disclosing the end of the relationship.

1st Quarter, 2024

Q1 Report

In Q1, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on April 22. Original Filing: 301574296.xml

Lobbying Issues

United Spinal supports Increased funding for SCI Model Systems. This program is long overdue for a significant funding increase that considers inflation and the approximate 50% growth in the SCI population since 2000 (from approximately 200,000 to more than 300,000) - $16.8 million. Increased funding for the National Spinal Cord Injury Statistical Center (NSCISC), which serves as the premier source of spinal cord injury-related statistical data in the United States - $1.8 million. Increased funding for the Model Systems Knowledge Translation Center (MSKTC), the MSKTC works with the NSCISC and the SCI Model Systems on research and translating the data into useful fact sheets on various topics related to spinal cord injury that are used not only in the United States but globally - $2.1 million. United Spinal staff met with staff with the Senate Aging Committee to provide information for an appropriations support letter for the National Institute on Disability, Independent Living, and Rehabilitation Research. United Spinal endorsed comments on the Medicare Advantage proposed rule as a Steering Committee member of the Coalition to Preserve Rehabilitation and United Spinal endorsed comments on the Notice of Benefit and Payment Parameters proposed rule as a Steering Committee member of the Independence Through Enhancement of Medicare and Medicaid Coalition.

Agencies Lobbied

Type of Issue

Lobbying Issues

United Spinal staff participated in a quarterly call with Amtrak along with other representatives from disability organizations. United Spinal staff participated in a meeting with Amtrak to review their plans for their replacement long-distance trainsets. United Spinal staff met with DOT staff to provide information about the results of United Spinals data gathering efforts regarding the availability of accessible parking spaces in different states and urging DOT to support updating the current ADA minimum standards for the number of accessible parking spaces required in lots and garages. House Senate United Spinal supported the accessibility provisions in, H.R. 7126, the Autonomous Vehicle Accessibility Act, introduced by Representative Greg Stanton (D-AZ-4). https://www.congress.gov/bill/118th-congress/house-bill/7126/all-info?s=1&r=3 Department of Labor Department of Transportation United Spinal contributed comments and responded to comments of others in an IdeaScale: Dialogue about Exploring the Future of Public Transportation Research: A National Online Dialogue Comments in part included topic about research keeping pace with the continuing development of technologies that could improve accessibility for people with disabilities. Department of Transportation United Spinal supported the Department of Transportations future initiative to address the substantive issues involved with the service animal rule. The comments read in part, We request that as soon as possible you also convene meetings and conduct outreach throughout the disability community ,including wheelchair users, to address issues specific to the usefulness of the form, its role in the equitable air travel rights and responsibilities of passengers with disabilities as well as evaluating how well the current regulatory environment assist individuals using service animals in air travel. Department of Transportation United Spinal, along with numerous other disability organizations, as members of the Consortium for Constituents with Disabilities (CCD) Transportation Task Force signed on to comments on the Department of Transportations request for information (RFI) on accessibility improvements for transportation facilities, Docket No: DOT-OST-2023-0166. United Spinal submitted our own comments to the U. S. Department of Transportations (DOT) request for information on accessibility improvements for transportation facilities, Docket No: DOT-OST-2023-0166. The comments read in part: United Spinal contributed to and wholeheartedly supports the comments submitted by the Consortium for Constituents with Disabilities (CCD) in response to this RFI. We wish to further comment on some topics specifically from the perspective of the wheelchair user. Department of Transportation United Spinal, as a member of the SecureRide Coalition, helped draft and signed a letter to Tool, Inc., a company that has submitted an application for a Department of Transportation Small Business Innovation Research (SBIR) Program 24-NH4 Phase I Pre-Offer, Re: 24-NH4: Lightweight Universal Docking Interface Geometry Manual Wheelchair Attachment. The letter read in part: The SecureRide Coalition strongly supports Tool, Inc.s application for the U. S. Department of Transportations (DOT) Phase I Small Business Innovation Research (SBIR) 24-NH4: Lightweight Universal Docking Interface Geometry Manual Wheelchair Attachment. Due to the obvious efficiencies that can be achieved by employing integrated research, design and development methodologies with the two essential components of a wheelchair securement system, SecureRide also fully supports Tool., Inc.s SBIR application, 24-NH6: Anchor Design for Universal Docking Interface Geometry. National Highway Traffic Safety Administration United Spinal, as a member of SecureRide, met with National Highway TrafficSafety Administration officials in the Human Factors/Engineering Integration Division to discuss coordination of development of safe wheelchair securement standards. United Spinal Association appreciated the opportunity to provide comments on the Department of Transportations (DOT) renewal of the Service Animal Behavior and Health Attestation Form and supported the Department of Transportations future initiative to address the substantive issues involved with the service animal rule. The comments read in part, We request that as soon as possible you also convene meetings and conduct outreach throughout the disability community, including wheelchair users, to address issues specific to the usefulness of the form, its role in the equitable air travel rights and responsibilities of passengers with disabilities as well as evaluating how well the current regulatory environment assist individuals using service animals in air travel.

Agencies Lobbied

Type of Issue

Lobbying Issues

United Spinal supports the accessibility provisions in, H.R. 7351 / S. 3747, Removing Access Barriers to Running for Elected Office for People with Disabilities Act, introduced by Representative Madeleine Dean (D-PA-4) and Senator Robert P. Casey, Jr. (D-PA). United Spinal supported the accessibility provisions in H.R. 7389 / S. 3748, Accessible Voting Act of 2024, introduced respectively by Representative Mary Gay Scanlon (D-PA-5) and Senator Robert P. Casey, Jr. (D-PA). United Spinal supports the accessibility provisions in H.R. 7350 / S. 3749, The Accessibility and Inclusion to Diversity Local Government Leadership Act (the AID Local Government Act) introduced by Representative Madeleine Dean (D-PA-4) and Senator Robert P. Casey, Jr. (D-PA). United Spinal participated in White House Office of Public Engagement Aging and Disability Communities Calls on 2.29.24, 3/7/2024, 3/21/24. United Spinal, as a member of the Consortium for Constituents with Disabilities (CCD), signed on to comments the CCD submitted in response to the Department of Justices request, Nondiscrimination on the Basis of Disability: Accessibility of Medical Diagnostic Equipment of State and Local Government Entities (DOJ-CRT-2024-0001). United Spinal also submitted our own comments on the above opportunity, DOJ-CRT-2024-0001-0001. The comments read in part, United Spinal Association supports DOJs efforts to apply specific requirements to accessible medical equipment. Inaccessible MDE effectively excludes certain people with disabilities from accessing routine examinations and specialized medical care. United Spinal participated in the National Council on Disabilitys virtual discussion about ground transportation for wheelchair users, sharing our lived experiences with the barriers commonly encountered. United Spinal staff led a delegation of disability organizations in a meeting with Assistant Attorney General Kristen Clarke and Civil Rights Division section leaders to discuss many critical issues facing the disability community.

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

United Spinal Association supports: H.R. 3935/S. 1939 Securing Growth and Robust Leadership in American Aviation Act/FAA Reauthorization Act of 2023 United Spinal Association supports full inclusion of all of the provisions contained in H.R. 1267/ S. 545, the Air Carrier Access Amendments Act (ACAAA) and H.R. 1499 / S. 753, the Good Jobs for Good Airports (GJGA) Act. As one of the Air Carrier Access Act (ACAA) Advisory Committee recommendations: a U.S. Department of Transportation (DOT) Public Awareness Campaign to Ensure Air Travelers with Disabilities Know Their Rights - United Spinal partcipated and provided recommendations. United Spinal Association supported is participating in the U.S. Department of Transportation's Office of Aviation Consumer Protection (OACP) ongoing efforts to launch a new database, Aviation Complaint, Enforcement, and Reporting System (ACERS). In support of Democratic Committee Members of the U.S. House Committee on Transportation and Infrastructure letter sent to Airlines for America (A4A) President and CEO Nicholas Calio expressing concern and dismay regarding the continued trend of mishandled wheelchairs and scooters.

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

H.R. 5408 / S. 2767 - Introduced by Representative Brian Higgins (D- NY-26) and Senator Sherrod Brown (D-OH) SSI Savings Penalty Elimination Act. United Spinal, along with numerous other disability organizations, as members of the Consortium for Constituents with Disabilities (CCD), including CCDs Social Security Task Force (SSTF) and Housing Task Force (HTF), submitted comments to the Social Security Administrations Administrator in response to its Notice of Proposed Rulemaking: Docket No. SSA-2023-0010 Expansion of Rental Subsidy Policy for SSI. United Spinal, along with numerous other disability organizations, as members of the Social Security Task Force of the Consortium for Citizens with Disabilities (CCD) submitted comments about the proposed expansion of the definition of public assistance household in the Supplemental Security Income program (SSI), Docket No. SSA-2023-0015. United Spinal, along with numerous other disability organizations, as members of the Social Security Task Force of the Consortium for Citizens with Disabilities (CCD) submitted comments about the proposed Intermediate Improvement to the Disability Adjudication Process: Including How We Consider Past Work, Docket No. SSA-2023-0024.

Agencies Lobbied

Type of Issue

Lobbying Issues

Urge CMS to lift 'in the home' restriction under Medicare and Social Security Act language for wheelchairs. Support Medicare coverage for standing systems wheelchairs. Seek FY25 Appropriations programmatic report language: Medicare should provide coverage for individuals to obtain wheelchairs that allow them to integrate safely in both their communities and their homes. The Committee directs CMS to update the 2005 National Coverage Determination under Medicare for Mobility Assistive Equipment (MAE) by adding, and/or in the community" after "in the home. And urge the Centers for Medicare and Medicaid Services to provide Medicare coverage for standing systems in power wheelchairs to facilitate increased options for independent and community living for all wheelchair users. Centers for Medicare and Medicaid Services United Spinal, along with numerous other disability and disability related organizations, as members of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition and other supporting organizations that endorsed our original request in 2020 for the Centers for Medicare and Medicaid Services (CMS) to conduct a National Coverage Analysis (NCA) for Medicare coverage of seat elevation and standing systems in power wheelchairs, we write to reaffirm our request for CMS to expeditiously open an NCA for standing systems in Group 3 power wheelchairs, which are classified by Medicare as complex rehabilitative technology (CRT) wheelchair.

Agencies Lobbied

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Lobbying Issues

United Spinal supports H.R.7138, Supplemental Security Income Restoration Act of 2024, introduced by Raul M. Grijalva (D-AZ-7). The bill increases income disregard amounts that have not changed since 1974. Social Security Administration (SSA) currently reduces benefit amounts based on these out-of-date amounts and updates the asset limit to $10,000 / $20,000 for an eligible couple, so people are not excluded for responsibly saving money. United Spinal supports H.R. 5408 / S. 2767, the SSI Savings Penalty Elimination Act, introduced by Representative Brian Higgins (D- NY-26) and Senator Sherrod Brown (D-OH). United Spinal signed on to a Consortium for Constituents with Disabilities Social Security Task Force transition memo to the Honorable Martin OMalley, Commissioner, Social Security Administration. The comments in part read, We use our collective expertise to offer recommendations on a wide range of legislative and administrative issues impacting people with disabilities.

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4th Quarter, 2023

Q4 Report

In Q4, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on Jan. 22. Original Filing: 301538441.xml

Lobbying Issues

Supports "Supporting Our Direct Care Workforce and Family Caregivers Act (S. 1298). Supports "Better Care Better Jobs Act" (H.R. 547/S. 100). Supports "Home and Community Based Services (HCBS) Access Act" (H.R. 1493/ S. 762). United Spinal Association provided comments on the proposed update to the National Institutes of Health (NIH) mission statement. United Spinal, along with numerous other disability organizations, as members of the Disability & Rehabilitation Research Coalition (DRRC) endorsed comments on the proposed update to the National Institutes of Health (NIH) mission statement. On November 20th, United Spinal policy staff, along with numerous other members of the Disability Rehabilitation Research Coalition (DRRC), met with representatives for the National Institutes of Health, National Institute for Neurological Disorders and Stroke to discuss medical rehabilitation programs and needs. United Spinal, along with numerous other disability organizations, as members of the Disability & Rehabilitation Research Coalition (DRRC) provided comments supporting a Limb Loss Preservation Registry (LLPR). United Spinal provided a letter of support for a proposed project from the University of Michigan Transportation Research Institute (UMTRI) for the National Institute on Disability, Independent Living and Rehabilitation Researchs (NIDILRR) request for proposals on field-Initialed Projects, Dynamic Comfort of Vehicle Occupants in Wheelchairs. United Spinal provided a letter of support for a proposed project from the University of Michigan Transportation Research Institute (UMTRI) for the National Institute on Disability, Independent Living and Rehabilitation Researchs (NIDILRR) request for proposals on field-Initialed Projects, Developing Education Modules to Promote Use of Crash Tested Wheelchairs".

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Support the Transportation Assistance for Individuals with Disabilities Act - H.R. 5859 United Spinal participated in a quarterly call with AMTRAK along with other representatives from disability organizations. United Spinal Association staff participated in a meeting with AMTRAK to review their plans for their replacement long-distance trainsets. United Spinal Association supported and participated in the U.S. Department of Transportations Office of Aviation Consumer Protection (OACP) ongoing efforts to launch a new database, Aviation Complaint, Enforcement, and Reporting System (ACERS). United Spinal policy staff, as members of the Consortium for Constituents with Disabilities (CCD) Transportation Task Force, met with representatives from the National Highway Traffic Safety Administration to discuss issues related to wheelchair securement in ground transportation. United Spinal Association staff, as members of the Consortium for Constituents with Disabilities (CCD) Transportation Task Force, met with representatives from the National Highway Traffic Safety Administration to discuss issues related to wheelchair securement in ground transportation. Met with the U.S. Access Board to discuss wheelchair securement in ground transportation. Supports Disaster Relief Medicaid Act - S. 3120/H.R. 6029.

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United Spinal led a delegation of disability organizations in a meeting with Assistant Attorney General, DOJ, Kristen Clarke and Civil Rights Division section leaders to discuss many critical issues facing the disability community. United Spinal signed a thank you letter to the Department of Health and Human Services for publishing its proposed rule updating Section 504 regulations. Section 504 - Rehabilitation Act - United Spinal Association submitted comments in response to the Notice of Proposed Rulemaking on Discrimination on the Basis of Disability in Health and Human Service Programs or Activities. Docket No: 2023-19149, RIN: 0945-AA15. United Spinal also endorsed and drafted comments submitted by the Consortium of Citizens with Disabilities. United Spinal Association. as members of the Disability & Rehabilitation Research Coalition (DRRC) endored/drafted comments to the U.S. Department of Health and Human Services (HHS). United Spinal, along with numerous other disability organizations, as members of multiple Task Forces of the Consortium for Citizens with Disabilities (CCD) submitted comments about the proposed Department of Justices Notice of Proposed Rulemaking (NPRM) implementing Title II of the Americans with Disabilities Act for web- and mobile-app-based information and services. United Spinal signed and drafted a Consortium for Constituents with Disabilities comment letter to the Department of Health and Human Services providing comments on its proposed rule updating Section 504 regulations. in response to the landmark proposed rule that would update and advance protections for people with disabilities pursuant to Section 504 of the Rehabilitation Act of 1973. United Spinal signed and wrote a comment letter to HHS on its proposed rule updating Section 504 regulations. United Spinal signed a letter to the Department of Justice applauding the release of the Notice of Proposed Rulemaking implementing Title II of the ADA for web- and mobile-app-based information and services and providing comments. United Spinal signed a letter to the Census Bureau opposing proposed changes to the definition of disability in the American Community Survey. On November 29th, United Spinal staff participated remotely in a hybrid Capitol Hill briefing from members of the Consortium for Constituents with Disabilities (CCD) for members of Congress. Supports REAADI for Disasters Act/S. 1049/H.R. 2371. Endorsed American Spinal Injury Association/Academy of Spinal Cord Injury Professionals' Letter to the U.S. Census Bureau raising concerns about diminished calculations of the disability population. Discussed pending nominations with White House Office. Discussed advocating for Medicare coverage of standing CRT under the DMEPOS benefit with White House Office.

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United Spinal Association supports accessibility provisions for people with disabilities in the following bills to reauthorize the Federal Aviation Administrations programs: H.R. 3935, Securing Growth and Robust Leadership in American Aviation Act - S. 1939, FAA Reauthorization Act of 2023, United Spinal Association support full inclusion of all of the provisions contained in H.R. 1267/ S. 545, the Air Carrier Access Amendments Act (ACAAA), H.R. 1499 / S. 753, the Good Jobs for Good Airports (GJGA) Act. United Spinal Association supported a letter sent by Democratic Committee Members of the U.S. House Committee on Transportation and Infrastructure sent to Airlines for America (A4A) President and CEO Nicholas Calio expressing concern and dismay regarding the continued trend of mishandled wheelchairs and scooters, most recently on display in a video showing airline employees mistreatment of a passengers wheelchair at the Miami International Airport (MIA). United Spinal Association supported and participated in a working group, dedicated to implementing one of the Air Carrier Access Act (ACAA) Advisory Committee recommendations, a U.S. Department of Transportation (DOT) Public Awareness Campaign to Ensure Air Travelers with Disabilities Know Their Rights. United Spinal Association supported and participated in the U.S. Department of Transportations Office of Aviation Consumer Protection (OACP) on-going efforts to launch a new database, Aviation Complaint, Enforcement, and Reporting System (ACERS).

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United Spinal Association, along with numerous other disability organizations, as members of the Consortium for Constituents with Disabilities (CCD) Technology & Telecommunications Task Force signed on to a letter to the leadership of the Congressional Bipartisan Disabilities Caucus to express our strong support for the Federal Communications Commissions (FCC) Affordable Connectivity Program (ACP) and to urge Congress to allocate additional funding to this crucial initiative. United Spinal Association supports H.R. 4858 / S. 2494, the Communications, Video, and Technology Accessibility (CVTA) Act, reintroduced by Senator Edward J. Markey (D-Mass.), and Representative Anna G. Eshoo (CA-16). This legislation would update and strengthen existing accessibility regulations secured through Senator Markeys CVAA to stay up-to-date with the proliferation of new technologies-from video conferencing platforms to artificial intelligence-which have become prevalent since the CVAA became law in 2010. United Spinal Association, along with numerous other disability organizations, as members of the Consortium for Constituents with Disabilities (CCD) Technologies and Telecommunications Task Force, engaged with the Director of the Government-wide IT Accessibility Program, U.S. General Services Administration and his fellow colleagues, from the Federal CIO Council's Accessibility Community of Practice, who presented on their ongoing work to support Section 508 across the federal government. United Spinal Association consulted with Senate congressional staff on potential legislative language regarding federal departments and agencies compliance with section 508 of the Rehabilitation Act of 1973. United Spinal Association, as a member of the Consortium for Constituents with Disabilities (CCD) Technologies and Telecommunications Task Force, shared a Federal Communications Commission (FCC) 8.17.23 outreach email with fellow Task Force members that while 20 million households have signed up to participate in the Affordable Connectivity Program, one organization estimates that at least 48 million households are eligible.

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Home and Community-Based Services (HCBS) Relief Act of 2023, S. 3118. Wrote a comment letter to CMS requesting their continued work with the disability community on issues involving the role that home health aide services play in ensuring the health, well-being, and independence of beneficiaries across the nation and provided Request for Information comments and for the following: Medicare Program; Calendar Year (CY) 2024 Home Health (HH) Prospective Payment System Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin Items and Services; Hospice Informal Dispute Resolution and Special Focus Program Requirements, Certain Requirements for Durable Medical Equipment Prosthetics and Orthotics Supplies; and Provider and Supplier Enrollment Requirements. [CMS-1780-P] Wrote a comment letter to CMS in response to the proposed rulemaking: Ensuring Access to Medicaid Services NPRM (CMS 2442-P) especially as it relates to Home and Community Based Services (HCBS). United Spinal expressed their support of the proposed rulemaking and its impacts on our members. On November 2nd, United Spinal, along with numerous other organizations, as members of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition met with representatives of the Centers for Medicare and Medicaid Services (CMS) to discuss the status of a proposed issuance of a National Coverage Determination (NCD) for power wheelchair standing systems. Supported the Ensuring Patient Access to Critical Breakthrough Product Act of 2023 as a member of the ITEM Coalition Steering Committee. Enodrsed/drafted joint ITEM/CPR Coalition Letter on Section 504 Proposed Rule. Endorsed letter to CDC and GAO and U.S. Senate on access to catheters and catheter acquired urinary tract infections. United Spinal supports Telehealth Expansion Act - S. 1001/H.R. 1848

Agencies Lobbied

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3rd Quarter, 2023

Q3 Report

In Q3, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on Oct. 20, 2023. Original Filing: 301516987.xml

Lobbying Issues

United Spinal Association advocated for and expressed thanks to Senator Marco Rubio (R-FL) and Senator Tammy Baldwin (D-Wisconsin) for championing the passage of a resolution designating September 2023 as National Spinal Cord Injury Awareness Month. United Spinal Association, as a member of the Consortium for Constituents with Disabilities (CCD) and several of its task forces, signed on to a letter commending and thanking the Secretary of the Department of Health and Human Services, Xavier Becerra, and Melanie Fontes Rainer, Director Office for Civil Rights for the publication of its historic proposed rule, Discrimination on the Basis of Disability in Health and Human Service Programs or Activities - the 504 rule/Rehabilitation Act. United Spinal Association, along with numerous other disability organizations, as members of the Disability Rehabilitation Research Consortium, signed a letter to the bipartisan leadership of the U. S. Senates Committee on Appropriations, expressing serious concerns with the proposed $14 billion in cuts and eliminations of programs for the Department of Health & Human Services (HHS) in the House of Representatives proposed FY 2024 Labor, Health and Human Services, Education, and Related Agencies (L-HHS) appropriations bill. On September 26, the National Institutes of Health (NIH) announced that it had people with disabilities as a population with health disparities for research supported by the NIH. United Spinal Association, as a member of the Disability Rehabilitation Research Coalition along with numerous other organizations, has long sought the designation. United Spinal, along with numerous other disability organizations, as members of the Disability Rehabilitation Research Consortium (DRRC), signed a letter to the National Institute on Minority Health and Health Disparities (NIMHD) and the Agency for Healthcare Research and Quality (AHRQ) expressing the need to the agencies to move forward with the Advisory Committee to the Director (ACD) Working Group on Diversity, Subgroup on Individuals with Disabilities recommendation to recognize people with disabilities as a health disparities population. United Spinal, along with 1,290 healthcare providers, researchers, caregivers, organizations, and people with disabilities signed on to a letter urging the US Department of Health and Human Services (DHHS) to reconsider the recent National Institute of Minority Health and Health Disparities (NIMHD) working group recommendation to reject designating people with disabilities as a health disparities population. On 9.19.23 United Spinal Association submitted the following question for the 9.21.23 @ 2:00pm White House Office of Public Engagement Aging and Disability Communities Call: Will the President assist to reconsider NIMHD working group recommendation to reject designating people with disabilities as a health disparities population? United SpinalAssociation, along with numerous other disability organizations, as members of the Disability Rehabilitation Research Consortium (DRRC), met with National Institutes of Health (NIH) leaders, Dr. Alison Cernich, Deputy Director, National Institute of Child Health and Human Development and Dr. Theresa Hayes Cruz, Director, NICHD National Center for Medical Rehabilitation Research (NCMRR). Discussion topics included: Current Status of Disability and Rehabilitation Research at NIH Status of ACD Recommendations and DEIA at NIH Engagement with Other Federal Agencies FY 2024 Appropriations and Funding of NIH Policy staff also asked about any response that had been received from researchers to: Home and Community-Based Physical Activity Interventions to Improve the Health of Wheelchair Users (R01 Clinical Trial Required): https://grants.nih.gov/grants/guide/rfa-files/RFA-HD-22-017.html Dr. Cruz responded, We received a strong number of applications to this RFA and were able to fund two R01s. United Spinal Association supports H.R. 5308 - Rural Telehealth and Education Enhancement Act of 2023, reauthorizing the Distance Learning and Telemedicine Program administered by the Department of Agriculture (USDA) which allocates grants to assist rural communities in acquiring the essential technology and training needed to establish connections between educational and medical experts, students, teachers, and patients residing in rural areas. United Spinal Association met with NIDILRR, along with other staleholders, as part of the ITEM Coalition, to dsicuss improved access to bowel and bladder management supplies under Medicare. United Spinal Association endorsed MS Coalition comments to ICER reagrding evaluation of patient-reported outcomes in regards to MS therapies. United Spinal Association supported, as part of the Coalition to Preserve Rehabilition, Rep. Pascrells NDAA amendments that would require the U.S. Department of Defense to conduct two separate studies on (1) eliminating outpatient rehabilitation limits for active duty servicemembers suffering from TBI; and (2) recognizing non-governmental bodies for accrediting brain injury treatment programs for servicemembers. These studies will provide critical information to the Department of Defense and Congress about the possible expansion of rehabilitation treatment to our service members that have suffered a brain injury while serving this great country.

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United Spinal Association: participated in a quarterly call with Amtrak along with other representatives from disability organizations. participated in a roundtable discussion with Amtraks Board of Directors. participated in a meeting with Amtrak to review their plans for their replacement long-distance trainsets. United Spinal Association submitted comments in response to the U. S. Department of Transportation, National Highway Traffic Safety Administration New Car Assessment Program - Crashworthiness Pedestrian Protection, Docket No. NHTSA-2023-0020. United Spinal submitted comments on the U. S. Department of Transportations Request for Information on Potential Research and Development Areas of Interest for the Advanced Research Projects Agency-Infrastructure (ARPA-I) (Docket No. DOT-OST-2023-0092). United Spinal Association commented on DOT NHTSA notice of proposed rulemaking (NPRM) to adopt a new Federal Motor Vehicle Safety Standard to require automatic emergency braking (AEB), including pedestrian AEB (PAEB), systems on light vehicles, [Docket No. NHTSA-2023-0021]. United Spinal Association, along with numerous other disability organizations, as members of the Consortium for Citizens with Disabilities (CCD) Transportation Task Force and fellow advocates, signed on to comments to the bipartisan congressional leadership of the House Energy and Commerce Committee for the record of a hearing held on July 26th, Self-Driving Vehicle Legislation on Framework: Enhancing Safety, Improving Lives and Mobility, and Beating China. United Spinal Association, as a member of the Transportation Task Force of the Consortium for Citizens with Disabilities (CCD), supported comments submitted by the task Forces co-chairs on Bus Compartment Redesign and Bus of the Future Initiatives, Docket No. FTA-2023-0013.

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United Spinal supports the Air Carrier Access Amendments Act S. 545/H.R. 1267, the Prioritizing Accountability and Accessibility for Aviation Consumers Act H.R. 1445/S. 400, H.R. 3762 / S.1765 - the Emergency Vacating of Aircraft Cabin Act, the Airline Safety Information and Entertainment Access Act, S. 1119, the MOBILE Act introduced by U.S. Rep. Steve Cohen (D-TN-09) H.R. 3802/S. 1459; H.R.3743, a bill To amend the FAA Reauthorization Act of 2018 to extend the advisory committee on the air travel needs of passengers with disabilities. United Spinal supports H.R.1772, the wheelchairs on Airplanes Act introduced by U.S. Representative Dina Titus (D-NV-01). The would help prevent discrimination against airline passengers with disabilities who use lithium-ion-powered wheelchairs and mobility aids that are safe for air travel. United Spinal supports the disability-related provisions contained in the FAA Reauthorization Act of 2023, S. 1939. Prioritizing Accountability and Accessibility for Aviation Consumers Act of 2023:requires the U.S. Department of Transportation (DOT) publish an annual report on how quickly, effectively and efficiently consumer complaints related to traveling with a disability are received, addressed and resolved by DOT. Mobility Aids On Board Improve Lives and Empower All (MOBILE) Act: requires DOT issue an advisory circular that provides guidance to airlines on publishing information related to powered wheelchairs, including the dimensions of aircraft cargo holds, and evaluate the frequency and types of mishandling of mobility aids and take actions towards making in-flight wheelchair seating available. Access and Dignity for All People who Travel (ADAPT) Act: requires DOT issue regulations regarding seating accommodations for passengers with disabilities that takes into account being seated next to their companion and requires the Secretary of Transportation establish an optional Known Service Animal Travel Pilot Program, providing service animal users the opportunity to participate in a streamlined pre-registration process. Equal Accessibility to Passenger Portals (Equal APP) Act: requires DOT issue regulations to ensure that customer-facing websites, applications and information communication technologies (ICT) of airlines and airports are accessible. It would require the Secretary to conduct regular audits of such websites, applications and ICTs and allow the Secretary to hold non-compliant entities accountable by issuing civil penalties. Store On-board Wheelchairs in Cabin (STOWIC) Act: requires airlines provide information on the airline website-and anywhere people can make reservations- regarding the rights and responsibilities of both airlines and passengers as to the availability of on-board wheelchairs. It would also require annual staff training regarding assisting people with disabilities on the use of on-board wheelchairs and the right to request an on-board wheelchair. It would allow the Secretary to issue enhanced civil penalties if airlines fail to provide an on-board wheelchair. Airport Accessibility Grants: authorizes a pilot grant program to help airports make their facilities more accessible. The program would be funded at $20 million per year from Airport Improvement Program (AIP) funds. Provisions of the Air Carrier Access Amendments Act. United Spinal supports the disability-related provisions contained in the FAA Reauthorization Act of 2023, H. R. 3935/S. 1939, the Securing Growth and Robust Leadership in American Aviation Act including provisions of the Air Carrier Access Amendments Act. United Spinal Association supports H.R. 1499/ S. 753, the Good Jobs for Good Airports Act. SEIU members from across the nation joined United Spinal Association, the National Association for the Advancement of Colored People and National Disability Rights Network in thanking U.S. Senator Edward Markey (D-MA) for his leadership on the Good Jobs for Good Airports bill. Met with Sen.Ted Budd to express support fo GJGA. United Spinal submitted comments in response to the U.S. Department of Transportations (DOT) Request for Information (RFI) about the critical role Advanced Air Mobility (AAM), Docket:(DOT-OST-2023-0079), should play in the lives of people with disabilities, especially wheelchair users. United Spinal, along with numerous other disability organizations, met periodically with U. S. Department of Transportation, Office of Aviation Consumer Protection, to discuss disability rights advocacy. United Spinal, along with numerous other disability organizations and aviation industry representatives, participated in a U.S. Department of Transportation public awareness campaign to increase awareness of the different types and levels of accommodations that airlines can provide to passengers with disabilities. United Spinal staff consulted with House Congressional staff per their request on potential legislative language regarding accessible adult changing stations in airports. On September 28th, as part of a coalition of nonprofit organizations advocating for safe and accessible air travel, Paralyzed Veterans of America, Hand In Hand, the Christopher & Dana Reeve Foundation, and United Spinal Association issued a joint statement in response to a settlement agreement reached by the U.S. Department of Transportation and United Airlines following a complaint from the late disability rights advocate Engracia Figueroa.

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On 9.12.23, United Spinal Association, along with 369 other disability organizations, signed on to a letter to bipartisan, bicameral members of Congress endorsing the SSI Savings Penalty Elimination Act, H.R 5408/S. 2767 which - for the first time in over 30 years - would raise the amount of assets Supplemental Security Income (SSI) recipients can save without jeopardizing their vital SSI benefits. United Spinal Association, as a member of the Social Security Task Force (SSTF) of the Consortium for Citizens with Disabilities (CCD), supported comments submitted by the SSTF co-chairs to Social Security Administration, Kilolo Kijakazi, in response to SSAs proposal related to setting the manner and appearance of parties at witnesses at hearings. The comments read in part: We greatly appreciate that the Social Security Administration (SSA) is taking steps to improve hearing efficacy and to increase flexibility for claimants. We hope that any changes implemented will improve claimants access to adjudicative processes and ultimately, benefits. We are concerned, however, that some of these changes will have the opposite effect and instead may present obstacles to claimants

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On September 14th, United Spinal Association participated in a Complex Rehabilitation Technology (CRT) Product Expo on Capitol Hill for members of Congress and their staffs hosted by the National Coalition for Assistive and Rehab Technology (NCART) and the National Registry of Rehabilitation Technology Suppliers (NRRTS). Policy staff invited members of Congress and their staffs and explained how CRT makes our lives healthier and productive. Additionally, attendees could interact with CRT products, other CRT users, clinicians, providers, manufacturers, and other advocates provided demonstrations and answered questions. United Spinal Association commends the Centers for Medicare and Medicaid Services (CMS) for their announcement in May 2023 in support of Medicare coverage of seat elevation for power wheelchairs, and we are urging CMS to expand on this progress and hold to its commitment of swiftly opening a comment period for standing systems in power wheelchairs and to conduct a full review of its mobility device coverage, coverage, coding and payment policies. Additionally, due to the increasingly restrictive interpretation of Medicare's "in the home" language and the adoption of Medicare coverage policy by commercial insurers, wheelchair users face constant insurance denials and delays in obtaining appropriate equipment resulting in health injuries and secondary health conditions such as pressure injuries (pressure sores) and rotator cuff and carpal tunnel injuries, due to overuse of their upper extremities. United Spinal advocated for members of Congress to support a legislative or regulatory fix by asking that they join a House Dear Colleague Letter sent to CMS July 13, led by Rep. Debbie Dingell (D-MI) and Rep. Brian Fitzpatrick (R-PA) that requested: 1) CMS hold to its commitment of opening the comment period for Medicare coverage of standing systems; 2) lifting the "in the home" restriction on coverage of mobility devices that meet the medical and functional needs of all people with mobility disabilities; adding "and/or in the community" to the MAE language in the NCD; and 3) conducting a full review of current mobility device coverage, coding and payment policies. On September 26th, United Spinal policy staff participated in an ITEM Coalition meeting with the Centers for Medicare & Medicaid Services (CMS) to discuss the national coverage determination (NCD) request for standing systems in power wheelchairs. United Spinal Association advocated for and supported a letter Senators Maggie Hassan (D-NH), Marsha Blackburn (R-TN), Bob Casey (D-PA), and Tammy Duckworth (D-IL) sent the Centers for Medicare and Medicaid Services (CMS) request a full review of its 2005 National Coverage Determination for Mobility Assistive Equipment (MAE) for Medicare beneficiaries, including its interpretation of the in the home requirement. Current Medicare coverage limitations on equipment used outside the home can limit patients access to mobility equipment and to their communities. United Spinal submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the proposed rule addressing the CY 2024 update to the Home Health Prospective Payment System, [CMS-1780-P]. The comments focused solely on the proposed language under Definition of a Brace. United Spinal Association supports NCART and NRRTS legislative asks: Ask 1: CMS must move forward with establishing Medicare coverage for Power Standing Systems We are incredibly thankful to CMS for following the medical evidence and initiating coverage for Seat Elevation this past year. However, CMS has not yet moved forward on establishing coverage for Power Standing Systems used with CRT Power Wheelchairs. This request was submitted jointly with the request for power seat elevation in September 2020, but CMS separated the two technologies and opted to consider coverage individually. Clinical evidence shows that Power Standing Systems provide significant medical benefits and allow people with disabilities to maintain independence in their homes and communities. This delay is resulting in a denial of access for individuals with mobility impairments and we are asking Congress to contact CMS Administrator Brooks-LaSure to urge needed action. Ask 2: CMS must allow consumers equal opportunity to upgrade their own equipment For some Medicare enrollees, enhanced options like titanium or carbon fiber are available for the CRT equipment recommended by their clinical team. However, these upgrades are currently only available through a complicated process that does not allow Medicare beneficiaries to simply cover the difference in cost. This limits patient choice and forces individuals to either utilize equipment that may not be optimized for their medical needs or pay entirely out of pocket for equipment with the desired upgrades. HR 5371 introduced by Rep. John Joyce (R-PA) allows for code upgrades for titanium and carbon fiber wheelchairs under Medicare. We believe that individuals should have the right to utilize their insurance benefits while still being able to optimize their equipment if they choose to do so. This would not result in any additional cost to the Medicare program. We ask each Representative to contact Matt Joyce in Representative Joyces office to Cosponsor HR 5371 and allow this important change for individuals with disabilities. Ask 3: Congressional Support must be provided to maintain access to CRT equipment. Currently, providers are only reimbursed for a portion of the multi-layer process of supplying CRT equipment, which includes clinical evaluation, technology assessment, equipment simulation, assembly/configuration, delivery, fitting, programming, and training. Ongoing inflation and increased operating expenses further threaten access to needed equipment, repairs, and other services for individuals with disabilities. Relief is needed and we are asking Congress to discuss CRT stakeholder recommendations and pursue actions that support a strong provider network and secure access for individuals who rely on this life-changing equipment. Submitted comments to CMS re RFI on Home Health Aide Services. United Spinal Association met with CMS, with other stakeholders, to discuss the expansion of HCPCS coding for catheters. United Spinal Association, as a member of the ITEM Coalition, submitted comenmts on Transtioanl Coverage for Emerging Technologies (TCET). United Spnal Association, as part of the Coalition to Preserve Rehabilitation, submitted comments on the IRF Review Choice Demonstration. United Spinal Asociaton met with CMS to discuss the need for coverage of standing systems in wheelchairs and thanked CMS for the coverage of seat elevation under Medicare. United Spinal Asociaton met with ACL to discuss the need for coverage of standing systems in wheelchairs and thanked ACL's support for the coverage of seat elevation under Medicare.

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United Spinal Association supports Pioneering Antimicrobial Subscriptions to End Upsurging Resistance Act of 2023 (The PASTEUR Act of 2023; S. 1355/H.R. 2940). Joined almost thirty other organizations in Washington, D.C. to advocate for the Pioneering Antimicrobial Subscriptions to End Upsurging Resistance Act of 2023 (The PASTEUR Act of 2023; S. 1355/H.R. 2940). The PASTEUR Act of 2023 is sponsored by Senator Bennet (D-CO) and Representative Ferguson (R-GA). Met with the offices of Rep. Juan Ciscomani (R-AZ-06), Rep. Burgess Owens (R-UT-04), Rep. Chrissy Houlahan (D-PA-06), Rep. Glenn Grothman WI-06 and Rep. GT Thompson (R-PA-15) Wrote letters of support and appreciation to Sen. Bennet and Rep. Ferguson. PASTEUR Act creates solutions to encourage innovative drug development targeting the most threatening infections, improve the appropriate use of antibiotics, and ensure domestic availability of antibiotics when needed.

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2nd Quarter, 2023

Q2 Report

In Q2, United Spinal Association had in-house lobbyists, and was paid $100,000. The report was filed on July 20, 2023. Original Filing: 301491712.xml

Lobbying Issues

United Spinal urges the Congress to ask CMS to lift the in-the-home rule restricting Medicare wheelchair coverage and provide Medicare coverage of standing systems in power wheelchairs - House Dear Colleaugue letter led by Rep. Debbie Dingell and Rep. Brian Fitzpatrick. Asking Senators to support the same concept. We thanked CMS for providing coverage for seat elevation tied to power wheelchairs. For decades, Spinal Cord Injury Model Systems funding has not kept pace with inflation even though the SCI population has doubled. The critical research and innovative services SCIMS provide encompass the entire spectrum of rehabilitation, from emergency services when an SCI is initially sustained through an individuals return to full participation in employment and their community. As a member of the Disability and Rehabilitation Research Coalition (DRRC), United Spinal signed onto a letter the leadership of the DRRC submitted to the National Institutes of Health (NIH) and the Advisory Committee to the Director (ACD) commending the agencies formally endorsing the landmark recommendations from the ACD Working Group on Diversity, Subgroup on Individuals with Disabilities (the Subgroup). United Spinal policy staff participated in the June 28th Interagency Committee on Disability Research (ICDR) Stakeholder Meeting hosted by the Administration for Community Living. Policy staff followed up with the Deputy Director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development to obtain a copy of the Deputy Directors presentation which included progress on a number of issues important to wheelchair users health and functional abilities. United Spinal provided information to Congressional staff on the issue of exoskeleton technology to assist individuals with spinal cord injuries (SCI) and the question of Medicare coverage. Private sector health insurance providers as well as select Medicare Advantage plans and public sector providers namely, the U.S. Department of Veterans Affairs, in certain cases provide coverage of exoskeletons for individuals with an SCI. Exoskeleton technogoiy is another option to help with rehabilitation but has to be selected appropriately for individuals who need it. United Spinal, as a member of the Steering Committee of the Coalition to Preserve Rehabilitation (CPR), signed on to comments submitted to the Centers for Medicare and Medicaid Services (CMS) on the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) for Fiscal Year (FY) 2024 Proposed Rule, published in the Federal Register on April 3, 2023. The comments read in part, .the CPR Coalition continues to have serious concerns with the impact the IRF RCD will have on patient access to care.

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United Spinal participated in a quarterly call with Amtrak along with other representatives from disability organizations. United Spinal asked for support of Disability Access to Transportation Act (H.R. 3845/S. 1813). United Spinal, along with numerous other disability organizations, signed onto a letter led by the American Council of the Blind to U.S. Representative Cathy McMorris Rodgers, Chair of the House Energy and Commerce Committee to support the continued development and deployment of autonomous vehicles in the United States, which could significantly enhance the lives of millions of disabled Americans and their loved ones, and ask that Congress take swift action to ensure ongoing development of this industry can occur in this country. United Spinal Submitted comments on the U. S. Department of Transportations (DOT) Request for Information on Department of Transportation Equity Action Plan Update (Docket No. DOT-OST-2023-0087). United Spinal, as a member of the Consortium for Constituents with Disabilities (CCD) Transportation Task Force, supported comments from the Task Forces co-chairs submitted to the U.S. Department of Transportation providing feedback on the 2023 update to the Equity Action Plan. The letter read in part,It is important to ensure that equity measures advance access to and availability of transportation options for people with disabilities. The comments may be reviewed at:

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United Spinal advocacy and policy staff led a delegation of disability organizations in a meeting with Assistant Attorney General Kristen Clarke and Civil Rights Division section leaders to discuss many critical issues facing the disability community. United Spinal advocacy and policy staff met with Phil Brest from the White House Counsels office to urge that the White House take the opportunities it has to nominate more individuals with disabilities to the federal bench. United Spinal, along with numerous other disability organizations, as members the Consortium for Constituents with Disabilities Technology and Telecommunications Task Force, submitted requests for the inclusion of $49 million in the Fiscal Year (FY) 2024 House and Senate Labor, Health and Human Services and Education Appropriations (LHHS) bills for the Assistive Technology (AT) Act Programs. On Global Accessibility Awareness Day 2023, United Spinal Association and 51 other national disability organizations celebrate the transformative impact of accessible technology and call on the federal government to require websites and software applications to be accessible to and usable by people with disabilities. The roughly 61 million people with disabilities in the United States have a right to access employment, businesses, programs, and services, regardless of whether they are delivered in-person or online.

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United Spinal supports the Air Carrier Access Amendments Act S. 545/H.R. 1267, the Prioritizing Accountability and Accessibility for Aviation Consumers Act H.R. 1445/S. 400, H.R. 3762 / S.1765 - the Emergency Vacating of Aircraft Cabin Act, the Airline Safety Information and Entertainment Access Act, S. 1119, the MOBILE Act introduced by U.S. Rep. Steve Cohen (D-TN-09) H.R. 3802/S. 1459; H.R.3743, a bill To amend the FAA Reauthorization Act of 2018 to extend the advisory committee on the air travel needs of passengers with disabilities. United Spinal supports H.R.1772, the wheelchairs on Airplanes Act introduced by U.S. Representative Dina Titus (D-NV-01). The would help prevent discrimination against airline passengers with disabilities who use lithium-ion-powered wheelchairs and mobility aids that are safe for air travel. United Spinal supports the disability-related provisions contained in the FAA Reauthorization Act of 2023, S. 1939. Prioritizing Accountability and Accessibility for Aviation Consumers Act of 2023:requires the U.S. Department of Transportation (DOT) publish an annual report on how quickly, effectively and efficiently consumer complaints related to traveling with a disability are received, addressed and resolved by DOT. Mobility Aids On Board Improve Lives and Empower All (MOBILE) Act: requires DOT issue an advisory circular that provides guidance to airlines on publishing information related to powered wheelchairs, including the dimensions of aircraft cargo holds, and evaluate the frequency and types of mishandling of mobility aids and take actions towards making in-flight wheelchair seating available. Access and Dignity for All People who Travel (ADAPT) Act: requires DOT issue regulations regarding seating accommodations for passengers with disabilities that takes into account being seated next to their companion and requires the Secretary of Transportation establish an optional Known Service Animal Travel Pilot Program, providing service animal users the opportunity to participate in a streamlined pre-registration process. Equal Accessibility to Passenger Portals (Equal APP) Act: requires DOT issue regulations to ensure that customer-facing websites, applications and information communication technologies (ICT) of airlines and airports are accessible. It would require the Secretary to conduct regular audits of such websites, applications and ICTs and allow the Secretary to hold non-compliant entities accountable by issuing civil penalties. Store On-board Wheelchairs in Cabin (STOWIC) Act: requires airlines provide information on the airline website-and anywhere people can make reservations- regarding the rights and responsibilities of both airlines and passengers as to the availability of on-board wheelchairs. It would also require annual staff training regarding assisting people with disabilities on the use of on-board wheelchairs and the right to request an on-board wheelchair. It would allow the Secretary to issue enhanced civil penalties if airlines fail to provide an on-board wheelchair. Airport Accessibility Grants: authorizes a pilot grant program to help airports make their facilities more accessible. The program would be funded at $20 million per year from Airport Improvement Program (AIP) funds. Provisions of the Air Carrier Access Amendments Act. United Spinal supports the disability-related provisions contained in the FAA Reauthorization Act of 2023, H. R. 3935, the Securing Growth and Robust Leadership in American Aviation Act including provisions of the Air Carrier Access Amendments Act. United Spinal supports H.R. 1499/ S. 753, the Good Jobs for Good Airports Act. United Spinal endorsed a letter, dated May 3, 2023, U.S. Representatives Dina Titus (D-NV 1st), Steve Cohen (D-TN-09) and Abigail Spanberger (D-VA-07) submitted to U.S. Department of Transportation (DOT) Secretary Pete Buttigieg seeking greater transparency of disability-related air travel complaints the DOT receives

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Supporting broadband deployment, equity and inclusion for the disability community to new members of the 118th Congress in a welcome Letter. United Spinal supports a sustained federal investment ensuring the deployment and maintenance of a high capacity, secure and reliable 5G broadband national network that is accessible, adoptable and affordable for all Americans. To make broadband affordable to all, we endorse a permanent financial support system for households based on the Federal Communications Commissions Affordable Connectivity Program. United Spinal responded to a request for comments from the National Telecommunications and Information Administrations (NTIAs) regarding the development of a National Spectrum Strategy, Docket No.230308-0068/(NTIA-2023-0003). The comments read in part, our communitys needs demand a more balanced spectrum allocation..."

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1st Quarter, 2023

Q1 Report

In Q1, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on April 20, 2023. Original Filing: 301467390.xml

Lobbying Issues

United Spinal participated in calls with staff for Sen. Bob Casey (D-PA) about a sign-on letter for funding for the Model Systems programs at the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). United Spinal discussed the need for increased funding for the Model Systems programs at NIDILRR with House and Senate offices. United Spinal requested the Director of National Institute on Disability, Independent Living and Rehabilitation Research Centers to stress the critical role that adaptive FITNESS programs can play for the vast majority of members in the disability community who dont participate in any sports during her presentation in an upcoming webinar on adaptive sports. United Spinal commented on the Centers for Medicare and Medicaid Services (CMS) proposed National Coverage Decision (NCD) for seat elevation systems in Complex Rehabilitation Technology (CRT) power wheelchairs.

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United Spinal participated in a quarterly call with Amtrak along with other representatives from disability organizations. United Spinal participated in a call with Amtrak providing an update on the new Acela trainsets. United Spinal participated in calls with staff for Rep. Dina Titus (D-NV) and Sen. Bob Menendez (D-NJ) about reintroduction of the Disability Access to Transportation Act. United Spinal agreed to support a transportation bill drafted by Representative Joe Wilson (D-SC-2). The legislation would direct the Secretary of Transportation to establish a program to provide grants to protection and advocacy systems to advocate for individuals with disabilities to access transportation, and for other purposes. United Spinal supports the EVAC Act (Sen. Duckworth).

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4th Quarter, 2022

Q4 Report

In Q4, United Spinal Association had in-house lobbyists, and was paid $85,000. The report was filed on Jan. 20, 2023. Original Filing: 301443901.xml

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United Spinal advocacy and policy staff participated in a meeting with Department of Health and Human Service General Counsel Sam Bagenstos and colleagues. Topics discussed included how to guard against judicial erosion of disability rights, Medicares in-the-home rule for wheelchairs, Medicare coverage of seat elevation and standing systems for wheelchairs, and accessible medical diagnostic equipment. United Spinal Association endorsed a Consortium for Constituents with Disabilities letter to the Office of Civil Rights at the Department of Health and Human Services in support of proposed rulemaking related to Section 1557 of the Affordable Care Act and provided comments and suggestions. United Spinal policy staff submitted comments to the National Institute on Disability, Independent Living, and Rehabilitation Researchs (NIDILRR) to help develop its Long-Range Plan for 2024-2028. As a member of the Disability Rehabilitation Research Coalition (DRRC), United Spinal also signed on to the DRCC comments made on NIDILRRs Plan. Submitted comments on Section 1557 proposed rule to HHS, Health Equity comments to the White House and to CMS. Increase funding for Spinal Cord Injury Model Systems. Met with the Director of the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Dr. Anjali Forber-Pratt, to discuss research opportunities in the area of therapy caps and catastrophic exception from rehabilitation lengths of stay for spinal cord injury. Recommended catheter coding reform. Met with the Director of the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Dr. Anjali Forber-Pratt, to discuss research opportunities in the area of therapy caps and catastrophic exception from rehabilitation lengths of stay for spinal cord injury.

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Active Transportation Infrastructure Investment Program Funding Wrote letters to both the House and Senate appropriations committees and their subcommittee on Transportation, Housing, Urban Development, and Related Agencies thanking them for their funding and stating that we supported the House Appropriations funding amount of $100 million over the Senates $25 million. Description: CONNECTING AMERICAS ACTIVE TRANSPORTATION SYSTEM ACT (H.R> 2991/S. 684) while passed was not fully funded. This bill directs the Department of Transportation (DOT) to carry out an active transportation investment program to provide competitive grants to state, local, and regional government entities, and Indian tribes to construct projects that connect walking and bicycling infrastructure within and between communities, metropolitan regions, or states. United Spinal advocacy and policy staff participated in a quarterly call with Amtrak along with other representatives from disability organizations. United Spinal advocacy and policy staff participated in a call with Amtrak along with other representatives from disability organizations to discuss a marketing research plan regarding service between Chicago, IL and St. Louis, MO. United Spinal advocacy and policy staff participated in a meeting with staff for Sen. Menendez (D-NJ) to discuss reintroduction of the Disability Access to Transportation Act in the 118th Congress. To ensure safer, more accessible rail travel for people with disabilities and as a member of the Consortium for Constituents with Disabilities (CCD) Transportation Task Force, United Spinal supported a letter the Task Forces Co Chairs sent to Amtraks President & CEO regarding a meeting held on July 21, 2022 at the Marriott Marquis Hotel in Washington, D.C. The letter read in part: We appreciated receiving updates on Amtraks latest activities to ensure its services and facilities are accessible. However, our organizations were disappointed that the meeting was less interactive with the Board than anticipated. Additionally, concerns remain that were not addressed. We request a new meeting with the Amtrak Board and leadership to act as a catalyst to spur further conversation.

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HR 3304 CARS for Vets Act - This bill allows service-connected veterans to receive a VA Automobile Grant every ten years for the purchase of a new or used adapted vehicle and expands the definition of medical services to include additional vehicle modifications using the VA Automobile Adaptive Equipment program. United Spinal is urging Members of Congress to cosponsor and pass this legislation because it would help reduce the financial burden for veterans with disabilities who require adapted vehicles. S 444/HR 1361 AUTO for Veterans Act - This bill allows eligible service-connected veterans to receive a VA Automobile Grant every ten years for the purchase of a new or used adapted vehicle. United Spinal is urging Members of Congress to cosponsor and pass this legislation because it would help reduce the financial burden for veterans with disabilities who require adapted vehicles. HR 2916/S 1467 VA Medicinal Cannabis Research Act - This bill requires the Department of Veterans Affairs (VA) to conduct clinical trials of the effects of medical-grade cannabis on the health outcomes of covered veterans diagnosed with chronic pain and those diagnosed with post-traumatic stress disorder. Covered veterans are those who are enrolled in the VA health system. Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) -- United Spinal sent a targeted action alert urging members of to submit comments on proposed changes to the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). United Spinal supports changes to CHAMPVA that would allow audio-only telehealth and increased access to mental health services. RIN 2900-AP89, Change in Rates VA Pays for Special Modes of Transportation - This proposed rule would cut the Department of Veterans Affairs (VA) reimbursement rate for emergency air medical services. Fiscal Year (FY) 2023 Military Construction, Veterans Affairs, and Related Agencies Appropriations (MilCon-VA) - This bill provides appropri8ations for military construction, the Department of Veterans Affairs (VA), and related agencies. Workforce Innovations Opportunity Act (WIOA) and the Disabled Veterans Outreach Program (DVOP) - WIOA is designed to help job seekers access employment, education, training, and support services to succeed in the labor market. DVOP provides intensive services to help veterans obtain placement in competitive employment.

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United Spinal policy staff, along with numerous other disability organizations, participated in a U.S. Department of Transportation (DOT) - Disability Advocates Meeting. Policy staff raised concerns about whether DOT had adequate staffing and resources to more effectively and expeditiously respond to passengers with disabilities air travel complaints. Currently, complaints administered by the DOTs Office of Aviation Consumer Protection are averaging a response timeframe of over a year. To ensure safer, more accessible air travel for people with disabilities, United Spinal in response to the Federal Aviation Administrations request for comments on minimum seat dimensions necessary for safety of air passengers, (Emergency Evacuation) submitted comments to Docket No. FAA-2022-1001. United Spinal, as members of the Consortium for Constituents with Disabilities (CCD) Transportation and Emergency Management Task Forces, United Spinal supported comments the Task Force Co-Chairs submitted. United Spinal also supported comments made by Paralyzed Veterans of America on Docket No. FAA-2022-1001. To ensure safer, more accessible air travel for people with disabilities, especially wheelchair users, United Spinal submitted written testimony for the hearing record of the House Committee On Transportation And Infrastructure Subcommittee on Aviation: Accessible air travel: addressing challenges for passengers with disabilities, held on November 17, 2022. United Spinals comments addressed the reauthorization of the Federal Aviation Administration next year and our longstanding priority that the provisions of H.R.1696 - Air Carrier Access Amendments Act of 2021 (ACAAA) be included in the reauthorization. To ensure safer, more accessible air travel by people with disabilities, especially wheelchair users, United Spinal submitted comments in response to a Notice of Proposed Rulemaking (NPRM) on airline ticket refunds and airline consumer protections, DOT-OST-2022-0089. Co-sponsor and pass S. 642/H.R. 1696, the Air Carrier Access Amendments Act (ACAA) of 2021.

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3rd Quarter, 2022

Q3 Report

In Q3, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on Oct. 21, 2022. Original Filing: 301420412.xml

Lobbying Issues

United Spinal Association supports HR 3932 / S 2076 The Pioneering Antimicrobial Subscriptions to End Up surging Resistance (PASTEUR) Act. Signed onto letter to Sen. Schumer and Sen. McConnell asking to extend coverage for telehealth services under Medicare to continue for another 2 years following the end of the Public Health Emergency (PHE). Support increased funding for SCI Model Systems via NIDILRR funding. Support catheter coding reform Support Medicare coverage of seat elevation and standing devices in poweer wheelchairs and support regulation to lift the 'in-the-home' restriction on Medicare coverage of wheelchairs. Support the H.R. 4040, the Advancing Telehealth Beyond COVID-19 Act." Financial Assistance for complex rehab technology wheelchair manufacturers and wheelchair service providers to encourage federal financial assistance to address unsustainable cost increases CRT suppliers have incurred over the past two years to allow them to maintain critical access to CRT and the supporting services for people with disabilities. CRT providers and manufacturers have incurred significant operating challenges and increased expenses over the past two years. Supports increaed funding for home and community-based services. To increase health outcomes, safety and accessibility,on August 3, United Spinal, a member of the Steering Committee of the ITEM Coalition, participated in a virtual roundtable discussion on Medicare coverage of seat elevation and standing systems used in power wheelchairs hosted by the National Council on Disability. United Spinal also submitted comments to NCD on the need for Medicare coverage. On 9.14.22, United Spinal GR Staff presented at and United Spinal, as Steering Committee member of the ITEM Coalition, co-hosted an ITEM Coalition Congressional Briefing on Medicare Coverage of Seat Elevation and Standing Systems in Power Wheelchairs. It featured remarks from Members of Congress, wheelchair users advocates and clinicians. United Spinal, as a member of the ITEM Coalition, advocated for members of Congress to sign on to hosue and Senate Dear Colleague letters to support Medicare Coverage of Seat Elevation and Standing Systems in Power Wheelchairs. Submitted comments to CMS National Coverage Analysis to urge for Medicare coverage of seat elevation in power wheelchairs and to urge for Medicare coverage of standindg devices systems in power wheelchairs. Submitted comments to HHS to ensure non-discrimination protections for people with disabilities under Section 1557. Support H.R. 8746 "Access to Inpatient Rehabilitation Therapy Act" or three hour rule bill. Endorsed a Colaiton to Preserv Rehabilitation comment letter for Calendar Year (CY) 2023 Physician Fee Schedule proposed rule. This letter focuses on two main provisions in the rule, in line with past CPR comment letters (in particularly our comments on the CY 2021 Proposed Rule). 1.The impact of proposed reimbursement cuts that will potentially impact patient access to care; and 2.The treatment of telehealth as the federal government prepares for the expiration of the public health emergency.

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United Spinal advocacy and policy staff participated in a quarterly call with Amtrak along with other representatives from disability organizations. United Spinal advocacy and policy staff participated in a call with Amtrak along with other representatives from disability organizations to discuss updates regarding Amtraks new intercity trainsets. On July 26th, to increase accessibility and protect and promote the civil rights of people with disabilities, United Spinal attended the U.S. Department of Transportations celebration of Disability Pride Month and the 32nd Anniversary of the Americans with Disabilities Act at the Washington, D.C. headquarters. On July 13th, to increase accessibility and protect and promote the civil rights of people with disabilities, United Spinal spoke with a US Department of Transportation, Office of Aviation Consumer Protection, as part of a DOT Consumer Advisory Meeting for updates on: Rule makings, ACAA Advisory Committee, Service Animal Complaints and Mishandled wheelchairs and scooters Discussed our support for Disability Access to Transportation Act (S. 2038) To increase accessibility at electric vehicle charging stations, United Spinal submitted comments to the Federal Highway Administrations request, National Electric Vehicle Infrastructure (NEVI) Program (Docket: FHWA-2022-0008). In its comments, United Spinal also supported the comments submitted by the Paralyzed Veterans of America. And United Spinal also supported the comments submitted by Consortium for Constituents with Disabilities Transportation Task Force. To increase accessibility for transit, United Spinal supported comments by the Consortium for Constituents with Disabilities (CCD) Transportation Task Force Co-Chairs submitted in response to the US Department of Transportation (USDOT) Federal Transit Administration (FTA) request for information on transit bus automation research and demonstrations, Docket Number: FTA-2022-0012. As a member of the Consortium for Constituents with Disabilities (CCD) Transportation Task Force United Spinal, along with numerous other disability organizations, endorsed the response the Task Force submitted to questions posed by the National Highway Traffic Safety Administration (NHTSA) regarding Ford's and General Motors' petitions for exemptions from the Federal Motor Vehicle Safety Standards for autonomous vehicles (AVs) Docket No. NHTSA- 2022-0067. The responses read in part: We urge NHTSA to make full accessibility for all people with disabilities a primary condition and prerequisite to granting any exemption allowing the operation of autonomous vehicle services. United Spinal submitted a response to questions posed by the National Highway Traffic Safety Administration (NHTSA) in support of General Motors petition for exemptions from the Federal Motor Vehicle Safety Standards for autonomous vehicles (Avs) Docket No. NHTSA- 2022-0067. Submitted complaint letter to DOT regarding mishandling/injurying (including damage to his wheelchair) and dropping of United Spinal's President and CEO (a wheelchair user) on two recent flights.

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United Spinal advocacy and policy staff, as a co-chair of the CCD Rights Task Force, met with Department of Justice officials regarding disability community priorities. United Spinal advocacy and policy staff met with House offices to urge support for passage of the ABLE Age Adjustment Act (H.R. 1219) as part of a larger package of retirement-focused legislation. United Spinal advocacy and policy staff, as a co-chair of the CCD Rights Task Force, co-signed a letter to Susan Rice, Director of the Domestic Policy Council, urging that the Administration take steps to achieve digital accessibility in federal agencies as required by Section 508 of the Rehabilitation Act. United Spinal advocacy and policy staff, as a co-chair of the CCD Rights Task Force, co-signed a letter to the Senate Aging Committee thanking them for holding a hearing on digital accessibility under Section 508. On July 26th, to increase accessibility and protect and promote the civil rights of people with disabilities, United Spinal attended the Bipartisan Disabilities Caucus Celebration of the 32nd Anniversary of the Americans with Disabilities Act including a discussion about accessible transportation and the next generation of caucus leadership. To increase accessibility, United Spinal, along with numerous other disability organizations signed on to a Statement for the Written Record as Members of the Consortium for Constituents with Disabilities (CCD) which was submitted to the Special Committee on Aging United States Senate for its Hearing "Accessible Federal Technology for People with Disabilities, Older Americans, and Veterans held on July 28, 2022. The hearing addressed the critical issue of ensuring that federal agencies are held accountable for achieving digital accessibility under Section 508 of the Rehabilitation Act. To increase accessibility, United Spinal, as a member of the Consortium for Constituents with Disabilities (CCD) Technology & Telecommunications and Rights Task Forces, endorsed a letter sent to the Director of the White House Domestic Policy Councils Director in support of the Administrations efforts to advance diversity, equity, inclusion, and accessibility (DEIA) in the federal workforce. Throughout July, to increase accessibility and protect and promote the civil rights of people with disabilities, United Spinal participated in the White House Office of Public Engagement, Disabled Stakeholder Calls for Disability Pride Month which addressed critical issues of the disability community. To increase accessibility and protect and promote the civil rights of people with disabilities, United Spinal attended the U.S. Department of Transportations celebration of Disability Pride Month and the 32nd Anniversary of the Americans with Disabilities Act held on July 28th.

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2nd Quarter, 2022

Q2 Report

In Q2, United Spinal Association had in-house lobbyists, and was paid $150,000. The report was filed on July 20, 2022. Original Filing: 301394856.xml

Lobbying Issues

United Spinal Association supports HR 3932 / S 2076 The Pioneering Antimicrobial Subscriptions to End Up surging Resistance (PASTEUR) Act. United Spinal advocacy and policy staff met with staff for Sen. Bob Casey (D-PA) to discuss support for increasing funding for the Spinal Cord Injury Model Systems program at NIDILIRR. To advocate for the disability community being included as a population In equitable diversity efforts and as a member of the Disability Rehabilitation Research Coalition (DRRC), United Spinal endorsed DRRCs Comments to NIH on the NIH-Wide Strategic Plan Framework for Diversity, Equity, Inclusion, and Accessibility. As a member of the Disability Rehabilitation Research Coalition (DRRC), United Spinal supported DRRCs Comments on submitted comments to National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) on their proposed rule updating the peer review criteria to increase consideration of how projects employ and reach out to people with disabilities. As a member of the Disability Rehabilitation Research Coalition (DRRC), United Spinal, along with numerous other disability organizations, signed onto DRRCs Comments to NIH and AHRQ urging consideration of designating people with disabilities as a health disparity population for purposes of federal research conducted at the National Institute on Minority Health and Health Disparities (NIMHD) and across the National Institutes of Health (NIH). Ask the House and Senate for Increased Funding for Spinal Cord Injury Model Systems at NIDILRR. United Spinal supports the Improving Seniors' Timely Access to Care Act - H.R 3173/S. 3018. United Spinal provided comments to CMS on the proposed IRF payment rule - our comments focus on CMS Request for Information (RFI) regarding potential application of the home health transfer policy to IRFs, as well as broader concerns with access to appropriate rehabilitation for complex conditions in the Medicare IRF benefit.

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United Spinal advocacy and policy staff participated shared concerns around access in a quarterly call with Amtrak along with other representatives from disability organizations. United Spinal advocacy and policy staff attended a site visit of a soft mockup of Amtraks forthcoming intercity trainset cars. United Spinal advocacy and policy staff attended a site visit of the new Amtrak Acela trainset. United Spinal supports the Disability Access to Transportation Act (H.R. 1697/S. 2038) (supports including in FY23 transportation appropriations the intermediate one stop pilot program contained in H.R. 1697 and the Air Carrier Access Amendments Act (H.R. 1696/S. 642). United Spinal continued partnering with May Mobility and other partners on a project for further consideration with the U.S. Department of Transportations Inclusive Design Challenge to create more accessibility for people with disabilities as well as everyone else, particularly in utilizing new technologies with automated vehicles and related infrastructure. United Spinal staff continue to partner with May Mobility on the US Department of Transportations Inclusive Design Challenge on automated vehicle accessible components and technologies. United Spinal policy staff participated in a virtual US Department of Transportation Information Session on DOT Priorities. United Spinal, along with numerous other disability organizations, and as members of the Consortium for Constituents with Disabilities Transportation Task Force adopted AV principles and recommendations in the areas of: autonomous vehicle accessibility; costs; data; infrastructure; legislation; licensing and insurance; research and funding; resiliency, regulation, equivalent and integrated service; safety; and workforce for regulatory and legislative considerations. United Spinal, along with numerous other disability organizations, as members of the Consortium for Constituents with Disabilities (CCD) Transportation Task Force submitted comments to the National Highway Traffic Safety Administration (NHTSA) on their New Car Assessment Program (NCAP), Docket No. NHTSA-2021- 0002. The comments read in part, We are grateful for the U.S. Department of Transportations (DOTs) attention to the safety of people traveling outside of vehicles in the NCAP and its inclusion of pedestrian automatic emergency braking (PAEB) and other Advanced Driver Assistance Systems (ADAS).

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United Spinal advocacy and policy staff met with Senate HELP Committee staff to discuss ADA anniversary commemorations, including putting together a briefing for Congressional staff on housing issues. United Spinal, along with numerous other disability organizations, and as members of the Consortium for Constituents with Disabilities(CCD), supported a letter Senators Tammy Duckworth (D-IL) and Dick Durbin (D-IL and Chair of the Senate Judiciary Committee) sent to the Department of Justice calling on the agency to take regulatory and subregulatory action to ensure that state and local governments and public accommodations covered under Titles II and III of the Americans with Disabilities Act are accessible to and usable by people with disabilities. United Spinal submitted comments to the U.S. Access Board on accessible medical diagnostic equipment and wheelchair height. United Spinal endorsed an ITEM Coalition letter to DOT highlighting the concerns of the lack of training in the airline industry as it relates to the handling of wheelchairs. Incorrect information was shared by the airline industry at a DOT Public meeting in March regarding Air Travel and Persons with Disabilities.

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To advocate for equitable and inclusive accessibility in air travel for people with disabilities, especially wheelchair users, United Spinal public policy staff met with congressional staff in support of the Air Carrier Access Amendments Act H.R. 1696/S. 642. To advocate for equitable and inclusive accessibility in air travel for people with disabilities, especially wheelchair users, United Spinal submitted additional comments to the US Department of Transportations Docket No. DOT-OST-2022-0014, Air Travel by Persons Who Use Wheelchairs. To increase accessibility in air travel, United Spinal submitted comments to the U.S. Department of Transportation (DOT) regarding the proposed rule, Accessible Lavatories on Single-Aisle Aircraft: Part 2, RIN 2105-AE89, DOT-OST-2021-0137. United Spinal, as a member of the Consortium for Constituents with Disabilities (CCD) Transportation Task Force, supported comments submitted to the Department of Transportation (DOT) in response to the proposed rule, Accessible Lavatories on Single-Aisle Aircraft: Part 2, RIN 2105-AE89. United Spinal, along with numerous other disability and veterans organizations, coordinated by Paralyzed Veterans of America submitted programming recommendations for inclusion in the Fiscal Year 2023 Federal Aviation Administration Reauthorization to the Senate Commerce Committee.

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To increase accessibility for people with disabilities to Social Security Administration services, and as a member of the Consortium of Constituents with Disabilities (CCD) Social Security Task Force, United Spinal, along with numerous other disability organizations, submitted a letter to bipartisan congressional leadership urging immediate action be taken to assure that the Social Security Administration has the resources it needs to respond to the increased demand associated with reopening Field Offices to the public after two years without any in-person services. To serve the needs of people with disabilities, United Spinal advocated for increased appropriations for the Social Security Administrations administrative budget with congressional staff. United Spinal policy staff, along with numerous other disability organizations, advocated for adequate FY23 Appropriations for the Social Security Administrations administrative budget to serve the needs of claimants and beneficiaries, especially those with disabilities.

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1st Quarter, 2022

Q1 Report

In Q1, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on May 16, 2022. Original Filing: 301375142.xml

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United Spinal Association supports HR 2168 / S 3193 Expanded Telehealth Access Act. United Spinal Association supports HR 3932 / S 2076 The Pioneering Antimicrobial Subscriptions to End Up surging Resistance (PASTEUR) Act. United Spinal Association/VetsFirst supports The Advanced Safe Testing at Residence Telehealth (A-START) Act of 2021. Increase Funding for Spinal Cord Injury Model Systems - House/Senate. Discussed the need for SCIMS increased funding and next steps with Director Anjali Forber-Pratt, Dir., NIDILRR. United Spinal Association raised concerns: regarding accessibility of COVID-19 tests; MA and Part D programs, notice of benefit and payment parameters; support CMS access to dental surgical services, support the DMEPOS Relief Act (H.R. 6641); share concerns re the CMS ACA Exchange Rule; support the Health Data Use and Privacy Commission Act (S. 3620); shared concerns with CMS regarding access to DME in times of public health emergency. United Spinal advocacy and policy staff participated in a meeting with representatives from the CDC, CMS, and ACL urging the CDC to issue guidance on census reduction of nursing homes and other institutional settings as an infection control measure. United Spinal supported comments as part of the Disability and Rehabilitation Research Coalition on the draft Strategic Plan for the NIH Chief Officer for Scientific Workforce Diversity (COSWD). Support significant investment into home and community-based services and supports. Met with House and Senate in support of improvements in health equity (Ways and Means Committee Subcommittee on Health United States House of Representatives; testimony); SUPPORT EQUITABLE REFORMS TO THE MEDICARE PHYSICIAN FEE SCHEDULE; SUPPORT H.R. 944 TO ADDRESS SPECIALTY MEDICINE PHYSICIAN SHORTAGES IN RURAL AREAS; SUPPORT H.R. 2256/S. 834 TO INCREASE THE NUMBER OF GME RESIDENCY SLOTS; SUPPORT H.R. 2903/S. 1512; SUPPORT H.R. 5030/S.2706 TO IMPROVE DIVERSITY IN CLINICAL TRIALS TO PERMANENTLY EXPAND TELEHEALTH SERVICES

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United Spinal advocacy and policy staff participated shared concerns around access in a quarterly call with Amtrak along with other representatives from disability organizations. United Spinal supports the Disability Access to Transportation Act (H.R. 1697/S. 2038), and the Air Carrier Access Amendments Act (H.R. 1696/S. 642). United Spinal continued partnering with May Mobility and other partners on a project for further consideration with the U.S. Department of Transportations Inclusive Design Challenge to create more accessibility for people with disabilities as well as everyone else, particularly in utilizing new technologies with automated vehicles and related infrastructure. Shared concerns regarding the DOT Public Meeting on Air Travel for Passengers with Disabilities. Submitted comments to Department of Transportations Research, Development, and Technology (RD&T) Strategic Plan for fiscal years (FY) 2022-2026. Submitted comments to the Federal Highway Administration regarding electric vehicles and chargers.

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United Spinal advocacy and policy staff raised issues to discuss in a conversation with Senator Duckworths (D-IL) office about disability rights issues that office would like to pursue. United Spinal raised concerns about access to healthcare with HHS OCR and Section 504 of the Rehabilitation Act. United Spinal advocacy and policy staff helped to organize and participated in a listening session with representatives from the U.S. Department of Justices Civil Rights Division on issues of importance to the disability community, including enforcement of the Olmstead decision, web accessibility, medical discrimination, the 988 hotline, discrimination against students, AI discrimination, voting, guardianship issues, and coordination with other agencies.

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4th Quarter, 2021

Q4 Report

In Q4, United Spinal Association had in-house lobbyists, and was paid $85,000. The report was filed on Jan. 19, 2022. Original Filing: 301327663.xml

Lobbying Issues

United Spinal advocacy and policy staff, along with our CEO, met with several Congressional offices to discuss priorities, including funding for caregiving, funding for Spinal Cord Injury Model Systems, telehealth. United Spinal advocacy and policy staff were invited to meet with staff from Sen. Tim Kaines (D-VA) office to discuss legislation addressing the effects of long COVID. United Spinal met with the HHS Office of Inspector General to discuss challenges with Medicare and Medicaid coverage of urological supplies for people with disabilities. As a member of the Disability and Rehabilitation Research Coalition, United Spinal supported comments submitted by the Coalition on the Draft HHS Strategic Plan Fiscal Years 2022 - 2026. United Spinal supports provisions in H.R.5376 - the Build Back Better Act. To improve transportation options and accessibility for all, especially people with disabilities, United Spinal advocated for enactment of Senate Amendment 2137 to H.R. 3684, the Infrastructure Investment and Jobs Act. To modernize and increase federal investment for in-home care for people with disabilities, United Spinal partnered with the White House on a Roundtable on Funding for Home and Community-Based Services on October 6, 2021. To bring increased awareness to people living with spinal cord injuries and other neurological conditions, United Spinal advocated for the enactment of S.Res.278 - A resolution recognizing the 75th anniversary of United Spinal Association, a leading national advocacy organization that is dedicated to promoting the independence and enhancing the quality of life of all people living with spinal cord injuries and neurological disorders, including veterans, and providing support and information to their loved ones, care providers, and personal support networks. To encourage maintaining the policy changes that allowed 35 million Americans with high-deductible health plans coupled with Health Savings Accounts (HDHP-HSAs) to receive telehealth benefits from their employer or insurer pre-deductible, United Spinal, as a member of the Personal Connected Health Alliance ( PCHAlliance), supported a letter the PCHAlliance signed onto and that was submitted to bipartisan congressional leadership urging telehealth benefits to be maintained. To bring increased awareness to people living with spinal cord injuries and other neurological conditions, United Spinal advocated for the enactment of S.Res.698 - A resolution designating September 2020 as "National Spinal Cord Injury Awareness Month". To support health care delivery, including behavioral health services, through the use of information and technology which serves serve as the backbone to evidence-based health care, United Spinal, as a member of the Personal Connected Health Alliance ( PCHAlliance), supported a memo the PCHAlliance sent to bipartisan congressional leadership, U.S. Senate Finance Committee Chairman Ron Wyden and Ranking Member Mike Crapo, responding to the Finance Committees outreach to obtain input on evidence-based policies to enhance and improve access to behavioral health services. The memo addressed the following topics, strengthening workforce, Increasing Integration, Coordination and Access to Care and expanding telehealth, specifically including a call for Equitable Access to affordable, reliable, and quality broadband. As a member of the Disability and Rehabilitation Research Coalition, United Spinal supported comments submitted by the Coalition on the COVID-19 Health Equity Task Forces, Office of Minority Health, U.S. Department of Health and Human Services Final Report and Recommendations. United Spinal supported the House passage of the Build Back Better Act. Signed on as subgrantee recipient and partner for the National Institutes of Health All of Us program. Medicare Coverage of Innovative Technology (MCIT) and Definition of Reasonable and Necessary [CMS-3372-P2; RIN: 0938-AT88] - As a steering Committee member of the ITEM Coalition, United Spinal signed onto these comments where the ITEM Coalition strongly supported the proposal to create the MCIT pathway and allow immediate Medicare coverage of FDA-designated and market-approved breakthrough devices. Thus, we are disappointed in the agencys decision to back away from this proposal and recommend that CMS reconsider whether this is the most appropriate stance to protect Medicare beneficiaries and press forward with an alternative that accomplishes a similar purpose the final rule was intended to achieve. Proposed Review Choice Demonstration for Inpatient Rehabilitation Facility Services (CMS-10765). As a Steering Committee member of the Coalition to Preserve Rehabilitation, United Spinal signed onto a letter raising concerns about the proposed demonstration and the consequences it would have for patient access to care in inpatient rehabilitation hospitals and rehabilitation units of acute care hospitals. Unfortunately, these concerns were not adequately addressed by CMS as a result of the initial comment period in February 2021, and CMS continues to signal its intention to move forward with this expansive new demonstration project that disproportionately impacts Medicare beneficiaries with disabilities and chronic conditions. We therefore urge CMS to withdraw this proposal in its entirety and discuss with stakeholders other, less problematic ways to achieve its program integrity goals.

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United Spinal advocacy and policy staff participated shared concerns around access in a quarterly call with Amtrak along with other representatives from disability organizations. United Spinal advocacy and policy staff, along with our CEO, met with several Congressional offices to discuss priorities, including the Disability Access to Transportation Act (H.R. 1697/S. 2038), and the Air Carrier Access Amendments Act (H.R. 1696/S. 642). United Spinal continued partnering wtih May Mobility and other partners on a project for further consideration with the U.S. Department of Transportations Inclusive Design Challenge to create more accessibility for people with disabilities as well as everyone else, particularly in utilizing new technologies with automated vehicles and related infrastructure.

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United Spinal advocacy and policy staff met with staff for Rep. Grace Meng (D-NY) to discuss her introduction of a resolution recognizing United Spinals 75th anniversary. United Spinal advocacy and policy staff met with staff for Sen. Richard Blumenthal (D-CT) to discuss possible legislation related to guardianship reform. United Spinal signed onto a letter to DOJ re reupping rulemaking on web access, Next Gen 911, and access to medical diagnostic/other equipment & furniture. Public Charge Ground of Inadmissibility, Advance Notice of Proposed Rulemaking, DHS Docket No. USCIS- 2021-0013, RIN 1615-AC74 (Aug. 23, 2021). United Spinal signed onto this Consortium for Citizens with Disabilities letter - While elimination of the rule is a matter for Congress, we urge DHS to adopt the narrowest possible interpretation of the rule within its authority, to avoid needless harms to our immigrant communities, including immigrants with disabilities. Comments for the Record of October 20, 2021 Hearing on Oversight of the Americans with Disabilities Act of 1990: The Current State of Integration of People With Disabilities to the House Judiciary Committee. United Spinal is a member of the CCD Rights Task Force and Employment and Training Task Force: submitted these comments for the record of the above-captioned hearing on the Americans with Disabilities Act. We applaud you for conducting a hearing concerning implementation of the Americans with Disabilities Act (ADA) and its integration mandate. As you and others observed at the hearing, the full promise of the ADA remains unrealized for far too many people with disabilities. Implementation and enforcement of the integration mandate and the Supreme Courts Olmstead decision are critically important to the lives of disabled people.

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United Spinal/VetsFirst supports the AUTO for Veterans Act - S. 444/H.R 1361. United Spinal/VetsFirst supports the Care for the Veteran Caregiver Act - H.R. 110. United Spinal/VetsFirst signed onto a letter facilitated by the Natioanl and Military Veterans Alliance regarding VA's Program of Comprehensive Assistance for Family Caregivers (PCAFC) Final Rule Changes issued on July 31, 2020 regarding proposed and final rule which tightened the eligibility criteria beyond what is required by law. United Spinal/VetsFirst signed onto letters, facilitated by The Military Coalition, to: the Senate stating that another continuing resolution (CR) would damage national security and progress on critical priorities. the House and Senate NDAA conferees on important legislation to ensure appropriate pay and benefits for veterans and military families. Following support and recommendations: Incentive Pay Parity (H.R.4350/ S.2792 Sec. 602) - TMC appreciates the House and Senate including parity of Incentive Pay benefits for National Guard and Reserve members who meet the same standards as Active Duty. It is also gratifying that several Reserve Component Chiefs have testified on the positive impact this benefit will have in retaining technicians and other RC service members. The individuals who meet this criteria serve in hardship specialties that demand training beyond other specialties and retaining them will both recognize their efforts and help the services retain their leadership and experience. Servicemembers Civil Relief Act (H.R.4350 Sec. 6414) - TMC supports a commonsense approach to binding arbitration. We also encourage the House and Senate to extend this authority to USERRA. This additional authority will help future employment compliance and fulfill the intent of USERRA, to keep National Guard and Reserve members employed. We stand by to continue working this issue in the second Session. Skillbridge program (H.R.4350 Sec. 553) - TMC requests the committee change eligibility for the program from 180-day orders to 179-day orders. The National Guard and Reserve continue to lose vital benefits because DoD deliberately cuts-off orders one day prior to eligibility. In this case, Reserve Component service members have problems staying employed which is evident in the number of cases the Department of Labor and ESGR work on each year with companies not meeting USERRA laws. Skillbridge is a program that can provide valuable services. Medical Billet Cuts (H.R.4350 Sec. 721) - TMC is concerned about the impact on beneficiary access to care if the Services move forward with proposed military medical billet cuts. We support the House provision which would pause military medical billet reductions for one year and would require a report to Congress on the impact of any cuts and plans to mitigate those effects. Autism Care (H.R.4350 Sec. 738) - TMC supports an independent analysis of the Autism Care Demonstration. Obstetrical Care (S.2792 Sec. 701) - TMC supports adding coverage of preconception and prenatal carrier screening, to address a gap in TRICARE policy and ensure that military families can access widely available screening tests. Mental Health (H.R.4350 Sec. 734 and 736) - TMC supports authorizing pilot programs on mental health appointment scheduling (Sec. 734) and surveying access to mental health care (736). Sexual Assault and Harassment Prevention (S.2792 Secs. 531-538, and H.R.4350 Secs. 532-538, 539A, 539C, 539F, 541) - TMC supports inclusion of Senate and House provisions addressing sexual assault and harassment prevention and disposition. Basic Needs Allowance (H.R. 4350/S. 2792 Sec. 601) - TMC supports the House version of Military Family Basic Needs Allowance, which excludes the Basic Allowance for Housing as income. No military family should go hungry. Child Care (H.R.4350 Sec. 626 and 2814) - TMC supports child care provisions that improve access to quality, affordable care, ensure safety of Child Development Centers (Sec. 2814), and expand the in-home child care fee assistance pilot program (Sec. 626). Military Retirement Pay (S.2792 Sec. 606) - TMC supports prohibiting the Defense Finance and Accounting Service (DFAS) from suspending military retired pay or a military retirement annuity until DFAS provides the beneficiary with 90-day notice to the retiree, annuitant, or their designated representative that explains the reason for the suspension. This provision also requires DFAS to provide a single annual eligibility procedure for retirees and annuitants.

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In September 2021, to help improve accessibility at airports, United Spinal advocacy and policy staff attended the virtual 19th Annual TSA Disability and Multicultural Coalition Conference and raised with Transportation Security Administration (TSP) Administrator David P. Pekoske TSA procedures for wheelchair users who are traveling with toddlers. United Spinal participated in a US Department of Transportation (DOT) Office of Aviation Consumer Protection Disability Advocates air travel meeting during which service animals and damaged wheelchairs were the main topics discussed. United Spinal asked how consumer complaints to the DOT were prioritized when received. Service denials and injuries are given priority but patterns of behavior by airlines are also monitored.

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To improve and update financial limits in the Supplemental Security Income (SSI) Program, United Spinal submitted a statement in support of H.R. 3824 - S. 2065 - Supplemental Security Income Restoration Act of 2021 to the Senate Subcommittee on Social Security, Pensions, and Family Policy Hearing on Policy Options for Improving SSI held on Tuesday, September 21, 2021. As a member of the Consortium for Citizens with Disabilities Social Security and Employment Task Forces, United Spinal supported comments the Task Forces Co Chairs submitted in response to the Request for Information on Potential Disability Insurance and Supplemental Security Income Demonstrations, Docket Number SSA-2021-0025. The comments to SSA in part stated, SSI and SSDI benefits are important to millions of people with disabilities. Doing demonstrations in a way that improves the experience of claimants and beneficiaries without harming them or creating additional risks to them is crucial. As a member of the Consortium for Citizens with Disabilities Social Security Task Force, United Spinal supported comments the Task Forces Co Chairs submitted in response to the Request for Waiver of Overpayment Recovery or Change in Repayment Rate OMB, Control Number: 0960-0037, ICR Reference Number: 202106-0960-008, about the Social Security Administrations (SSAs) revised Form SSA 632-BK. As a member of the Consortium for Citizens with Disabilities Social Security Task Force, United Spinal supported a letter the Task Forces Co Chairs sent to congressional leadership encouraging SSI provisions be included in the current modified Build Back Better bill draft.

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3rd Quarter, 2021

Q3 Report

In Q3, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on Oct. 20, 2021. Original Filing: 301314450.xml

Lobbying Issues

United Spinal advocacy and policy staff facilitated virtual meetings with staff for Senate Appropriations Committee lead offices to discuss increased funding for Spinal Cord Injury Model Systems in the Senates FY22 Labor-HHS-Education appropriations bill. These offices were Sen. Leahy (D-VT), Sen. Shelby (R-AL), Sen. Murray (D-WA), and Sen. Blunt (R-MO). To promote greater accessibility to healthcare, United Spinal, as a member of the Personal Connected Healthcare Alliance, PCHAlliance, along with numerous other organizations, supported a letter sent to Congressional leadership outlining priorities for Medicare Telehealth reform. To improve the delivery of new health care treatments and cures through federal legislation building on the 21st Century Cures Act of 2016 which accelerated the discovery, development, and delivery of new treatments and cures for patients and which have had a tremendous impact on our health care ecosystem, United Spinal supported a memo submitted to select members of Congress by the Healthcare Information and Management Systems Society (HIMSS) and the Personal Connected Health Alliance (PCHAlliance). United Spinal is a member of the PCHAlliance. To advance accessibility in standards for remote patient monitoring, United Spinal supported a memo from the Healthcare Information and Management Systems Society (HIMSS) and the Personal Connected Health Alliance (PCHAlliance) in response to National Committee on Vital and Health Statistics on standard setting for remote patient monitoring. Response to National Committee on Vital and Health Statistics (NCVHS) Request for Information on Data Standards, Harmonization of Standards, and Code Sets. To improve health outcomes for people with disabilities, United Spinal, as a member of the Disability Rehabilitation Research Coalition (DRRC), supported comments submitted by the DRRC in response to a request from the Congressional Social Determinants of Health (SDOH) Caucus for information from stakeholders. To improve accessible health outcomes for people with disabilities, United Spinal, as a member of the Personal Connected Health Alliance (PCHAlliance) supported comments on telehealth the PCHAlliance, along with the Healthcare Information and Management Systems Society (HIMSS), submitted in response to the Notice of Proposed Rule Making (NPRM) on Medicare Program; CY 2022 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Provider Enrollment Regulation Updates; Provider and Supplier Prepayment and Post- Payment Medical Review Requirements (CMS 1751-P). To improve accessible health outcomes for people with disabilities, United Spinal, as a member of the Personal Connected Health Alliance (PCHAlliance) supported comments on telehealth the PCHAlliance, along with numerous other health related organizations, submitted in response to theNotice of Proposed Rule Making (NPRM) on Medicare Program; CY 2022 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Provider Enrollment Regulation Updates; Provider and Supplier Prepayment and Post-Payment Medical Review Requirements (CMS 1751-P). United Spinal Association signed a letter to the CDC asking for a meeting to discuss the importance of guidance calling for census reduction in congregate care facilities during a pandemic. SCI Awareness Month - worked with Senators Rubio and Baldwin to pass SCI Awareness Month resolution in the Senate.

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Modernizing the VA Automobile Adaptive Grant program (S. 444/H.R. 1361 - AUTO For Veterans Act). Reconfirm VetsFirst's strong support of the AUTO for Veterans Act. VetsFirst meetings with Senate Veterans Affairs Committee in support of S. 927, TEAM Act and with House Veterans Affairs Committee on the House companion bill, H.R 2127. VetsFirst met with Rep. Bilirakis (R-FL), HVAC Minority and SVAC Majority staff regarding push to obtain cosponsors for Major Richard Star Act, S. 344, H.R. 1282. VetsFirst met with staff from Rep. Hudson (R-NC) to discuss revisions to HR 110, Care for the Veteran Caregivers Act. VetsFirst supports Credit for Caring Act, S. 167; Military Spouse Hiring Act, H.R. 2974; Veteran Employment Recovery Act H.R. 3582

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United Spinal advocacy and policy staff participated in calls with Senate offices to promote funding for Medicaid home and community-based services in the upcoming reconciliation bill. These offices were Sen. Van Hollen (D-MD), Sen. Cardin (D-MD), Sen. Menendez (D-NJ), and Sen. Coons (D-DE). United Spinal advocacy and policy staff met with the White House and planned a Roundtable featuring United Spinal members on the subject of increasing funding for caregiving in the Build Back Better Act. United Spinal advocacy and policy staff provided comments and guidance on the National Council on Disabilitys 2022-2026 strategic plan. To help ensure independent living for people with disabilities, United Spinal, along with numerous other disability organizations, signed on to a letter, led by AAPD, to Congressional leadership expressing support for the full $400 billion for Medicaid Home and Community Based Services (HCBS). United Spinal Association signed onto a letter to CMS commenting on their interim final rule related to vaccine requirements for residents and staff of long-term care facilities. United Spinal joined Coalition for Citizens with Disabilities Comments to the House and Senate on supporting the Better Care Better Jobs Act. The Coalition to Preserve Rehabilitation (CPR), including United Spinal Association, appreciate the opportunity to comment on the Calendar Year 2022 Home Health Prospective Payment System proposed rule. Our comments focus on the proposal to expand the Home Health Value-Based Purchasing Model (HHVBP) nationwide and the broader impact of the recently implemented Patient-Driven Groupings Model (PDGM) on access to care for Medicare beneficiaries in the home health setting. CY 2022 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model Requirements and Proposed Model Expansion; Home Health Quality Reporting Requirements Proposed Rule [CMS-1747-P; RIN: 0938-AU37] United Spinal supported efforts to increase access to complex rehab technology for customized wheelchairs.

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To advance equity, especially in underserved communities, United Spinal supported a response to the Request for Information on Methods and Leading Practices for Advancing Equity and Support for Underserved Communities Through Government [Docket No. OMB- 2021-0005] submitted by the co-chairs of the Consortium for Citizens with Disabilities (CCD) Social Security Task Force in response to the Office of Management and Budget (OMB) Request for Information (RFI). The letter read in part, We appreciate that OMB is collecting information on equity and supporting underserved communities; we look forward to providing comments and suggestions to the Social Security Administration (SSA)...... regarding barriers to accessing Social Security and other benefits, particularly among people with disabilities and low-incomes. United Spinal supports the SSI Restoration Act - House and Senate

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United Spinal advocacy and policy staff met with staff from Sen. Menendezs office to discuss a possible Dear Colleague to seek cosponsors for the Disability Access to Transportation Act (S. 2038). United Spinal advocacy and policy staff participated in a quarterly call with Amtrak along with other representatives from disability organizations. To promote access to transportation, United Spinal, as a member of the Consortium for Citizens with Disabilities (CCD) Transportation Task Force drafted a letter to support the Disability Access to Transportation Act (H.R.1697 / S. 2038). To help ensure safety for people with disabilities using public transit, United Spinal as a member of the Consortium for Citizens with Disabilities (CCD) Transportation Task Force supported comments the Task Force Co Chairs submitted to the US Department of Transportation in response to the Request for Information on Transit Safety Concerns Docket No. FTA 2021-0011. The comments read in part, We urge the Federal Transit Administration to account for the accessibility of the safety systems that are put into effect and to actively seek rider-oriented perspectives on safety priorities. United Spinal supports the All Stations Access Program (Sen. Duckworth). House INVEST Act - United Spinal supports various consumer protections provisions for people with disabilities in the INVEST Act. Met with Rep. Titus to thank her for her leadership on DATA - H.R. 1697 and discuss next steps.

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United Spinal advocated for sustained federal support for accessible affordable broadband service and for its deployment along with a cost support program. Accessible, Affordable Internet for All Act, H.R. 1783/S. 745 United Spinal is advocating for a sustained federal investment ensuring the deployment and maintenance of a high capacity, secure and reliable 5G broadband national network that is accessible and adoptable for all Americans. Please support the Accessible, Affordable Internet for All Act, H.R. 1783/S. 745, introduced by Majority Whip, Representative James Clyburn (D-SC) in the House and Sen. Amy Klobuchar (D-MN) in the Senate. United Spinal and VetsFirst, as part of the Clear 2 Connect Coalition, supports a request from a number of Internet Protocol Captioned Telephone Service (IP CTS) service providers that have asked the FCC to defer implementing a reduced IP CTS compensation rate, which was effective on July 1, 2021. United Spinal joined disability advocacy groups in Text to 988 petition that was filed with the FCC.

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2nd Quarter, 2021

Amendment

United Spinal Association amended a lobbying report for in-house lobbying in Q22021 on Nov. 23, 2021 Original Filing: 301318556.xml

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United Spinal advocacy and policy staff worked with staff from the office of Rep. Lucy McBath (D-GA) in support of a House sign-on letter to the House Appropriations Labor, Health and Human Services, Education, and Related Agencies Subcommittee in support of additional funding for Spinal Cord Injury Model Systems, the National Spinal Cord Injury Statistical Center, and the Model Systems Knowledge Translation Center in Fiscal Year 2022. United Spinal advocacy and policy staff submitted appropriations requests to House and Senate in support of additional funding for Spinal Cord Injury Model Systems, the National Spinal Cord Injury Statistical Center, and the Model Systems Knowledge Translation Center in Fiscal Year 2022. United Spinal advocacy and policy staff worked with chapters and advocates around the country to secure letters of support from members of Congress for United Spinals application for the National Paralysis Resource Center federal grant from the Department of Health and Human Services. Support: Increased funding for Spinal Cord Injury Model Systems; increased funding for Medicaid home and community-based services (HCBS); Support: CONNECT for Health Act - S. 1512/H.R. 2903 and HOUSE: Protecting Access to Post-COVID-19 Telehealth Act - H.R. 366 and Expanded Telehealth Access Act - H.R. 2168 support expanding telehealth access beyond the pandemic. To continue efforts to achieve a more equitable culture within the biomedical research enterprise and to break down barriers to equity in the workforce, United Spinal, as a member of the Disability Rehabilitation Research Coalition, signed on to a letter to the Director of the National Institutes of Health (NIH) in response to NIHs Request for Information to Advance and Strengthen Racial Equity, Diversity, and Inclusion in the Biomedical Research Workforce and Advance Health Disparities and Health Equity Research (NOT-OD-21-066). To recognize that disability cuts across all demographics and almost all areas of research conducted by the NIH and should be recognized as such in its Strategic Plan, United Spinal, as a member of the Disability Rehabilitation Research Coalition (DRRC), supported the DRRCs letter on the on FY 2021-2025 NIH-Wide Strategic Plan Framework. Support telehealth expansion and improvements in the delivery of rehabilitation and access to assistive devices and assistive technology. To support federal research impacting people with disabilities, illnesses, injuries, and chronic conditions, especially those suffering from acute or long-term impacts of COVID-19, United Spinal signed onto a letter of recommendations and requests for program funding in Fiscal Year (FY) 2022 to congressional appropriations leadership as a member of the Disability and Rehabilitation Research Coalition (DRRC). To expand the knowledge base around access to assistive technologies and devices (AT) and lay the groundwork for improvements in care and policy solutions to support people with limb loss and limb difference, United Spinal as a member of the Disability and Rehabilitation Research Coalition (DRRC), signed onto letters of support for legislation recently introduced by Reps. G.K. Butterfield (D-NC) and Brett Guthrie (R-KY), the Access to Assistive Technology and Devices for Americans Study Act (the Triple A Study Act, H.R. 2461), urging members of Congress to cosponsor this bipartisan legislation. To advocate for people with disabilities,United Spinal supported a Disability and Rehabilitation Research Coalition letter of welcome and congratulations to Dr. Anjali Forber-Pratt, the new Director of the National Institute on Disability, Independent Living, and Rehabilitation Research. To increase access to telemental health care, United Spinal as a member of the Personal Connected Health Alliance, supported letters the PCHAlliance sent endorsing the Telemental Health Care Access Act to Senator Bill Cassidy and other Senate supporters and to U.S. Representatives Doris Matsui and Bill Johnson.

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Toxic Exposure. Two separate VSO briefings from OSVA officials on VA position on toxic exposure. One meeting held before SVAC/HVAC hearing and second meeting after hearing. VetsFirst and other VSOs advocated for different provisions in the House and Senate legislation COST OF WAR Act and the PATH Act - H.R 3967 -PCAFC - Caregivers Expansion. VA provided 2 updates on status of Caregivers Expansion that began Oct. 1, 2020. VSOs expressed concern in the lack of consistency in decision making across the VA system and that applications for the program had a denial rate of more than 85% and only an approval rate of 12%. Support the Toxic Exposure in the American Military Act - H.R. 2127 to S. 927. Support for HR. 3967 - the Honoring Our Promise To Address Comprehensive Toxics Act Of 2021 or the Honoring our PACT Act. United Spinal/VetsFirst raised concern re eligibility populations and the Secretarys authority to delay actions on eligibility. Continue discussions on concurrent receipt with House and Senate. Support the Care for the Veteran Caregiver Act - H.R. 110. co lead on 75th Anniversary Resolution in Senate. S. Res. 278 introduced and passed by Senate, on June 26, 2021. 2 separate meeting with SVAC Minority officials review and discuss GHAPS Act of 2021. Exchange of much information, VetsFirst determined to not take a position at this time and continue to monitor as bill moves to mark up in July. Submitted VetsFirst Statement for the record SVAC Hearing Pending Legislation April 28, 2021. Benefits Improvements Legislation VetsFirst. Supported and urged passage of these bills: S.444, AUTO for Veterans Act, S. 976, Caring for Survivors Act, and S. 458, Veterans Claim Transparency Act. Also support: S.927, Toxic Exposures in the American Military (TEAM) Act, S. 952, Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act, and S. 437, Veterans Burn Pits Exposure Recognition Act.

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United Spinal advocacy and policy staff worked with the staff of Sen. Bob Casey (D-PA) and Sen. Jerry Moran (R-KS) to introduce and pass S. Res. 278, a Senate resolution recognizing United Spinals 75th anniversary. United Spinal advocacy and policy staff discussed disability representation among Congressional staff, with Rep. Ayanna Pressley as well as other issues such as Spinal Cord Injury Model Systems funding and United Spinals 75th anniversary resolution. United Spinal advocacy and policy staff met with staff from the House Select Committee on the Modernization of Congress to discuss the recruitment, hiring, development, and retention of people with disabilities as Congressional staffers, as well as the need for every Congressional office to formally designate a staffer or legislative team to cover disability issues as a part of their issue portfolio.

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Support the SSI Restoration Act. S. 630 Support the Disability Employment Incentive Act To expand eligibility for the Medicaid Ticket to Work Program to include individuals who are 65 years of age or older. (Under the current program, states may establish a Medicaid buy-in option for working individuals with disabilities whose income exceeds the customary limits and who are between the ages of 16 and 64.), United Spinal, as a member of the Secure Work Coalition, signed on to a letter supporting Senator Rob Portmans reintroduction of the SENIOR Care Act in the 117th Congress. To support including long-overdue improvements to the Supplemental Security Income (SSI) program in the pandemic recovery legislation now being considered, United Spinal as a member of the Consortium for Citizens with Disabilities (CCD) signed onto a letter to bipartisan congressional leadership. The letter may be reviewed at: http://c-c-d.org/fichiers/CCD-SSI-Letter_5-20-21.pdf To enhance service delivery at the Social Security Administration (SSA), United Spinal supported a hearing statement submitted by the cochairs of the Social Security Task Force of the Consortium for Citizens with Disabilities to the bipartisan leadership of the Senate Finance Committee. The comments focus on issues related to SSAs Operations component because the Deputy Commissioner of Operations was the agencys witness for this hearing. To support updating the maximum fee that a claimants representative can be paid using a fee agreement (the fee cap) for successfully representing an individual applying for Social Security Disability or SSI benefits, and for putting into place a process to ensure annual inflation-linked updates, United Spinal, along with numerous other disability organizations, signed onto a letter to the Social Security Commissioner. To support including long-overdue improvements to the Supplemental Security Income (SSI) program in the pandemic recovery legislation now being considered, United Spinal as a member of the Consortium for Citizens with Disabilities (CCD) signed onto a letter to bipartisan congressional leadership. To enhance service delivery at the Social Security Administration (SSA), United Spinal supported a hearing statement submitted by the cochairs of the Social Security Task Force of the Consortium for Citizens with Disabilities to the bipartisan leadership of the Senate Finance Committee. The comments focus on issues related to SSAs Operations component because the Deputy Commissioner of Operations was the agencys witness for this hearing. To support updating the maximum fee that a claimants representative can be paid using a fee agreement (the fee cap) for successfully representing an individual applying for Social Security Disability or SSI benefits, and for putting into place a process to ensure annual inflation-linked updates, United Spinal, along with numerous other disability organizations, signed onto a letter to the Social Security Commissioner. To ease the reporting burden on Social Security Disability beneficiaries, especially throughout the COVID Pandemic, United Spinal supported a letter the co-chairs of the Social Security Task Force of the Consortium for Citizens with Disabilities (CCD sent to the Social Security Administration responding to a notice that would have allowed the collection of an array of new information from people with disabilities. To eliminate a programmatic work disincentive by allowing young adults with disabilities to try and work and see if they can support themselves without losing eligibility for DAC benefits, the cochairs of the Consortium for Citizens with Disabilities (CCD) Social Security Task Force wrote bill sponsors in support of the Work Without Worry Act and thanked them for introducing this crucial legislation.

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United Spinal supports H.R 1697/ S. 2038 - the Disability Access to Transportation Act. United Spinal supports the Air Carrier Access Amendments Act. S. 642/H.R.1696. To outline the transportation limitations and needs of persons with disabilities in order to access the imperative COVID-19 vaccine, United Spinal Signed on to a letter to the Biden Administration organized by two Task Forces of the Consortium for Citizens with Disabilities. To advocate for greater accessibility in transportation and to respond to the request for comments on the Automated Driving Systems (ADS) Framework, United Spinal supported a letter to U.S. Secretary of Transportation Buttigieg by the Co Chairs of the Consortium for Citizens with Disabilities Transportation Task Force. To provide competitive grants to assist State and local governmental authorities in addressing accessibility needs of legacy rail fixed guideway public transportation systems, United Spinal supported a Consortium for Citizens with Disabilities Transportation Task Force Co-Chairs letter supporting supporting Senator Tammy Duckworths introducing the All Station Accessibility Program Act of 2021 or the ASAP Act. As Congress and the Administration craft major infrastructure legislation, United Spinal help draft and signed onto letters, along with numerous other stakeholders, to congressional leaders and administration officials seeking to harness innovations in transportation to dramatically improve equitable services in public transportation, particularly for those with disabilities, seniors, and underserved populations by: (1) Increasing investment in on-demand microtransit while ensuring accessibility in those and any other future transit services; and (2) Creating a federal grant program to bring innovation to ADA paratransit services. To enhance transportation opportunities and efficiencies in transit and paratransit, United Spinal, along with numerous other disability organizations and organizations and Via, a transit technology company, shared a letter with members of Congress and their staffs advocating for increased focus and federal funding for micro transit on demand transportation technologies programs and services.

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To promote a sustained federal investment to ensure deployment and maintenance of a high capacity, secure and reliable 5G broadband national network that is accessible, affordable, adoptable for all Americans that is fundamental to our daily independence, United Spinal supported the Co Chairs of the Consortium for Citizens with Disabilities Telecommunications and Technology Task Force letter to the Federal Communications Commission comments on the Emergency Broadband Connectivity Fund Assistance Program. To promote technology, including assistive technology and accessible information and communication technology, that plays an increasingly important role in peoples lives in business, communication, education, employment and interaction with all levels of government as well as facilitating activities of daily living for people with disabilities, United Spinal supported the Co Chairs of the Consortium for Citizens with Disabilities Telecommunications and Technology Task Force welcome letter to members of the 117th Congress. To make telehealth services for Medicare beneficiaries permanent, United Spinal supports comments made by the Personal Connected Health Alliance and the Healthcare Information and Management Systems Society, Inc. to the Senate Telehealth Working Group and Congressional Telehealth Caucus on January 8, 2021 about the the CONNECT for Health Act as important revisions and updates to this legislation for the 117th Congress are considered. The comments read in part, Many of the barriers and restrictions to Medicare telehealth that had been in place for decades disappeared almost overnight, allowing millions of Americans to have critical access to a new range of virtual services. To promote permanent universal broadband deployment with Congress and the Federal Communications Commission (FCC), United Spinal Association responded with a letter to the FCCs request for comments on the new temporary Emergency Broadband Benefit Program. To support the inclusion of $50 million in the FY 2022 Senate Labor, Health and Human Services and Education Appropriations (LHHS) bill for the Assistive Technology (AT) Act Programs United Spinal signed onto letter to congressional leaders as a member of the Consortium for Citizens with Disabilities Technology and Telecommunications Task Force. Funding provided through the AT Act supports programs that ensure people with disabilities have access to and are able to acquire the assistive technology, devices, and services they need to live, work, and attend school in their communities.

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Accessible, Affordable Internet for All Act, H.R. 1783/S. 745 United Spinal is advocating for a sustained federal investment ensuring the deployment and maintenance of a high capacity, secure and reliable 5G broadband national network that is accessible and adoptable for all Americans. Please support the Accessible, Affordable Internet for All Act, H.R. 1783/S. 745, introduced by Majority Whip, Representative James Clyburn (D-SC) in the House and Sen. Amy Klobuchar (D-MN) in the Senate. To sustain federal investment ensuring the deployment and maintenance of a high capacity, secure and reliable 5G broadband national network that is accessible, affordable and adoptable for all Americans, United Spinal, a member of the Personal Connected Healthcare Alliance (PCHAlliance), supported letters the PCHAlliance submitted to bipartisan Congressional leadership and to President Biden.

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2nd Quarter, 2021

Q2 Report

In Q2, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on July 20, 2021. Original Filing: 301285576.xml

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1st Quarter, 2021

Amendment

United Spinal Association amended a lobbying report for in-house lobbying in Q12021 on Aug. 25, 2021 Original Filing: 301294707.xml

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To maximize the return on the federal research investment with the goal of improving the ability of Americans with disabilities, United Spinal as a member of the the Disability and Rehabilitation Research Coalition (DRRC), along with numerous other disability organizations, signed onto DRRC comments on the draft Strategic Plan for the National Institute for Neurological Disorders and Stroke. To support federal funding for assistive technology through supporting the Assistive Technology Act and to share with members of Congress how AT plays a role in people with disabilities lives, the Consortium for Citizens with Disabilities Telecommunications and Technology Task Force promoted National Assistive Technology Awareness Day to be held April 14, 2021. United Spinal advocacy and policy staff met with ACL Acting Administrator Alison Barkoff and staff to discuss the Paralysis Resource Center grant and United Spinals support of increased funding for the Spinal Cord Injury Model Systems program, which is funded through ACL. United Spinal signed a letter to HHS supporting moving forward with a Request for Information regarding disability rights, withdrawing and revising a proposed rule on HIPAA, and revisiting a final rule on the ACAs nondiscrimination provisions. United Spinal advocacy and policy staff participated in a meeting with Marcella Nunez-Smith, Chair of the COVID-19 Equity Task Force, and officials from HHS and the White House Domestic Policy Council to discuss COVID-19 equity issues for the disability community. United Spinal advocacy and policy staff met with Rep. Lucy McBath and staff to discuss support for United Spinals application for the Paralysis Resource Center, a funding increase for the Spinal Cord Injury Model Systems program at the National Institute on Disability, Independent Living, and Rehabilitation Research, and a Congressional resolution marking United Spinals 75th anniversary. United Spinal advocacy and policy staff met with Rep. Grace Meng and staff to discuss support for United Spinals application for the Paralysis Resource Center, a funding increase for the Spinal Cord Injury Model Systems program at the National Institute on Disability, Independent Living, and Rehabilitation Research, and a Congressional resolution marking United Spinals 75th anniversary. United Spinal signed a Consortium for Citizens with Disabilities letter of support for the Mental Health Justice Act (H.R. 1368/S. 515). Signed on to a Consortium for Citizens with Letter to the House and Senate thanking them for dedicated HCBS funding. Signed onto letters of support for protections for durable medical equipment, complex rehab technology and rehabilitation. United Spinal supports: * Protecting Access to Post-COVID-19 Telehealth Act, bipartisan legislation introduced by Reps. Mike Thompson (D-CA), Peter Welch (VT-AL), David Schweikert (R-AZ), Bill Johnson (R-OH), and Doris Matsui (D-CA * Expanded Telehealth Access Act (H.R. 2168), a bipartisan bill introduced by Reps. Mikie Sherrill (D-NJ) and David McKinley (R-WV). To promote healthcare of wheelchair users, United Spinal submitted comments in support of the National Institutes of Health (NIH) Pathways to Prevention Workshop: Physical Activity and Health for Wheelchair Users draft (Draft) report.

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United Spinal's VetsFirst program discussed issues with VA: CHAMPVA, mental health and suicide prevention, MISSION Act (Caregivers, Community Care, AIR Commission, Toxic Exposure for the American Military Act, disability indemnity compensation, Electronic Health Records Management, Veterans Benefits Administration issues and National Cemetery Administration memorial affairs issues. United Spinal's VetsFirst program discussed with DOL VETS the following: employment and training, veterans unemployment, The Veteran Employment Through Technology Education Courses (VET TEC) program. United Spinal/VF supports the Toxic Exposure for the American Military Act. S. 927 and H.R. 2127. United Spinal/VF discussed United Spinal and VetsFirst priorities regarding the American Rescue Plan. United Spinal/VF Supports H.R 110.Care for the Veteran Caregiver Act. United Spinal/VF provided a statement of support Omnibus Veterans Bill PL 116-315 to House and Senate. CHAMPVA Childrens Protection Act - Young dependents of catastrophically disabled veterans can be covered for health insurance under this program operated by the Department of Veterans Affairs. When the Affordable Care Act passed in 2010, CHAMPVA was not included in the provisions allowing dependents to remain on their parents insurance until age 26. As a result, young people on CHAMPVA are the only population of dependents that lose their coverage at age 22. It is critical that this inequity be corrected by enacting legislation similar to the CHAMPVA Childrens Protection Act (H.R. 1801/S. 727). Letter of support furnished to Rep. Brownley (CA) and Senator Brown (OH), sponsors of the CHAMPVA Children's Protection Act. United Spinal/VetsFirst supports the S. 444/ Senator Collins (ME) H.R. 1361 Rep. Meuser (PA)- AUTO For Veterans Act - Modernizing the VA Automobile Adaptive Grant program. United Spinal/VetsFirst seeks the enactment of legislation that authorizes comprehensive expansion of concurrent receipt of uniformed services retired pay and VA disability compensation, by expanding Concurrent Retirement and Disability Payments (CRDP) to beneficiaries with 20 or more years of service with less than 50 percent disability rating and all those medically retired with less 20 years of service (Chapter 61) who are not eligible for concurrent receipt. United Spinal/VetsFirst supports S. 344/Hr 1282- Major Richard Starr Act.

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United Spinal advocacy and policy staff participated in a Consortium for Citizens with Disabilities co-chairs meeting with ACL Acting Administrator Alison Barkoff and officials from ACL, HUD, and DOJ to discuss ways federal agencies can coordinate to enforce the Olmstead decision, and to transfer and divert people with disabilities from nursing homes or congregate settings to community settings. United Spinal advocacy and policy staff participated in a Consortium for Citizens with Disabilities Rights Task Force co-chairs meeting with Kim Knackstedt, Disability Policy Director for the White House Domestic Policy Council to discuss disability representation in the federal workforce, the Biden Administrations commitments on caregiving, and ending the subminimum wage, disability rights initiatives. United Spinal signed a Consortium for Citizens with Disabilities letter of support for a resolution (H. Res. 183/S. Res. 86) supporting disability rights and the role of the disability community in the struggle for civil rights, marking the 20th anniversary of the installation of a statue of President Franklin Delano Roosevelt in a wheelchair at the FDR Memorial in Washington, DC. United Spinal signed a Consortium for Citizens with Disabilities letter to the Senate Judiciary Committee in support of the nomination of Vanita Gupta to be Associate Attorney General. United Spinal signed a National Coalition on Accessible Voting position statement on the For the People Act (S. 1), expressing concerns with a paper ballot mandate and asking for several changes to the bill in order to ensure that people with disabilities have the right to a private and independent vote consistent with their rights under the law. United Spinal and VetsFirst signed onto Consortium for Citizens with Disabilities priority statements for the Administration and Congress on all issues impacting the disability community including disabled veterans.

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To help achieve United Spinals goal of greater accessibility in transportation and to congratulate Secretary Buttigieg on his confirmation, United Spinal sent the Secretary a letter advocating for the Consortium for Citizens with Disabilities Transportation Task Force request for a meeting with him and his modal administrators to discuss the shared goals of President Bidens and his agenda, along with our priorities and urged he adopt Senator Tammy Duckworths recommendation that his senior leadership team include a staff person to focus on accessibility and universal design. The staff person would ideally engage with all modal administrators and have significant experience working with the disability community. United Spinal advocacy and policy staff participated in a virtual call with Amtrak, where they discussed their settlement with the Department of Justice over violations of the ADA. United Spinal advocacy and policy staff participated in a quarterly disability community meeting with Amtrak. United Spinal advocacy and policy staff met with Josh Sanders, Legislative Assistant for Sen. Bob Menendez (D-NJ) to discuss introducing a Senate companion bill to the Disability Access to Transportation Act (H.R. 1697). United Spinal supports H.R 1697 - the Disability Access to Transportation Act. United Spinal supports the Air Carrier Access Amendments Act. S. 642/H.R.1696. United Spinal supports the Disability Employment Incentive Act. S. 630. To promote transportation accessibility, United Spinal supported the comments of the Consortium for Citizens with Disabilities (CCD) Transportation Task Force Co-Chairs to the US Department of Transportation (DOT) on its draft Strategic Plan on Accessible Transportation (Strategic Plan): United Spinal signed onto comments submitted by the Paralyzed Veterans of America. United Spinal also submitted comments. To promote transportation opportunities for people with disabilities, United Spinal signed onto a congratulatory welcome letter from the Consortium for Citizens with Disabilities (CCD) Transportation Task Force to the US Department of Transportation (DOT) Secretary Pete Buttigieg. United Spinal supported a similar letter submitted by the Co Chairs of the Consortium for Citizens with Disabilities (CCD) telecommunications and Technology Task Force. To promote greater transportation opportunities for people with disabilities, United Spinal provided comments in response to the U.S. Department of Transportations Request for Information for the Inclusive Design Reference Hub. To help balance vehicle safety and accessibility for people with disabilities United Spinal supported comments submitted by the Consortium for Citizens with Disabilities Transportation Task Force CoChairs to the Nation Highway Traffic Safety Administrations (NHTSA) Supplemental Notice of Proposed Rulemaking (SNPRM) Docket Number: NHTSA-2016-0031. United Spinal submitted its own comments as well.

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United Spinal advocacy and policy staff participated in a Consortium for Citizens with Disabilities co-chairs meeting with EEOC Chair Charlotte Burrows, Vice Chair Jocelyn Samuels, and staff to discuss employment-related issues, including potential guidance on employer mandates for COVID vaccination, policies for recruiting and hiring people with disabilities for federal jobs, and hiring discrimination. United Spinal signed a Consortium for Citizens with Disabilities letter of support for the Pregnant Workers Fairness Act (H.R. 1065). United Spinal signed a letter to House and Senate Democratic leaders and committee chairs asking that any proposal to increase the minimum wage include commensurate Medicaid funding for rate increases to cover the increased labor costs.

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To promote a sustained federal investment to ensure deployment and maintenance of a high capacity, secure and reliable 5G broadband national network that is accessible, affordable, adoptable for all Americans that is fundamental to our daily independence, United Spinal supported the Co Chairs of the Consortium for Citizens with Disabilities Telecommunications and Technology Task Force letter to the Federal Communications Commission comments on the Emergency Broadband Connectivity Fund Assistance Program: http://www.c-c-d.org/fichiers/CCD-Tech-TF-Letter-on-Emergency-Broadband-Connectivity-Fund.pdf To promote technology, including assistive technology and accessible information and communication technology, that plays an increasingly important role in peoples lives in business, communication, education, employment and interaction with all levels of government as well as facilitating activities of daily living for people with disabilities, United Spinal supported the Co Chairs of the Consortium for Citizens with Disabilities Telecommunications and Technology Task Force welcome letter to members of the 117th Congress. To make telehealth services for Medicare beneficiaries permanent, United Spinal supports comments made by the Personal Connected Health Alliance and the Healthcare Information and Management Systems Society, Inc. to the Senate Telehealth Working Group and Congressional Telehealth Caucus on January 8, 2021 about the the CONNECT for Health Act as important revisions and updates to this legislation for the 117th Congress are considered. The comments read in part, Many of the barriers and restrictions to Medicare telehealth that had been in place for decades disappeared almost overnight, allowing millions of Americans to have critical access to a new range of virtual services. To promote permanent universal broadband deployment with Congress and the Federal Communications Commission (FCC), United Spinal Association responded with a letter to the FCCs request for comments on the new temporary Emergency Broadband Benefit Program.

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1st Quarter, 2021

Q1 Report

In Q1, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on April 19, 2021. Original Filing: 301258769.xml

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To promote a sustained federal investment to ensure deployment and maintenance of a high capacity, secure and reliable 5G broadband national network that is accessible, affordable, adoptable for all Americans that is fundamental to our daily independence, United Spinal supported the Co Chairs of the Consortium for Citizens with Disabilities Telecommunications and Technology Task Force letter to the Federal Communications Commission comments on the Emergency Broadband Connectivity Fund Assistance Program: http://www.c-c-d.org/fichiers/CCD-Tech-TF-Letter-on-Emergency-Broadband-Connectivity-Fund.pdf To promote technology, including assistive technology and accessible information and communication technology, that plays an increasingly important role in peoples lives in business, communication, education, employment and interaction with all levels of government as well as facilitating activities of daily living for people with disabilities, United Spinal supported the Co Chairs of the Consortium for Citizens with Disabilities Telecommunications and Technology Task Force welcome letter to members of the 117th Congress. To make telehealth services for Medicare beneficiaries permanent, United Spinal supports comments made by the Personal Connected Health Alliance and the Healthcare Information and Management Systems Society, Inc. to the Senate Telehealth Working Group and Congressional Telehealth Caucus on January 8, 2021 about the the CONNECT for Health Act as important revisions and updates to this legislation for the 117th Congress are considered. The comments read in part, Many of the barriers and restrictions to Medicare telehealth that had been in place for decades disappeared almost overnight, allowing millions of Americans to have critical access to a new range of virtual services. To promote permanent universal broadband deployment with Congress and the Federal Communications Commission (FCC), United Spinal Association responded with a letter to the FCCs request for comments on the new temporary Emergency Broadband Benefit Program.

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4th Quarter, 2020

Q4 Report

In Q4, United Spinal Association had in-house lobbyists, and was paid $85,000. The report was filed on Jan. 20, 2021. Original Filing: 301242606.xml

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Support H.R. 8581/S. 4343, the Assistive Technology and Devices for Americans Study Act (Triple A Study Act). Consortium for Citizens with Disabilities - Vaccine Allocation Comments United Spinal signed onto a CCD letter to the Advisory Committee on Immunization Practices at the Centers for Disease Control and Prevention regarding vaccine allocation for the disability community. In short, we urge the committee to: 1. Include all residents of congregate facilities in Phase 1 along with long term care residents. Protect the civil rights of people with disabilities in allocation decisions 3. Ensure that the physical distribution and administration of the vaccine is accessible to people with disabilities. National Institutes of Health (NIH) United Spinal advocacy and policy staff and Resource Center staff met with NIH personnel and shared our suggestions for research priorities for the SCI/D community related to functional and quality of life issues. Advocate for the need for increased funding for Spinal Cord Injury Model Systems as well as restoring the number of federally-funded Model Systems back to 18, as it was in 2000, from the present 14. United Spinal advocacy and policy staff met with staff from the Administration for Community Living to discuss funding issues. U.S. Department of Health and Human Services (PCHAlliance) - Chronic Disease Management Landscape Analysis to Leverage Novel Technologies for Chronic Disease Management for Aging Underserved Populations United Spinal, as a member of the Personal Connected Health Alliance (PCHAlliance), supported comments to Health and Suman Services Department submitted by the Healthcare Information and Management Systems Society (HIMSS) and the PCHAlliance on the U.S. Department of Health and Human Services Request for Information - Landscape Analysis to Leverage Novel Technologies for Chronic Disease Management for Aging Underserved Populations. Over 60 national organizations representing all ages and disabilities, including United Spinal supported increased funding, $10 million for FY 2021, for the Lifespan Respite Care Program, administered by the Administration on Aging, Administration for Community Living.

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Reviewed and discussed H.R. 8506 (House Version of TEAM Act). Discussed strategy for H.R. 5701, Care for the Veteran Caregiver Act and reintroduction in the 117th Congress as H.R. 110. Discussed VAs Program of Comprehensive Assistance for Family Caregivers. Support of Omnibus Veterans Bill (HR 7105). With the Consortium for Citizens with Disabilities: Support the CHAMPVA Childrens Protection Act - Young dependents of catastrophically disabled veterans can be covered for health insurance under this program operated by the Department of Veterans Affairs. Support legislation to restore reproductive rights of service-disabled veterans - Veterans who have lost the ability to have children through their service to the nation should not be denied the opportunity to have a family. Support legislation to improve mental health care for veterans - the Commander John Scott Hannon Veterans Mental Health Care Improvement Act in the 116th Congress. Support legislation to remove work disincentives and barriers to employment for veterans with significant disabilities - Veterans with significant service-connected disabilities do not receive adequate transition guidance concerning their rights as persons with disabilities when retiring from the military and the VA vocational rehabilitation program often fails to serve these veterans other than preparing them for a life outside the workforce. Legislation such as the Veterans Economic Recovery Act would strengthen the VA Veterans Readiness and Employment (VR&E) program to provide consistent and predictable benefits for veterans with disabilities. Modernizing the VA Automobile Adaptive Grant program - Congress authorizes VA to provide one-time grants in the amount of $21,058.69 to service-connected disabled veterans to purchase a new or used automobile with appropriate adaptive equipment to accommodate their disability. On average, the cost to replace modified vehicles ranges from $40,000 to $65,000 when the vehicle is new and $21,000 to $35,000 when the vehicle is used. Establish DIC equity with other federal survivor benefits - Dependency and Indemnity Compensation (DIC) is a benefit paid to surviving spouses of service members who die in the line of duty or veterans who die from service-related injuries or diseases, and includes additional payments for dependent children. Reduce the 10-Year Rule for DIC - For the survivor of a veteran with a 100 percent disability rating to receive DIC, the veteran must have had that rating for 10 consecutive years. However, if the veteran passes away due to a nonservice-connected condition before reaching 10 consecutive years of being totally disabled, the dependents are not eligible for any DIC benefit. Toxic Exposure in American Military (TEAM) Act Clinical TEAM Culture Act - Provisions like those contained in the Clinical TEAM Culture Act would require VA to develop standards for the provision of care by non-VA providers through the Community Care Program, and require community care providers to complete specified training, including training on suicide and military sexual trauma. Swiftly implement the DOL VETS Disabled Veterans Outreach Program - In 2019, Congress created a Disabled Veterans Outreach Program within DOL VETS to focus on the particular challenges faced by veterans with significant disabilities in returning to the workforce. Unfortunately, the agency has been slow in filling this position. Reverse FCC policy governing automated voice recognition technology and Preserve the Lifeline Program - In mid-2020, the Federal Communications Commission (FCC) approved an application from MachineGenius to provide Internet Protocol Captioned Telephone Service (IP CTS), also known as captioned telephone service, using automatic speech recognition (ASR) only technology. ASR can be problematic for many veterans and others with disabilities. Make improvements in Social Security Administration processing of Wounded Warrior/VAPT disability insurance claims - Claims for SSDI by service members and veterans with catastrophic disabilities are supposed to receive expedited processing by the Social Security Administration. However, an SSA Inspector General report in July 2019 found that the Social Security Administration had no consistent processes in place for handling SSDI claims of service-injured service members or veterans with 100% permanent and total disability ratings from the VA.

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Raised concerns in two letters to the Senate, led by the Bazelon Center, about the views of Judge Amy Coney Barrett regarding the Affordable Care Act, her dissent from a decision in the Seventh Circuit Court of Appeals that concluded that the Trump administrations public charge rule discriminates against people with disabilities, and her decision finding that Wisconsin didnt discriminate against children with learning disabilities by forcing them to apply for placement in school districts separately from other children and allowing their exclusion on the basis of their service needs. Discussed with U.S. Department of Housing and Urban Development the accessibility of their website. Department of Labor - Office of Disability Employment Policy Proposed Transfer of Ticket to Work Program Raised concerns regarding the Presidents budget proposal to transfer the Ticket to Work Program from the Social Security Administration to the U.S. Department of Labor. United Spinal has raised concerns with the moving of the program due to limited staff expertise on the TTW Program at DOL and other issues. Department of Health and Human Services - Office for Civil Rights United Spinal endorsed a letter to OCR, facilitated by Not Dead Yet, regarding the need for nondiscrimination regulations in organ transplants and suicide prevention. Health Innovation Alliance coalition - United Spinal signed on to a Congressional letter in support of the need to build on and clarify existing statute to modernize public health data collection, transmission, and reporting systems, through specific partnerships with expertise in the private sector, the Centers for Disease Control and Prevention (CDC) and the Department of Health and Human Services (HHS) to make necessary data available for public health officials, policy makers, and frontline providers to improve decision making, care delivery, and patient outcomes. United Spinal Association signed onto a letter led by the Leadership Conference on Civil and Human Rights to the EEOC, asking them to extend the comment period on a Notice of Proposed Rulemaking that would significantly change their conciliation procedures and potentially make it harder for people experiencing workplace discrimination from seeking redress. United Spinal signed onto a petition to the Federal Communications Commission, along with many in the disability community, (the National Disability Leadership Alliance) urging FCC to reconsider and revise its Order in this proceeding to mandate that, by July 16, 2022 - i.e., the same deadline that applies to the covered providers implementation of voice calling to 988 - wireless carriers and covered text providers, as defined in the Text-to-911 proceeding, also must implement text-to-988 capability to communicate with the National Suicide Prevention Lifeline (Lifeline) and its trained counselors, so that the benefits of the easy-to-remember and -dial 988 code will be equally available to deaf, hard-of-hearing, late-deafened, deafblind, speech-disabled, or deaf with other disabilities people in crisis and to others in crisis for whom texting is the predominant mode of mobile communication. Provided recommendations to the Community-Based Response Act, S. 4791, legislation that would provide grants to establish non-police emergency response for certain crisis interventions. The disability community is seeking to engage Congressional offices interested in this area to ensure that the disability perspective is considered in the development of such legislation. Opposed H.R. 8478, the Online Accessibility Act. This bill would significantly weaken the ADAs protections regarding website accessibility.

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SSA Waiver of Recovery of Certain Overpayment Debts Accruing During the COVID-19 Pandemic Period United Spinal, along with numerous other members of the Social Security Task Force of the Consortium for Citizens with Disabilities (CCD), submitted comments on the Interim Final Rule to expedite the waiver process for beneficiaries who experience overpayments through no fault of their own during the pandemic due to SSAs reprioritizing of manual workloads that could have resulted in a reduction, suspension or termination of benefits. Continuing Disability Review (CDR) United Spinal, along with numerous other members of the Social Security Task Force of the Consortium for Citizens with Disabilities (CCD), submitted comments about the Social Security Administration (SSA) re-starting its Continuing Disability Review (CDR) workload to share some ideas and recommendations so that CDRs are conducted efficiently and with appropriate regard for the rights and needs of beneficiaries. United Spinal also met with OMB on this issue. Marriage Penalties for Disabled Adult Child (DAC) Beneficiaries United Spinal supported a Congressional memo on this important issue. People with disabilities who rely on Social Security DAC benefits are often penalized or lose their benefits entirely if they marry. These marriage penalties also place access to Medicare and Medicaid at risk. Consortium for Citizens with Disabilities (CCD) Social Security Task Force Congressional letter on minimum Social Security withholding United Spinal, as a member of the Consortium for Citizens with Disabilities (CCD) Social Security Task Force, along with numerous other disability organizations, wrote members of Congress in response to proposals to use changes to the minimum Social Security withholding to pay for other improvements to the Social Security program. Consortium for Citizens with Disabilities (CCD) Social Security Task Force comments to the US Office of Management and Budget (OMB) concerning Social Security concerning disability benefits reviews. United Spinal supported Consortium for Citizens with Disabilities comments opposing SSA scheduling beneficiaries for continuing disability reviews differently depending on whether their claims were awarded at Step 3 or Step 5 of the sequential evaluation process. Also submitted our own comments and met with OMB to discuss.

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3rd Quarter, 2020

Q3 Report

In Q3, United Spinal Association had in-house lobbyists, and was paid $85,000. The report was filed on Oct. 20, 2020. Original Filing: 301218461.xml

Lobbying Issues

As a member of the PCHAlliance, United Spinal joined comments on the Draft Technical Brief titled Automated-Entry Patient-Generated Health Data for Chronic Conditions: The Evidence on Health Outcomes to the Agency for Health Research and Quality. Support H.R. 7663, the Protecting Access to Post-COVID-19 Telehealth Act of 2020. United Spinal provided comments for the National Institutes at Health regarding Research Topics on Disability & COVID as part of the Disability and Rehabilitation Research Coalition and discussed with NIH, United Spinal's own priorities regarding access to medical devices and supplies and physical fitness and nutrition. Support legislation to address specialty medicine physician shortages in rural areas - H.R. 5924 would encourage urologists and other specialty medicine providers to practice in rural communities by creating a student loan forgiveness program. The legislation is introduced by Rep. David McKinley (R-WV-1st). National Institutes of Health - COVID-19 Research As a member of the Disability and Rehabilitation Research Coalition, United Spinal signed onto a letter to NIH in support for Federal investment into COVID-19 Research on disability, independent living, and rehabilitation. National Institutes of Health - National Center for Medical Rehabilitation Research (NCMRR) As a member of the Disability Rehabilitation Research Consortium, United Spinal supported a letter the DRRC sent congratulating Dr. Theresa Hayes Cruz on her appointment as the permanent Director of the National Center for Medical Rehabilitation Research (NCMRR) within the National Institutes of Health. Public Health Infrastructure - Congressional Outreach United Spinal endorsed a letter to House Energy and commerce Committee leadership and Senate Health Education, Labor and Pensions leadership urging them to act quickly to modernize public health systems by establishing the network required under 319D of the Public Health Service Act. United Spinal advocacy and policy staff organized SCI Virtual Hill visits with Congressional staffers for the House Appropriations Committee - greater funding for the SCI Model Systems, including restoring them from 14 back to 18 funded Model Systems, and for continued funding for the National Neurological Conditions Surveillance System (NNCSS) at the CDC, including spinal cord injury in the NNCSS, which would allow for a national SCI registry. There is also dialogue on these two important issues with the Senate Appropriations Committee leadership. United Spinal worked with Congress to introduce a National Spinal Cord Injury Awareness Month resolution and sent out an action alert urging U.S. Senators to cosponsor the National Spinal Cord Injury Awareness Month resolution, introduced by Senators Marco Rubio (R-FL) and Tammy Baldwin (D-WI).

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Received briefing from VA officials in the Office of Connected Care regarding the rollouts of CCN, and the change in Third-Party Administrators. Raised concerns. Participated in White House roundtable and release of the PREVENTS Roadmap, outlining a national level response to ending suicide in the military and veteran population. Meeting with VA VBA to discuss the full digital acceptance and move towards complete automation at the VA, particularly towards complete digitization of all inbound mail, and the discontinuation of fax machines for disability services and claims as of 9 January 2020. Provided comments to VA on the VAs Caregiver expansion program - an intermediary addition of population to the caregiving community that implements a new financial management system (CARMA) and over 1,000 employees to manage the system. Program of Comprehensive Assistance for Family Caregivers (PCAFC). Support NDAA priorities with House and Senate. Support Toxic Exposure in the American Military Act of 2020/S. 4393. Provided comments on FCC letter addressing Lifeline expansion in the middle of a pandemic: FCC wanted providers to offer twice the data at half the cost by the end of the year. Per briefing from VA re consolidated pharmacy mailing system that VA. Raised concerns with delivery of prescription drugs during pandemic. Engaged with the DHS CBP Veteran Task Force to outline an educational supplement for their train-the-trainer nationwide peer support group. Discussed VetsFirst as a resource and call center. Support S.785 Commander John Scott Hannon Veterans Mental Health Care Improvement Act. Share comments of support with House and Senate. Support H.R. 8247 Veterans Compact Act.

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As a member of ITEM Coalition's Steering Committee, support and advocate for Medicare coverage of seat elevation and standing systems. The ITEM Coalition is engaging in multiple virtual Congressional Hill visits on this issue and has met with the National Council on Disability, and the Centers for Medicare and Medicaid Services along with United Spinal advocates. The Coalition submitted comments to CMS urging coverage of these features. As a member of the Coalition to Preserve Rehabilitation Steering Committee, United Spinal supported a Dear Colleague letter, led by Sens. Pat Toomey (R-PA) and Michael Bennet (D-CO), to the Centers for Medicare and Medicaid Services from CMS to review and delay the implementation of a unified payment system for post-acute care (PAC) under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. United Spinal submitted comments to the Commission on Safety and Quality in Nursing Homes in favor of increased responsiveness regarding care delivery and maximized quality of life for all residents. United Spinal signed onto a letter opposing H.R. 7059, a bill that would give broad liability protections for nursing homes and other health care providers for the duration of the public health emergency. United Spinal sent letters to Capitol Hill requesting increased funding for the Spinal Cord Injury Model Systems - including sending out Congressional action alerts. United Spinal sent letters to Capitol Hill one support of $5 million in funding for the National Neurological Conditions Surveillance System (NNCSS) - including sending out Congressional action alerts. Shared with grassroots a Congressional action alert in support of United Spinals priorities for a fourth federal COVID-19 relief package - including increased HCBS funding. Medicare and Medicaid Programs; CY 2021 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Requirements; and Home Infusion Therapy Services Requirements As a member of the Personal Connected Health Alliance (PCHAlliance), United Spinal supported written comments in response to the Medicare and Medicaid Programs; CY 2021 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Requirements; and Home Infusion Therapy Services Requirements Proposed Rule, published in the Federal Register April 6, 2020. PCHAlliance supports the CMS proposal to make permanent the use of technology under the Home Health and the Hospice benefits. Advocated for Congressional sign-ons to a Dear Colleague led by Representatives John Larson (D-CT) and Lee Zeldin (R-NY) which ensures people with disabilities who use complex manual wheelchairs are treated the same as those using complex power wheelchairs regarding coverage of critical manual components, that is competitive bidding pricing should not apply to complex manual wheelchair components such as seating and positioning features. United Spinal urged members of Congress to amend the HEALS Act, because it fails to include any dedicated funding for Medicaid home and community-based services (HCBS) and because it would roll back portions of the ADA related to civil rights for people with disabilities in employment and in places of public accommodation. As a member of the Coalition to Preserve Rehab - Steering Committee, United Spinal requested that CMS authorize a series of speech language pathology, audiology, and speech generating devices (SGD)-related codes for provision via telehealth during the COVID-19 public health emergency. United Spinal also endorsed a letter to Medicare expanding telehealth services to assist with rehab care as part of the Medicare Physician Fee Schedule comments: the proposed cuts to reimbursement across specialties, particularly with regards to the impact for rehabilitation-related services (PT, OT, SLP, physical medicine) and the expansion of telehealth. United Spinal supported Improving Seniors Timely Access to Care Act (H.R. 3107) recently introduced by Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Roger Marshall (R-KS), and Ami Bera (D-CA). This bipartisan legislation would help protect patients from unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program, providing much-needed oversight and transparency of health insurance for Americas seniors. We urge you to join your colleagues in supporting this important legislation. Physician Fee Schedule - CMS 1743-P Medicare Program United Spinal as a member of the Personal Connected Health Alliance and the Healthcare Information and Management Systems Society (HIMSS) supported comments submitted to the Centers for Medicare & Medicaid Services in response to the Medicare Program; CY 2021 Payment Policies. When our nations COVID-19 Public Health Emergency (PHE) declaration ends, the waivers and temporary healthcare standards and policies that have been adopted for Medicare, Medicaid, private payers, and professional licensure will require a transition, rather than a sudden termination, to ensure stability, embed resilience, and develop a modern, value-based, health delivery system. We believe a framework focused on advancing value-based, patient-centered healthcare should guide the phasing down of some waivers and the transition to permanence of others. CY2021 Revisions to Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies; etc. (CMS-1734-P) Personal Connected Health Alliance (PCHAlliance), with United Spinal as a member, signed onto multi-stakeholder comments to the Centers for Medicare and Medicaid Services on the need for the expanded use of connected health technologies in healthcare.

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United Spinal Association was saddened and outraged by the events surrounding the death of Michael Hickson, age 46, in Austin, Texas on June 11, 2020. Mr. Hickson, a black man and father of five, was a quadriplegic and had a brain injury due to a sudden cardiac arrest while driving in 2017. United Spinal called on HHS Office for Civil Rights to investigate the death of Mr. Hickson. United Spinal signed a letter to House and Senate leadership asking that they take specific steps to make voting and voter registration processes more accessible. These include emphasizing website accessibility, protecting and expanding in-person and early voting options, requiring multiple accessible voting options, and providing funding to research, create, and test systems to improve access for voters with disabilities. United Spinal engaged with House and Senate officers in conducting a series of ADA30 briefings throughout the summer. Support Coronavirus Language Access Act (S. 4526). Was asked to speak to the Office of Representative Lisa Blunt Rochester (D-DE). Discussed disability rights issues including transportation issues, autonomous vehicles and Money Follows the Person funding which allows for states to help individuals transition out of institutional care into their communities.

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As a member of the Consortium for Citizens with Disabilities (CCD) Social Security Task Force, United Spinal supported a letter sent to Congressional leadership in response to proposals to include a payroll tax cut in the next COVID-19 relief package that would reduce contributions to the Social Security Trust Funds. Cutting payroll contributions does little to help low-wage essential workers, who pay a proportionate amount of payroll contributions to their low-wages. Also endorsed a similar statement. United Spinal supports a Consortium for Citizens with Disabilities statement which opposes a legislative proposal in the Presidents FY21 budget that would reduce Social Security benefits. The Presidents FY21 budget includes a legislative proposal that would change the minimum from $10 to 10% of the Social Security benefit. As a member of the Consortium for Citizens with Disabilities (CCD) Social Security Task Force, United Spinal, along with numerous other organizations, wrote to congressional leadership in response to a recent change made by the Social Security Administration (SSA) to restart Continuing Disability Reviews (CDRs) in the middle of this global pandemic. United Spinal filed a complaint with the D.C. U.S. District Court against the Social Security Administration for the alleged unlawful wet ink signature requirements imposed on persons with disabilities in connection with applications for certain disability benefits of the Social Security Administration (SSA). We believe the requirements interfere with the ability to pursue rights to federal disability benefits, making a cumbersome application process even more difficult. US Department of Transportation (DOT) - National Highway Traffic Safety Administration Automated Vehicle Transparency and Engagement for Safe Testing (TEST) United Spinal submitted comments suggesting the centralized database of the AV TEST Initiative from ADS developers and local authorities be elevated to the DOTs Office of the Secretary, that accessibility and inclusion criteria be included, that information submissions be required not voluntary. United Spinal signed onto comments We acknowledge USDOTs stated commitment to improving access and mobility for people with disabilities and older adults in AV 3.0 and AV 4.0, and during the Departments recent celebration in honor of the ADAs 30th Anniversary. We urge NHTSA to prioritize access and safety for all passengers and road users. Including requirements to ensure accessibility and engage with the disability and other underserved communities would be a reminder to all stakeholders of USDOTs commitment to uphold the promise of greater mobility and safety for all.

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United Spinal continued discussions around key provisions of H.R. 6248, the Disability Access to Transportation Act (DATA) bill, that were successfully included in the Democratic version of the surface transportation bill, H. R. 2, INVEST in America or Moving Forward Act, that has passed the House. And continues to focus efforts on including similar provisions in the Senate Republican led version S. 2302, Americas Transportation Infrastructure Act of 2019. United Spinal supported a letter from the cochairs of the CCD Transportation Task force for the National Highway Transportation and Safety Administration on Federal motor vehicle safety standards and minimal sound requirements for hybrid and electric vehicles - stating disappointment that manufacturers have been unable to implement FMVSS 141. United Spinal submitted comments to the U.S. Department of Transportation's national online dialogue, Feedback on the Accessibility Strategic Plan Framework, to identify best ways to ensure that America's transportation system is accessible to all travelers. Discussed autonomous vehicle priorities with the U.S. Access Board. U.S. Access Board reached out to us to discuss.

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2nd Quarter, 2020

Q2 Report

In Q2, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on July 20, 2020. Original Filing: 301200700.xml

Lobbying Issues

COVID-19 Advocacy/CARES Act Support A one-year expansion of federal funding for Medicaid home and community-based services (HCBS), from July 1, 2020 to June 30, 2021. An expansion of the paid leave program to cover family caregiving of adults with disabilities, which would allow all family members, not just parents, to take paid leave for caregiving. Additional pay of up to $10,000 for personal care attendants, home health aides, and direct support professionals for their work during the COVID-19 pandemic. An additional round of Economic Impact Payments, resolving bureaucratic issues for SSI, SSDI, and VA benefits recipients, and fixing an issue that left adult dependents ineligible for these payments. A requirement that that the Department of Health and Human Services (HHS) make specific plans to ensure that COVID-19 testing is accessible to people with disabilities and people with underlying health conditions or compromised immune systems. A requirement that States ensure that absentee or mail-in ballots are accessible for people with disabilities. Support All Dependent Children Count Act introduced by Rep. Craig in the House (H.R. 6420), and Sen. Smiths All Dependents Count Act, S. 3652. Support H.R. 6680 which would disregard unemployment benefits from eligibility consideration for means-tested programs such as SSI and SNAP - Strengthening UI for Coronavirus Impacted Workers and Students Act. Department of Health and Human Services Supported letter to Secretary Azar and Director Severino to express our strong and urgent support for the Departments Office for Civil Rights to issue additional guidance to ensure that schemes to ration scarce health care resources during the coronavirus disease 2019 (COVID-19) pandemic comply with federal nondiscrimination laws. Justice in Aging request HHS Secretary Azar to Remove Barriers for Medicare Enrollment During COVID Pandemic United Spinal joined Justice in Aging and numerous organizations requesting the Department of Health and Human Services take action to remove barriers and to streamline enrollment in health insurance coverage for low-income older adults and people with disabilities who are at highest risk of serious illness and death from COVID-19. United Spinal advocated to exempt non-invasive ventilators from Medicares competitive bidding program which limits choice for consumers and cuts reimbursement to Medicare providers. During the COVID-19 pandemic, it is the wrong time to place additional restrictions on access to life-saving equipment. United Spinal sent in its own letter to Congress along with other stakeholders such as the ALS Association and the company RESMED. As a CCD Rights Task Force co-chair, United Spinal advocacy and policy staff signed a letter to HHS Secretary Alex Azar, CMS Administrator Seema Verma, and CDC Director Robert Redfield urging them to collect and report data on the impact of COVID-19 on people with disabilities, including numbers of tests, testing rates, numbers and rates of positive tests, hospitalizations, deaths and death rates, recoveries, transfers from community living to institutional settings and discharges from institutional settings, and analysis of that data to identify trends and correlational factors. United Spinal advocacy and policy staff provided comments as part of the Disability and Rehabilitation Research Coalition (DRRC) to Senator Warren (D-MA) and Reps. Pressley (D-MA) & Kelly (D-IL) on a bill to require the CDC to collect and report demographic data related to COVID-19; we urged them to include data collection on disability factors. oOn April 14, Reps. Ayanna Pressley, Robin Kelly, and other members of the Congressional Black Caucus, along with Sen. Elizabeth Warren and others introduced the Equitable Data Collection and Disclosure on COVID-19 Act, which would require the Department of Health and Human Services (HHS) to collect and report racial, ethnic, and other demographic data on COVID testing, treatment, and fatality rates. The introduced legislation did mention disability but did not include significant focus on the importance of disability data collection. oMembers of the DRRC, which includes United Spinal, along with other stakeholders, drafted revisions to the legislation. The edits were intended to achieve three purposes: 1) integrate the concerns and interests of the disability community throughout the bill to ensure that disability rights are universally considered civil rights, 2) include on the mandated data collection commission agencies with disability, independent living, and rehabilitation research portfolios, and 3) authorize targeted COVID research funding to NIDILRR comparable to the targeted funding provided to other research agencies. These edits were shared with Sen. Warrens office along with other congressional disability champions, including Sen. Bob Casey (D-PA) and Rep. Jim Langevin (D-RI). Following work in March that resulted in Federal guidance being issued by the Office for Civil Rights (OCR) at the Department of Health and Human Services to remind States and health care providers of their responsibilities under Federal law not to discriminate against people with disabilities in providing health care, United Spinal signed onto a guidance document developed by the disability community outlining principles for states and health care providers to follow in adhering to the Federal guidance. United Spinal also joined over 400 organizations in calling on HHS for additional Federal guidance on nondiscrimination in health care to be issued by OCR. United Spinal, as a member of the ITEM Coalition Steering Committee, endorsed a letter to HHS Secretary Alex Azar urging for improved access to this treatment. We have written to CMS before about the complex and burdensome billing requirements associated with the dNPWT benefit that have resulted in decreased patient access to this important treatment. Proposed Rule and Medicare Advantage (MA), Medicare Part D and Medicaid United Spinal, as a Steering Committee member of CPR endorsed comments to the Centers for Medicare and Medicaid Services highlighting important provisions of benefit to Medicare and Medicaid beneficiaries: Revisions to supplemental benefits for beneficiaries with chronic conditions (SSBCI), Network adequacy requirements for MA plans, Star rating program enhancements, and New tools for beneficiaries under the Medicare prescription drug benefit program (Part D). PCHAlliance Proposed Rule and Medicare Advantage (MA), Medicare Part D and Medicaid United Spinal, as a member of PCHAlliance signed onto this coalitions letter: Interoperable, connected health, requires a broad ecosystem of shared digital health information. It is particularly noteworthy that this proposed rule advances Medicare Advantage coverage of patient centered digital, interoperable, connected healthcare. PCHAlliance members support the advancement of evidence based connected health. CMS work to develop and ensure appropriate use of connected care is particularly noteworthy as one of the key enablers of modernizing Medicare for the use of evidence based connected care is to improve patient outcomes. United Spinal comments on FY 2021-2025 NIH-Wide Strategic Plan Framework United Spinal provided comments on the National Institutes of Healths (NIH) Request for Information on the FY 2021-2025 NIH-Wide Strategic Plan Framework, in support of strengthening and advancing disability and rehabilitation research and included support of the comments submitted by the Disability and Rehabilitation Research Coalition, of which United Spinal Association is a member. United Spinal supports COVID-19 Recovery for Seniors and People with Disabilities Act - S. 3740. United Spinal supports Nursing Home COVID-19 Protection and Prevention Act - S. 3768. United States Postal Services (USPS) - COVID-19 United Spinal signed onto a letter, facilitated by AARP, to House and Senate leadership in support of USPS continued funding in order to provide the vital services that millions of Americans, especially older Americans and those with chronic conditions, depend upon, especially during this pandemic, as it relates to pharmacy and medical supplies needs as well as access to voting. United Spinal sent a letter to the U.S. Senate Aging Committee thanking them for holding a hearing examining the devastating impact COVID-19 has had on nursing homes and urging them to engage the disability community as they seek solutions. Support increased appropriations funding for the SCI Model Systems under the NIDILRR grant. Support continued appropriations funding for CDC's National Neurological Conditions Surveillance System. As a member of the Coalition to Preserve Rehabilitation Steering Committee, United Spinal endorsed these comments: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Value-Based Purchasing Program for Federal Fiscal Year 2021 [CMS-1737-P, RIN: 0938-AU13] - Concerns with the Patient-Driven Payment Model. CPR continues to be concerned with the observed and ongoing impact of the Patient-Driven Payment Model (PDPM) implemented in the SNF PPS effective October 1, 2019. CMS implemented this new case-mix classification model to group patients admitted to SNFs during covered Medicare Part A stays, replacing the Resource Utilization Group, Version IV (RUG-IV) system. As a member of the Coalition to Preserve Rehabilitation Steering Committee, United Spinal endorsed these comments: Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2021 Proposed Rule [CMS-1729-P; RIN 0938-AU05]. Under this proposal, non-physician practitioners would be able to conduct or designate another certified clinician to conduct the preadmission screening (PAS), review and concur with the findings of the preadmission screening, conduct the post-admission physician evaluation (PAPE), which CMS proposes to eliminate, lead the required weekly interdisciplinary team meetings, conduct required face-to-face visits with the patient, and develop and modify the patients plan of care. In sum, CMS proposes to defer to the IRF to determine whether a non-physician practitioner has sufficient specialized training and experience in inpatient rehabilitation to essentially fulfill the role of the rehabilitation physician. CPR views this proposal as a major broadside attack on the integrity and value of care provided by inpatient rehabilitation hospitals and units. We strongly oppose this proposal and believe that, if finalized, it would materially undercut IRF care and decrease the level and quality of care provided in an IRF, potentially causing significant harm to patients with complex conditions who need an intensive, coordinated, interdisciplinary course of inpatient hospital-level rehabilitation treatment.

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Veterans: House and Senate Veterans Affairs Committees Supported letter to Chairman Moran, Ranking Member Tester, Chairman Takano, and Ranking Member Roe requesting an immediate increase of 25% for catastrophically disabled veterans who receive Department of Veterans Affairs (VA) Special Monthly Compensation (SMC)/Aid and Attendance (A&A) benefit to cover the increased costs of PPE for their caregivers. Supported letter to Chairman Moran, Ranking Member Tester, Chairman Takano, and Ranking Member Roe outlining our 16 priorities and recommendations for the COVID19 relief packages. Supported letter to Chairman Moran, Ranking Member Tester, Chairman Takano, and Ranking Member Roe expressing our support for H.R. 6957, National Guard 5 COVID-19 Earned Benefits Guarantee Act that directs the Secretaries of Defense and Veterans Affairs to treat a period of full-time National Guard duty as not shorter than 90 days when performed in response to the COVID-19 national emergency proclamation dated March 13, 2020. Veterans: Department of Veterans Affairs Supported a letter urging Secretary Wilkie to hold for-profit colleges targeting student veterans accountable under 38 USC 3696 for their predatory practices. Postal: Senate and House Signed letter to Sen McConnell, Sen Schumer, Rep Pelosi, Rep McCarthy urging support to ensure there is no disruption in U.S. Postal Service (USPS) during this critical time. The USPS is providing essential services to many Americans, including members of the military and veteran communities. Veterans: Department of Veterans Affairs Supported a letter urging Secretary Wilkie to hold for-profit colleges targeting student veterans accountable under 38 USC 3696 for their predatory practices.

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District of Columbia Homeland Security Emergency Management Agency - Emergency Management United Spinal and DC CIL litigation against the District United Spinal, along with co-plaintiff DC Center for Independent Living, sent a letter to DC Mayor Muriel Bowser outlining several areas of transportation in which the DC government should improve its response to COVID-19 for people with disabilities. United Spinal advocacy and policy staff participate, ask questions of the District, in weekly COVID-19 calls with DC HSEMA and DC Office of Disability Rights on DCs COVID-19 response. United Spinal advocacy and policy staff provide comments to quarterly reports and additional documentation related to the emergency response including a United Spinal/DC CIL letter to DC Mayor Bowser urging for improved transportation service for people with disabilities. United Spinal advocacy and policy staff participated in a virtual town hall on DCs upcoming revised Olmstead community integration plan to support people with disabilities living in the community.

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Defense: Senate Subcommittee on Defense on Appropriations Supported a coalition letter to Chairman Shelby and Ranking Member Durbin outlining the request for continued FY 2021 funding the Gulf War Illness Research Program, part of the Congressionally Directed Medical Research Program (CDMRP) within the Department of Defense. Defense: Senate and House Armed Services Committees Supported a coalition letter to Chairman Inhofe, Ranking Member Reed, Chairman Smith and Ranking Member Thornberry regarding the need to waive co-payments for Tricare mail-order prescriptions for the remainder of the COVID-19 pandemic in order to decrease traffic in the Military Treatment Facility (MTF) pharmacies effort to protect service members, their families, retirees, and vital medical staff. Co-signed a letter to Chairmen Inhofe and Smith and Ranking Members Reed and Thornberry with the Toxic Exposures in the American Military (TEAM) Coalition to express our priorities for toxic exposure legislation, as they relate to the Department of Defense (DOD) for the National Defense Authorization Act (NDAA) for Fiscal Year 2021. Defense: Senate and House Subcommittee on Defense on Appropriations Supported letter to Chairman Visclosky and Ranking Member Calvert to encourage continued support and a funding increase by five percent plus inflation for the critical and highly successful defense health research programs funded through the Congressionally Directed Medical Research Programs (CDMRP) at the Department of Defense (DoD). Many of these programs are directly related to preparedness and response to global pandemics, while other equally important CDMRPs fund research to protect the men and women who serve in our Armed Forces, military families, veterans, and civilian populations from a wide range of medical conditions and health challenges. Defense: House and Senate Subcommittee of Military Personnel Armed Services Committee Supported a letter submitted by The Military Coalition to urge inclusion of a provision in the FY21 NDAA to halt planned downsizing of military hospitals and clinics. Military treatment facility (MTF) restructuring directed by the FY17 NDAA and medical billet cuts proposed in the FY21 DoD budget are based on outdated assessments of military medical end strength requirements. The COVID-19 pandemic demands medical readiness requirements be reassessed and updated with lessons learned from the whole of nation response to the coronavirus emergency.

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Social Security Administration and Veterans beneficiaries - COVID-19 Consortium for Citizens with Disabilities (CCD) Social Security Task Force United Spinal, along with numerous other disability organizations and are members and allies of the Consortium for Citizens with Disabilities (CCD), wrote in response to the recently announced deadline for Social Security beneficiaries to file taxes or utilize the new web tool to claim economic impact payments for child dependents under the age of 17 or wait until 2021 to claim the payments. We are extremely concerned by the unexpected announcement of this very short deadline. Announcing a Wednesday deadline on a Monday afternoon is simply put, not enough time. Media reports that the deadline is noon on Wednesday (with the time zone unspecified) add to the urgency and the confusion. Social Security Administration - COVID-19 United Spinal, as a member of the Consortium for Citizens with Disabilities (CCD) Social Security Task Force supported a letter the Task Forces Co-Chairs sent the Social Security Commissioner urging further response to the COVID19 pandemic. Thank you for all the work you and your staff are doing to adapt the Social Security Administrations activities and keep the public informed during these challenging times. We, the undersigned co-chairs of the Consortium for Citizens with Disabilities Social Security Task Force, realize this is an enormous task, but one that is vital to the nearly 70 million Americans who receive Social Security benefits and the millions more who use SSAs other services. We appreciate your efforts to make automatic economic impact payments for recipients of SSI and Title II benefits. We encourage you to continue working with the Treasury Department so that SSI and Title II beneficiaries who use the IRS non-filer portal (for example, those with dependent children) can elect to have their stimulus payments sent to their Direct Express cards. Consortium for Citizens with Disabilities (CCD) letter to Internal Revenue Service (IRS) on Electronic Impact Payments United Spinal, along with numerous other organizations, and as a member of the Consortium for Citizens with Disabilities (CCD) submitted a letter to the IRS detailing our concerns with how the non-filer tool has been functioning, how Electronic Impact Payments have been and will be issued, and reiterating our position from last month that we believe that there should not be a deadline for filing for dependent credits.

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United Spinal endorsed a letter by HIMSS and PCHAlliance which expressed tremendous support for the $200 million in additional funding to enable the provision of telehealth under the Coronavirus Aid, Relief, and Economic Security (CARES) Act, and use those funds to establish the COVID-19 Telehealth Program, in addition to the $100 million for the Connected Care Pilot Program. Draft 2020-2025 Federal Health IT Strategic Plan As a member of the PCHAlliance, United Spinal supported a letter in which the Healthcare Information and Management Systems Society (HIMSS) and the Personal Connected Health Alliance (PCHAlliance) provided written comments in response to the Draft 2020-2025 Federal Health IT Strategic Plan, which was published January 15, 2020. HIMSS and PCHAlliance suggest there is considerable value in the Strategic Plan placing greater emphasis on advancing health information infrastructure that enables individuals to take more control over their personal health and wellness through access to their personal health data and digital tools that educate and guide personal health decisions that support health and wellness. 2020 Communications and Video Accessibility Act - Biannual Report to Congress United Spinal supported comments submitted by the Co-Chairs of the Consortium for Citizens with Disabilities Technology and Telecommunications Task Force about the Federal Communications Commission (Commission) Public Notice seeking input on the 2020 Biannual report to Congress required by the 21st Century Communications and Video Accessibility Act (CVAA)( PL 111-260)(DA 20-216). For nearly ten years, we have worked to codify and implement the CVAA. We believe the CVAA has largely increased accessibility for people with disabilities. The increased amounts of accessible wireless devices, video content and equipment is directly related to the CVAA requirements and the collaboration between the Commission, industry, and the disability community. As we near the tenth anniversary of the CVAA, we remain committed to protect the requirements of the CVAA and to ensure the most accessible technology and telecommunications experience for all consumers.

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United Spinal endorsed comments from the Consortium of Citizens with Disabilities Transportation Task Force to the Department of Transportation on the agencys Design Challenge Initiative, highlighting recommendations in accessible design. United Spinal also sent in its own comments. United Spinal, as a member of the Consortium for Citizens with Disabilities (CCD) Transportation Task Force, supported a letter to the U.S. House and U.S. Senate submitted by the Task Forces Co-Chairs urging increased funding for Department of Transportation (DOT) programs impacting people with disabilities in the FY 2021 Transportation, Housing and Urban Development, and Related Agencies (T-HUD) appropriations bill. United Spinal, as a member of the Consortium for Citizens with Disabilities (CCD) Transportation Task, supported a Task Force Co-Chairs letter to House leadership to urge amending mask and protective face covering requirements for all passengers in transit, Amtrak and air travel in in the HEROES Act, and to take into consideration the needs of people with disabilities. United Spinal supports the Disability Access to Transportation Act, H.R 6248. U.S. Department of Transportation - Autonomous Vehicles United Spinal signed onto a letter sent to the Department of Transportation offering comments on the National Highway Traffic Safety Administrations proposed rulemaking on Occupant Protection for Automated Driving Systems. This proposed rulemaking seeks to update safety standards to take into account the inherent differences between typical road-worthy vehicles and autonomous vehicles. The letter offers several suggestions for incorporating the needs of people with disabilities. Comments Concerning Occupant Protection for Automated Driving Systems Docket Number: NHTSA-2020-0014 United Spinal, along with numerous disability organizations, as members of the Consortium for Citizens with Disabilities (CCD) Transportation Task submitted comments in response to the National Highway Traffic Safety Administration (NHTSA) request for comments regarding Occupant Protection for Automated Driving Systems (ADSs). The letter read in part: The promise and safety of ADS-equipped vehicles will only be realized if vehicles equipped with ADS and without steering wheels are fully accessible, the Americans with Disabilities Act upheld, and safety elements take into account the needs of people with disabilities. We view this time of innovation and reimaging as an opportunity to not only maintain the current level of protection and performance offered by the 200 Series Federal Motor Vehicle Safety Standards (FMVSS), but also to improve the levels of safety and accessibility that they afford. Surface Transportation Legislative Proposals and PrioritiesUnited Spinal, along with numerous disability organizations, as members of the Consortium for Citizens with Disabilities (CCD) Transportation Task developed Surface Transportation Legislative Proposals and Priorities. Transportation is necessary for 57 million people with disabilities in the U.S. to contribute to and participate in their communities, support and spend time with family and friends, and live their lives to the fullest; however, significant barriers to accessible, equitable, reliable transportation remain across modes. Priorities cited include: Assess and increase the availability of fully-accessible, integrated transit and on-demand mobility services. Assess and address continued discrimination in transit and on-demand mobility services through partnerships and public accommodation and other issues.

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Consortium for Citizens with Disabilities (CCD) Technology and Telecommunications Task Force Congressional Appropriations request for Funding the AT Act at $45 million United Spinal, as a member of the Consortium for Citizens with Disabilities Technology and Telecommunications Task Force along with numerous other disability organizations, sent a letter to Congressional appropriators in support for the inclusion of $45 million in the FY 2021 House Labor, Health and Human Services and Education Appropriations (LHHS) bill for the Assistive Technology (AT) Act Programs. Funding provided through the AT Act supports programs that assure people with disabilities have access to and acquisition of the assistive technology devices and services they need to live, work, and attend school in their communities.

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1st Quarter, 2020

Q1 Report

In Q1, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on May 8, 2020. Original Filing: 301182697.xml

Lobbying Issues

Administration for Community Living - Rehabilitation Research and Training Center (RRTC) Programs RRTC programs conduct coordinated, integrated, and advanced programs of research, training, and information dissemination in topical areas that are specified by the Department of Health and Human Services National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). RRTCs conduct research to improve rehabilitation methodology and service delivery systems; improve health and functioning; and promote employment, independent living, family support, and economic and social self-sufficiency for individuals with disabilities. United Spinal is subcontracting with Medstar Washington Hospital on an educational grant on the issue of Neurogenic Lower Urinary Tract Dysfunction (NLUTD) which is a term used for neurogenic bladder. U.S. Food & Drug Administration - Public Workshop - Evolving Role of Artificial Intelligence in Radiological Imaging United Spinal was asked to participate in a consumer panel representing the North American Spinal Cord Injury Consortium to discuss the challenges manual and power wheelchair users face when using medical devices at home. United Spinal has been fully engaged in Congressional and grassroots advocacy related to COVID-19 relief for the disability community, with continual discussions with Congressional offices, and Consortium for Citizens with Disabilities advocacy, highlighting United Spinal priorities, engaging in adding Congressional signatories to letters to Vice President Mike Pence, head of the White House Coronavirus Task Force on the needs of the disability community regarding accessible communications, caregiving and supplies. Coronavirus Aid, Relief, and Economic Security Act, the CARES Act, S. 3548/H.R. 748. The SCI/D community achieved important priorities in this bill including: increased funding for Aging and Disability Resource Centers, Administration for Community Living Aging and Disability Services Programs, and an extension of Money Follows the Person funding through November 30, 2020 and other provisions Support S.3544/H.R. 6305 - Coronavirus Relief for Seniors and People with Disabilities Act of 2020 H.R. 6074, the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, provided the Secretary of Health and Human Services (HHS) with limited waiver authority over Medicare telehealth restrictions during the 2019 Coronavirus public health emergency. While we applaud your efforts to bring these safe and cost-effective services to additional Medicare beneficiaries who are otherwise ineligible to receive telehealth benefits, we believe additional changes are needed to further reduce barriers to timely care, decrease risk of transmission for health care workers and patients, and maximize the benefits of a connected health ecosystem during this public health emergency. 1)Modify the qualified provider section of the to remove administratively cumbersome and overly restrictive barriers to telehealth delivery of care. 2)Provide secretarial authority to add Medicare Part B coverage for remote physiological monitoring for those testing positive for COVID-19 during the public health emergency. Lifespan Respite Care Program Action Alert United Spinal advocacy and policy staff created and distributed an action alert in support of a Congressional appropriations letter seeking $10 million in funding for the Lifespan Respite Care Program in fiscal year 2021. Support the Accessible Voting Act (S. 3206). Congressional Disability Policy Accountability Project United Spinal formally proposed and received support from other disability organizations for the Congressional Disability Policy Accountability Project. The goal of this project is to increase competency in disability policy issues among Congressional staff by ensuring that each Congressional office assigns disability issues to the issues portfolio of at least one policy staffer in that office. Engaged with Congressional House offices on this issue. Support "Recognizing the Role of Direct Support Professionals Act (S. 3369)/(H.R. 6045). Worked with the National Multiple Sclerosis Society on the Real Emergency Access for Aging and Disability Inclusion (REAADI), and Disaster Relief Medicaid Act (DRMA); access to MS medications and increased funding for Congressionally-Directed Medical Research Programs focused on MS research. Brain Injury Awareness Day - Congressional Briefing United Spinal advocacy and policy staff attended a Brain Injury Awareness Day Congressional Briefing. The SCI/D community and the traumatic brain injury (TBI) community are working together on reviewing avenues of funding and the provision of rehab and program expertise. Health Innovation Alliance United Spinal signed onto a letter to Congress in support of an updated Federal Data framework to allow for interoperability with health IT, artificial intelligence and portable medical devices. Coalition to Preserve Rehabilitation Department of Health and Human Services (HHS) Notice of Benefit and Payment Parameters As a Steering Committee member of CPR, United Spinal signed onto a comment letter in response to HHS proposed rule focusing on benefit and payment provisions focusing on Rehabilitative Services and Devices protections under the ACA; Changes to the Automatic Enrollment Process under the Proposed Rule and Expanding Special Enrollment Periods under the Proposed Rule. As a member of the Disability Rehabilitation and Research Coalition, United Spinal commented on NIHs framework for the strategic plan, which identifies cross-cutting themes and three major objectives for the agency - specifically related to disability and rehabilitation research. Signed onto a CPR/ITEM Coalition letter to Congress for the exemption for non-invasive ventilators (NIVs) in the next round of the Medicare competitive bidding program scheduled to begin on January 1, 2021. United Spinal also send a similar letter to Congress on behalf of our own Access and Care Coalition as well as onto a ResMed and ALS Association facilitated letter to Congress. Signed onto an AAPD letter to Congress on the priorities of the disability community during this time of the COVID-19 pandemic. Public Comments on Notice of Benefit and Payment Parameters for 2021 (RIN 0938-AT98, CMS-9916-P) United Spinal, as a member of the Coalition to Preserve Rehabilitation (CPR) commented on the Department of Health and Human Services (HHS) proposed rule, Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 20211 (the Proposed Rule). CPR is a coalition of national consumer, clinician, and membership organizations that advocate for policies to ensure access to rehabilitative care so that individuals with injuries, illnesses, disabilities, and chronic conditions may regain and/or maintain their maximum level of health and independent function. The Proposed Rule sets forth benefit and payment parameters, changes the automatic enrollment process, expands special enrollment periods, and sets out many other policies implementing the Patient Protection and Affordable Care Act (ACA). This comment letter will focus on key proposed provisions that specifically impact enrollees in need of medical rehabilitation and post-acute care. Signed on to ACLU Coalition letter to HHS OCR re: Withholding of Life-Sustaining Treatment.

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Support H.R. 4870/S. 2629, United States Public Health Service Modernization Act of 2019, to ensure full support and timely deployment of the Ready Reserve of the Commissioned Corps of the USPHS and amends the Commissioned Corps and Ready Reserve Corps through providing a technical fix to an existing authorization. Signed onto letter to the Postal Regulatory Commission strongly discouraging the Postal Regulatory Commission (PRC) from proceeding with its proposed rule affecting the system for regulating market dominant postal rates and classifications. As proposed, this rule would significantly impair the ability of our member organizations to meet the challenges faced by communities that have served and sacrificed for our national security (Docket RM2017-3). Supporting S.2981 and H.R. 2406, the National Oceanic and Atmospheric Administration Commissioned Officer Corps Amendments Act of 2019. Support Care for the Veteran Caregiver Act (H.R. 5701). Signed on to letters of support to both Senate and House Committees on Appropriations requesting that the Vision Research Program (VRP) be funded at $30 million for Fiscal Year 2021 (FY21). Signed on to letter to the Senate and House Committees on Appropriations in support of securing the necessary resources to support the continued work by the treatment-focused Gulf War Illness Research Program (GWIRP), part of the Congressionally Directed Medical Research Program (CDMRP) funded within the Department of Defense (DoD). Submitted letter to House and Senate Armed Service Committees in support of S.3503, which provides VA with the authority it needs to administer VA education benefits without disruption as schools across the nation respond to COVID-19. Signed letter of support for the Major Richard Star Act H.R. 5995, and the Senate companion bill S.3393. Signed letter of support to House and Senate for waiving co-payments for Tricare mail-order prescriptions.

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United Spinal continues dialogue with Congressional offices and with members of other disability advocacy organizations as we work together to agree on legislative language that would both advance accessibility in transportation and protect the hard-won gains of the ADA. United Spinal responded to the Congressional request for continued feedback on the bicameral, bipartisan self-driving car legislation. United Spinal noted that automakers need to include information on their accessibility features as part of their consumer education; include accessibility and universal design expertise in their personnel and staffing hiring; include a process for taking preventative and corrective actions to mitigate against vulnerabilities, including cybersecurity incident response plans which must address accessibility; and, we must make certain that the Model Minimum Uniform Crash Criteria address disability and accessibility matters. United Spinal also supported similar comments to Congress, drafted by the Consortium for Citizens with Disabilities Transportation Task Force. United Spinal has provided input to the U.S. Access Board on: A Study Initiated on Equipping Passenger Aircraft with Wheelchair Restraint Systems on January 13, 2020. The Access Board is undertaking a study that has the potential to advance access to air travel for passengers who use wheelchairs. As directed by Congress, this project will assess the feasibility of equipping passenger planes with restraint systems so that passengers can remain in their wheelchairs on flights. Having to transfer out of wheelchairs makes air travel very difficult, if not impossible, for many people with disabilities. Accessible Lavatories on Single-Aisle Aircraft Consortium for Citizens with Disabilities (CCD) Transportation Task Force United Spinal, as a member of the Consortium for Citizens with Disabilities (CCD) Transportation Task Force, supported a letter in response to a rulemaking on Accessible Lavatories on Single-Aisle Aircraft; Part 1. While the ability to access an aircraft lavatory inflight is an opportunity most air travelers take for granted, people with disabilities often face barriers to the use of the aircraft lavatory that requires changes to their ability and willingness to fly. The Department of Transportation must support further defining accessible with respect to call buttons and door locks. Transportation Access and Safety for People with Disabilities During and After COVID-19 As a member of the Consortium for Citizens with Disabilities (CCD) Transportation Task Force along with numerous other disability organizations, United Spinal signed on to a letter to urge US Department of Transportation Secretary Chao to ensure that transportation service responses to COVID-19 do not discriminate based on disability, that service is maintained in line with public health and social distancing standards, and the needs of workers and passengers with disabilities are met. Transportation for America United Spinal, along with numerous other organizations, signed on to a letter to Congress requesting additional funding to ensure access to public transportation during the COVID-19 pandemic. Rep. Jim Langevin (D-RI) introduced the Disability Access to Transportation Act (H.R. 6248) on March 12, 2020, along with Representatives Dina Titus (D-NV-1) and John Katko (R-NY-24). This bill is the result of months of discussions initiated by United Spinal staff with Rep. Langevins staff about the disability communitys transportation accessibility needs and what improvements can be included in the next 5-year surface transportation bill that is due to be considered this year. Provisions include a paratransit pilot program to allow for one stop during a paratransit trip; finalizing public rights of way, Proposed Accessibility Guidelines for Pedestrian Facilities in the Public Right-of-Way from July 2011; an improved accessibility complaints process and an accessibility data collection system on transportation modes. United Spinal signed onto a press release, spearheaded by American Association for Justice along with Disability Rights Education and Defense Fund, Access Living and others highlighting the need to remove forced arbitration from litigation options which can negatively impact the rights of people with disabilities and others if there are any accessibility standards violated. AAJ and others met with Congress on this issue.

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DC Government Homeland Security and Management Agency As one of two plaintiffs, (United Spinal Association and the DC Center for Independent Living) to the lawsuit against the District Government for failing to provide adequate emergency management and preparedness services for people with disabilities. In the month of January, United Spinal provided comments to the attorneys who filed our case, Disability Rights Advocates, on sheltering needs and wayfinding analysis and submitted comments on their biannual report. Disability Community Advisory Group (DCAG) - 3rd quarterly meeting As co-plaintiffs in the United Spinal Association, et al. v. District of Columbia litigation settlement with the District Government, the 3rd quarterly meeting took place to address: the Districts COVID-19 response as well as components of the settlement including: Emergency Public Communications; High-Rise Task Force progress (gap analysis due August 3, 2020); PECO plan progress (PECO plan due August 3, 2020); Emergency Sheltering and Power and Accessible Transportation for Evacuation. Also beginning in March, there have been weekly COVID-19 check-in conference calls with the District Government.

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Social Security Administration - Continuing Disability Reviews We agree that the Social Security Administration (SSA) is required by Congress to perform periodic Continuing Disability Reviews (CDR) on recipients of Supplemental Security Income (SSI) or Title II Social Security benefits awarded on the basis of disability. We also agree with SSA that no changes to the current Medical Improvement Review Standard are appropriate. However, we have significant concerns about SSAs proposal to perform more CDRs, more frequently. Given a lack of data or evidence to change the CDR process, we found the proposed rule so vague commenters cannot do so in a meaningful way. We urge SSA to withdraw this rule since it fails to comply with the Administrative Procedure Act. United Spinal submitted its own comments and endorsed comments of the Consortium for Citizens with Disabilities Social Security Task Force. Support SSI Restoration Act - H.R. 4280/S. 2753. Support the Disability Employment Incentive Act, H.R 3992/S. 255. Support the ABLE Age Adjustment Act. - S. 651/H.R. 1814. Support H.R 4280/S. 2753 - Supplemental Security Income (SSI) Restoration Act. Support Senior Care Act - H.R. 5429/S. 3010.

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Support Sec. 9 of the CONNECT for Health Act of 2019 (S. 2741/H.R. 4932) in the upcoming COVID-19 supplemental legislation Supported submitted comments to the Federal Communications Commission regarding Docket Nos. 11-42, 09-197, 96-45, 17-287 EMERGENCY REQUEST FOR INCREASED LIFELINE SUPPORT DURING THE COVID-19 CRISIS. The Chairmans Keep Americans Connected Pledge and Federal Communications Commissions (FCC or Commission) decision to temporarily waive recertification and reverification requirements for existing Lifeline customers were laudable first steps in the early days of the crisis, but more is needed as the extent and length of the emergency becomes evident. United Spinal provided edits to a Health Innovation Alliance letter to Congress on interoperability; medical devices and access to care for people with disabilities. The letter outlined a mechanism to create a modern regulatory framework that governs health data privacy and interoperability.

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4th Quarter, 2019

Q4 Report

In Q4, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on Jan. 21, 2020. Original Filing: 301128273.xml

Lobbying Issues

United Spinal signed onto a Leadership Council of Aging Organizations letter to Congressional leadership urging them to reauthorize the Older Americans Act (OAA). The OAA is the authorizing vehicle for a number of important programs, including those focused on caregiving. United Spinal was invited to attend a meeting at the CDC to discuss and provide input on SCI registries. United Spinal had signed onto House and Senate Congressional letters in support of the Prescription Drug Pricing Reduction Act, which includes provisions of increased support for low-income beneficiaries and caps on out-of-pocket costs and supports preservation and improvement of the Medicare Rebate Drug Program. Personal Connected Health Alliance (United Spinal is a member) Committee on Ways & Means Rural and Underserved Communities Health Task Force - the Committees forum to convene Members and experts to discuss the delivery and financing of health care and related social determinants in urban and rural underserved areas and identify strategies to address the challenges that contribute to health inequities, issued a Request for Information (RFI) soliciting input on priority topics that affect health status and outcomes for consideration and discussion in future Member sessions of the Task Force. United Spinal supported increased Federal Government funding at NIH. United Spinal signed onto House and Senate letters, in support of extending the 7.5% threshold for the medical expense deduction, S. 110, The Medical Expense Savings Act, introduced by Sen. Susan Collins (R-ME) and a similar bill in the House, H.R. 2073, introduced by Rep. Katie Porter (D- CA 45). National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Medstar Health Research Institute MHRI and United Spinal Association - United Spinal Association finalized an agreement in December with MHRI as a subcontracting partnership to NIDILIRRs Rehabilitation Research and Training Center (RRTC) Program which conducts research to improve rehabilitation methodology and service delivery systems; improves health and functioning; and promotes employment, independent living, family support, and economic and social self-sufficiency for individuals with disabilities. United Spinal will be assisting with recruiting participants for research projects and reviewing educational material: Rehabilitation and Research Training Center on Health and Function for People with Physical Disabilities focused on Neurogenic Lower Urinary Tract Dysfunction.

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Supports Specially Adaptive Housing (SAH), S.2022 / H.R. 3504 The Department of Veterans Affairs (VA) maintains an SAH grant program to help seriously injured veterans purchase or construct an adaptive home or make modifications to an existing home to help accommodate their level of ability. Supports Veterans Expedited TSA Screening Safe Travel Act, S.1881 / H.R. 3356 The VETS Safe Travel Act would grant TSA Pre to veterans who are amputees, paralyzed, or blind at no cost and enable them to pass through airport security easier with prosthetics, wheelchairs, or other mobility aids - allowing for a more dignified experience when passing through security checkpoints at our nations airports. Supports National Suicide Hotline Designation Act of 2019, S.2661 / H.R.4194 Veteran mental health is a national crisis. The National Suicide Prevention Lifeline is a critical tool for preventing suicide, giving people a lifeline in a time of need. Supports Permanent Grants for Rural Veteran Medical Care Transport, H.R 4589 This bill makes permanent the authority of the Secretary of Veterans Affairs to make grants for the transportation of highly rural veterans to medical care. Supports Modernizing VAs Records Management Program Act, H.R 4588 Amends title 38, United States Code, to treat digitized records as originals with respect to claims under the laws administered by the Secretary of Veterans Affairs, and for other purposes. Supports Protect the GI Bill Act, H.R 4625 To amend title 38, United States Code, to require that educational institutions abide by certain principles as a condition of approval for purposes of the educational assistance programs of the Department of Veterans Affairs, and for other purposes.

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United Spinal, along with other members of the Consortium for Citizens with Disabilities, met with Jennifer Sheehy, Deputy Assistant Secretary, ODEP, and her team, to discuss the agencys efforts on its 14(c) online dialogue as well as its efforts on providing resources to states and providers to move towards competitive integrated employment and away from holding certificates to provide subminimum wage [14(c) certificates] to people with disabilities. United Spinal, along with numerous other disability organizations as members of the Consortium for Citizens with Disabilities (CCD) Long Term Services and Supports (LTSS) Task Force, signed onto a letter to Senator Kamala Harris (D-CA) and Rep. Pramila Jayapal (D-WA-7) supporting the principles that inform the Domestic Workers Bill of Rights Act of 2019 without supporting the bill itself. (S. 2112/H.R. 3760). United Spinal policy endorsed Secure the Secure Work Coalitions Statement in support of the Disability Employment Incentive Act H.R. 3992, introduced by Representatives Brian Fitzpatrick (D-CA-1st) and Josh Harder (R-PA-10th).

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Support Disability Integration Act - HR. 555/S. 117. United Spinal staff attended and gave public comment before the U.S. Commission on Civil Rights briefing on the 14(c) program, which allows certain employers to run sheltered workshops for employees with disabilities and pay them less than the minimum wage. United Spinal supports the Transformation to Competitive Employment Act (S. 260/H.R 873), which is legislation that would responsibly end the 14(c) program. Submitted comment letter to Sen. Udall and Rep. Lowenthal opposing their ban on single-use plastic straws in all retail and service establishments. Single-use plastic straws are used by members of the disability community (those who do not have use of their hands) to drink. Support Domestic Workers Bill of Rights Act - S. 2112/H.R 3760

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U.S. Food and Drug Administration (FDA) Scientific Data and Information About Products Containing Cannabis or Cannabis-Derived Compounds; Public Hearing; Request for Comments United Spinal provided comments on the FDAs Public Hearing for Scientific Data and Information about Products Containing Cannabis or Cannabis-Derived Compounds urging for lifting research restrictions on cannabis. The letter read in part: As more states move forward with medical and recreational marijuana legalization, it is critical that Congress take action to protect their right to do so. For this reason, United Spinal supports the passage of the Strengthening the Tenth Amendment Through Entrusting States (STATES) Act, which ensures that each state has the right to determine for itself the best approach to marijuana within its borders. This bill extends these protections to Washington, DC, U.S. territories and contains common-sense guidance to ensure states are regulating in a rational and safe manner. We also support H.R. 712/S.179 known as The VA Medicinal Cannabis Research Act of 2019 which directs the Secretary of Veterans Affairs to carry out a clinical trial of the effects of cannabis on certain health outcomes of adults with chronic pain and post-traumatic stress disorder. We also support H.R. 601, The Medical Cannabis Research Act which increases the number of manufacturers registered under the Controlled Substances Act to manufacture cannabis for legitimate research purposes and authorizes health care increases the number of manufacturers registered under providers of the Department of Veterans Affairs to provide recommendations to veterans regarding participation in federally approved cannabis clinical trials.

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3rd Quarter, 2019

Q3 Report

In Q3, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on Oct. 21, 2019. Original Filing: 301074547.xml

Lobbying Issues

United Spinal, as a member of the DRRC, supported a DRRC request to meet with HHS Secretary Alex Azar to discuss the implementation of the government-wide strategic plan on disability, independent living, and rehabilitation research. United Spinal signed onto a letter to House and Senate leadership in support of the permanent repeal of the medical device tax which has a direct impact on access to critical medical devices for individuals with disabilities and chronic illnesses. National Institutes of Health (NIH) - Request for Information - SCI 2020 Conference United Spinals response included the following main points: United Spinal advocates for improved care of SCI patients in the acute trauma setting so that individuals with SCI are transported to the appropriate rehabilitation facilities, ideally, to have access to maximum rehabilitation potential and functional mobility outcomes. United Spinal advocates for SCI education and SCI expertise throughout the rehab continuum. The essential role of assistive technology to improve functional recovery. The importance of adaptive fitness and nutrition and adaptive and accessible technologies. Regarding the consumer voice in the research space, it is incumbent upon all stakeholders in this space to work collaboratively and it is critical that there is meaningful consumer engagement throughout the research continuum. United Spinal is in dialogue with Congress on the need to designate Spinal Cord Injury Centers of Excellence As a member of the Coalition to Preserve Rehabilitation Steering Committee, United Spinal signed onto a letter to HHS in support of nondiscrimination protections: RIN 0945-AA11; Nondiscrimination in Health and Health Education Programs or Activities; and in a letter to CMS, Patients over Paperwork raised our concerns in a response to CMS RFI on reducing administrative burden in Medicare and Medicaid. As a Steering Committee member of the ITEM Coalition, United Spinal also signed on to this letter. United Spinal advocacy and policy staff played a leading role in the passage of S. Res. 329, a resolution designating September 2019 as National Spinal Cord Injury Awareness Month. Senator Marco Rubio (R-FL) and Senator Tammy Baldwin (D-WI) were the co-leads on the resolution.

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S. 1881, the Veterans Expedited TSA Screening (VETS) Safe Travel Act Provided letter of support to SEN Youngs office and the SVAC in support of this bill expanding access to TSA Pre to severely disabled veterans at no cost. H.R 3356, the Veterans Expedited TSA Screening (VETS) Safe Travel Act Provided letter of support Rep Gosar and Rep Kirkpatrick to the HVAC in support of this bill expanding access to TSA Pre to severely disabled veterans at no cost. Provided letter of support through Consortium of Citizens with Disabilities to the 2020 Labor, Health and Human Services, Education and Related Agencies appropriations committees in both the House and the Senate requesting funding to establish a Disabled Veteran Program at the U.S. Department of Labor (DOL). Signed onto letter from The Military Coalition to Reps Pelosi, McCarthy, Lowey, and Granger of the House and the House Committee on Appropriations urging their attention to passing the Fiscal Year (FY) 2020 Military Construction, Veterans Affairs, and Related Agencies Appropriations bills before the current fiscal year ended on September 30, 2019. H.R. 3867, Violence Against Women Veterans Act Provided letter of support to Rep. Velasquez for her reintroduction of this act which requires the Secretary of Veterans Affairs to improve the provision of services and benefits from the Department of Veterans Affairs for veterans who experience domestic violence or sexual assault, and for other purposes. H.R.3504 - Ryan Kules Specially Adaptive Housing Improvement Act of 2019 Provided letter of support to Rep Bilirakis and Rep Levin for the Ryan Kules SAH Improvement Act, which would increase the number of times veterans could tap into the specially adaptive housing (SAH) program and give access to the full amount every 10 years. S.2022 - Paul Benne Specially Adaptive Housing Improvement Act of 2019 Provided letter of support for the Paul Benne SAH Improvement Act of 2019 to Sens. Moran and Sinema for this act which would increase the number of times and the amount of funding veterans could use in the specially adaptive housing (SAH) program. Bipartisan Budget Act of 2020. Signed onto letter from The Military Coalition to the SASC and HASC covering support for specific parts of the Bipartisan Budget Act of 2020: Elimination of Medical Billets Survivor Benefits Basic Needs Allowance (BNA) Signed onto letter through the Veteran Education Success coalition to Director Kathleen Kraninger of the Consumer Financial Protection Bureau regarding Comment on Debt Collection Practices (Regulation F); Docket No. CFPB-2019-0022 which implements the Fair Debt Collection Practices Act (FDCPA), expressing our views on several pieces of the amendments which may cause undue hardship or loss of clearance for veterans and military members. United Spinal and VetsFirst signed onto coalition comments to the FCC in response to public notices seeking comment on applications to provide Internet Protocol Captioned Telephone Service (IP CTS) from companies that provide Automatic Speech Recognition (ASR) only services; followed up comments by participating in two in-person meetings with FCC staff. Discussed emerging technology at the VA with VA staff.

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United Spinal supports H.R. 2293 introduced by Representatives John Larson and Lee Zeldin - Protecting Access to Wheelchairs Act. United Spinal supports S. 1223 introduced by Senators Bob Casey and Rob Portman. - Protecting Beneficiary Access to Complex Rehab Technology Act of 2019. United Spinal supports HR 2408 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019. As a member of the ITEM Coalition Steering Committee, United Spinal, Christopher & Dana Reeve Foundation, Amputee Coalition, PVA and clinicians, SCI physicians and advocates met with Liz Richter, Deputy Director, Center for Medicare at CMS and others to discuss the need for standing feature and seat elevation components to be covered by Medicare. Medicaid Program; Methods for Assuring Access to Covered Medicaid Services - Rescission, RIN:0938-AT41 Adequate access to services under Medicaid is especially important to people with disabilities. CCD has commented on numerous iterations of this rule, including the original notice of proposed rulemaking in 2011,1 final rule with comment period in 2016,2 request for information in 2016,3 and proposed rulemaking in 2018.4 People with disabilities rely on Medicaid for access to basic health care services and for services that ensure their functioning, independence, and well-being, including: nursing and personal care services, specialized therapies, intensive mental health services, special education services, and other needed services that are unavailable through other insurance. Access to these services is a matter of life, death, and independence for the millions of people with disabilities on Medicaid and the protections provided by the equal access statute are of particular importance to our community. United Spinal signed onto the Durable Medical Equipment Prosthetics, Orthotics and Supplies CY 2020 Proposed Rule to raise concerns about pricing calculated from the 1980s on new technologies and new codes for medical equipment and prosthetics and orthotics which hinders companies from providing newer equipment or investing in developing new technologies and prevents consumer access to reasonably priced products. United Spinal signed onto a Congressional House letter in support of H.R. 3107, Improving Seniors Timely Access to Care Act which protects patients from unnecessary delays in care by supporting and seeks to streamline and standardize prior authorization under the Medicare Advantage program. United Spinal, as a member of the Personal Connected Health Alliance, supports a letter submitted to the Centers for Medicare and Medicaid Services. Medicare and Medicaid Programs; CY 2020 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; Home Health Quality Reporting Requirements; and Home Infusion Therapy Requirements; Proposed Rule. The letter read in part: Our comments focus on important connected care aspects of the home health prospective payment system and the home infusion therapy benefit, and we offer our comments to ensure efficacious, effective, and non-duplicative coverage for remote patient monitoring. United Spinal also commented as a member of ITEM Coalition's Steering Committee on (CMS-1711-P) Medicare and Medicaid Programs; CY 2020 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; Home Health Quality Reporting Requirements; and Home Infusion Therapy Requirements The Proposed Rule updates the home health prospective payment system (HH PPS) payment rates and implements the transition in the unit of payment from a 60-day episode of care to a 30-day episode of care, as required by the Bipartisan Budget Act of 2018. The Proposed Rule also implements the Patient-Driven Groupings Model (PDGM), proposed payment rate changes for home infusion therapy temporary transitional payments, and adjustments to the home infusion therapy benefit, and proposes to phase out the Request for Anticipated Payment (RAP). The Proposed Rule would also change the Home Health Value-Based Purchasing Model (HH VBP) and the Home Health Quality Reporting Program (HH QRP), among other things. Although some components of CMSs new home health payment reform were finalized last year, we continue to have concerns regarding the implementation of and rationale behind the new payment methodology. Our comments focussed largely on the proposed implementation of the PDGM, the proposed authorization of therapist assistants to provide maintenance therapy, and the impact of these proposals on patients receiving rehabilitative care in the home health setting.

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Discussed ADA compliance in AMTRAK railcars with AMTRAK. Sent comments on accessible autonomous vehicles to House and Senate. Discussed TNC Accountability with Congressional House staffers. U.S. Department of Transportation (DOT) Secretary Elaine L. Chao announced the formation of the Air Carrier Access Act Advisory Committee (ACAA Advisory Committee) and the appointment of 19 members, including Nicholas LiBassi, Vice President, Partnership Expansion, United Spinal Association, as representative of national disability organizations and James Sinocchi of JP Morgan Chase. The ACAA Advisory Committee is being established pursuant to the FAA Reauthorization Act of 2018 (FAA Act). United Spinal staff attended Transportation Security Administration (TSA) Annual Disability & Multicultural Coalition Conference 2019 to discuss agency outreach to the disability community. U.S. Access Board Released Voluntary Guidelines for Onboard Wheelchairs United Spinal is advocating for increased accessibility in airline travel in relation to the U.S. Access Board releasing for public comment advisory guidelines for wheelchairs used on commercial passenger aircraft during flight. United Spinal Policy staff monitored a hearing the Board held on September 12 on the guidelines. The Board notice read in part, These onboard wheelchairs are provided by air carriers as a means of facilitating the transfer of passengers with disabilities to aircraft lavatories since personal wheelchairs cannot be used in the cabin. The Department of Transportation (DOT) has expressed its intention to supplement its regulations under the Air Carrier Access Act (ACAA) to include performance standards for onboard wheelchairs on covered aircraft. The Board is developing these non-binding guidelines as technical assistance to air carriers and manufacturers of onboard wheelchairs by providing an example of how to meet DOT's planned performance standards. United Spinal will be submitting comments to the U.S. Access Board.

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On July 25, 2019, United Spinal, and numerous other disability organizations, as members of the Consortium for Citizens with Disabilities (CCD) sent a letter to all members of Congress in recognition of the 29th anniversary of the Americans with Disabilities Act (ADA). The American Civil Liberties Union, Center for Public Representation, and sixteen other national disability advocacy groups, including United Spinal Association, represented by the global law firm Latham & Watkins filed an amicus brief in support of litigation to stop the U.S. Department of Homeland Security (DHS) from implementing its new public charge rule. United Spinal signed a letter addressed to Representatives Jamie Raskin (D-MD) and Chip Roy (R-TX), Chairman and Ranking Member of the House Oversight Subcommittee on Civil Rights and Civil Liberties, thanking the Subcommittee for holding a hearing on the revocation of medical deferred action for critically ill children. The letter urges United States Citizenship and Immigration Services (USCIS) to reverse its decision to stop considering visa applications based on medical deferred action for people who have a serious health condition, and for Congress to make the program permanent. The subcommittee hearing was well attended along with representatives from other disability organizations such as Disability Rights Education and Defense Fund. Due to some strong advocacy from the disability community, USCIS did rescind its decision later the same month.

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United Spinal and the DC Center for Independent Living as plaintiffs in litigation against the Government of the District of Columbia attended and presented at the launch of the DC Homeland Security and Emergency Management Agency Disability Integration Initiative at Gallaudet University. The litigation was completed and signed by both parties earlier in the year. Both United Spinal and the DC CIL are co-chairs of the DC Disability Community Advisory Group which include representatives of the disability community representing individuals who are deaf, blind, who have cognitive and intellectual disabilities etc. DC HSEMA is engaging in workgroup activity, as required by the settlement, in the following areas: post-emergency canvassing operations, communications, sheltering, accessible transportation, high-rise evacuation etc.

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2nd Quarter, 2019

Q2 Report

In Q2, United Spinal Association had in-house lobbyists, and was paid $150,000. The report was filed on July 19, 2019. Original Filing: 301052450.xml

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U.S. Department of Transportation (DOT) United Spinal advocacy and policy staff, along with numerous other disability organizations, as members of the Air Carriers Access Act (ACAA) working group, met with Alexander A. Taday III, Director of Civil Rights Advocacy, Aviation Consumer Protection Division, U.S. Department of Transportation. and Blane Workie, Assistant General Counsel for Aviation Enforcement and Proceedings. The purpose of the meeting was to obtain an update on the progress DOT staff have made in implementing disability related provisions in a new law. On October 5, 2018, President Trump signed into law, H.R. 302 as amended, the FAA Reauthorization Act of 2018, which United Spinal supported. The Act funds the FAA for the next five years. The new law includes an entire section devoted to improving air travel for people with disabilities (Sections 431-441), including restroom accessibility and service animals on planes; studies on airport accessibility, airline employee training, and in-cabin wheelchair restraint systems; and establishment of an advisory committee for passengers with disabilities. Support S.669/H.R. 1549 - Air Carrier Access Amendments Act of 2019

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Outreach to new Members of Congress and committees of jurisdiction on the need to reform rehabilitation access, therapy and expertise for the spinal cord injury. Was asked by the Congressional Telehealth Caucus to submit comments on their RFI on telemedicine, which we did, highlighting the specific needs of access to healthcare and the challenges that our population face with reaching medical experts. Submitted appropriations requests for robust funding to the Hill for the SCI Research Program and the MS Research program at the Department of Defense. National Institutes of Health (NIH) - National Institute for Neurological Disorders and Stroke (NINDS) SCI 2020: Launching a Decade for Disruption in Spinal Cord Injury Research - Post SCI 2020 Call - Had a meaningful discussion with NIH about research priorities for the SCI population and discussed our efforts to advocate on establishing SCI Centers of Excellence. National Institute on Neurological Disorders and Strokes (NINDS) Nonprofit Forum 2019: Progress through Partnership United Spinal Policy staff participated in the Progress through Partnership Forum which provided an opportunity for nonprofit leaders to network with colleagues and to engage in discussions with NINDS staff. The agenda featured panel discussions on cell and gene therapy, data collection and storage, motivating the next generation of researchers, neuroethics and success stories. National Institute of Disability, Independent Living and Rehabilitation Research (NIDILRR) United Spinal policy staff met, along with numerous other disability organizations as members of the Disability Rehabilitation Research Coalition, to outline rehabilitation research priorities to the new director, Jim Whitehead. United Spinal policy staff emphasized fitness, exercise, nutrition and maximizing consumer outcomes from acute care and rehabilitation programs. United Spinal supports and signed onto letters to Congress on H.R.2073 and S. 110 (The Medical Expense Savings Act) - amend the Internal Revenue Code of 1986 to permanently extend the 7.5 percent adjusted gross income floor for the medical expense deduction. HHS - Administration for Community Living United Spinal signed onto CCDs letter to the U.S. Department of Health and Human Services ACL to oppose the ACL reorganization which is supposed to improve efficiency and effectiveness of the organization; strengthen infrastructure; and improve the connections between the organization and its stakeholder, grantees and consumers at the national, state and local levels. CCD is concerned that the reorganization plan may have the opposite result. HHS - Office of the National Coordinator for Health IT As a member of the Personal Connected Health Alliance (PCHAlliance), a non-profit membership association, United Spinal joined in commenting on the proposed rule, titled 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program, published in the Federal Register on March 4, 2019. The letter read in part: PCHAlliance appreciates ONCs extensive work to develop consensus around interoperability standards. Consensus-based standards, certification programs, and policies comprise the essential backbone to enable interoperability and the broad sharing of health care information to support and improve health care delivery, decision-making, and operations. NIH United Spinal submitted comments addressing the National Center for Medical Rehabilitation Researchs Request for Information: Research Plan on Rehabilitation. The comments read in part: We echo the comments we joined in submitting as a member of the Disability Rehabilitation Research Consortium (DRRC), the plan should ensure an understanding of rehabilitation research that is cross-cutting, multi-disciplinary, and focused on 1) understanding the mechanisms of disability, 2) supporting efforts to restore and improve functional capacity in individuals undergoing rehabilitation, and 3) maintaining and preventing deterioration of functional skills while enhancing quality of life for people with disabilities. 21st Century Assistive Technology Bill/S. 1835. Submitted letter of support to Senator Caseys office for the introduction for the 21st Century Assistive Technology Act which would help address the need for increased education of and access to the latest assistive technology devices, particularly for people with disabilities living in rural regions. United Spinal sent in comments to Rep. Suzan DelBene (D-WA) on telemedicine restrictions regarding telehealth policies in her bill entitled Mental Health Telemedicine Expansion Act/H.R. 1301 and highlighted our opposition to in-person visit requirements.

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H.R. 1925/S. 898: A bill to designate the Manhattan Campus of the New York Harbor Health System of the Department of Veterans Affairs as the Margaret Cochran Corbin Campus of the New York Health Care System". Supporting the first renaming of a VAMC after a woman veteran by providing a letter of support directly to the House Veterans Affairs Committee. Margaret Corbin was the first female combat veteran to receive a pension from the US government, serving in the Revolutionary War. H.R. 846, the Veterans Serving Veterans Act Provided letter of support to Rep Gonzalez-Colons office for the Veterans Serving Veterans Act which directs the Secretary of the VA to establish a vacancy recruitment database to facilitate the recruitment of certain members of the Armed Forces to satisfy occupational needs within the Department in order to overcome chronic staffing shortage. H.R. 2557, The Get Veterans a Doctor Now Act Provided letter of support to Representative Sean Patrick Maloneys office for the Get Veterans a Doctor Now Act, which allows the VA to recruit resident physicians earlier, offering doctors a conditional job offer up to two years prior to their graduation. H.R. 299: The Blue Water Navy Vietnam Veterans Act. Signed onto joint letter of support to the HVAC as part of the 18-member National Military and Veterans Alliance. This act recognizes and brings relief to veterans who, during active military, naval, or air service, served offshore of the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975 by amending Title 38 to recognize the presumption that these veterans have been exposed to the herbicide Agent Orange, notwithstanding that there is no record of evidence of such disease during the period of such service.

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Department of Health and Human Services (HHS) United Spinal, as a Steering Committee Co-Chair of both ITEM Coalition and the Coalition to Preserve Rehabilitation, met with HHS External Affairs team to discuss the need for specialized rehabilitation for our population and the importance of protections for customized wheelchair features such as standing wheelchairs and seat elevation. Continue to advocate for opposition to HHS competitive bidding program for customized wheelchairs and ventilators and medical supplies to be included in Medicares competitive bidding program. United Spinal signed on to and helped draft a letter to the Centers for Medicare and Medicaid Services (CMS) opposed to including ventilators in the competitive bidding program. As part of the ITEM Coalition and CPR Steering Committees and HAB Coalition membership, we also raised concerns in a letter to CMS on its proposal to expand the sale of health insurance across state lines which may leave adults and children, particularly those with disabilities and chronic health conditions, with less comprehensive coverage and higher out-of-pocket costs but we support the efforts of increasing coverage in general. Sent letters to CMS opposing inclusion of ventilators in Medicares competitive bidding program. Worked with PCHA, ResMed and helped draft letters for the ITEM Coalition for Congress. United Spinal supports H.R. 2293 introduced by Representatives John Larson and Lee Zeldin - Protecting Access to Wheelchairs Act. United Spinal supports S. 1223 introduced by Senators Bob Casey and Rob Portman. - Protecting Beneficiary Access to Complex Rehab Technology Act of 2019. United Spinal supports HR 2408 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019. United Spinal, as a member of the MAP Rx Coalition, signed onto a letter to leadership of the House Ways and Means Committee and the Energy & Commerce Committee supporting caps to out of pocket costs for Medicare Part D beneficiaries and other issues. CMS As a member of the Personal Connected Health Alliance (PCHAlliance), a non-profit membership association, United Spinal joined in comments on the Interoperability and Patient Access for Medicare Advantage Organization and Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans in the Federally-Facilitated Exchanges and Health Care Providers (CMS-9115-P) in an effort to advance CMS policy to enable consumers access to health information and administrative consumer information. United Spinal Association supports H.R.3215/S.1754 - Disaster Relief Medicaid Act which would ensure that Medicaid-eligible individuals displaced during a disaster are able to access those same services. United Spinal submitted a letter of support for H.R. 1839/ Medicaid Services Investment and Accountability Act of 2019, Public Law 116-16. This bill extends protection for Medicaid recipients of home and community-based services against spousal impoverishment as well as strengthens the Medicaid program for children with complex medical needs and protects seniors and people with disabilities. Medicares Competitive Bidding Program United Spinal, as a member of the ITEM Coalitions Steering Committee, United Spinal helped draft and singed on to letters to Congress supporting CRT bills and exemption of manual CRT accessories from competitive bidding as well as opposition to inclusion of ventilators in the competitive bidding program and helped with additional Congressional signatories to opposing including ventilators in the program.

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S. 260/H.R. 873 Transformation to Competitive Employment Act (TCE) United Spinal policy staff sent out a letter of support for S. 260/H.R. 873 the Transformation to Competitive Employment Act (TCE) to Senate and House staffers urging for passage. This bill seeks to assist employers in transforming their business models to support individuals with disabilities into competitive, integrated employment settings and to phase out the use of special wage certificates under section 14(c)of the FLSA over a six-year period. This is an important bill as TCE aims to ultimately remove artificial barriers to employment opportunities for people with disabilities. United Spinal signed onto the Consortium for Citizens with Disabilities comments to DOLs OFCCP concerning the proposed information collection for focused reviews of compliance with Section 503 of the Rehabilitation Act. United Spinal and CCD support OFCCPs plan to conduct focused reviews of compliance with Section 503. We believe the information that OFCCP is seeking to collect is critically important for assessing compliance. United Spinal, along with numerous other organizations as members of the Secure Work Coalition, sent follow up comments on ensuring successful employment outcomes for Social Security program beneficiaries. The letter read in part: Thank you for taking the time to meet with return to work stakeholders at the recent summit meeting on ensuring successful employment outcomes for recipients of Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Many of the Employment Networks (EN) invited to participate in the program are members of the Secure Work Coalition (SWC) and have shared positive feedback on the experiences and ideas discussed there with other Coalition members.

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Outreach to new 116th Members of Congress and appropriate committees of jurisdiction regarding the support of expanding access to accessible autonomous vehicles. United Spinal supports the reintroduction of AV legislation. As part of the Mobility Equity and Access Coalition, United Spinal provided edits and signed onto a letter to Finch Fulton, Deputy Assistant Secretary for Transportation Policy at DOT related to automated driving systems demonstration grants and accessibility and transportation issues. United Spinal advocacy and policy staff joined Amtrak for their quarterly meeting with the disability community to discuss the progress of their disability-related projects. Among the biggest concerns currently, is the removal of staff at several stations throughout the country. Amtrak is working with the community to ensure that people with disabilities are not left out if any assistance is needed. The second biggest issue is related to the rolling out of their revamped app, which by the end of January should allow people with disabilities to book their travel and use their discounts. Met with Rep. Jim Langevins office to discuss transportation network companies and other challenges for the disability community.

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United Spinal policy staff has submitted multiple requests to various Members of Congress, including those on the Appropriations committees to ensure continued robust funding for critical SCI and disability programs, such as the Spinal Cord Injury Program and the Congressionally Directed Medical Research Program for Multiple Sclerosis, both at the Department of Defense. Also, United Spinal policy staff supported the following issues: Assistive Technology Funding United Spinal, along with the Consortium for Citizens with Disabilities Autism, Developmental Disabilities and Family Supports Task Force sent a letter to House and Senate Appropriations Committee leadership to urge adequate Fiscal Year 2020 funding for programs authorized by the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (DD Act) and State Assistive Technology Programs.

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United Spinal, as member of the Personal Connected Health Alliance (PCHAlliance), joined in comments PCHAlliance and the Healthcare Information and Management Systems Society (HIMSS) submitted to the US Food and Drug Administration in response to the Discussion Paper and Request for Feedback entitled, Proposed Regulatory Framework for Modifications to Artificial Intelligence/Machine Learning (AI/ML)-Based Software as a Medical Device (SaMD), (hereinafter Proposed Framework). The letter read in part: We recommend using other industries who have been involved in the discussions and regulatory review of AI/ML, as an example for the health care industry. FDA should also consider convening a technical expert panel of stakeholders from multiple areas that would have material involvement in future frameworks such as the one represented in this paper, or in the alternative, leverage the experience of participants in the Pre-Cert Program, to participate on an expert committee. FDA should consider establishing an ongoing program - such as Smart and Connected Health - that focuses on the interface between research and industry domains to identify and maintain key issues and share learnings. Meeting with Senator Thunes office (R-SD) on issues of accessible autonomous vehicles (AV), on the need for universal accessible design funding as well as establishing national AV standards and related technology testing.

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1st Quarter, 2019

Q1 Report

In Q1, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on May 10, 2019. Original Filing: 301040704.xml

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United Spinal and other advocacy groups, including Paralyzed Veterans of America, National Council on Independent Living and others met with DOT personnel to discuss the implementation of air travel provisions for passengers with disabilities as passed in the 115th Congress in 2018 related to the Air Carriers Access Amendments Act, such as regulating that passengers with disabilities receive dignified, timely and effective assistance at airports; establishing the Advisory Committee on the Air Travel Needs of Passengers with Disabilities; increasing civil penalties for bodily harm to a passenger with a disability and damage to wheelchairs or other mobility aid as well as discussing the Air Travel Accessibility Advisory Committee nominations. Support S.669/H.R. 1549 - Air Carrier Access Amendments Act of 2019

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United Spinal Association is an official non-federal partner of NIH for their February SCI 2020 Conference. United Spinal Policy staff are working: with NIH representatives to include discussions of rehab therapy and rehab denials/rehab outcomes for the SCI population in the Conference. to disseminate throughout our network a North American Spinal Cord Injury Consortium SCI survey they developed and plan on presenting the results at the conference. with the lead institute for the Conference, the National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH) to promote attendance for the Conference from the clinician community. United Spinal, as a member of the Disability and Rehabilitation Research Coalition (DRRC), and along with other members, supported the DRRCs comments on the Eunice Kennedy Shriver National Institute of Child Health and Human Developments (NICHD) Request for Information: NICHD Strategic Plan Fiscal Years 2020-2024. The comments emphasized the importance of the National Center for Medical Rehabilitation Research (NCMRR) and its mission to foster development of scientific knowledge needed to enhance the health, productivity, independence, and quality of life of people of all ages with physical disabilities. An important component of this includes the integration of nutritional guidance and exercise into rehabilitation efforts, as well as maximizing the outcomes of those twin pillars of health throughout a childs development. Outreach to new 116th Members of Congress and appropriate committees of jurisdiction on maximizing rehabilitation outcomes for people with spinal cord injuries and disorders. As a member of the Societys Activism Advisory Committee and as a member of the Multiple Sclerosis Coalition, United Spinal policy staff attended the Societys PPC conference in March. The PPC advocated Congress for lower drug pricing; penalties to pharmaceutical companies who pay to delay the introduction of generics to the market; and the funding for the National Institutes of Health, and the Congressionally-Directed Medical Research Program for Multiple Sclerosis at the Department of Defense.

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United Spinal and NCART met with the office of Representative Sensenbrenner (R-WI) to discuss reintroduction, in the new 116th Congress, of legislation to improve access to customized wheelchairs. United Spinal, as part of the Coalition to Preserve Rehabilitation, submitted comments to CMS, on the Medicare Advantage (MA) and Part D programs through the Medicare Advantage and Part D Draft CY 2020 Call impacting benefits related to people with disabilities. United Spinal, as part of the Coalition to Preserve Rehabilitation requested a meeting with Secretary Azar to discuss the value of inpatient hospital rehabilitation and coverage of seat elevation and standing feature power wheelchairs for Medicare beneficiaries. United Spinal signed onto letters to the Centers for Medicare and Medicaid Services spearheaded by the above-named groups urging the agency to not restrict access to the six protected classes of drugs. We submitted comments to the Centers for Medicare and Medicaid Services and opposed sections of the CMS' Proposed Rule: Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce, which would establish broad exceptions to Part Ds protected classes policy. As a Steering Committee member of the ITEM Coalition, United Spinal and others discussed with CMS Principal Deputy Administrator Demetrios Kouzoukas the need for Medicare coverage of standing wheelchairs and seat elevation as a follow-up to an in-person meeting, United Spinal and others had in October with CMS Chief Medical Officer, Kate Goodrich. ITEM Coalition continues to advocate for improved access for people with physical disabilities and chronic illnesses, to all assistive technologies and devices. United Spinal's Access and Care Coalition made a series of Hill visits over the course of two days to inform Members of Congress on the House Energy and Commerce and the House Ways and Means Committees of the negative impacts of the Centers for Medicare and Medicaid Services competitive bidding program on urology and ostomy supplies. S. 584/H.R. 1342 EMPOWER Care Act CCD Support Letter United Spinal Association signed onto a Consortium for Citizens with Disabilities letter led by the Long-Term Services & Supports (LTSS) Task Force addressed to both House and Senate leadership urging support for S. 584/H.R. 1342 a bill which reauthorizes the Money Follows the Person (MFP) Medicaid demonstration program for five more years. Medicaid Services Investment and Accountability Act of 2019/H.R.1839 One of the important provisions of this bill, which United Spinal supports, is that the bill extends the applicability of Medicaid eligibility criteria that protect against spousal impoverishment (spousal income is excluded for Medicaid eligibility criteria) for recipients of home- and community-based services.

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On January 14, 2019 the Co-Chairs of the Social Security Task Force of the Consortium for Citizens with Disabilities (CCD), of which United Spinal Association (along with numerous other disability organizations), is a member, commented on the Notice of Proposed Rulemaking on Setting the Manner for the Appearance of Parties and Witnesses at a Hearing, 83 Fed. Reg. 57368 (November 15, 2018), Docket No. SSA- 2017-0015, raising concerns about removing in-person hearings as an option. Consideration of Pain in the Disability Determination Process United Spinal, along with numerous other disability organizations that are members of the Social Security Task Force of the Consortium for Citizens with Disabilities (CCD), signed onto comments about the Social Security Administrations Advanced Notice of Proposed Rulemaking on Consideration of Pain in the Disability Determination Process, 83 Fed. Reg. 64493 (December 17, 2018), Docket No. SSA-2018-0017, ensuring that chronic pain and disability be appropriately recognized in medical documentation as part of the determination process. United Spinal supports Social Security Task Force of the Consortium for Citizens with Disabilities (CCD) Co-Chairs comments on Review and Reassessment of the Social Security Administration's (SSA) Representative Payee Selection and Replacement Policies

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4th Quarter, 2018

Q4 Report

In Q4, United Spinal Association had in-house lobbyists. The report was filed on Jan. 22, 2019. Original Filing: 301017078.xml

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Accessible Exercise Equipment United Spinal helped introduce legislation of Senator Tammy Duckworth, S. 3729 - Exercise and Fitness For All Act that would authorize the Access Board to issue guidelines specifying the number and types of accessible exercise equipment required. It also provides for a tax credit for a small business purchasing accessible exercise equipment. United Spinal Association discussed with NIH and CDC the work related to appropriating $5 million per year for 4 years for the National Neurological Conditions Surveillance System in 2018 appropriations. Communicated with NIH the importance of focusing on the need for better outcomes data on rehab for the SCI community. United Spinal became an official non-Federal partner along with others for NIH's SCI 2020 Conference. United Spinal provided feedback on challenges and opportunities regarding improved communication and focused priorities with NIDILRR. United Spinal presented at the Spinal Cord Injury Model Systems Project Directors Meeting on the need for better rehab research outcomes for the SCI/D community.

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Supports H.R. 750 The Ensuring Access to Quality Complex Rehabilitation Technology (CRT) Act. Supports S. 486 Protecting Beneficiary Access to Complex Rehab Technology Act of 2017 Supports H.R. 3730 (To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative manual wheelchairs and accessories) was introduced by Representatives Lee Zeldin (R-NY) and John Larson (D-CT) to stop CMS from using Competitive Bid pricing for accessories used with CRT manual wheelchairs. Discussed with CMS, the issue of power wheelchair standing and seat elevation devices and the need for appropriate coverage under Medicare. Discussed with CMS, the need for excluding ostomy and urology supplies from CMS' competitive bidding program. Sent letter to CMS re: the National Coverage Decision on Blood Pressure Monitoring to account for the specific needs of the SCI population. Sent letter to CMS on appropriate coding for powered orthotic and prosthetic devices for the SCI/D population. Spoke with CMS on the issue of catheter-associated UTIs and to ask CMS to look at the policy around removing indwelling catheters from individuals with SCI in a hospital setting. Removing catheters from SCI individuals is a very complex decision. Supported HR 7217 - the IMPROVE Act. Supported additional telehealth benefits in Medicare Advantage as United Spinal, and as a member of the Coalition, PCHAlliance. And provided comments to CMS on digital health and need the innovation to CMMI as part of PCHAlliance. Continued to provide comments on appropriate access to assistive technology and medical devices, as part of the ITEM Coalition on behalf of the SCI community and on appropriate rehabilitation as part of the Coalition to Preserve Rehabilitation.

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3rd Quarter, 2018

Q3 Report

In Q3, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on Oct. 22, 2018. Original Filing: 300996093.xml

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Support H.R. 5603 the Access to Telehealth Services for Opioid Use Disorders Act. Sent a letter to ACL/HHS related to concerns about community living remarks by ACL and the disability community. Met with ACL several times to discuss community living issues including access to CRT, our support for the Disability Integration Act, S. 910/HR. 2472, competitive integrated employment and employment for people with disabilities in the healthcare sector and accessible medical diagnostic equipment. Support H.R. 6042 and HR. 5912 which amend Title XIX of the Social Security Act, to delay the reduction in Federal medical assistance percentage for Medicaid personal care services furnished without an electronic visit verification system. Accessible Exercise Equipment United Spinal helped draft and provide comments to a former Access Board member to a letter to Senator Tammy Duckworth (D-IL) urging her to introduce legislation, similar to HR 5541/S. 2888, 113th Congress - Exercise and Fitness For All Act that you co-sponsored in 2014, that would authorize the Access Board to issue guidelines specifying the number and types of accessible exercise equipment required. It also provides for a tax credit for a small business purchasing accessible exercise equipment. Medical Expense Coalition United Spinal has been advocating to increase and expand the medical expense deduction and so we signed onto a letter to Senators Susan Collins (R-ME) and Rob Portman (R-OH) who have introduced medical expense provisions in the past,as well as to the House of Representatives. For the approximately 8.8 million Americans who annually take this deduction, it provides important tax relief which helps offset the costs of acute and chronic medical conditions for older Americans, children, pregnant women and other adults as well as the costs associated with long term care and assisted living. Medical expenses that qualify for this deduction can include amounts paid for prevention, diagnosis, treatment, equipment, qualified long-term care services costs as well as long term care insurance premiums. Families across the country with high health care costs face a constant stream of deductibles and high co-pays, and also pay out-of-pocket for various services and devices that enable the individual to live a productive life in the community. Opposed move of NIDILRR from ACL included in House and Senate appropriations committee language. United Spinal signed onto a Health IT Now Coalition letter to the Office of the National Coordinator for Health Information Technology and the Office of the Inspector General, both at the Department of Health and Human Services to follow up on regulatory implementation issues. Section 4004 of 21st Century Cures Act, which was signed into law in December 2016, requires the Secretary of Health and Human Services to issue regulations to prevent information blocking and to also identify reasonable and necessary activities that do not constitute information blocking. Further, the law requires the Office of the National Coordinator (ONC) to implement a standardized process for the public to submit reports on claims of health information technology products or developers of such products not being interoperable or resulting in information blocking and actions that result in information blocking. The Office of the Inspector General (OIG) has enforcement authority over vendors and providers who are found to engage in information blocking. United Spinal Association signed onto a thank you letter to Congress for appropriating $5million per year for 4 years for the National Neurological Conditions Surveillance System in 2018 appropriations.

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CIV- Civil Rights/Civil Liberties - Department of Health and Human Services, Centers for Medicare and Medicaid Services VetsFirst, along with United Spinal Association, signed onto a letter of support from the ITEM Coalition regarding Medicare coverage of elevation and standing feature power wheelchairs. Along with 22 other organizations, we support Medicare coverage of such equipment in order to improve access and quality of life for wheelchair users. FIN- Financial Institutions/Investments/Securities - Department of Defense VetsFirst signed onto an action letter from the Consumer Financial Protection Bureau asking Secretary of Defense James Mattis for continued strong enforcement and supervision of the Military Lending Act. This legislation helps protect service members from predatory lending practices, which, in turn, helps protect defense funding. EDU- Education - Department of Education VetsFirst signed onto an action letter from Veterans Education Success urging the Department of Education to retain program integrity rules for colleges wanting to receive taxpayer dollars. These rules help protect students by requiring that teachers actually teach students, instead of relying on videos for lecture material. The letter also requests that the Education Department include a representative of veterans, service members, military families, and survivors on the negotiated rule-making panels.

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Supports H.R. 750 The Ensuring Access to Quality Complex Rehabilitation Technology (CRT) Act. Supports S. 486 Protecting Beneficiary Access to Complex Rehab Technology Act of 2017 Supports H.R. 3730 (To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative manual wheelchairs and accessories) was introduced by Representatives Lee Zeldin (R-NY) and John Larson (D-CT) to stop CMS from using Competitive Bid pricing for accessories used with CRT manual wheelchairs. Supports H.R. 626, the Access to Inpatient Rehabilitation Therapy Act of 2017, which would amend the Social Security Act to include recreational therapy among the therapy methods that can be considered part of an intensive rehabilitation therapy program in an inpatient rehabilitation hospital or unit. Myomos MyoPro support letter to CMS Policy staff, as members of United Spinal Association, wrote the Centers for Medicare and Medicaid Services (CMS) in strong support of an application to CMS for a unique Healthcare Common Procedure Coding System (HCPCS) code for the MyoPro device, created by the medical technology company, Myomo. Support of S. 2227/H.R.5306 Empower Care Act which reinstates the Money Follows the Person program and facilitates smooth transitions out of nursing facilities and into the community. Signed onto letters to Congress in support of including functional quality measures in rehabilitation metrics. United Spinal supports this letter but CCD Task Force co-chairs: The co-chairs of the Consortium for Citizens with Disabilities (CCD) Health, Long-Term Services and Supports, and Rights Task Forces write in opposition to proposals that expand coverage of institutional services in Medicaid without addressing gaps in Medicaid community services. CCD is the largest coalition of national organizations working together to advocate for Federal public policy that ensures the self-determination, independence, empowerment, integration and inclusion of children and adults with disabilities in all aspects of society.

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2nd Quarter, 2018

Q2 Report

In Q2, United Spinal Association had in-house lobbyists, and was paid $150,000. The report was filed on July 20, 2018. Original Filing: 300977501.xml

Lobbying Issues

Continued lobby efforts on HR 620 The ADA Education and Reform Act meetings to oppose this legislation. United Spinal continues to advocate for the Disability Integration Act (S. 910, H.R. 2472). The legislation builds on the Americans with Disabilities Act and the Supreme Courts Olmstead decision, and asserts that people with disabilities have a right to live in their own homes and communities and to receive the services and supports they need to do so. United Spinal signed onto a letter of support for the Disability Integration Act (S. 910, H.R. 2472)along with numerous other disability organizations as members of the Consortium for Citizens (CCD), signed onto a letter to congressional leaders, Majority Leader McConnell and Minority Leader Schumer, Speaker Ryan and Leader Pelosi reiterating support of the Disability Integration Act (S. 910, H.R. 2472). This legislation, if passed, would ensure the rights of people with disabilities to live full and independent lives in their communities. Working with the Department of Labor in Twitter chats in promoting accessible transportation for people with disabilities. United Spinal and other stakeholder groups met with Sen. Caseys office to discuss employment challenges and opportunities for people with disabilities.

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S. 2372, VA MISSION Act: Advocated on and submitted letter of support to Senate Veterans Affairs Committee Chairman Johnny Isakson regarding this legislation. S. 2372 would combine multiple existing programs to establish a permanent Community Care Program under the Department of Veterans Affair. This program is designed to allow for timely and quality access to medical care for veterans across the nation. It would also provide clear access guidelines and quality care standards, as well as offer education programs for veterans and medical staff members regarding the program. H.R. 4146, Disabled Veterans Life Insurance Act Advocated on and submitted a letter of support to Representative Steve Pearce (R-NM) regarding this legislation. H.R. 4146 will provide congressional mandates to update mortality and annuity tables used by the VA to calculate insurance payouts for disabled veterans life insurance policies. This bill will also extend the application period from two (2) years to ten (10) years in order for all qualifying veterans to be afforded the opportunity to apply. Updating this program will allow disabled veterans to receive affordable and equitable life insurance policies that they may otherwise not qualify for in the civilian sector. H.R. 5536, Disabled Access Credit Expansion Act: Submitted a letter of support regarding this legislation. H.R. 5536 offers incentives for small businesses to comply with landmark ADA requirements resulting in expanded access and job opportunities for disabled veterans. Support of S. 2193 - Caring for our Veterans Act.

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As a member of the Disability Rehabilitation Research Coalition (DRRC), United Spinal helped draft and signed onto a letter the DRRC sent to the House and Senate bipartisan appropriations subcommittees leadership recommending that the FY 2019 Labor, HHS, Education, and Related Agencies appropriations bill provide necessary and sufficient funding for the various federal agencies supporting and conducting disability, independent living, and rehabilitation research to address the current and future needs for individuals with disabilities and society. Signed on to a letter to Congress to express our strong opposition to the Administrations proposal in its FY 2019 Budget to transfer the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) to the National Institutes of Health (NIH). United Spinal signed onto a Congressional letter, facilitated by the National Respite Coalition, in support of Fiscal Year 2019 Labor/HHS/Education Appropriations bill for respite and family caregiver support that provide a safety net for family caregivers across the lifespan supporting $5 million for the Lifespan Respite Care Program and at least level funding (though pushing for a 12% increase) for the National Family Caregiver Support Program.

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Supports H.R. 750 The Ensuring Access to Quality Complex Rehabilitation Technology (CRT) Act. Supports S. 486 Protecting Beneficiary Access to Complex Rehab Technology Act of 2017 Supports H.R. 3730 (To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative manual wheelchairs and accessories) was introduced by Representatives Lee Zeldin (R-NY) and John Larson (D-CT) to stop CMS from using Competitive Bid pricing for accessories used with CRT manual wheelchairs. Supports H.R. 626, the Access to Inpatient Rehabilitation Therapy Act of 2017, which would amend the Social Security Act to include recreational therapy among the therapy methods that can be considered part of an intensive rehabilitation therapy program in an inpatient rehabilitation hospital or unit. Myomos MyoPro support letter to CMS Policy staff, as members of United Spinal Association, wrote the Centers for Medicare and Medicaid Services (CMS) in strong support of an application to CMS for a unique Healthcare Common Procedure Coding System (HCPCS) code for the MyoPro device, created by the medical technology company, Myomo. Support of S. 2227/H.R.5306 Empower Care Act which reinstates the Money Follows the Person program and facilitates smooth transitions out of nursing facilities and into the community. Signed onto letters to Congress in support of including functional quality measures in rehabilitation metrics. United Spinal supports this letter but CCD Task Force co-chairs: The co-chairs of the Consortium for Citizens with Disabilities (CCD) Health, Long-Term Services and Supports, and Rights Task Forces write in opposition to proposals that expand coverage of institutional services in Medicaid without addressing gaps in Medicaid community services. CCD is the largest coalition of national organizations working together to advocate for Federal public policy that ensures the self-determination, independence, empowerment, integration and inclusion of children and adults with disabilities in all aspects of society.

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1st Quarter, 2018

Q1 Report

In Q1, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on April 20, 2018. Original Filing: 300957598.xml

Lobbying Issues

Continued lobby efforts on HR 620 The ADA Education and Reform Act meetings to oppose this legislation. Met with Congressional staff in the House and Senate to voice our concerns with the bill. Shared United Spinal letter of opposition on H.R. 620 the ADA Education and Reform Act via email to all House staff voicing our concerns with this legislation. United Spinal participated in NCD quarterly meeting to discuss potential new policy initiatives from autonomous vehicles to transitioning away from subminimum wage and 14(c) certificates. Attended, along with several other disability organizations, a meeting with Sen. Feinstein and Sen. Flake judiciary staffers to discuss our concerns with and opposition to H.R. 620 the ADA Education and Reform Act which was passed out of the House. H.R. 620, ADA Education and Reform Act: VetsFirst, a program of United Spinal Association, submitted a letter of opposition regarding this legislation. H.R. 620 restricts disabled patrons rights to accessible and accommodative facilities and services required by law through the Americans with Disabilities Act (ADA) by allowing businesses to delay meeting their obligations to make necessary changes to noncompliant facilities and services. United Spinal, along with numerous other disability organizations, signed on to a Consortium for Citizens with Disabilities (CCD) and the Collaboration to Promote Self Determination (CPSD) letter to express concern about the Justice Departments recent withdrawal of a number of guidance and technical assistance documents concerning the Americans with Disabilities Act (ADA). United Spinal met with Congressional staff in Rep. Langevin's office and Sen. Tammy Baldwin's office to thank them for their leadership on their bills, S, 1318 and HR 5004 and to discuss advocacy strategy together.

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Signed onto letter, led by the CCD Transportation Task Force, to Senator Tammy Baldwin, in support of the Air Carrier Access Amendments Act of 2017, her bill, S.1318. Congressional staff with U.S. Representative Jim Langevin's (D-RI-02) office discussed air travel for people with disabilities and related policy issues with United Spinal and other disability stakeholders. United Spinal, along with numerous disability organizations, signed on to an Air Carrier Access Act (ACAA) working group letter to the U.S. Department of Transportation expressing concern with the revised service animal policies announced by Delta Air Lines and United Airlines (United) in January. The letter read in part: We believe that these policies, which are slated to go into effect on March 1, are inconsistent with the Department of Transportations regulations implementing the Air Carrier Access Act (ACAA) (14 C.F.R 382) and the Departments Guidance Concerning Service Animals in Air Transportation, [68 Fed. Reg. 24,874 (May 9, 2003)]. Consequently, the Department must deem these revised policies to be in violation of the ACAA and advise Delta and United accordingly. United Spinal, along with numerous other disability organizations, signed on to a Consortium for Citizens with Disabilities (CCD) letter to U.S. Senator Tammy Baldwin in support of the Air Carriers Access Amendments Act of 2017 (ACAAA). Although the Air Carriers Access Act of 1986 (ACAA) prohibited discrimination based on disability in air travel and despite the ACAA has led to improved access for passengers with disabilities, significant disability-related problems persist in air travel. Travelers with disabilities still encounter damaged equipment, delayed assistance, lack of seating accommodations, and other challenges when traveling by air. Airlines reported receiving more than 30,000 passenger filed disability-related complaints in 2016. United Spinal, along with numerous other disability organizations, signed on to a Consortium for Citizens with Disabilities (CCD) letter to U.S. Senator Tammy Baldwin in support of the Air Carriers Access Amendments Act of 2017 (ACAAA). Although the Air Carriers Access Act of 1986 (ACAA) prohibited discrimination based on disability in air travel and despite the ACAA has led to improved access for passengers with disabilities, significant disability-related problems persist in air travel. Travelers with disabilities still encounter damaged equipment, delayed assistance, lack of seating accommodations, and other challenges when traveling by air. Airlines reported receiving more than 30,000 passenger filed disability-related complaints in 2016.

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H.R. 4508, Promoting Real Opportunity, Success, and Prosperity Through Education Reform Act (PROSPER): VetsFirst, a program of United Spinal Association,signed onto a Student Veterans of America opposition letter regarding this legislation. HR 4508 would enable proprietary institutions to use deceptive recruitment practices that emphasize enrollment numbers rather than positive student outcomes. In addition, the bill proposes eliminating the 90/10 rule-a requirement that proprietary schools receive no more than 90 percent of its revenue from the federal government. United Spinal wrote a letter to the Department of Education (DOE) regarding Section 5005 of the Every Student Succeeds Act (ESSA). Rural school districts can be isolated and as such may not have access to the services/resources provided by urban educational organizations and disability entities. These resource restrictions can include the lack of services provided by full-time nurses, school psychologists, counselors and social workers who are most knowledgeable regarding identifying complex neurological conditions. The result is an inability to provide free and appropriate public education (FAPE). United Spinal Association and other members of the Consortium for Citizens with Disabilities (CCD) Civil Rights, Education, and Technology & Telecommunications Task Forces wrote to Congress in reference to Section 735 of the Promoting Real Opportunity, Success, and Prosperity through Education Reform (PROSPER) Act, H.R. 4508. Section 735 encourages institutions of higher education to design and use accessible instructional materials. We support the provisions of Section 735 of PROSPER Act and the Senate companion bill that would authorize the creation of a commission to develop voluntary accessibility guidelines for electronic instructional materials and related technologies used in postsecondary education. Our serious concern is with the inclusion of a safe harbor provision.

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United Spinal, along with numerous other disability organizations, signed on to a Consortium for Citizens with Disabilities (CCD) and a separate CCD letter to Congressional House and Senate leadership in support of H.R. 3730 to protect access to essential components of complex rehabilitation manual wheelchairs known as accessories for people with significant disabilities prior to the Federal governments funding agreements in January. Complex Rehabilitation Technology (CRT) are medically necessary, individually configured products such as manual and power wheelchairs, adaptive seating systems and alternative positioning systems that keep people with significant disabilities such as Amyotrophic Lateral Sclerosis (ALS), spinal cord injury, multiple sclerosis (MS) and muscular dystrophy healthy and independent. United Spinal was actively engaged with Congress, as part of the Therapy Cap Coalition, (and signed onto several letters) in opposing any limits to therapy visits for speech-language, occupational or physical therapy. United Spinal signed onto a letter to the Centers for Medicare and Medicaid Services regarding the importance of balancing the goals of health plan flexibility with ensuring beneficiary protections. Department of Health and Human Services - Centers for Medicare and Medicaid Services (CMS) - Winter Outreach Call United Spinal attended a stakeholder meeting with CMS and a group of disability advocacy organizations who were invited by CMS and the Administration for Community Living (ACL) to participate in a Winter Outreach call to discuss competitive bidding complaints, the announcement of additional ombudsman positions and related updates, the issuance of new Medicare cards and other beneficiary issues. United Spinal signed onto a letter to CMS, facilitated by the American Urology Association, to eliminate the administrative barriers to patient access to medically necessary services that are imposed by Medicare Advantage plans increasing prior authorization requirements. United Spinal, as a member of the ITEM Coalition Steering Committee, signed on to and sent an ITEM letter to Congress in support of protecting CRT legislation and other device legislation to be included in Congress continual funding as they work to finalize FY 2018 budgets which have not yet been finalized from the supposed end of the fiscal year of September 30, 2017. United Spinal sent a letter to the Centers for Medicare and Medicaid Services (CMS) in support of an application for a unique Healthcare Common Procedure Coding System (HCPCS) code for the MyoPro device, created by the medical technology company, Myomo. The MyoPro, is a custom fabricated arm brace, the only one of its kind, that uses safe, noninvasive myoelectric technology to enable individuals living with spinal cord injuries and other neurological conditions to retain functional mobility in their arms. United Spinal signed on to an American Academy of Physical Medicine and Rehabilitation (AAPM&R) letter, to Congress, along with numerous rehabilitation and disability in strongly supporting H.R. 626, the Access to Inpatient Rehabilitation Therapy Act of 2017. United Spinal, along with numerous other disability organizations, signed on to a Consortium for Citizens with Disabilities (CCD) letter opposing taking health care/Medicaid away from people who are unemployed. The letter expressed CCDs strong opposition to the Centers for Medicare and Medicaid Services (CMS) January 11, 2017 guidance authorizing states to implement unprecedented work requirements for the Medicaid program, and its subsequent approval of Kentuckys waiver application seeking to implement work requirements. ITEM Coalition Steering Committee As a member of the Steering Committee, United Spinal continues to advocate to protect access to medical devices and assistive technologies, in this changing healthcare landscape, through letters to both Congress and the Administration as well as meetings and conference calls. On a related issue, United Spinal sent in joint comments to the Medicare Payment Advisory Commission (MedPAC) opposing any expansion of Medicares competitive bidding program on urology and ostomy supplies which restricts consumer access to medically necessary products and supplies. Coalition to Preserve Rehabilitation Steering Committee As a member of the Steering Committee, United Spinal continues to advocate for improved rehabilitation benefits for the disability community, in this changing healthcare landscape, through letters to both Congress and the Administration as well as meetings and conference calls; such as sending an opposition comment letter to the Department of Labor regarding Employer-Sponsored Association Health plans which can provide less comprehensive coverage and higher out-of-pocket costs. We believe that insurance coverage, whether through an employer, a plan purchased on the exchange, or an association health plan (AHP), must ensure access to timely, affordable, high-quality health care that meets the needs of individuals with disabilities.

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United Spinal, along with several other disability organizations, signed on to a letter from the Consortium for Citizens with Disabilities Social Security Task Force (SSTF) and the Employment &Training Task Force (E&TTF) responding to the request for information regarding strategies to improve adult outcomes for youth receiving supplemental security income, 83 Fed. Reg. 411, published on January 3, 2018 [Docket No. SSA-2017-0049]. The letter stressed the basic point that the Task Forces were pleased that Social Security Administration (SSA) is interested in improving the outcomes for youth who receive SSI in adulthood, but that it is the position of the SSTF and the E&TTF that SSA does not and should not have responsibility for outcomes for SSI youth. Poor children rely on a number of systems that have a responsibility to ensure that children with disabilities are prepared to achieve good economic outcomes when they transition from school. The Department of Education and, to a lesser but very important extent the Department of Health and Human Services (HHS) through the provision of Early and Periodic Screening, Diagnostic and Treatment (EPSTD) services, are and should remain primarily responsible for identifying the needs of childhood SSI beneficiaries as they transition to adulthood and ensuring that SSI beneficiaries leave secondary education prepared for employment and/or post-secondary education. The Department of Labor should assist through youth training programs and apprenticeship opportunities. United Spinal Policy staff continue to monitor the implementation of the Compassionate and Responsive Service (CARES) plan to reduce the current wait time for a Social Security Disability claim hearing decision.

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4th Quarter, 2017

Q4 Report

In Q4, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on Jan. 19, 2018. Original Filing: 300930761.xml

Lobbying Issues

H.R. 2123/S. 925, The Veterans E-Health & Telemedicine Support (VETS) Act of 2017 United Spinal, along with other disability organizations, signed onto a letter to the bipartisan leadership of Congress which introduced the Veterans E-Health & Telemedicine Support (VETS) Act of 2017 to improve the ability of veterans to access care via telehealth by relieving geographic restrictions on telehealth services and promoting access to high quality, coordinated care for all veterans, particularly those in rural areas. United Spinal is a member of the HealthIT Now Coalition which works on telemedicine initiatives at the national and state levels. Proposed Rule, Prosthetic and Rehabilitative Items and Services: This proposed rule would strike and replace Title 38, CFR 17.150, and update 17.3200-3250, by addressing vague and subjectively interpreted language regarding the feasibility and medical need of certain medical equipment and services for disabled veterans, as well as update the currently limited list of such services and items. Submitted comments regarding our support for efforts to improve current policy and benefit disabled veterans. S. 1318, Air Carrier Access Amendments Act: This bill is to amend Title 49 of U.S.C., Section 41705, by addressing the needs of disabled Americans, including veterans, traveling by air, including needed safety training for TSA staff and flight attendants, reasonable accommodations for Americans with spinal cord injuries and/or disease, and accessibility issues throughout the airline industry for such Americans. United Spinal's VetsFirst program sent a letter to the House Veterans Affairs Subcommittee on Economic Opportunity opposing proposed legislation which is designed to diminish the current approved and valuable training and education track for veterans. It would "liquidate" the GI bill and push veterans to end their benefit in 18 months, thus discouraging selection of aviation education programs at approved public universities. United Spinal's VetsFirst program sent a letter of support to Congresswoman Dina Titus (D-NV) specifically in support of her bill HR 3197, which puts an end to research practices at the Department of Veterans Affairs which do not lead to any positive outcomes for veterans. United Spinal's VetsFirst program signed onto a letter in support of S.1318, the Aircraft Carrier Access Amendments Act, and S.1405, the Federal Aviation Administration Reauthorization Act, which are both designed to expand access measures for disabled aircraft passengers, as well as training requirements for aircraft and TSA personnel in handling disabled passengers and their equipment. United Spinal co-wrote a letter to the Senate stating objections to amendments added to the National Defense Authorization Act bill on the Senate floor that would harm vital defense health research programs specifically initiated to help US soldiers who sustain traumatic brain (TBI) and spinal cord injuries (SCI). The letter was sent to the Senate Armed Services Committee.

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Supports FAA Reauthorization including some disability specific sections (H.R. 323). Supported language in S. 1872, the Transportation Security Administration (TSA) Modernization bill regarding improvements for screening of passengers with disabilities related to training, handling and airport signage. United Spinal supports Air Carriers Access Amendments Act, S.1318. U.S. Department of Transportation Notification of Regulatory Review: in response to DOT's notification of regulatory review, United Spinal and others signed onto a letter to DOC which points out that the ACAA, a civil rights law that prohibits disability-based discrimination in air travel and its regulations, are crucial to safety issues and calls on DOT to move forward in publishing rules concerning access to lavatories on single-aisle aircraft and in-flight entertainment. United Spinal, along with numerous other disability organizations, and as a member of the Air Carriers Access Act (ACAA) working group, signed on to a letter to the U.S. Department of Homeland Security, Transportation Security Administration (TSA) supporting a proposal to add a Request for Assistance in electronic form

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Support H.R. 750 The Ensuring Access to Quality Complex Rehabilitation Technology (CRT) Act will create a separate category for CRT within the Medicare DME benefit. Support H.R. 3730 - provides a permanent exemption from Medicare's competitive acquisition program for manual CRT and wheelchairs and related components(including endorsing a letter to Congress). Support S.486 - Protecting Beneficiary Access to Complex Rehab Technology Act of 2017 United Spinal and National Disability Leadership staff met with CMS' Office of Minority Health to discuss issues around the representation of disability professionals in the healthcare sector. Support S. 253/H.R 807 - Medicare Access to Rehabilitation Services Act of 2017. Also support therapy cap extenders to be included in CR government funding. Support improved payments at CMS for joint replacements and improving the quality of care for Medicare beneficiaries who use custom orthotic braces and prosthetic limbs. Met with MedPAC to discuss our opposition to including non-commodity items into Medicare's competitive bidding program. United Spinal signed onto a CMS comment letter: HHS Notice of Benefit and Payment Parameters for 2019. This proposed rule sets forth benefit and payment parameters, provisions related to essential health benefits (EHBs), qualified health plans (QHPs), risk adjustment, and the operation of Federally-facilitated exchanges (FFEs) and State-based exchanges (SBEs), as well as many other policies implementing the Affordable Care Act (ACA). This comment letter focusses on key proposed provisions that relate to enrollees in need of medical rehabilitation and post-acute care, specifically rules related to the essential health benefit category of rehabilitation and habilitation services and devices, as well as provider network adequacy requirements.

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United Spinal Association, along with numerous other disability organizations, signed on to a letter encouraging Congressional bipartisan leadership and members of Congress to honor the original intent of the Stephen Beck, Jr. Achieving a Better Life Experience Act of 2014 (ABLE Act) and stand with the individuals with disabilities who are denied the opportunity to achieve a better life experience simply due to the age at which they became disabled. The letter requested, that the ABLE Age Adjustment Act (H.R. 1894/S. 817) be passed before, or concurrently with, any legislation that provides for further benefits to those already eligible for the program. The ABLE Age Adjustment Act would increase the age requirement from 26 to 46 as a first step to eliminating the age restrictions in allowing certain individuals with disabilities the opportunity to save resources in a tax advantaged savings account (an ABLE account) for the purposes of covering disability related expenses. The resources saved in an ABLE account are not taken into consideration when determining the individuals eligibility for federally funded means tested benefits, including Supplemental Security Income (SSI) and Medicaid. United Spinal is concerned about the movement of any legislation related to the ABLE Act that does not include a meaningful increase to the age requirement within the eligibility criteria of the law. It supports both the ABLE to Work Act (H.R. 1896/S. 818) and the ABLE Financial Planning Act (H.R. 1897/S. 816), however it opposes their movement absent the movement of the ABLE Age Adjustment Act. United Spinal, along with numerous other disability organizations, signed on to a letter addressed to the Senate and House Committees on Appropriations bipartisan leadership regarding Senate appropriations language considering eliminating the Ticket to Work Program. The letter detailed the disability communitys long-standing support for the Social Security Ticket to Work Program.

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United Spinal Public Policy staff discussed the topic of autonomous vehicles (AV) and their potential to remove barriers to employment for people with disabilities. The chat was co-hosted by the US Department of Labors Office of Disability Employment Policy (ODEP) and Securing Americas Future Energy (SAFE). United Spinal stressed this years NDEAM theme Inclusion Drives Innovation. And that the unemployment rate for PWD is about double those without disabilities, but that by improving transportations reliability, accessibility and affordability for people with disabilities improves employment opportunities for all. We also made the important point that autonomous vehicles universal design will bring production costs down to pass on to customers, both public and private.

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3rd Quarter, 2017

Q3 Report

In Q3, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on Oct. 18, 2017. Original Filing: 300907252.xml

Lobbying Issues

United Spinal supports the existence of the Paralysis Resource Center. The PRC provides comprehensive information for people living with spinal cord injury, paralysis and mobility-related disabilities and their families. Resources include information and referral by phone and email in multiple languages including English and Spanish; a peer and family support mentoring program; a military and veterans program; multicultural outreach services; free lending library; quality of life grants; and a national website. The grant components and requirements may differ in upcoming grant announcements. United Spinal signed on to multiple letters to Congress in opposition to efforts to repeal the ACA regarding limiting pre-existing conditions, removing essential health benefits and cutting Medicaid. United Spinal policy staff was invited to a workshop with providers, manufacturers and payers in the biopharmaceutical space, including the U.S Food and Drug Administration, to discuss consumer education, guidelines and policy. Lupus and Allied Diseases Association - United Spinal endorsed their letter to the Centers for Medicare and Medicaid Services opposing CMS policy on payment for biosimilar biological products that assigns shared codes to multiple distinct biological products. Shared codes make it more difficult for individuals to receive the right products for their needs.

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Signed onto letters to Congress, and engaged in multiple Hill visits, opposing the ADA Education and Reform Act H.R. 620 which would create significant obstacles for people with disabilities to enforce their rights under Title III of the ADA. Title III (public accommodations) was intended to balance the interests of small businesses along with the accessibility concerns of people with disabilities. Title III does not require any action with respect to existing buildings that would cause an undue burden on businesses or that is not readily achievable. Supports S. 910/H.R. 2472 - Disability Integration Act United Spinal endorsed H.Con.Res.80 - Expressing the sense of the Congress that assisted suicide (sometimes referred to as death with dignity, end-of-life options, aid-in-dying, or similar phrases) puts everyone, including those most vulnerable, at risk of deadly harm and undermines the integrity of the health care system.

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Support VA Accountability Legislation to Enable VA Leaders to Manage Workforce Issues Effectively to Improve Healthcare Access for Veterans - HR 1259. Enhance Department of Veterans Affairs Vocational Rehabilitation and Employment Benefits Program. United Spinal and VetsFirst (a program of United Spinal Association, supports more pathways for veterans to become aviation maintenance technicians-- and expand their career opportunities. There is an FAA flight regulation (Part 147) that would be updated by a pending FAA regulation that actually updates training standards and would create a smoother pathway to expand maintenance training programs reflecting modern aircraft. H.R. 2123/S. 925, The Veterans E-Health & Telemedicine Support (VETS) Act of 2017 United Spinal, along with other disability organizations, signed onto a letter to the bipartisan leadership of Congress which introduced the Veterans E-Health & Telemedicine Support (VETS) Act of 2017 to improve the ability of veterans to access care via telehealth by relieving geographic restrictions on telehealth services and promoting access to high quality, coordinated care for all veterans, particularly those in rural areas. United Spinal is a member of the HealthIT Now Coalition which works on telemedicine initiatives at the national and state levels.

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Endorsed letter to Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education requesting full funding for the Assistive Technology Act. Met with bipartisan budget and appropriation committee leadership to urge continued federal funding for the Paralysis Resource Center at ACL. Endorsed letter on FY 2018 appropriations to the leadership of the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies recommending that the FY 2018 Labor, HHS, Education, and Related Agencies appropriation bill provide necessary and sufficient funding for the various federal agencies supporting and conducting disability, independent living, and rehabilitation research to address the current and future needs for individuals with disabilities and society. We also recommend that the report accompanying the bill include language recognizing the critical importance of disability, independent living, and rehabilitation research.

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H.R. 750 The Ensuring Access to Quality Complex Rehabilitation Technology (CRT) Act will create a separate category for CRT within the Medicare DME benefit. H.R. 3730 - provides a permanent exemption from Medicare's competitive acquisition program for manual CRT and wheelchairs and related components(including endorsing a letter to Congress). United Spinal Association signed onto a letter to CMS spearheaded by Consumer Voice opposing a nursing home rule on pre-dispute arbitration agreements. The existing regulation is designed to ensure that a resident enters into an arbitration agreement only if he or she knows what is at stake and has made a conscious decision to choose arbitration. The proposed regulation, on the other hand, would lead to the routine use and enforcement of pre-dispute binding arbitration agreements that were signed when the resident knew nothing of the dispute that ultimately is arbitrated, and signed only because the resident had to agree to arbitration in order to be admitted. Nursing facilities would quickly institute policies requiring pre-dispute binding arbitration agreements from all incoming residents. CONGRESSIONAL AND CMS SUPPORT LETTERS United Spinal Association supports the Benefits Improvement and Protection Act (BIPA), (including Section 427) which urges CMS to ensure that Medicare beneficiaries continue to have access to quality prosthetic and custom-fabricated orthotic care provided by practitioners and suppliers with appropriate education, training and experience. Supports H.R. 3635 which is companion legislation to S. 794 which would help ensure basic procedural fairness in Local Coverage Determinations (LCDs), and thereby provide an important Medicare beneficiary protection that is often lacking in local coverage decisions. Signed onto a letter to HR 3178, the Medicare Part B Improvement Act: bill contains provisions addressing beneficiary access to care, including prosthetic & orthotics, home infusion, and ESRD issues. United Spinal Association, as part of the Coalition to Preserve Rehabilitation, shared concerns with Congress on limiting caps on therapy services and reviewing issues around pre- and post-payment review and complications of complex patients. Also opposed, as part of this coalition the Graham Cassidy proposal to repeal the ACA. Also submitted comments on this: (CMS-1672-P) Medicare and Medicaid Programs; CY 2018 Home Health Prospective Payment System Rate Update and Proposed CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Raised concerns related to Jimmo, therapy thresholds and billing timeframes.

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United Spinal and VetsFirst (a program of United Spinal Association), supports more pathways for veterans to become aviation maintenance technicians-- and expand their career opportunities. There is an FAA flight regulation (Part 147) that would be updated by a pending FAA regulation that actually updates training standards and would create a smoother pathway to expand maintenance training programs reflecting modern aircraft. Reviewed draft transportation legislation on autonomous vehicles with Congressional staff on the Senate Committee on Commerce, Science and Transportation and the House Energy and Commerce Committee. United Spinal attended a meeting with the Transportation Security Administration to hear updates from the agency and to raise travel concerns for people with disabilities and other vulnerable populations. United Spinal met with the US Department of Transportation (USDOT), Office of the Secretary on the issue of autonomous vehicles (AV). United Spinal Public Policy staff, along with numerous disability organizations met with USDOT officials to obtain: 1) a point of contact in the Secretary's office for follow up and ongoing engagement 2) a commitment to bring together stakeholders (advocacy groups, industry, standards setting bodies (SAE, US Access Board, etc.) the accessible design of a fully autonomous vehicle 3)Establish an ongoing dialogue with NHTSA on issues involving highly AVs 4)Secretary Chaos help ensuring that states don't eject barriers to riding in highly autonomous vehicles like licensing and training requirements.

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Social Security Disability Backlog House Ways and Means Committee Subcommittee on Social Security Hearing on Determining Eligibility for Disability Benefits: Challenges Facing the Social Security Administration September 6, 2017. United Spinal, along with numerous disability organizations, signed on to testimony discussing the following topics: Human Toll of the Hearing Backlog, SSA Needs Adequate Resources to Administer the Social Security Process and SSAs CARES Plan: More Must Be Done to Reduce Wait Times. The testimony concluded by saying: The number of people waiting for a hearing before an ALJ and the long waiting time is unacceptable. Claimants often experience incredible hardship during the delay in getting their claim decided - homelessness, bankruptcy, and sometimes death. SSA needs additional resources to be able to serve all its customers in a timely and accurate manner. The Task Force also urges SSA to take additional steps to ensure that eligible claims are awarded as early in the process as possible by improving the development of evidence earlier in the process and ensuring that claims that do not require a hearing to establish eligibility for benefits are processed without a hearing.

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2nd Quarter, 2017

Q2 Report

In Q2, United Spinal Association had in-house lobbyists, and was paid $150,000. The report was filed on July 20, 2017. Original Filing: 300896358.xml

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Discussed options for United Spinal to be a potential grantee of the agencys Paralysis Resource Center. The PRC provides comprehensive information for people living with spinal cord injury, paralysis and mobility-related disabilities and their families. Resources include information and referral by phone and email in multiple languages including English and Spanish; a peer and family support mentoring program; a military and veterans program; multicultural outreach services; free lending library; quality of life grants; and a national website. The grant components and requirements may differ in upcoming grant announcements. United Spinal signed onto a letter facilitated by The National Health Council (NHC) and the National Organization for Rare Disorders (NORD) and submitted to Members of Congress. The letter, in part, reads, "The chronic and rare disease and disability patient communities rely on FDA to ensure that innovative, safe, and effective treatments reach those in need. We thank Congress for moving forward with these critical funding mechanisms, [FDA user fess] and look forward to their swift and unimpeded passage." United Spinal helped draft a Congressional statement on the issue of biopharmaceuticals to ensure consumer protections. United Spinal also submitted questions to the Congress for the nomination hearing for FDA Commissioner nominee and provided report language to the Agriculture Committee on sufficient funding needs for appropriations. United Spinal participated in this multi-coalition Hill Day, (CPR/ITEM/HAB) on June 27 to highlight to Congress the importance of rehabilitation and habilitation benefits to be included in any health reform legislation. United Spinal signed onto a letter, led by NMSS, on the need for improved patient engagement at the U.S. Food and Drug Administration. United Spinal supports robust assistive technology funding for the Assistive Technology Act Programs; protecting Medicaid funds; supporting CRT (exempting CRT power and manual chairs and components from Medicares competitive bidding program - HR 1361/S. 486); the Medicare Demonstration of Coverage for Low Vision Devices Act of 2017, H.R. 2050 and support of Steve Gleason Enduring Voices Act, H.R. 2465/S.1132 - protection of speech-generating devices under Medicare. United Spinal signed on to multiple letters to Congress in opposition to Republican efforts to reform the ACA regarding limiting pre-existing conditions, removing essential health benefits and cut Medicaid. Opposes HR. 1628, AHCA, opposes BCRA. United Spinal sent a letter to Congress joining over 80 other groups voicing our opposition to H.R. 1215 the Protecting Access to Care Act of 2017. This bill would limit the legal rights of injured patients and families of those killed by negligent health care. The bills sweeping scope covers not only cases involving medical malpractice, but also cases involving unsafe drugs and nursing home abuse and neglect.

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United Spinal signed onto a letter to Congress, facilitated by the National Federation of the Blind, to ensure that any Congressional request for an increase to the minimum wage, include people with disabilities, as well. United Spinal and the US Department of Labor, the Office of Disability Employment Policys (ODEP) are discussing partnering opportunities with the State Exchange on Employment and Disability (SEED) program. As a member of the Disability and Rehabilitation Research Coalition (DRRC), United Spinal continues to participate in dialogue with agencies, members of Congress and administration officials about the development of the Interagency Committee on Disability Research (ICDR) government wide rehabilitation research plan. The Workforce Innovation and Opportunity Act (WIOA) (Public Law 113-128) requires the ICDR to develop a comprehensive government wide strategic plan for disability, independent living, and rehabilitation research. United Spinal signed onto a letter, facilitated by the Consortium of Citizens with Disabilities, addressed to Secretary Acosta, OMB Director Mulvaney and ccd to Chair Lipnic of the EEOC, voicing our opposition to the proposed budget transfer of the Office of Federal Contract Compliance Programs (OFCCP) from DOL to the EEOC.

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United Spinal, along with other organizations, signed onto a letter to the leadership of the Senate Committee on Finance and the House Ways and Means Committee concerning a second article in a Washington Post series on the Social Security disability programs-titled Generations, Disabled (June 4, 2017 print edition)- paints a misleading and inaccurate picture of these essential programs. Requested Senate Finance and House Ways and Means committees to call for a hearing to address the Social Security Backlog. There are more than 1.1 million Americans with disabilities waiting for a Social Security Disability Insurance hearing before an administrative law judge (ALJ). Nationwide, the average wait is 578 days and growing, and occurs after a 120- to 365-day wait through the previous two levels of the disability process. Then, after their hearing, claimants often wait an estimated 75 days on average for a decision to be handed down and for monthly benefit payments to begin.

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Meetings with Members of Congress and their staffs continue to discuss the Groups draft legislation for extending rights to the disability community in a long term Federal Aviation Administration (FAA) reauthorization bill. United Spinal signed onto a letter to the House Transportation and Infrastructure Committee Chairman, Rep. Bill Shuster in support of disability protections contained in recently introduced legislation extending Federal Aviation Administration programs. The House 21st Century AIRR Act, H.R. 4441,included three sections focused on aviation consumers with disabilities. The Senate's version of the FAA Reauthorization included some disability specific sections. United Spinal supports Air Carriers Access Amendments Act, S.1318.

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United Spinal signed onto an Appropriations Funding FY 2018 letter for the Lifespan Respite Care Program and the National Family Caregiver Support Program. The funding request was for $5.0 million for the Lifespan Respite Care Program and $158 million for the National Family Caregiver Support Program. United Spinal, along with other disability organizations, signed onto Disability Rehabilitation Research Consortium (DRRC) comments on FY 2018 Appropriations to the leadership of the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies recommending that the FY 2018 Labor, HHS, Education, and Related Agencies appropriation bill provide necessary and sufficient funding for the various federal agencies supporting and conducting disability, independent living, and rehabilitation research to address the current and future needs for individuals with disabilities and society. We also recommend that the report accompanying the bill include language recognizing the critical importance of disability, independent living, and rehabilitation research. United Spinal submitted report language to include in the FY 2018 House Appropriations bill. Language was included in the FY 2017 Agriculture Appropriations that reports directing FDA to increase its efforts on education for patients surrounding biosimilars.

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H.R. 750 The Ensuring Access to Quality Complex Rehabilitation Technology (CRT) Act will create a separate category for CRT within the Medicare DME benefit. H.R. 1361/S486 - provides a permanent exemption from Medicare's competitive acquisition program for complex power and manual components and wheelchairs. As a member of the MapRx Coalition, United Spinal signed onto a letter to the Centers for Medicare and Medicaid Services, regarding ensuring safeguards in Medicare Part D regarding specialty tiers, protected pharmacy classes and out-of-pocket costs for beneficiaries. United Spinal wrote a letter to the Centers for Medicare and Medicaid Services (CMS) urging for separate coding options for titanium materials (makes for lighter wheelchairs/easier maneuverability) for wheelchairs if it is the beneficiarys choice. CMS issued a recent policy determination not allowing wheelchair providers to bill the beneficiary for titanium. United Spinal policy staff convened a meeting with senior personnel at CMS, along with PVA, National Multiple Sclerosis Society, Christopher and Dana Reeve Foundation and ITEM Coalition to discuss expanded access to CRT under Medicare; the seat elevation feature (which is not covered by Medicare), and titanium wheelchairs. Met with other personnel at CMS to discuss future delays of the competitive bidding program. United Spinal submitted a letter to CMS urging for discrete coding for hydrophilic (lubricated) catheters. United Spinal opposes any provision that expands the Medicaid Secondary Payer statute to allow for the Agency to collect funds from a judgment or settlement beyond what was provided for medical care is unfair and harmful to Medicaid beneficiaries and has submitted a letter to House and Senate. United Spinal supports S. 253/H.R. 807 - Medicare Access to Rehabilitation Services Act, which would protect Medicare beneficiaries from arbitrary limits on outpatient physical therapy, occupational therapy, and speech-language pathology services that are often needed to recover from debilitating illnesses, such as stroke, or support the effective management of conditions including SCI, multiple sclerosis and arthritis. Sent letter of support for the HR 2465/S 1132 Steve Gleason Enduring Voices Act of 2017 to revise the Steve Gleason Act of 2015 (114th Congress S. 984). United Spinal signed onto a similar letter, facilitated by the Center for Medicare Advocacy. The Steve Gleason Enduring Voices Act will remove the sunset date, currently identified in law as October 1, 2018. We seek this revision to prevent extremely vulnerable Medicare beneficiaries from ever again having to relinquish their only means of communication. By revising the Steve Gleason Act of 2015 to remove the sunset date, beneficiaries with ALS, MS, Parkinsons disease, paralysis, cerebral palsy and other debilitating conditions will be assured that Medicare coverage for speech generating devices (SGD) and related accessories will continue to be available.

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1st Quarter, 2017

Amendment

United Spinal Association amended a lobbying report for in-house lobbying in Q12017 on Aug. 7, 2017 Original Filing: 300899282.xml

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Discussed concerns regarding confirmation of Senator Jefferson Sessions as Attorney General relating to his view of the protection of civil rights. Signed onto letters to Congress opposing the ADA Education and Reform Act H.R. 620 which would create significant obstacles for people with disabilities to enforce their rights under Title III of the ADA. Title III (public accommodations) was intended to balance the interests of small businesses along with the accessibility concerns of people with disabilities. Title III does not require any action with respect to existing buildings that would cause an undue burden on businesses or that is not readily achievable. Support HR 634 - the existence of the Election Assistance Commission - which provides the election administration and accessible resources at polling places.

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Supported protecting non-defense discretionary funding. NDD programs serve many vital national needs but have been subject to repeated cuts over the past six years, including through the appropriations caps and sequestration process established by the 2011 Budget Control Act. Discussed and submitted an appropriation programmatic request for the Congressionally Directed Medical Research Program, Spinal Cord Injury Research Program (SCIRP). The SCIRP was established by Congress in FY09 with a $35 million appropriation to support research into regenerating/repairing damaged spinal cords and improving rehabilitation therapies. From FY10-15, Congress appropriated an additional $122.85 million to continue this research. Submitted report language to Congress to include in FY 2018 Appropriations regarding directing FDA to increase its efforts on educating patients surrounding biosimilars.

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1st Quarter, 2017

Q1 Report

In Q1, United Spinal Association had in-house lobbyists, and was paid $70,000. The report was filed on April 20, 2017. Original Filing: 300876574.xml

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4th Quarter, 2016

Q4 Report

In Q4, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on Jan. 20, 2017. Original Filing: 300853774.xml

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Signed letter to Senate members urging the passing of Senate Resolution 703 designation of November 2016 as National Bladder Health Month in the United States. Sent letter to members of House Energy and Commerce Subcommittee on Health and Senate HELP committee voicing opposition to delays by FDA on key patient safety guidance on biosimilars. Advocated on H.R.6/H.R. 34 - 21st Century Cures Act including: supporting S.849, Advancing Research for Neurological Diseases Act of 2015 that would create a centralized data collection system and the Centers for Disease Control and Prevention to track and collect data on the epidemiology of neurological diseases. Supports S. 800 / H.R. 1631, Enhancing the Stature and Visibility of Medical Rehabilitation. Research at the NIH Act. Discussed quality measures for the SCI/D community and those living with Parkinson's, spina bifida, multiple sclerosis. Supports S.3252 / H.R. 5779 Automatic Voter Registration Act of 2016. Discussed some concerns with S. 2689 - REGROW Act.

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H.R. 3229/S. 2196 - H.R. 3229/S. 2196 to protect access to complex rehab wheelchairs and essential components required by people with disabilities. H.R. 1516/S. 1013 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015 that will create separate recognition for complex rehab technology. United Spinal opposes a proposal in the Presidents FY2017 Budget which expands the competitive bidding program to additional categories, including ostomy and urological supplies. Met with White House to discuss CRT. Support reauthorizing Money Follows the Person under Medicaid. Support protecting rehabilitative and habilitative services for people with disabilities. United Spinal Association joined the Alliance for Healthcare Security in a Preserving the Affordable Care Act (ACA) Advertisement, along with numerous non-profits, in an ad to Congress with the message: Repealing the Affordable Care Act without an immediate plan to replace it is a big risk - like walking off an unfinished bridge. TELL CONGRESS: DONT REPEAL HEALTHCARE WITHOUT A PLAN TO PROTECT OUR CARE.

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Discussed uniform standards for the design of accessible parking placards for individuals with disabilities. United Spinal, along with numerous disability organizations, signed onto a letter offering comments to the US Department of Transportation's National Highway Traffic Safety Administration developing guidance on self-driving cars, supporting policy that balances the responsibility to keep Americas roads safe with the need to get and keep autonomous vehicles on public roads as quickly as it can be done safely. The letters recommendations included suggestions on a proposed 15-point safety assessment, accessibility, technical training and education assistance, input from the disability community, drivers licenses requirements, hosting a national conversation on liability and insurance issues and establishing a federal resource center. United Spinal public policy staff agreed to participate in a coalition on autonomous vehicles as it relates to the disability community.

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United Spinal signed onto a letter to House and Senate Appropriations Committee leadership requesting that the Fiscal Year 2017 Labor-HHS Appropriations Bills final version include the Presidents Budget Request of $13.067 billion for SSAs Limitation on Administrative Expenses (LAE) account. United Spinal, along with numerous other disability organizations signed onto a letter to the Social Security Administration, in response to the Notice of Proposed Rulemaking (NPRM) on Revisions to Rules Regarding the Evaluation of Medical Evidence in Social Security claims. The letter urged the Social Security Administration (SSA)to not move forward with restricting the use of medical evidence included in beneficary benefits appeals. As member of the Consortium for Citizens with Disabilities (CCD) Social Security Task Force, United Spinal, along with other disability organizations, signed onto comments in response to a Notice of Proposed Rulemaking to ensure consistent and uniform rules across the nation for the submission of evidence and notice for hearings for Social Security benefits. United Spinal joined other disability organizations and signed on to comments from the CCDs Social Security and Employment and Training Task Forces in response to the NPRM issued by SSA to make improvements to the expedited reinstatement and unsuccessful work attempt work incentives. United Spinal, as a member of the Consortium for Citizens with Disabilities Social Security Task Force (CCD,) continues to support increasing the cap on fees that representatives can receive for representing applicants for SSDI and SSI benefits. Ensuring that claimants representatives will be paid a fee for successful work on a claimants behalf helps to ensure that a knowledgeable, experienced pool of representatives is available to represent claimants. United Spinal, along with numerous other disability organizations signed onto a letter regarding possible demonstration projects designed to improve employment and earnings outcomes for individuals with musculoskeletal impairments, 81 Fed. Reg. 64254 published on September 19, 2016 (Docket No. SSA-2012-0036). Expressed concerns about SSA designing and implementing a demonstration designed to test early intervention for non Social Security disability beneficiaries.

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3rd Quarter, 2016

Q3 Report

In Q3, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on Oct. 20, 2016. Original Filing: 300838914.xml

Lobbying Issues

HR 3229/S. 2196 To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories. Spoke with Rep. Jared Polis district staff member regarding casework for a United Spinal member. H.R. 1516/S. 1013 Amends title XVIII (Medicare) of the Social Security Act to cover, as medical and other health services, complex rehabilitation technology (CRT) items designed or individually configured for a specific qualified individual to meet that individual's unique: (1) medical, physical, or functional needs related to a medical condition; and (2) capacities for basic activities of daily living (ADLs) or instrumental ADLs. A proposal in the Presidents FY2017 Budget expands the competitive bidding program to additional categories, including ostomy and urological supplies. This decision will limit access to prosthetic supplies which need to be clinically prescribed, selected, and/or adjusted and fitted for individuals by specially trained health care professionals based on the unique medical and physical needs of each person in relation to their disease or condition. The incorrect catheters or ostomy supplies can put individuals at risk of severe skin damage, infection, hospitalization and possibly death. Since ostomy and urological medical supplies restore the lost functions of waste storage and elimination, they are defined in the Social Security Act as prosthetics. United Spinal signed onto a letter, led by the Center for Medicare Advocacy, to the Centers for Medicare and Medicaid Services highlighting the problems with access to durable medical equipment (such as wheelchairs and other assistive technology and medical equipment that can be used in the home) when individuals are dual-eligibles - that is, on Medicare and Medicaid. There continues to be a misalignment of payment procedures in Medicare and Medicaid resulting in denials, delays, and higher than appropriate health care costs for essential DME among dually eligible beneficiaries. United Spinal supports the recommended solution which requires state Medicaid agencies, as is the law in Connecticut, to process prior authorization requests for DME for Medicaid beneficiaries whether or not they also are on Medicare. United Spinal signed onto a letter to the House in support of H.R. 5721, the Local Coverage Determination Clarification Act. This important legislation would help ensure basic procedural fairness in Local Coverage Determinations (LCDs), and thereby provide an important Medicare beneficiary protection that is often lacking in local coverage decisions. Competitive Bidding Letter United Spinal signed on to a letter to the Centers for Medicare and Medicaid Services (CMS) supporting competitive bidding reforms including the requirement of DME provider state licensure; the letter states its opposition to the competitive bidding programs limits on choice, access and quality of durable medical equipment. Negative Pressure Wound Therapy United Spinal signed onto this CMS letter which focused on the proposal to implement the newly created statutory benefit to pay home health agencies separately for disposable negative pressure wound therapy. In general, the letter supports the Centers for Medicare and Medicaid Services (CMS) proposal implementing the new statutory benefit to ensure patient access to this important therapy. United Spinal signed onto and helped draft a letter to the Centers for Medicare and Medicaid Services opposing charging people with mobility impairments an extra payment for physician time. PAC VBP United Spinal signed onto this written statement on the Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (H.R. 3298) regarding Medicare Spending per Beneficiary (MSPB) measure. MSPB is an economic measure to assess Medicare utilization and is used to ascertain the productivity of a provider within a given setting, or a type of provider compared to another type of provider. The letter states that the PAC-VBP program should not measure MSPB without simultaneously measuring quality, function, and quality of life outcomes so that the Medicare program knows what it is getting for its payments to providers. ICD-10 United Spinal Association, and other stakeholders, requested an in-person meeting to discuss the unintended consequences of ICD-10 conversion on access to inpatient rehabilitation hospitals and units (IRFs) for Medicare beneficiaries with brain injuries and select orthopedic conditions, and to explore possible remedies to this problem. MPFS 2017 and OPPS 2017 United Spinal signed onto a couple of letters to the Centers for Medicare and Medicaid Services on related to various health IT provisions ensuring better protections of chronic care management services and streamlining tools for advanced imaging services.

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Signed on to a joint letter of support of the National Defense Authorization Act for FY 2017, HR 4909, provision advocating protecting victims of military sexual trauma from non-disability mental health discharges from the military that give them other than honorable discharges - House and Senate HR 5620 Sent a letter of support to amend title 38, United States Code, to provide for the removal or demotion of employees of the Department of Veterans Affairs based on performance or misconduct, and for other purposes - House HR 5128 & S 3141 Protection & Advocacy for Veterans Act. Sent a letter of support of this legislation - a VA grant to improve the monitoring of mental health & substance abuse treatment programs of the Department of Veterans Affairs. - House and Senate Sent a letter for the Congressional record to VA Transportation & Infrastructure subcommittee requesting that they fund VA leases for VA medical facilities - House and Senate National Defense Authorization Act FY 2017, HR 4909 United Spinal signed onto a letter to the House and Senate Armed Services Committee regarding the FY 2017 National Defense Authorization Act (NDAA) opposing weakened provisions regarding the federal contractors that have violated Section 503 of the Rehabilitation Act of 1973, Vietnam Era Veterans Readjustment Assistance Act of 1974 (VEVRAA) - both of which address the recruiting and hiring of people with disabilities and veterans and other civil rights or labor laws when they bid on contracts. This provision is limited to contractors that have actually been debarred. This letter from the CCD Employment, Rights, and Veterans Task Forces urges the Armed Services committee leadership in both houses to remove the weakened provision. Doing so would hold federal contractors accountable for disability discrimination and discrimination against veterans (as well as violations of other laws).

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Sent a letter on borrower defense for repayment of student loans to the Secretary of Education. United Spinal, along with other disability organizations, signed onto comments to the Department of Education, in response to the U.S. Department of Educations proposed rule implementing programs under Title I of the Every Student Succeeds Act (ESSA) that could address the inherent problem for students with disabilities in the shift to digital educational assessments. New digital assessment platforms may increase (rather than decrease) access barriers and penalize students with disabilities by forcing them to learn new built-in access features (e.g. text-to-speech system, magnification technology, etc.) rather than using their own assistive technologies (AT). The letter reads in part: All of these situations are avoidable if assessments are developed consistent with a nationally accepted accessibility standard. If the assessment is not digital, a nationally recognized accessibility standard could be the National Instructional Materials Accessibility Standard (NIMAS). Requiring assessments be developed consistent with a nationally recognized accessibility standard will enable students with disabilities to use the AT that they regularly use to access instruction and the general education curriculum to demonstrate proficiency on assessments. United Spinal signed on to a comment letter to the US Department of Educations recently issued Guidance on Virtual Schools: Given the Department of Educations Office of Civil Rights recent actions enforcing web content accessibility requirements (citing WCAG 2.0 in resolution agreements) .. the Department should be proactively addressing the issue of accessibility of online content in any guidance or request for proposals (RFP) issued. . [United Spinal] looks forward to this discussion, but also asks that the Department immediately consider including verbiage on ensuring full accessibility to digital content, when applicable, in further publications and information issued from the Department of Education.

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CIV - Civil Rights/Civil Liberties - Agency: Dept. of Justice - House and Senate HR 3765 and S. 3446 the ADA Education and Reform Act, sent a letter to the House and Senate in opposition to this legislation. Spoke with the Government and Accountability Office regarding voter accessibility at polling locations throughout the nation. GAO contacted United Spinal for data regarding the issues people with disabilities face at the polls. Support The Disability Integration Act - S. 2427/ H.R. 5689 - To prohibit discrimination against individuals with disabilities who need long-term services and supports, and for other purposes. United Spinal signed on to a letter to Congress in support of reauthorizing Money Follows the Person (MFP). MFP provides assistance, support and funding to help individuals with intellectual and developmental disabilities, individuals with physical disabilities, and older adults who want to transition to their own homes or a community residence instead of living in a facility. Since 2005, the program has assisted more than 51,000 people move out of institutions. United Spinal signed on to a comment letter to the US Department of Justice regarding the Supplemental Advance Notice of Proposed Rulemaking titled, Nondiscrimination on the Basis of Disability; Accessibility of Web Information and Services of State and Local Government Entities: United Spinal has been and will continue to be committed to ensuring people with disabilities have full accessibility to Web information. Therefore, we would be remiss to not mention the disappointment our membership feels regarding the delay in issuing rules for web accessibility while the world of the internet continues to expand without a clear directive to be accessible, especially for the Title II covered entities.

Agencies Lobbied

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Testified at the Food and Drug Administration July 12th Arthritis Advisory Committee to oppose the biologics license application 761024, for ABP 501, a proposed biosimilar to AbbVie Inc.'s HUMIRA (adalimumab), submitted by Amgen, Inc. Read testimony at the Food and Drug Administration July 13th Arthritis Advisory Committee to oppose biologics license application 761042, for GP2015, a proposed biosimilar to Amgen Inc.s ENBREL (etanercept) submitted by Sandoz, Inc. Support H.R. 1631/S. 800 Enhancing the Stature and Visibility of Medical Rehabilitation Research at NIH Act: To improve, coordinate, and enhance rehabilitation research at the National Institutes of Health. Support S.849, Advancing Research for Neurological Diseases Act of 2015 that would create a centralized data collection system and the Centers for Disease Control and Prevention to track and collect data on the epidemiology of neurological diseases. United Spinal Association signed onto a bill, introduced by Sen. Ed Markey (D-MA), Sen. John Cornyn (R-TX), Sen. Rob Portman (R-OH), and Sen. Michael Bennet (D-CO), S. 3130, legislation which establishes an independence at home medical practice program. This program would be directed by physicians, nurse practitioners, or physician assistants; and emphasize home-based care that is designed to reduce expenditures and improve health outcomes in the provision of items and services to applicable beneficiaries. The goal of the legislation is to garner support for the concept of converting the successful Independence at Home (IAH) demonstration into a nationwide program.

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Agencies Lobbied

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United Spinal joined other disability organizations in signing onto a letter to the Social Security Administration (SSA) about a proposed rule for Social Security claimants addressing Evidence From Statutorily Excluded Medical Sources. The rule is intended to comply with Section 812 of the Bipartisan Budget Act of 2015, which requires the Social Security Administration (SSA) to exclude evidence furnished by certain individuals or entities, except for good cause as determined by the Commissioner. The letter reads in part: We recognize the importance of relying on credible medical evidence from trustworthy medical providers when determining whether an individual meets the definition of disability. We are pleased that SSA also recognizes that not all evidence that is provided by excluded providers is unreliable and is proposing good cause exceptions to permit consideration of otherwise excluded evidence. Expedited Reinstatement and Unsuccessful Work Attempt United Spinal joined other disability organizations and signed on to joint comments from CCDs Social Security and Employment and Training Task Forces in response to the NPRM issued by SSA to make improvements to the expedited reinstatement and unsuccessful work attempt work incentives. The letter reads in part: Both CCD Task Forces have long advocated for simplifying the SSDI and SSI program rules regarding work. The work incentives in these programs are complex and can be confusing to beneficiaries and their families. We applaud the Social Security Administration (SSA) for proposing changes to make the unsuccessful work attempt (UWA) and expedited reinstatement (EXR) rules simpler and easier to understand. The proposed changes will help beneficiaries comprehend and use the rules, thereby encouraging and supporting attempts to work.

Agencies Lobbied

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Special Needs Trust Fairness Act of 2015/HR 670 United Spinal signed on to a letter to the U.S. House of Representatives Energy and Commerce Committee thanking the committee for bringing H.R. 670, the Special Needs Trust Fairness Act of 2015, for a vote before the Energy and Commerce Committee. This legislation corrects an error in the law that prevents capable individuals with disabilities from creating their own special needs trusts. United Spinal signed onto letters to both the House and Senate articulating substantial concern with the movement of any legislation related to the Stephen Beck, Jr. Achieving a Better Life Experience Act of 2014 (ABLE Act) that does not include a meaningful increase to the age requirement within the eligibility criteria of the law. United Spinal cannot support, and will oppose, regardless of merit, movement of any legislation that aims to increase the benefits of currently eligible individuals, while ignoring the needs of individuals with disabilities solely based on the age when that individual first experienced their disability.

Agencies Lobbied

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National Defense Authorization Act FY 2017, HR 4909 United Spinal signed onto a letter to the House and Senate Armed Services Committee regarding the FY 2017 National Defense Authorization Act (NDAA) opposing weakened provisions regarding the federal contractors that have violated Section 503 of the Rehabilitation Act of 1973, Vietnam Era Veterans Readjustment Assistance Act of 1974 (VEVRAA) - both of which address the recruiting and hiring of people with disabilities and veterans and other civil rights or labor laws when they bid on contracts. This provision is limited to contractors that have actually been debarred. This letter from the CCD Employment, Rights, and Veterans Task Forces urges the Armed Services committee leadership in both houses to remove the weakened provision. Doing so would hold federal contractors accountable for disability discrimination and discrimination against veterans (as well as violations of other laws). United Spinal, along with other disability advocacy stakeholders, engaged in dialogue with DOLs Office of Disability Employment Policy (ODEP) and the Office of Federal Contract Compliance Programs (OFCCP) to hear updates on contractor compliance and non-compliance regarding the 503 rule and Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), that is, the hiring and recruitment of individuals with disabilities, including veterans, amongst federal contractors. United Spinal signed on to a letter to Congress on the Transition to Independence Act, HR 5903, introduced by Rep. Chris Van Hollen, (D-MD-8th) which will foster skills building and career advancement for thousands of people with disabilities as well as providing the necessary data to expand successful practices nationwide.

Agencies Lobbied

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Agencies Lobbied

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Agencies Lobbied

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2nd Quarter, 2016

Q2 Report

In Q2, United Spinal Association had in-house lobbyists, and was paid $150,000. The report was filed on July 20, 2016. Original Filing: 300818240.xml

Lobbying Issues

United Spinal supports H.R. 292/S.849 - Advancing Research for Neurological Diseases Act of 2015. This bill will mandate that the Centers for Disease Control and Prevention track the incidence and prevalence of neurological diseases. United Spinal supports S. 800/H.R. 1631 - Enhancing the Stature and Visibility of Medical Rehabilitation Research at the NIH Act which better coordinates rehabilitation and disability research at the NIH. S. 2689 REGROW Act: Met and worked with Sen. Mark Kirks office on language edits to this bill. Participated in a roundtable discussion with Sen. Kirks office along with several other organizations regarding the REGROW Act which sets up an expedited process to get therapies to market. United Spinal, along with the Disability Research and Rehabilitation Coalition, have identified some gaps in the Interagency Committee on Disability Research (ICDR), defining the need for a comprehensive government wide strategic plan for disability, independent living, and rehabilitation research and has shared these comments with appropriate government officials at NIH (including the NIH Research Plan on Rehabilitation) and NIDILRR. As a member of Patients for Biologics Safety and Access, United Spinal is working to educate Congress on the needs for patient protections on pharmaceuticals and better guidance from the Food and Drug Administration on patient use of biosimilars. HR 5009 - Ensuring Patient Access to Critical Breakthrough Products Act of 2016 United Spinal endorses this legislation and signed on to a Congressional House letter in support. This bill provides prompt access to breakthrough diagnostics and treatments. United Spinal Association submitted comments to FDA regarding biologics license application 761024, for ABP 501 (Humira).

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HR 385 HAVEN Act. Working with Congressman Al Greens office to make recommendations to Department of Housing and Urban Development for the implementation of a grant program that helps low income disabled veterans rehabilitate dilapidated buildings for use as residences. HR 3471 Veterans Mobility Safety Act- this bill is to amend title 38, United States Code, to make certain improvements in the provision of automobiles and adaptive equipment by the Department of Veterans Affairs-Wrote letter in support of this legislation to Congresswoman Walorski. Lobbied Congressional offices of the need to revamp VAs Vocational Rehabilitation and Employment Program (VR&E). The expectation is that by raising the disability rating qualification, the understaffed VR&E workforce can focus on those veterans most in need of services. HR 3975 Veterans Homebuyer Accessibility Act of 2015-this bill amends the Internal Revenue Code, with respect to the tax credit for first-time homebuyers, to: (1) allow a veteran of the Armed Forces a tax credit for 10% of the purchase price of a principal residence purchased prior to January 1, 2018; (2) allow an additional credit for the cost, not exceeding $8,000 in a taxable year, of installing special fixtures or movable facilities in a residence to accommodate a disability of the veteran; and (3) require a recapture of credit amounts if the veteran sells such residence within 36 months after purchasing it. S 2683-sent a letter to Senator Hirono to support this legislation which verifies that leave credited to such an employee is used for treating a service-connected disability, the employee shall certify to FAA Human Resource Management that the employee used that leave for purposes of being furnished treatment for that disability by a health care provider. Wrote a letter to Senator Durbin in support of an amendment to HR 2577 requiring the VA to flag colleges that are under investigation. Sent a letter to VA Health Services Research & Development in support of a VA study Improving Home Accessibility for Veterans with Disabilities.

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Agencies Lobbied

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United Spinal and other disability stakeholders met with the White House to discuss employment issues for people with disabilities including disabled veterans from the AbilityOne program (alleged fraud related to the requirement that 75% of federal contractors employees must be people with significant disabilities is not being adhered to and the steering of contracts is also occurring) to hiring and recruitment of people with disabilities across the federal government. United Spinal provided recommendations to DOL on the issue of federal regulations on the hiring and recruitment of people with disabilities across the federal government related to the release of contractor data on existing affirmative action plans, which has been a government recommendation since March 2014. United Spinal met with the AbilityOne Commission to discuss the AbilityOne program which is established to hire and recruit individuals with disabilities.

Agencies Lobbied

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Supports H.R. 1516/S. 1013 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015 - Creates a separate benefit under Medicare for complex rehab technology. Supports H.R. 3229/S. 2196 - This bill amends title XVIII (Medicare) of the Social Security Act to prohibit the application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories. (A competitive bidding program has replaced the use of established fee schedule amounts to determine payments under Medicare for certain durable medical equipment such as wheelchairs.) Conducted a Congressional Expo and Briefing on HR 1516/S. 1013 and H.R. 3229 and S. 2196 and educated Congress and the Government Accountability Office on the differences between manual and power CRT. United Spinal, as one of several consumer and disability stakeholders, raised concerns with the Administration for Community Living and the Centers for Medicare and Medicaid Services on access to durable medical equipment as urological and ostomy supplies with the expansion of competitive bidding under Medicare. United Spinal, in collaboration with United Spinals Urology Coalition, opposes expanding Medicares competitive bidding program to urology and ostomy supplies, as laid out in the Presidents Budget. United Spinal also sent a consumer and clinician letter to the committees of jurisdiction opposing the expansion. Part B Demonstration United Spinal signed onto two separate letters led by the Partnership to Improve Patient Care and the MS Coalition, to the Centers for Medicare and Medicaid Services opposing tying payment of drugs to cost-effectiveness. In early 2016, several bipartisan and nonpartisan organizations, including the Bipartisan Policy Center and the Long-Term Care Financing Collaborative, released reports on a path forward for future financing of our nations long-term care needs. The problem is clear: while our nation is aging and people are living longer with disabilities and chronic conditions, we lack a coherent plan on how to provide for their care and supports. Our current financing system relies almost entirely on Medicaid and unpaid family caregivers, both of which thwart family financial planning and hinder the economic opportunities of women, people of color, and people with disabilities. The Consortium for Citizens with Disabilities (CCD) Long-Term Services and Supports Task Force of CCD released a statement, which United Spinal endorsed, to weigh in on the recent reports on long-term care financing, express our support for Medicaid improvements, and support the emerging consensus on the need for a public insurance program. United Spinal signed onto an ITEM Coalition letter in support of HR 5210, the Protecting Patient Access to Durable Medical Equipment Act to Secretary Sylvia Burwell of the Department of Health and Human Services. This letter urged the Centers for Medicare and Medicaid Services (CMS) to extend the current six-month phase-in of modified payment for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) for an additional 12 months to avoid disruption in care to beneficiaries. United Spinal is working on increasing coverage for powered exoskeleton devices and on a Congressional advocacy campaign to make Congress aware of research showing benefits to SCI individual in the use of these devices and to help powered exoskeleton devices gain and maintain regulatory approvals and additional insurance carrier recognition.

Agencies Lobbied

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United Spinal supports S. 2427 - the Disability Integration Act which ensures that people with disabilities have the right to choose where they live in the community. United Spinal signed onto letters to the leadership of the House Judiciary Subcommittee on the Constitution and Civil Justice opposing three bills that would prohibit individuals with disabilities aggrieved by certain public accommodation violations from commencing a civil action for discrimination unless they provide additional written notification to owners or operators of public accommodations. The bills also provide owners and operators additional periods of time (up to 90 days in some instances) to take corrective action. H.R. 4719: Correcting Obstructions to Mediate, Prevent, and Limit Inaccessibility Act or the COMPLI Act - Sponsored by: Representative Jerry McNerney (D-CA). H.R. 241: ACCESS (ADA Compliance for Customer Entry to Stores and Services) Act of 2015 - Sponsored by Representative Ken Calvert (R-CA). H.R. 3765: ADA Education and Reform Act of 2015 - Sponsored by Representative Ted Poe (R-TX). United Spinal attended a meeting with AbilityOne, along with other members of the National Disability Leadership Alliance and as co-chair to the National Disabilities Leadership Alliance - Employment Team. United Spinal and others, explained the 7 principles of reform of the AbilityOne program in detail, namely: commitment to the expressed integration mandate set forth by the Supreme Court of the United States in the case of Olmstead v. L.C; implementation and development of best practices for employment of people with significant disabilities; elimination of conflicts of interest that contribute to exploitation, fraud, and abuse; payment of prevailing wages and the elimination of subminimum-wage payments; ensuring financial and operational transparency and accountability; better defining relationship with employer; prioritizing awarding of contracts available through the procurement process to disability-owned businesses, including self-employed individuals with disabilities. United Spinal signed onto a letter to the Equal Employment Opportunity Commission on Section 501 of the Rehab Act (nondiscrimination and affirmative action for federal employment of people with disabilities). We believe that some aspects of the rule must be strengthened. For example, the employment goals for employment of individuals with disabilities and targeted disabilities are too low, and the need for agencies to have a centralized accommodation fund is critical. Recruitment efforts must include formal linkage agreements with disability organizations as well as state disability service systems and vocational rehabilitation agencies, and must focus on people with targeted disabilities (including people who use supported and customized employment services) as well as people with disabilities more generally. Personal services enabling people with significant disabilities to work should include not just attendant care but also supported employment services that are critical for many people with intellectual and significant psychiatric disabilities to maintain employment.

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Agencies Lobbied

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Ensuring Access to Quality Representation for Social Security Disability Applicants addresses difficulties in keeping lawyers representing disabilities community. The request reads in part, We therefore ask you to exercise your authority to increase the fee cap to $6904, which matches SSAs Cost of Living Adjustments (COLAs) since 2009. We also encourage you to put procedures in place to ensure that the fee cap is updated on a more consistent and regular basis, such as automatically increasing it annually by an amount that is no less than the applicable COLA for that year. We appreciate your commitment to improving the Social Security disability determination process and believe that ensuring adequate representation for claimants is an important part of creating and maintaining a fair and efficient system. Action: United Spinal signed onto a letter with other disability organizations to Acting SSA Commissioner Colvin expressing support for increasing the cap on fees that representatives can receive for representing applicants for SSDI and SSI benefits. United Spinal signed on to a letter to appropriators requesting adequate funding for the SSAs FY2017 administrative budget. Employee Retirement Income Security Act of 1974 (ERISA) ERISA is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans. United Spinal signed onto comments in response to regulations released by the Employee Benefits Security Administration to revise and strengthen the ERISA claims procedures for claimants for disability benefits under private insurance claims.

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Agencies Lobbied

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United Spinal signed onto a letter supporting DOTs decision to establish a negotiated rulemaking (Reg Neg) committee on the following issues under the purview of the Air Carrier Access Act (ACAA): accessible in-flight entertainment and communications, service animals, and accessible lavatories on new single aisle aircraft. United Spinal signed onto a letter with other disability organizations providing our strong support for Senator Bill Nelsons amendment to the Senates version of the Federal Aviation Administration Reauthorization (H.R. 636) that will provide increased enforcement of the protections available to travelers with disabilities under the Air Carrier Access Act. United Spinal signed onto a letter with other disability organizations providing our strong support for Senator Richard Blumenthals amendment to the Senates version of the Federal Aviation Administration Reauthorization (H.R. 636) that would allow people with disabilities to privately enforce the anti-discrimination protections available to them under the Air Carrier Access Act. United Spinal participated in a Congressional staff briefing with the Paralyzed Veterans of America and other disability organizations to reflect on the history of the ACAA, discuss the problems that impact travelers with disabilities and lay out solutions to improve the air travel experience for people with disabilities. Federal Register on May 6 provided a draft FAA Advisory Circular titled, "Access to Airports by Individuals with Disabilities." The federal register notice specifically seeks comments related to Way-Finding Technologies and Service Animal Relief Areas. United Spinal endorsed comments sent by CCD's Transportation Task Force. United Spinal signed on to a letter with other disability organizations to the leadership of the Senate Commerce, Science and Transportation and House Transportation and Infrastructure Committees urging that four provisions (Sections 3106, 3116-3118) included in the Senate Federal Aviation Administration Reauthorization language (H.R. 636) that would increase access to air travel for millions of Americans with disabilities also be included in any reauthorization or extension of the FAAs current operating authority.

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Agencies Lobbied

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Agencies Lobbied

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1st Quarter, 2016

Q1 Report

In Q1, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on April 20, 2016. Original Filing: 300798609.xml

Lobbying Issues

Support H.R. 292/S. 849 - Advancing Research for Neurological Diseases Act of 2015. Wrote a letter to CDC advocating for a Traumatic Brain Injury (TBI) survey. United Spinal signed onto Senate Health Education Labor and Pensions comment letter, facilitated by the HEALTH IT Now Coalition, of which United Spinal is a member, supporting expanded use of telehealth for individuals living with stroke and for expanded prediabetes education. United Spinal is actively engaged in ensuring improved access to, and education of, all prescription drugs including biologic pharmaceuticals (organic compounds used to treat individuals with MS, SCI etc.) and has requested additional meetings with personnel from the U.S. Food and Drug Administration. United Spinal supports S.849 - Advancing Research for Neurological Diseases Act of 2015. This bill will mandate that the Centers for Disease Control and Prevention track the incidence and prevalence of neurological diseases. United Spinal supports S. 800/H.R. 1631 - Enhancing the Stature and Visibility of Medical Rehabilitation Research at the NIH Act which better coordinates rehabilitation and disability research at the NIH. The Disability and Rehabilitation Research Coalition (DRRC), of which United Spinal is a member, offered comments in a letter to the Administration for Community Living, U.S. Department of Health and Human Services, on the proposed rule entitled, National Institute on Disability, Independent Living, and Rehabilitation Research. The proposed rule would implement the Workforce Innovation and Opportunity Act of 2014 which made significant changes to Title II (Research) of the Rehabilitation Act of 1973. It would also move NIDILRR from the Department of Education to the Department of Health and Human Services (Administration for Community Living). United Spinal submitted comments to the FDA Arthritis Advisory Committee meeting to raise concerns about a Remicade-luck drugs and the effects of ankylosing spondylitis.

Agencies Lobbied

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Lobbying Issues

HR 3016 Advocated against this bill because it caps funding for certain aviation degree programs and discriminates against veterans who want to train as rotary wing pilots. HR 385 HAVEN Act. Working with Congressman Al Greens office to make recommendations to Department of Housing and Urban Development for the implementation of a grant program that helps low income disabled veterans rehabilitate dilapidated buildings for use as residences. HR 2264/S 2596. Signed onto a letter of support to go in base National Defense Authorization Act for 100% disabled veterans (who had not retired from military service) to receive space available (Space A) on military flights. Liaised with numerous Congressional offices to inform them of the need to support HR 3229 Complex Rehabilitation Technology legislation. HR 3471 Veterans Mobility Safety Act- this bill is to amend title 38, United States Code, to make certain improvements in the provision of automobiles and adaptive equipment by the Department of Veterans Affairs-Wrote letter in support of this legislation to Congresswoman Walorski. Lobbied Congressional offices of the need to revamp VAs Vocational Rehabilitation and Employment Program (VR&E). The expectation is that by raising the disability rating qualification, the understaffed VR&E workforce can focus on those veterans most in need of services. Signed onto a letter to Department of Labors Veterans Employment and Training Service to support its efforts to increase employment for veterans with disabilities. HR 4683 Wrote a letter in support of HR 4683 Fairness for Veterans Act that provides for the reevaluation of discharges for veterans released under other than honorable conditions due to the effects of traumatic brain injury or post-traumatic stress.

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Agencies Lobbied

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Transportation Research Board (TRB) Annual Meeting United Spinal attended the 2016 annual meeting of the TRB. United Spinal raised accessibility issues in workshops, and spoke with US Department of Transportation (USDOT) officials, and transit agency officials from Boston and Dallas, and national academics regarding taxis, equity and accessible TNCs. United Spinal spoke with a convener appointed by the USDOT about the possibility of a negotiated regulations (Reg Neg) rulemaking for the Air Carrier Access Act. The Reg Neg process would pull together industry stakeholders and members of the disability community to discuss potential regulations regarding: accessible in-flight entertainment, access to in-flight medical oxygen, service animals, accessible lavatories on new single aisle aircraft, classes of service for purposes of seating accommodations, and airline reporting requirements. United Spinal signed on to, and weighed in on, comments to the USDOT proposed Reg Negs drafted by PVA. The letter suggested that, should the USDOT choose to adopt a Reg Neg process through a committee, USDOT: ensure broad representation of the disability community on the committee and any working groups; ensure participation from the US Access Board on the committee so that they may share their technical expertise regarding accessibility standards; ensure that the framing of the discussions is geared towards prioritizing the civil rights of persons with disabilities. The letter also urged USDOT to consider that: there is a need to address current requirements for individuals who require emotional support and psychiatric service dogs; and to broaden the scope of passengers who must be afforded seats with extra leg room. United Spinal participated in a discussion with the Amtrak Government Affairs and Engineering staff with other disability stakeholders on issues related to progress and plans towards compliance with the ADA. Air Carrier Access Act update / Federal Aviation Administration (FAA) Reauthorization By July 15th, Congress must reauthorize funding and establish priorities for the Federal Aviation Administration (FAA), which is tasked with ensuring safety across all aviation sectors and operating an efficient air traffic control system. Action: A short term measure extending FAA programs until July 15, 2016 was enacted into law providing Congress time to work on a longer term reauthorization. United Spinal has been participating in a coalition of disability organizations to craft legislative language updating the provisions of the ACAA that could be included in a future long term FAA reauthorization. United Spinal signed onto a letter thanking the Senate Commerce Committee in appreciation of their efforts

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Agencies Lobbied

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Supports H.R. 1516/S. 1013 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015 - Creates a separate benefit under Medicare for complex rehab technology. Supports H.R. 3229/S. 2196 - This bill amends title XVIII (Medicare) of the Social Security Act to prohibit the application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories. (A competitive bidding program has replaced the use of established fee schedule amounts to determine payments under Medicare for certain durable medical equipment such as wheelchairs.) Supports S. 2425 - Patient Access and Medicare Protection Act - A bill to amend titles XVIII and XIX of the Social Security Act to improve payments for complex rehabilitation technology and certain radiation therapy services, to ensure flexibility in applying the hardship exception for meaningful use for the 2015 EHR reporting period for 2017 payment adjustments, and for other purposes. Discussed with CMS, ACL and GAO concerns as it relates to access to durable medical equipment and complex rehab technology and accessories under Medicare's competitive acquisition program. Discussed with CMS consumer access problems with Medicare's competitive bidding program. United Spinal submitted comments to the Centers for Medicare and Medicaid Services regarding Medicaid access to covered services. United Spinal signed onto a comment letter to entities in the Federally-Facilitated Marketplaces, seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Marketplaces (FFMs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs) with operational and technical guidance for the disability population. United Spinal opposes the provision in the FY2017 Presidential Budget to provide authority to expand competitive bidding for certain durable medical equipment specifically: ostomy and urological supplies. United Spinal commented to CMS on the issue of discharge planning for hospitals, critical access hospitals, and home health agencies. This proposed rule would revise the discharge planning requirements in order to participate in the Medicare and Medicaid programs. United Spinal signed onto a letter to CMS opposing the same reimbursement to Medicare from skilled nursing facilities as well as in-patient rehab facilities and units (IRFs). United Spinal also edited and endorsed a letter from Congressman G. T. Thompson (R-PA) to the Centers for Medicare and Medicaid Services to urge Medicare Advantage plants to follow Medicare criteria Medicare IRF coverage criteria when determining coverage for IRF care. United Spinal signed onto a comment letter to the Centers for Medicare and Medicaid Services (CMS) regarding the Summary of Benefits and Coverage, the Uniform Glossary of Medical Terms. United Spinal signed onto a letter to MedPAC on Medicare Part D cost sharing for LIS and dual eligible beneficiaries. Generic Utilization is already high in both LIS and non-LIS populations and higher cost sharing for branded products could reduce adherence, increase spending on other health care services in Medicare/Medicaid.

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United Spinal supports S. 2427 - the Disability Integration Act. United Spinal opposes ADA Notification bill, HR 3765. Disability community stakeholders, including United Spinal Association, TASH, National Council on Independent Living and National Disability Rights Network met with the Civil Rights Division of the Department of Justice to discuss alleged fraudulent activity by the AbilityOne program and next steps related to the hiring, employing and recruiting of people with significant disabilities. The AbilityOne program provides employment opportunities to more than 45,000 people with significant disabilities including 3,000 veterans. The program is among the largest providers of jobs for individuals who are blind or who have significant disabilities. United Spinal signed on to comments to the Administration on Community Living in response to their draft Adult Protective Services Consensus Guidelines. The comments suggested the rules clarify standards and accessibility requirements, make the client the center of decision making, ensure there are appropriate numbers of experienced caseworkers, and emphasize the importance of working with protection and advocacy and developmental disability agencies. United Spinal signed on to a letter to Congress, opposing HR 2646, Helping Families in Mental Health Crisis Act of 2015.

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United Spinal testified at a WMATA Accessibility Advisory Committee meeting and a WMATA Board meeting, sharing concerns regarding a proposal for Uber to provide alternative paratransit service. United Spinal facilitated meetings, drafted a letter, and worked with labor and community advocates to submit a letter to the General Manager of WMATA ccing the Board) calling on WMATA to hold high standards for any alternative paratransit company. The letter calls on WMATA to ensure that any contracts awarded require: provision of wheelchair accessible service; prioritize working conditions of their drivers and other workers, and prioritize hiring of any MetroAccess workers displaced by the transfer of work to taxi or TNC-based paratransit programs; prioritize compliance, and accept their role as a transportation provider under the ADA; prioritize safety of the passengers and workers, and accept liability; prioritize accessibility through all of its business lines; and consider awarding the contract to more than one company so that local businesses can benefit and so there are back up companies if one is not able to meet the demand. United Spinal organized and facilitated a meeting of the DCTC Accessibility Advisory Committee. The committee recommends, first and foremost, requiring Uber et al to provide accessible service. United Spinal responded to District of Columbia Homeland Security and Emergency Management Agency (HSEMA) regarding accessibility concerns. United Spinal participated in a meeting between disability advocate and paratransit riders with the DC Taxicab Commission Chairman, and the Directors of the District Departments of Transportation (DDOT) and Aging (DCOA). The meeting was scheduled in response to a sign-on letter organized by United Spinal and sent to the DC mayor. The letter expressed concerns regarding rumors of cuts to the accessible taxi program. The letter requested a meeting with the Mayor.

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Agencies Lobbied

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United Spinal supports Ensuring Access to Quality Representation for Social Security Disability Applicant - in a coalition letter to SSA expressing our support for raising the cap on fees that representatives can earn using the fee agreement when representing applicants for Social Security Disability benefits (Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs) and for putting in place procedures to ensure more regular and consistent increases in this fee cap to keep pace with inflation moving forward. Employee Retirement Income Security Act of 1974 (ERISA) ERISA is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans. United Spinal signed onto comments in response to regulations released by the Employee Benefits Security Administration to revise and strengthen the ERISA claims procedures for claimants for disability benefits under private insurance claims.

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Agencies Lobbied

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United Spinal took the lead on maintaining a requirement in current law, Section 609 of the Coast Guard Authorization Act of 2010 that the use of survival craft that do not keep all parts of the body out-of-the-water be phased out by 2015. Supporting 100% of passenger and crew members with out-of-water flotation equipment on passenger vessels is particularly important for people with disabilities, children, and older adults. United Spinal corresponded with coalition allies and key congressional offices in support of maintaining the 2010 requirements. Congress passed a reauthorization bill that now only requires vessels built or converted after January 1, 2016 operating in cold water to provide out of water survival craft. Became Public Law 114-120 on February 8, 2016.

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United Spinal signed on to a letter to the Federal Communications Commission, in support of the Lifeline Program which facilitates wider access to telecommunications services that are necessary for disabled Americans to stay connected and participate in society. The wireless voice services provided by Lifeline have been critical in allowing Americans with disabilities to stay connected with their families, access health care services, seek employment and educational opportunities and to have the peace of mind to be able to call for help in emergencies. Action: United Spinal signed onto a letter to the Federal Communications Commission not to adopt policies that would disenfranchise current Lifeline participants but instead allow current participants to choose between continuing to receive wireless voice service or to receive broadband instead. This position is consistent with both the position taken in the February 10 letter, to which United Spinal was a signatory and that of the Obama Administration in comments recently filed with the FCC on this matter by the National Telecommunications and Information Administration.

Agencies Lobbied

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4th Quarter, 2015

Q4 Report

In Q4, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on Jan. 20, 2016. Original Filing: 300782694.xml

Lobbying Issues

Support H.R. 292/S. 849 - Advancing Research for Neurological Diseases Act of 2015 Amends the Public Health Service Act to require the Centers for Disease Control and Prevention to: (1) enhance and expand infrastructure and activities to track the epidemiology of neurological diseases, including multiple sclerosis and Parkinson's disease; and (2) incorporate information obtained through those activities into a National Neurological Diseases Surveillance System. Requires the Department of Health and Human Services (HHS) to ensure that the System facilitates further research on neurological diseases. Support HR 1969 Military and Veteran Caregiver Services Improvement Act. This bill expands eligibility for the family caregiver program of the Department of Veterans Affairs (VA) to include members of the Armed Forces or veterans who are seriously injured or who became ill on active duty prior to September 11, 2001. United Spinal submitted RFI comments as a member of the Disability and Rehabilitation Research Coalition as well as independently: "Inviting Comments and Suggestions on the Priorities specified for the NIH-wide Rehabilitation Research Plan". Support Lifespan Respite Reauthorization Act , HR 3913 and the Military and Veteran Caregiver Services Improvement Act (S. 1085 & HR 1969 - includes provisions to reauthorize the Lifespan Respite Care Program. Support S. 2141 - Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act of 2015 - To amend the Public Health Service Act with respect to health information technology. Advocate for repeal of medical device tax. Submitted a comment letter to the FDA regarding the announcement of the establishment of their Patient Engagement Advisory Committee and stated our availability to help the FDA regarding patient preference information, benefit-risk determinations and clinical trial or registry design.

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Submitted testimony in support of HR 353-Veterans Access to Hearing Health Act. This bill is designed to amend title 38, United States Code, to include licensed hearing aid specialists as eligible for appointment in the Veterans Health Administration of the Department of Veterans Affairs, and for other purposes. Wrote a letter of support for HR 3970, Housing our Heroes Act that would provide funding for a test program designed to renovate abandoned property to provide housing for veterans Liaised with numerous Congressional offices to inform them of the need to support H.R. 3229/S.2196 - To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories. Support HR 3471 Veterans Mobility Safety Act- this bill is to amend title 38, United States Code, to make certain improvements in the provision of automobiles and adaptive equipment by the Department of Veterans Affairs. Support S.1203 This is a bill to amend title 38, United States Code, to improve the furnishing of health care to veterans by the Department of Veterans Affairs, to improve the processing by the Department of claims for disability compensation, and for other purposes. Support S. 1021 Wounded Warrior Workforce Enhancement Act- A bill to require the Secretary of Veterans Affairs to award grants to establish, or expand upon, master's degree programs in orthotics and prosthetics, and for other purposes. S. 1022 Wounded Warrior Research Enhancement Act- This bill directs the Secretary of Defense to award research grants for: actions that can be taken to prevent amputation of limbs, the most effective point for orthotic and prosthetic intervention during patient treatment, orthotic interventions that are most effective in treating the physical effects of traumatic brain injury, patients that benefit most from particular orthotic and prosthetic technologies, orthotic and prosthetic services that best facilitate the return to active duty of members of the Armed Forces, and the effect of aging on the use of prosthetics.

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United Spinal Association signed onto a letter, facilitated by the National Academy of Elder Law Attorneys, to Department of Housing and Urban Development, out of concern that public housing authorities (PHAs) and other rental assistance program administrators are interpreting national HUD policy to be that all distributions from special needs trusts are income for HUD rental assistance programs. The letter stated that HUD rules, in light of special needs trust law and policy, require that distributions from special needs trusts not be counted as income. Support H.R. 3975, the Veterans Homebuyer Accessibility Act - The bill would authorize a veteran first-time homebuyers tax credit equal to 10 percent of the purchase price of the residence and an adaptive housing credit of up to $8,000 for veterans to address structural and other changes to their home to accommodate their disabilities.

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Submitted comments to CMS requiring better clarification of resident rights and person-centered planning needs. United Spinal signed onto a letter of support for the nomination of Henry Claypool to serve as a Commissioner on the Medicaid and CHIP Payment and Access Commission (MACPAC). United Spinal signed onto a letter of support to CMS regarding Section 1557 and nondiscrimination towards people with disabilities in health programs and activities including the ACA regarding the enrollment of people with disabilities and the availability of plans and services for the disability community. Transition to Independence Act (S. 1604) United Spinal Association supports the Transition to Independence Act (S. 1604), introduced by Senator Charles Grassley (R-IA) and signed onto a Consortium for Citizens with Disabilities letter. This bill directs the Secretary of Health and Human Services to establish a demonstration program over five fiscal years, beginning with FY2017, under which a Medicaid Buy-In-State program meeting certain criteria may receive bonus payments for: meeting specific measurable benchmarks in expanding individual integrated employment and reducing subminimum wage work, congregate setting work, or facility-based day habilitation placements for working-age individuals with a disability receiving Medicaid-funded home or community-based services; and taking other actions conducive to expanding employment opportunities for individuals with disabilities within the state. United Spinal signed onto a letter to CMS in support of protecting and improving access to electronic health records - Medicare and Medicaid Programs: Electronic Health Record Incentive Program. Support H.R. 3229/S. 2196 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015 Amends title XVIII (Medicare) of the Social Security Act to cover, as medical and other health services, complex rehabilitation technology (CRT) items designed or individually configured for a specific qualified individual to meet that individual's unique: (1) medical, physical, or functional needs related to a medical condition; and (2) capacities for basic activities of daily living (ADLs) or instrumental ADLs. Support H.R. 1516/S. 1013 - This bill amends title XVIII (Medicare) of the Social Security Act to prohibit the application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories. (A competitive bidding program has replaced the use of established fee schedule amounts to determine payments under Medicare for certain durable medical equipment such as wheelchairs.) Support S. 2425 - Patient Acsess and Medicare Protection Act - A bill to amend titles XVIII and XIX of the Social Security Act to improve payments for complex rehabilitation technology and certain radiation therapy services, to ensure flexibility in applying the hardship exception for meaningful use for the 2015 EHR reporting period for 2017 payment adjustments, and for other purposes. Discussed with CMS, ACL and GAO concerns as it relates to access to durable medical equipment and accessories under Medicare's competitive acquisition program.

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United Spinal signed onto comments, organized by the Autistic Self Advocacy Network, in response to the Administration for Community Living (ACL) proposed guidelines for adult protective services (APS) procedures. The guidelines attempted to make APS programs more effective at pursuing cases of abuse and neglect on aging individuals and people with disabilities. The comments urged ACL to ensure: the individual is the center of the decision-making process; communication supports are provided; caseworkers come from diverse academic backgrounds; state protection & advocacy agencies and developmental disability councils are engaged; conflict of interest cases include cases involving friends, family and associates of staff members; and the ADA is respected. Discussed issues related to consumer-directed care, chronic illness and assisted suicide issues with ACL as they relate to people with disabilities. Discussed accessibility options and responsibilities with AMTRAK and Union Station officials.

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DC Olmstead Working Group United Spinal participated in a District of Columbia inter-agency and stakeholder meeting to discuss the compilation of the DC Olmstead 2016 and future transition plans. The transition plan lays out the requirements of the District to ensure that residents with disabilities are able to live in the most integrated setting if they choose. The plan provides an overview of the Districts current HCBS, performance measures, and work to be done in key areas, including: housing, access to healthcare, education and transportation. United Spinal provided follow-up comments for the draft plan. United Spinal met with DDOT staff to discuss adopting accessibility as a priority within the agency. United Spinal shared the WMATA Call to Action, and the DCTC Accessibility Advisory Committee report. Discussion included the need for increased accessible taxis and other demand responsive transportation, accessible bikeshare, and bus stops. DDOT and United Spinal discussed collaborating to establish a working group to advise DDOT including local disability advocates. United Spinal provided additional comments on the virtual training module for DC taxi drivers. The training focuses on disability etiquette and the legal requirements, both federal and local, for taxi drivers to ensure accessible service. United Spinal met with the DCTC ADA Coordinator to discuss progress of accessible taxi and Transport DC efforts, as well as challenges to address. United Spinal organized and facilitated a meeting of the DCTC Accessibility Advisory Committee and annual report subcommittee. The Committee submitted an update of its third annual report. The report was submitted to the Taxi Commission, Mayor and councilmembers. The committee recommends, first and foremost, requiring Uber et al to provide accessible service. United Spinal testified at a DCTC Public Meeting, supporting fines for both taxis and transportation network companies that discriminate, and expansion of the Transport DC program. United Spinal expressed concern over Transport DC language that stated trips would be based on MetroAccess approved locations, rather than all locations within the District. United Spinal also expressed disappointment and concern regarding proposed changes to rules allowing wheelchair accessible taxis to be on the road longer as an incentive. United Spinal participated in a Review Panel for the DCTC Transport DC expansion grant. The grant provides funds for DC taxi companies to participate in and provide service for Transport DC. United Spinal, along with local advocates, met with the DC Council Transportation Committees staff to discuss progress of accessible taxi and Transport DC efforts, as well as challenges to address. United Spinal presented, along with a local advocate, at a meeting with staff of the National Rehabilitation Hospital. United Spinal presented on local accessible transportation efforts and requested support to increase accessible transportation in the District. United Spinal met with a representative of Together International to discuss a future campaign to highlight the lack of accessible service provided by Uber. United Spinal organized and facilitated a meeting of the DCTC Accessibility Advisory Committee and annual report subcommittee. The Committee has submitted an update of its third annual report. The report was submitted to the Taxi Commission, Mayor and councilmembers. The committee recommends, first and foremost, requiring Uber et al to provide accessible service. United Spinal participated in a meeting of DC Red Top Meter Program Stakeholders. The DC Department of Transportation (DDOT) presented at the meeting on the status of the Red Top Meter parking program, as well as plans to issue proposed rulemaking to implement the program. Meeting participants provided feedback on current plans. United Spinal advocated for a list on the DDOT website of accessible parking garages and reserved van accessible parking spaces. Action: United Spinal will introduce DDOT staff to the DC Chapter so that local advocates may continue to provide feedback on the program going forward. Bicycle/Pedestrian (bike/ped) Safety Legislation Testimony United Spinal testified in support of a DC Bicycle and Pedestrian Safety bill (B21-0335) and a Vision Zero bill (B21-0383) introduced by the DC Mayor. The Safety bill was based on recommendations made by a working group convened by the DC Council Transportation Committee in which United Spinal participated. The working group is comprised of bike/ped safety advocates, DC agencies including the DC police department, and department of motor vehicles, as well as the taxi commission and Uber. United Spinal supported the Bicycle Safety Act and recommended that: age, race and disability demographic crash data be collected; that DDOT and the police department collect and publish whether vehicles involved are public or used for commercial purposes; the complete streets policy reference the latest US Access Board public rights of way guidelines; safety education in schools reaches students with disabilities; the proposed training program for public and private vehicles for hire remain in the legislation; people with disabilities be included in a Major Crash Review Task Force. United Spinal also expressed concern that law enforcement penalties and high fines may fall disproportionately on people with low incomes, or people of color. United Spinal testified at a DC Council hearing regarding the Transportation Reorganization Act of 2015. United Spinal had submitted testimony for an earlier draft of the bill in 2014. United Spinal thanked the Council for the inclusion of a multimodal accessibility advisory council and for requiring DDOT to prioritize the transportation access needs of people with disabilities and underserved populations. United Spinal also urged the Council to consider prioritizing the provision of accessible bikeshare, equity performance reviews, the collection of private vehicle for hire data, and regulation of private vehicles for hire (aka transportation network companies). United Spinal organized a sign-on letter sent to the DC mayor that expressed concerns regarding rumors of cuts to the accessible taxi program. The letter requested a meeting with the Mayor. United Spinal organized and facilitated working group meetings of the DCTC Accessibility Advisory Committee. The Committee has submitted an update of its third annual report. The report was submitted to the Taxi Commission, Mayor and councilmembers. The committee recommends, first and foremost, requiring Uber et al. to provide accessible service.

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3rd Quarter, 2015

Amendment

United Spinal Association amended a lobbying report for in-house lobbying in Q32015 on Oct. 21, 2015 Original Filing: 300766073.xml

Lobbying Issues

Discussed the FY 2016 National Defense Authorization Act FY 2016 National Defense Authorization Bill, Space Available Transportation Disabled Vets legislation that allows for certain veterans who did not retire from the military, but have significant disabilities to utilize space availability military travel Supported FY 2016 National Defense Authorization Bill amendment #1556, The Servicemember Student Loan Affordability Act of 2015 Supported House efforts to increase DoD and VA support for Joint Centers of Excellence. Discussed the possibility of opening up military specialties to women that are currently open to men only. Discussed concerns for the long term physical impacts of females serving in combat arms jobs from which they are currently banned. Discussed the transfer of DoD health records to VA upon a servicemembers transition off active duty.

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Wrote Testimony in support of HR 353-Veterans Access to Hearing Health Act. Wrote OpEd in support of H.R. 1994- The VA Accountability Act of 2015. Discussed VA Health Care Budget Shortfall and System Shutdown. This is an area of concern that if VA is not properly funded, certain services will not be available for veterans. Discussed the needs of military and veteran caregivers at a US Chamber of Commerce hosted event Discussed the VA Office of Inspector Generals Final Report on the Inappropriate Use of Position and the Misuse of the Relocation Program and Incentives in preparation for Oct 21 testimony before the House Committee on Veterans Affairs. Discussed the change in the 40 mile rule with Veterans Health Administration (VHA) Discussed how to address transportation difficulties experienced by veterans needing to travel to VA healthcare appointments. Discussed draft legislation that would improve benefits and services for veterans and their families.

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Supports H.R. 1516/S. 1013 - Ensuring Access to Quality Complex Rehabilitation Technology Act - to ensure Medicare beneficiaries' access to customized wheelchairs. Supports H.R.3229 - To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories. Opposes CMS' Miscellaneous Coding policy which limits access to wheelchair accessories based on whether the price of that accessory exceeds $150 [Healthcare Common Procedure Coding System (HCPCS) Codes Used for Processing Medicare Claims for Miscellaneous Durable Medical Equipment (DME)]. The HAB Coalition discussed with CMS the provision of habilitation benefits at the federal and state levels and asking for better clarification on coverage to include habilitative devices. United Spinal Association signed on to letters as part of the Coalition to Preserve Rehabilitation Steering Committee to the Centers for Medicare and Medicaid Services opposing bundling payments of episodes of care for Medicare beneficiaries and opposing restrictive lower limb prosthesis policy. United Spinal staff was interviewed by the U.S. Government Accountability Office on the impact of Medicares competitive acquisition program on people with disabilities for their 2015 report. United Spinal continues to monitor the impact of the program on access issues for Medicare beneficiaries. As a member of the Coalition to Preserve Rehabilitation Steering Committee, United Spinal supports strengthening consumer protections in rehab facilities and urged Medicare to establish stronger language around resident services provided with clearer definitions; stronger language around comprehensive person-centered planning urging CMS to add that if facility discharge is determined to not be feasible, the plan must document the specific reasons for that conclusion, the services that resident receives and the reasons why those services could not be provided; better definition around the provision of rehabilitative services, discharge planning and resident rights for example. United Spinal also signed onto an American Association for Justice letter urging CMS to remove pre-dispute arbitration clauses as inherently unfair and disadvantageous to nursing home residents. First and foremost, an essential component of any decision-making process is gathering the information needed to make the best decision. Pre-dispute arbitration agreements force individuals to make a decision without any information at all about the dispute, for example, in cases of alleged severe neglect, serious injuries or death.

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Supports S.849 - Advancing Research for Neurological Diseases Act of 2015. This bill will mandate that the Centers for Disease Control and Prevention track the incidence and prevalence of neurological diseases. Also support the companion bill, HR 292 (which was included in the 21st Century Cures Initiative). United Spinal supports the Patient Access to Disposable Medical Technology Act of 2015, S.1253/H.R. 1018 - portable medical equipment that can be used outside of the hospital. United Spinal joined a coalition, led by the Center for Responsible Science, to file an FDA petition to broaden testing options in drug development and to update regulations that govern preclinical drug and device development. As a member of the Patients for Biologics Safety and Access, United Spinal is engaged in an advocacy campaign with Congress to ensure that Congress hold an oversight hearing with the Food and Drug Administration to ask for expedited publication of guidances on consumer safety and clinical testing for biological pharmaceuticals. A Senate HELP hearing with the FDA CDRH Director, Janet Woodcock testifying took place in September. United Spinal Association signed on to a letter spearheaded by the Advanced Medical Technology Association (AdvaMed) in support of repealing the tax on medical device manufacturers. Research shows that innovations in medical technology have greatly improved outcomes of individuals with disabilities. We are concerned that the medical device tax will curtail investments in future innovation, thereby reducing consumer access to innovative medicine and hampering their quality of life.

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21st Century Community Policing United Spinal attended an Executive Administration Disability Community briefing on the 21st Century Community Policing Taskforce activities. Other members of the CCD Rights Task Force, as well as representatives from the National Council on Disability and Lead On were present. Representatives from the Domestic Policy Council, the US Department of Justice, and the Task Force presented. Members of the disability community spoke on a range of concerns, including lack of disability issues presented in the Task Force report. Participants discussed the need for the criminal justice system to be aware of the needs and concerns of the disability community, to treat victims, witnesses and those suspected of crime with respect; data collection regarding people with disabilities and police violence; as well as time spent in the prison system, and access to supports and services while in and transitioning out. United Spinal supports a Consortium for Citizens with Disabilities Rights Task Force letter sent to the United States Senate. The letter voiced concerns about the Helping Families in Mental Health Crisis Act (H.R. 2646). The letter pointed out that instead of addressing the dramatic gaps in community services, the bill would remove critical protections for individuals with psychiatric disabilities and promote involuntary treatment. Community Integration Act - United Spinal supports the concepts described in the Community Integration Act, supported by Senator Charles Schumer (D-NY), which ensures that people with disabilities receive home and community-based supports and services in the home setting of their choice. NDLA members are continuing the dialogue with each other to consider additional language tweaks.

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Federal Surface Transportation Bill United Spinal submitted a letter to key Senators advocating for the removal of a harmful pay-for provision in a proposed long-term surface transportation bill. United Spinal urged the Senators to oppose Section 52303 of the DRIVE Act. The provision would have cut Social Security benefits to hundreds of thousands of people as one solution to dwindling transportation funding. United Spinal supported the efforts of the CCD Social Security Task force to raise awareness of the harmful provision and call for action amongst disability advocates and the Transportation Equity Caucus. United Spinal discussed with U.S. DOT the issue of adding equity to the US DOTs Beyond Traffic report on the future of transportation in the US. United Spinal recommended changes to the existing report, and inclusion of income as a barrier to transportation for people with disabilities. United Spinal submitted comments to US DOT in response to proposed rulemaking regarding paratransit fares. The proposed rule would have allowed an exception for a provider in LA County to charge more than the federally allotted rate (twice the fixed route fare). United Spinal urged US DOT to deny the request. United Spinal submitted similar comments on behalf of the Consortium for Citizens with Disabilities Transportation Task force as well. United Spinal Association wrote a letter to Representative Frank LoBiondo, (R-NJ), who sits on the House Committee on Transportation and Infrastructure in support of expanded Federal Aviation Administration language to allow for power inhibition devices to be used when stowing passenger wheelchairs as airline cargo. The inhibition device stops the power from accidentally turning on in the cargo which has been the cause of fires. The inhibition device/plug is also easy to insert and avoids airline crew being up to speed on all the variations of chairs and varying battery set-ups where battery cables must be disconnected.

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Protect Fair Housing Senate Letter United Spinal signed on to a letter, also co-signed by the Consortium for Citizens with Disabilities Housing Task Force, urging all Senators to ensure local, private fair housing and housing anti-discrimination laws are protected. In June, the House of Representatives passed its Fiscal Year 2016 the Commerce, Justice, Science (CJS) Appropriations bill, H.R. 2578, and its Transportation, Housing and Urban Development (THUD) appropriations bill, H.R. 2577, with highly concerning anti-fair housing amendments attached that would all but eliminate local private fair housing enforcement, and undermine the federal governments ability to protect Americans from housing discrimination. The letter was organized by the National Fair Housing Alliance.

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United Spinal signed onto Consortium for Citizens with Disabilities Social Security Task Force describing ways to improve work incentives and Social Security Disability Insurance (SSDI) benefits for SSDI. United Spinal Association signed onto a Consortium for Citizens with Disabilities Social Security Task Force letter in support of H.R. 3150, the One Social Security Act to the Ranking Member of the Social Security Subcommittee of the House Ways and Means Committee, Representative Xavier Becerra, (D-CA 34th). The legislation combines two trust funds, the Social Security Trust Fund and the Old Age and Survivor and Disability Insurance. The Disability Insurance Trust Fund is projected to be depleted at the end of 2016, at which time Social Security Disability Insurance beneficiaries face a nearly 20% benefit cut unless action is taken. United Spinal Association signed onto a Consortium for Citizens with Disabilities Social Security Task Force letter and supports Senator Wyden and Representative Levins Social Security Earned Benefits Payment Act. The bill implements the Presidents proposal to reallocate funds between the Old Age and Survivors Insurance and Disability Insurance trust funds to equalize both funds through 2034. The bill will prevent the 20% across the board cut in Social Security Disability Insurance (SSDI) at the end of 2016 and doing so with no cuts to Social Security benefits, eligibility or coverage. Benefit Offset Review United Spinal supports the Consortium for Citizens with Disabilities Social Security Task Force response to Congress on recommendations regarding review of a Benefit Offset program. The purpose of a Benefit Offset program is to determine the effect of various interventions, in combination with a benefit offset, on employment outcomes including wages, benefits, hours worked, and job retention. Economic security and work incentives must be core concepts within a benefit offset program with $1 benefit offset for every $2 of earnings over the earning disregard threshold.

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3rd Quarter, 2015

Q3 Report

In Q3, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on Oct. 20, 2015. Original Filing: 300762819.xml

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3rd Quarter, 2015

Amendment

United Spinal Association amended a lobbying report for in-house lobbying in Q32015 on Oct. 20, 2015 Original Filing: 300763370.xml

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2nd Quarter, 2015

Q2 Report

In Q2, United Spinal Association had in-house lobbyists, and was paid $120,000. The report was filed on July 17, 2015. Original Filing: 300738982.xml

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Discussed the change in the 40 mile rule with Veterans Health Administration (VHA) Discussed how to address transportation difficulties experienced by veterans needing to travel to VA healthcare appointments. Discussed draft legislation that would improve benefits and services for veterans and their families. Discussed how to transform VAs vocational rehabilitation program into a 21st century vocational rehabilitation program. Discussed proposed legislation to provide a presumption of service connection for mental health conditions related to military sexual trauma. Discussed proposed legislation regarding telework for certain VA employees. Supported House efforts to increase DOD and VA support for Joint Centers of Excellence. Discussed reforming the VAs claims process to ensure that it is veteran-centered. Discussed with advocates a legislative proposal to expand the approved uses of the Post 9/11 GI Bill. Discussed access to VA mental health services with the Department of Veterans Affairs, Veterans Health Administration. Urged Congress to expand VA home and community-based services for veterans with disabilities. Urged Congress to provide appropriate oversight for and resources to address the VAs benefits claims processing backlog. Wrote a letter of support for HR 2894 CARE For All Veterans Act Wrote a letter in support of HR 2360, the Career-Ready Student Veterans Act

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Signed onto a Coalition Letter for Sign On Opposing Legislation to Repeal Gainful Employment and Incentive Compensation Rule. Signed on to a letter to Secretary of Education Duncan requesting a discharge of student loans based on Corinthian College going out of business and leaving its veteran students saddled with debt and no degree. Signed on to support HR 2360, the Career-ready Student Veterans Act. Provided support to Senator Blumenthals Bill to restore Post-9/11 education benefits for veterans at closed schools. Released a press statement in support of Military and Veterans Education Protection Act of 2015, legislation introduced by Senators Carper, Durbin and Blumenthal that proposes to close the 90-10 Loophole in veteran education benefits.

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Supports H.R. 1516/S. 1013 - ENsuring Access to Quality Compex Rehabiliation Technology Act - to ensure Medicare beneficiaries' access to customized wheelchairs. United Spinal advocated distributed a Congressional Dear Colleague letter urging that CRT accessories (specialty controls such as head-rests) are not set at competitive bidding pricing the same as standard wheelchairs due to their highly customized nature for a small population living with significant disabilities. United Spinal highlighted our concern with CRT Accessories, described above and with our concerns with access to durable medical equipment for wheelchair users under the competitive acquisition program. United Spinal signed on to a letter to US Health and Human Services Secretary Burwell and CMS officials regarding a pending case, Davis v. Shah, in the U.S. Second Circuit Court of Appeals - a challenge to New York Medicaid's attempt to limit coverage of compression stockings and orthopedic shoes only to Medicaid recipients with specific diagnoses. Supports the Steve Gleason Act which lifts caps on access to speech-generating devices. (HR 1919, H.R. 629, S, 768, S. 984. United Spinal supported Congressional testimony on behalf of the Coalition to Preserve Rehabilitation Steering Committee highlighting the need to eliminate site-neutral payments under Medicare and also advocated for additional signatories to a Dear Colleague letter stating the same issue. United Spinal supports expanded state participation in Medicaid programs that increase funding for HCBS such as the Community First Choice Option, Money Follows the Person, and the Balancing Incentive Program; and oppose restructuring of Medicaid funding through block grants, State Flexibility Funds, or per capita caps. United Spinal signed on to a letter to the Centers for Medicare and Medicaid Services in support of an improved mechanism for the reimbursement of Lemtrada to ensure speedier access to this therapy for individuals with multiple sclerosis. United Spinal signed onto three comment letters to the Centers for Medicare and Medicaid Services in support of improved rehab policy, namely: on in-patient rehabilitative facilities and on skilled nursing facilities to allow for improved quality reporting and on acute care hospitals and payment issues to ensure that bundled payments of services does not hinder coverage of episodes of care for individuals with multiple needs. United Spinal signed onto a MapRx letter to urge the Senate Finance Committee to include, in their discussion of chronic care, robust formularies, coverage of the six-protected classes of drugs, strong oversight, and transparency for consumers are among the design principles essential to meet the needs of Medicare beneficiaries. In addition, a process for notice of non-coverage, appeals and exceptions is critical to providing access to needed drug therapies. United Spinal supports S.1253, the Patient Access to Disposable Medical Technology Act of 2015.The legislation amends title XVIII (Medicare) of the Social Security Act to cover disposable medical technology in addition to equipment traditionally described as durable medical equipment. This legislation was introduced by Senators Burr (R-NC) and Bennet (D-CO) this spring and is identical to its House counterpart, H.R. 1018, which United Spinal has also supported. United Spinal supports the Protect Medical Innovation Act of 2015, HR 160, introduced by Rep. Eric Paulsen of Minnesota, which repeals the medical device tax on medical device manufacturers and importers. United Spinal signed on to a letter to Congress to convey support for the goals of the final Home and Community Based Settings (HCBS) rule issued by the Centers for Medicare & Medicaid Services (CMS) in January 2014. This rule is the first time CMS has defined community for Medicaid-funded HCBS programs. The letter also urges Congress to: protect cuts to funding; support the requested additional $2.8m in CMS funding for HCBS; and defend against policies or changes to the rule that would hinder the goal of providing supports through HCBS so that people with disabilities can live meaningful lives.

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United Spinal Association calls for FDA Oversight and Congressional Hearings on Biologic Medicines Biologic medicines are made from living organisms and are far more complex and difficult to develop than traditional chemical drugs. United Spinal signed onto a Congressional letter to ask for support for the inclusion of $38 million in the FY 2016 Labor, Health and Human Services and Education Appropriations (LHHS) bill for the Assistive Technology (AT) Act Programs. Funding provided through the AT Act supports programs that assure people with disabilities have access to and acquisition of the assistive technology services they need to live, work, and attend school in their communities. United Spinal wrote a Congressional letter in support of The Enhancing the Stature and Visibility of Medical Rehabilitation Research at the NIH Act (companion bills: S. 800 and H.R. 1631) to improve, coordinate, and enhance medical rehabilitation research at the National Institutes of Health (NIH). Support HR 292, Advancing Research for Neurological Diseases Act of 2015, which amends the Public Health Service Act to require the Centers for Disease Control and Prevention to: (1) enhance and expand infrastructure and activities to track the epidemiology of neurological diseases, including multiple sclerosis and Parkinson's disease; and (2) incorporate information obtained through those activities into a National Neurological Diseases Surveillance System and requires the Department of Health and Human Services (HHS) to ensure that the System facilitates further research on neurological diseases. United Spinal signed on to a letter organized by the Autistic Self Advocacy Network to be sent to the Federal Drug Administration (FDA). The letter urged the FDA to act on the recommendations of the Neurological Devices Panel of the Medical Devices Advisory Committee that the harms of aversive conditioning devices used for contingent electric shock outweigh any potential benefits. The letter signatories called for the FDA to issue a total ban on any aversive conditioning devices used for contingent electric shock, in order to protect the publics right to safe, evidence-based treatment and the inherent human rights and dignity of people with disabilities. United Spinal Association signed onto an ARCH National Respite Network letter for House and Senate funding requests for FY2016 for the Labor/HHS/Education Appropriations bill for respite and other critical family support programs that provide a safety net for family caregivers across the lifespan and provides savings with proven prevention strategies. The letter requests $5.0 million for the Lifespan Respite Care Program, the amount included in the Presidents FY 2016 budget. We are also seeking support for the National Family Caregiver Support Program ($150 million), the Native American Caregiver Support Program ($6.8 million), and for the new Family Support program ($15 million) proposed by the President. United Spinal commended the United States House of Representatives Committee on Energy & Commerce Committee in support of the $10 billion NIH Innovation Fund which was added to a second discussion draft of the 21st Century Cures Act which makes improvements with access to medical devices, and prescription drugs. United Spinal policy staff requested members of Congress on the House and Senate Appropriations Committees to assist with United Spinal taking a leading role with an Administration for Community Living (ACL) federal $19,589,469 multi-year grant that funds a national Paralysis Resource Center (PRC) to provide access to the most comprehensive, high quality information and supports for people of all ages living with paralysis, their family and caregivers. United Spinal supports efforts by the American Academy of Pain Management and signed onto their letter to the Senate Finance Committee in implementing the development of a comprehensive population-level strategy to advance pain research, education, care and prevention, called the National Pain Strategy (NPS).

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United Spinal signed on to comments organized by the CCD Rights Task force and submitted to the Co-Chairs of the Presidents Task Force on 21st Century Policing. The comments urged the Task Force to give full consideration to the ways in which law enforcement officers interact with individuals with physical and mental disabilities, and the need for improved awareness and training. United Spinal Association signed onto a letter drafted by the Consortium of Citizens with Disabilities asking Democratic Whip of the United States House of Representatives, Rep. Steny Hoyer, to weigh in with the Equal Employment Opportunity Commission regarding its April 20, 2015 proposed rule to amend its ADA regulations which takes away important workplace rights that Congress enacted to protect people with disabilities. The letter shared concerns that the EEOCs Proposed Rule narrows the protections of the ADA-specifically, its limits on employers ability to subject employees to medical inquiries and examinations unrelated to their jobs.

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United Spinal participated, as an alternate, in the U.S. Access Board's Rail Vehicles Access Advisory Committee (RVAAC) April meeting. The RVAAC is developing consensus recommendations for the Access Boards use in updating sections of the guidelines that cover vehicles of fixed guideway systems, including rapid, light, commuter, intercity, and high speed rail. United Spinal submitted comments concerning U.S.DOT proposed rulemaking on Geographic-Based Hiring Preferences in Administering Federal Awards. United Spinal supported USDOTs efforts to allow city and state departments of transportation to set economic and geographic preferences for projects receiving federal funds. In addition, United Spinal urged USDOT to extend the allowance for targeted hiring provisions, including women and people with disabilities. United Spinal recommended language supporting contractor compliance with the U.S. Department of Labor (DOL) Section 503 rule requiring affirmative action policies leading to the employment of people with disabilities. United Spinal participated in an executive roundtable at the USDOT on Connectivity. The roundtable sought to examine equity measures seeking to ensure all people, including mobility device users, are getting where they need to go. United Spinal participated in a conference call with USDOT staff regarding future webinars to support the USDOTs Mayors Challenge for Safer People, Safer Streets initiative. Mayors offices (and state and other local officials, and planning organizations) who had signed up to participate in the challenge convened for a day at the USDOT headquarters earlier this year. Participants will receive technical assistance throughout the year. United Spinal supports S.705, the Transportation Alternatives Program Improvement Act. S.705 ensures adequate funding for sidewalk and other pedestrian and biking programs. The bill would allocate funds to local communities, and smaller rural communities, to build accessible networks, and to non-profits for safety education. United Spinal signed on to a letter to all members of Congress in support of adequate funding for transportation alternative programs (TAP), which includes funding for sidewalks and curb ramps. United Spinal signed on to a letter to all members of Congress in support of adequate funding for transportation alternative programs (TAP), which includes funding for sidewalks and curb ramps. United Spinal signed on to a letter to Congress regarding the need for reauthorization for a surface transportation bill. The letter highlighted the need for accessible transportation programs, funding for travel training and technical assistance, accessible taxis and public rights-of-way, and quality paratransit and coordinated transportation. United Spinal attended a conversation with USDOT Secretary Foxx, the DC DOT Director, Iowa DOT Director, and a key VA DOT official. The speakers discussed funding challenges and potential solutions. United Spinal attended a talk and interview with House Transportation & Infrastructure Chairman Shuster on transportation funding. Supports HR 2071, the Safe Streets Act of 2015, sponsored by Rep. Matsui (D-CA-6th). The bill encourages communities to consider safety improvements for all users in transportation project planning. United Spinal also calls on Congress to pass a long-term surface transportation bill with adequate funding measures. Any bill should incentivize solutions to ensuring an accessible, affordable, reliable and safe transportation system for all in urban, suburban, and rural settings. United Spinal provided guidance to Representative Duckworths staff regarding a bill that would require spaces be provided in airports for mothers to breastfeed. Duckworths staff requested recommended language to ensure the spaces provided would be accessible to all H.R.2530 - the Friendly Airports for Mothers Act of 2015. United Spinal provided a letter of support to Representative Langevins office in support of HR 1448, the Transit Accessibility Innovation Act of 2015. The bill would provide grants to public transit agencies to improve paratransit programs. United Spinal co-signed a letter to the Coast Guard as the Co-Chair of the CCD Transportation Task Force. The letter was addressed to Coast Guard Admiral Zukunft, and ccd key Senate offices on the Coast Guard subcommittee, FEMA, and the White House. The letter raised the concern that the House-passed Coast Guard Reauthorization Act weakens a requirement that survival craft keep a persons entire body out of the water. United spinal co-signed a letter, as Co-Chair of the CCD Transportation Task force, thanking Representative Rick Larsen for adding language to the Federal Aviation Administration (FAA) reauthorization. The language urged the U.S. Department of Transportation (DOT) to swiftly promulgate long-awaited regulations on the Air Carrier Access Act (ACAA) that increase access to accessible air travel for people with disabilities. The letter also raised the hope that rulemaking would increase access to lavatories, for passengers with service animals, and ensure the safety of people with disabilities mobility devices during travel. United Spinal signed on to a Congressional letter organized by Rails-to-Trails in support of funding and maintenance of the Trasnportation Alternatives Program (TAP) under USDOT. TAP provides authorization and funding for bicycle and pedestrian infrastructure and safety programs around the country. United Spinal participated, as an alternate, in the US Access Board Rail Vehicles Access Advisory Committee (RVAAC) June meeting. The RVAAC is developing consensus recommendations for the Access Boards use in updating sections of the guidelines that cover vehicles of fixed guideway systems, including rapid, light, commuter, intercity, and high speed rail.

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United Spinal is working with the FCC on highlighting and encouraging broadband enabled health solutions for people with disabilities by introducing partnerships with companies in the consumer electronics space and working with the FCCs Connect to Health Task Force. The FCC is planning technology expos for people with disabilities this Fall. United Spinal has been working closely with Verizon and other IT companies to expand access for people with disabilities to consumer electronics, software applications and communications devices. United Spinal is looking at ways to improve upon the Telecommunications Act of 1996. So many technology changes have occurred since then. United Spinal continues to highlight with Congressional offices the need to look at a new policy framework which encourages investment and innovation; promotes competition, and protects consumers. Regarding consumer access to devices and content, a light regulatory approach would be beneficial being mindful that there continue to be multiple communication platforms with different software and application versions for use by individuals who are blind, deaf and live with manual dexterity limitations. United Spinal continues to advocate against restrictions on access to telemedicine for our members and the broader disability community.

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1st Quarter, 2015

Q1 Report

In Q1, United Spinal Association had in-house lobbyists, and was paid $70,000. The report was filed on April 17, 2015. Original Filing: 300720118.xml

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Supports Ensuring Quality Access to Complex Rehab Technology Act - working to reintroduce House and Senate legislation. HR 1516 was introduced in March. Working on reintroducing Senate legislation. The bill provides separate recognition for customized wheelchairs under Medicare for indiduals with significant disabilities. Supports Steve Gleason Act, 2015, HR 628 - provides Medicare beneficiary access to eye-tracking accessories for speech genearating devices and removes the rental cap restriction for SGDs. Supports Medicare Access to Rehabilitation Services Act - HR 773/S.539 - amends title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. Supports Patient Access to Disposable Medical Technology Act of 2015/HR 1018 which amends title XVIII (Medicare) of the Social Security Act to cover substitute disposable medical technology, subject it to a special payment rule, and exempt it from competitive acquisition. Supports HR 729 Medicare Demonstration of Coverage for Low Vision Devices Act of 2015 which directs the Secretary of Health and Human Services to commence a project to demonstrate and evaluate the fiscal impact of covering low vision devices under part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act in the same or similar manner as coverage is provided for durable medical equipment under such part. Directs the Secretary of Health and Human Services to commence a project to demonstrate and evaluate the fiscal impact of covering low vision devices under part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act in the same or similar manner as coverage is provided for durable medical equipment under such part. Discussed improvements to orthotics and prosthetics rules and essential health benefits regulations. Discussed support of the Affordable Care Act, definitions of the summary of benefits and coverage for rehabilitation and habilitation services to prescription drug formularies. Discussed removing competitive acquisition pricing from complex rehab technology accessories. Support HR 2 - the Medicare Access and CHIP Reauthorization Act of 2015 which amends title XVIII (Medicare) of the Social Security Act (SSAct) to: (1) remove sustainable growth rate (SGR) methodology. Supports Improving Medicare Post-Acute Care Transformation Act of 2014 (S. 2553/HR 4994) - amends title XVIII of the Social Security Act to provide for standardized post-acute care assessment data for quality, payment, and discharge planning. Discussion of postponement of consideration of site-neutral payment policy for inpatient rehabilitation hospitals and units (IRFs) and skilled nursing facilities (SNFs).

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Discussed US DOT's Safer Streets initiative and increased accessibility including the need for accessibility and disability-related data collection; the importance of human services coordinated transportation in rural America; needed regulation for the non-motorized safety performance measures and the Pedestrian Safety Enhancment Act; ADA enforcment; AMTRAK, air travel, technical assistance; and commercial drivers' licenses for people with disabilities. US Access Board Rail Vehicles Access Advisory Committee (RVAAC) - discussed the development of consensus recommendations regarding vehicles of fixed guideway systems, inlcuding rapid, light, commmuter, intercity and high speed rail. United Spinal suppported an amendment to HR 749 - Passenger Rail Reform and Investment Act of 2015. The amendment requires Amtraks Office of Inspector General to submit a report to the House T&I and Senate Commerce Committees on boarding procedures at the 10 busiest stations for wheelchair users and passengers using or transporting bicycles. Rep. Lipinski mentioned United Spinals support in his floor speech and clarified that the amendment would require the report to include motorized and non-motorized wheelchairs. HR 749 passed with the amendment. United Spinal supports HR 1448 - Transit Accessibility Innovation act of 2015 (HR 1448). The legislation would create a competitive grant program under the Federal Transit Administration (FTA) to encourage transit systems to make public transportation more accessible and user-friendly for individuals with disabilities. United Spinal provided recommendations on multi-modal accessible transporation appplications that would promote independent living and mobility of travelers with disabilities and improve the travel experience of all users. United Spinal discussed strategies for creating successful models for building connected communities and measuring the benefits for its citizens. United Spinal raised questions regarding the accessibility of innovative transportation modes, and the importance of ensuring existing transportation is connecting people with disabilities to their homes, work, schools, and other important destinations. United Spinal engaged in a discussion with senior National Highway Traffic Safety Administration (NHTSA) staff regarding data collection of pedestrians with disabilities injuries and fatalities, as well as the need to report on wheelchair user injuries and fatalities.

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United Spinal signed onto a statement for the record to testimony given to the House Ways and Means Committee, Maintaining the Disability Insurance Trust Funds Solvency in support of budget fixes, called reallocation, to protect the Social Security ensure that Social Security Disability Insurance (SSDI) is available to both current and future beneficiaries, including the 7 in 10 SSDI beneficiaries who are age 50 and older. United Spinal also signed onto a letter to the Social Security Administration urging for improved oversight of representative payees, those who represent individuals eligible for social security benefits. United Spinal also signed onto a letter to the Senate Committee on Finance, the House Committee on Ways and Means in opposition to proposals to eliminate or reduce concurrent Social Security Disability Insurance (SSDI) and Unemployment Insurance (UI) benefits, including the Social Security Disability Insurance and Unemployment Benefits Double Dip Elimination Act of 2015 (S. 499; H.R. 918) and the Reducing Overlapping Payments Act of 2015 (S. 343). United Spinal signed onto comments to the Social Security Administration regarding the improved monitoring of representative payees. The Social Security Administration's Representative Payment Program provides financial management for Social Security payments of beneficiaries who are incapable of managing their own payments.

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4th Quarter, 2014

Amendment

United Spinal Association amended a lobbying report for in-house lobbying in Q42014 on Jan. 23, 2015 Original Filing: 300709363.xml

Lobbying Issues

Signed on to a letter to President Obama urging him to address in his 2016 budget proposal the impending cuts to Social Security Disability Insurance benefits due to the projected depletion of the reserve funds. Supported the CHAMPVA Childrens Protection Act (H.R. 288/S. 325). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs). Discussed improvements to HR 4090, the Social Security Fraud and Error Prevention Act of 2014 and HR 5260, the Stop Disability Fraud Act of 2014. Supports providing improved guidance around notification on Medicare eligibility to individuals not yet collecting Social Security benefits. Supports Achieving a Better Life Experience Act of 2014, HR 647/S. 313. Continue to advocate for improvements to the law.

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Discussed the Suicide Prevention Research INnovaTion Act (S. 2035). Supported the Mental Health First Aid Act of 2013 (S. 153). Supported ensuring network adequacy and protections for pediatric benefits within ACA's essential health benefits. Supports providing improved guidance around notification on Medicare eligibility to individuals not yet collecting Social Security benefits. Supports improving health benefit designs and a guarantee that there is health insurance plan transparency for Affordable Care Act enrollees. Supports protecting the definition of habilitative services and ensuring nondiscrimination as its relates to the provision of health benefits and services. Continues to discuss the 21st Century Cures Initiative with Congress. This initiative attempts to ensure improved access in the discovery, development and delivery of pharmaceutical therapies for the spinal cord injury community. Supports improved access to durable medical equipment and assistive technologies. Supports the Food and Drug Administration (FDA) addressing patient safety issues and the need for more guidance from the FDA on how biologics and biosimilars are being tested and made available to the public. Urges Congress to repeal the cap on therapy services under Medicare. Urges Congress to pursue passage of Ensuring Access To Quality Complex Rehabilitation Technology Act (HR 942/S. 948). Urges Congress to pass HR 4920 - The DMEPOS Medicare Improvement Act - requires state licenses for providers of durable medical equipment (DME) providers and requires that DME companies contracted with the Centers for Medicare and Medicaid must be bound by that contract to provide services and equipment to Medicare and Medicaid beneficiaries. Supports S. 1027 - improved co-ordination of disability and rehabilitation research funding at the National Institutes of Health. Opposes site-neutral payments under Medicare. Supports CMS including a broader range of remote access technologies in the basic health benefit packages offered under CMS.

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Discussed the FY 2015 National Defense Authorization Act (H.R. 4435/S. 2410). Discussed the FY 2015 National Defense Authorization Act compromise legislation (H.R. 3979). Supported S. 1659, the POST Act. This legislation would allow for-profit schools to receive no more than 85% of their revenues from federal sources and include DoD Tuition Assistance and G.I. Bill funds in the 85% calculation. Supported the Caring for Military Children with Developmental Disabilities Act of 2014 (H.R. 4630/S.2333). This legislation would improve access to behavioral health services, including applied behavior analysis, for TRICARE beneficiaries with autism and other developmental disabilities. Supported H.R. 164 which would permit former members of the Armed Forces who have a service-connected disability rated as total to travel on military aircraft in the same manner and to the same extent as retired members of the Armed Forces are entitled to travel on such aircraft. Supported the Rehabilitative Therapy Parity for Military Beneficiaries Act (H.R. 1705). Discussed the Military Justice Improvement Act of 2013 (S. 967). Supported the Disabled Military Child Protection Act (H.R. 2249/S. 1076). Supported House efforts to increase DoD and VA support for Joint Centers of Excellence.

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Discussed: transportation difficulties experienced by veterans needing to travel to VA healthcare appointments. draft legislation that would improve benefits and services for veterans and their families. how to transform VAs vocational rehabilitation program into a 21st century vocational rehabilitation program. Department of Veterans Affairs Expiring Authorities Act of 2014 (H.R. 5404). Restore Trust in Veterans Access to Health Care Act (H.R. 5007). Guarantee Housing for Terminally Ill Veterans Act (H.R. 4674). Rural Veterans Improvement Act of 2014 (S. 2009). Veteran Voting Support Act (S. 2145). Veterans Appeals Improvement Act of 2014 (S. 2296). 21st Century Veterans Benefits Delivery Act (S. 2091). This legislation would seek to improve the VA claims process. S. 2316, which would require the VAs Inspector General to submit a report on wait times for veterans seeking medical care from VA and to prohibit closure of VA medical facilities. S. 2362, which would prohibit the payment of performance awards in fiscal year 2015 to Veterans Health Administration employees. Increasing Medical Oversight in the Department of Veterans Affairs Act of 2014 (S. 2401). Veterans Access to Care Act of 2014 (H.R. 4810). H.R. 4037, the Improving Veterans Access to Vocational Rehabilitation and Employment Act of 2014. H.R. 2119, the Veterans Access to Speedy Review Act. H.R. 3876, the Burial with Dignity for Heroes Act of 2014. S. 1584 which would provide replacement automobiles for certain disabled veterans and servicemembers. with VAs Prosthetic and Sensory Aids Service standards for installation of adaptive auto equipment paid for by VA. legislation to provide a presumption of service connection for mental health conditions related to military sexual trauma. legislation regarding telework for certain VA employees. H.R. 2088 which would direct VA to carry out a pilot program to establish claims adjudication centers of excellence. H.R. 2726 which would authorize VA to enter into contracts and agreements for the transfer of veterans to non-VA medical foster homes for certain veterans who are unable to live independently. Veterans Health and Benefits Improvement Act of 2013, as amended (S. 944). Access to Appropriate Immunizations for Veterans Act of 2013 (S. 1165). Improving the Lives of Children with Spina Bifida Act (S. 832). VA Claims Efficiency Through Information Act (H.R. 1623). H.R. 2189 which would establish a commission or task force to evaluate the backlog of disability claims. Veterans Pension Protection Act (H.R. 2341). Ending VA Claims Disability Backlog and Accountability Act (H.R. 2138). reforming the VAs claims process to ensure that it is veteran-centered. with advocates a legislative proposal to expand the approved uses of the Post 9/11 GI Bill. access to VA mental health services with the Department of Veterans Affairs, Veterans Health Administration. VetSuccess Enhancement Act (H.R. 844). This legislation would extend from 12 to 17 years the authorized period for an eligible veteran to receive vocational training and rehabilitation from VA. H.R. 894 which would reform VAs fiduciary program. Reducing Barriers to Veterans Benefits Act (H.R. 369). Opposed the Access to Veterans Benefits Improvement Act (H.R. 733). Signed on to a letter to the Chairs and Ranking Members of the Senate and House Veterans Affairs Committee supporting additional resources for VA as it seeks to meet its healthcare obligations. Supported: the Protect Veterans Employment and Training Services Act (Protect VETS Act) (S. 2834). the Creating Options for Veterans Expedited Recovery Act (H.R. 4977). the Clay Hunt Suicide Prevention for American Veterans Act (H.R. 5059). Also discussed the Suicide Prevention for American Veterans Act (S. 2182). Toxic Exposure Research Act of 2014 (H.R. 5484). Wounded Warrior Employment Improvement Act (H.R. 5032). H.R. 4971, the Ask Veterans Act. This legislation would solicit veterans opinions regarding their experiences with VA health care. S. 1659, the POST Act. This legislation would allow for-profit schools to receive no more than 85% of their revenues from federal sources and include DoD Tuition Assistance and G.I. Bill funds in the 85% calculation. S. 2115, the American Cures Act. This legislation would create a biomedical trust fund to sustain federal investment in four leading federal agencies and programs dedicated to mental health and prosthetic research for veterans. Military and Veteran Caregiver Services Improvement Act of 2014 (S. 2243/H.R. 4892). This legislation would increase access to caregiver benefits and make other critical changes needed to ensure improved services for significantly disabled veterans and servicemembers and their caregivers. Disabled Veterans Jobs Opportunity Act (H.R. 4247). This legislation would increase preference in federal hiring for veterans who have disability ratings of 70 percent or greater from VA. Express Appeals Act (H.R. 4616). This legislation would provide veterans with the opportunity to have their appeals of claims for disability compensation benefits reviewed using an expedited review process. Serving Americas Veterans Effectively Act (SAVE Act) (H.R. 5332). This legislation would promote greater awareness of the health care needs of our nations veterans by requiring health care providers who participate in the Medicare and Medicaid programs to ask about a patients veteran status. Veterans Access to Care Through Choice, Accountability, and Transparency Act of 2014 (S. 2450). This legislation represents an important step toward ensuring that veterans have timely access to health care and that VA employees who gamed the system for scheduling care will be held accountable. S. 2450 was inserted into H.R. 3230 (Veterans Access to Care through Choice, Accountability, and Transparency Act of 2014) as an amendment in the nature of a substitute. S. 1950/S. 1982, the Comprehensive Veterans Health and Benefits and Military and Retirement Pay Restoration Act. Also supported Amendment 2755 to add advance appropriations for additional VA accounts to S. 1982. H.R. 2527 which expands access to counseling and treatment for sexual trauma that occurred while a service member was on inactive duty for training status. H.R. 2974 which expands beneficiary travel for veterans seeking treatment or care for military sexual assault at a specialized outpatient or residential facility. H.R. 3958, the Healing our Heroes Act. This legislation would prevent veterans who have sustained a traumatic brain injury (TBI) from being forced to prematurely end their rehabilitation due to the expiration of the Assisted Living Pilot Program for Veterans with TBI. In addition, we supported H.R. 4276 and S. 2607 which would also extend the authorization of the program. H.R. 4234, the Ensuring Veterans Resiliency Act. This legislation would encourage psychiatrists to dedicate their careers to serving our veterans by authorizing a select number of full-time hires to be offered loan repayment incentives commensurate with other federal entities. H.R. 4150, the Veterans Employment and Training Service Longitudinal Study Act of 2014. H.R. 4151, the Veterans Education Survey Act of 2014. H.R. 2018, the Honor Those Who Served Act of 2013. H.R. 2529, the Veteran Spouses Equal Treatment Act. H.R. 3671 which would furnish a medallion to signify the veteran status of a deceased individual. H.R. 4095/S. 2258, the Veterans Compensation Cost-of-Living Adjustment Act of 2014. H.R. 4102 which would allow the estates of deceased veterans to receive accrued benefits. H.R. 4141 which would allow enhanced-use leases for excess property of the National Cemetery Administration. S. 2311/H.R. 3508 which would clarify qualifications of hearing aid specialist of the VHA. Services to Veterans Caregivers (SOS Veterans Caregivers) Act (H.R. 3672). Protecting Those Who Protected Us Act of 2013 (S. 1564). Quicker Veterans Benefits Delivery Act (H.R. 1980/H.R. 4191). House efforts to increase DOD and VA support for Joint Centers of Excellence. Homeless Veterans Assistance Fund Act of 2013 (H.R. 2797). Veterans Independent Living Enhancement Act (H.R. 3330). American Heroes COLA Act (H.R. 570). Veterans Second Amendment Protection Act (H.R. 602). Ruth Moore Act of 2013 (H.R. 671). Honor Americas Guard-Reserve Retirees Act (H.R. 679). VA Claims, Operations, and Records Efficiency Act (H.R. 1729). World War II Merchant Mariner Service Act (H.R. 1288). Blue Water Navy Ship Accountability Act (H.R. 1494). Pay As You Rate Act (H.R. 2086). H.R. 1809 which would require VA to provide notice of average times for processing claims and percentage of claims approved. Prioritizing Urgent Claims for Veterans Act (H.R. 2382). Disabled Veterans Access to Medical Exams Improvement Act (H.R. 2423). Putting Veterans Funding First Act of 2013 (H.R. 813/S. 932). Wounded Warrior Workforce Enhancement Act (S. 522). Veterans Affairs Research Transparency Act (S. 877). legislation authorizing VA to transport individuals to and from VA facilities in connection with rehabilitation, counseling, examination, treatment, and care (H.R. 1702/S. 455). Caregivers Expansion and Improvement Act of 2013 (H.R. 33

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Urged the Department of Labors Assistant Secretary for Veterans Employment and Training Service to swiftly implement Section 521 of the National Defense Authorization Act (P.L. 113-66). Discussed with the Department of Labor implementation of the Workforce Innovation and Opportunity Act (P.L. 113-128) as it relates to disabled veterans. Supported the Protect Veterans Employment and Training Services Act (Protect VETS Act) (S. 2834). Discussed recommendations for implementation of Section 503 of the Rehabilitation Acct of 1973. US DOL Home Care Rule - Urges Congress to delay implmentation of the DOL Home Care Rule. Supports providing improved guidance around notification on Medicare eligibility to individuals not yet collecting Social Security benefits.

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Supported the Housing Assistance for Veterans Act of 2013 (Haven Act) (H.R. 385/H.R. 3743/S. 1387). This legislation will leverage the ability of nonprofits to assist disabled and low-income veterans with needed housing adaptations and home repairs. Discussed the Homes for Heroes Act of 2013 (H.R. 384/H.R. 386). Requested adequate funding for the 811 PRA program in HUDs request to OMB. Through the Section 811 Supportive Housing for Persons with Disabilities program, HUD provides funding to develop and subsidize rental housing with the availability of supportive services for very low- and extremely low-income adults with disabilities. Discussed the Universal Home Design Act (S. 2889) which would increase the availability of accessible housing for individuals with disabilities.

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4th Quarter, 2014

Q4 Report

In Q4, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on Jan. 20, 2015. Original Filing: 300706672.xml

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3rd Quarter, 2014

Amendment

United Spinal Association amended a lobbying report for in-house lobbying in Q32014 on Oct. 21, 2014 Original Filing: 300689369.xml

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Discussed the Suicide Prevention Research Innovation Act (S. 2035). Supported the Mental Health First Aid Act of 2013 (S. 153). Signed on to a letter to the U.S. Department of Transportation and the U.S. Department of Health and Human Services asking for all modes of public transportation to announce the Suicide Prevention Lifeline for passengers on World Suicide Prevention Day. United Spinal highlighted improved clinical outcomes for rehabilitative care at in-patient rehab facilities over skilled nursing facilities for individuals with spinal cord injuries and other conditions such as brain injury and stroke. United Spinal discussed the 21st Century Cure initiative of Chairman Fred Upton (R-MI-6th) focusing on patient centered care. United Spinal supports Lifespan Respite Care Reauthorization Act (H.R.4683), a free-standing bill that reauthorizes the Lifespan Respite Care Program at $15 million a year for five years. United Spinal discussed the need to provide clarity and certainty for appropriate, risk-based oversight of health information technology.United Spinal supports HR 3077, the TeleMed Act, which allows Medicare providers licensed in one state to provide telemedicine services to certain Medicare beneficiaries across state lines. CMS has proposed a rule to expand prior authorization for DME affecting power wheelchairs, lower limb prostheses and negative pressure wound therapy. United Spinal is in general support of prior authorization is a process that certifies DME suppliers with CMS before they provide equipment and services to Medicare beneficiaries. United Spinal highlighted improved clinical outcomes for rehabilitative care at in-patient rehab facilities over skilled nursing facilities for individuals with spinal cord injuries and other conditions such as brain injury and stroke. United Spinal supports Ensuring Access to Quality Complex Rehabilitation Technology Act/HR 942/ S 948. which creates a separate benefit under Medicare for customized equipment known as complex rehab technology needed by people with significant disabilities. United Spinal discussed the negative impact capped rental agreements for medical equipment and supplies have on access to equipment for individuals with disabilities. United Spinal supports action on improving benefit designs, including cost-sharing options, and guarantee that there is plan transparency for ACA enrollees. United Spinal discussed the 21st Century Cure initiative of Chairman Fred Upton (R-MI-6th) focusing on patient centered care with Congressional staff. United Spinal discussed ACA enrollment and reenrollment matters with HHS. Discussed state of managed care in NYC for dual eligibles and potential improvements in the short term. United Spinal supports greater transparency in Medicare's competitive acquisition program for DMEPOS program as to how providers are evaluated by the Centers for Medicare and Medicaid Services and how the health of beneficiaries are being evaluated. United Spinal supports Medicare Demonstration of Coverage for Low Vision Devices Act of 2013 (H.R. 3749) which would establish a demonstration under the Medicare program for coverage of low vision aids. United Spinal supports HR 713/ S. 367 - Medicare Access to Rehabilitation Services Act of 2013 which eliminates therapy caps for rehabilitative services under Medicare without requiring an exceptions process. United Spinal presented recommendations to the Centers for Medicare and Medicaid Services regarding improvements to the Home and Community Based Services (HCBS) rule which was implemented in January 2014. The rule enhances the quality of HCBS, provides additional protections to HCBS program participants, and ensures that individuals receiving services through HCBS programs have full access to the benefits of community living. The letters recommendations include: ensuring transparency throughout the process; maintaining consistency with Olmstead [The Olmstead Supreme Court decision requires states to provide people with disabilities with the most integrated setting appropriate to their needs]; issuing necessary guidance promptly; clarifying consumer rights and ensuring that states properly identify and categorize settings. United Spinal supports the Community Integration Act/S. 2515. The Act would support the rebalancing of policies to ensure individuals with disabilities can leave institutions and live in the setting of their choosing. United Spinal supports HR 4920, the DMEPOS Medicare Improvement Act of 2014 which requires that providers of durable medical equipment, in areas known as competitive bidding areas, must be licensed in the states that they provide equipment and services and must be bound to the contract that they submitted to CMS if they are awarded a contract to provide equipment and services to Medicare beneficiaries. United Spinal discussed and presented recommendations to the Centers of Medicare and Medicaid Services to proceed with extreme caution when implementing a reimbursement cut in the provision of wound care therapy due to the effects of implementation on beneficiary access to NPWT. Supports making improvements to Medicare trust funds regarding liability settlements.

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Discussed the FY 2015 National Defense Authorization Act (H.R. 4435/S. 2410). Supported S. 1659, the POST Act. This legislation would allow for-profit schools to receive no more than 85% of their revenues from federal sources and include DoD Tuition Assistance and G.I. Bill funds in the 85% calculation. Supported the Caring for Military Children with Developmental Disabilities Act of 2014 (H.R. 4630/S.2333). This legislation would improve access to behavioral health services, including applied behavior analysis, for TRICARE beneficiaries with autism and other developmental disabilities. Supported H.R. 164 which would permit former members of the Armed Forces who have a service-connected disability rated as total to travel on military aircraft in the same manner and to the same extent as retired members of the Armed Forces are entitled to travel on such aircraft. Supported the Rehabilitative Therapy Parity for Military Beneficiaries Act (H.R. 1705). Discussed the Military Justice Improvement Act of 2013 (S. 967). Supported the Disabled Military Child Protection Act (H.R. 2249/S. 1076). Supported House efforts to increase DoD and VA support for Joint Centers of Excellence.

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Discussed the following: how to transform VAs vocational rehabilitation program into a 21st century vocational rehabilitation program. Department of Veterans Affairs Expiring Authorities Act of 2014 (H.R. 5404). Restore Trust in Veterans Access to Health Care Act (H.R. 5007). Guarantee Housing for Terminally Ill Veterans Act (H.R. 4674).Rural Veterans Improvement Act of 2014 (S. 2009). Veteran Voting Support Act (S. 2145). Veterans Appeals Improvement Act of 2014 (S. 2296). S. 2316 requires the VAs Inspector General to submit a report on wait times for veterans seeking medical care from VA and to prohibit closure of VA medical facilities. S. 2362 prohibits the payment of performance awards in fiscal year 2015 to Veterans Health Administration employees. Increasing Medical Oversight in the Department of Veterans Affairs Act of 2014 (S. 2401). Veterans Access to Care Act of 2014 (H.R. 4810).H.R. 4037, the Improving Veterans Access to Vocational Rehabilitation and Employment Act of 2014.21st Century Veterans Benefits Delivery Act (S. 2091). This legislation would seek to improve the VA claims process. H.R. 2119, the Veterans Access to Speedy Review Act. H.R. 3876, the Burial with Dignity for Heroes Act of 2014. S. 1584 which would provide replacement automobiles for certain disabled veterans and servicemembers. VAs Prosthetic and Sensory Aids Service standards for installation of adaptive auto equipment paid for by VA. legislation to provide a presumption of service connection for mental health conditions related to military sexual trauma. legislation regarding telework for certain VA employees. H.R. 2088 which would direct VA to carry out a pilot program to establish claims adjudication centers of excellence. H.R. 2189 which would establish a commission or task force to evaluate the backlog of disability claims. reforming the VAs claims process to ensure that it is veteran-centered. H.R. 2726 which would authorize VA to enter into contracts and agreements for the transfer of veterans to non-VA medical foster homes for certain veterans who are unable to live independently. Veterans Health and Benefits Improvement Act of 2013, as amended (S. 944). Access to Appropriate Immunizations for Veterans Act of 2013 (S. 1165). Improving the Lives of Children with Spina Bifida Act (S. 832). Ending VA Claims Disability Backlog and Accountability Act (H.R. 2138). VA Claims Efficiency Through Information Act (H.R. 1623). Veterans Pension Protection Act (H.R. 2341). a legislative proposal, with advocates to expand the approved uses of the Post 9/11 GI Bill. access to VA mental health services with the Department of Veterans Affairs, Veterans Health Administration. VetSuccess Enhancement Act (H.R. 844). This legislation would extend from 12 to 17 years the authorized period for an eligible veteran to receive vocational training and rehabilitation from VA. H.R. 894 which would reform VAs fiduciary program. Reducing Barriers to Veterans Benefits Act (H.R. 369). Supported the following: Protect Veterans Employment and Training Services Act (Protect VETS Act) (S. 2834). Creating Options for Veterans Expedited Recovery Act (H.R. 4977). Clay Hunt Suicide Prevention for American Veterans Act (H.R. 5059). Also discussed the Suicide Prevention for American Veterans Act (S. 2182). Toxic Exposure Research Act of 2014 (H.R. 5484). Wounded Warrior Employment Improvement Act (H.R. 5032). H.R. 4971, the Ask Veterans Act. This legislation would solicit veterans opinions regarding their experiences with VA health care. S. 1659, the POST Act. This legislation would allow for-profit schools to receive no more than 85% of their revenues from federal sources and include DoD Tuition Assistance and G.I. Bill funds in the 85% calculation. S. 2115, the American Cures Act. This legislation would create a biomedical trust fund to sustain federal investment in four leading federal agencies and programs dedicated to mental health and prosthetic research for veterans. Military and Veteran Caregiver Services Improvement Act of 2014 (S. 2243/H.R. 4892). This legislation would increase access to caregiver benefits and make other critical changes needed to ensure improved services for significantly disabled veterans and servicemembers and their caregivers. Disabled Veterans Jobs Opportunity Act (H.R. 4247). This legislation would increase preference in federal hiring for veterans who have disability ratings of 70 percent or greater from VA. Express Appeals Act (H.R. 4616). This legislation would provide veterans with the opportunity to have their appeals of claims for disability compensation benefits reviewed using an expedited review process. Serving Americas Veterans Effectively Act (SAVE Act) (H.R. 5332). This legislation would promote greater awareness of the health care needs of our nations veterans by requiring health care providers who participate in the Medicare and Medicaid programs to ask about a patients veteran status. Veterans Access to Care Through Choice, Accountability, and Transparency Act of 2014 (S. 2450). This legislation represents an important step toward ensuring that veterans have timely access to health care and that VA employees who gamed the system for scheduling care will be held accountable. S. 2450 was inserted into H.R. 3230 (Veterans Access to Care through Choice, Accountability, and Transparency Act of 2014) as an amendment in the nature of a substitute. S. 1950/S. 1982, the Comprehensive Veterans Health and Benefits and Military and Retirement Pay Restoration Act. Also supported Amendment 2755 to add advance appropriations for additional VA accounts to S. 1982. H.R. 2527 which expands access to counseling and treatment for sexual trauma that occurred while a service member was on inactive duty for training status. H.R. 2974 which expands beneficiary travel for veterans seeking treatment or care for military sexual assault at a specialized outpatient or residential facility. H.R. 3958, the Healing our Heroes Act. This legislation would prevent veterans who have sustained a traumatic brain injury (TBI) from being forced to prematurely end their rehabilitation due to the expiration of the Assisted Living Pilot Program for Veterans with TBI. In addition, we supported H.R. 4276 and S. 2607 which would also extend the authorization of the program. H.R. 4234, the Ensuring Veterans Resiliency Act. This legislation would encourage psychiatrists to dedicate their careers to serving our veterans by authorizing a select number of full-time hires to be offered loan repayment incentives commensurate with other federal entities. H.R. 4150, the Veterans Employment and Training Service Longitudinal Study Act of 2014. H.R. 4151, the Veterans Education Survey Act of 2014. H.R. 2018, the Honor Those Who Served Act of 2013. H.R. 2529, the Veteran Spouses Equal Treatment Act. H.R. 3671 which would furnish a medallion to signify the veteran status of a deceased individual. H.R. 4095/S. 2258, the Veterans Compensation Cost-of-Living Adjustment Act of 2014. H.R. 4102 which would allow the estates of deceased veterans to receive accrued benefits. H.R. 4141 which would allow enhanced-use leases for excess property of the National Cemetery Administration. S. 2311/H.R. 3508 which would clarify qualifications of hearing aid specialist of the VHA. Support our Services to Veterans Caregivers (SOS Veterans Caregivers) Act (H.R. 3672). Protecting Those Who Protected Us Act of 2013 (S. 1564). Quicker Veterans Benefits Delivery Act (H.R. 1980/H.R. 4191). House efforts to increase DOD and VA support for Joint Centers of Excellence. Homeless Veterans Assistance Fund Act of 2013 (H.R. 2797). Veterans Independent Living Enhancement Act (H.R. 3330). American Heroes COLA Act (H.R. 570). Veterans Second Amendment Protection Act (H.R. 602). Ruth Moore Act of 2013 (H.R. 671). Honor Americas Guard-Reserve Retirees Act (H.R. 679). VA Claims, Operations, and Records Efficiency Act (H.R. 1729). World War II Merchant Mariner Service Act (H.R. 1288). Blue Water Navy Ship Accountability Act (H.R. 1494). Pay As You Rate Act (H.R. 2086). H.R. 1809 which would require VA to provide notice of average times for processing claims and percentage of claims approved. Prioritizing Urgent Claims for Veterans Act (H.R. 2382). Disabled Veterans Access to Medical Exams Improvement Act (H.R. 2423). Putting Veterans Funding First Act of 2013 (H.R. 813/S. 932). Wounded Warrior Workforce Enhancement Act (S. 522). Veterans Affairs Research Transparency Act (S. 877). legislation authorizing VA to transport individuals to and from VA facilities in connection with rehabilitation, counseling, examination, treatment, and care (H.R. 1702/S. 455). Caregivers Expansion and Improvement Act of 2013 (H.R. 3383/S. 851). H.R. 1284/S. 633 which would provide coverage under the beneficiary travel program of VA of certain disabled veterans for travel in connection with certain special disabilities rehabilitation. H.R. 1405 which would require VA to include an appeals form in any notice of decision issued for the denial of a benefit. Servicemembers Choice in Transition Act of 2013 (H.R. 631/S. 889) and recommended an amendment that would ensure inclusion of information about disabi

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Discussed the Transportation for Heroes Act of 2013 (H.R. 2362). Signed on to a letter to the U.S. Department of Transportation and U.S. Department of Health and Human Services asking for all modes of public transportation to announce the Suicide Prevention Lifeline for passengers on World Suicide Prevention Day. Discussed disability and civil rights with the Department of Transportation FTAs Office of Civil Rights regarding new ADA compliance review processes. United Spinal participated in US Department of Transportation Town Hall discussions regarding drafting language that would bolster the US DOTs proposed surface transportation bill, ensuring that people of color, low income communities and people with disabilities have access to jobs in the transportation industry. United Spinal supports retaining the requirement in section 609 of the Coast Guard Authorization Act of 2010, Pub. L. 111-281 (Section 609), in the Coast Guard and Maritime Transportation Act of 2014. Section 609 provides the common sense requirement that the use of survival craft that do not keep all parts of the body out-of-the-water be phased out by 2015. United Spinal endorsed Representative Langevins Transit Accessibility Innovation Program (TAIF) proposal. The program encourages public transit systems to take actions to address deficiencies in service for individuals with disabilities. United Spinal participated as an alternate in the Access Boards Rail Vehicle Access Advisory Committee (RVAAC) meeting. The Committee reviewed draft reports from subcommittees, including: Boarding and Alighting, Rooms and Spaces, and On-Board Circulation and Seating. The Committee is tasked with presenting recommendations to the Access Board which will draft guidelines. United Spinal discussed Amtrak ADA compliance with Amtrak. Supported HR 3978,New Opportunities for Bicycle and Pedestrian Infrastructure Financing Act (NOBPIFA). The bill includes funding for achieving compliance with the ADA,improving public transit, biking and pedestrian infrastructure. Supported HR 3494/S1708, the Bicycle and Pedestrian Safety Act. The bills would require the DOT to set a non-motorized safety performance measure. United Spinal supports passage of a long-term surface transportation bill with adequate funding measures which incentivize solutions to ensuring an accessible, affordable, reliable and safe transportation system in urban, suburban,and rural settings.

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United Spinal presented recommendations to the FCC regarding net neutrality rules, known as Open Internet regulations regarding people with disabilities' access to devices and content. United Spinal submitted comments to the Federal Communications Commission to ensure that funding for broadband infrastructure is not restricted, especially for individuals with disabilities living in rural areas. United Spinal sent a letter to President Obama urging the Department of Justice to release internet accessibility regulations. United Spinal has met with the United States House of Representatives Committee on Homeland Security to discuss recommendations for improved planning and communications for emergency preparedness for people with disabilities and has reviewed legislation regarding improving integration and the chain of command on disabilities communications within the U.S Department of Homeland Securitys Federal Emergency Management Agency.

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3rd Quarter, 2014

Q3 Report

In Q3, United Spinal Association had in-house lobbyists, and was paid $75,000. The report was filed on Oct. 20, 2014. Original Filing: 300688956.xml

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2nd Quarter, 2014

Q2 Report

In Q2, United Spinal Association had in-house lobbyists. The report was filed on July 16, 2014. Original Filing: 300658372.xml

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Discussed the Guarantee Housing for Terminally Ill Veterans Act (H.R. 4674). Discussed the Rural Veterans Improvement Act of 2014 (S. 2009). Discussed the Veteran Voting Support Act (S. 2145). Discussed the Veterans Appeals Improvement Act of 2014 (S. 2296). Discussed S. 2316, which would require the VAs Inspector General to submit a report on wait times for veterans seeking medical care from VA and to prohibit closure of VA medical facilities. Discussed S. 2362, which would prohibit the payment of performance awards in fiscal year 2015 to Veterans Health Administration employees. Discussed the Increasing Medical Oversight in the Department of Veterans Affairs Act of 2014 (S. 2401). Discussed the Veterans Access to Care Act of 2014 (H.R. 4810). Discussed the Suicide Prevention for American Veterans Act (S. 2182). Supported H.R. 4971, the Ask Veterans Act. This legislation would solicit veterans opinions regarding their experiences with VA health care. Supported S. 1659, the POST Act. This legislation would allow for-profit schools to receive no more than 85% of their revenues from federal sources and include DoD Tuition Assistance and G.I. Bill funds in the 85% calculation. Supported S. 2115, the American Cures Act. This legislation would create a biomedical trust fund to sustain federal investment in four leading federal agencies and programs dedicated to mental health and prosthetic research for veterans. Supported the Military and Veteran Caregiver Services Improvement Act of 2014 (S. 2243/H.R. 4892). This legislation would increase access to caregiver benefits and make other critical changes needed to ensure improved services for significantly disabled veterans and servicemembers and their caregivers. Supported the Disabled Veterans Jobs Opportunity Act (H.R. 4247). This legislation would increase preference in federal hiring for veterans who have disability ratings of 70 percent or greater from VA. Supported the Express Appeals Act (H.R. 4616). This legislation would provide veterans with the opportunity to have their appeals of claims for disability compensation benefits reviewed using an expedited review process. Supported the Serving Americas Veterans Effectively Act (SAVE Act). This legislation would promote greater awareness of the health care needs of our nations veterans by requiring health care providers who participate in the Medicare and Medicaid programs to ask about a patients veteran status. Supported the Veterans Access to Care Through Choice, Accountability, and Transparency Act of 2014 (S. 2450). This legislation represents an important step toward ensuring that veterans have timely access to health care and that VA employees who gamed the system for scheduling care will be held accountable. S. 2450 was inserted into H.R. 3230 (Veterans Access to Care through Choice, Accountability, and Transparency Act of 2014) as an amendment in the nature of a substitute. Signed on to a letter to the Chair and Ranking Members of the Senate and House Veterans Affairs Committees regarding key points that we want to see in a VA health care reform bill. We want to make sure that any compromise includes the following: a focus on access to treatment for all veterans waiting for care, VA responsibility for care coordination, fully funded expanded care, protection and preservation of the VA health care system, and an open and transparent process for making reforms. Discussed H.R. 4037, the Improving Veterans Access to Vocational Rehabilitation and Employment Act of 2014. Supported S. 1950/S. 1982, the Comprehensive Veterans Health and Benefits and Military and Retirement Pay Restoration Act. Also supported Amendment 2755 to add advance appropriations for additional VA accounts to S. 1982. Supported H.R. 2527 which expands access to counseling and treatment for sexual trauma that occurred while a service member was on inactive duty for training status. Supported H.R. 2974 which expands beneficiary travel for veterans seeking treatment or care for military sexual assault at a specialized outpatient or residential facility. Supported H.R. 3958, the Healing our Heroes Act. This legislation would prevent veterans who have sustained a traumatic brain injury (TBI) from being forced to prematurely end their rehabilitation due to the expiration of the Assisted Living Pilot Program for Veterans with TBI. In addition, we supported H.R. 4276 which would also extend the authorization of the program. Supported H.R. 4234, the Ensuring Veterans Resiliency Act. This legislation would encourage psychiatrists to dedicate their careers to serving our veterans by authorizing a select number of full-time hires to be offered loan repayment incentives commensurate with other federal entities. Discussed the 21st Century Veterans Benefits Delivery Act (S. 2091). This legislation would seek to improve the VA claims process. Supported H.R. 4150, the Veterans Employment and Training Service Longitudinal Study Act of 2014. Supported H.R. 4151, the Veterans Education Survey Act of 2014. Supported H.R. 2018, the Honor Those Who Served Act of 2013. Discussed H.R. 2119, the Veterans Access to Speedy Review Act. Supported H.R. 2529, the Veteran Spouses Equal Treatment Act. Supported H.R. 3671 which would furnish a medallion to signify the veteran status of a deceased individual. Supported H.R. 4095/S. 2258, the Veterans Compensation Cost-of-Living Adjustment Act of 2014. Supported H.R. 4102 which would allow the estates of deceased veterans to receive accrued benefits. Supported H.R. 4141 which would allow enhanced-use leases for excess property of the National Cemetery Administration. Discussed H.R. 3876, the Burial with Dignity for Heroes Act of 2014. Discussed S. 1584 which would provide replacement automobiles for certain disabled veterans and servicemembers. Supported S. 2311/H.R. 3508 which would clarify qualifications of hearing aid specialist of the VHA. Discussed with VAs Prosthetic and Sensory Aids Service standards for installation of adaptive auto equipment paid for by VA. Discussed legislation to provide a presumption of service connection for mental health conditions related to military sexual trauma. Discussed legislation regarding telework for certain VA employees. Discussed H.R. 2088 which would direct VA to carry out a pilot program to establish claims adjudication centers of excellence. Supported the Support our Services to Veterans Caregivers (SOS Veterans Caregivers) Act (H.R. 3672). Supported the Protecting Those Who Protected Us Act of 2013 (S. 1564). Discussed H.R. 2726 which would authorize VA to enter into contracts and agreements for the transfer of veterans to non-VA medical foster homes for certain veterans who are unable to live independently. Supported the Quicker Veterans Benefits Delivery Act (H.R. 1980/H.R. 4191). Supported House efforts to increase DOD and VA support for Joint Centers of Excellence. Supported the Homeless Veterans Assistance Fund Act of 2013 (H.R. 2797). Supported the Veterans Independent Living Enhancement Act (H.R. 3330). Discussed the Veterans Health and Benefits Improvement Act of 2013, as amended (S. 944). Discussed the Access to Appropriate Immunizations for Veterans Act of 2013 (S. 1165). Discussed the Improving the Lives of Children with Spina Bifida Act (S. 832). Supported the American Heroes COLA Act (H.R. 570). Supported the Veterans Second Amendment Protection Act (H.R. 602). Supported the Ruth Moore Act of 2013 (H.R. 671). Supported the Honor Americas Guard-Reserve Retirees Act (H.R. 679). Supported the VA Claims, Operations, and Records Efficiency Act (H.R. 1729). Discussed the Ending VA Claims Disability Backlog and Accountability Act (H.R. 2138). Supported the World War II Merchant Mariner Service Act (H.R. 1288). Supported the Blue Water Navy Ship Accountability Act (H.R. 1494). Discussed the VA Claims Efficiency Through Information Act (H.R. 1623). Supported the Pay As You Rate Act (H.R. 2086). Supported H.R. 1809 which would require VA to provide notice of average times for processing claims and percentage of claims approved. Supported the Prioritizing Urgent Claims for Veterans Act (H.R. 2382). Supported the Disabled Veterans Access to Medical Exams Improvement Act (H.R. 2423). Supported the Putting Veterans Funding First Act of 2013 (H.R. 813/S. 932). Discussed the Veterans Pension Protection Act (H.R. 2341). Opposed the Access to Veterans Benefits Improvement Act (H.R. 733). Supported the Wounded Warrior Workforce Enhancement Act (S. 522). Supported the Veterans Affairs Research Transparency Act (S. 877). Supported legislation authorizing VA to transport individuals to and from VA facilities in connection with rehabilitation, counseling, examination, treatment, and care (H.R. 1702/S. 455). Supported the Caregivers Expansion and Improvement Act of 2013 (H.R. 3383/S. 851). Supported (H.R. 1284/S. 633) which would provide coverage under the beneficiary travel program of VA of certain disabled veterans for travel in connection with certain special disabilities rehabilitation. Supported H.R. 1405 which would require VA to include an appeals form in any notice of decision issued for the denial of a benefit. Discussed H.R. 2189 which would establish a commission or task force to evaluate the backlog of disability claims. Supported the Servicemembers Choice in Transition Act of 2013 (H.R. 631/S. 889) and recommended an amendment that would ensure inclusion of information about disability related protections for disabled veterans seeking employment and/or education opportunities. This provision is now part of H.R. 357. Discussed reforming the VAs claims process to ensure that it is veteran-centered. Supported the Women Veterans and Other Health Care Improvements Act of 2013 (S. 131/H.R. 958). This legislation includes greater assistance through VA for veterans who have infertility issues related to their military service. Discussed with advocates a legislative proposal to expand the approved uses of the Post 9/11 GI Bill. Discussed access to VA mental health services with the Department of Veterans Affairs, Veterans Health Administration. Discussed the VetSuccess Enhancement Act (H.R. 844). This legislation would extend from 12 to 17 years the authorized period for an eligible veteran to receive vocational training and rehabilitation from VA. Discussed H.R. 894 which would reform VAs fiduciary program. Discussed the Reducing Barriers to Veterans Benefits Act (H.R. 369). Supported the Veterans Dog Training Therapy Act (H.R. 183). This legislation would direct the VA Secretary to carry out a pilot program for assessing the effectiveness of addressing post-deployment mental health and post-traumatic stress disorder symptoms through a therapeutic medium of service dog training and handling for veterans with disabilities. Supported the CHAMPVA Childrens Protection Act (H.R. 288/S. 325). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged Congress to expand VA home and community-based services for veterans with disabilities. Urged Congress to provide appropriate oversight for and resources to address the VAs benefits claims processing backlog.

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Discussed possible solutions for improving access to Medicaid for military families who have children with disabilities.Advocated for Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013 which creates a separate benefit under Medicare for customized wheelchairs and equipment. (HR 942/S. 948). Discussed legislative options for improved access to wheelchair repair, capped rental equipment and speech-generating devices. Advocated for Access to Inpatient Rehabilitation Therapy Act of 2014(H. R. 4755) which includes recreational therapy among the therapy modalities that constitute an intensive rehabilitation therapy program in an inpatient rehabilitation hospital or unit. Discussed suggested improvements for collecting data on patients within the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) which addresses data collectin procedures on rehabilitiation treatments and therapies under Medicare. Discussed personal injury settlements under Medicare affecting individuals with disabilities. Advocated for improved access for consumers to telemedicine and advocated for the lifting of restrictions of reimbursement for telemedicine at Accountable Care Organizations. Discussed strategies to improve information sharing for ACA navigators for the purpose of helping them enroll people with disabilities into the right health care plans.

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Discussed the Transportation for Heroes Act of 2013 (H.R. 2362).Support HR 3978, New Opportunities for Bicycle and Pedestrian Infrastructure Financing Act (NOBPIFA), sponsored by Rep. Albio Sires (D-NJ 8th). The bill includes funding for achieving compliance with the ADA, improving public transit, biking and pedestrian infrastructure. Support HR 3494/S 1708, the Bicycle and Pedestrian Safety Act, sponsored by Rep. Earl Blumenauer (D-OR 3rd) and Rep. Howard Coble (R-NC 6th), and Sen. Jeff Merkley (D-OR) and Sen. Kelly Ayotte (R-NH). The bills would require the DOT to set a non-motorized safety performance measure. Advocated for passage of a long-term surface transportation bill with adequate funding measures. Any bill should incentivize solutions to ensuring an accessible, affordable, reliable and safe transportation system in urban, suburban, and rural settings. Support public transit, funding for Section 5310, pilot programs that measure connectivity, including usability of sidewalks, TIGER and FAST grants that can support sidewalk and curb cut maintenance. Suupport biking and pedestrian programs and accessible pathways in MAP-21 reauthorization. Requested funding for progams that support people with disabilities' access to transportation. Discussed improving regulations for out-of-water survival craft included in the Coast Guard reauthorization bill. Discussed dedicated paratransit funding options and the creation of an incentive program to improve paratransit and transit operations for people with disabilities. Discussed establishing a transportation careers workforce development progam at the DOT to create pathways into quality operations, repair, maintenance, and construction jobs for disadvantaged workers including people with disabilities; foster investments in underserved communities in public transportation, bicycle and pedestrian projects (including ADA compliance) through DOT TIGER and TIFIA grants; and leverage DOT and related agency data collection, performance measures, and collaboration to ensure transportation projects benefit all by requiring DOT to prepare a quadrennial report of non-discrimination. United Spinal signed on to a letter to the U.S. Senate Environment and Public Works in support of financing for transit-oriented development (TOD). The EPWs bill included a proposal that would 1) recognize TOD as an eligible category in the TIFIA grant program and (2) lower the project cost threshold from $50million to $10million for TOD-projects. The provision passed and remains in the EPW bill. United Spinal signed on to a letter to Senate and House Transportation Housing and Urban Development and Related Agencies (T-HUD) subcommittee leadership. The letter urges leadership to maintain funding for Department of Transportation programs impacting people with disabilities in the FY 2015 T-HUD appropriations bill. United Spinal has recommended that US DOT ensure that a non-motorized measure would include people who use motorized and non-motorized wheelchairs as part of the Highway Safety Performance Management proposed rules. Supported legislation allowing states and cities to require local residents be hired for highway and public transportation projects. Local residents could include people with disabilities. H. R. 3620 - Local Hire Act.

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Agencies Lobbied

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1st Quarter, 2014

Q1 Report

In Q1, United Spinal Association had in-house lobbyists. The report was filed on April 21, 2014. Original Filing: 300648638.xml

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Sent letter to DOD regarding TRICARE's lack of coverage for over 100 lab developed tests, such as the test for Fragile X Syndrome. Supported H.R. 164 which would permit former members of the Armed Forces who have a service-connected disability rated as total to travel on military aircraft in the same manner and to the same extent as retired members of the Armed Forces are entitled to travel on such aircraft.Supported the Rehabilitative Therapy Parity for Military Beneficiaries Act (H.R. 1705). Discussed legislation that would provide certain behavioral health treatment under the TRICARE program for adults and children with developmental disabilities. Discussed the Military Justice Improvement Act of 2013 (S. 967). Supported the Disabled Military Child Protection Act (H.R. 2249/S. 1076). Supported House efforts to increase DOD and VA support for Joint Centers of Excellence.

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Supported the CHAMPVA Childrens Protection Act (H.R. 288/S. 325). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs).Oppose the Chained CPI which lowers social security benefits significantly over time and support the Chained CPI-E (Experimental Price Index for the Elderly) to calculate SSI and SSDI to ensure people with disabilities continue to have the critical income support they need to cover essential needs such as food, medicine and shelter. Support HR 649/S.308 - Protecting and Preserving Social Security Act of 2013and S.567 - Strengthening Social Security Act of 2013. Oppose reducing or eliminating concurrent unemployment insurance/disability insurance benefits as a partial pay-for for legislation to extend unemployment benfits as part of the budget discussions that ended in mid-January. Oppose the policy to not provide SSN print outs and benefit verification statements at SSA field offices.

Agencies Lobbied

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Lobbying Issues

Discussed H.R. 4037, the Improving Veterans Access to Vocational Rehabilitation and Employment Act of 2014. Supported S. 1950/S. 1982, the Comprehensive Veterans Health and Benefits and Military and Retirement Pay Restoration Act. Also supported Amendment 2755 to add advance appropriations for additional VA accounts to S. 1982. Supported H.R. 2527 which expands access to counseling and treatment for sexual trauma that occurred while a service member was on inactive duty for training status. Supported H.R. 2974which expands beneficiary travel for veterans seeking treatment or care for military sexual assault at a specialized outpatient or residential facility. Supported H.R. 3958, the Healing our Heroes Act. This legislation would prevent veterans who have sustained a traumatic brain injury (TBI) from being forced to prematurely end their rehabilitation due to the expiration of the Assisted Living Pilot Program for Veterans with TBI. Supported H.R. 4234, the Ensuring Veterans Resiliency Act. This legislation would encourage psychiatrists to dedicate their careers to serving our veterans by authorizing a select number of full-time hires to be offered loan repayment incentives commensurate with other federal entities. Discussed the 21st Century Veterans Benefits Delivery Act (S. 2091). This legislation would seek to improve the VA claims process. Supported H.R. 4150, the Veterans Employment and Training Service Longitudinal Study Act of 2014. Supported H.R. 4151, the Veterans Education Survey Act of 2014. Supported H.R. 2018, the Honor Those Who Served Act of 2013. Discussed H.R. 2119, the Veterans Access to Speedy Review Act. Supported H.R. 2529, the Veteran Spouses Equal Treatment Act. Supported H.R. 3671 which would furnish a medallion to signify the veteran status of a deceased individual. Supported H.R. 4095, the Veterans Compensation Cost-of-Living Adjustment Act of 2014. Supported H.R. 4102 which would allow the estates of deceased veterans to receive accrued benefits. Supported H.R. 4141 which would allow enhanced-use leases for excess property of the National Cemetery Administration. Discussed H.R. 3876, the Burial with Dignity for Heroes Act of 2014. Discussed S. 1584 which would provide replacement automobiles for certain disabled veterans and servicemembers. Supported H.R. 3508 which would clarify qualifications of hearing aid specialist of the VHA. Discussed with VAs Prosthetic and Sensory Aids Service standards for installation of adaptive auto equipment paid for by VA. Discussed legislation to provide a presumption of service connection for mental health conditions related to military sexual trauma. Discussed legislation regarding telework for certain VA employees. Discussed H.R. 2088 which would direct VA to carry out a pilot program to establish claims adjudication centers of excellence. Supported the Support our Services to Veterans Caregivers (SOS Veterans Caregivers) Act (H.R. 3672). Supported the Protecting Those Who Protected Us Act of 2013 (S. 1564). Discussed H.R. 2726 which would authorize VA to enter into contracts and agreements for the transfer of veterans to non-VA medical foster homes for certain veterans who are unable to live independently. Supported the Quicker Veterans Benefits Delivery Act (H.R. 1980/H.R. 4191). Supported House efforts to increase DOD and VA support for Joint Centers of Excellence. Supported the Homeless Veterans Assistance Fund Act of 2013 (H.R. 2797). Supported the Veterans Independent Living Enhancement Act (H.R. 3330). Discussed the Veterans Health and Benefits Improvement Act of 2013, as amended (S. 944). Discussed the Access to Appropriate Immunizations for Veterans Act of 2013 (S. 1165). Discussed the Improving the Lives of Children with Spina Bifida Act (S. 832). Supported the American Heroes COLA Act (H.R. 570). Supported the Veterans Second Amendment Protection Act (H.R. 602). Supported the Ruth Moore Act of 2013 (H.R. 671). Supported the Honor Americas Guard-Reserve Retirees Act (H.R. 679). Supported the VA Claims, Operations, and Records Efficiency Act (H.R. 1729). Discussed the Ending VA Claims Disability Backlog and Accountability Act (H.R. 2138). Supported the World War II Merchant Mariner Service Act (H.R. 1288). Supported the Blue Water Navy Ship Accountability Act (H.R. 1494). Discussed the VA Claims Efficiency Through Information Act (H.R. 1623).Supported the Pay As You Rate Act (H.R. 2086). Supported H.R. 1809 which would require VA to provide notice of average times for processing claims and percentage of claims approved. Supported the Prioritizing Urgent Claims for Veterans Act (H.R. 2382). Supported the Disabled Veterans Access to Medical Exams Improvement Act (H.R. 2423). Supported the Putting Veterans Funding First Act of 2013 (H.R. 813/S. 932). Discussed the Veterans Pension Protection Act (H.R. 2341). Opposed the Access to Veterans Benefits Improvement Act (H.R. 733). Supported the Wounded Warrior Workforce Enhancement Act (S. 522). Supported the Veterans Affairs Research Transparency Act (S. 877). Supported legislation authorizing VA to transport individuals to and from VA facilities in connection with rehabilitation, counseling, examination, treatment, and care (H.R. 1702/S. 455). Supported the Caregivers Expansion and Improvement Act of 2013 (H.R. 3383/S. 851). Supported (H.R. 1284/S. 633) which would provide coverage under the beneficiary travel program of VA of certain disabled veterans for travel in connection with certain special disabilities rehabilitation. Supported H.R. 1405 which would require VA to include an appeals form in any notice of decision issued for the denial of a benefit. Discussed H.R. 2189 which would establish a commission or task force to evaluate the backlog of disability claims. Supported the Servicemembers Choice in Transition Act of 2013 (H.R. 631/S. 889) and recommended an amendment that would ensure inclusion of information about disability related protections for disabled veterans seeking employment and/or education opportunities. This provision is now part of H.R. 357. Discussed reforming the VAs claims process to ensure that it is veteran-centered. Urged VA to expedite housing adaptations available for disabled veterans with ALS and other terminal illnesses under chapter 21 of title 38, USC. Supported the Women Veterans and Other Health Care Improvements Act of 2013 (S. 131/H.R. 958). This legislation includes greater assistance through VA for veterans who have infertility issues related to their military service. Discussed with advocates a legislative proposal to expand the approved uses of the Post 9/11 GI Bill. Discussed access to VA mental health services with the Department of Veterans Affairs, Veterans Health Administration. Discussed the VetSuccess Enhancement Act (H.R. 844). This legislation would extend from 12 to 17 years the authorized period for an eligible veteran to receive vocational training and rehabilitation from VA. Discussed H.R. 894 which would reform VAs fiduciary program. Discussed the Reducing Barriers to Veterans Benefits Act (H.R. 369). Discussed the Veteran Voting Support Act that would direct the VA Secretary to provide mail voter registration application forms to each veteran who: (1) seeks to enroll in VA health care system at the time of such enrollment; and (2) is already enrolled in such system when there is a change in the veteran's enrollment status or when there is a change in the veteran's address. Supported the Veterans Dog Training Therapy Act (H.R. 183). This legislation would direct the VA Secretary to carry out a pilot program for assessing the effectiveness of addressing post-deployment mental health and post-traumatic stress disorder symptoms through a therapeutic medium of service dog training and handling for veterans with disabilities. Supported the CHAMPVA Childrens Protection Act (H.R. 288/S. 325). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged Congress to expand VA home and community-based services for veterans with disabilities. Urged Congress to provide appropriate oversight for and resources to address the VAs benefits claims processing backlog.

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Type of Issue

Lobbying Issues

Discussed possible solutions for improving access to Medicaid for military families who have children with disabilities. Discussed passage of House and Senate legislation, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013 - HR 942/S 948. Discussed raising the capped rental rule on some complex rehab technology products and accessories. Discussed possible solutions around improved access to wheelchair repair. Discussed next steps regarding FDA action around biosimilar regulation and the implementation of biosimilar clinical trials. Discussed opposition to restricting Medicare coverage of protected classes of prescription drugs under Medicare Part D. Discussed solutions regarding Medicare physician payment updates known as the 'doc fix' including the repeal of the therapy cap. Discussed solutions regarding Medicare and Medicaid secondary payer regulations. Discussed solutions with state governments and Federal agencies regarding the administration of Medicaid Managed Care programs to ensure protections are in place for people with disabilities. Discussed solutions around CMS guidance on home and commuity based settings. Promote adequate fudning for all Medicaid services that allow people with disabilities to remina in their homes and contribute to the community. Discussed solutions to Medicare's current competitive acquisition program and support - Medicare DMEPOS Market Pricing Program Act of 2013 - HR 1717 Discussed solutions around improved quality measures for home and community based services for the aging and disability communities with HHS. Support advocacy efforts to expand Medicaid.

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Discussed solutions to support transportation equity performance measures. Discussed improved and increased transportation infrastructure, affordable transportation options, increased safety measures, equity performance measures, and expanded access to transportation careers for all Americans, especially disadvantaged communities such as low-income, communities of color, women, and people with disabilities. Support the Bicycle and Pedestrian Safety Act (HR 3494 and S 1708) and New Opportunities for Bicycle and Pedestrian Infrastructure Financing Act (NOBPIFA) (HR 3978) which would require the Department of Transportation (DOT) to set a non-motorized safety performance measure. NOBPIFA includes funding for projects to achieve compliance with the ADA. Advocate on behalf of people with disabilities to ensure that the requirement that poeple with disabilities are not immersed in water in any survival craft used for people with disabilities on passenger vessels. Request adequate fuding for surface transportation and programs that support access to transportation for people with disabilities. Discussed the Transportation for Heroes Act of 2013 (H.R. 2362).

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Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

4th Quarter, 2013

Q4 Report

In Q4, United Spinal Association had in-house lobbyists. The report was filed on Jan. 21, 2014. Original Filing: 300622823.xml

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

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Lobbying Issues

Supported H.R. 164 which would permit former members of the Armed Forces who have a service-connected disability rated as total to travel on military aircraft in the same manner and to the same extent as retired members of the Armed Forces are entitled to travel on such aircraft.Supported the Rehabilitative Therapy Parity for Military Beneficiaries Act (H.R. 1705). Discussed legislation that would provide certain behavioral health treatment under the TRICARE program for adults and children with developmental disabilities. Discussed the Military Justice Improvement Act of 2013 (S. 967). Supported the Disabled Military Child Protection Act (H.R. 2249/S. 1076). Supported House efforts to increase DOD and VA support for Joint Centers of Excellence.

Agencies Lobbied

Type of Issue

Lobbying Issues

Supported The Independent Budget for the VA budget recommendations for VA and related agencies serving veterans for FY 2014 and FY 2015. Advocated to protect social security, Medicare and Medicaid benefits and services on behalf of people with disabilities.Supported an amendment to the Senates FY 2014 Budget Resolution that would prohibit using the chained CPI to determine the COLA for veterans and Social Security benefits. Supported the highest funding level possible for the House and Senate versions of the Transportation and Housing and Urban Development appropriation for FY 2014. Supported the Barber Amendment to the House Transportation, Housing and Urban Development, and Related Agencies appropriations bill (H.R. 2610) which would add $1 million to the HUD VASH program. Supported efforts to limit educational institutions use of GI Bill funds in the House and Senate versions of the Military Construction VA appropriation for FY 2014 (H.R. 2216). Supported efforts to limit educational institutions use of DODs Tuition Assistance Program and MyCAA funds and level fund spinal cord injury research in the House and Senate versions of the Defense appropriation for FY 2014. Discussed the FY 2014 National Defense Authorization Act and related amendments (H.R. 1960/H.R. 3304/S. 1197). FY2014 budget appropriations letter U.S Congress requesting funding for programs that matter most to people with disabilities: ADA compliance, paratransit, technical assistance, and programs that increase access to transportation options.

Agencies Lobbied

Type of Issue

Lobbying Issues

Supported the CHAMPVA Childrens Protection Act (H.R. 288/S. 325). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs).Supported an amendment to the Senates FY 2014 Budget Resolution that would prohibit using the chained CPI to determine the COLA for veterans and Social Security benefits. Supported Senate Concurrent Resolution 15 which expresses the sense of Congress that the Chained CPI should not be used to calculate COLAs for Social Security or veterans benefits. Achieving a Better Life Experiecne Act of 203 (ABLE Act) - HR 647/S. 313 adjusts the Internal Revenue Code to establish tax-exempt ABLE accounts to assist people with disabilities save private funds to pay for education, housing, transportation, employment support and other personal support expenses. Special Needs Trust Fairness Act, H.R. 2123 - The bill rewrites statute to state that individuals with disabilities are allowed to set up and administer their own trusts. United Spinal supports S. 308/Protecting and Preserving Social Security Act; and S. 567 /H.R. 3118 Strengthening Social Security Act of 2013, all of which would increase cost-of-living adjustments.

Agencies Lobbied

Type of Issue

Lobbying Issues

Discussed S. 1584 which would provide replacement automobiles for certain disabled veterans and servicemembers. Supported H.R. 3508 which would clarify qualifications of hearing aid specialist of the VHA. Discussed with VAs Prosthetic and Sensory Aids Service standards for installation of adaptive auto equipment paid for by VA. Discussed legislation to provide a presumption of service connection for mental health conditions related to military sexual trauma. Discussed legislation regarding telework for certain VA employees. Discussed H.R. 2088 which would direct VA to carry out a pilot program to establish claims adjudication centers of excellence. Supported the Support our Services to Veterans Caregivers (SOS Veterans Caregivers) Act (H.R. 3672). Supported the Protecting Those Who Protected Us Act of 2013 (S. 1564). Discussed H.R. 2726 which would authorize VA to enter into contracts and agreements for the transfer of veterans to non-VA medical foster homes for certain veterans who are unable to live independently. Discussed the Quicker Veterans Benefits Delivery Act (H.R. 1980). Supported House efforts to increase DOD and VA support for Joint Centers of Excellence. Supported the Homeless Veterans Assistance Fund Act of 2013 (H.R. 2797). Supported the Veterans Independent Living Enhancement Act (H.R. 3330). Discussed the Veterans Health and Benefits Improvement Act of 2013, as amended (S. 944). Discussed the Access to Appropriate Immunizations for Veterans Act of 2013 (S. 1165). Discussed the Improving the Lives of Children with Spina Bifida Act (S. 832). Supported the Veterans Compensation Cost-of-Living Adjustment Act (H.R. 569). Supported the American Heroes COLA Act (H.R. 570). Supported the Veterans Second Amendment Protection Act (H.R. 602). Supported the Ruth Moore Act of 2013 (H.R. 671). Supported the Honor Americas Guard-Reserve Retirees Act (H.R. 679). Supported the VA Claims, Operations, and Records Efficiency Act (H.R. 1729). Discussed the Ending VA Claims Disability Backlog and Accountability Act (H.R. 2138). Supported the World War II Merchant Mariner Service Act (H.R. 1288). Supported the Blue Water Navy Ship Accountability Act (H.R. 1494). Discussed the VA Claims Efficiency Through Information Act (H.R. 1623). Supported the Pay As You Rate Act (H.R. 2086). Supported H.R. 1809 which would require VA to provide notice of average times for processing claims and percentage of claims approved. Supported the Prioritizing Urgent Claims for Veterans Act (H.R. 2382). Supported the Disabled Veterans Access to Medical Exams Improvement Act (H.R. 2423). Supported the Putting Veterans Funding First Act of 2013 (H.R. 813/S. 932). Discussed the Veterans Pension Protection Act (H.R. 2341). Opposed the Access to Veterans Benefits Improvement Act (H.R. 733). Supported the Wounded Warrior Workforce Enhancement Act (S. 522). Supported the Veterans Affairs Research Transparency Act (S. 877). Supported legislation authorizing VA to transport individuals to and from VA facilities in connection with rehabilitation, counseling, examination, treatment, and care (H.R. 1702/S. 455). Supported the Caregivers Expansion and Improvement Act of 2013 (H.R. 3383/S. 851). Supported (H.R. 1284/S. 633) which would provide coverage under the beneficiary travel program of VA of certain disabled veterans for travel in connection with certain special disabilities rehabilitation. Supported H.R. 1405 which would require VA to include an appeals form in any notice of decision issued for the denial of a benefit. Discussed H.R. 2189 which would establish a commission or task force to evaluate the backlog of disability claims. Supported the Servicemembers Choice in Transition Act of 2013 (H.R. 631/S. 889) and recommended an amendment that would ensure inclusion of information about disability related protections for disabled veterans seeking employment and/or education opportunities. This provision is now part of H.R. 357. Discussed reforming the VAs claims process to ensure that it is veteran-centered. Urged VA to expedite housing adaptations available for disabled veterans with ALS and other terminal illnesses under chapter 21 of title 38, USC. Supported the Women Veterans and Other Health Care Improvements Act of 2013 (S. 131/H.R. 958). This legislation includes greater assistance through VA for veterans who have infertility issues related to their military service. Discussed with advocates a legislative proposal to expand the approved uses of the Post 9/11 GI Bill. Discussed access to VA mental health services with the Department of Veterans Affairs, Veterans Health Administration. Discussed the VetSuccess Enhancement Act (H.R. 844). This legislation would extend from 12 to 17 years the authorized period for an eligible veteran to receive vocational training and rehabilitation from VA. Discussed H.R. 894 which would reform VAs fiduciary program. Discussed the Reducing Barriers to Veterans Benefits Act (H.R. 369). Discussed the Veteran Voting Support Act that would direct the VA Secretary to provide mail voter registration application forms to each veteran who: (1) seeks to enroll in VA health care system at the time of such enrollment; and (2) is already enrolled in such system when there is a change in the veteran's enrollment status or when there is a change in the veteran's address. Supported the Veterans Dog Training Therapy Act (H.R. 183). This legislation would direct the VA Secretary to carry out a pilot program for assessing the effectiveness of addressing post-deployment mental health and post-traumatic stress disorder symptoms through a therapeutic medium of service dog training and handling for veterans with disabilities. Supported the CHAMPVA Childrens Protection Act (H.R. 288/S. 325). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged Congress to expand VA home and community-based services for veterans with disabilities. Urged Congress to provide appropriate oversight for and resources to address the VAs benefits claims processing backlog.

Agencies Lobbied

Type of Issue

Lobbying Issues

Discussed possible solutions for improving access to Medicaid for military families who have children with disabilities.HR 942/S. 948 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013 Creates a separate benefit category under Medicare for CRT, protecting access to these customized products so that people living with significant disabilities, including MS, can remain independent and address their medical needs. Advocate for improved benefits and services under Medicare and Medicaid for people with disabilities. Supports HR 1717 - The Medicare DMEPOS Market Pricing Program Act of 2013/HR 1717 will replace the poorly designed bidding program at the Centers for Medicare and Medicaid Services (CMS) with a market pricing program to ensure that access to quality equipment and services is protected.

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3rd Quarter, 2013

Q3 Report

In Q3, United Spinal Association had in-house lobbyists. The report was filed on Oct. 18, 2013. Original Filing: 300599789.xml

Lobbying Issues

Discussed with DOJ Civil Rights Division a multitude of issues related to the ability of people with disabilities to fully integrate into their communities, including access to voting. Discussed with DOJ efforts to provide long-term services and supports to veterans in the most integrated setting. Opposed the ADA Compliance for Customer Entry to Stores and Services (ACCESS) Act (H.R. 994). Opposed the Pool Safety and Accessibility for Everyone (Pool SAFE) Act (H.R. 203). Opposed the ADA Notification Act (H.R. 777). In request for information comments submitted to the HHS' Office of Civil Rights, United Spinal highlighted the physical barriers to health facilities and programs as well as regulatory barriers - such as Affordable Care Act restrictions around the provision of essential health benefits namely rehabilitative and habilitative services and devices which includes durable medical equipment - in providing full access to care regarding accessible medical equipment diagnostic equipment to individuals with disabilities. United Spinal advocated for members of Congress about joining the Congressional Bipartisan Disabilities Caucus in the House of Representatives. United Spinal discussed Medicaid protections for people with disabilities with members of Congress.

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Agencies Lobbied

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Supported The Independent Budget for the VA budget recommendations for VA and related agencies serving veterans for FY 2014. Supported an amendment to the Senates FY 2014 Budget Resolution that would prohibit using the chained CPI to determine the COLA for veterans and Social Security benefits. Supported the highest funding level possible for the House and Senate versions of the Transportation and Housing and Urban Development appropriation for FY 2014. Supported efforts to limit educational institutions use of GI Bill funds in the House and Senate versions of the Military Construction VA appropriation for FY 2014 (H.R. 2216). Supported efforts to limit educational institutions use of DODs Tuition Assistance Program and MyCAA funds and level fund spinal cord injury research in the House and Senate versions of the Defense appropriation for FY 2014. Discussed the FY 2014 National Defense Authorization Act (H.R. 1960/S. 1197). United Spinal met with House Representatives and supports $2.49 million for lifespan respite programs as approved by the Senate Labor, Health and Human Services Appropriations subcommittee.

Agencies Lobbied

Type of Issue

Lobbying Issues

Supported the Protecting Those Who Protected Us Act of 2013 (S. 1564). Discussed H.R. 2726 which would authorize VA to enter into contracts and agreements for the transfer of veterans to non-VA medical foster homes for certain veterans who are unable to live independently. Discussed the Quicker Veterans Benefits Delivery Act (H.R. 1980). Supported the Disabled Military Child Protection Act (H.R. 2249/S. 1076). Supported the Barber Amendment to the House Transportation, Housing and Urban Development, and Related Agencies appropriations bill (H.R. 2610) which would add $1 million to the HUD VASH program. Supported House efforts to increase DOD and VA support for Joint Centers of Excellence. Supported the Homeless Veterans Assistance Fund Act of 2013 (H.R. 2797). Supported the proposed Veterans Independent Living Enhancement Act. Discussed the Veterans Health and Benefits Improvement Act of 2013, as amended (S. 944). Discussed the Access to Appropriate Immunizations for Veterans Act of 2013 (S. 1165). Discussed the Improving the Lives of Children with Spina Bifida Act (S. 832). Supported the Veterans Compensation Cost-of-Living Adjustment Act (H.R. 569). Supported the American Heroes COLA Act (H.R. 570). Supported the Veterans Second Amendment Protection Act (H.R. 602). Supported the Ruth Moore Act of 2013 (H.R. 671). Supported the Honor Americas Guard-Reserve Retirees Act (H.R. 679). Supported the VA Claims, Operations, and Records Efficiency Act (H.R. 1729). Discussed the Ending VA Claims Disability Backlog and Accountability Act (H.R. 2138). Supported the World War II Merchant Mariner Service Act (H.R. 1288). Supported the Blue Water Navy Ship Accountability Act (H.R. 1494). Discussed the VA Claims Efficiency Through Information Act (H.R. 1623). Supported the Pay As You Rate Act (H.R. 2086). Supported H.R. 1809 which would require VA to provide notice of average times for processing claims and percentage of claims approved. Supported the Prioritizing Urgent Claims for Veterans Act (H.R. 2382). Supported the Disabled Veterans' Access to Medical Exams Improvement Act (H.R. 2423). Discussed the Putting Veterans Funding First Act of 2013 (H.R. 813). Opposed the Access to Veterans Benefits Improvement Act (H.R. 733). Supported the Wounded Warrior Workforce Enhancement Act (S. 522). Supported the Veterans Affairs Research Transparency Act (S. 877). Supported legislation authorizing VA to transport individuals to and from VA facilities in connection with rehabilitation, counseling, examination, treatment, and care (S. 455). Supported the Caregivers Expansion and Improvement Act of 2013 (S. 851). Supported H.R. 1284/S. 633 which would provide coverage under the beneficiary travel program of VA of certain disabled veterans for travel in connection with certain special disabilities rehabilitation. Supported H.R. 1405 which would require VA to include an appeals form in any notice of decision issued for the denial of a benefit. Discussed H.R. 2189 which would establish a commission or task force to evaluate the backlog of disability claims. Supported the Servicemembers' Choice in Transition Act of 2013 (H.R 631/S. 889) and recommended an amendment that would ensure inclusion of information about disability related protections for disabled veterans seeking employmnet and/or education opportunities. This provision is now part of H.R. 357. Discussed reforming the VA's claims process to ensure that is it veteran-centered. Urged VA to expedite housing adaptations available for disabled veterans with ALS and other terminal illnesses under Chapter 21 of Title 38, USC. Supported the Women Veterans and Other Health Care Improvements Act of 2013 (S.131/H.R. 958). This legislation includes greater assistance through VA for veterans who have infertility issues related to their military service. Discussed with advocates a legislative proposal to expand the approved uses of the Post 9/11GI Bill. Discussed access to VA mental health services with the Department of Veterans Affairs, Veterans Health Administration. Discussed the VetSuccess Enhancement Act (H.R. 844). This legislation would extend from 12-17 years the authorized period for an eligible veteran to receive vocational training and rehabilitation from VA. Discussed H.R. 894 which would reform VA's fiduciary program. Discussed the Reducing Barriers to Veterans' Benefits Act (HR 369). Discussed the Veteran Voting Support Act that would direct the VA Secretary to provide mail voter registration application forms to each veteran who: 1) seeks to enroll in VA health care system at the time of such enrollment: and 2) is already enrolled in such system when there is a change in the veteran's enrollment statuts or when there is a change in the veteran's address. Supported the Veterans Dog Training Therapy Act (H.R. 183). This legislation would direct the VA Secretary to carry out a pilot program for assessing the effectiveness of addressing post-deployment mental health and post-traumatic stress disorder symptoms through a therapeutic medium of service dog training and handling for veterans with disabilities. Supported the CHAMPVA Childrens Protection Act (H.R. 288/S. 325). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged Congress to expand VA home and community-based services for veterans with disabilities. Urged Congress to provide appropriate oversight for and resources to address the VAs benefits claims processing backlog.

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Supported an amendment to the Senate's FY 2014 Budget Resolution that would prohibit using the chained CPI to determine the COLA for veterans and Social Security benefits. Supported Senate Concurrent Resolution 15 which expresses the sense of Congress that the Chained CPI should not be used to calculate COLAs for Social Security or veterans benefits.United Spinal supports and discussed the Achieving a Better Life Experience (ABLE) Act of 2013 (H.R. 647/S. 313). This measure, which continues to have broad bipartisan support, will allow individuals to have tax-exempt savings accounts to be used for health education and wellness, employment supports, vehicle modification, assistive technology. United Spinal continues to advocate the Social Security Administration to ensure the preservation of disability benefits and advocates Congress and the Administration to oppose cutting social security benefits with a formula known as the Chained CPI formula which will result in significant benefit cuts for supplemental security income recipients and social security disability income recipients. United Spinal submitted comments and recommendations to the Commission on Long-Term Care in favor of measures that support consumers with spinal cord injuries and disorders and continued dialogue with Congress on these matters. United Spinal supported the CHAMPVA Children's Protection Act (H.R. 288/S. 325). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs). United Spinal opposes the chained consumer price index which lowers social security benefits significantly over time and supports the chained CPI-E (Experimental Price Index for the Elderly) to calculate SSI and SSDI to ensure people with disabilities continue to have the critical income support they need to cover essential needs such as food, medicine and shelter. United Spinal supports H.R. 649/S. 308 Protecting and Preserving Social Security Act of 2013, and S. 567/H.R. 3118, Strengthening Social Security Act of 2013. Supports H.Con. Res. 34, Expressing the sense of the Congress that the Chained Consumer Price Index should not be used to calculate cost-of-living adjustments for Social Security benefits.

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Discussed possible solutions for improving access to Medicaid for military families who have children with disabilities.Promote Congressional support of H.R. 942/S.948 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013. This legislation creates a separate benefit for complex rehab technology under Medicare for individuals with significant disabilities and functional limitations. United Spinal discussed concerns with the Centers for Medicare and Medicaid Services (CMS) regarding access to wheelchair repair under CMS' competitive acquisition program and outside of competitive acquisition areas across the country. United Spinal raised concerns with CMS regarding the Affordable Care Act healthcare marketplaces and navigator training to ensure consumer protections for enrollees. United Spinal discussed with the Department of Health and Human Services' Administration for Community Living access to the right type of wheelchair equipment, H.R. 942/S.948 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013 (described above) and related wheelchair coding issues, concerns with consumer protections under Medicaid, essential health benefits under the Affordable Care Act and respite care funding matters. In June 2012, Medicare issued an Advanced Notice of Proposed Rulemaking (ANPRM) that seeks to significantly expand Medicare Secondary Payer authority to require that current Medicare beneficiaries and non-beneficiaries project what their future medical needs may be related to the accident, injury or illness in question and then place settlement funds in trust to ensure future medical treatment is fully funded before the beneficiary can access any additional settlement funds. United Spinal raised our concerns regarding the need for consumer protections in this regulation and met with the White House, Congress and CMS. United Spinal signed on to a letter to the Director of the Medicare-Medicaid Coordination Office at the Centers for Medicare and Medicaid Services. The letter thanked the office for providing states with an opportunity to apply for funding to develop independent Demonstration Ombudsman Programs. United Spinal and a host of other organizations have been recommending that CMS require ombudsmen for dual demonstration projects. United Spinal submitted comments to the Centers for Medicare and Medicaid Services regarding their proposed policy of converting complex rehab technology (Medicare beneficiary customized purchase items) to capped rental items. United Spinal supports Part D Beneficiary Appeals Fairness Act, S. 1365/H.R. 2827 which permits Medicare Part D beneficiaries to request lower co-pays for high-cost specialty drugs used to treat chronic illnesses. Healthcare Coalition Protecting Dialysis Care United Spinal signed onto a letter to CMS Administrator Marilyn Tavenner opposing a proposed 9.4% cut to dialysis care. This significant cut is likely to result in restrictions in access or have other negative effects on patient care. United Spinal supports Medicare Access to Rehabilitation Services Act of 2013 (H.R 713/S. 367) and have raised our concerns with CMS and Congress. United Spinal raised concerns with the White House regarding recent companionship regulations and matters around institutionalization for the disability community as well as our support of improvements to the provision of home and community-based services. United Spinal supports the Medicare DMEPOS Market Pricing Program Act of 2013/H.R. 1717 which replaces CMS' current competitive acquisition program to allow for imporved choces of medical equipment providers for Medicare beneficiaries.

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Supported the Eleanor Smith Inclusive Home Design Act (H.R. 2352). Supported the Housing Assistance for Veterans Act of 2013 (Haven Act) (H.R. 385/S. 1387). This legislation will leverage the ability of nonprofits to assist disabled and low-income veterans with needed housing adaptations and home repairs. Discussed the Homes for Heroes Act of 2013 (H.R. 384/H.R. 386). Discussed improving accessibility and visitability in Department of Housing and Urban Development programs. United Spinal supports the proposed rule: Affirmatively Furthering Fair Housing which recognizes that furthering fair housing includes affording people with disabilities the opportunity to live in the most integreated setting appropriate to their needs. United Spinal supports Arkansas' decision to accept fedal Medicaid funding to move forward with the extension of coverage to low-income parents and adults.

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2nd Quarter, 2013

Q2 Report

In Q2, United Spinal Association had in-house lobbyists. The report was filed on July 22, 2013. Original Filing: 300585687.xml

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Supported the CHAMPVA Childrens Protection Act (H.R. 288/S. 325). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs).Supported an amendment to the Senates FY 2014 Budget Resolution that would prohibit using the chained CPI to determine the COLA for veterans and Social Security benefits. Supported Senate Concurrent Resolution 15 which expresses the sense of Congress that the Chained CPI should not be used to calculate COLAs for Social Security or veterans benefits. Discussed the President's Budget proposal and social security protections and benefits for people with disabilities. Opposed the Chained CPI which lowers social security benefits significantly over time and support the Chained CPI-E (Experimental Price Index for the Elderly) to calculate SSI and SSDI to ensure people with disabilities continue to have the critical income support they need to cover essential needs such as food, medicine and shelter. Support HR 649/S. 308 Protecting and Preserving Social Security Act of 2013 and S. 567, Strengthening Social Security Act of 2013.

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Discussed the Access to Appropriate Immunizations for Veterans Act of 2013 (S. 1165). Discussed the Improving the Lives of Children with Spina Bifida Act (S. 832). Supported the Veterans Compensation Cost-of-Living Adjustment Act (H.R. 569). Supported the American Heroes COLA Act (H.R. 570). Supported the Veterans Second Amendment Protection Act (H.R. 602). Supported the Ruth Moore Act of 2013 (H.R. 671). Supported the Honor Americas Guard-Reserve Retirees Act (H.R. 679). Supported the VA Claims, Operations, and Records Efficiency Act (H.R. 1729). Discussed the Ending VA Claims Disability Backlog and Accountability Act (H.R. 2138). Supported the World War II Merchant Mariner Service Act (H.R. 1288). Supported the Blue Water Navy Ship Accountability Act (H.R. 1494). Discussed the VA Claims Efficiency Through Information Act (H.R. 1623). Supported the Pay As You Rate Act (H.R. 2086). Supported H.R. 1809 which would require VA to provide notice of average times for processing claims and percentage of claims approved. Supported the Prioritizing Urgent Claims for Veterans Act (H.R. 2382). Supported the Disabled Veterans Access to Medical Exams Improvement Act (H.R. 2423). Discussed the Putting Veterans Funding First Act of 2013 (H.R. 813). Discussed the Veterans Pension Protection Act (H.R. 2341). Opposed the Access to Veterans Benefits Improvement Act (H.R. 733). Supported the Wounded Warrior Workforce Enhancement Act (S. 522). Supported the Veterans Affairs Research Transparency Act (S. 877). Supported legislation authorizing VA to transport individuals to and from VA facilities in connection with rehabilitation, counseling, examination, treatment, and care (S. 455). Supported the Caregivers Expansion and Improvement Act of 2013 (S. 851). Supported (H.R. 1284/S. 633) which would provide coverage under the beneficiary travel program of VA of certain disabled veterans for travel in connection with certain special disabilities rehabilitation. Supported H.R. 1405 which would require VA to include an appeals form in any notice of decision issued for the denial of a benefit. Discussed H.R. 2189 which would establish a commission or task force to evaluate the backlog of disability claims. Supported the Servicemembers Choice in Transition Act of 2013 (H.R. 631/S. 889) and recommended an amendment that would ensure inclusion of information about disability related protections for disabled veterans seeking employment and/or education opportunities. This provision is now part of H.R. 357. Discussed reforming the VAs claims process to ensure that it is veteran-centered. Urged VA to expedite housing adaptations available for disabled veterans with ALS and other terminal illnesses under chapter 21 of title 38, USC. Supported the Women Veterans and Other Health Care Improvements Act of 2013 (S. 131/H.R. 958). This legislation includes greater assistance through VA for veterans who have infertility issues related to their military service. Discussed with advocates a legislative proposal to expand the approved uses of the Post 9/11 GI Bill. Discussed access to VA mental health services with the Department of Veterans Affairs, Veterans Health Administration. Discussed the VetSuccess Enhancement Act (H.R. 844). This legislation would extend from 12 to 17 years the authorized period for an eligible veteran to receive vocational training and rehabilitation from VA. Discussed H.R. 894 which would reform VAs fiduciary program. Discussed the Reducing Barriers to Veterans Benefits Act (H.R. 369). Discussed the Veteran Voting Support Act that would direct the VA Secretary to provide mail voter registration application forms to each veteran who: (1) seeks to enroll in VA health care system at the time of such enrollment; and (2) is already enrolled in such system when there is a change in the veteran's enrollment status or when there is a change in the veteran's address. Supported the Veterans Dog Training Therapy Act (H.R. 183). This legislation would direct the VA Secretary to carry out a pilot program for assessing the effectiveness of addressing post-deployment mental health and post-traumatic stress disorder symptoms through a therapeutic medium of service dog training and handling for veterans with disabilities. Supported the CHAMPVA Childrens Protection Act (H.R. 288/S. 325). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged Congress to expand the extended caregivers program authorized by the Caregivers and Veterans Omnibus Health Services Act (P.L. 111-163) to include all veterans who are eligible for VA health care and meet certain needs-based criteria. Urged Congress to expand VA home and community-based services for veterans with disabilities. Urged Congress to provide appropriate oversight for and resources to address the VAs benefits claims processing backlog.

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Support and promote HR 942/S.948 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013. This legislation creates a separate benefit for complex rehab technology under Medicare for individuals with significant disabilities and functional limitations. United Spinal discussed CMS' competitive bidding program with CMS and explained United Spinal's main complaints with the program: Difficulty getting wheelchair repairs and delays in wheelchair repair Delivery delays Wrong products/parts delivered Difficulty contacting suppliers and obtaining wheelchairs Supplier locations too far from home In some cases, inferior quality of services and supplies Discussed protecting peoples access to medically necessary medical equipment and related services (HR 1717 - the Medicare DMEPOS Market Pricing Act) and ensure that individuals with disabilities receive high-quality service and equipment that will give our community the ability to live active, productive independent lives with improved health outcomes. Oppose CMS' Medicare Secondary Payer authority that requires current Medicare beneficiaries and non-beneficiaries to project what their future medical needs may be related to the accident, injury or illness in question. Discussed opposition to CMS' DME coding decisions related to K0009 wheelchairs and the issue of seat elevation which is not covered under Medicare. Ensure adequate funding for all Medicaid services, including waiver programs that allow people with disabilities to remain in their homes and contribute to the community. Oppose restructuring of Medicaid funding known as block grants or per capita caps. Support and expand state participation in Medicaid programs that increase funding for HCBS such as the Community First Choice Option; Money Follows the Person; and the Balancing Incentive Program; and, increase HCBS eligibility such as the Enhanced 1915(i) State Plan Option. Promote state adoption of the Consortium for Citizens with Disabilities (CCD) and National Disability Leadership Alliance (NDLA) Managed Care Principles. Adoption of the principles would ensure consumers transitioning to managed care have access to consumer-directed care and the specialized and supportive services they need to improve their quality of life and remain in the community. Advocate for the creation of state-level ombudsmen for any Medicaid demonstration projects geared toward integrating care for individuals eligible for Medicare and Medicaid. An ombudsman would provide individual assistance, assist with complaints, advocate, and monitor and report on the programs provision of information and services for consumers. Support and fund quality measures (i.e. data collection) that track how well Medicaid programs allow for person-centered and consumer-directed services; timely provision of care; access to necessary services such as housing and employment; and, consumer satisfaction with those services. Discussed Commission on Long-Term Care principles with Commissioners and Congressional offices on the following issues as they relate to long-term care: financing, the role of consumers and family caregivers, quality of life, quality of care and workforce protections. Supports HR 713/S. 367 - Medicare Access to Rehabilitation Services Act - legislation that would repeal the arbitrary cap on outpatient rehabilitation services. We submitted comments to the EEOC regarding the potential of wellness programs to discriminate against our members with spinal cord injuries or diseases (SCI/D) and individuals with other disabilities. Distributed testimony to the House Ways and Means Health Subcommittee as a member of the Coalition to Preserve Rehabilitation highlighting the need to preserv acdess to high-quality rehabiliation in response to various Medicare proposals addressing post-acute care such as site neutral payment proposals which would reduce access significantly to inpatient rehabilitation for patients with different types of SCI; opposition to increasing the 60% rule for inpatient rehabilitation hospitals to 75%. This rule is used to define inpatient rehabilitation facilities (IRF) in order for them to receive payment as an IRF. The rule requires that at least 60 percent of cases an IRF admits have one or more selected conditions such as stroke, spinal cord injury. The testimony also addressed opposition to audit contractors review of claims in excess of $3700 which creates a chilling effect on access to services above the $3700 cap. Support protections for dual-eligible demonstration projects to include the following: transparency, ombudsman programs; financing structure, quality measures. Discussed possible solutions for improving access to Medicaid for military families who have children with disabilities.

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1st Quarter, 2013

Q1 Report

In Q1, United Spinal Association had in-house lobbyists. The report was filed on April 19, 2013. Original Filing: 300556772.xml

Lobbying Issues

Advocate against Medicaid cuts and in support of home and community-based services. Support and promote HR 942 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013. This legislation creates a separate benefit for complex rehab technoogy under Medicare for individuals with significant disabilities and functional limitations. Raised our concerns with the Centers for Medicare and Medicaid Services, the Government Accountability Office, the United States House of Representatives and the United States Senate regarding CMS' competitive acquisition program for DMEPOS. Under this program, providers are too far from the homes of beneficiaries and consumers have difficulty funding suppliers to repair their wheelchairs. Support/advocate for nomination of Marilyn Tavenner as CMS Administrator. Support the Medicare Access to Rehabilitation Services Act of 2013 (HR 713/S 367). The bill would repeal the arbitrary Medicare Part B outpatient therapy caps now affecting an estimated 640,000 Medicare beneficiaries being denied access to needed services. Discussed possible solutions for improving access to Medicaid for military families who have children with disabilities.

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Advocating against Chained Consumer Price Index which would change the Social Security cost of living adjustment (COLA) to a lower index for beneficiaries resulting in lower COLAs for beneficiaries. HR 8 - American Taxpayer Relief Act - advocated to have consumer representation on the Commission on Long-Term Care(Sec 643, HR 8), namely Paul J. Tobin, President and CEO of United Spinal Association. Supported the CHAMPVA Childrens Protection Act (H.R. 288/S. 325). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Supported an amendment to the Senates FY 2014 Budget Resolution that would prohibit using the chained CPI to determine the COLA for veterans and Social Security benefits.

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Support nomination of Chai R. Feldblum for a second term on the Equal Employment Commission. Oppose HR 803 - Supporting Knowledge and Investing in Lifelong Skills (SKILLS) Act since the legislation does not adequately address the chronically low labor force participation rate of people with disabilities.Support the nomination of Tom Perez to be Secretary of Labor. Support the reappointment of Kathy Martinez to her current position within the Department of Labor as Assistant Secretary of Labor for Disability Employment Policy. Discussed efforts to ensure that disabled veterans have information regarding disability rights and protections in seeking employment and education opportunities. Discussed and supported elimination of subminimum wage for people with disabilities that is authorized by section 14(c) of the Fair Labor Standards Act.

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Supported the Servicemembers Choice in Transition Act of 2013 (H.R. 631) and recommended an amendment that would ensure inclusion of information about disability related protections for disabled veterans seeking employment and/or education opportunities. Discussed reforming the VAs claims process to ensure that it is veteran-centered. Urged VA to expedite housing adaptations available for disabled veterans with ALS and other terminal illnesses under chapter 21 of title 38, USC. Supported the Women Veterans and Other Health Care Improvements Act of 2013 (H.R. 958). This legislation includes greater assistance through VA for veterans who have infertility issues related to their military service. Discussed with advocates a legislative proposal to expand the approved uses of the Post 9/11 GI Bill. Discussed access to VA mental health services with the Department of Veterans Affairs, Veterans Health Administration. Discussed the VetSuccess Enhancement Act (H.R. 844). This legislation would extend from 12 to 17 years the authorized period for an eligible veteran to receive vocational training and rehabilitation from VA. Discussed H.R. 894 which would reform VAs fiduciary program. Discussed the Reducing Barriers to Veterans Benefits Act (H.R. 369). Discussed the Veteran Voting Support Act that would direct the VA Secretary to provide mail voter registration application forms to each veteran who: (1) seeks to enroll in VA health care system at the time of such enrollment; and (2) is already enrolled in such system when there is a change in the veteran's enrollment status or when there is a change in the veteran's address. Discussed the long-term care benefits available to birth children of Korean and Vietnam conflict veterans who have spina bifida. Supported the Veterans Dog Training Therapy Act (H.R. 183). This legislation would direct the VA Secretary to carry out a pilot program for assessing the effectiveness of addressing post-deployment mental health and post-traumatic stress disorder symptoms through a therapeutic medium of service dog training and handling for veterans with disabilities. Supported the CHAMPVA Childrens Protection Act (H.R. 288/S. 325). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged Congress to expand the extended caregivers program authorized by the Caregivers and Veterans Omnibus Health Services Act (P.L. 111-163) to include all veterans who are eligible for VA health care and meet certain needs-based criteria. Urged Congress to expand VA home and community-based services for veterans with disabilities. Urged Congress to provide appropriate oversight for and resources to address the VAs benefits claims processing backlog.

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4th Quarter, 2012

Q4 Report

In Q4, United Spinal Association had in-house lobbyists. The report was filed on Jan. 22, 2013. Original Filing: 300540280.xml

Lobbying Issues

Continues to advocate on HR 4378 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2012. This legislation creates a separate benefit for complex rehab technology under Medicare for individuals with significant disabilities and functional limitations. Discussed concerns and possible solutions to prior authorization and physician documentation matters regarding the submission of medical claims for Medicare beneficiaries and people with disabilities. Discussed concerns with the dual-eligible population regarding those who are individuals with disabilities and the availability of home and community-based services and supports. Supports HR 3613, Part D Beneficiary Appeal Fairness Act of 2011. This legislation resolves some of the concerns surrounding high-cost prescription drug coverage in the following ways: It would permit requests from beneficiaries for exceptions and appeals for all tiers in Medicare Part D tiers, including specialty tier drugs. It would prohibit insurance companies from blocking a more favorable cost-sharing structure as an outcome of the exceptions and appeals process decision. This legislation ensures that all Part D beneficiaries have access to an exceptions and appeals process if they find their medications unaffordable and prevents anyone from being at a disadvantage or subject to discrimination due to a specific condition. Supports HR 1546 and S. 829 - Medicare Access to Rehabilitation Services Act. This legislation would repeal the arbitrary Medicare Part B outpatient therapy caps now affecting an estimated 640,000 Medicare beneficiaries who depend on outpatient rehabiliation therapy. United Spinal advocated for lifting the cap on therapy and extending the exceptions process for beneficiaries that are in need of additional therapy and who have exceeded the cap. Supports HR 6490 - Medicare DMEPOS Market Pricing Program Act of 2012 replaces Medicare's current competitive bidding program under Medicare with a market pricing program for durable medical equipment. United Spinal supports changes to HHS' proposed rule entitled, Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation. Section 1302(b) of the Affordable Care Act directs the Secretary of Health and Human Services (the Secretary) to define essential health benefits (EHB) which must include the following 10 benefit categories: (1) ambulatory patient services, (2) emergency services (3) hospitalization, (4) maternity and newborn care, (5) mental health and substance use disorder services, including behavioral health treatment, (6) prescription drugs, (7) rehabilitative and habilitative services and devices, (8) laboratory services, (9) preventive and wellness services and chronic disease management, and (10) pediatric services, including oral and vision care. Non-grandfathered plans in the individual and small group markets both inside and outside of the state insurance marketplaces, (known as the exchanges), certain Medicaid plans and other health programs must cover EHB beginning in 2014. United Spinal supports the need for greater clarity related to nondiscrimination regulations and state mandates and for more specificity and expanded coverage regarding habilitation, mental health and prescription drug benefits. In market reform comments to CMS, United Spinal supports the need for consumer protections against discrimination and adverse selection. Discussed possible solutions for improving access to Medicaid for military families who have children with disabilities. Advocated with Congress on the need to protect people with disabilities from additional cuts to Medicaid.United Spinal supports the following principles for an improved prescription drug benefit design over what currently exists under Medicare Part D: a robust formulary; required coverage for the six protected classes of drugs plus additional classes where there are unnecessary restrictions in place; appropriate oversight to the benefit; transparency on coverage and out-of-pocket costs; clear description of notice of non-coverage, appeals and exceptions process and rigorous oversight of medication utilization management tools (such as medication substitution, step therapy or quantity limits). Under Medicaid: Expand managed care where feasible to higher risk, higher cost beneficiaries and those dually eligible for Medicare with strict oversight and patient protections to improve care coordination and achieve efficiencies for these patients. Restore Medicaids discount prescription drug pricing to those dually eligible for Medicare. Under the state demonstrations to integrate care for dual-eligible individuals, urge CMS to establish and fund ombudsmen for each demonstration project, who would, at a minimum, provide: 1) information and assistance in pursuing complaints and appeals, 2) negotiation and mediation, 3) case advocacy assistance interpreting law, 4) reports on patterns of non-compliance, and 5) individual case advocacy in hearings and court proceedings related to benefits. United Spinal supports protecting Medicaid against future cuts. United Spinal opposes cuts to Medicaid provider taxes. Provider tax reductions would result in a cost shift to the states that could cause significant problems with state Medicaid budgets and restrictions on the provision of and access to healthcare. Other sustainable ways to address Medicaid costs should be investigated.

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FDAs Prescription Drug User Fee Act Patient-Focused Drug Development - this FDA initiative is being conducted to fulfill FDA performance commitments made as part of the fifth authorization of the Prescription Drug User Fee Act (PDUFA V). This effort provides for a more systematic approach under PDUFA V for obtaining the consumer/patient perspective on the disease severity and the currently available treatments for a set of disease areas. FDA is published a preliminary list of nominated disease areas for this initiative, which currently does not include multiple sclerosis or ALS. United Spinal provided comments on this issue requesting that FDA expand its current list of nominated disease areas to include MS, ALS, co-morbidities and related secondary conditions. United Spinal urged the release of the Food and Drug Administrations (FDA) draft guidance on the regulation of laboratory developed diagnostic tests (LDTs). We have reached a critical point in the development of advanced diagnostics at which it has become essential that FDA move this guidance forward to ensure appropriate and efficient oversight of safe and effective diagnostics.

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United Spinal supports preserving the Social Security benefit. Social Securitys disability programs are critical to people with disabilities and their families. United Spinal is opposed to proposing linking social security benefits to a different CPI measure, the chained CPI, instead of the CPI-W (Urban Wage Earners and Clerical Workers) will result in a significant benefit cut for both current and future Social Security beneficiaries in the disability, retirement, and survivors programs. United Spinal opposes the Chained Consumer Price Index (CPI). The chained CPI would lead to lower COLAs for beneficiaries. Use of a chained CPI could have dramatic impacts on current and future Social Security beneficiaries. Beneficiaries receiving the average 2012 Disability Insurance benefit could see cuts of 2.6% after 10 years, 5.4% after 20 years, and 8.13% after 30 years. United Spinal Association stated to the Office of Management and Budget the need of a minimum of $12.3 billion for its FY 2014 administrative funding to be able to manage increasing workloads regarding claimant hearings and disability determination services (DDS) with reduced staff. Discussed the CHAMPVA Childrens Protection Act of 2011 (H.R. 115/S. 490). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged Congress to leave any needed Social Security reforms out of the fiscal cliff negotiations. Includes the submission of a letter to Congress detailing the detrimental impact that adopting the chained CPI would have on veterans.

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Opposed H.R. 2032 which would limit the ability of individuals with developmental and intellectual disabilities who are living in intermediate care facilities to participate in certain lawsuits that would help them to live in the most integrated setting, in their communities. Sent a letter to DOJ concerning practices related to the settlement of Federal Tort Claims Act claims brought by individuals with disabilities who have been harmed by medical malpractice. Discussed with DOJ Civil Rights Division a multitude of issues related to the ability of people with disabilities to fully integrate into their communities, including access to voting. Opposed the ADA Compliance for Customer Entry to Stores and Services (ACCESS) Act (H.R. 3356). Opposed legislation that would amend the Americans with Disabilities Act of 1990 to prohibit the Attorney General from administering or enforcing certain accessibility regulations relating to pools at public accommodations or provided by public entities (H.R. 4200). Opposed the Pool Safety and Accessibility for Everyone (Pool SAFE) Act (H.R. 4256). Opposed legislation that would amend the Americans with Disabilities Act of 1990 to prohibit the Attorney General from administering or enforcing certain accessibility regulations relating to pools at public accommodations or provided by public entities (S. 2191). Opposed legislation that would amend the Americans with Disabilities Act of 1990 to prohibit the Attorney General from administering or enforcing certain accessibility regulations relating to pools at public accommodations or provided by public entities (S. 2186).

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Type of Issue

Lobbying Issues

Supported an amendment to the FY 2013 National Defense Authorization Act (H.R. 4310) that would require all programs that receive funding from Tuition Assistance and Post-9/11 GI Bill to be "Title IV" eligible. Supported an amendment to the FY 2013 National Defense Authorization Act (H.R. 4310) that would increase access to mental health services for veterans, servicemembers, and their families. Supported an amendment to the FY 2013 National Defense Authorization Act (H.R. 4310) that would leverage the ability of nonprofits to assist disabled and low-income veterans with needed housing adaptations and home repairs. Discussed S. 67 which would permit former members of the Armed Forces who have a service-connected disability rated as total to travel on military aircraft in the same manner and to the same extent as retired members of the Armed Forces are entitled to travel on such aircraft. Supported an amendment to the FY 2013 National Defense Authorization Act (H.R. 4310) that would provide certain types of treatment for Autism and other developmental disabilities under TRICARE. Urged support for the Disabled Military Child Protection Act (H.R. 4329). The measure would enable military retirees who invest in a Survivor Benefit Plan to transfer their benefits to a Special Needs Trust for a child with a disability, accessible after the retiree passes away. Urged inclusion of this legislation as an amendment to the House version of the FY 2013 National Defense Authorization Act. Discussed the Caring for Military Kids with Autism Act (H.R. 2288). This legislation requires the autism spectrum disorder treatment authorized for dependents in uniformed services facilities under TRICARE to include behavioral health treatment, including applied behavior analysis, when prescribed by a physician. Supported the Military and Veterans Educational Reform Act (S. 2179). This legislation would make needed reforms to ensure that veterans and servicemembers receive the full benefit of their DoD and VA educational benefits. Urged adoption of amendments to the FY 2012 National Defense Authorization Act regarding tuition assistance disclosures. Urged removal of a provision in the FY 2012 National Defense Authorization Act that would remove Office of Federal Contract Compliance Programs jurisdiction over TRICARE. Urged the Department of Defense to delay implementation of an MOU between DoD and educational institutions regarding DoDs Tuition Assistance program. Urged Congress to eliminate the offset of military Survivor Benefit Plan annuities. Discussed potential amendment to the FY 2012 National Defense Authorization Act regarding special needs trusts and military Survivor Benefit Plan annuities. Discussed a provision in the FY2012 National Defense Authorization Act to fund programs for wounded warriors.

Agencies Lobbied

Type of Issue

Lobbying Issues

Discussed the need to protect people with disabilities in negotiations of how to resolve the fiscal cliff.Opposed amendments to the House Commerce, Justice, Science Appropriations bill (H.R. 5326) that would prohibit the Department of Justice from enforcing its ADA regulations relating to fixed pool lifts and the definition of a service animal and defund the American Community Survey. Discussed the Senate version of this legislation and our desire to ensure that these amendments not attach to that version. Supported continued funding for the competitive Special Cord Injury research account in FY 2013 Defense Appropriations bills in the House (H.R. 5856) and Senate versions. Urged Congress to provide the highest level of funding possible for the Transportation, Housing, and Urban Development, and Related Agencies FY 2013 appropriation. Supported The Independent Budget for the VA budget recommendations for VA and related agencies serving veterans for FY 2012 and 2013. Urged the Select Committee on Deficit Reduction to consider the negative impact of budget reductions on veteran specific and other programs that benefit disabled veterans before enacting cuts. Discussed the potential impact of the budget proposal of House Budget Chairman Paul Ryan on programs for veterans and people with disabilities. Discussed the potential impact of the deficit reduction proposals of Senator Claire McCaskill on programs that benefit veterans with disabilities.

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Urged VA to expedite housing adaptations available for disabled veterans with ALS and other terminal illnesses under chapter 21 of title 38, USC.Supported S. 1806. This legislation would allow individuals to designate tax overpayments as contributions to a fund for homeless veterans. Supported the Women Veterans and Other Health Care Improvements Act of 2012 (H.R. 6527). This legislation includes greater assistance through VA for veterans who have infertility issues related to their military service. This is a companion bill to the Women Veterans and Other Health Care Improvements Act of 2012 (S. 3313). Supported the Military Service Integrity Act (S. 3372). This legislation would allow for individuals who falsely claim military service or receipt of awards for military service to be charged with a criminal violation if the claim is made to secure a tangible benefit or a personal gain. Discussed with advocates a legislative proposal to expand the approved uses of the Post 9/11 GI Bill. Discussed with advocates a legislative amendment that would provide continuity of care for incarcerated veterans with mental health issues. Supported the GI Bill Consumer Awareness Act of 2012 (S. 2241). Supported the Honoring Americas Veterans and Caring for Camp Lejeune Families Act of 2012 (HR 1627). This omnibus legislation contains many provisions that we have advocated for including access for service dogs to VA facilities. Discussed access to VA mental health services with the Department of Veterans Affairs, Veterans Health Administration. Supported the Veterans I.D. Card Act (H.R. 2985). This legislation directs the Secretary of VA to issue a veteran's identification card to any veteran who requests such card and is neither entitled to military retired pay nor enrolled in the VA system of patient enrollment. Supported the Veterans Data Breach Timely Notification Act (H.R. 3730). Requires the VA Secretary, in the event of a data breach with respect to sensitive personal information that is processed or maintained by the Secretary, to notify Congress and each individual whose sensitive personal information is involved in the data breach. Supported the Veterans Affairs Employee Accountability Act (H.R. 4481). Directs the VA Secretary to ensure that no employee of VA who violates any civil law covered by the Federal Acquisition Regulation receives any retention incentive, payment, or award for or during the year of such violation. Discussed the Veterans Fiduciary Reform Act of 2012 (H.R. 5948). Supported the Mental Health Access to Continued Care and Enhancement of Support Services Act (S. 3340) Discussed legislation that would amend title 38, United States Code, to require the Secretary of Veterans Affairs to consider the resources of individuals applying for pension that were recently disposed of by the individuals for less than fair market value when determining the eligibility of such individuals for such pension, and for other purposes (S. 3270). Supported legislation that would amend title 38, United States Code, to provide for coverage under the beneficiary travel program of the Department of Veterans Affairs of certain disabled veterans for travel for certain special disabilities rehabilitation, and for other purposes (S. 1755). Discussed the Veteran Voting Support Act of 2011 (S. 1264). Directs the VA Secretary to provide mail voter registration application forms to each veteran who: (1) seeks to enroll in VA health care system at the time of such enrollment; and (2) is already enrolled in such system when there is a change in the veteran's enrollment status or when there is a change in the veteran's address. Discussed with VA the long-term care benefits available to birth children of Korean and Vietnam conflict veterans who have spina bifida. Discussed the Consolidating Veteran Employment Services for Improved Performance Act of 2012 (H.R. 4072). This legislation would consolidate programs currently carried out by DOLs Veterans Employment and Training Service in VA. It would also consolidate the disabled veterans' outreach program specialists and local veterans' employment representatives into a single provision establishing veteran employment specialists, which shall perform both tasks. Supported the Military and Veterans Educational Reform Act (S. 2179). This legislation would make needed reforms to ensure that veterans and servicemembers receive the full benefit of their DOD and VA educational benefits. Supported the VOW to Hire Heroes Act of 2011 (H.R. 674/Pub. Law 112-56). This legislation includes provisions to increase employment opportunities for veterans and represents a blend of proposals that were included in H.R. 2433 and S. 951. Discussed the Veteran Voting Support Act of 2011 (S. 1264). This legislation would require VA to provide voter registration applications and assistance in absentee voting for certain veterans. Urged Congress and the Administration to address the treatment of our nations veterans by some for-profit educational institutions. This includes amending the 90/10 rule. Supported the Veterans Opportunity to Work Act (H.R. 2433). This legislation would help to ensure that veterans receive the training, transition, and placement assistance they need to allow them to gain meaningful employment opportunities. Supported the Helping Our Homeless Heroes Act (H.R. 2559). This legislation would make improvements to Department of Veterans Affairs (VA) programs that assist homeless veterans and their families. Supported the CAL Undiagnosed Diseases Research and Collaboration Network Act of 2011 (H.R. 2671). This legislation would help to track undiagnosed diseases and facilitate collaboration between physicians, researchers, and government agencies by creating a patient registry to be maintained by the National Institutes of Health. Supported the Veterans Dog Training Therapy Act (H.R. 198). This legislation would direct the VA Secretary to carry out a pilot program for assessing the effectiveness of addressing post-deployment mental health and post-traumatic stress disorder symptoms through a therapeutic medium of service dog training and handling for veterans with disabilities. Also discussed Senate companion bill (S. 1838). Supported H.R. 2074, as amended. The amended legislation includes H.R. 198 and H.R. 1154. Supported S. 914, as amended. The amended legislation includes S. 769, S. 411, and S. 957. Discussed the Hiring Heroes Act of 2011 (S. 951) and the need to ensure that there are platforms for the development of internship opportunities for wounded warriors with private employers. Supported the Helping our Homeless Veterans Act (S. 411/H.R. 1133). This legislation would allow changes to the U.S. Department of Housing and Urban Development and the U.S. Department of Veterans Affairs Supported Housing (HUD-VASH) program to ensure that homeless veterans receive more effective case management services. Supported the Veterans Traumatic Brain Injury Rehabilitative Services Improvements Act of 2011 (S. 957). This legislation would help to ensure that veterans with traumatic brain injuries receive the critical rehabilitation services needed to allow them to maximize their independence. Supported the Housing, Employment, and Living Programs (HELP) for Veterans Act of 2011 (H.R. 117). This legislation includes provisions that would not only reform the VAs Special Home Adaptation grant program to allow veterans who meet the nationally accepted standard of legal blindness to receive assistance with critical home modification, but also increase the amount of grant funding available for this program and the Specially Adapted Housing grant program. Supported the Andrew Connolly Veterans Housing Act (H.R. 1671). This legislation would extend until December 31, 2016, the authority of the VA Secretary to provide adaptive housing assistance under the Temporary Residence Adaptation grant program to veterans with disabilities who are temporarily residing with family members. Supported legislation establishing an Injured and Amputee Veterans Bill of Rights (H.R. 805). This legislation directs the VA Secretary to ensure that an Injured and Amputee Veterans Bill of Rights is printed on signage in accessible formats and displayed prominently and conspicuously in each VA prosthetics and orthotics clinic. It also requires VA employees who work at such clinics, as well as patient advocates of veterans who receive care there, to receive training on the Bill of Rights and directs the Secretary to conduct outreach to inform veterans about it. Supported the Veterans Equal Treatment for Service Dogs Act (VETS Dogs Act) (H.R. 1154/S. 769). The VETS Dogs Act states that the VA Secretary may not prohibit the use of service dogs in VA facilities or on VA property. Discussed the CHAMPVA Childrens Protection Act of 2011 (H.R. 115/S. 490). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged Congress to expand the extended caregivers program authorized by the Caregivers and Veterans Omnibus Health Services Act (P.L. 111-163) to include all veterans who are eligible for VA health care and meet certain needs-based criteria. Urged Congress to expand VA home and community-based services for veterans with disabilities. Urged Congress to increase Dependency and Indemnity Compensation benefits and to eliminate the offset of military Survivor Benefit Plan annuities. Urged Congress to provide appropriate oversight for and resources to address the VAs benefits claims processing backlog. Urged VA to accept the authority granted to them by states through the National Voter Registration Act of 1993 to serve as a voter registration agency.

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Supported the Housing Assistance for Veterans Act of 2012 (Haven Act) (H.R. 6381/S. 3614). This legislation will leverage the ability of nonprofits to assist disabled and low-income veterans with needed housing adaptations and home repairs. The language of the HAVEN Act was folded into H.R. 6361, the Vulnerable Veterans Housing Reform Act of 2012.Supported the reintroduction of the Inclusive Home Design Act (H.R. 5781). This legislation would require newly constructed single-family houses and townhouses that are built with federal assistance to include a minimum standard of visitability. Discussed improving accessibility and visitability in Department of Housing and Urban Development programs. Supported the Helping our Homeless Veterans Act (S. 411/H.R. 1133). This legislation would allow changes to the U.S. Department of Housing and Urban Development and the U.S. Department of Veterans Affairs Supported Housing (HUD-VASH) program to ensure that homeless veterans receive more effective case management services.

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Discussed potential modifications to the Air Carriers Access Act to allow a private right of action.Discussed the Local Flexibility for Transit Assistance Act (H.R. 3200). This legislation would allow public transportation systems to use some of their federal Urbanized Area Formula Program funds (Section 5307) to pay for operating costs, and provide this flexibility only to communities that are suffering from sudden spikes in fuel costs or high unemployment. Supported the National Surface Transportation and Freight Policy Act (Title XII of S. 1950). This legislation would ensure a comprehensive national strategy for breaking gridlock, reducing fatality rates, reducing our dependence on foreign oil, and efficiently moving goods and people while improving access, quality of life, and public health. Discussed the Moving Ahead for Progress in the 21st Century Act (MAP-21) (S. 1813) and the American Energy and Infrastructure Jobs Act (H.R. 7). We support a final bill that will support transit and meet the specific needs of people with disabilities.

Agencies Lobbied

Type of Issue

3rd Quarter, 2012

Q3 Report

In Q3, United Spinal Association had in-house lobbyists. The report was filed on Oct. 19, 2012. Original Filing: 300515130.xml

Lobbying Issues

Sent a letter to DOJ concerning practices related to the settlement of Federal Tort Claims Act claims brought by individuals with disabilities who have been harmed by medical malpractice. Discussed with DOJ Civil Rights Division a multitude of issues related to the ability of people with disabilities to fully integrate into their communities.Opposed the ADA Compliance for Customer Entry to Stores and Services (ACCESS) Act (H.R. 3356). Opposed legislation that would amend the Americans with Disabilities Act of 1990 to prohibit the Attorney General from administering or enforcing certain accessibility regulations relating to pools at public accommodations or provided by public entities (H.R. 4200). Opposed the Pool Safety and Accessibility for Everyone (Pool SAFE) Act (H.R. 4256). Opposed legislation that would amend the Americans with Disabilities Act of 1990 to prohibit the Attorney General from administering or enforcing certain accessibility regulations relating to pools at public accommodations or provided by public entities (S. 2191). Opposed legislation that would amend the Americans with Disabilities Act of 1990 to prohibit the Attorney General from administering or enforcing certain accessibility regulations relating to pools at public accommodations or provided by public entities (S. 2186).

Agencies Lobbied

Type of Issue

Lobbying Issues

Discussed an amendment to the House version of the FY 2013 National Defense Authorization Act (H.R. 4310) that would provide certain treatment of Autism under TRICARE.Urged support for the Disabled Military Child Protection Act (H.R. 4329). The measure will enable military retirees who invest in a Survivor Benefit Plan to transfer their benefits to a Special Needs Trust for a child with a disability, accessible after the retiree passes away. Urged inclusion of this legislation as an amendment to the House version of the FY 2013 National Defense Authorization Act. Discussed the Caring for Military Kids with Autism Act (H.R. 2288). This legislation requires the autism spectrum disorder treatment authorized for dependents in uniformed services facilities under TRICARE to include behavioral health treatment, including applied behavior analysis, when prescribed by a physician. Supported the Military and Veterans Educational Reform Act (S. 2179). This legislation would make needed reforms to ensure that veterans and servicemembers receive the full benefit of their DoD and VA educational benefits. Urged adoption of amendments to the FY 2012 National Defense Authorization Act regarding tuition assistance disclosures. Urged removal of a provision in the FY 2012 National Defense Authorization Act that would remove Office of Federal Contract Compliance Programs jurisdiction over TRICARE. Urged the Department of Defense to delay implementation of an MOU between DoD and educational institutions regarding DoDs Tuition Assistance program. Urged Congress to eliminate the offset of military Survivor Benefit Plan annuities. Discussed potential amendment to the FY 2012 National Defense Authorization Act regarding special needs trusts and military Survivor Benefit Plan annuities. Discussed a provision in the FY2012 National Defense Authorization Act to fund programs for wounded warriors. Discussed infertility benefits available through TRICARE for wounded warriors and their families.

Agencies Lobbied

Type of Issue

Lobbying Issues

Opposed amendments to the House Commerce, Justice, Science Appropriations bill (H.R. 5326) that would prohibit the Department of Justice from enforcing its ADA regulations relating to fixed pool lifts and the definition of a service animal and defund the American Community Survey. Discussed the Senate version of this legislation and our desire to ensure that these amendments not attach to that version.Supported continued funding for the competitive Special Cord Injury research account in FY 2013 Defense Appropriations bills in the House (H.R. 5856) and Senate versions. Urged Congress to provide the highest level of funding possible for the Transportation, Housing, and Urban Development, and Related Agencies FY 2013 appropriation. Supported The Independent Budget for the VA budget recommendations for VA and related agencies serving veterans for FY 2012 and 2013. Urged the Select Committee on Deficit Reduction to consider the negative impact of budget reductions on veteran specific and other programs that benefit disabled veterans before enacting cuts. Discussed the potential impact of the budget proposal of House Budget Chairman Paul Ryan on programs for veterans and people with disabilities. Discussed the potential impact of the deficit reduction proposals of Senator Claire McCaskill on programs that benefit veterans with disabilities. Urged Congress to protect government services and supports for people with disabilities in light of deficit reduction discussions.

Agencies Lobbied

Type of Issue

Lobbying Issues

Discussed the CHAMPVA Childrens Protection Act of 2011 (H.R. 115/S. 490). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged Congress to leave any needed Social Security reforms out of the deliberations of the Joint Select Committee on Deficit Reduction. Includes the submission of a letter and report to Congress and the Administration detailing the detrimental impact that adopting the chained CPI would have on veterans. Endorsed the importance of Social Security for veterans and their families through the booklet, Social Security: Serving Those Who Serve Our Nation. United Spinal endorsed Consortium for Citizens with Disabilities testimony at a hearing September 14 entitled, Securing the Future of the Social Security Disability Insurance (SSDI) Program, before the House Ways and Means Committee Social Security Subcommittee. The testimony highlighted the need to protect SSDI for those with significant disabilities and their families. The Social Security Administration has asked the Government Accountability Office (GAO) to review the GAOs opinion regarding its recommendation that the Work, Incentives, Planning and Assistance Program (WIPA) and the Protection and Advocacy for the Beneficiaries of Social Security Program have legal authority to continue despite its lack of appropriations. Unfortunately, during its review, neither program can provide assistance to those in need of its services. United Spinal continues to advocate for measures (particularly WIPA and PABSS) to stimulate employment opportunities and improved income security for people with disabilities which promotes self-sufficiency and independent living via meaningful work opportunities, income generation, asset-building and community integration and engagement. Supports, HR 6061, WIPA and PABSS Continuation of Services Act of 2012. This legislation amends Title XI of the Social Security Act to repeal the expired authorization of appropriations for (and thus continue services under) the Work Incentives Planning and Assistance (WIPA) program and the Protection and Advocacy for Beneficiaries of Social Security (PABSS) program.

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Supported S. 1806. This legislation would allow individuals to designate tax overpayments as contributions to a fund for homeless veterans. Supported the Women Veterans and Other Health Care Improvements Act of 2012 (H.R. 6527). This legislation includes greater assistance through VA for veterans who have infertility issues related to their military service. This is a companion bill to the Women Veterans and Other Health Care Improvements Act of 2012 (S. 3313). Supported the Military Service Integrity Act (S. 3372). This legislation would allow for individuals who falsely claim military service or receipt of awards for military service to be charged with a criminal violation if the claim is made to secure a tangible benefit or a personal gain. Discussed with advocates a legislative proposal to expand the approved uses of the Post 9/11 GI Bill. Supported the GI Bill Consumer Awareness Act of 2012 (S. 2241). Supported the Honoring Americas Veterans and Caring for Camp Lejeune Families Act of 2012 (HR 1627). This omnibus legislation contains many provisions that we have advocated for including access for service dogs to VA facilities. Discussed access to VA mental health services with the Department of Veterans Affairs, Veterans Health Administration. Supported the Veterans I.D. Card Act (H.R. 2985). This legislation directs the Secretary of VA to issue a veteran's identification card to any veteran who requests such card and is neither entitled to military retired pay nor enrolled in the VA system of patient enrollment. Supported the Veterans Data Breach Timely Notification Act (H.R. 3730). Requires the VA Secretary, in the event of a data breach with respect to sensitive personal information that is processed or maintained by the Secretary, to notify Congress and each individual whose sensitive personal information is involved in the data breach. Supported the Veterans Affairs Employee Accountability Act (H.R. 4481). Directs the VA Secretary to ensure that no employee of VA who violates any civil law covered by the Federal Acquisition Regulation receives any retention incentive, payment, or award for or during the year of such violation. Discussed the Veterans Fiduciary Reform Act of 2012 (H.R. 5948). Supported the Mental Health Access to Continued Care and Enhancement of Support Services Act (S. 3340). Discussed legislation that would amend title 38, United States Code, to require the Secretary of Veterans Affairs to consider the resources of individuals applying for pension that were recently disposed of by the individuals for less than fair market value when determining the eligibility of such individuals for such pension, and for other purposes (S. 3270). Supported legislation that would amend title 38, United States Code, to provide for coverage under the beneficiary travel program of the Department of Veterans Affairs of certain disabled veterans for travel for certain special disabilities rehabilitation, and for other purposes (S. 1755). Discussed the Veteran Voting Support Act of 2011 (S. 1264). Directs the VA Secretary to provide mail voter registration application forms to each veteran who: (1) seeks to enroll in VA health care system at the time of such enrollment; and (2) is already enrolled in such system when there is a change in the veteran's enrollment status or when there is a change in the veteran's address. Discussed with VA the long-term care benefits available to birth children of Korean and Vietnam conflict veterans who have spina bifida. Discussed the Consolidating Veteran Employment Services for Improved Performance Act of 2012 (H.R. 4072). This legislation would consolidate programs currently carried out by DOLs Veterans Employment and Training Service in VA. It would also consolidate the disabled veterans' outreach program specialists and local veterans' employment representatives into a single provision establishing veteran employment specialists, which shall perform both tasks. Supported the Military and Veterans Educational Reform Act (S. 2179). This legislation would make needed reforms to ensure that veterans and servicemembers receive the full benefit of their DOD and VA educational benefits. Supported the VOW to Hire Heroes Act of 2011 (H.R. 674/Pub. Law 112-56). This legislation includes provisions to increase employment opportunities for veterans and represents a blend of proposals that were included in H.R. 2433 and S. 951. Discussed the Veteran Voting Support Act of 2011 (S. 1264). This legislation would require VA to provide voter registration applications and assistance in absentee voting for certain veterans. Urged Congress and the Administration to address the treatment of our nations veterans by some for-profit educational institutions. This includes amending the 90/10 rule. Supported the Veterans Opportunity to Work Act (H.R. 2433). This legislation would help to ensure that veterans receive the training, transition, and placement assistance they need to allow them to gain meaningful employment opportunities. Supported the Helping Our Homeless Heroes Act (H.R. 2559). This legislation would make improvements to Department of Veterans Affairs (VA) programs that assist homeless veterans and their families. Supported the CAL Undiagnosed Diseases Research and Collaboration Network Act of 2011 (H.R. 2671). This legislation would help to track undiagnosed diseases and facilitate collaboration between physicians, researchers, and government agencies by creating a patient registry to be maintained by the National Institutes of Health. Supported the Veterans Dog Training Therapy Act (H.R. 198). This legislation would direct the VA Secretary to carry out a pilot program for assessing the effectiveness of addressing post-deployment mental health and post-traumatic stress disorder symptoms through a therapeutic medium of service dog training and handling for veterans with disabilities. Also discussed Senate companion bill (S. 1838). Supported H.R. 2074, as amended. The amended legislation includes H.R. 198 and H.R. 1154. Supported S. 914, as amended. The amended legislation includes S. 769, S. 411, and S. 957. Discussed the Hiring Heroes Act of 2011 (S. 951) and the need to ensure that there are platforms for the development of internship opportunities for wounded warriors with private employers. Supported the Helping our Homeless Veterans Act (S. 411/H.R. 1133). This legislation would allow changes to the U.S. Department of Housing and Urban Development and the U.S. Department of Veterans Affairs Supported Housing (HUD-VASH) program to ensure that homeless veterans receive more effective case management services. Supported the Veterans Traumatic Brain Injury Rehabilitative Services Improvements Act of 2011 (S. 957). This legislation would help to ensure that veterans with traumatic brain injuries receive the critical rehabilitation services needed to allow them to maximize their independence. Supported the Housing, Employment, and Living Programs (HELP) for Veterans Act of 2011 (H.R. 117). This legislation includes provisions that would not only reform the VAs Special Home Adaptation grant program to allow veterans who meet the nationally accepted standard of legal blindness to receive assistance with critical home modification, but also increase the amount of grant funding available for this program and the Specially Adapted Housing grant program. Supported the Andrew Connolly Veterans Housing Act (H.R. 1671). This legislation would extend until December 31, 2016, the authority of the VA Secretary to provide adaptive housing assistance under the Temporary Residence Adaptation grant program to veterans with disabilities who are temporarily residing with family members. Supported legislation establishing an Injured and Amputee Veterans Bill of Rights (H.R. 805). This legislation directs the VA Secretary to ensure that an Injured and Amputee Veterans Bill of Rights is printed on signage in accessible formats and displayed prominently and conspicuously in each VA prosthetics and orthotics clinic. It also requires VA employees who work at such clinics, as well as patient advocates of veterans who receive care there, to receive training on the Bill of Rights and directs the Secretary to conduct outreach to inform veterans about it. Supported the Veterans Equal Treatment for Service Dogs Act (VETS Dogs Act) (H.R. 1154/S. 769). The VETS Dogs Act states that the VA Secretary may not prohibit the use of service dogs in VA facilities or on VA property. Discussed the CHAMPVA Childrens Protection Act of 2011 (H.R. 115/S. 490). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged Congress to expand the extended caregivers program authorized by the Caregivers and Veterans Omnibus Health Services Act (P.L. 111-163) to include all veterans who are eligible for VA health care and meet certain needs-based criteria. Urged Congress to expand VA home and community-based services for veterans with disabilities. Urged Congress to increase Dependency and Indemnity Compensation benefits and to eliminate the offset of military Survivor Benefit Plan annuities. Urged Congress to provide appropriate oversight for and resources to address the VAs benefits claims processing backlog. Urged VA to accept the authority granted to them by states through the National Voter Registration Act of 1993 to serve as a voter registration agency.

Agencies Lobbied

Type of Issue

Lobbying Issues

Continues to educate Congress on HR 4378 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2012. This legislation creates a separate benefit for complex rehab technology under Medicare for individuals with significant disabilities and functional limitations. Discussed possible solutions for improving access to Medicaid for military families who have children with disabilities. Discussed concerns and possible solutions to prior authorization and physician documentation matters regarding the submission of medical claims for Medicare beneficiaries and people with disabilities. Discussed concerns with the dual-eligible population regarding those who are individuals with disabilities and the avaialability of home and community-base services and supports. Discussed our concerns and possible solutions around Medicare caps on rehabilitation therapy for individuals with disabilities. Supports HR 3613, Part D Beneficiary Appeal Fairness Act of 2011. This legislation resolves some of the concerns surrounding high-cost prescription drug coverage in the following ways: It would permit requests from beneficiaries for exceptions and appeals for all tiers in Medicare Part D tiers, including specialty tier drugs. It would prohibit insurance companies from blocking a more favorable cost-sharing structure as an outcome of the exceptions and appeals process decision. This legislation ensures that all Part D beneficiaries have access to an exceptions and appeals process if they find their medications unaffordable and prevents anyone from being at a disadvantage or subject to discrimination due to a specific condition. Supports HR 1546 and S. 829 - the Medicare Access to Rehabilitation Services Act. This legislation would repeal the arbitrary Medicare Part B outpatient therapy caps now affecting an estimated 640,000 Medicare beneficiaries who depend on outpatient rehabiliation therapy. Under Medicaid: Expand managed care where feasible to higher risk, higher cost beneficiaries and those dually eligible for Medicare with strict oversight and patient protections to improve care coordination and achieve efficiencies for these patients. Restore Medicaids discount prescription drug pricing to those dually eligible for Medicare.

Agencies Lobbied

Type of Issue

Lobbying Issues

Participated in discussions regarding the staff discussion draft of the Workforce Investment Act reauthorization. Support HR 4227, the Workforce Investment Act (WIA) of 2012. This legislation would modernize Rehabilitation Act programs, promote employment in competitive integreated employment and foster post-secondary education for people with disabilities.Support reauthorization and funding of the Work Incentives Planning Assistance (WIPA) and Protection and Advocacy for Beneficiaries of Social Security (PABSS), two employment counseling programs that help SSDI beneficiaries return to work. Their funding expires June 30 and September 30, 2012 respectively. Support H.R. 3086, the Fair Wages for Workers with Disabilities Act, introduced by Reps. Cliff Stearns (R-6th FL) and Tim Bishop (D-1st NY), to phase out outmoded special wage certificates under the Fair Labor Standards Act of 1938 (FLSA). These certificates allow individuals with disabilities to be employed at subminimum wage rates in sheltered settings. Advancements in vocational rehabilitation, technology, and training of workers with disabilities have contributed to dramatic growth of such workers in the national workforce and rendered the FLSA provision obsolete. Support making the Medicaid Buy In program mandatory nationwide. To maintain their capacity for employment that keeps them off the Medicaid rolls, workers with disabilities often need long-term services and supports. In many states, they are able to purchase affordable Medicaid coverage for this purpose but the benefits vary. To promote the productivity and independence of workers with disabilities, Medicaid buy-in coverage should be made consistent in scope, remain affordable and offered for purchase in all states.

Agencies Lobbied

Type of Issue

Lobbying Issues

Supported the Housing Assistance for Veterans Act of 2012 (Haven Act) (H.R. 6361/S. 3614). This legislation will leverage the ability of nonprofits to assist disabled and low-income veterans with needed housing adaptations and home repairs. The language of the HAVEN Act was folded into H.R. 6361, the Vulnerable Veterans Housing Reform Act of 2012.Testified before the House Financial Service Committee, Subcommittee on Insurance, Housing, and Community Opportunity regarding the access of homeless and low-income veterans to housing assistance and federal services. Supported the reintroduction of the Inclusive Home Design Act (H.R. 5781). This legislation would require newly constructed single-family houses and townhouses that are built with federal assistance to include a minimum standard of visitability. Discussed improving accessibility and visitability in Department of Housing and Urban Development programs. Supported the Helping our Homeless Veterans Act (S. 411/H.R. 1133). This legislation would allow changes to the U.S. Department of Housing and Urban Development and the U.S. Department of Veterans Affairs Supported Housing (HUD-VASH) program to ensure that homeless veterans receive more effective case management services.

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Discussed potential modifications to the Air Carriers Access Act to allow a private right of action. Discussed the Local Flexibility for Transit Assistance Act (H.R. 3200). This legislation would allow public transportation systems to use some of their federal Urbanized Area Formula Program funds (Section 5307) to pay for operating costs, and provide this flexibility only to communities that are suffering from sudden spikes in fuel costs or high unemployment. Supported the National Surface Transportation and Freight Policy Act (Title XII of S. 1950). This legislation would ensure a comprehensive national strategy for breaking gridlock, reducing fatality rates, reducing our dependence on foreign oil, and efficiently moving goods and people while improving access, quality of life, and public health. Discussed the Moving Ahead for Progress in the 21st Century Act (MAP-21) (S. 1813) and the American Energy and Infrastructure Jobs Act (H.R. 7). We support a final bill that will support transit and meet the specific needs of people with disabilities.

Agencies Lobbied

Type of Issue

2nd Quarter, 2012

Q2 Report

In Q2, United Spinal Association had in-house lobbyists. The report was filed on July 20, 2012. Original Filing: 300495786.xml

Lobbying Issues

HR 4378 - Ensuring Access to Quality Complex Rehabiliation Technology Act of 2012. Throughout the second quarter, 2012, United Spinal has been advocating on this legislation to create a separate benefit category in Medicare for coverage of complex rehabilitation technology such as highly sophisticated, customized power mobility devices. The bill entails a broader baseline of services than those that are currently referred to under the Medicare program as durable medical equipment. HR 4378 ensures access to appropriate prodcuts and technology based on a person's functional needs in addition to their diagnosis and the severity of their injury or disorder; allows individuals to access devices that can be used outside of the home and in the community, allows individuals to work and participate in community life; and, ensuring access to local CRT suppliers equipped to make repairs and maintenance for specialized devices. United Spinal Association wrote a letter in April to Secretary Sebelius applauding the newly created Administration for Community Living (ACL) in support of the focus on community living and urged the agency to lift the outdated rule that ties Medicare coverage of wheelchairs and other mobility assistive equipment to in-the-home use. United Spinal also met with the ACL to discuss complex rehab technology and Medicaid managed care and there will be a continuing dialogue between the Association and the ACL on these and other matters. In April, United Spinal submitted comments to the Centers for Medicare and Medicaid Services in response to the proposed information collection requirements for the Medicare prior authorization demonstration applied to coverage claims for power mobility devices. We insisted that CMS be proactive in providing guidance, in the form of guides or templates, to assist physicians and treating practitioners in filing claims and documenting medical necessity and functional limitations from the outset. In June comments to the Office of Management and Budget, we continue to urge the creation of an electronic template under this demonstration to help accelerate the delivery of necessary equipment that will enhance mobility-related activities of daily living and support the independendce of individuals with disabilities. In April, United Spinal signed onto a letter to the Food and Drug Administration's Center for Devices and Radiological Health on the Medical Device User Fee and Modernization Act (MDUFA) agreement in principle between industry and FDA (Docket No. FDA-2010-N-0389). The letter supports the agency-industry agreements intent to do the following: significantly improve FDA review times to help speed up safe and effective treatments to patients; vastly enhance the consistency and timeliness of the approval process, helping to provide patients more information and certainty about the process; offer greater accountability and improved transparency resulting in more data points on FDAs performance; provide enhanced resources to give FDA the necessary tools for meeting new performance goals. Medicaid Eligibility Rules United Spinal co-signed a Consortium for Citizens with Disabilities letter to HHS Secretary Kathleen Sebelius, spearheaded by the Healthcare for America Now coalition urging the Centers for Medicare & Medicaid Services (CMS) to reconsider the provision of the final Medicaid rule (CMS-2349-F) that permits important eligibility determination functions to be contracted to private entities. Public accountability for Medicaid eligibility determinations is essential. The best way to ensure accountability is if governmental staff carries out these functions in the best interest of the public, free of bias or conflicts of interest. This has been the policy in Medicaid for decades: to change it without a process for notice and comment would be highly unusual and set a bad precedent. Congressional Hearing on Competitive Acquisition United Spinal Association submitted a statement for the record to the United States House Committee on Ways and Means Subcommittee on Health. United Spinal urged the committee to look closely at how the Centers for Medicare and Medicaid Services is gathering data on the impact this program has on all consumers, including people with disabilities. United Spinal Association will continue to monitor how the program is impacting consumers. United Spinal signed onto a Coalition for Disability Health Equity letter to CMS in response to the agencys proposed rules on the agency's electronic health record incentive program. Health information technology and electronic health records have the power to collect aggregated data on people with disabilities to provide information to improve the quality of care of all people with disabilities. The incentive program offers an important opportunity to reduce health disparities and improve equity in the U.S. health care system. Reducing disparities is included in the first of the five pillars of meaningful use health outcomes policy priorities and health disparities among those with disabilities are included in HHS policies to reduce health disparities, including Healthy People 2020 and the Affordable Care Act. Supported reauthorization of the Traumatic Brain Injury Act. This is the only federal legislation that specifically assists states and other entities to develop and expand service delivery systems, and provide needed advocacy to meet the needs and protect the rights of individuals who have sustained a TBI and their families. HR 3613: Part D Beneficairy Appeal Fairness Act which supports implementation of a fair and reasonable exceptions and appeals process under Medicare Part D coverage for seniors and people with disabilities that depend on 'specialty tier' drugs to improve or maintain their health status and function. Support making the Medicaid Buy In program mandatory nationwide. To maintain their capacity for employment that keeps them off the Medicaid rolls, workers with disabilities often need long-term services and supports. In many states, they are able to purchase affordable Medicaid coverage for this purpose but the benefits vary. To promote the productivity and independence of workers with disabilities, Medicaid buy-in coverage should be made consistent in scope, remain affordable and offered for purchase in all states. Request that DOL issue the Rehab Act Section 503 Final Rules governing Federal Contractor compliance with measurable affirmative action goals for recruiting, hiring and advancing workers with disabilities. Federal contractors and subcontractors account for one-fifth of all jobs in the employment marketplace. It is critical that they be held accountable to the law. HR 1546 and S 829, the Medicare Access to Rehabilitation Services Act which eliminates Medicare Part Bs arbitrary and unfair outpatient rehab therapy payment caps. Advance the use of home and community-based services and supports as mandatory long-term care benefits (currently optional to the states) which are far less costly than nursing home and other facility-based care for such purposes and are currently mandatory under Medicaid. Expand managed care where feasible to higher risk, higher cost beneficiaries and those dually eligible for Medicare as well with strict oversight and patient protections to improve care coordination and achieve efficiencies for these patients. Restore Medicaids discount prescription drug pricing to those dually eligible for Medicare. Intensify efforts to reduce fraud and abuse which accounted for $12.9 billion in Medicaid improper payments in FY 2007. Insist that Medicare restore its pre-2008 catheter policy language around individual consideration that enabled physicians to diagnose and prescribe the proper treatment based on their patients specific needs, circumstances and risk factors. Add a new criterion for Medicare eligibility for a closed system catheter that allows automatic qualification for patients with permanent severe bladder impairments, reducing their risk of bacterial contamination which can lead to life-threatening UTIs.

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United Spinal Association has been advocating to protect the civil rights of persons with disabilities and is opposed to various pieces of legislation including H.R. 4200, recently introduced by Rep. David Schweikert (R-5th AZ) which amends the Americans with Disabilities Act of 1990 to prohibit the U.S. Attorney General from administering or enforcing certain ADA accessibility regulations relating to pools at public accommodations or provided by public entities. We also oppose H.R. 4256, the Pool Safety and Accessibility for Everyone (Pool SAFE) Act, introduced by Rep. Rick Mulvaney (R-5th SC), directs the Attorney General to revise certain rules under Titles II and III of the ADA each requirements related to accessible means of entry to public pools. The counterpart bills in the Senate are S. 2191 and S.2186, both introduced by Sen. Jim DeMint (R-SC). United Spinal also submitted comments to the Department of Justice on its delay in implementing the final ADA pool accessibility regulations until May 21, 2012 in response to hotel owner complaints to the White House despite the fact that the intended rules were first announced in 2010. United Spinal expressed that the existing provisions for program accessibility (28 CFR 35.150) and readily achievable barrier removal (28 CFR 36.304) provide sufficient relief for entities that may not be able to immediately comply with the requirements to provide pool or spa access, especially when they more than one such facility as a property. We urged that the requirement be made effective immediately upon the close of the comment period on May 21, 2012. United Spinal opposes the following: H.R. 881, the ADA Notification Act of 2011, denies lawsuit in state or federal court for discrimination in public accommodations and certain private services unless the plaintiff notified defendant prior in writing, notice alleged specific facts, 90 days elapsed after notice, notified they had 90 days, notice states complaint has not been corrected. H.R. 3356 is the ACCESS (ADA Compliance for Customer Entry to Stores and Services) Act of 2011 and denies lawsuits based on inaccessibility in public buildings unless owner/operator is provided notice and they fail to provide description of improvements or plan on how barrier will be removed. H.R. 2032 prohibits any agency that receives funds from the government (such as DOJ) to consult with residents of DD facilities before filing lawsuits (i.e., on Olmstead violations). Residents can remove themselves from a lawsuit to remove the threat of being discharged from that facility. United Spinal helped to craft a Consortium for Citizens with Disabilities statement for the record following the hearing on the pool regulations issue held at the end of April, before the Committee on the Judiciarys Subcommittee on the Constitution entitled, Department of Justices Guidance on Access to Pools and Spas under the ADA. Also, United Spinal submitted our own statement for the record following the hearing stating that United Spinal Association strongly supports the principles of the ADA, enabling equal opportunities for individuals with disabilities in the areas of employment, public services, public transportation, public accommodations and communications. The law reflects hard-fought victories for civil rights and equality. We urge that the Department of Justice be permitted to move forward without further delay to make effective the requirements to provide access to polls, wading pools and spas on May 21, 2012. United Spinal also signed on to an Association of University Centers on Disabilities (AUCD) letter to the United States House of Representatives in opposing an amendment of Representative John Carter (R-31st TX) to the Commerce, Justice, and Science Appropriations Bill that would prevent the Justice Department from using its funds to enforce the ADA regulations to increase access for people with disabilities to swimming pools. Opposed the ADA Compliance for Customer Entry to Stores and Services (ACCESS) Act (H.R. 3356). Opposed legislation that would amend the Americans with Disabilities Act of 1990 to prohibit the Attorney General from administering or enforcing certain accessibility regulations relating to pools at public accommodations or provided by public entities (S. 2191). Opposed legislation that would amend the Americans with Disabilities Act of 1990 to prohibit the Attorney General from administering or enforcing certain accessibility regulations relating to pools at public accommodations or provided by public entities (S. 2186). Support ratification of the Convention on the Rights of Persons with Disabilities to advance the rights of people with disabilities throughout the world.

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United Spinal Association, as part of the Consortium for Citizens with Disabilities, submitted a statement for the record, entitled, "Stay-at-Work and Return-to-Work Strategies: Lessons from the Private Sector" hearing which was before the Senate HELP Committee in April. The statement emphasized the Social Security Disability Insurance and Supplemental Security Income (SSI) programs as vital to our nations safety net. Recommendations for strengthening Social Security Disability Insurance (SSDI) include the following: Support and strengthen programs designed to allow flexibility for people with disabilities to return to work, including programs authorized under the Ticket to Work and Work Incentives Improvement Act (TWWIIA). Provide a continued attachment to SSDI and Medicare, as long as a beneficiarys impairments last. Revise rules for impairment-related work expenses (IRWE). CCD proposals for revising IRWE include: Apply the current SSI blindness rule to SSDI disability claimants and beneficiaries to allow the consideration of all work expenses, not only those that are impairment-related. Allow beneficiaries to include their health insurance premiums as Impairment Related Work Expenses (IRWEs). This would recognize the higher costs incurred by workers with disabilities who must pay premiums for the Medicaid Buy-In or for continued Medicare after the termination of free Part A benefits. Reinstate SSAs Title II Demonstration Authority and the Demonstration to Maintain Independence, which expired in 2005. Work Incentives Planning and Assistance (WIPA) and Protection and Advocacy for Beneficiaries of Social Security. United Spinal Association signed onto a letter spearheaded by NDLA to support extending the Work Incentives Planning and Assistance (WIPA) and Protection Advocacy for Beneficiaries of Social Security (PABSS) for an additional 18 months. The extension of these two programs will ensure the continuity of employment support counseling services for SSA disability beneficiaries as Congress deliberates and reauthorizes the WIPA/PABSS programs. Discussed the CHAMPVA Childrens Protection Act of 2011 (H.R. 115/S. 490). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged Congress to leave any needed Social Security reforms out of the deliberations of the Joint Select Committee on Deficit Reduction. Includes the submission of a letter and report to Congress and the Administration detailing the detrimental impact that adopting the chained CPI would have on veterans. Endorsed the importance of Social Security for veterans and their families through the booklet, Social Security: Serving Those Who Serve Our Nation.

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Support of the Office of Federal Compliance Contractor/Section 503 of the Rehabilitation Act United Spinal Association expressed its continuing support to the Department of Labors OFCCP to issue final regulations implementing and strengthening the compliance goals of Section 503 of the Rehabilitation Act which speaks to affirmative action in federal contractor and subcontractor hiring of qualified workers with disabilities. These contractors are estimated to be employers to about 20% of the overall U.S. workforce. United Spinal Association signed onto a letter spearheaded by the Consortium for Citizens with Disabilities supporting the Department of Labors thorough review of public comments on its proposed changes to rules implementing Section 503 of the Rehabilitation Act and the Vietnam Era Veterans Adjustment Act (VEVRAA), and urged that the final revised regulations be issued as soon as possible. Participated in discussions regarding the staff discussion draft of the Workforce Investment Act reauthorization. HR 4227: the Workforce Investment Act (WIA) of 2012 which reauthorizes WIA of 1998 to strengthen investment in innovation, alignment and improvement of employment, training and education programs. The bill, introduced by Reps. John Tierney (D-6th MA), Ruben Hinojosa (D-15th TX) and George Miller (D-7th CA), would modernize Rehabilitation Act programs, promote employment in competitive integrated employment and foster post-secondary education for people with disabilities. Reauthorization and funding of the Work Incentives Planning Assistance (WIPA) and Protection and Advocacy for Beneficiaries of Social Security (PABSS), two employment counseling programs that help SSDI beneficiaries return to work. Their funding expires June 30 and September 30, 2012 respectively. H.R. 3086: the Fair Wages for Workers with Disabilities Act, introduced by Reps. Cliff Stearns (R-6th FL) and Tim Bishop (D-1st NY), to phase out outmoded special wage certificates under the Fair Labor Standards Act of 1938 (FLSA). These certificates allow individuals with disabilities to be employed at subminimum wage rates in sheltered settings. Advancements in vocational rehabilitation, technology, and training of workers with disabilities have contributed to dramatic growth of such workers in the national workforce and rendered the FLSA provision obsolete.

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United Spinal Supports H.R. 5428 - The Injured and Amputee Veterans Bill of Rights As part of the Independence through Enhancement of Medicare and Medicaid (ITEM) Coalition, United Spinal Association signed on to a letter to the House Veterans Affairs Committee in support of HR 5428 - the Injured and Amputee Veterans Bill of Rights.This bill would establish a written list of rights that all injured and amputee veterans have access to high quality orthotic and prosthetic (O&P) care. O&P care, consisting of orthopedic braces, artificial limbs, and the clinical services necessary to treat the patient, is vital to veterans who have lost limbs or have sustained injuries or disorders of the arms, legs, back and neck. Supported the GI Bill Consumer Awareness Act of 2012 (S. 2241). Supported the Honoring Americas Veterans and Caring for Camp Lejeune Families Act of 2012 (HR 1627). This omnibus legislation contains many provisions that we have advocated for including access for service dogs to VA facilities. Discussed access to VA mental health services with the Department of Veterans Affairs, Veterans Health Administration. Supported the Veterans I.D. Card Act (H.R. 2985). This legislation directs the Secretary of VA to issue a veteran's identification card to any veteran who requests such card and is neither entitled to military retired pay nor enrolled in the VA system of patient enrollment. Supported the Veterans Data Breach Timely Notification Act (H.R. 3730). Requires the VA Secretary, in the event of a data breach with respect to sensitive personal information that is processed or maintained by the Secretary, to notify Congress and each individual whose sensitive personal information is involved in the data breach. Supported the Veterans Affairs Employee Accountability Act (H.R. 4481). Directs the VA Secretary to ensure that no employee of VA who violates any civil law covered by the Federal Acquisition Regulation receives any retention incentive, payment, or award for or during the year of such violation. Supported the Veterans Fiduciary Reform Act of 2012 (H.R. 5948). Supported the Women Veterans and Other Health Care Improvements Act of 2012 (S. 3313). Supported the Mental Health Access to Continued Care and Enhancement of Support Services Act (S. 3340) Discussed legislation that would amend title 38, United States Code, to require the Secretary of Veterans Affairs to consider the resources of individuals applying for pension that were recently disposed of by the individuals for less than fair market value when determining the eligibility of such individuals for such pension, and for other purposes (S. 3270). Supported legislation that would amend title 38, United States Code, to provide for coverage under the beneficiary travel program of the Department of Veterans Affairs of certain disabled veterans for travel for certain special disabilities rehabilitation, and for other purposes (S. 1755). Discussed the Veteran Voting Support Act of 2011 (S. 1264). Directs the VA Secretary to provide mail voter registration application forms to each veteran who: (1) seeks to enroll in VA health care system at the time of such enrollment; and (2) is already enrolled in such system when there is a change in the veteran's enrollment status or when there is a change in the veteran's address. Discussed with VA the long-term care benefits available to birth children of Korean and Vietnam conflict veterans who have spina bifida. Discussed the Consolidating Veteran Employment Services for Improved Performance Act of 2012 (H.R. 4072). This legislation would consolidate programs currently carried out by DOLs Veterans Employment and Training Service in VA. It would also consolidate the disabled veterans' outreach program specialists and local veterans' employment representatives into a single provision establishing veteran employment specialists, which shall perform both tasks. Supported the Military and Veterans Educational Reform Act (S. 2179). This legislation would make needed reforms to ensure that veterans and servicemembers receive the full benefit of their DOD and VA educational benefits. Supported the VOW to Hire Heroes Act of 2011 (H.R. 674/Pub. Law 112-56). This legislation includes provisions to increase employment opportunities for veterans and represents a blend of proposals that were included in H.R. 2433 and S. 951. Discussed the Veteran Voting Support Act of 2011 (S. 1264). This legislation would require VA to provide voter registration applications and assistance in absentee voting for certain veterans. Urged Congress and the Administration to address the treatment of our nations veterans by some for-profit educational institutions. This includes amending the 90/10 rule. Supported the Veterans Opportunity to Work Act (H.R. 2433). This legislation would help to ensure that veterans receive the training, transition, and placement assistance they need to allow them to gain meaningful employment opportunities. Supported the Helping Our Homeless Heroes Act (H.R. 2559). This legislation would make improvements to Department of Veterans Affairs (VA) programs that assist homeless veterans and their families. Supported the CAL Undiagnosed Diseases Research and Collaboration Network Act of 2011 (H.R. 2671). This legislation would help to track undiagnosed diseases and facilitate collaboration between physicians, researchers, and government agencies by creating a patient registry to be maintained by the National Institutes of Health. Supported the Veterans Dog Training Therapy Act (H.R. 198). This legislation would direct the VA Secretary to carry out a pilot program for assessing the effectiveness of addressing post-deployment mental health and post-traumatic stress disorder symptoms through a therapeutic medium of service dog training and handling for veterans with disabilities. Also discussed Senate companion bill (S. 1838). Supported H.R. 2074, as amended. The amended legislation includes H.R. 198 and H.R. 1154. Supported S. 914, as amended. The amended legislation includes S. 769, S. 411, and S. 957. Discussed the Hiring Heroes Act of 2011 (S. 951) and the need to ensure that there are platforms for the development of internship opportunities for wounded warriors with private employers. Supported the Helping our Homeless Veterans Act (S. 411/H.R. 1133). This legislation would allow changes to the U.S. Department of Housing and Urban Development and the U.S. Department of Veterans Affairs Supported Housing (HUD-VASH) program to ensure that homeless veterans receive more effective case management services. Supported the Veterans Traumatic Brain Injury Rehabilitative Services Improvements Act of 2011 (S. 957). This legislation would help to ensure that veterans with traumatic brain injuries receive the critical rehabilitation services needed to allow them to maximize their independence. Supported the Housing, Employment, and Living Programs (HELP) for Veterans Act of 2011 (H.R. 117). This legislation includes provisions that would not only reform the VAs Special Home Adaptation grant program to allow veterans who meet the nationally accepted standard of legal blindness to receive assistance with critical home modification, but also increase the amount of grant funding available for this program and the Specially Adapted Housing grant program. Supported the Andrew Connolly Veterans Housing Act (H.R. 1671). This legislation would extend until December 31, 2016, the authority of the VA Secretary to provide adaptive housing assistance under the Temporary Residence Adaptation grant program to veterans with disabilities who are temporarily residing with family members. Supported legislation establishing an Injured and Amputee Veterans Bill of Rights (H.R. 805). This legislation directs the VA Secretary to ensure that an Injured and Amputee Veterans Bill of Rights is printed on signage in accessible formats and displayed prominently and conspicuously in each VA prosthetics and orthotics clinic. It also requires VA employees who work at such clinics, as well as patient advocates of veterans who receive care there, to receive training on the Bill of Rights and directs the Secretary to conduct outreach to inform veterans about it. Supported the Veterans Equal Treatment for Service Dogs Act (VETS Dogs Act) (H.R. 1154/S. 769). The VETS Dogs Act states that the VA Secretary may not prohibit the use of service dogs in VA facilities or on VA property. Discussed the CHAMPVA Childrens Protection Act of 2011 (H.R. 115/S. 490). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged Congress to expand the extended caregivers program authorized by the Caregivers and Veterans Omnibus Health Services Act (P.L. 111-163) to include all veterans who are eligible for VA health care and meet certain needs-based criteria. Urged Congress to expand VA home and community-based services for veterans with disabilities. Urged Congress to increase Dependency and Indemnity Compensation benefits and to eliminate the offset of military Survivor Benefit Plan annuities. Urged Congress to provide appropriate oversight for and resources to address the VAs benefits claims processing backlog. Urged VA to accept the authority granted to them by states through the National Voter Registration Act of 1993 to serve as a voter registration agency.

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United Spinal has been working with the Consortium for Citizens with Disabilities as well as taking the lead with the National Disabilities Leadership Alliance on creating recommendations for Medicaid Managed Care. The disability community is extremely concerned about the fast pace at which many states are proceeding with mandatory Medicaid managed care models for people with disabilities. Recommendations include: establishing protections for individuals with disabilities and chronic conditions, ensuring access to appropriate care and qualified providers and ensuring managed care systems do not discriminate against people with disabilities. Discussed possible solutions for improving access to Medicaid for military families who have children with disabilities.

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Opposed amendments to the House Commerce, Justice, Science Appropriations bill (H.R. 5326) that would prohibit the Department of Justice from enforcing its ADA regulations relating to fixed pool lifts and the definition of a service animal and defund the American Community Survey. Discussed the Senate version of this legislation and our desire to ensure that these amendments not attach to that version. Supported continued funding for the competitive Special Cord Injury research account in FY 2013 Defense Appropriations bills in the House (H.R. 5856) and Senate versions. Urged Congress to provide the highest level of funding possible for the Transportation, Housing, and Urban Development, and Related Agencies FY 2013 appropriation. Supported The Independent Budget for the VA budget recommendations for VA and related agencies serving veterans for FY 2012 and 2013. Urged the Select Committee on Deficit Reduction to consider the negative impact of budget reductions on veteran specific and other programs that benefit disabled veterans before enacting cuts. Discussed the potential impact of the budget proposal of House Budget Chairman Paul Ryan on programs for veterans and people with disabilities. Discussed the potential impact of the deficit reduction proposals of Senator Claire McCaskill on programs that benefit veterans with disabilities.

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Supported the reintroduction of the Inclusive Home Design Act (H.R. 5781). This legislation would require newly constructed single-family houses and townhouses that are built with federal assistance to include a minimum standard of visitability.Discussed improving accessibility and visitability in Department of Housing and Urban Development programs. Discussed legislative proposal to provide funding for adaptive housing for veterans. Supported the Helping our Homeless Veterans Act (S. 411/H.R. 1133). This legislation would allow changes to the U.S. Department of Housing and Urban Development and the U.S. Department of Veterans Affairs Supported Housing (HUD-VASH) program to ensure that homeless veterans receive more effective case management services.

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1st Quarter, 2012

Q1 Report

In Q1, United Spinal Association had in-house lobbyists. The report was filed on April 19, 2012. Original Filing: 300467192.xml

Lobbying Issues

Prepared and submitted a comment letter to HHS on behalf of the National Disability Leadership Alliance in response to CMS' Center for Consumer Information and Insurance Oversight's December 16th release of a pre-regulatory bulletin on the defnition of the "essential health benefits" to be included in all policies sold on the insurance exchanges nationwide under ACA. United Spinal raised the following issues: the need for more information on model plans; the need for strong federal oversight to ensure adequacy of coverage under the various plan options proposed and compliance with the letter of the law; the need to clarify the relationship of essential benefits for insurance exchange plans to Medicaid coverage and access to long-term services and supports and Medicaid buy-in options; the need for further assurance of an acceptable habilitative care definition and benefit and how mental health parity will be met and the need to determine how and on what basis "medical necessity" will be defined. United Spinal staff also worked closely with the Consortium for Citizens with Disabilities (CCD) to prepare the CCDs comments on this guidance. The CCD response recommended the following to HHS; HHS should establish a federal oversight process; HHS should create an Advisory Board: the Secretary should establish a formal public transparent process to review, EHB plans in future years; HHS should develop and enforce safeguards for EHB coverage; HHS should specify what constitutes a plan that is substantially equal to a benchmark plan; HHS should provide a process for states to include their mandates in their EHB plans at federal expense, at least for an initial two-year period; HHS should prohibit benchmark plans from using benefit-specific limitations; insurers should be directed to capture a patients individual functional needs in determining medical necessity; evidence-based medicine or comparative effectiveness research should be applied in a manner that does not lead to inappropriate restrictions in coverage of and access to therapies, treatments, medications, assistive devices and long term services and supports for people with disabilities and chronic illnesses; HHS should define in regulations the term rehabilitation and habilitation services and devices in the EHB package to explicitly include services that maintain as well as improve function; HHS should apply mental health parity in the EHB context to coverage under the mental health, substance use disorder and behavioral health coverage category; HHS should require plans to use medical criteria to make benefit determinations and disclose such criteria to consumers. United Spinal Association met with CMS Acting Administrator, Marilyn Tavenner to discuss a range of issues including: CMS' power mobility device demonstration project; the importance of creating a separate benefit for complex rehab technology such as sophisticated, customized mobility devices that can save enormous costs in medical and hospitalization costs due to injuries and lesions experienced with the wrong equipment; the impact of CMS' competitive acquisition program on the SCI/D community on access to durable medical equipment and the ability to service such equipment as the Round One Rebid saw a significant diminution in eligible suppliers nationwide; needing consumer representation from United Spinal President Paul Tobin on any external advisory panel that is created to help CMS seriously examine Medicare's treatment of DME and its impacts on those with significant disabilities; and the faulty rationale for Medicare's restrictive policy on approval of wheelchair and other mobility device use in the home only. United Spinal, along with other stakeholders, have crafted legislation to create a separate benefit for complex rehab technology (CRT). CRT is used by individuals with disabilities who have medical conditions significantly different from those experienced by the traditional elderly Medicare population. CRT requires a broader range of services and specialized personnel than those required for standard DME. Many of the products require a physician evaluation and CMS has included additional and more rigorous quality standards with which CRT companies must comply. In March, United Spinal sent letters of support to all members of the House and Senate respectively to encourage sign-on to Dear Colleague letters initiated by Rep . Jim Langevin (D-RI) and Senators Robert Casey (D-PA) and Dick Blumenthal (D-CT), requesting that the Appropriations Committees in each house approve $5 million for the Lifespan Respite Care programs in FY 2013. The letter cautioned that Lifespan Respite Care program is small and therefore vulnerable to being cut without appreciating its value. Yet, the correspondence stated, the program plays a powerful role in helping states to: (1) better coordinate federal, state and local resources; (2) recruit and train respite workers; (3) better train the caregivers themselves; and (4) make more efficient the delivery of both emergency and assigned respite services. Supported reauthorization of the Traumatic Brain Injury Act. This is the only federal legislation that specifically assists states and other entities to develop and expand service delivery systems, and provide needed advocacy to meet the needs and protect the rights of individuals who have sustained a TBI and their families.

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United Spinal submitted a statement for the record as part of the House Ways and Means Social Security Subcommittee hearing on Securing the Future of the Social Security Disability Insurance Program. The statement noted that the SSDI program provides vital and much-needed economic security and access to health care for individuals with significant impairments. This income support program is an integral component of our nation's safety net. Discussed the CHAMPVA Childrens Protection Act of 2011 (H.R. 115/S. 490). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged Congress to leave any needed Social Security reforms out of the deliberations of the Joint Select Committee on Deficit Reduction. Includes the submission of a letter and report to Congress and the Administration detailing the detrimental impact that adopting the chained CPI would have on veterans. Endorsed the importance of Social Security for veterans and their families through the booklet, Social Security: Serving Those Who Serve Our Nation.

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United Spinal staff participated in drafting a MAPRx Coalition letter to the CMS Administrator commenting on the Draft 2013 Medicare Call Letter regarding proposed changes to the Part D prescription drug program. Specifically, MAPRx comments addressed the following issues: improved beneficiary protections; specialty tier guidance; co-pay thresholds; tier labeling and hierarchy; proposed plan rating criteria; Medicare Therapy Management (MTM) programs; and, drug utilization review controls under Medicare Part D. The Coalition urged CMS to maintain and strengthen the six protected classes (antineoplastics, immuno-suppressants, anti-retrovirals, anti-convulsants, antidepressants, and antipsychotics) as the HHS Secretary develops and issues new criteria as directed under the Affordable Care Act. It is critical that beneficiaries continue to have access to the full range of therapies within these six classes in order to pursue the optimal management of their conditions. In late March, United Spinal coordinated advocacy efforts with the Consortium for Citizens with Disabilities (CCD) in distributing a letter from the CCD to the U.S. House of Representatives expressing concerns regarding the devastating impacts that House Budget Committee Chair Paul Ryans (R-WI) proposed budget would have on Medicaid beneficiaries and calling these outcomes a potential public health crisis of a national scale. Specifically, the Medicaid restructuring proposals within the House Budget for FY 2013 would undermine the integrity of the Medicaid program and would likely result in an increased number of Americans unable to access the care they need. We strongly recommended that lawmakers protect Medicaid from drastic cuts and from other harmful changes to the program, such as block grants. United Spinal has released a new advocacy tool as a member of the National Disability Ability Leadership Alliance (NDLA)a coalition of 14 leading disability organizationsthat highlights key principles for providing coordinated quality health care in Medicaid managed care programs for people living with significant disabilities. As the Centers for Medicare and Medicaid Services (CMS) and state Medicaid programs grapple with how best to apply managed care to our higher risk, higher cost population, United Spinal and the NDLA hope this new set of principles will provide utility to payers, as well as to beneficiaries, their advocates and other stakeholders who must be actively involved in all aspects of program development, evaluation, refinement and innovation. Such stakeholder engagement will help to ensure that beneficiaries will continue to receive necessary services and supports while reinforcing their capacity to work and enjoy productive, quality lives in their communities. Among the 16 principles are ones emphasizing patient choice; advancing home- and community-based services and supports, ensuring access to durable medical equipment and assistive technology; maintaining Medicaid buy-in option for low income workers; and supporting family caregivers. As part of its collaboration with the Consortium for Citizens with Disabilities (CCD), United Spinal developed a set of principles for states to follow in developing and implementing managed care systems that apply to Medicaid long-term services and supports. Draft principles involve the following issues: stakeholder involvement; staged implementation; specificity in contracts; due process and appeals; access to durable medical equipment; strong federal/state oversight; define target pupulations and ensure choice; provider network and specialist accessibility; care coordination and continuity; patient-centered care; making use of community-based disability service networks; the provision of continuous feedback opportunities; quality care management; non-discrimination; and, family/informal caregiver supports. United Spinal Association joined with several other disability and consumer advocacy groups in endorsing an amicus brief in the case before the U.S. Supreme Court on the issue of the constitutionality of the Medicaid expansion under the health reform legislation. The amicus brief is designed to not only defend the Affordable Care Act's Medicaid expansion, but also to try to prevent the Supreme Court from doing damage to other federal spending statues, such as the Individuals with Disabilities Education Act (IDEA); Title I of the Elementary and Secondary Education Act, most recently reauthorized in the No Child left Behind Act; the federal foster care and child support enforcement programs (Titles IV-E and IV-D of the Social Security Act); the Religious Land Use and Institutionalized Persons Act; and the Boy Scouts of America Equal Access Act. Other "Spending Clause" enactments include Title VI of the Civil Rights Act, Title IX of the Education Amendments of 1972, and Section 504 of the Rehabilitation Act, which prohibit various forms of discrimination (racial, gender, disability) by entities that receive federal funds. Discussed possible solutions for improving access to Medicaid for military families who have children with disabilities.

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In a March 16 letter, United Spinal Association joined more than 900 other health and disability groups (Coalition for Health Funding) in a letter to the leadership of the Senate and House Labor, Health and Human Services, Education and Related Agencies Appropriations Subcommittees urging them to recommend the largest possible FY 2013 302(b) allocation without exceeding the discretionary cap established by the Budget Control Act (BCA). The letter the full allowable funding for these domestic programs will boost the economy and reduce the deficit through through prevention of costly chronic diseases, increased earnings, and reduced expenditures for unemployment and other social service programs. Urged Congress to provide the highest level of funding possible for the Transportation, Housing, and Urban Development, and Related Agencies FY 2013 appropriation. Supported The Independent Budget for the VA budget recommendations for VA and related agencies serving veterans for FY 2012 and 2013. Urged the Select Committee on Deficit Reduction to consider the negative impact of budget reductions on veteran specific and other programs that benefit disabled veterans before enacting cuts. Discussed the potential impact of the budget proposal of House Budget Chairman Paul Ryan (D-1st WI) on programs for veterans and people with disabilities. Discussed the potential impact of the deficit reduction proposals of Senator Claire McCaskill (D-MO) on programs that benefit veterans with disabilities.

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Discussed the Caring for Military Kids with Autism Act (H.R. 2288). This legislation requires the autism spectrum disorder treatment authorized for dependents in uniformed services facilities under TRICARE to include behavioral health treatment, including applied behavior analysis, when prescribed by a physician. Supported the Military and Veterans Educational Reform Act (S. 2179). This legislation would make needed reforms to ensure that veterans and servicemembers receive the full benefit of their DoD and VA educational benefits. Urged adoption of amendments to the FY 2012 National Defense Authorization Act regarding tuition assistance disclosures. Urged removal of a provision in the FY 2012 National Defense Authorization Act that would remove Office of Federal Contract Compliance Programs jurisdiction over TRICARE. Urged the Department of Defense to delay implementation of an MOU between DoD and educational institutions regarding DoDs Tuition Assistance program. Urged Congress to eliminate the offset of military Survivor Benefit Plan annuities. Discussed potential amendment to the FY 2012 National Defense Authorization Act regarding special needs trusts and military Survivor Benefit Plan annuities. Discussed a provision in the FY2012 National Defense Authorization Act to fund programs for wounded warriors.

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Submitted testimony to the House Veterans Affairs Committee regarding community supports for veterans. Discussed the Consolidating Veteran Employment Services for Improved Performance Act of 2012 (H.R. 4072). This legislation would consolidate programs currently carried out by DOLs Veterans Employment and Training Service in VA. It would also consolidate the disabled veterans' outreach program specialists and local veterans' employment representatives into a single provision establishing veteran employment specialists, which shall perform both tasks. Supported the Military and Veterans Educational Reform Act (S. 2179). This legislation would make needed reforms to ensure that veterans and servicemembers receive the full benefit of their DOD and VA educational benefits. Supported the VOW to Hire Heroes Act of 2011 (H.R. 674/Pub. Law 112-56). This legislation includes provisions to increase employment opportunities for veterans and represents a blend of proposals that were included in H.R. 2433 and S. 951. Discussed the Veteran Voting Support Act of 2011 (S. 1264). This legislation would require VA to provide voter registration applications and assistance in absentee voting for certain veterans. Urged Congress and the Administration to address the treatment of our nations veterans by some for-profit educational institutions. This includes amending the 90/10 rule. Supported the Veterans Opportunity to Work Act (H.R. 2433). This legislation would help to ensure that veterans receive the training, transition, and placement assistance they need to allow them to gain meaningful employment opportunities. Supported the Helping Our Homeless Heroes Act (H.R. 2559). This legislation would make improvements to Department of Veterans Affairs (VA) programs that assist homeless veterans and their families. Supported the CAL Undiagnosed Diseases Research and Collaboration Network Act of 2011 (H.R. 2671). This legislation would help to track undiagnosed diseases and facilitate collaboration between physicians, researchers, and government agencies by creating a patient registry to be maintained by the National Institutes of Health. Supported the Veterans Dog Training Therapy Act (H.R. 198). This legislation would direct the VA Secretary to carry out a pilot program for assessing the effectiveness of addressing post-deployment mental health and post-traumatic stress disorder symptoms through a therapeutic medium of service dog training and handling for veterans with disabilities. Also discussed Senate companion bill (S. 1838). Supported H.R. 2074, as amended. The amended legislation includes H.R. 198 and H.R. 1154. Supported S. 914, as amended. The amended legislation includes S. 769, S. 411, and S. 957. Discussed the Hiring Heroes Act of 2011 (S. 951) and the need to ensure that there are platforms for the development of internship opportunities for wounded warriors with private employers. Supported the Helping our Homeless Veterans Act (S. 411/H.R. 1133). This legislation would allow changes to the U.S. Department of Housing and Urban Development and the U.S. Department of Veterans Affairs Supported Housing (HUD-VASH) program to ensure that homeless veterans receive more effective case management services. Supported the Veterans Traumatic Brain Injury Rehabilitative Services Improvements Act of 2011 (S. 957). This legislation would help to ensure that veterans with traumatic brain injuries receive the critical rehabilitation services needed to allow them to maximize their independence. Supported the Housing, Employment, and Living Programs (HELP) for Veterans Act of 2011 (H.R. 117). This legislation includes provisions that would not only reform the VAs Special Home Adaptation grant program to allow veterans who meet the nationally accepted standard of legal blindness to receive assistance with critical home modification, but also increase the amount of grant funding available for this program and the Specially Adapted Housing grant program. Supported the Andrew Connolly Veterans Housing Act (H.R. 1671). This legislation would extend until December 31, 2016, the authority of the VA Secretary to provide adaptive housing assistance under the Temporary Residence Adaptation grant program to veterans with disabilities who are temporarily residing with family members. Supported legislation establishing an Injured and Amputee Veterans Bill of Rights (H.R. 805). This legislation directs the VA Secretary to ensure that an Injured and Amputee Veterans Bill of Rights is printed on signage in accessible formats and displayed prominently and conspicuously in each VA prosthetics and orthotics clinic. It also requires VA employees who work at such clinics, as well as patient advocates of veterans who receive care there, to receive training on the Bill of Rights and directs the Secretary to conduct outreach to inform veterans about it. Supported the Veterans Equal Treatment for Service Dogs Act (VETS Dogs Act) (H.R. 1154/S. 769). The VETS Dogs Act states that the VA Secretary may not prohibit the use of service dogs in VA facilities or on VA property. Discussed the CHAMPVA Childrens Protection Act of 2011 (H.R. 115/S. 490). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged Congress to expand the extended caregivers program authorized by the Caregivers and Veterans Omnibus Health Services Act (P.L. 111-163) to include all veterans who are eligible for VA health care and meet certain needs-based criteria. Urged Congress to expand VA home and community-based services for veterans with disabilities. Urged Congress to increase Dependency and Indemnity Compensation benefits and to eliminate the offset of military Survivor Benefit Plan annuities. Urged Congress to provide appropriate oversight for and resources to address the VAs benefits claims processing backlog. Urged VA to accept the authority granted to them by states through the National Voter Registration Act of 1993 to serve as a voter registration agency.

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Discussed potential modifications to the Air Carriers Access Act to allow a private right of action. Discussed the Local Flexibility for Transit Assistance Act (H.R. 3200). This legislation would allow public transportation systems to use some of their federal Urbanized Area Formula Program funds (Section 5307) to pay for operating costs, and provide thisflexibility only to communities that are suffering from sudden spikes in fuel costs or high unemployment. Supported the National Surface Transportation and Freight Policy Act (Title XII of S. 1950). This legislation would ensure a comprehensive national strategy for breaking gridlock, reducing fatality rates, reducing our dependence on foreign oil, and efficiently moving goods and people while improving access, quality of life, and public health. Discussed the Moving Ahead for Progress in the 21st Century Act (MAP-21) (S. 1813) and the American Energy and Infrastructure Jobs Act (H.R. 7). We support a final bill that will support transit and meet the specific needs of people with disabilities.

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4th Quarter, 2011

Q4 Report

In Q4, United Spinal Association had in-house lobbyists. The report was filed on Jan. 20, 2012. Original Filing: 300447073.xml

Lobbying Issues

Urged adoption of amendments to the FY 2012 National Defense Authorization Act regarding tuition assistance disclosures. Urged removal of a provision in the FY 2012 National Defense Authorization Act that would remove Office of Federal Contract Compliance Programs jurisdiction over TRICARE. Urged the Department of Defense to delay implementation of an MOU between DOD and educational institutions regarding DOD's Tuition Assistance Program. Urged Congress to eliminate the offset of military Survivor Benefit Plan annuitites. Discussed potential amendment to the FY2012 National Defense Authorization Act regarding special needs trusts and military Survivor Benefit Plan annuities. Discussed a provision in the FY 2012 National Defense Authorization Act to fund programs for wounded warriors.

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Urged the Joint Select Committee on Deficit Reduction to consider the negative impact of budget reductions on veteran specific and other programs that benefit disabled veterans before enacting cuts. Supported the Independent Budget for the Department of Veterans Affairs (VA) budget recommendations for VA and related agencies serving veterans for FY 2012.Discussed the potential impact of the budget proposal of House Budget Chairman Paul Ryan on programs for veterans and people with disabilities. Met with key House and offices and staff of the House Budget Committee. Discussed the potential impact of the deficit reduction proposals of Senator Claire McCaskill on programs that benefit veterans with disabilities. Supported funding for Alternative Financing Programs (AFPs) for individuals with disabilities to help them pay for adaptive and assistive technologies needed to live independently. Requested that a minimum of $13.4 billion be included in the President's FY 2013 budget request for the Social Security Administration's administrative funding and that the agency be excluded from any budget freezes or reductions.

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Discussed the CHAMPVA Children's Protection Act of 2011 (HR 115/S.490). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs (VA). Urged Congress to leave any needed Social Security reforms out of the deliberations of the Joint Select Committee on Deficit Reduction. Includes the submission of a letter and report to Congress and the Administration detailing the detrimental impact that adopting the chained CPI would have on veterans. Endorsed the importance of Social Security for veterans and their families through the booklet, "Social Secruity: Serving Those Who Serve Our Nation." Helped draft and endorse a letter to the Social Security Administration in opposition to interim final rules that would ban claimants from SSA offices for as much as three years for displaying disruptive behavior. Supported co-sponsorship of H.R. 3613 - Part D Beneficiary Appeals Fairness Act. This legislation allows beneficiaries an exceptions process that would allow specialty drugs to be moved to lower, more affordable and accessible categories for beneficiaries with high cost chronic conditions and disabilities. United Spinal signed onto a letter encouraging cosponsorship of H.R. 3613. Opposed H.R. 1173, Fiscal Responsibility and Retirement Security Act of 2011. This legislation repeals the Community Living Assistance Services and Supports (CLASS) program. Endorsed comments in response to proposed rule for Changes to the Medicare Prescription Drug Program (Part D) for Contract Year 2013. Comments expressed support for the rule's efforts to improve Part D beneficairy protections and remove poorly performing plans. Areas addressed in the rule are: coverage gap provisions, beneficiary protections, excluding poor performers, program efficiencies and program requirements. Participated in the development of Consortium for Citizens with Disabilities Principles for reforms in the Social Security disability benefit programs, including Supplemental Security Income (SSI) and disability coverage in the Old Age, Survivors and Disability Insurance (SSDI). Submitted principles to House Ways and Means Social Security Subcommittee hearing on the social security disability programs.

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Supported the VOW to Hire Heroes Act of 2011 (H.R. 674/P.L. 112-56). This legislation includes provisions to increase employment opportunities for veterans and represents a blend of proposals that were included in H.R. 2433 and S. 951. Discussed the Veteran Voting Support Act of 2011 (S.1264). This legislation would require VA to provide voter registration applications and assistance in absentee voting for certain veterans. Urged Congress and the Administration to address the treatment of our nation's veterans by some for-profit educational institutions. This includes amending the 90/10 rule. Supported the Veterans Opportunity to Work Act (H.R. 2433). This legislation would help to ensure that veterans receive the training, transition, and placement assistance they need to allow them to gain meaningful employment opportunities. Supported the Helping Our Homeless Heroes Act (H.R. 2559). This legislation would make improvements to Department of Veterans Affairs (VA) programs that assist homeless veterans and their families. Supported the CAL Undiagnosed Diseases Research and Collaboration Network Act of 2011 (H.R. 2671). This legislation would help to track undiagnosed diseases and facilitate collaboration between physicians, researchers, and government agencies by creating a patient registry to be maintained by the National Institutes of Health. Supported the Veterans Dog Training Therapy Act (H.R. 198). This legislation would direct the VA Secretary to carry out a pilot program for assessing the effectiveness of addressing post-deployment mental health and post-traumatic stress disorder symptoms through a therapeutic medium of service dog training and handling for veterans with disabilities. Also discussed Senate companion bill (S. 1838). Supported HR 2074, as amended. The amended legislation includes H.R. 198 and H.R. 1154. Supported S. 914, as amended. The amended legislation includes S. 769, S. 411 and S. 957. Discussed the Hiring Heroes Act of 2011, (S. 951) and the need to ensure that there are platforms for the development of internship opportunities for wounded warriors with private employers. Supported the Helping our Homeless Veterans Act (S.411/H.R. 1133). This legislation would allow changes to the US Department of Housing and Urban Development and the U.S. Department of Veterans Affairs Supported Housing (HUD-VASH) program to ensure that homeless veterans receive more effective case management services. Supported the Veterans' Traumatic Brain Injury Rehabilitative Services' Improvements Act of 2011 (S. 957). This legislation would help to ensure that veterans with traumatic brain injuries receive the critical rehabilitation services needed to allow them to maximize their independence. Supported the Housing, Employment, and Living Programs (HELP) for Veterans Act of 2011 (H.R 117). This legislation includes provisions that would not only reform the VA's Special Home Adaptation grant program to allow veterans who meet the nationally accepted standard of legal blindness to receive assistance with critical home modification, but also increase the amount of grant funding available for this program and the Specially Adapted Housing grant program. Supported the Andrew Connolly Veterans' Housing Act (H.R. 1671). This legislation would extend until December 31, 2016, the authority of the VA Secretary to provide adaptive housing assistance under the Temporary Residence Adaptation grant program to veterans with dsiabilities who are temporarily residing with family members. Supported legislation establishing an Injured and Amputee Veterans Bill of Rights (H.R. 805). This legislation directs the VA Secretary to ensure that an Injured and Amputee Veterans Bill of Rights is printed on signage in accessible formats and displayed prominently and conspicuously in each VA and prosthetics and orthotics clinic. It also requires VA emplyees who work at such clinics, as well as patient advocates of veterans who receive care there, to receive training on the Bill of Rights and directs the Secretary to conduct outreach to inform veterans about it. Supported the Veterans Equal treatment for Service Dogs Act (VETS Dogs Act) (H.R. 1154/S. 769). The VETS Dogs Act states that the VA Secretary may not prohibit the use of service dogs in VA facilities or on VA property. Discussed the CHAMPVA Children's Protection Act of 2011 (H.R. 115/S. 490). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged Congress to expand the extended caregivers program authorized by the Caregivers and Veterans Omnibus Health Services Act (P.L. 111-163) to include all veterans who are eligible for VA health care and meet certain needs-based criteria. Urged Congress to expand VA home and community-based services for veterans with disabilities. Urged Congress to increase Dependency and Indemnity Compensation benefits and to eliminate the offset of milittary Survivor Benefit Plan annuities. Urged Congress to provide appropriate oversight for and resources to address the VA's benefits claims processing backlog. Urged VA to accept the authority granted to them by states through the National Voter Registration Act of 1993 to serve as a voter registration agency.

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Discussed possible solutions for improving access to Medicaid for military families who have children with disabilities. Urged issuance of a final rule clarifying that Medicaid's Home and Community Based Services must not be delivered on the grounds of an institution, in a housing complex designed expressly around an individual's diagnosis or disability, or in a setting that has thecharacteristics of an institution. United Spinal Association is in ongoing discussions with the U.S. House of Representatives and the U.S. Senate on the development of a separate benefit for complex rehab technology to enable people with certain conditions within the disability community to access the appropriate equipment for their needs. Signed onto a letter expressing concerns with proposals to cut Medicare funding for rehabilitation hospitals as part of deficit reduction strategies. Wrote a letter to CMS and key members of Congress urging for a delay in a CMS widespread three-year demonstration project for power mobility devices in seven demonstration states; California, Florida, Illinois, Michigan, new York, North Carolina and Texas. The project is scheduled to be implemented January 1, 2012. Also supported letter opposing CMS' power mobility device demonstration project. Participated in discussions on Medicare, disabilities and senior issues with CMS.

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Discussed the critical importance of entitlement programs to the United Spinal community and the potential impacts of deficit reduction actions. Discussed disability and health policy. Provided comments to HHS on the essential health benefits bulletin released by Department of Health and Human Services' CMS Center for Consumer Information and Insurance Oversight highlighting concerns with small business product coverage as well as habilitative and rehabilitiative services. Supported Lifespan Respite Care Reauthorization Act (HR 3266). This legislation, enacted in 2006, provides competitive grants to states to establish or enhance statewide Lifespan Respite systems that maximize existing resources and help ensure that quality respite is available and accessible to all family caregivers. Discussed Joint Select Committee on Deficit Reduction potential recommendations, concerns about Medicaid reductions and the potential impact on beneficiaries as well as the issue of unemployment among people with disabilities which is more than double the national average. Endorsed letter expressing concerns that any cuts to Medicare Part D prescription drug program would have significant negative impacts on beneficiary access, treatment affordability and health outcomes. Joined letter in support of greater clarification regarding the development of the Essential Health Benefits (EHB) package under the Affordable Care Act (ACA, P.L. 111-148). The letter stated that EHB must be comprehensive; the EHB package must adopt strong federal standards; the Secretary must define medical necessity; services covered as part of EHB must have a foundation in both evidence-based medicine and best practice standards; the Secretary should carefully balance considerations of affordability and comprehensiveness; the design of EHB must comply with nondiscrimination standards; the Secretary should develop consistent standards for the calculation of actuarial value; the Secretary must define a clear and transparent process for updating the services covered as EHB; and, the Secretary must develop a process for dealing with state mandates. Joined letter requesting that Department of Health and Human Services make publicly available the three largest national Federal Employee Health Benefits Program plan options by enrollment and, for each state, the three largest plans by enrollment in the small-group market, the three largest state employee health benefit plans by enrollment and the largest insured commercial non-Medicaid Health Maintenance Organization (HMO) operating in the state.

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3rd Quarter, 2011

Q3 Report

In Q3, United Spinal Association had in-house lobbyists. The report was filed on Oct. 19, 2011. Original Filing: 300419533.xml

Lobbying Issues

See next pageMet with Congressional members in the House and Senate to discuss alternatives to Medicaid block granting, global spending limits and to the "Chained" CPI for determining Social Security COLA increases as methods to reduce federal spending. Supported the proposal of the Coalition for Health Funding (CHF) for Function 550 program funding within the FY 2012 federal budget and a Coalition letter to the Senate and House Appropriations Committees urging recognition of health, education and job training programs as critical national priorities as they determine final 302 (b) allocations for the FY 2012 Labor-HHS-Education Appropriations bill and that they not be further cut. Supported the Independent Budget for the Department of Veterans Affairs (VA) budget recommendations for VA and related agencies serving veterans for FY 2012. Urged members of Congress to support full FY 2012 funding for Social Security Administration to ensure continuing progress at reducing the growing backlog of disability determination hearings around the country. Discussed with legislative staff the potential impact of the budget proposal of House-approved FY 2012 budget on programs for veterans and people with disabilities. Met with members and staff in both the House and Senate to discuss budget proposals and deficit reduction strategies and their implications for people with disabilities. Met with staff from the Joint Select Committee "Super Committee" to talk about possible reductions in federal spending and changes to the entitlement programs -- Social Security, Medicare and Medicaid -- and their impacts on disability populations. Wrote to members of the Joint Select Committee on Deficit Reduction on behalf of the National Disability Leadership Alliance (NDLA) to urge rejection of arbitrary, across-the-board cuts to Medicaid and transitioning the program's culture to emphasize lower cost home and community-based services and supports. Joined with others in the CCD in writing to the "Super Committee" emphasizing that changes to Medicaid, Medicare, Social Security, Supplemental Security Income and veterans' disability compensation and pension benefits must not result in service obstacles, benefit cuts or eligibility restrictions, whether directly or indirectly. Joined with others in Families USA coalition on two letters to the "Super Committee." One was focused on protecting the Affordable Care Act from deficit reduction cuts and other discussed the impacts of possible Medicaid cuts on beneficiaries, there families, providers and states. Joined with others in the MapRx coalition in writing to the Super Committee to protect the effective Medicare prescription drug benefit (Part D) from federal spending cuts to reduce the deficit. Served on Steering Committee to organize the "My Medicaid Rally" involving constituents from more than 90 patient/consumer organizations to speak out on Capitol Hill and with policymakers against reducing the deficit on the backs of Medicaid recipients. Joined on a letter with the Center for Budget and Policy Priorities that was sent to all members of Congress to oppose a balanced budget constitutional amendment, arguing that it would damage the economy, not strengthen it.

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See next page. Have continued to advocate against the repeal of the 2010 Affordable Care Act. Have met with Congressional staff and signed letters of support for the ACA and full enactment of its various provisions. Participated in discussion with DHHS of data development on health disparities and capturing information on people with disabilities as a disparity population criteria. Continued to reinforce with the DHHS Secretary and the Quality Measures Workgroup of the Health Information Technology Policy Committee better ways to address the health care needs of people with disabilities within the new clinical quality measures to be developed to leverage the evolving health IT infrastructure and decrease disability health disparities. Supported HR 1862 the National Regenerative Medicine Strategy legislation. Supported HR 2376 the Stem Cell Research Advancement Act. Participated in meetings of FDA-sponsored MDUFA III Stakeholders Group. Endorsed group letter to FDA Center for Devices and Radiological Health to comment on the Institute of Medicine (IOM) report on "Medical Devices and the Public Health" and recommend ways to strengthen the 510 (k) new device review process. Joined with 70 other organizations in a letter to the Senate HELP Committee urging reauthorization of the Lifespan Respite Care program. Participated in letters from the NDLA and CCD to the President urging implementation of the CLASS long-term services an supports insurance program. Participated in briefing with Centers for Disease Control and Prevention (CDC) officials on Year One progress the CDC Disability and Health Work Group. See Budget/Appropriation, Medicaid, and Medicare.

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See next page Met with senior HHS officials, members and staff of the House and Senate to talk about the future of the Community Living Assistance and Supports Act (CLASS Act) insurance program, as well as implementation of other health reform act programs. Discussed the CHAMPVA Childrens Protection Act of 2011 (H.R. 115). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Joined with other CCD members to express comments to Institute of Medicine (IOM) task force charged with making recommendations on the "essential benefits" to be included in the standard package of benefits for insurance policies to be offered by the insurance exchanges under the Affordable Care Act. Co-hosted a congressional staff briefing on rehabilitation and habilitation as components of the "essential benefits." Urged members of Congress to support full funding for Social Security Administration to ensure continuing progress at reducing the growing backlog of disability determination hearings around the country. Testified before the House Committee on Veterans Affairs regarding the need to improve employment opportunities for veterans with significant disabilities. The written testimony covered issues relating to the Workforce Investment Act, Social Security, vocational rehabilitation, and attitudinal barriers to the employment of people with disabilities. Endorsed the importance of Social Security for veterans and their families through the booklet, Social Security: Serving Those Who Serve Our Nation. Opposed chained CPI for Social Security COLA formula reform in letters to Members of Congress.

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See next pageParticipated in meetings with CMS concerning round one and the upcoming round two of the Medicare DME Competitive Bidding program. Worked on draft legislation that would create a separate category for complex rehabilitative technology under Medicare. Supported a House bill sponsored by Representatives Glenn Thompson and Jason Altmire to end the Medicare competitive bidding program for home medical equipment and services (HME) in view of its serious flaws and its impact on patients access to medically required home medical equipment and services. Participated with GAO in discussions on state interests in Medicaid managed care models. Supported Senate bill introduced by Senators Cardin and Collins to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. Supported a House bill introduced by Representatives Thornberry and Carnahan to in the House and amend title XVIII of the Social Security Act to permit coverage of certain covered part D drugs for uses that are determined to be for medically accepted indications based upon clinical evidence in peer reviewed medical literature Urged Congress to ensure stable Medicaid and CHIP coverage, per provisions in the Affordable Care Act, by requiring states to hold steady on Medicaid and CHIP eligibility until 2014 for adults and 2019 for children. To date, these stability protections have worked exactly as intended, preventing states from reducing Medicaid and CHIP eligibility and adding red-tape barriers to enrollment just when people need help the most. Discussed possible solutions for improving access to Medicaid for military families who have children with disabilities. Met with the White House staff and House and Senate staff to discuss the Maintenance of Effort (MOE) and proposed blended rate formula under Medicaid. Met with staff of the Joint Select Committee "Super Committee" members to talk about Medicaid and Medicare concerns. Signed on to three letters with other members of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition. Two went to CMS concerning respectively the Summary of Benefits and Coverage procedures glossary and Round 2 of Medicare DMEPOS competitive bidding. The third letter went to Members of Congress in support of HR 1958, the Medicare Orthotics and Prosthetics Improvement Act of 2011. Joined on CCD letter to CMS Administrator to express serious concerns about pending payment cuts in California and other states to Medicaid providers serving individuals with disabilities. Wrote to members of the Joint Select Committee on Deficit Reduction on behalf of the National Disability Leadership Alliance (NDLA) to urge rejection of arbitrary, across-the-board cuts to Medicaid and transitioning the program's culture to emphasize lower cost home and community-based services and supports. Joined with others in the CCD in writing to the "Super Committee" emphasizing that changes to Medicaid, Medicare, Social Security, Supplemental Security Income and veterans' disability compensation and pension benefits must not result in service obstacles, benefit cuts or eligibility restrictions, whether directly or indirectly. Joined with others in Families USA coalition on two letters to the "Super Committee." One was focused on protecting the Affordable Care Act from deficit reduction cuts and other discussed the impacts of possible Medicaid cuts on beneficiaries, there families, providers and states. Joined with others in the MapRx coalition in writing to the Super Committee to protect the effective Medicare prescription drug benefit (Part D) from federal spending cuts to reduce the deficit. Served on Steering Committee to organize the "My Medicaid Rally" involving constituents from more than 90 patient/consumer organizations to speak out on Capitol Hill and with policymakers against reducing the deficit on the backs of Medicaid recipients.

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See next page. Supported the Veterans Opportunity to Work Act (H.R. 2433). This legislation would help to ensure that veterans receive the training, transition, and placement assistance they need to allow them to gain meaningful employment opportunities. Supported the Helping Our Homeless Heroes Act (H.R. 2559). This legislation would make improvements to Department of Veterans Affairs (VA) programs that assist homeless veterans and their families. Supported the CAL Undiagnosed Diseases Research and Collaboration Network Act of 2011 (H.R. 2671). This legislation would help to track undiagnosed diseases and facilitate collaboration between physicians, researchers, and government agencies by creating a patient registry to be maintained by the National Institutes of Health. Supported the Veterans Dog Training Therapy Act (H.R. 198). This legislation would direct the VA Secretary to carry out a pilot program for assessing the effectiveness of addressing post-deployment mental health and post-traumatic stress disorder symptoms through a therapeutic medium of service dog training and handling for veterans with disabilities. Also discussed Senate companion bill. Supported H.R. 2074, as amended. The amended legislation includes provisions similar to H.R. 198 and H.R. 1154. Supported S. 914, as amended. The amended legislation includes provisions similar to S. 769 and S. 411. Discussed the Hiring Heroes Act of 2011 (S. 951) and the need to ensure that there are platforms for the development of internship opportunities for wounded warriors with private employers. Urged Congress to address the treatment of our nations veterans by some for-profit educational institutions. This includes whether the 90/10 rule should be amended. Supported the Helping our Homeless Veterans Act (S. 411/H.R. 1133). This legislation would allow changes to the U.S. Department of Housing and Urban Development and the U.S. Department of Veterans Affairs Supported Housing (HUD-VASH) program to ensure that homeless veterans receive more effective case management services. Supported the Veterans Traumatic Brain Injury Rehabilitative Services Improvements Act of 2011 (S. 957). This legislation would help to ensure that veterans with traumatic brain injuries receive the critical rehabilitation services needed to allow them to maximize their independence. Supported the Housing, Employment, and Living Programs (HELP) for Veterans Act of 2011 (H.R. 117). This legislation includes provisions that would not only reform the VAs Special Home Adaptation grant program to allow veterans who meet the nationally accepted standard of legal blindness to receive assistance with critical home modification, but also increase the amount of grant funding available for this program and the Specially Adapted Housing grant program. Supported the Andrew Connolly Veterans Housing Act (H.R. 1671). This legislation would extend until December 31, 2016, the authority of the VA Secretary to provide adaptive housing assistance under the Temporary Residence Adaptation grant program to veterans with disabilities who are temporarily residing with family members. Supported legislation establishing an Injured and Amputee Veterans Bill of Rights (H.R. 805). This legislation directs the VA Secretary to ensure that an Injured and Amputee Veterans Bill of Rights is printed on signage in accessible formats and displayed prominently and conspicuously in each VA prosthetics and orthotics clinic. It also requires VA employees who work at such clinics, as well as patient advocates of veterans who receive care there, to receive training on the Bill of Rights and directs the Secretary to conduct outreach to inform veterans about it. Supported the Veterans Equal Treatment for Service Dogs Act (VETS Dogs Act) (H.R. 1154/S. 769). The VETS Dogs Act states that the VA Secretary may not prohibit the use of service dogs in VA facilities or on VA property. Discussed the CHAMPVA Childrens Protection Act of 2011 (H.R. 115/S. 490). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged Congress to expand the extended caregivers program authorized by the Caregivers and Veterans Omnibus Health Services Act (P.L. 111-163) to include all veterans who are eligible for VA health care and meet certain needs-based criteria. Urged Congress to expand VA home and community-based services for veterans with disabilities. Urged Congress to increase Dependency and Indemnity Compensation benefits and to eliminate the offset of military Survivor Benefit Plan annuities. Urged Congress to provide appropriate oversight for and resources to address the VAs benefits claims processing backlog. Urged VA to accept the authority granted to them by states through the National Voter Registration Act of 1993 to serve as a voter registration agency. Supported the Helping our Homeless Veterans Act (S. 411/H.R. 1133). This legislation would allow changes to the U.S. Department of Housing and Urban Development and the U.S. Department of Veterans Affairs Supported Housing (HUD-VASH) program to ensure that homeless veterans receive more effective case management services.

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See next pageSubmitted testimony for the record to the Senate Health, Education, Labor, and Pensions Committee. The written testimony covered issues relating to the Workforce Investment Act, Social Security, vocational rehabilitation, and attitudinal barriers to the employment of people with disabilities. Participated in discussions regarding the Senate HELP Committee's discussion draft for the Workforce Investment Act (WIA) reauthorization. Submitted written comments to the Committee on the draft. Wrote to the President as part of the NDLA urge that his soon-to-be-proposed Jobs Act focus attention on the alarmingly high rate of unemployment among employable people with disabilities. It also called for heightened enforcement of the rules implementing Section 503 of the Rehabilitation Act, which requires employers with federal contracts or subcontracts exceeding $10,000 to hire, retain, and promote individuals with disabilities and refrain from discrimination in employment of such individuals.

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2nd Quarter, 2011

Q2 Report

In Q2, United Spinal Association had in-house lobbyists. The report was filed on July 19, 2011. Original Filing: 300398929.xml

Lobbying Issues

See next pageSupported CCD testimony before Senate Appropriation on the FY 2012 budget request for the Social Security Administration and the impacts of possible cuts to the Fiscal Year 2011 budget. Joined with CCD Colleagues to urge both the Senate and House about the drastic Medicaid cuts and restructuring proposals within the House Budget Resolution for FY 2012 introduced by Representative Ryan, noting it would cause a public health crisis on a national scale. Such deep cuts would undermine the integrity of the Medicaid program and would likely result in an increased number of Americans unable to access the care they need. We urged lawmakers to protect Medicaid from such drastic cuts and from other harmful changes to the program, such as block grants or caps on federal funding. Met with Congressional members in the House and Senate to discuss alternatives to Medicaid block granting as methods to save on federal spending (see also Medicaid) Supported the proposal of the Coalition for Health Funding for Function 550 program funding within the FY 2012 federal budget. Supported The Independent Budget for the Department of Veterans Affairs (VA) budget recommendations for VA and related agencies serving veterans for FY 2012. Urged members of Congress to support full funding for Social Security Administration to ensure continuing progress at reducing the growing backlog of disability determination hearings around the country. Discussed the potential impact of the budget proposal of House Budget Chairman Paul Ryan on programs for veterans and people with disabilities. Discussed the potential impact of the deficit reduction proposals of Senator Claire McCaskill on programs that benefit veterans with disabilities. Met with members and staff in both the House and Senate to discuss budget reductions in light of the debt limit and implications for people with disabilities.

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See following page. Have continued to advocate against the repeal of the 2010 Affordable Care Act. Have met with Congressional staff and signed letters of support for the ACA and full enactment of provisions included in it. Participated in HHS discussion of data development on health disparities. Recommended to the DHHS Secretary and the Quality Measures Workgroup of the Health Information Technology Policy Committee ways to address the health care needs of people with disabilities within the new clinical quality measures to be developed to leverage the evolving health IT infrastructure and decrease disability health disparities. Supported HR 1862 the National Regenerative Medicine Strategy legislation. Supported HR 2376 the Stem Cell Research Advancement Act.

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See next page Met with senior HHS officials, members and staff of the House and Senate to talk about the future of the CLASS Act as well as health reform implementation. Discussed the CHAMPVA Childrens Protection Act of 2011 (H.R. 115). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged members of Congress to support full funding for Social Security Administration to ensure continuing progress at reducing the growing backlog of disability determination hearings around the country. Continued support of the Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. Discussed the CHAMPVA Childrens Protection Act of 2011 (H.R. 115). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Testified before the House Committee on Veterans Affairs regarding the need to improve employment opportunities for veterans with significant disabilities. The written testimony covered issues relating to the Workforce Investment Act, Social Security, vocational rehabilitation, and attitudinal barriers to the employment of people with disabilities. Endorsed the importance of Social Security for veterans and their families through the booklet, Social Security: Serving Those Who Serve Our Nation. Opposed chained CPI for Social Security COLA Formula

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See next pageParticipated in meetings with CMS concerning round one and the upcoming round two of the Medicare DME Competitive Bidding program. Joined with CCD Colleagues to urge both the Senate and House about the drastic Medicaid cuts and restructuring proposals within the then-proposed House Budget for FY 2012 introduced by Representative Ryan, noting it would cause a public health crisis on a national scale. Such deep cuts would undermine the integrity of the Medicaid program and would likely result in an increased number of Americans unable to access the care they need. We urged lawmakers to protect Medicaid from such drastic cuts and from other harmful changes to the program, such as block grants or caps on federal funding. Met with Congressional members to advocate on the importance of Medicaid for people with disabilities. Worked on draft legislation that would create a separate category for complex rehabilitative technology under Medicare. Supported a House bill sponsored by Representatives Glenn Thompson and Jason Altmire to end the Medicare competitive bidding program for home medical equipment and services (HME) in view of its serious flaws and its impact on patients access to medically required home medical equipment and services. Supported Senate bill introduced by Senators Cardin and Collins to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. Supported a House bill introduced by Representatives Thornberry and Carnahan to in the House and amend title XVIII of the Social Security Act to permit coverage of certain covered part D drugs for uses that are determined to be for medically accepted indications based upon clinical evidence in peer reviewed medical literature Urged Congress to ensure stable Medicaid and CHIP coverage, per provisions in the Affordable Care Act, by requiring states to hold steady on Medicaid and CHIP eligibility until 2014 for adults and 2019 for children. To date, these stability protections have worked exactly as intended, preventing states from reducing Medicaid and CHIP eligibility and adding red-tape barriers to enrollment just when people need help the most. Discussed possible solutions for improving access to Medicaid for military families who have children with disabilities. Met with the White House to talk about the Maitenance of Effort (MOE) under Medicaid. As well as communicated with with the House and Senate on the MOE issue.

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See next page. Testified before the House Committee on Veterans Affairs regarding the need to improve employment opportunities for veterans with significant disabilities. The written testimony covered issues relating to the Workforce Investment Act, Social Security, vocational rehabilitation, and attitudinal barriers to the employment of people with disabilities. Supported the Helping our Homeless Veterans Act (S. 411/HR 1133). This legislation would allow changes to the U.S. Department of Housing and Urban Development and the U.S. Department of Veterans Affairs Supported Housing (HUD-VASH) program to ensure that homeless veterans receive more effective case management services. Discussed the CHAMPVA Childrens Protection Act of 2011 (H.R. 115). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged Congress to expand the extended caregivers program authorized by the Caregivers and Veterans Omnibus Health Services Act (P.L. 111-163) to include all veterans who are eligible for VA health care and meet certain needs-based criteria. Urged Congress to expand VA home and community-based services for veterans with disabilities. Urged Congress to increase Dependency and Indemnity Compensation benefits and to eliminate the offset of military Survivor Benefit Plan annuities. Discussed the Hiring Heroes Act of 2011 (S. 951). This legislation seeks to improve employment opportunities for veterans. Urged Congress to provide appropriate oversight for and resources to address the VAs benefits claims processing backlog. Urged VA to accept the authority granted to them by states through the National Voter Registration Act of 1993 to serve as a voter registration agency. Supported the Veterans Traumatic Brain Injury Rehabilitative Services Improvements Act of 2011 (S. 957). This legislation would help to ensure that veterans with traumatic brain injuries receive the critical rehabilitation services needed to allow them to maximize their independence. Supported proposed House legislation that would develop a patient registry to help facilitate collaboration and research regarding undiagnosed diseases. Supported the Housing, Employment, and Living Programs (HELP) for Veterans Act of 2011 (H.R. 117). This legislation includes provisions that would not only reform the VAs Special Home Adaptation grant program to allow veterans who meet the nationally accepted standard of legal blindness to receive assistance with critical home modification, but also increase the amount of grant funding available for this program and the Specially Adapted Housing grant program. Supported the Andrew Connolly Veterans Housing Act (H.R. 1671). This legislation would extend until December 31, 2016, the authority of the VA Secretary to provide adaptive housing assistance under the Temporary Residence Adaptation grant program to veterans with disabilities who are temporarily residing with family members. Supported the proposed amendment in the nature of a substitute to the Veterans Dog Training Therapy Act (H.R. 198). This legislation directs the VA Secretary to carry out a pilot program for assessing the effectiveness of addressing post-deployment mental health and post-traumatic stress disorder symptoms through a therapeutic medium of service dog training and handling for veterans with disabilities. Supported legislation establishing an Injured and Amputee Veterans Bill of Rights (H.R. 805). This legislation directs the VA Secretary to ensure that an Injured and Amputee Veterans Bill of Rights is printed on signage in accessible formats and displayed prominently and conspicuously in each VA prosthetics and orthotics clinic. It also requires VA employees who work at such clinics, as well as patient advocates of veterans who receive care there, to receive training on the Bill of Rights and directs the Secretary to conduct outreach to inform veterans about it. Supported the Veterans Equal Treatment for Service Dogs Act (VETS Dogs Act) (H.R. 1154/S. 769). The VETS Dogs Act states that the VA Secretary may not prohibit the use of service dogs in VA facilities or on VA property.

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1st Quarter, 2011

Q1 Report

In Q1, United Spinal Association had in-house lobbyists. The report was filed on April 20, 2011. Original Filing: 300379527.xml

Lobbying Issues

FY 2012 (see next page)Supported CCD testimony before Senate Appropriation on the FY 2012 budget request for the Social Security Administration and the impacts of possible cuts to the Fiscal Year 2011 budget. Joined with CCD Colleagues to urge both the Senate and House about the drastic Medicaid cuts and restructuring proposals within the House Budget Resolution for FY 2012 introduced by Representative Ryan, noting it would cause a public health crisis on a national scale. Such deep cuts would undermine the integrity of the Medicaid program and would likely result in an increased number of Americans unable to access the care they need. We urged lawmakers to protect Medicaid from such drastic cuts and from other harmful changes to the program, such as block grants or caps on federal funding. Met with Congressional members in the House and Senate to discuss alternatives to Medicaid block granting as methods to save on federal spending (see also Medicaid) Supported the proposal of the Coalition for Health Funding for Function 550 program funding within the FY 2012 federal budget. Supported The Independent Budget for the Department of Veterans Affairs (VA) budget recommendations for VA and related agencies serving veterans for FY 2012. Testified before the House Committee on Veterans Affairs, Subcommittee on Economic Opportunity regarding the Department of Veterans Affairs Vocational and Rehabilitation and Employment program, including fiscal requirements. Urged members of Congress to support full funding for Social Security Administration to ensure continuing progress at reducing the growing backlog of disability determination hearings around the country.

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See next page Met with senior HHS officials to talk about the future of the CLASS Act as well as health reform implementation. Discussed the CHAMPVA Childrens Protection Act of 2011 (H.R. 115). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Urged members of Congress to support full funding for Social Security Administration to ensure continuing progress at reducing the growing backlog of disability determination hearings around the country. Signed on to testimony given before the Senate Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies from the Consortium for Citizens with Disabilities Social Security Task Force regarding the FY2011 and 2012 budgets for the Social Security Administration. Continued support of the Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits.

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See next pageMedicare/Medicaid Participated in meetings with CMS concerning round one and the upcoming round two of the Medicare DME Competitive Bidding program. Joined with CCD Colleagues to urge both the Senate and House about the drastic Medicaid cuts and restructuring proposals within the then-proposed House Budget for FY 2012 introduced by Representative Ryan, noting it would cause a public health crisis on a national scale. Such deep cuts would undermine the integrity of the Medicaid program and would likely result in an increased number of Americans unable to access the care they need. We urged lawmakers to protect Medicaid from such drastic cuts and from other harmful changes to the program, such as block grants or caps on federal funding. Met with Congressional members to advocate against upcoming legislation in the House that would block grant Medicaid to the states and territories. Worked on draft legislation that would create a separate category for complex rehabilitative technology under Medicare. Supported a House bill sponsored by Representatives Glenn Thompson and Jason Altmire to end the Medicare competitive bidding program for home medical equipment and services (HME) in view of its serious flaws and its impact on patients access to medically required home medical equipment and services. Supported Senate bill introduced by Senators Cardin and Collins to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. Supported a House bill introduced by Representatives Thornberry and Carnahan to in the House and amend title XVIII of the Social Security Act to permit coverage of certain covered part D drugs for uses that are determined to be for medically accepted indications based upon clinical evidence in peer reviewed medical literature Urged Congress to ensure stable Medicaid and CHIP coverage, per provisions in the Affordable Care Act, by requiring states to hold steady on Medicaid and CHIP eligibility until 2014 for adults and 2019 for children. To date, these stability protections have worked exactly as intended, preventing states from reducing Medicaid and CHIP eligibility and adding red-tape barriers to enrollment just when people need help the most.

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See next page. Testified before the House Committee on Veterans Affairs, Subcommittee on Economic Opportunity regarding the Department of Veterans Affairs Vocational and Rehabilitation and Employment program, including proposed programmatic changes. Supported the Veterans Equal Treatment for Service Dogs Act (VETS Dogs Act) (H.R. 1154/S. 769). The VETS Dogs Act states that the VA Secretary may not prohibit the use of service dogs in Department of Veterans Affairs (VA) facilities or on VA property. Supported the Helping our Homeless Veterans Act (S. 411). This legislation would allow changes to the U.S. Department of Housing and Urban Development and the U.S. Department of Veterans Affairs Supported Housing (HUD-VASH) program to ensure that homeless veterans receive more effective case management services. Discussed the CHAMPVA Childrens Protection Act of 2011 (H.R. 115). This legislation increases from 23 to 26 the maximum age of eligibility for certain dependent children of veterans for medical care under CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs [VA]). Discussed the Veterans Dog Training Therapy Act (H.R. 198). This legislation directs the Secretary of Veterans Affairs to carry out a pilot program for assessing the effectiveness of addressing post-deployment mental health and post-traumatic stress disorder symptoms through a therapeutic medium of service dog training and handling for veterans with disabilities. Submitted testimony to the House Committee on Veterans Affairs, Subcommittee on Health regarding the Department of Veterans Affairs implementation of the caregivers program included in the Caregivers and Veterans Omnibus Health services Act (P.L. 111-163). Submitted a letter to the Senate Veterans Affairs Committee in support of their efforts to ensure proper implementation of the caregivers program included in the Caregivers and Veterans Omnibus Health services Act (P.L. 111-163) and to urge expansion of the program to include veterans of all eras. Urged the Department of Veterans Affairs to accept the authority granted to them by states through the National Voter Registration Act of 1993 to serve as a voter registration agency. Submitted a formal request for a regulation change to the Department of Veterans Affairs regarding 38 C.F.R. 1.218(a)(11) to ensure access for service dogs to VA facilities. Urged Congress to provide appropriate oversight for and resources to address the Department of Veterans Affairs benefits claims processing backlog. Urged Congress to increase Dependency and Indemnity Compensation benefits and to eliminate the offset of military Survivor Benefit Plan annuities.

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4th Quarter, 2010

Q4 Report

In Q4, United Spinal Association had in-house lobbyists. The report was filed on Feb. 3, 2011. Original Filing: 300357075.xml

Lobbying Issues

Labor-HHS-Education and Related Agencies appropriations bill-- for additional administrative funding for the Social Security Admininstration in order to reduce the tragic backlogs in Social Security disability applications and for support of many social service programs in appropriations. (continued)As yet to be introduced legislation that may be in Budget/Appropriations or may be in another bill regarding possible terms of extending deadline for Amtrak obligation to make all stations accessible to people with disabilities past original deadline of July 26, 2010. Supported funding for new Vocational Rehabilitation and employment programs for people with disabilities including new competitive grant program to expand supported employment for youth with disabilities as they transition from school to the workforce, Projects with Industry, Supported Employment State Grant Program, Supported Employment Extended Services for Youth Grant Program, Workforce Innovation Fund, Model Transition Program for Students with Intellectual Disabilities into Higher Education, and Agribility. Supported inclusion of appropriate funding levels to support VA research programs in FY 2011 Military Consruction-VA Appropriations (House and Senate). Supported inclusion of funding in the Fiscal 2011 Defense Appropriation legislation (House and Senate) for conducting multiple sclerosis research under the Congressionally Directed Medical Research Programs of the Department of Defense. Supported the inclusion of $22 million for FY 2011 to fund programs authorized by the Traumatic Brain Injury Act Amendments of 2008 under the Department of Health and Human Services and $11 million for the National Institute on Disability and Rehabilitation Research TBI Model Systems administered by the Department of Education. Supported funding for new Agent Orange presumptive VA benefits claims as part of the Supplemental Appropriations Act of 2010 (H.R. 4899). Supported an effort for $10 million to be appropriated for Family to Family Health Information Centers for children with special health care needs. Supported the Able Act H.R. 1205 would provide individuals with disabilities and their families with a savings instrument for specified education, medical and community-based services, including housing, transportation, employment training, and supports for their child without disqualifying that child from receipt of funds from entitlement programs which are vital in ensuring their quality of life. Supported inclusion of funding in the Fiscal 2011 Defense Appropriation legislation (House and Senate) for conducting multiple sclerosis research under the Congressionally Directed Medical Research Programs of the Department of Defense. Supported inclusion of appropriate funding levels to support VA research programs in the Fiscal 2011 Military Construction-VA Appropriations (H.R. 5822). Supported the inclusion of $50 million in the FY 2012 budget to fund the Lifespan Respite Care Program. Supported funding for the Easter Seals Veterans Community Reintegration Project in a sign on letter to VA Secretary Eric Shinseki. Discussed the FY 2011 Military Construction and Veterans Affairs and Related Agencies Appropriations Act (H.R. 5822).

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

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Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. In health care reform HR 3590.Advocated for health insurance parity for coverage of prosthetic and orthotics devices, components and benefits for other medical and surgical services: under ERISA and HR 2575 for group health plans and group health insurance Supported HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration Supported HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions would have expired without reauthorization. Met with senior Senior SSA officials, as well as Senate and House staff regarding policies and possible legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities, electronic filing of disabilty applications and electronic authorizations for SSA to obtain medical records in connection with disabilities claims. Submitted comments (in response to an SSA request) on complicated medical evidence issues when Social Security disability applicants have a co-occurring alcohol or substance use diagnosis and a serious mental illness. Supported HR 4532 to renew SSAs demonstration authority and to make permanent a successful demonstration that enables both attorneys and non-attorneys (who meet certain qualifications) representing Social Security disability claimants to be paid reasonable fees out of retroactive benefits. This practice enables many claimants (including those with mental illnesses and conditions such as post-traumatic stress disorder) to have good representation rather than to navigate the esoteric and complex application process on their own (often to be denied for procedural rather than substantive reasons). Supported President's Budget proposal for SSA Limitation on Administrative expenses because the increased funding will help cut the backlog and delays in both the initial and hearing level disability determinations, thus providing disability benefits with less delay to people who meet SSA's strict eligibility requirements. Asked HHS to ensure that lifetime caps are prohibited as of September 2010. Health insurance companies are arguing that they can keep lifetime caps on health insurance for up to another year. Met with senior HHS officials to talk about the future of the CLASS Act as well as health reform implementation. Supported the Prosthetic and Custom Orthotic Parity Act of 2010 (HR 2575/S 3220). The legislation would ensure that there that insurance provide equal coverage for prosthetics and orthotics that it does for other medical treatment. Met with senior House and Senate Hill staff to strategize on obtaining sufficient appropriations for the Social Security Administration to reduce the backlog in disability determinations and otherwise better serve people with disabilities. Met with senior SSA officials regarding SSAs new proposal for work incentives under SSDI and other Title II disability Letter in support of S. 3223

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Lobbying Issues

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

Agencies Lobbied

Type of Issue

Lobbying Issues

See next page. Discussed with House and Senate Committees on Veterans Affairs staff concerns about legislation proposed by the Secretary of Veterans Affairs to address the claims backlog. The proposed legislation is the Veterans Benefit Programs Improvement Act of 2010. Urged Congress to consider methods for addressing the VA benefits claims processing backlog. Discussed the Rating and Processing Individuals Disability (RAPID) Claims Act (H.R. 5549). Discussed and submitted correspondence to Senate Committee on Veterans Affairs Chairman Daniel Akaka (D-HI) concerning the Claims Processing Improvement Act of 2010 (S. 3517). Supported Veterans Benefits Enhancement Act (H.R. 1037/S. 728)includes increases for the Veterans Mortgage Life Insurance program. Supported H.R. 1169would provide a significant increase in the VAs Specially Adapted Housing grant, the Special Home Adaptation grant, and the grant to purchase an automobile. Supported the Veterans Training Act (H.R. 3813)would grant veterans access under the Post-9/11 GI Bill to non-degree granting training programs and schools. Supported Surviving Spouses Benefit Improvement Act of 2009 (H.R. 2243)would replace the current rate of VA Dependency and Indemnity Compensation (DIC )with a formula setting the rate of DIC at a rate equal to 55 percent of the rate paid to a veteran with a total disability rating. Supported Military Surviving Spouses Equity Act (H.R. 775) and S. 535would eliminate the offset to the military Survivor Benefit Plan (SBP) annuities for families who receive VA Dependency and Indemnity Compensation (DIC). Supported the Improving Veterans Electronic Transition Services Act (H.R. 5225)would give veterans electronic access to their official military personnel files and require an assessment of the feasibility of using a centralized web portal to improve veterans access to benefits and records. Supported the Severely Injured Veterans Benefit Improvement Act of 2009 (H.R. 3407)would increase the rate of special monthly compensation available to veterans who have been severely injured and grant eligibility to veterans with traumatic brain injuries to receive aid and attendance benefits. Supported the Homeless Veterans and Other Health Care Authorities Act of 2010 (S. 1237), which includes provisions of the Zero Tolerance for Veterans Homelessness Act of 2009 (S. 1547). Supported the End Veteran Homelessness Act of 2010 (H.R. 4810), which includes provisions of H.R. 2504, the Help Our Homeless Veterans Act (H.R. 2559), H.R. 2735, and H.R. 3906. Supported H.R. 5014which clarifies that the health care provided by the Department of Veterans Affairs constitutes minimum essential coverage for the purposes of health reform. Supported the Compensation Owed for Mental Health Based on Activities in Theatre (COMBAT) Post-traumatic Stress Disorder Act of 2009 (H.R. 952)which would expand the definition of combat with the enemy to include active duty service in a theatre of combat operations during a period of war. Supported the Veterans Employment Transition Act (S. 3398/H.R. 5400)which would simplify the process employers must follow to receive tax credits for hiring veterans who meet certain classifications. Supported the Veterans Employment Transition Act (S. 3398)which would simplify the process employers must follow to receive tax credits for hiring veterans who meet certain classifications. Discussed with House and Senate Committees on Veterans Affairs staff concerns about legislation proposed by the Secretary of Veterans Affairs to address the claims backlog. The proposed legislation is the Veterans Benefit Programs Improvement Act of 2010. Urged Congress to consider methods for addressing the VA benefits claims processing backlog. Discussed the Rating and Processing Individuals Disability (RAPID) Claims Act (H.R. 5549). Discussed the Claims Processing Improvement Act of 2010 (S. 3517). Supported HR 2059 to enable military personnel who have a family member with a disability to designate a special needs trust to receive military retiree and survivor benefits annuities rather than a natural person. Without this bill, if benefits are paid directly to the family member, the payments can jeopardize that persons eligibility for Social Security and Medicaid benefits. Supported the Veterans Benefits Act of 2010 (H.R. 3219)omnibus veterans legislation that includes increases for the Veterans Mortgage Life Insurance program. Supported the Women and Injured and Amputee Veterans Bill of Rights (H.R. 5428/H.R. 5953). Supported the Post-9/11 Veterans Education al Assistance Improvements Act (S. 3447/H.R. 5933)which would make needed modifications to the Post-9/11 GI Bill, including adding additional types of educational training programs for which veterans would be eligible to receive assistance. Supported the Housing, Employment and Living Programs for Veterans Act (H.R. 5360)which would not only reform the VAs Special Home Adaptation grant program to allow veterans who meet the nationally accepted standard of legal blindness to receive assistance with critical home modification, but also increase the amount of grant funding available for this program and the Specially Adapted Housing grant program. Urged the Department of Veterans Affairs to accept the authority granted to them by six states through the National Voter Registration Act of 1993 to serve as a voter registration agency. Discussed the Veterans Appeals Improvement and Modernization Act of 2009 (H.R. 4121) which includes proposed improvements to the VAs appeals process and the establishment of the Veterans Judicial Review Commission. Discussed the Veterans' Disability Claims Efficiency Act of 2010 (H.R. 5928) which would improve the efficiency of processing certain claims for disability compensation by veterans through the use of interim disability ratings and fast track review of initial claims for benefits.

Agencies Lobbied

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Agencies Lobbied

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Agencies Lobbied

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Agencies Lobbied

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Agencies Lobbied

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3rd Quarter, 2010

Q3 Report

In Q3, United Spinal Association had in-house lobbyists. The report was filed on Nov. 1, 2010. Original Filing: 300331670.xml

Lobbying Issues

Labor-HHS-Education and Related Agencies appropriations bill-- for additional administrative funding for the Social Security Admininstration in order to reduce the tragic backlogs in Social Security disability applications and for support of many social service programs in appropriations. (continued)As yet to be introduced legislation that may be in Budget/Appropriations or may be in another bill regarding possible terms of extending deadline for Amtrak obligation to make all stations accessible to people with disabilities past original deadline of July 26, 2010. Supported funding for new Vocational Rehabilitation and employment programs for people with disabilities including new competitive grant program to expand supported employment for youth with disabilities as they transition from school to the workforce, Projects with Industry, Supported Employment State Grant Program, Supported Employment Extended Services for Youth Grant Program, Workforce Innovation Fund, Model Transition Program for Students with Intellectual Disabilities into Higher Education, and Agribility. Supported inclusion of appropriate funding levels to support VA research programs in FY 2011 Military Consruction-VA Appropriations (House and Senate). Opposed proposed cuts to Section 811 and Section 202 HUD housing programs in President's proposed budget for FY 2011 as these programs help provide affordable and accessible housing to people with disabilities. Supported inclusion of funding in the Fiscal 2011 Defense Appropriation legislation (House and Senate) for conducting multiple sclerosis research under the Congressionally Directed Medical Research Programs of the Department of Defense. Supported the inclusion of $22 million for FY 2011 to fund programs authorized by the Traumatic Brain Injury Act Amendments of 2008 under the Department of Health and Human Services and $11 million for the National Institute on Disability and Rehabilitation Research TBI Model Systems administered by the Department of Education. Supported funding for new Agent Orange presumptive VA benefits claims as part of the Supplemental Appropriations Act of 2010 (H.R. 4899). Supported an effort for $10 million to be appropriated for Family to Family Health Information Centers for children with special health care needs. Supported the Able Act H.R. 1205 would provide individuals with disabilities and their families with a savings instrument for specified education, medical and community-based services, including housing, transportation, employment training, and supports for their child without disqualifying that child from receipt of funds from entitlement programs which are vital in ensuring their quality of life. Supported inclusion of funding in the Fiscal 2011 Defense Appropriation legislation (House and Senate) for conducting multiple sclerosis research under the Congressionally Directed Medical Research Programs of the Department of Defense. Supported inclusion of appropriate funding levels to support VA research programs in the Fiscal 2011 Military Construction-VA Appropriations (H.R. 5822). Supported the inclusion of $50 million in the FY 2012 budget to fund the Lifespan Respite Care Program. Supported funding for the Easter Seals Veterans Community Reintegration Project in a sign on letter to VA Secretary Eric Shinseki. Discussed the FY 2011 Military Construction and Veterans Affairs and Related Agencies Appropriations Act (H.R. 5822).

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Agencies Lobbied

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Agencies Lobbied

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See next page. Discussed with House and Senate Committees on Veterans Affairs staff concerns about legislation proposed by the Secretary of Veterans Affairs to address the claims backlog. The proposed legislation is the Veterans Benefit Programs Improvement Act of 2010. Urged Congress to consider methods for addressing the VA benefits claims processing backlog. Discussed the Rating and Processing Individuals Disability (RAPID) Claims Act (H.R. 5549). Discussed and submitted correspondence to Senate Committee on Veterans Affairs Chairman Daniel Akaka (D-HI) concerning the Claims Processing Improvement Act of 2010 (S. 3517). Supported Veterans Benefits Enhancement Act (H.R. 1037/S. 728)includes increases for the Veterans Mortgage Life Insurance program. Supported H.R. 1169would provide a significant increase in the VAs Specially Adapted Housing grant, the Special Home Adaptation grant, and the grant to purchase an automobile. Supported the Veterans Training Act (H.R. 3813)would grant veterans access under the Post-9/11 GI Bill to non-degree granting training programs and schools. Supported Surviving Spouses Benefit Improvement Act of 2009 (H.R. 2243)would replace the current rate of VA Dependency and Indemnity Compensation (DIC )with a formula setting the rate of DIC at a rate equal to 55 percent of the rate paid to a veteran with a total disability rating. Supported Military Surviving Spouses Equity Act (H.R. 775) and S. 535would eliminate the offset to the military Survivor Benefit Plan (SBP) annuities for families who receive VA Dependency and Indemnity Compensation (DIC). Supported the Improving Veterans Electronic Transition Services Act (H.R. 5225)would give veterans electronic access to their official military personnel files and require an assessment of the feasibility of using a centralized web portal to improve veterans access to benefits and records. Supported the Severely Injured Veterans Benefit Improvement Act of 2009 (H.R. 3407)would increase the rate of special monthly compensation available to veterans who have been severely injured and grant eligibility to veterans with traumatic brain injuries to receive aid and attendance benefits. Supported the Homeless Veterans and Other Health Care Authorities Act of 2010 (S. 1237), which includes provisions of the Zero Tolerance for Veterans Homelessness Act of 2009 (S. 1547). Supported the End Veteran Homelessness Act of 2010 (H.R. 4810), which includes provisions of H.R. 2504, the Help Our Homeless Veterans Act (H.R. 2559), H.R. 2735, and H.R. 3906. Supported H.R. 5014which clarifies that the health care provided by the Department of Veterans Affairs constitutes minimum essential coverage for the purposes of health reform. Supported the Compensation Owed for Mental Health Based on Activities in Theatre (COMBAT) Post-traumatic Stress Disorder Act of 2009 (H.R. 952)which would expand the definition of combat with the enemy to include active duty service in a theatre of combat operations during a period of war. Supported the Veterans Employment Transition Act (S. 3398/H.R. 5400)which would simplify the process employers must follow to receive tax credits for hiring veterans who meet certain classifications. Supported the Veterans Employment Transition Act (S. 3398)which would simplify the process employers must follow to receive tax credits for hiring veterans who meet certain classifications. Discussed with House and Senate Committees on Veterans Affairs staff concerns about legislation proposed by the Secretary of Veterans Affairs to address the claims backlog. The proposed legislation is the Veterans Benefit Programs Improvement Act of 2010. Urged Congress to consider methods for addressing the VA benefits claims processing backlog. Discussed the Rating and Processing Individuals Disability (RAPID) Claims Act (H.R. 5549). Discussed the Claims Processing Improvement Act of 2010 (S. 3517). Supported HR 2059 to enable military personnel who have a family member with a disability to designate a special needs trust to receive military retiree and survivor benefits annuities rather than a natural person. Without this bill, if benefits are paid directly to the family member, the payments can jeopardize that persons eligibility for Social Security and Medicaid benefits. Supported the Veterans Benefits Act of 2010 (H.R. 3219)omnibus veterans legislation that includes increases for the Veterans Mortgage Life Insurance program. Supported the Injured and Amputee Veterans Bill of Rights (H.R. 5428). Supported the Post-9/11 Veterans Education al Assistance Improvements Act (S. 3447/H.R. 5933)which would make needed modifications to the Post-9/11 GI Bill, including adding additional types of educational training programs for which veterans would be eligible to receive assistance. Supported the Housing, Employment and Living Programs for Veterans Act (H.R. 5360)which would not only reform the VAs Special Home Adaptation grant program to allow veterans who meet the nationally accepted standard of legal blindness to receive assistance with critical home modification, but also increase the amount of grant funding available for this program and the Specially Adapted Housing grant program. Submitted testimony to the House Committee on Veterans Affairs, Subcommittee on Economic Opportunity as a co-chair of the CCD Veterans Task Force regarding federal contractor compliance with affirmative action requirements concerning veterans. Urged the Department of Veterans Affairs to accept the authority granted to them by six states through the National Voter Registration Act of 1993 to serve as a voter registration agency. Discussed the Veterans Appeals Improvement and Modernization Act of 2009 (H.R. 4121) which includes proposed improvements to the VAs appeals process and the establishment of the Veterans Judicial Review Commission. Discussed the Veterans' Disability Claims Efficiency Act of 2010 (H.R. 5928) which would improve the efficiency of processing certain claims for disability compensation by veterans through the use of interim disability ratings and fast track review of initial claims for benefits.

Agencies Lobbied

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Agencies Lobbied

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Agencies Lobbied

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Agencies Lobbied

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2nd Quarter, 2010

Q2 Report

In Q2, United Spinal Association had in-house lobbyists. The report was filed on July 21, 2010. Original Filing: 300304161.xml

Lobbying Issues

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

Agencies Lobbied

Type of Issue

Lobbying Issues

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

Agencies Lobbied

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Agencies Lobbied

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Agencies Lobbied

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

Agencies Lobbied

Type of Issue

Lobbying Issues

See next page. Supported Caregivers and Veterans Omnibus Health Services Act of 2009 (S. 1963)includes funding for family caregivers, improved access to services for women veterans and veterans living in rural areas, and other health matters. S. 1963 includes aspects of the Caregiver Assistance and Resource Enhancement Act (H.R. 3155), Women Veterans Health Care Improvement Act (H.R. 1211), Disabled Veterans Home Improvement and Structural Alteration Grant Increase Act of 2009 (H.R. 1293),and Veterans Nonprofit Research and Education Corporations Enhancement Act of 2009 (H.R. 2770). Supported Veterans Benefits Enhancement Act (H.R. 1037/S. 728)includes increases for the Veterans Mortgage Life Insurance program. Supported H.R. 1169would provide a significant increase in the VAs Specially Adapted Housing grant, the Special Home Adaptation grant, and the grant to purchase an automobile. Supported the Veterans Training Act (H.R. 3813)would grant veterans access under the Post-9/11 GI Bill to non-degree granting training programs and schools. Supported Surviving Spouses Benefit Improvement Act of 2009 (H.R. 2243)would replace the current rate of VA Dependency and Indemnity Compensation (DIC )with a formula setting the rate of DIC at a rate equal to 55 percent of the rate paid to a veteran with a total disability rating. Supported Military Surviving Spouses Equity Act (H.R. 775) and S. 535would eliminate the offset to the military Survivor Benefit Plan (SBP) annuities for families who receive VA Dependency and Indemnity Compensation (DIC). Supported the Improving Veterans Electronic Transition Services Act (H.R. 5225)would give veterans electronic access to their official military personnel files and require an assessment of the feasibility of using a centralized web portal to improve veterans access to benefits and records. Supported the Severely Injured Veterans Benefit Improvement Act of 2009 (H.R. 3407)would increase the rate of special monthly compensation available to veterans who have been severely injured and grant eligibility to veterans with traumatic brain injuries to receive aid and attendance benefits. Supported the Homeless Veterans and Other Health Care Authorities Act of 2010 (S. 1237), which includes provisions of the Zero Tolerance for Veterans Homelessness Act of 2009 (S. 1547). Supported the End Veteran Homelessness Act of 2010 (H.R. 4810), which includes provisions of H.R. 2504, the Help Our Homeless Veterans Act (H.R. 2559), H.R. 2735, and H.R. 3906. Supported H.R. 5014which clarifies that the health care provided by the Department of Veterans Affairs constitutes minimum essential coverage for the purposes of health reform. Supported the Compensation Owed for Mental Health Based on Activities in Theatre (COMBAT) Post-traumatic Stress Disorder Act of 2009 (H.R. 952)which would expand the definition of combat with the enemy to include active duty service in a theatre of combat operations during a period of war. Supported the Veterans Employment Transition Act (S. 3398)which would simplify the process employers must follow to receive tax credits for hiring veterans who meet certain classifications. Discussed with House and Senate Committees on Veterans Affairs staff concerns about legislation proposed by the Secretary of Veterans Affairs to address the claims backlog. The proposed legislation is the Veterans Benefit Programs Improvement Act of 2010. Urged Congress to consider methods for addressing the VA benefits claims processing backlog. Discussed the Rating and Processing Individuals Disability (RAPID) Claims Act (H.R. 5549). Discussed the Claims Processing Improvement Act of 2010 (S. 3517). Supported HR 2059 to enable military personnel who have a family member with a disability to designate a special needs trust to receive military retiree and survivor benefits annuities rather than a natural person. Without this bill, if benefits are paid directly to the family member, the payments can jeopardize that persons eligibility for Social Security and Medicaid benefits.

Agencies Lobbied

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Agencies Lobbied

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Agencies Lobbied

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1st Quarter, 2010

Q1 Report

In Q1, United Spinal Association had in-house lobbyists. The report was filed on April 26, 2010. Original Filing: 300277154.xml

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

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4th Quarter, 2009

Q4 Report

In Q4, United Spinal Association had in-house lobbyists. The report was filed on Jan. 22, 2010. Original Filing: 300249713.xml

Lobbying Issues

Labor-HHS-Education and Related Agencies appropriations bill HR 3288-- for additional administrative funding for the Social Security Admininstration in order to reduce the tragic backlogs in Social Security disability applications and for support of many social service programs in appropriations. (continued)Amtrak Consolidated Appropriations bill, HR 3288, particularly provisions governing Amtrak's obligation to make its train stations accessible to people with disabilities. Supported legislation that includes crimes against people with disabilities as hate crimes -- included in HR 2647, the Department of Defense military activitites 2010 appropriations (originally introduced as H.R. 1913 and S. 909). Supported continuing resolution that allowed the government to continue running temporarily until permanent FY 2010 appropriations were enacted.

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

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

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

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3rd Quarter, 2009

Amendment

United Spinal Association amended a lobbying report for in-house lobbying in Q32009 on Jan. 22, 2010 Original Filing: 300249717.xml

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

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

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

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3rd Quarter, 2009

Q3 Report

In Q3, United Spinal Association had in-house lobbyists. The report was filed on Oct. 20, 2009. Original Filing: 300221428.xml

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2nd Quarter, 2009

Q2 Report

In Q2, United Spinal Association had in-house lobbyists. The report was filed on Aug. 28, 2009. Original Filing: 300198144.xml

Lobbying Issues

See next page BUDGET & APPROPRIATIONS Budget for FY 2010 HCR 85 and SCR 13 Appropriations for FY 2010 (no bill # yet) including Labor-Health & Human Services- Education & Related Agencies, including funds committed to comprehensive health care reform and the related goals of reducing costs, improving quality and expanding coverage for all Americans including the 46 million Americans who lack health insurance; increased funds for Social Security Administration Limitation on Administrative Expenses (SSA-LAE) ( For details and recommendations, see 3-24-09 testimony of United Spinal Associations Vice President for Public Policy on behalf of the Consortium for Citizens with Disabilities (CCD) at http://waysandmeans.house.gov/hearings.asp?formmode=view&id=7618); Medicare including but not limited to repeal of arbitrary outpatient therapy caps; Medicaid; State Childrens Health Insurance Program; special education under Individuals with Disabilities Education Act (IDEA), vocational rehabilitation, family support and maternal and child health. support of 302b and general health funding; funds for Lifespan Respite Care Act; Funds for the core missions and activities of the major federal public health agencies including discretionary budget allocation for NIH, CDC, HRSA, FFS and other public health service agencies, including Biomedical and Behavioral Research: Maintaining a vigorous portfolio of investigator-initiated basic research and pivotal translational and clinical studies to address the myriad health challenges that confront the American people and to develop a stable pool of talented new investigators whose ideas and fresh perspectives are vital to invigorating the research enterprise; Disease Prevention and Health Promotion: Improving community-based prevention and early intervention activities that address costly chronic diseases, infectious diseases, including those that are becoming increasingly drug-resistant, strengthening public health capacity and ensuring those with disabilities reach their highest potential in function and health; Access to Safety Net Health Care Services: Assuring access to basic and targeted health care services for the rapidly growing numbers of Americans who lack health insurance as recession-related unemployment increases; Health Professions Education: Assuring that there is a well-trained, diverse health and public health workforce to serve as the foundation for the nations health care system; Mental Health and Substance Abuse: Assuring access to needed mental health and substance abuse services for hundreds of thousands who must wait months for care, including Veterans returning from Iraq and Afghanistan; reducing the 15-20 year lag from bench to bedside of promising new treatments; Health Services Research: Building the evidence needed to ensure patients get the right care at the right time, every time; providing decision makers with information that will help control unsustainable costs; Health care for American Indians and Alaska Natives: Reversing current health disparities for this population that now suffers a life expectancy that is four years lower than the general population; Food and Drug Safety: Assuring the nation has a safe food supply and a safe and effective supply of drugs and medical devices. Funds for state Vocational Rehabilitation programs, Centers for Independent Living, and many other programs. Veterans Affairs funding for the level for VA medical care as championed by the Independent Budget (a detailed budget developed annually by several veterans organizations) including funds to research and treat mental health, post-traumatic stress disorder and traumatic brain injury; assurance that the VA will not bill private health insurers for treatment of health problems related to military service; VA health care funding reform including advanced appropriations and mandatory funding; one unified lifetime electronic health record for members of our armed services that will contain their administrative and medical information; increased funding for VA homeless veterans programs; funds for Medical and Prosthetic Research Program and to bring VA research facilities into the 21st century. Defense: funds to conduct multiple sclerosis (MS) research under the Congressionally Directed Medical Research Programs (CDMRP) of the Department of Defense (DOD). Matthew Shepherd Hates Crimes Prevention Act Matthew Shepherd Hate Crimes Prevention Act (HCPA), S. 909, HR 1913, added to S. 1390 the 2010 Department of Defense Authorization bill. Gives greater tools to law enforcement to investigate and prosecute federal crimes based on the victims disability, whether real or perceived, and authorizes funding for states to help with prosecution of hate crimes.

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

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

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Supported S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. See additional page Advocated for reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. Supported HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. Commented on draft CMS Medicare Part D Transition letter --- intended to clearly inform Medicare beneficiaries of the transition process and their rights when the prescription medications prescribed by their physician are not covered by their plan. Urged HHS Secretary Sibelius to exempt wheelchair seating cushions from the CMS Competitive Acquisition program for Durable Medical Equipment Prosthetics and Supplies (DMEPOS) commonly known as "DME competitive bidding." Urged CMS to reinstate Orthotic Codes L2860 and L3890 for certain custom orthotic components used by children and adults with disabling orthotic impairments. Their deletion effective January 1, 2009 especially affects people whose health care payer is Medicaid or private insurance.

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Support The Combat PTSD Act of 2009, HR 952 - to require the VA to recognize that documented military service in Iraq and Afghanistan during Operations Iraqi and Enduring Freedom (OIF and OEF) will be presumed to have exposed the veteran to sufficient psychological stressors to support a diagnosis of PTSD. see next page Support the Family Caregiver Act of 2009, S. 801 to facilitate support for the proliferation of family caregivers for severely disabled veterans whether or not the veteran participated in Operations Iraqi and Enduring Freedom (OIF and OEF). Support HR 2059 to allow military survivor benefit plans to provide for payments to special needs trusts for dependents of a deceased service member. Existing law allows only payments to a natural person, but this is the way service members need to designate payments to a special needs trust for a loved one who has disabilities.

Agencies Lobbied

Type of Issue

1st Quarter, 2009

Q1 Report

In Q1, United Spinal Association had in-house lobbyists. The report was filed on July 20, 2009. Original Filing: 300193465.xml

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1st Quarter, 2009

Q1 Report

In Q1, United Spinal Association had in-house lobbyists. The report was filed on July 20, 2009. Original Filing: 300198140.xml

Lobbying Issues

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Agencies Lobbied

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1st Quarter, 2009

Q1 Report

In Q1, United Spinal Association had in-house lobbyists. The report was filed on April 20, 2009. Original Filing: 300160296.xml

Lobbying Issues

See following pages American Recovery and Reinvestment Act (H.R. 1, S.1) including funds for: $250 stimulus payments to many veterans and most recipients of Social Security Title II and Title XVI benefits; Social Security administrative costs including costs to handle the surge in applications due to the economic crisis and for a National Computer Center; COBRA subsidy for workers who have lost their jobs ; extended and increased unemployment insurance payments and decreases income tax owed on unemployment benefits; Medicaid: increase in the federal share of Medicaid spending (known as the Federal Medical Assistance Percentage or FMAP); moratoria on certain previously promulgated Medicaid regulations including those affecting reimbursement to public and teaching hospitals(which are the safety net for America's imperfect health care system and which provide emergency response capabilities, trauma care, neonatal intensive care, burn units, and psychiatric emergency care), level of graduate medical education funding available to teaching hospitals in support of training new physicians (at a time when all patientsnot just Medicaid beneficiariesface physician shortages), restrictions on what states may cover as hospital outpatient services, provision of school-based services and rehabilitative services (including services for individuals with mental illnesses or developmental disabilities) and transportation to school for some students with disabilities; the ability of states to use provider taxes to fund healthcare for indigent populations. making all health care records electronic by 2014 comparative effectiveness research (particularly provisions that the research will focus on medical outcomes and contain the flexibility to take into account variations among different patient populations) scientific research at the National Institutes of Health and funding to the National Center for Research Resources for construction, renovation, repair and improvement of research facilities and capital research equipment. IDEA the Individuals with Disabilities Education Act including grants to states and funds for pre-school/early intervention under IDEA repairing and modernizing public schools and colleges and universities, which may include modifications for accessibility under the Americans with Disabilities Act and for eliminating exposure to mold, asbestos, mildew and lead based paint, as well as for training funds that may be used to train general education teacher candidates to more effectively teach students with disabilities. grants to state Vocational Rehabilitation programs and funding for job training for adults and youth (including but not exclusively for people with disabilities).; affordable, accessible housing including funds to the Public Housing Capital Fund for building repair, modernization and renovation including energy conservation retrofitting ; and funding for full-year renewals of project-based Section 8 rental assistance contracts which will help alleviate a longstanding under-funding problem of housing subsidies on which many people with disabilities and very low incomes depend. HUD for grants and loans to upgrade Section 202 elderly, Section 811 disabled and Section 8 project-based housing to increase energy efficiency. Funding for the Neighborhood Stabilization program for communities to purchase and rehabilitate foreclosed abandoned properties to create more affordable housing. Funding for the National Housing Trust Fund. $140 million for Centers for Independent Living to help people with disabilities be as independent as possible and remain in their homes and communities. Appropriations for FY 2009 HR 1105 Budget for FY 2010 HCR 85 and SCR 13 Appropriations for FY 2010 (no bill # yet) including Labor-Health & Human Services- Education & Related Agencies, including funds committed to comprehensive health care reform and the related goals of reducing costs, improving quality and expanding coverage for all Americans including the 46 million Americans who lack health insurance; increased funds for Social Security Administration Limitation on Administrative Expenses (SSA-LAE) ( For details and recommendations, see 3-24-09 testimony of United Spinal Associations Vice President for Public Policy on behalf of the Consortium for Citizens with Disabilities (CCD) at http://waysandmeans.house.gov/hearings.asp?formmode=view&id=7618); Medicare; Medicaid; State Childrens Health Insurance Program; special education under Individuals with Disabilities Education Act (IDEA); support of 302b and general health funding; Funds for the core missions and activities of the major federal public health agencies including discretionary budget allocation for NIH, CDC, HRSA, FFSand other public health service agencies, including Biomedical and Behavioral Research: Maintaining a vigorous portfolio of investigator-initiated basic research and pivotal translational and clinical studies to address the myriad health challenges that confront the American people and to develop a stable pool of talented new investigators whose ideas and fresh perspectives are vital to invigorating the research enterprise; Disease Prevention and Health Promotion: Improving community-based prevention and early intervention activities that address costly chronic diseases, infectious diseases, including those that are becoming increasingly drug-resistant, strengthening public health capacity and ensuring those with disabilities reach their highest potential in function and health; Access to Safety Net Health Care Services: Assuring access to basic and targeted health care services for the rapidly growing numbers of Americans who lack health insurance as recession-related unemployment increases; Health Professions Education: Assuring that there is a well-trained, diverse health and public health workforce to serve as the foundation for the nations health care system; Mental Health and Substance Abuse: Assuring access to needed mental health and substance abuse services for hundreds of thousands who must wait months for care, including Veterans returning from Iraq and Afghanistan; reducing the 15-20 year lag from bench to bedside of promising new treatments; Health Services Research: Building the evidence needed to ensure patients get the right care at the right time, every time; providing decision makers with information that will help control unsustainable costs; Health care for American Indians and Alaska Natives: Reversing current health disparities for this population that now suffers a life expectancy that is four years lower than the general population; Food and Drug Safety: Assuring the nation has a safe food supply and a safe and effective supply of drugs and medical devices. Funds for state Vocational Rehabilitation programs, Centers for Independent Living, and many other programs. Veterans Affairs funds for the level for VA medical care as championed by the Independent Budget (a detailed budget developed annually by several veterans organizations) including funds to research and treat mental health, post-traumatic stress disorder and traumatic brain injury; assurance that the VA will not bill private health insurers for treatment of health problems related to military service; VA health care funding reform including advanced appropriations and mandatory funding; one unified lifetime electronic health record for members of our armed services that will contain their administrative and medical information; increased funding for VA homeless veterans programs; funds for Medical and Prosthetic Research Program and to bring VA research facilities into the 21st century; Transportation-Housing-Urban Development & Related Agencies funds for affordable, accessible housing including funds for public housing, Section 8, 202 elderly, Section 811, and National Housing Trust Fund; funds for accessible transportation including for Amtrac and the New Freedom initiative. Defense: funds to conduct multiple sclerosis (MS) research under the Congressionally Directed Medical Research Programs (CDMRP) of the Department of Defense (DoD).

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Agencies Lobbied

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

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Christopher & Dana Reeve Paralysis Act (S. 22/H.R 146, and HR 307) which became law in March 2009 The act authorizes the Secretary of Health and Human Services to direct research on paralysis. It would also authorize up to $25 million per year through 2011.Stem Cell Research Improvement Act of 2009 allows for federal funding of embryonic stem cell research (HR 873 and S. 487). We also support President Obama's Executive Order allowing such research.Advocated for Biomedical and Behavioral Research: Maintaining a vigorous portfolio of investigator-initiated basic research and pivotal translational and clinical studies to address the myriad health challenges that confront the American people and to develop a stable pool of talented new investigators whose ideas and fresh perspectives are vital to invigorating the research enterprise; Disease Prevention and Health Promotion: Improving community-based prevention and early intervention activities that address costly chronic diseases, infectious diseases, including those that are becoming increasingly drug-resistant, strengthening public health capacity and ensuring those with disabilities reach their highest potential in function and health; Access to Safety Net Health Care Services: Assuring access to basic and targeted health care services for the rapidly growing numbers of Americans who lack health insurance as recession-related unemployment increases; Health Professions Education: Assuring that there is a well-trained, diverse health and public health workforce to serve as the foundation for the nations health care system; Mental Health and Substance Abuse: Assuring access to needed mental health and substance abuse services for hundreds of thousands who must wait months for care, including Veterans returning from Iraq and Afghanistan; reducing the 15-20 year lag from bench to bedside of promising new treatments; Health Services Research: Building the evidence needed to ensure patients get the right care at the right time, every time; providing decision makers with information that will help control unsustainable costs; Health care for American Indians and Alaska Natives: Reversing current health disparities for this population that now suffers a life expectancy that is four years lower than the general population; Food and Drug Safety: Assuring the nation has a safe food supply and a safe and effective supply of drugs and medical devices.

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Lobbying Issues

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

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

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Compensation Owed for Mental Health Based on Activities in Theater Post-traumatic Stress Disorder Act of 2009 -- the COMBAT PTSD Act; H.R. 952. Requested introduction of legislation to increase coverage in support of VAs Veterans Mortgage Life Insurance Program; no bill yet. continuedAppropriations for Veterans Affairs funds for the level for VA medical care as championed by the Independent Budget (a detailed budget developed annually by several veterans organizations) including funds to research and treat mental health, post-traumatic stress disorder and traumatic brain injury; assurance that the VA will not bill private health insurers for treatment of health problems related to military service; VA health care funding reform including advanced appropriations and mandatory funding; one unified lifetime electronic health record for members of our armed services that will contain their administrative and medical information; increased funding for VA homeless veterans programs; funds for Medical and Prosthetic Research Program and to bring VA research facilities into the 21st century. In addition, advocated for: -Immediate increased cooperation and coordination between the DoD and the VA in order to facilitate the soldier-to-civilian transition process, disabled service member health care planning, increased research concerning post-deployment mental health challenges and TBI. -Maintenance of critical Veterans Health Administration infrastructure, construction of new VA medical facilities, as opposed to building structures for other entities and leasing them back thereby endangering the capacity to treat future generations of veterans. -Reformation of the VA claims adjudication process to improve the timeliness and accuracy of claims decisions, reduce delays caused by unnecessarily burdensome procedures, poor adjudicator training and a lack of accountability. -Increased cooporation and coordination between the VA and the Department of Labor to work on the issues of veterans employment, training and business opportunities.

Agencies Lobbied

Type of Issue

4th Quarter, 2008

Q4 Report

In Q4, United Spinal Association had in-house lobbyists. The report was filed on Jan. 21, 2009. Original Filing: 300132737.xml

Lobbying Issues

Labor-HHS-Education appropriations bills for FY 2009 (S. 3230, no House bill #) -- especially appropriations for Social Security Administration Limitation on Administrative Expenses (SSA-LAE), Medicare, Medicaid, State Childrens Health Insurance Program, National Family Caregiver Support Program, Lifespand Respite Care Act, Families of Children with Disabilities Act of 2008, funding for special education under Individuals with Disabilities Education Act (IDEA), support of 302b and general health funding, cont and for many disabilities programs funded by the Labor-HHS-Education appropriations bill. Defense appropriations bill for FY 2009 - support for multiple sclerosis research under the Congressionally Directed Medical Research Programs at the Department of Defense. HR 2638 - Continuing Resolution (CR) making appropriations for all agencies and activities that would be covered by the regular fiscal year 2009 appropriations bills. Requested inclusion of additional appropriations for SSA-LAE in order to enable SSA to reduce the tragic backlog in disability determinations as well as funding for many disabilities programs funded by the Labor-HHS-Education appropriations bill. HR 1424 -- Emergency Economic Stabilization Act of 2008 --Title V. Subtitle B -- Paul Wellstone and Pete Domenicia Helath Parity and Addiction Equity Act of 2008, Section 511, requiring group health plans that provide both (i) medical and surgical benefits and (ii) mental health or substance use disorder benefits to meet certain requirements to provide parity between (i) and (ii). Support for funding for disability research across all federal agencies. Support for Independent Budget for Veterans Admininstration. Possible future legislation to include in the expected second economic stimulus package: - funding of direct support workers for people with disabilities - funding for state vocational rehabilitation programs including needed funding for Title I programs under the Rehabilitation Act of 1973 - funding for new National Computer Center for Social Security Administration to enable major overhaul of antiquated IT building and equipment and increased Limitation on Administrative Expenses (LAE) to enable SSA to reduce the tragic backlog of applications for disability benefits - funding for programs supporting employment of people with disabilities, - funding for affordable, accessible housing - funding for biomedical research -funding to renovate aging schools and make them accessible to students and staff with disabilities.

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Health care reform: proposals for major health care reform, including Senator Baucus' white paper Call to Action Health Care Reform 2009 and anticipated legislation for 111th Congress. No bill #'s yet. HR 1424 - Emergency Economic Stabilization Act of 2008 - Title V, Subtitle B - Paul Wellstone and Pete Domenicia Health Parity and Addiction Equity Act of 2008, Section 511 requiring group health plans that provide both (i) medical and surgical benefits and cont (ii) mental health or substance use disorder benefits to meet certain requirements to provide parity between (i) and (ii). Medical Device Safety Act of 2008 S 3398 Comparative Effectiveness Research Act of 2008 S 3408 Possible future legislation - health care reform to include long term services and supports for people with disabilities and chronic conditions.

Agencies Lobbied

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Lobbying Issues

Social Security - funding for Social Security Admninstration Limitation on Administrative Expenses (SSA-LAE) to enable SSA to reduce the tragic backlog in disability determinations -- Labor-HHS-Education appropriations bill for FY 2009 (S. 3230 - no House bill #) and HR 2683 - Continuing Resolution for FY 2009. Met with senior SSA officials to discuss legislation for expedited Records Review in connection with applications for Social Security disability benefits. Possible future legislation to help assure that a knowledgeable, experienced pool of representaitives is available to people claiming Social Security disability benefits by making permanent a demonstration project by which the Social Security Admininstration pays fees to attorneys and qualified non-attorney representatives of successful claimants out of retroactive benefits.

Agencies Lobbied

Type of Issue

Lobbying Issues

Ending the Medicare Disability Waiting Period Act, H 154, S 2101 to end Medicare's 24-month waiting period. Medicare Improvements for Patients & Providers Act of 2008 , HR 6331, and related bills, HR 6252, S 3118, including provisions to fix the physician payment rate, delay Medicare competitive bidding for durable medical equipment and exempt complex rehabilitation from competitive bidding altogether -- because of impacts on people who need wheelchairs and other durable medical equipment. cont.S. 3327 - to improve the state plan option under Medicaid providing for home & community-based services -- cjamges tje home and community-based services option in the 2005 Deficit Reduction Act to allow more people to access these services. HR 1845 & S. 6252 - Medicare DMEPOS Competitive Acquisition Reform Act of 2007 regarding competitive bidding for durable medical equiptment. HR 1809/ S 2103 -- Medicare Independent Living Act -- to reverse Medicare regulations and policies that restrict payment for power mobility devices (wheelchairs) to those needed "in the home" rather than in the community -- such as for going to work, school, grocery shopping, medical appointments, places of worship and to accompany childred to school and activities. HR 1621/ S 799 - Community Choice Act of 2007 -- to support Medicaid coverage of community based services such as personal care, activities of daily living, etc. HR 1279 -- Direct Support Professional's Fairness & Security Act -- to support equalization of wages between privately and publicly employed direct support professionals. Community Living Assistance and Supports, CLASS Act S. 1758, Senators Edward Kennedy (D-MA) and Tom Harkin (D-IA) H.R. 3001, Reps. Frank Pallone (D-NJ) and John Dingell (D-MI) Both bills provide for a cash benefit to help obtain services and support. They would establish a national insurance plan to be financed by voluntary payroll deductions to provide benefits to adults who become severely functionally impaired. Participants would not be required to impoverish themselves in order to qualify for benefits. Center for Medicare and Medicaid Services (CMS) -- oppose the Rhode Island 1115 Waiver application that would essentially block grant Medicaid to Rhode Island -- which would jeopardize Medicaid services. Discussions with senior CMS officials about what will be happening with competitive bidding following enactment of HR 6331 that delayed competitive bidding temporarily and exempted complex rehabilitation from competive bidding altogether. Discussions about possible future legislation in the 111th Congress regarding: - physician payment rate - Medicare competitive bidding for durable medical equipment - make permanent some of the temporary delays/moratoria that were included in HR 6331 and related bills - seek permanent repeals of Medicaid rules that were delayed by legislation (e.g. enactment of HR 5613) - increasing the federal share of Medicaid (known as FMAP) including increased FMAP for direct support workers.

Agencies Lobbied

Type of Issue

Lobbying Issues

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Lobbying Issues

Agencies Lobbied

Type of Issue

3rd Quarter, 2008

Q3 Report

In Q3, United Spinal Association had in-house lobbyists. The report was filed on Oct. 20, 2008. Original Filing: 300107475.xml

Lobbying Issues

Labor-HHS-Education appropriations bill for FY 2009 (S.3230, no bill # in House) -- especially appropriations for Social Security Administration Limitation on Administrative Expenses (SSA-LAE), Medicare, Medicaid, State Health Insurance Program, National Family Caregiver Support Program, Lifespan Respite Care Act, Families of Children with Disabilities Act of 2000, funding for special education under Individuals with Disabilities Education Act (IDEA), support of 302b and general health funding. contDefense appropriations bill (no bill #) for FY 09 -- support for multiple sclerosis research under the Congressionally Directed Medical Research Programs at the Department of Defense. HR 2638 - Continuing Resolution (CR) making appropriations for all agencies and activities that would be covered by the regular fiscal year 2009 appropriations bills -- requested inclusion of additional appropriations for Social Security Administration Limitation on Administrative Expenses (not included in the CR). HR 1424 -- Emergency Economic Stabilization Act of 2008 -- Title V, Subtitle B - Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, Section 511, requiring group health plans that provide both (i) medical and surgical benefits and (ii) mental health or substance use disorder benefits to meet certain requirements to provide parity between (i) and (ii).

Agencies Lobbied

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Agencies Lobbied

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Agencies Lobbied

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Timely Due Process for the Disabled Act of 2008, HR 6485 to put deadlines on SSA for hearings on denials of disability benefits and to set goals for monitoring of disability determinations and reconsideration. Funding for Social Security Administration Limitation on Administrative Expenses (SSA-LAE) to enable SSA to reduce disability determination backlog -- Labor-HHS-Education appropriations bill for FY 2009 (S.3230, no bill # in House). HR 2683 - Continuing Resolution for FY 2009. Met with Senior SSA officials and with Congressional staff to discuss potential legislation for Expedited Records Review in connection with applications for Social Security disability benefits. Met with Senior SSA officials regarding SSA Strategic Plan for FY 2008-2013. HR 1424 -- Emergency Economic Stabilization Act of 2008 - Title V, Subtitle B -- Paul Wellstone and Pete Domenici Health Parity and Addiction Equity Act of 2088, Section 511, requiring group health plans that provide both (i) medical and surgical benefits and (ii) mental health or substance use disorder benefits to meet certain requirements to provide parity between (i) and (ii).

Agencies Lobbied

Type of Issue

Lobbying Issues

Medicare Improvements for Patients & Providers Act of 2008, HR 6331, and related bills, HR 6252, S. 3118, including provisions to fix the physician payment rate, delay Medicare competitive bidding for durable medical equipment and exempt complex rehabilitation from competitive bidding altogether (because of impacts on popel who need wheelchairs and other durable medical equipment), provider Medicare mental health parity, delay cuts to Medicare therapies, require Medicare Part D to cover cont. certain drugs, strengthen CMS authority to require Part D plans to ensure broad coverage on prescription durg plan formularies, improve access to the Medicare Savings Program, eliminate Medicare Part D enrollment penalties, limit out-of-pocket costs for people who are qualified Medicare beneficiaries and people who are eligible for both Medicare and Medicaid (dual eligibles), simplify and align Medicare low-income assistance programs, bring outdated asset limits in line with today's cost of living, improve outreach and participation for those people currently eligible. S 3327 -- to improve the state plan option under Medicaid providing for home and community-based services -- changes the home and community-based services option in the 2005 Deficit Reduction Act to allow more people to access these services. HR 1845 & S. 6252 - Medicare DMEPOS Competitive Acquisition Reform Act of 2007 regarding competitive bidding for durable medical equiptment. HR 1809/ S 2103 -- Medicare Independent Living Act -- to reverse Medicare regulations and policies that restrict payment for power mobility devices (wheelchairs) to those needed "in the home" rather than in the community -- such as for going to work, school, grocery shopping, medical appointments, places of worship and to accompany childred to school and activities. HR 1621/ S 799 - Community Choice Act of 2007 -- to support Medicaid coverage of community based services such as personal care, activities of daily living, etc. HR 1279 -- Direct Support Professional's Fairness & Security Act -- to support equalization of wages between privately and publicly employed direct support professionals. Discussions with senior CMS officials about what will be happening with competitive bidding following enactment of HR 6331 that delayed competitive bidding temporarily and exempted complex rehabilitation from competive bidding altogether. Discussions about possible future legislation to: -- make permanent some of the temporary delays/moratoria that were included in HR 6331 and related bills -- protect the Medicaid waiver application process and require transparency on behalf of states and CMS. -- delay the Medicare 24-month waiting period -- seek permanent repeal of Medicaid rules that were delayed by legislation (e.g. enactment of HR 5613)

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

2nd Quarter, 2008

Q2 Report

In Q2, United Spinal Association had in-house lobbyists. The report was filed on July 21, 2008. Original Filing: 300081147.xml

Lobbying Issues

Labor-HHS-Education appropriations bill (no bill number yet) FY 09 -- especially appropriations for Social Security Administration Limitation on Administration Expenses (SSA-LAE), Medicare, Medicaid, State Children's Health Insurance Program, National Family Caregiver Support Program, Lifespan Respite Care Act, Families of Children with Disabilities Act of 2000, funding for special education under Individuals w Disabilities Education Act (IDEA), support of 302b & general health funding.Defense appropriations bill (no bill number yet) FY 09 -- support for multiple sclerosis research under the Congressionally Directed Medical Research Programs at the Dept. of Defense. HR 2642 -- supplemental appropriations for military consturction, Dept. of Veterans Affairs and related agencies for FY 08, including Title III - GI bill -- Veterans Educational Assistance of 2008; Title V -- Medicaid provisions including amending the Medicare, Medicaid and SCHIP Extension Act of 2007 to extend moratorium on restrictions relating to Medicaid coverage or payment for rehabilitation services or school-based administration and school-based transportation, moratoria on specific Medicaird reguslations,

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

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Agencies Lobbied

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Lobbying Issues

Funding for Social Security administrative expenses (SSA-LAE) to reduce disability determination backlog. Met with covered executive branch officials of Social Security Administration (SSA) to discuss long-range planning for the agency, plans to reduce the disability determination backlog, issues with children and SSI program. How mandatory employment verification -- including that suggested by HR 4088, Secure America Through Verification and Enforcement Act, would overwhelm SSA with new administrative burdens that would have a devastating impact on SSA's efforts to reduce the Social Security disability determination backlog. HR 3001/S 1758 -- Community Living Assistance and Supports Act (CLASS Act) -- to create a voluntary national long-term care insurance to be paid for by payroll deductions.

Agencies Lobbied

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Agencies Lobbied

Type of Issue

Lobbying Issues

Medicare Improvements for Patients and Providers Act of 2008, HR. 6331, and related bills, HR 6252, S 3118, including provisions to fix the physician payment rate, delay Medicare competitive bidding, exempt complex rehab from competitive bidding (because of the impact of competitive bidding on people who need wheelchairs and other durable medical equipment) provide Medicare mental health parity, delay cuts to Medicare therapies, require Medicare Part D to cover certain drugs, strengthen CMS authority to require Part D plans to ensure broad coverage on prescription drug plan formularies, improve access to the Medicare Savings Program, eliminate Medicare Part D late enrollment penalties, limit out-of-poicket costs for dual eligibles and qualified Medicare beneficiaries, revise the definition of medically accepted indication for drugs, simplify and align Medicare low-income assistance programs, bring outdated asset limits in line with today's cost of living, improve outreach and participation for those currently eligible. HR 1845 and S. 1428 - Medicare Durable Medical Equipment Act of 2007 regarding competitive bidding for durable medical equipment (DME). S. 3144 and HR 6252 -- Medicare DMEPOS Competitive Acquisition Reform Act of 2007, to delay implementation of Medicare competitive bidding program. HR 2642 - Iraq War supplemental appropriation -- support provision to put a moratorium on certain Medicaid regulations. HR 5613 - Protecting Medicaid Safety Net -- support provision for moratoria on existing reguslations including those that would severely restrict rehabilitation and targeted case management. Medicare Independent Living Act (HR 1809/S 2103) to reverse Medicare regulations that restrict payment for power mobility devices (wheelchairs) to those needed "in the home" rather than in the community -- such as for going to work, school, grocery store, medical appointments, places of worship, and to accompany children to school and activities. Community Choice Act of 2007 (HR 1621/S 799) -- support Medicaid coverage of community based services such as personal care, activities of daily living, etc. Direct Support Professional's Fairness & Security Act (HR 1279) -- support equalization of wages between privately and publicly employed direct support professionals. Promoting Wellness for People with Disabilities Act of 2007 (S. 1050) -- support accessibility of medical examination and diagnostic equipment for people with disabilities. Letter to President Bush and Health & Human Services Secretary Leavitt urging CMS to change the policy in its directives of August 17, 2007 and May 7, 2008 in order to eliminate the hurdles for states to provide SCHIP (State Childrens Health Insurance Plan) coverage to uninsured children. HR 2642 -- supplemental appropriations for military consturction, Dept. of Veterans Affairs and related agencies for FY 08, including: Title III - GI bill -- Veterans Educational Assistance of 2008; Title V -- Medicaid provisions including amending the Medicare, Medicaid and SCHIP Extension Act of 2007 to extend moratorium on restrictions relating to Medicaid coverage or payment for rehabilitation services or school-based administration and school-based transportation, moratoria on specific Medicaird reguslations,

Agencies Lobbied

Type of Issue

Lobbying Issues

H.R. 2642 -- Supplemental Appropriation for Military Construction, the Dept. of Veterans Affairs and related agencies for FY 08, including GI bill -- Veterans Educational Assistance of 2008. Prior to passage, met with covered executive branch officials of Veterans Administration regarding implementation of proposed Veterans Education Assistance Act. Filipino Veterans Equity Act of 2007 (S 57/HR 760) -- deems certain service performed before July 1, 1946, in the organized military forces of the Philippines and the Philippine Scouts as active military service for purposes of eligibility for veterans' benefits through the Dept. of Veterans Affairs; repeals certain provisions discounting such service as qualifying service. Veterans Benefits and Emouluments Act if 2007 (S. 1315) Title IV - Filipino World War II Veterans Matters.

Agencies Lobbied

Type of Issue

1st Quarter, 2008

Q1 Report

In Q1, United Spinal Association had in-house lobbyists. The report was filed on April 21, 2008. Original Filing: 300055515.xml

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Protecting Medicaid Safety Net Act (HR 5613) - moratoria on existing regulations including those that would severely restrict rehabilitation and targeted case management. Medicare Independent Living Act (HR 1809/S2103) to reverse the Medicare regulation that restricts payment for power mobility devices (wheel chairs) to those needed "in the home" rather than in the community (such as for going to work, school, (continued)grocery store, pharmacy, medical appointments, places of worship, to vote, to accompany children to school). Community Choice Act of 2007 (HR 1621/S 799) -- to provide for Medicaid coverage of community based services such as personal care, activities of daily living, etc. Direct Support Professional's Fairness & Security Act (HR 1279) -- to equalize wages between privately and publicly employed direct support personnel. Promoting Wellness for People with Disabilities Act of 2007 (S. 1050) --- to promote accessibility of medical examination and diagnostic equipment for people with disabilities.

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Lobbying Issues

Agencies Lobbied

Type of Issue

Source: Clerk of the U.S. House of Representatives and Secretary of the Senate

Legislators

Bills

Statements

Lobbying

Travel

Lobbyists

Disclosures Filed