HHS Inspector General Pubishes New Report Critical of Medicare Advantage Plans Finding Denials or Delays in Care Relative to Standard Medicare Coverage
April 28, 2022. The Inspector General for the Department of Health and Human Services has issued the report of an investigation finding significant problems in Medicare Advantage plans as compared to standard Medicare coverage in terms of denials or delays in approval of treatment. The report is entitled "Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care."
   Read the Report.
   Read the HHS IG Press Release on the Report.
   Watch the Inspector General's Video on the Release of the New Report.
   Access the Inspector General's Website.

A Different Kind of Challenge Launched Against Texas S.B. 8 Anti-Abortion Statute
April 23, 2022. Although the Texas Supreme Court ruling in March effectively ended the two major challenges then pending to the Texas S.B. 8 anti-abortion statute brought by Whole Woman's Health and also by the U.S. Department of Justice, a group working with the Lawyering Project filed a new challenge on April 19 on behalf of opponents of the Texas law in the U.S. District Court for the Western District of Texas in Austin. The case, Davis v. Sharp, Case No. 22-cv-273, April 19, 2022, was brought by an abortion fund and individuals who contribute to it against individuals who have formally committed to bring suit under the Texas statute against funding agencies and those who contribute to them. The case seeks a declaratory judgment and alleges, inter alia, that: "By banning abortion at a pre-viability stage of pregnancy, Section 3 of S.B. 8 violates the Due Process Clause of the Fourteenth Amendment, which protects the right to previability abortion access;" ... "By threatening to chill abortion funds' relationships with their donors, employees, and volunteers, Section 3 of S.B. 8 violates the freedom of expressive association protected by the First Amendment;" ... "By subjecting Plaintiffs and their attorneys to liability based on the viewpoint they express in litigation, Section 4 of S.B. 8 violates the First Amendment;" ... "With respect to claims brought under 42 U.S.C. § 1983, the fee-shifting scheme set forth in Section 4 of S.B. 8 is preempted by 42 U.S.C. § 1988." "Complaint," at 25-26.
   Read the Complaint.
   Read the Texas Supreme Court's March 11 ruling in Whole Woman's Health v. Jackson.

Federal District Judge in Florida Rules Against Mask Requirement in Transportation
April 18, 2022. U.S. District Judge Kathryn Kimball Mizelle of the Middgle District of Florida in Tampa has issued a ruling in a case challenging the federal requirement that persons wear masks in transportation facilities and on transportation conveyances, finding that the "the Mask Mandate exceeds the CDC's statutory authority and violated the procedures for rulemaking under the Administrative Procedure Act. Accordingly, the Court vacates the mandate and remands it to the CDC." Health Freedom Defense Fund v. Biden, Case No. 8:21-cv-1693-KKM-AEP, April 18 2022, Order, at 2.
   Read Order.

D.C. Officials Reach Settlement Agreement with Plaintiffs in Jail Case on Health Policy and Administration
February 16, 2022. The parties to a class action suit challenging healthcare policy and administration in the D.C. Department of Corrections facility, particularly with respect to COVID 19. The ACLU explained in its press release on the case that: "The D.C. Department of Corrections (DOC) late last night notified a federal court that it had agreed to implement comprehensive protections to reduce the spread of COVID-19 in the D.C. Jail. These measures are part of a settlement in Banks v. Booth, a federal class action lawsuit filed by the ACLU of the District of Columbia, the Public Defender Service for the District of Columbia, and the law firm of Munger, Tolles & Olson LLP in March 2020 on behalf of all residents of the D.C. Jail to compel DOC to meet its constitutional obligations to the 1,385 people in its custody by implementing basic sanitation standards and ensuring prompt medical care for people in custody."
   The settlement has been submitted to U.S. District Court Judge Colleen Kollar-Kotelly and is awaiting a hearing before a final court consent decree will be issued.
   Read the Memorandum in Support of the Join Motion for Settlement.
   Read the Proposed Settlement and Release.
   Access the ACLU Press Release on the Proposed Settlement.
   Read the.Complaint.
   Access the ACLU Webpage on the Banks v. Booth Case with Key Documents.

Virginia School Districts Challenge Governor's Executive Order Allowing Parents to Opt Out of Masking for School Children
January 24, 2022. Seven Virginia school districts announced a lawsuit today brought to challenge Governor Youngkin's Executive Order 2, issued on January 15 and set to take effect today that, inter alia, allows parents to decide whether to have their children attend school masked or not. In its announcement, the Arlington Schools wrote in part: "Today, the Schools Boards of Alexandria City, Arlington County, City of Richmond, Fairfax County, Falls Church City, Hampton City and Prince William County, filed a lawsuit to challenge the constitutionality of Executive Order 2 issued by the governor on January 15, 2022. The legal action, representing over 350,000 students across the state, defends the right of school boards to enact policy at the local level, including policies that protect the health and well-being of all students and staff. This legal action centers on fundamental questions about the framework of public education in Virginia, as set out in the Virginia Constitution and by the General Assembly. At issue is whether locally elected school boards have the exclusive authority and responsibility conferred upon them by Article VIII, § 7 of the Constitution of Virginia over supervision of the public schools in their respective communities, or whether an executive order can unilaterally override that constitutional authority. Also at issue is whether a governor can, through executive order, without legislative action by the Virginia General Assembly, reverse a lawfully-adopted statute. In this case, Senate Bill 1303, adopted with the goal of returning students to safe in-person instruction five days a week in March 2021 and still legally in effect, provides that local school boards should follow The Centers for Disease Control and Prevention (CDC) health and safety requirements. Without today's action, school boards are placed in a legally untenable position — faced with an executive order that is in conflict with the constitution and state law. Today's action is not politically motivated. These seven school divisions would welcome the opportunity to collaborate with the governor to ensure the safety and welfare of all students. This lawsuit is not brought out of choice, but out of necessity."
   The Executive Order directs as follows: "Therefore, by virtue of the authority vested in me as Governor by Article V of the Constitution of Virginia, by § 44-146.17 of the Code of Virginia, by any other applicable law, and by virtue of the authority vested in the State Health Commissioner pursuant to §§ 32.1-13, 32.1-20, and 35.1-10 of the Code of Virginia, Executive Order Number Seventy-Nine (2021) is rescinded and the following is ordered: 1. The State Health Commissioner shall terminate Order of Public Health Emergency Order Ten (2021). 2. The parents of any child enrolled in a elementary or secondary school or a school based early childcare and educational program may elect for their children not to be subject to any mask mandate in effect at the child's school or educational program. 3. No parent electing that a mask mandate should not apply to his or her child shall be required to provide a reason or make any certification concerning their child's health or education. 4. A child whose parent has elected that he or she is not subject to a mask mandate should not be required to wear a mask under any policy implemented by a teacher, school, school district, the Department of Education, or any other state authority. 5. The Superintendent of Public Instruction shall rescind the Interim Guidance for COVID-19 Prevention in Virginia PreK-12 Schools, issued January 14, 2021, and updated October 14, 2021, and issue new guidance for COVID-19 Prevention consistent with this Order. 6. School districts should marshal any resources available to improve inspection, testing, maintenance, repair, replacement and upgrades of equipment to improve the indoor air quality in school facilities, including mechanical and non-mechanical heating, ventilation, and air conditioning systems, filtering, purification, fans, control systems and window and door repair."
   Read the Complaint.
   Read the Press Release Issued by the Arlington Public Schools and the other School Districts About the Lawsuit.
   Read Governor Youngkin's Executive Order 2.

Supreme Court's Action on COVID 19 Policies Presents Important Administrative Law Questions
January 19, 2022. The Supreme Court in a per curiam opinion on a request of a stay of OSHA's rule about COVID policy mandates for employers of firms with over 100 employees made clear the majority's view of the OSHA rule as beyond its statutory authority. "Applicants now seek emergency relief from this Court, arguing that OSHA's mandate exceeds its statutory authority and is otherwise unlawful. Agreeing that applicants are likely to prevail, we grant their applications and stay the rule." National Federation of Independent Business v. Department of Labor, Slip op. at 2. At the same time, the Court issued a stay at the request of the president and the Secretary of Health and Human Services of lower court rulings that had blocked a rule that required Medicare and Medicaid providers to meet COVID policy requirements on employee vaccinations.
   The per curiam opinion for the majority in the OSHA case, coupled with the concurring opinion written by Justice Gorsuch and joined by Justices Thomas and Alito, suggest a strong movement by the Court in the direction of constraining the rulemaking authority of federal agencies using the so-called "major questions doctrine" developed in some opinions over time that requires clear language by Congress to support administrative action, though that doctrine was not specifically mentioned in the per curiam opinion. There is also serious question in light of the per curiam and concurring opinions about the status of the longstanding Chevron requirement for deference by courts to the interpretations of statutes by agencies charged with their administration unless Congress has spoken clearly and directly to the situation in question. This approach to determining administrative authority and jurisdiction under statute is also another way that some members of the Court have sought to reinterpret and reimpose the nondelegation doctrine concerning asserterd constitutional limitations on the validity of statutory delegations of rulemaking authority by the legislature to administrative agencies. In addition, the concurring opinion argues that the OSHA action usurps state policy powers under the Tenth Amendment. (Since a per curiam opinion does not indicate the author or others who joined, the other justices apart from those on the concurring opinion were persumably Chief Justice Roberts and Justices Kavanaugh and Coney Barrett, but again there was no specific reference to these three.)
   Justice Breyer wrote a dissent joined by Justices Sotomayor and Kagan in the OSHA case. He wrote, in part, "In our view, the Court's order seriously misapplies the applicable legal standards. And in so doing, it stymies the Federal Government's ability to counter the unparalleled threat that COVID-19 poses toour Nation's workers. Acting outside of its competence andwithout legal basis, the Court displaces the judgments ofthe Government officials given the responsibility to respondto workplace health emergencies. We respectfully dissent." Dissent, Slip Op. at 2. Speaking of the Court and the limits to its competence and legitimacy, the dissent concludes: "Its Members are elected by, and accountable to, no one. And we 'lack[] the background, competence, and expertise to assess' workplace health and safety issues. South Bay United Pentecostal Church, 590 U.S., at ___ (opinion of ROBERTS, C. J.) (slip op., at 2). When we are wise, we know enough to defer on matters like this one. When we are wise, we know not to displace the judgments of experts, acting within the sphere Congress marked out and under Presidential control, to deal with emergency conditions. Today, we are not wise. In the face of a still-raging pandemic, this Court tells theagency charged with protecting worker safety that it may not do so in all the workplaces needed. As disease and death continue to mount, this Court tells the agency that it cannot respond in the most effective way possible. Without legal basis, the Court usurps a decision that rightfully belongs to others. It undercuts the capacity of the responsible federal officials, acting well within the scope of their authority, to protect American workers from grave danger." Id. at 13-14.
   In the HHS case, however, the Court found: "We accordingly conclude that the Secretary did not exceed his statutory authority in requiring that, in order to remain eligible for Medicare and Medicaid dollars, the facilities covered by the interim rule must ensure that their employees be vaccinated against COVID-19. We also disagree with respondents' remaining contentions in support of the injunctions entered below. First, the interim rule is not arbitrary and capricious."... Other statutory objections to the rule fare no better.... Consistent with the existence of the good cause exception, which was properly invoked here, consultation during the deferred notice-and-comment period is permissible. We similarly concur with the Secretary that he need not prepare a regulatory impact analysis discussing a rule's effect on small rural hospitals when he acts through an interimfinal rule; that requirement applies only where the Secretary proceeds on the basis of a 'notice of proposed rulemaking,' §1302(b)(1), followed by a 'final version of [the] rule,' §1302(b)(2). Lastly, the rule does not run afoul of the directive in §1395 that federal officials may not 'exercise any supervision or control over the ... manner in which medical services are provided, or over the selection [or] tenure ... of any officer or employee of' any facility. That reading of section 1395 would mean that nearly every condition of participation the Secretary has long insisted upon is unlawful." Biden v. Missouri, Slip op. at 8-9.
   Justice Thomas wrote a dissent in the HHS case joined by Justices Alito, Gorsuch, and Coney Barrett, citing the kinds of "major questions doctrine" and other arguments that Justice Gorsuch presented in the concurring opinion in the OSHA case discussed above.
   Read the National Federation of Independent Business v. Department of Labor opinion.
   Read the Biden v. Missouri opinion.

Justice Department Asks U.S. Supreme Court to Lift Fifth Circuit Stay and Permit the Injunction Against Texas Anti-Abortion Statute to Take Effect
October 15, 2021. (Updated October 31, 2021)As expected, the U.S. Department of Justice has asked the U.S. Supreme Court to remove the stay placed by the Fifth Circuit on the injunction issued by U.S. District Court Judge Robert Pitman that would block implementation of Texas' SB 8 anti-abortion statute (See earlier posts on this page below). In a strongly worded 41 page brief in United States v. Texas, supporting the application, the DOJ also asked the Supreme Court to grant certiorari before judgment in the case, a request that asks the Supreme Court place the case on its current docket and not wait for the appeals process to conclude in the Court of Appeals. The Court has taken that step in cases of great national importance in which an expedited process is justified by the significance of the case. It was most recently done during the Trump administration in the case concerning questions on the 2020 Census (Department of Commerce v. New York) The Supreme Court granted expedited review and will hear this case along with the Whole Woman's Health case tomorrow.
   It is not surprising that there has been a rush by many parties to file amicus curiae briefs, but the extremely abbreviated schedule has meant that many who would otherwise file on all sides of the case have not done so. However, there is one particularly interesting brief in support of the federal government's case filed by 120 Current and Former Prosecutors and Law Enforcement Leaders, and Former State Attorneys General, Federal and State Court Judges, U.S. Attorneys, and U.S. Department of Justice Officials. They begin by asserting that:"While amici may not all agree on the issue of abortion, they have come together in this case based on their deeply held concerns over the dangerous and brazen disrespect for decades of settled legal precedent resulting from the implementation of Senate Bill 8, 87th Leg., Reg. Sess. (Tex. 2021) ("S.B. 8"). They are united in their view that this Court should step in to immediately halt Texas's effort to flagrantly disregard this Court's nearly five-decade-long pronouncement regarding Constitutional rights. Any other course of action would have profound consequences, inviting other States to evade binding federal law, simply by outsourcing enforcement to private citizens for cash bounties. And allowing S.B. 8 to remain in effect--even as the merits of this case are litigated--will erode trust in the rule of law and send the message that each State is effectively a law unto itself and can eviscerate any constitutional safeguard its legislature dislikes." Brief at 1-2. Indeed, they say, "S.B. 8 is perhaps the most blatant attempt to subvert federal authority since the Jim Crow era. The law is nakedly designed to override this Court's existing precedents by deputizing private citizens as bounty hunters tasked with enforcing laws the State could not enforce itself and then disclaiming responsibility before the courts." Id. at 2.
   Read the U.S. Department of Justice Application to Vacate the Stay of Preliminary Injunction Issued by the Univited States COurt of Appeals for the Fifth Circuit.
   Read the Response by the State of Texas to the U.S. Application.
   Read the Amicus Brief Filed by 120 Current and Former Prosecutors and Law Enforcement Leaders, and Former State Attorneys General, Federal and State Court Judges, U.S. Attorneys, and U.S. Department of Justice Officials.
   Access the Supreme Court Docket page on the U.S. DOJ Application for Stay for Follow-on Filings.
   Read Judge Pitman's Order.
   Read the October 14 Fifth Circuit Panel's Order.

GAO Issues Major New Study on the Costs of Rare Diseases
October 18, 2021. The U.S. Government Accounting Office explained in a new report issued today that: "In the United States, a rare disease is typically defined as any condition that affects less than 200,000 people in this country. There are many different rare diseases, however--about 7,000--and, as a result, 30 million people in the United States likely have one or more of them.1 According to the National Institutes of Health (NIH), about half of those with a rare disease are children. Often genetic, many rare diseases are chronic, progressive (that is, worsening over time), and life threatening. They are also more difficult to diagnose and less likely to be treatable than common diseases. . . . Rare diseases can have a substantial societal impact in terms of mortality, morbidity, and utilization of health care services." Report at 2-3. Because of these impacts and complexity, as well as the lack of comprehensive studies on the subject, Congress included in its Joint Explanatory Statement for the Further Consolidated Appropriations Act, 2020 a mandate for GAO to study "what is known about the total effect rare diseases have on the U.S. economy and the societal consequence of undiagnosed and untreated rare disease." Id. The GAO study reaches back to 2010 and to the present with both analysis of the literature and interviews. As GAO explains, this extensive report, entitled "Rare Diseases: Although Limited, Available Evidence Suggests Medical and Other Costs Can Be Substantial" considers: "1. the challenges to diagnosing rare diseases; 2. the challenges to identifying the costs of rare diseases; 3. what is known about the costs of rare diseases in the United States; and 4. what is known about the effects of rare diseases that are undiagnosed, misdiagnosed, or untreated." Id. at 3.
   Read the GAO Report.

Update: Fifth Circuit Stay of Federal District Court Injunction that Blocked Texas Ant-Abortion Statute to Remain Pending Appeals Process
October 15, 2021. After hearing arguments from the Department of Justice asking the Fifth Circuit to allow the injunction ordered by Judge Pittman against the Texas SB 8 anti-abortion statute to stay in effect pending the completion of the litigation and appeal, the appeals court panel issued a brief order keeping the stay in effect and calling for an expedited review in the case. The order was issued by a divided three-judge panel, with one judge dissenting. The order indicates that there is to be an expedited hearing by the same fifth circuit panel set to review the Whole Woman's Health case involving a challenge to the Texas law by health care providers and women affected1 by the statute (see posting for September 2 below).
   Read the October 14 Fifth Circuit Panel's Order.
   Read Earlier October 8 Fifth Circuit Panel's Order.

Federal District Court in Texas Issues Injunction to Block Texas Ant-Abortion Statute
October 7, 2021. U.S. District Court Judge Robert Pitman, of the Western District of Texas, has issued a 113 page order in United States v. Texas, the case brought by the U.S. Department of Justice, granting a preliminary injunction against that state's anti-abortion statute, SB 8. In so doing, the judge refused the state's request to stay the injunction pending appeal. He wrote: "Finally, the State has requested, in the event the Court preliminarily enjoins enforcement of S.B. 8, that the Court stay any injunction until the State has the opportunity to seek appellate review. The State has forfeited the right to any such accommodation by pursuing an unprecedented and aggressive scheme to deprive its citizens of a significant and well-established constitutional right. From the moment S.B.8 went into effect,women have been unlawfully prevented from exercising control over their lives in ways that are protected by the Constitution.That other courts may find a way to avoid this conclusion is theirs to decide; this Court will not sanction one more day of this offensive deprivation of such an important right." Order on the Preliminary injunction at 112.
   For more information on this suit, other challenges to SB 8, and the Texas statute itself, see the postings below for September 2 and 9.
   Read Judge Pitman's Order.
   Read Attorney General Garland's Statement on the Order.

U.S. Department of Justice Files Emergency Motion Seeking an Immediate Court Order to Block Texas Anti-Abortion Statute
September 9, 2021. The U.S. Justice Department has filed an emergency motion in the case it filed last week challenging Texas' SB 8 anti-abortion statute; this time seeking a temporary restraining order or a preliminary injunction. The DOJ explained that the serious impacts about which the original complaint warned have very rapidly come to pass, affecting not only women in Texas, but also women in neighboring states, and a variety of federal programs and people as well. In its prayer for relief, the DOJ motion states: "This Court should temporarily or preliminarily enjoin enforcement of S.B. 8. The United States requests that this injunction prohibit the maintenance of any civil proceeding pursuant to S.B. 8 and that it bind all of Texas's officers, employees, and agents, as well as those persons in active concert or participation with them. See Fed. R. Civ. P. 65(d)(2). For the reasons stated above, the Court could further specify the scope of that relief, including by expressly stating that it applies to 34 private individuals who attempt to initiate enforcement proceedings under S.B. 8. Of course, Texas is also free to propose the specific terms of an injunction that would prevent proceedings filed under S.B. 8 from being maintained. Texas is responsible for crafting S.B. 8, and it is therefore well positioned to shed lighton the provisions of an injunction that would prevent the State from implementing its unconstitutional scheme." Emergency Motion at 34-35.
   Read the emergency motion filed by the DOJ.

President Issues New Executive Orders and Call for Department of Labor Emergency Rule to Address COVID-19
September 9, 2021. President Biden today issued two new executive orders to address the COVID-19 emergency. The first requires vaccination for federal employees and the second mandates federal contractors to take steps to protect workers against COVID-19. The president also called upon the Department of Labor to issue emergency rules to mandate employers to take steps to protect employees.
   Read the Executive Order Executive Order on Ensuring Adequate COVID Safety Protocols for Federal Contractors.
   Read the Executive Order on Requiring Coronavirus Disease 2019 Vaccination for Federal Employees .

U.S. Announces Challenge to Texas' SB 8 Anti-Abortion Statute
September 9, 2021. In addition to the litigation brought by providers against the Texas anti-abortion statute, the U.S. Attorney General has announced that the Justice Department has filed suit against Texas, challenging the statute not only because it violates the rights of individuals under the constitutional precedents but also on grounds of a federal statute and that it is preempted by federal law. In announcing the suit, Attorney General Gardland said in part: "While the Justice Department urgently explores all options to challenge Texas SB8 in order to protect the constitutional rights of women and other persons, including access to an abortion, we will continue to protect those seeking to obtain or provide reproductive health services pursuant to our criminal and civil enforcement of the FACE Act, 18 U.S.C. §248. The FACE Act prohibits the use or threat of force and physical obstruction that injures, intimidates, or interferes with a person seeking to obtain or provide reproductive health services. It also prohibits intentional property damage of a facility providing reproductive health services. The department has consistently obtained criminal and civil remedies for violations of the FACE Act since it was signed into law in 1994, and it will continue to do so now. The department will provide support from federal law enforcement when an abortion clinic or reproductive health center is under attack. We have reached out to U.S. Attorneys' Offices and FBI field offices in Texas and across the country to discuss our enforcement authorities. We will not tolerate violence against those seeking to obtain or provide reproductive health services, physical obstruction or property damage in violation of the FACE Act." Press Statement The suit was filed in the U.S. District Court for the Western District of Texas in Austin.
   This action by the federal government is separate from the suit brought by Whole Woman's Health and many other organizations against the statute. See the posting for September 2 below.
   Read the Complaint Filed by the United States.
   Read the Press Statement by Attorney General Garland Announcing the U.S. Action.
   Read the FACE Act as codifield in 18 U.S.C. §248.
   Read the FACE Act as it was originally enacted as P.L. 103-259, 108 STAT. 694 (May 26, 1994).
   Read the Texas abortion bill SB 8.

Supreme Court Refuses to Block Texas Anti-Abortion Statute
September 2, 2021. The U.S. Supreme Court has denied an application for an injunction or other relief to block a new Texas anti-abortion statute, Senate Bill 8, 87th Leg., Reg. Sess. (Tex. 2021). The 5-4 decision came with four separate dissents with some of the dissenters joining other dissents as well. The Chief Justice and Justices Breyer, Kagan, and Sotomayor were the dissenters.
   Soon after SB 8 was enacted, Whole Woman's Health brought suit to challenge it and there followed a battle over whether the case was justiciable (could be heard and decided) in the U.S. District Court for the Western District of Texas. That court ultimately found the case justiciable and scheduled a hearing for this past Monday on the plaintiff's call for a preliminary injunction that would have blocked the Texas statute from going into force on September 1. The Court of Appeals for the Fifth Circuit issued a stay of any further proceedings in the district court on August 27. Whole Woman's Health went to the U.S. Supreme Court asking the Court to issue an injunction to stop SB 8 from taking effect or, in the alternative, asking the Supreme Court to remove the stay imposed by the Court of Appeals to allow the district court to take action in the case. The district court and court of appeals rulings are contained in an appendix to Whole Woman's Health's "Emergency Application to Justice Alito for Writ of Injunction and, in the Alternative, to Vacate Stays of District Court Proceedings." That document and the U.S. Supreme Court ruling and dissents as well as the Texas statute itself are posted below.
   Read the Court's Denial of Injunctive Relief with Dissents by the Chief Justice, and Justices Breyer, Sotomayor, and Kagan.
   Read the Whole Woman's Health Application for Injunctive Relief.
   Read the Texas abortion bill SB 8.

Supreme Court Allows Lower Court Order Against CDC Eviction Ban to Take Effect
August 30, 2021. The Supreme Court has once again addressed the CDC Eviction Ban, but, unlike its previous response to challenge brought by an Alabama realtors association, this time the Court issued a per curiam opinion finding that the lower court's ruling against the eviction ban should take effect, concluding: "If a federally imposed eviction moratorium is to continue,Congress must specifically authorize it. The application tovacate stay presented to THE CHIEF JUSTICE and by him referred to the Court is granted." Alabama Association of Realtors v. HHS, Slip op. at 8. The per curiam opinion spoke for 6 members of the Court. Justice Breyer issued a dissent joined by Justices Sotomayor and Kagan.
   On June 29, the Supreme Court voted 5-4 to deny an Alabama real estate group's petition to vacate a stay of a lower court ruling against the moratorium. Justice Kavanaugh issued a concurring opinion joining the majority's ruling, noting that although he had concerns about the case, the fact that he moratorium was time-limited militated against taking action against the moratorium at that time. However, the CDC renewed the program on August 3, all but guaranteeing another action before the Supreme Court. (See the posting for August 4 on this page.)
   Read the Supreme Court Opinions.
   Read the CDC Order Extending the Moratorium.

FDA Issues Full Approval of Pfizer-BioNTech COVID-19 Vaccine
August 23, 2021. The FDA today announced full approval for the Pfizer-BioNTech COVID-19 Vaccine, which has been given to millions of people under an emergency use authorization. As the FDA explained: "On August 23, 2021, the FDA approved the first COVID-19 vaccine. The vaccine has been known as the Pfizer-BioNTech COVID-19 Vaccine, and will now be marketed as Comirnaty, for the prevention of COVID-19 disease in individuals 16 years of age and older. The vaccine also continues to be available under emergency use authorization (EUA), including for individuals 12 through 15 years of age and for the administration of a third dose in certain immunocompromised individuals."
   Read the FDA Press Release.
   Read the FDA's August 23, 2021 Approval Letter.
   Read FDA's Q&A for for Comirnaty (COVID-19 Vaccine mRNA).
   Watch FDA's Media Call on Vaccine Approval on YouTube.

Texas Local Governments Sue Governor Challenging His Executive Order Prohibiting Mask Mandates in the COVID-19 Crisis
August 10, 2021. Dallas County Judge Clay Jenkins as the County's chief executive asked a Texas court to issue a temporary restraining order against Governor Greg Abbott's Executive Order GA-38, issued on July 29, prohibiting school officials and local government officials from imposing mask mandates or taking any of a number of other actions to respond to the COVID-19 crisis. In addition to the action taken by Dallas, the City of San Antonio and Bexar County have also filed suit against the governor's action.
   Read the Dallas County Judge's Request for a Temporary Restraining Order Against the Governor's Executive Order.
   Read the Governor's Executive Order GA-38.
   Read the City of San Antonio's Press Release Explaining the Suit Filed by the City and Bexar County Against the Governor's Executive Order.

Federal District Judge Issues Injunction Against Florida's Constraints on Cruise Lines' Practice of Requiring Vaccinations for Passengers and Crew
August 10, 2021. Judge Kathleen M. Williams issued a preliminary injunction on Sunday against Florida officials who had prohibited, pursuant to a state statute, cruise lines from mandating passengers and crew members to affirm that they had been fully vaccinated for COVID-19. As Judge Williams explained in her "Opinion on Preliminary Injunctions" in Norwegian Cruise Line v. Rivkees: "Under the Statute, Plaintiffs are prohibited from requiring passengers to provide 'any documentation certifying COVID-19 vaccination or post-infection recovery' prior to boarding. Fla. Stat. § 381.00316. NCLH explains that if it cannot maintain its vaccination policy in Florida, it would be forced to either cancel all voyages leaving from the state or allow unvaccinated passengers to sail, and both options would cause significant financial and reputational harms." Id. at 2. She also explained that: "NCLH brings this as-applied constitutional challenge, arguing that the Statute violates its rights under the First Amendment, the dormant Commerce Clause, and Substantive Due Process. It also claims that the Statute is preempted by the CDC's Conditional Sailing Order ("CSO") and subsequent instructions." Judge Williams found that "NCLH has shown a substantial likelihood of success on the merits of its First Amendment and dormant Commerce Clause claims." Id. at 16. Given her findings on these two grounds for the injunction, she did not rule at this time on the preemption claim. However, she noted that she would do so when the full proceedings seedking a permanent injunction moved forward and then added: "Nevertheless, the Court notes that Plaintiffs have raised compelling arguments as to why the Statute is conflict preempted by the CDC's guidelines." Id. at 55.
   The Governor had issued Executive Order 21-81 in April banning these kinds of requirements, but the legislature then enacted SB 2006 which the governor signed, making these prohibitions on businesses and other organizations a matter of statute, codified as Fla. Stat. § 381.00316
   Read the Order on the Preliminary Injunction.
   Read the Governor's Executive Order 21-81.
   Read Governor's Press Release on Signing SB 2006.
   Read SB 2006.

CDC Extends Eviction Ban
August 4, 2021. The Centers for Disease Control and Prevention (CDC) yesterday issued an "Order Under Section 361 of the Public Health Service Act (42 U.S.C. 264) and 42 Code of Federal Regulations 70.1--Temporary Halt in Residential Evictions in Communities with Substantila or High Levels of Community Transmission of COVID-19 to Prevent the Further Spread of COVID-19." The order extends the moratorium on evictions for 60 days until October 3, 2021.
   On June 29, the Supreme Court voted 5-4 to deny an Alabama real estate group's petition to vacate a stay of a lower court ruling against the moratorium. Justice Kavanaugh issued a concurring opinion joining the majority's ruling, noting that although he had concerns about the case, the fact that he moratorium was time-limited militated against taking action against the moratorium at that time.
   Read the CDC Order Extending the Moratorium.
   Read the CDC Press Release on the New Order.
   Read the Supreme Court Opinion with Kavanaugh's concurring opinion denying the petition to vacate the stay of the lower court's ruling.
   Read the Lower Court rulings in the case as well as the rulings on the motion for a stay to keep the moratorium in place pending appeal.

Leading Medical and Care Associations Issue Joint Statement Calling for Mandatory Immunization of Health Care Employees
July 26, 2021. A groups of 57 prestigious professional associations in health care and long-term care, including the American Medical Association and the American Nurses Association, have issued a "Joint Statement in Support of COVID-19 Vaccine Mandates for All Workers in Health and Long-Term Care." The Washington Post today published the statement as well as a story by Dan Diamond about the statement entitled "Doctors, Nurses and Medical Groups Call for Mandatory Coronavirus Vaccinations for Health Workers," quoting a number of leaders of some of the organizations that signed the statement.
   This statement follows a ruling by a federal district court in Texas rejecting a challenge to a mandatory immunization policy for employees by two Houston hospitals. (See the post for June 14 below.) It also comes a week after a ruling by a federal district court in Indiana rejecting a challenge to Indiana University's mandatory immunication policy
   Read the Statement.
   Read the Washington Post Story by Dan Diamon with quotes from organization leaders.
   Read the Order on Dismissal in the Texas Case.
   Read the Opinion in the Indiana Case.

Supreme Court Rejects Third Major Challenge to the Affordable Care Act
June 18, 2021. Justice Breyer, writing for a 7-2 majority of the U.S. Supreme Court, has written that the states that brought the third major round of challenges to the Court lacked standing. Justices Alito and Gorsuch dissented.
   Read the Opinion in Calfornia v. Texas.

Supreme Court Rules Against Philadelphia's Reaction to Church-Based Objections to Same-Sex Couples as Foster Parents
June 18, 2021.
   Read the Opinions.

Federal District Court Dismisses Challenge to Texas Medical Center COVID-19 Immunization Requirement
June 14, 2021. Judge Lynn N. Hughes of the U.S. District Court for the Southern District of Texas has dismissed a challenge brought by employees of the Houston Methodist Hospital and Houston Methodist The Woodlands Hospital who sought to overturn their employers' requirement that they receive vaccination against COVID-19. Judge Hughes rejected as "false" the claim that the vaccines are "experimental and dangerous." Bridges v. Houston Methodist Hospital, Order on Dismissal, at 1. The judge also rejected Bridges' claim that "the injection requirement violates public policy." Judge Hughes responded that: "The U.S. Supreme has held that (a) involuntary quarantine for contagious diseases and (b) state imposed requirements of mandatory vaccination do not violate due process." Id. at 2.
   Read the Order on Dismissal.

Biden Administration Issues National Strategy for COVID-19 Pandemic Response
January 21, 2021. The Biden Administration today published its National Strategy for COVID-19 Response and Pandemic Preparedness.
   Read the Strategy.

Settlement Announced in Flint, Michigan Cases Resulting from Lead Exposure in Drinking Water
December 10, 2020. The Michigan Attorney General's office has announced that they have reached a settlement in the cases related to lead exposure from Flint, Michigan water, In re Flint Water Cases Case 5:16-cv-10444-JEL-MKM. "Attorney General Dana Nessel, in coordination with Gov. Gretchen Whitmer, announced in August that a preliminary settlement had been reached, with the State then as the only participating defendant. But since then, the City of Flint, McLaren Regional Medical Center and Rowe Professional Services Co. have each agreed to settle the claims against them, bringing the total settlement to about $641.2 million." Press Release The proposed settlement together with the proposed order of the court certifying the class action and establishing the final approval proceedings for the settlement was presented to Judge Judith E. Levy of the U.S. District Court for the Eastern District of Michigan on November 17.
   The Eastern District of Michigan has established a webpage with key documents (see posting below) and the parties have established a separate website on the settlement (also posted below).
   Read the Proposed Settlement.
   Read the November 17 proposed order submitted to Judge Levy.
   Read the Michigan Attorney General's Press Release Announcing the Settlement.
   Access the Eastern District of Michigan Webpage on the Cases.
   Access the Settlement Website.

LJB School Produces New Collection of Work on COVID-19 Policy
December 10, 2020. Faculty of the LBJ School of Public Affairs at the University of Texas at Austin has just released a collection of papers published in a volume entitled Resiliency in the Age of COVID-19: A Policy Toolkit that is available as a .pdf file on their webpage.
   Read the Collection.
   Access UT Austin Webpage on the Collections.

GAO Presents New Report on COVID-19 Contracting
July 29, 2020. The U.S. Government Accountability Office has released a report entitled "COVID-19 Contracting: Observations on Federal Contracting in Response to the Pandemic" that considers the $17.8 billion in federal contracting from the beginning of pandemic to June 11, as well as the key policies under which that contracting was carried out. For more information and key reports on this and other emergency contracting, see the Public Contract Management page of this website.

Trump Administration HHS Diverts COVID-19 Data from CDC to DHS Working with a Private Firm
July 16, 2020. On July 10, the Trump administration issued something the Department of Health and Human Services called "COVID-19 Guidance for Hospital Reporting and FAQs For Hospitals, Hospital Laboratory, and Acute Care Facility Data Reporting," which mandated that COVID-19 data not be sent directly to the Centers for Disease Control at its National Healthcare Safety Network but instead be sent to HHS in a system developed and managed by a private firm, TeleTracking. According to the HHS "guidance" the data are not to be sent to the CDC, but instead to be sent by direct reporting or through state health agencies to https://teletracking.protect.hhs.gov. Although the document is termed "guidance," it is clearly a directive and, if enforced by HHS, it may be challenged as something that is in fact an administrative rule subject to the requirements of the Administrative Procedure Act. It is at this point unclear what this means for CDC data work.
   Read the HHS Directive.
   Access TeleTracking's Website.

Key Sources for Current Status on COVID-19
April 10, 2020. The three most commonly used websites for key health information on the COVID-19 pandemic are the World Health Organization (WHO) website, the Centers for Disease Control and Prevention (CDC), and, here in Oregon, the Oregon Health Authority (OHA) COVID-19 webpage.
   Access the Oregon Health Authority COVID-19 Website.
   Access the CDC COVID-19 Website.
   Access the WHO COVID-19 Website.

California Governor Issues Executive Order Mandating Shelter in Place for Nonessential Activities
March 20, 2020. California Governor Gavin Newsom issued Executive Order N-33-20 ordering all Californians to stay at home except for essential activities in order to limit the spread of the COVID-19 virus.
   Read the Governor's Executive Order.
   View the Governor's Announcement of the Order.

Recent Policy Actions from Congress and the White House on COVID-19 Virus Pandemic
March 19, 2020. The Congress sent H.R. 6201 the Families First Coronavirus Response Act to the White House yesterday and the president signed it into law this morning. In addition, President Trump has issued a number of proclamations, executive orders, and presidential memorandum.
   Read H.R.6201 Families First Coronavirus Response Act as an enrolled bill.
   Read the March 18 Executive Order "Prioritizing and Allocating Health and Medical Resources to Respond to the Spread of Covid-19."
   Read Proclamation 9996 "Suspension of Entry as Immigrants and Nonimmigrants of Certain Additional Persons Who Pose a Risk of Transmitting 2019 Novel Coronavirus."
   Read Presidential Memorandum of March 18 "Expanding State-Approved Diagnostic Tests."
   Read Presidential Proclamation 9994 of March 13 Declaring a National Emergency Concerning the Novel Coronavirus Disease (COVID–19) Outbreak.
   Read Presidential Memorandum of March 13 "Expanding State-Approved Diagnostic Tests."
   Read Presidential Proclamation 9993 of March 11 "Suspension of Entry as Immigrants and Nonimmigrants of Certain Additional Persons Who Pose a Risk of Transmitting 2019 Novel Coronavirus."
   Read Memorandum of March 11 "Memorandum on Making General Use Respirators Available."

USDA Proposes to Roll Back Obama Era Nutrition Requirements for School Meals
January 22, 2020. The US Department of Agriculture announced on January 17 that its Food and Nutrition Service was issuing a notice of proposed rulemaking to change the nutritional requirements for school meals. The proposed rule asserted that the purposes of the new rules are: [T]o simplify meal pattern and monitoring requirements in the National School Lunch and School Breakfast Programs. The proposed changes, including optional flexibilities, are customer-focused and intended to help State and local Program operators overcome operational challenges that limit their ability to manage these Programs efficiently. In the National School Lunch Program, the proposed rule would add flexibility to the existing vegetable subgroups requirement. In the School Breakfast Program, the proposed rule would make it easier for menu planners to offer meats/meat alternates and grains interchangeably (without offering a minimum grains requirement daily), and would allow schools to offer 1/2 cup of fruit in breakfasts served outside the cafeteria to reduce food waste. Other proposed changes would make it easier for local Program operators to plan menus for different age/grade groups, and expand the entrée exemption service timeframe for competitive foods. To improve efficiency in Program monitoring, the proposed rule also would ease several administrative review requirements, including the review cycle. . . ." Proposed Rule as Submitted to the Federal Register at 1.
   More specifically, the proposed rules roll back increased school meal nutrition requirements issued by the Obama administration in 2012, implementing the provisions of the Healthy, Hunger-Free Kids Act of 2010. That statute was enacted in part in response to the National Academies of Science, Engineering, and Medicine (formerly, the Institute of Medicine)Report School Meals: Building Blocks for Healthy Children.
   This action follows rule changes in 2018 issued by the Trump administration, reducing other restrictions from the Obama era related to milk, whole grains, and sodium restrictions in school meals. "Child Nutrition Programs: Flexibilities for Milk, Whole Grains, and Sodium Requirements," 83 Fed. Reg. 63775 (December 12, 2018). That final rule is currently in litigation brought by attorneys general from seven states and the District of Columbia in U.S. District Court for the Southern District of New York and another filed by the Center for Science in the Public Interest in the U.S. District Court for the District of Maryland.
   Read the Proposed Rule as Submitted to the Federal Register for Publication on January 23.
   Read the USDA Food and Nutrition Service Press Release.
   Read the USDA Press release
   Read the Healthy, Hunger-Free Kids Act of 2010.
   Read Obama administration rules implementing the Helathy, Hunger-Free Kids Act of 2010.
   Read the National Academies of Science, Engineering, and Medicine (formerly, the Institute of Medicine)Report School Meals: Building Blocks for Healthy Children.
   Read the 2018 Rules Child Nutrition Programs: Flexibilities for Milk, Whole Grains, and Sodium Requirements
   Read the Complaint in the case brought by states against the 2018 rule.
   Read the Complaint in the Case Brought by the Center for Science in the Public Interest.

GAO Calls for More Federal Agency Attention to Nutritional Needs of Seniors
December 23, 2019. The U.S. Government Accountability Office has issued a new report entitled "Nutrition Assistance Programs: Agencies Could Do More to Help Address the Nutritional Needs of Older Adults." The report explains: "By 2030, the U.S. Census Bureau projects that one in five Americans will be 65 or older. According to the U.S. Department of Health and Human Services’ (HHS) Administration on Aging, adequate nutrition is critical to good health, physical ability, and quality of life, and it is an important component of home and community-based services for older adults. Various federal programs provide nutrition assistance to older adults in the form of meals, food packages, and assistance to purchase food. These include programs overseen by the U.S. Department of Agriculture (USDA), as well as programs overseen by HHS that are authorized under the Older Americans Act of 1965, as amended (Older Americans Act). State agencies and local nutrition program providers, including state government entities and private nonprofit organizations, are generally responsible for administering these programs and providing nutrition assistance to older adults. In the last decade, attention has been given to federal nutrition assistance programs serving children, with a focus on improving the nutritional benefits of foods provided, but the extent to which this focus has been incorporated into programs serving older adults is unclear.2 This report examines (1) the relationship of older adults’ nutrition to health outcomes and the extent to which federal nutrition guidelines address older adults’ nutritional needs; (2) the extent to which federal nutrition assistance programs serving older adults have nutrition-related requirements and how these requirements are overseen; and (3) challenges program providers face in meeting the nutritional needs of older adults." Report at 1-2.
   Read the GAO Report

Fifth Circuit Panel Declares ACA Individual Mandate Unconstitutional
December 19, 2019. Writing for a panel of the U.S. Court of Appeals for the Fifth Circuit, Judge Jennifer Walker Elrod declared: "[T]he individual mandate is unconstitutional because it can no longer be read as a tax, and there is no other constitutional provision that justified this exercise of congressional power." Texas v. United States, at 3. However, in so doing, the panel refused to find that this ruling would mean the end of the ACA because the individual mandate is not severable from the rest of the statute. On that issue, she wrote: "[O]n the severability question, we remand to the district court to provide additional analysis of the provisions of the ACA as they currently exist." Id. That said, the district court previous concluded that the individual mandate is "entirely inseverable." Texas v. United States, Northern District of Texas, December 30, 2018, Order Granting Stay and Partial Final Judgment at 24. In order to understand this part of the opinion it is important to see the changes the DOJ took in the case as it moved to appeal.
   Before May 1, 2019 the Justice Department had argued that the individual mandate was severable in addition to defending the statute against the challenge. However, in a brief filed on May 1, the Trump administration has changed position in that critically important case challenging the Affordable Care Act. In the U.S. district court, the administration argued in favor of the ability to sever any parts of the ACA that the court would strike in the Texas v. United States case. That judge had declared the individual mandate exceeded the power of Congress but did not issue an injunction and stayed his ruling pending appeal. However, in its May 1 brief, the DOJ called on the Fifth Circuit to reject severability and strike sown the entire Affordable Care Act.Then the DOJ filed a supplemental brief on July 3 which the Fifth Circuit described by saying: "Simply put, the federal defendants have shifted their position on appeal more than once." Texas v. United States at 11. Some 21 state attorneys general entered the case defending the ACA in the earlier part of the case and additional states, such as Connecticut, joined that group. The California Attorney General leading that coalition of states supporting the ACA. The U.S. House of Representatives also intervened to defend the ACA.
   Given the confusion as to the position and arguments, the Fifth Circuit provided the following instructions to the district court on remand. "[W]e remand to the district court to undertake two tasks: to explain with more precision what provisions of the post-2017 ACA are indeed inseverable from the individual mandate; and to consider the federal defendants' newly-suggested relief of enjoining the enforcement only of those provisions that injure the plaintiffs or declaring the Act unconstitutional only as to the plaintiff states and the two individual plaintiffs." Id. at 44. In addition, the Fifth Circuit cautioned the lower court: "In summary, then, this issue involves a challenging legal doctrine applied to an extensive, complex, and oft-amended statutory scheme. All together, these observations highlight the need for a careful, granular approach to carrying out the inherently difficult task of severability analysis in the specific context of this case. We are not persuaded that the approach to the severability question set out in the district court opinion satisfies that need. The district court opinion does not explain with precision how particular portions of the ACA as it exists post-2017 rise or fall on the constitutionality of the individual mandate. Instead, the opinion focuses on the 2010 Congress' labeling of the individual mandate as 'essential' to its goal of 'creating effective health insurance markets,' 42 U.S.C. § 18091(2)(I), and then proceeds to designate the entire ACA inseverable. In using this approach, the opinion does not address the ACA's provisions with specificity, nor does it discuss how the individual mandate fits within the post-2017 regulatory scheme of the ACA." Id. at 51. The appeals court explained further that: "Although we understand and share the district court's general disinclination to engage in what it refers to as 'legislative guesswork'--and what a Supreme Court Justice has described as 'a nebulous inquiry into hypothetical congressional intent,'--we nevertheless conclude that the severability analysis in the district court opinion is incomplete in two ways. First, the opinion gives relatively little attention to the intent of the 2017 Congress, which appears in the analysis only as an afterthought despite the fact that the 2017 Congress had the benefit of hindsight over the 2010 Congress: it was able to observe the ACA's actual implementation. . . . Second, the district court opinion does not do the necessary legwork of parsing through the over 900 pages of the post-2017 ACA, explaining how particular segments are inextricably linked to the individual mandate." Id. at 56.
   Read the Fifth Circuit opinion.
   Read the Department of Justice Supplemental Brief of July 3.
   Read the Department of Justice Brief.
   Read the U.S. House of Representatives Brief as Intervenor supporting the ACA.
   Read the Northern District of Texas December 14, 2018 ruling.
   Read the Northern District of Texas December 30, 2018 ruling granting final judgment and stay.

GAO Focuses on Differences in Levels of Service Under IDEA for Children with Disabilities
November 27, 2019. The U.S. Government Accountability Office recently featured IDEA issues in a post to its WatchBlog on Education for Students with Disabiliteis. It highlighted the problem that children are receiving differnt levels of services in part at least because of different standards from state to state. The GAO issued report entitled "Special Education: Varied State Criteria May Contribute to Differences in Percentages of Children Served. In that report, GAO found: "About 13 percent of children aged 3 through 21 enrolled in public schools received special education services in school year 2015-16, and about 3 percent of children from birth through age 2 received special education services. The percentage of the population served under IDEA varies across states. For example, in fall 2016, the percentages of the population aged 6 through 21 served in individual states ranged from 6.4 percent to 15.1 percent. Concerns about the difficulties identifying and evaluating children for special education have been raised by the media, experts, and special education advocates." Report Summary In a second report on Military Personnel: DOD Should Improve Its Oversight of the Exceptional Family Member Program, GAO also found variations: "The support provided to families with special needs through the Department of Defense’s (DOD) Exceptional Family Member Program (EFMP) varies widely for each branch of Military Service." Report Summary.
   Read the GAO Blog Post
   Read the GAO Report on Varied State Criteria
   Read the Report on Oversight of the Exceptional Family Member Program.

Federal District Court Strikes Down Trump Administration Rule Allowing Organizations and Providers to Refuse to Participate in Medical Programs and Services Because of Religious or Moral Objection
November 6, 2019. (Updated November 22, 2019) judge William Alsup of the U.S. District Court for the Northern District of California is now the second judge to strike the Trump administration's so-called conscience rule, following a recent ruling by the Southern District of New York.
   Judge Paul A. Engelmayer of the U.S. District Court for the Southern District of New York has issued an Opinion and Order striking down the Trump administration's so-call consience ruled issued by the Department of Health & Human Services in in May allowing organizations and individuals "to abstain from participation in medical procedures, programs, services, or research activities on account of a religious or moral objection." New York v. Health & Human Services, Opinion and Order, at 3. The rule was challenged by 19 states and a number of family planning organizations. The court "vacate[d] the rule in full." In a 147 page opinion, the judge found: "The APA [Administrative Procedure Act] violations that the Court has found, however, are numerous, fundamental, and far-reaching. The Court's finding that HHS lacked substantive rule-making authority as to three of the five principal Conscience Provisions nullifies the heart of the Rule as to these statutes. The Court's finding that the agency acted contrary to two major existing laws (Title VII and EMTALA [Emergency Medical Treatment and Labor Act]) vitiates substantive definitions in the Rule affecting the health care employment and emergency contexts. The Court's finding that HHS failed to give proper notice of the definition it adopted of 'discriminate or discrimination' voids that central dimension of the Rule. And the Court's finding that the Rule was promulgated arbitrarily and capriciously calls into question the validity and integrity of the rulemaking venture itself. Indeed, the Court has found that HHS's stated justification for undertaking rulemaking in the first place--a purported 'significant increase' in civilian complaints relating to the Conscience Provisions--was factually untrue." Id., at 142.
   Read the Opinion and Order in the California Case.
   Read the Opinion and Order.
   Read the HHS Rule of May 21, 2019.

U.S. District Court Calls for Special Master to Lead Remedy in Mississippi Mental Health Case
September 10, 2019. Judge Carlton W. Reeves of the U.S. District Court for the Southern District of Mississippi has concluded that the state has failed to address serious issues in its mental health system and is in violation of the Americans with Disabilities Act (ADA). "At its heart, this case is about how Mississippi can best help the thousands of Melody Worshams who call our State home. The State generally understands the urgency of these needs,and it understands its obligations under federal law. It is moving toward fulfilling those obligations. The main question at trial was, has it moved fast enough to find itself in compliance with the ADA? The United States Department of Justice has presented compelling evidence that the answer to that question is "no." Mississippi's current mental health system-the system in effect, not the system Mississippi might create by 2029-falls short of the requirements established by law. The below discussion explains why." United States v. Mississippi, Memorandum Opinion and Order, at 3. However, also concluded that, rather than imposing the remedy proposed by DOJ, he would appoint a special master to lead negotiations on a remedy. He wrote: "The only role of this Court is to consider whether Mississippi's mental health system is operating in compliance with that law. The weight of the evidence proves that it is not. The United States has met its burden and shown that despite the State's episodic improvement, it operates a system that unlawfully discriminates against persons with serious mental illness. That discrimination will end only when every Mississippian with SMI has access to a minimum bundle of community-based services that can stop the cycle of hospitalization. Since the United States has proven its case, the Court could order the remedy proposed at trial by the Department of Justice and its experts. Acknowledging and understanding the complexity of this system, the progress that the State has made, and the need for any changes to be done in a patientcentered way that does not create further gaps in services for Mississippians, however, the Court is not ready to do so. The Court is hesitant to enter an Order too broad in scope or too lacking in a practical assessment of the daily needs of the system. In addition, it is possible that further changes might have been made to the system in the months since the factual cutoff. This case is well-suited for a special master who can help the parties craft an appropriate remedy-one that encourages the State's forward progress in a way that expedites and prioritizes community-based care. The evidence at trial showed what the State needs to do. The primary question for the special master is how quickly that can be done in a manner that is practical and safe for those involved. The parties are therefore ordered to submit, within 30 days, three names of potential special masters and a proposal for the special master's role." Id., at 59-60. The judge indicated that he would then hold hearings on the proposed remedy in the fall.
   This case stems from a findings letter issued by the Civil Rights Division of the Department of Justice in 2011. In 2016 DOJ filed suit against the state. In 2018, the state issued a report on improvements in its mental health system. However, the DOJ and ultimately the court concluded that the state was in violation of the ADA.
   Read Judge Carlton W. Reeves Memorandum Opinion and Order.
   Read Mississippi's 2018 Report on Progress in the Mississippi Public Mental Health System.
   Read Complaint Filed by DOJ Against Mississippi in 2016.
   Read the Findings Letter Issued in 2011 to Mississippi Finding Violations of the Americans with Disabilities Act
   Read the DOJ Case Summary

Oklahoma Court Rules Against Pharmaceutical Firms in Opioid Case
August 27, 2019. Judge Thad Blakman issued his decision in a case brought by the state against Opioid manufacurers and sellers, finding for the state and ordering payment of more than $572 million for costs incurred by the state and those needed to address opioid addiction. The state had settled with many other companies, but Johnson & Johnson refused to settle.
   This ruling comes just two months before the trial in the "National Prescription Opiate Litigation" case which is scheduled to begin in October in Ohio. See the July 24 posting on this webpage.
   Read Judge Balkman's Judgment After Nonjury Trial

Supreme Court Asked to Address the Requirements of the ADA for E-Commerce Online
August 26, 2019. Domino's Pizza filed a petition of certioari in the U.S. Supreme Court in June seeking the Court's review of a ruling by the Ninth Circuit concerning ADA requirements for accessible websites as part of a place of public accommodation. The Ninth Circuit issued its opinion in Robles v. Domino's Pizza, 913 F.3d 898 (9th Cir. 2019), in January, reversing a decison by a judge of the District Court for the Central District of California to dismiss a suit by Mr. Robles who charged that the company's website was not in compliance with the Americans with Disabilities Act (ADA) and California's Unruh Civil Rights Act. In particular, the challenges to the online operation of the company raised issues concerning accessibility for persons with blindness. Not surprisingly, the case attracting a significant number of amici curiae when it was before the Ninth Circuit. The petition and brief in opposition have been filed in the Supreme Court, along with some amicus briefs. One brief for the National Federation of Retailers is posted below. The Office of the Solicitor General of the United States has not filed an amicus brief with respect to the cert. petition.
   Read Petition for Certiorari filed by Domino's Pizza.
   Read the Brief in Opposition to the Petition for Certiorari for Respondent Guillermo Robles.
   Read the Ninth Circuit Panel's Opinion.
   Read the Amicus Brief of the National Retail Federation.

Connecticut Attorney General Leads Suit by 44 States Against Generic Drug Companies Alleging Price Fixing
May 13, 2019. Forty-four state attorneys general, led by the Connecticut AG, are suing a number of generic drug manufacturers for price fixing. The states include Connecticut, Alaska, Arizona, Colorado, Delaware, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey, New Mexiso, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, Tennessee, Utah, Vermont, and Virginia. The complaint alone runs 524 pages and names 33 companies and individuals as defendants. The case was filed in the U.S. District Court for the District of Connecticut. One earlier paragraph goes to the core of the claims made against the companies: "At the zenith of this collusive activity involving Teva, during a 19-month period beginning in July 2013 and continuing through January 2015, Teva significantly raised prices on approximately 112 different generic drugs. Of those 112 different drugs, Teva colluded with its 'High Quality' competitors on at least 86 of them (the others were largely in markets where Teva was exclusive). The size of the price increases varied, but a number of them were well over 1,000%." Connecticut v. TIVA Pharmaceuticals, Complaint at 3.
   Read the Complaint in Connecticut v. TIVA Pharmaceuticals.
   Read the Connecticut Attorney General's Press Release on the Case.

DOJ Moves to Strike Down Full Affordable Care Act
May 2, 2019. The Trump administration has changed position in a critically important case challenging the Affordable Care Act. In the U.S. district court, the administration argued in favor of the ability to sever any parts of the ACA that the court would strike in the Texas v. United States case. That judge had declared the individual manadate exceeded the power of Congress but did not issue an injunction and stayed his ruling pending appeal. However, yesterday it filed a brief in the Fifth Circuit calling on the Fifth Circuit to reject severability and strike sown the entire Affordable Care Act. Some 21 state attorneys general entered the case defending the ACA in the earlier part of the case and additional states, such as Connecticut, have joined that group. There has not yet been a response from the California Attorney General whose office is leading that coalition.
   Read the Department of Justice Brief.
   Read the Northern District of Texas December 14, 2018 ruling.
   Read the Northern District of Texas December 30, 2018 ruling granting final judgment and stay.

Trump Administration Issues Sweeping New 'Conscience' Exemptions from Mandatory Services and Coverage
May 2, 2019. The Department of Health and Human Services Office of Civil Rights has issued a sweeping new final rule entitled "Protecting Statutory Conscience Rights in Health Care; Delegations of Authority," which is designed to dramatically expand the ability of various providers, insurers, and other organizations to refuse to provide health care services or coverage based on their claim that they object on the basis of conscience.
   Read the Rule as Published in the Federal Register.
   Read the HHS Fact Sheet on the Rule.
   Read the HHS Press Release on the Rule.

U.S. District Court Rejects Trump Administration Labor Department Rule the Judge Finds is an Attempt to "End Run" the Affordable Care Act
March 30, 2019. Judge John R. Bates of the U.S. District Court for the District of Columbia has issued an opinion rejecting a Trump administration Labor Department rule that Bates found was nothing less than a deliberate "end run" around the requirements of the Affordable Care Act. Bates' ruling came in New York v. Department of Labor, a case brought by eleven states and the District of Columbia which challenges a clearly announced intention to allow a wide range of employers and individuals to avoid the requirements of the ACA. Bates wrote: "Because the ACA defines terms key to its implementation--including "employer" and "employee"--according to the definition of these terms in ERISA, the Final Rule expands AHPs [Association Health Plans] in a way that allows small businesses and some individuals to avoid the healthcare market requirements imposed by the ACA. The Final Rule is clearly an end-run around the ACA. Indeed, as the President directed, and the Secretary of Labor confirmed, the Final Rule was designed to expand access to AHPs in order to avoid the most stringent requirements of the ACA. Exec. Order 13,813, 82 Fed. Reg. 48,385 (Oct. 12, 2017), A.R. 6970; Final Rule, 83 Fed. Reg. at 28,912 (citing Executive Order); see also Alexander Acosta, A Health Fix for Mom and Pop Shops, Wall St. J., June 18, 2018. But equally important for the analysis that follows, the Final Rule does violence to ERISA. The Final Rule scraps ERISA's careful statutory scheme and its focus on employee benefit plans arising from employment relationships. It purports to extend ERISA to cover what are essentially commercial insurance transactions between unrelated parties. In short, the Final Rule exceeds the statutory authority delegated by Congress in ERISA. . . and must be set aside." Id. At 2-3.
   Read the Opinion.
   Read the June 21, 2018 Department of Labor Rule.

Purdue Pharma Settles Oklahoma Opioid Suit
March 27, 2019. Judge Thad Balkman of the District Court for Cleveland County, Oklahoma has entered a Consent Judgment approving the $270 million settlement of an opioid case brought by the Attorney General of Oklahoma in connection with serious opioid addiction and death associated with the drugs. Purdue released a statement on the agreement and the first of a number of companies that have been charged in various case to reach a major settlement.
   Read the Consent Judgment.
   Read the Oklahoma Attorney General's Press Release on the Case.
   Read Purdue Pharma's Press Release on the Settlement.

District Court Judge in Texas Declare the Affordable Care Act Illegal
December 15, 2018. Judge Reed O'Connor of the U.S. District Court for the Northern District of Texas has ruled that in light of the 2017 tax revisions, the Affordable Care Act is illegal. He wrote: "Here, the Plaintiffs allege that, following passage of the Tax Cuts and Jobs Act of 2017 (TCJA), the Individual Mandate in the Patient Protection and Affordable Care Act (ACA) is unconstitutional. They say it is no longer fairly readable as an exercise of Congress’s Tax Power and continues to be unsustainable under the Interstate Commerce Clause. They further urge that, if they are correct, the balance of the ACA is untenable as inseverable from the Invalid Mandate." Texas v. United States, Opinion, at 1-2. He concluded that they were correct and found the individual mandate "unconstitutional." "Further, the Court declares the remaining provisions of the ACA, Pub. L. 111-148, are invalid and therefore invalid." Id. at 55
   Attorney General Sessions informed the Congress in June that the Justice Department would not defend the ACA in the case. The act was defended by a group of state attorneys general with Xavier Becerra taking the lead counsel role.
   Read the Opinion and Order.
   Read the Letter Refusing to Defend the Act.
   Read the State Attorney General's Brief in Opposition to the Challenge to the ACA.

Centers for Medicare and Medicaid Services Announced Proposed Rule on Drug Price Tranparency
October 16, 2018. The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that would mandate disclosure of drug prices in television advertising. "This proposed rule would revise the Federal Health Insurance Programs for the Aged and Disabled by amending the Medicare Parts A, B, C and D programs, as well as the Medicaid program, to require direct-to-consumer (DTC) television advertisements of prescription drugs and biological products for which payment is available through or under Medicare or Medicaid to include the Wholesale Acquisition Cost (WAC, or 'list price') of that drug or biological product." Proposed Rule at 1.
   Although the CMS admits in the proposed rule that "Congress has not explicitly provided HHS with authority to compel the disclosure of list prices to the public," it goes on to assert that "Congress has explicitly directed HHS to operate Medicare and Medicaid programs efficiently" and this rule is justified by that obligation and the agency's general rulemaking authority. Id., at 9.
   The proposal does not indicate any specific enforcement actions other than disclosure of companies that do not comply. The proposed rule states: the Secretary shall maintain a public list that will include the drugs and biological products identified by the Secretary to be advertised in violation of this rule. We expect that this information will be posted publicly on a CMS internet website no less than annually. No other HHS-specific enforcement mechanism is proposed in this rule. However, we anticipate that the primary enforcement mechanism will be the threat of private actions under the Lanham Act Section 43(a), 15 U.S.C. Section 1125(a), for unfair competition in the form of false or misleading advertising." Id., at 23.
   Read the Proposed Rules.
   Read the Centers for Medicare and Medicaid Services Press Release on the Proposed Rule.

New Report on Access to Medicaid in States that Chose Not to Do the Extension Under ACA
October 15, 2018. The Government Accountability Office has produced a new report entitled, Medicaid: Access to Health Care for Low-Income Adults in States with and without Expanded Eligibility. In its summary of findings, GAO reported that: "According to the 2016 National Health Interview Survey (NHIS), an estimated 5.6 million uninsured, low-income adults-those ages 19 through 64-had incomes at or below the income threshold for expanded Medicaid eligibility as allowed under the Patient Protection and Affordable Care Act (PPACA). Estimates from this nationally representative survey showed that about 1.9 million of the 5.6 million uninsured, low-income adults lived in states that chose to expand Medicaid under PPACA, while the remaining 3.7 million lived in non-expansion states-those that did not choose to expand Medicaid. In 2016, over half of uninsured, low-income adults were male, over half were employed, and over half had incomes less than 100 percent of the federal poverty level in both expansion and non-expansion states. The 2016 NHIS estimates showed that low-income adults in expansion states were less likely to report having any unmet medical needs compared with those in non-expansion states, and low-income adults who were insured were less likely to report having unmet medical needs compared with those who were uninsured. Among the low-income adults who were uninsured, those in expansion states were less likely to report having any unmet medical needs compared with those in non-expansion states."
   Read the Report.

GAO Issues Report on Closure of Rural Hospitals
September 28, 2018. The Government Accountability has just issued a report entitled "Rural Hospital Closures: Number and Characteristics of Affected Hospitals and Contributing Factors." The report indicates as an important finding that: "GAO’s analysis of data from HHS and an HHS-funded research center shows that 64 rural hospitals closed from 2013 through 2017. This represents approximately 3 percent of all the rural hospitals in 2013 and more than twice the number of closures of the prior 5-year period. GAO’s analysis further shows that rural hospital closures disproportionately occurred in the South, among for-profit hospitals, and among hospitals that received the Medicare Dependent Hospital payment designation, one of the special Medicare payment designations for rural hospitals." Report Summary.
   Read the Report.

Cities Sue Trump Administration Charging Illegal Effort to Dismantle ACA
August 2, 2018. Columbus, Ohio, Baltimore, Cincinnati, and Chicago, along with officers of the group Democracy Forward have filed suit in the U.S. District Court for Maryland alleging that the Trump administration is illegally attempting through administrative action to dismantle the Affordable Care Act. The suit argues that the actions taken are driving up costs for uncompensated care that the cities must pay. The suit claims that these actions violate the Administrative Procedure Act and the Duty to Take Care clause of the Constitution. Specifically, they challenge the Centers for Medicare & Medicaid Service’s Notice of Benefit and Payment Parameters for 2019, 83 Fed. Reg. 16,930 (April 17, 2018) as arbitrary and capricious in violation of the APA.They also charge that the president and his administration have taken a series of other actions that undermine the statute in the face of a refusal by the Congress to repeal it. Those actions included "suppress[ing] the number of individuals and families obtaining health insurance through ACA exchanges; b. increas[ing] premiums for health insurance in the ACA exchanges; c. diminish[ing] the availability of comprehensive, reasonably-priced health insurance for individuals and families with preexisting conditions; d. discourag[ing] individuals and families from obtaining health insurance that provides the coverage that Congress, in the ACA, determined is necessary to protect American families against the physical and economic devastation that results from lesser insurance, with limits on coverage that leaves them unable to cover the costs of an accident or unexpected illness...." Columbus v. Trump, Complaint at 127.
   Read the Complaint.
   Read the CMS Final Rule.

White House Announces FY2019 Budget Proposal
February 23, 2018. The White House has released the President's budget request for FY 2019. After the base budget was prepared, Congress passed legislation changing the budget limits and that is addressed by the White House in an Addendum to the FY 2019 Budget. Along with the full budget request and the budget overview document, the White House has issued the "Major Savings and Reforms for FY 2019" document, the "Analytic Perspectives" document which provides the economic and policy assumptions behind the budget, fact sheets by subject, and the "Appendix" which is the document that contains the very detailed information on agency budgets and funds.
   Also posted below are the budget-in-brief documents which contain detailed program by program information for the Department of Health and Human Services, Department of Education, and the Environmental Protection Agency.
   Download the FY 2019 Addendum to the Budget from the Bipartisan Budget Act of 2018.
   Download the FY 2019 Budget proposal as a single .pdf document, including the President's Message to Accompany the FY 2019 Budget.
   Download the FY 2019 Budget Facts Sheets by Topic.
   Access the Major Savings and Reforms for FY 2019 document.
   Access the FY2019 Budget Appendix -- All detailed information about agencies and funds.
   Access the FY 2019 Budget Analytic Perspectives document (economic and budget assumptions).
   Access the FY 2019 Supplemental Documents website, including Federal Credit Program Information and Budget Date Spreadsheets among other items.
   Access the FY 2019 Supplemental Documents website, including Federal Credit Supplement.
   Access the U.S. Department of Education, Fiscal Year 2019 Budget Summary and Background Information.
   Access the U.S. Department of Health and Human Services, Fiscal Year 2019 Budget-in-Brief.
   Access the U.S. Environmental Protection Agency, Fiscal Year 2019 Budget-in-Brief.
   Access USASpending.gov

President Announces Executive Order on Healthcare
October 13, 2017. President Trump has issued an executive order entitled "Promoting Healthcare Choice and Competition Across the United States," which is designed to expand the use of what are known as Association Health Plans (AHPs). It directs the Department of Labor to "consider proposing regulations or revising guidance, consistent with law, to expand access to health coverage by allowing more employers to form AHPs. To the extent permitted by law and supported by sound policy, the Secretary should consider expanding the conditions that satisfy the commonality of-interest requirements under current Department of Labor advisory opinions interpreting the definition of an "employer" under section 3(5) of the Employee Retirement Income Security Act of 1974. The Secretary of Labor should also consider ways to promote AHP formation on the basis of common geography or industry." Execute order Section 2. It also directs the secretaries of Treasury, Labor, and Health and Human Services to "consider" administrative rules to ensure "Expanded Availability of Short-Term, Limited Duration Insurance" and "Expanded Availability and Permitted Use of Health Reimbursement Arrangements" as well as to facilitate wider use of AHPs.
   Read the Executive Order.

State Attorneys General Challenge Trump Administration Action on Contraceptive Coverage
October 11, 2017. The Washington attorney general has filed suit against the Trump administration's interim final rules entitled "Moral Exemptions and Accommodations for Coverage of Certain Preventive Services Under the Affordable Care Act" that significantly change the existing requirements for ensuring coverage for contraceptives for women. In addition, Health Resources and Services Administration (HRSA) issue a modified version of its Women's Preventive Services Guideline on October 6 which stated in part with respect to contraceptive services, "(I)(a) Objecting entities—religious beliefs. (1) These Guidelines do not provide for or support the requirement of coverage or payments for contraceptive services with respect to a group health plan established or maintained by an objecting organization, or health insurance coverage offered or arranged by an objecting organization, and thus the Health Resources and Service Administration exempts from any Guidelines requirements issued under 45 CFR 147.130(a)(1)(iv) that relate to the provision of contraceptive services. . . ." The Washinton v. Trump complaint was filed in the U.S. District Court for the Western District of Washington and alleges discrimination on the basis of gender in violation of the due process clause of the Fifth Amendment, establishment of religion in violation of the First Amendment, and violations of the Administrative Procedure Act for failure to meet rulemaking requirements and as an arbitrary and capricious action.
   Read the Complaint.
   Read the Washington Attorney General's Press Release on the Suit.
   Read the Interim Final Rules as submitted to the Federal Register (Scheduled for publication in the Register on October 13, 2017).
   Read the current HRSA Women's Preventive Services Guideline.

Court of Appeals Permits State Attorneys General to Defense Affordable Care Act Subsidy Payments
August 2, 2017. A panel of the D.C. Circuit has issued an order granting the request of 18 state attorneys general to intervene in the case of U.S. House of Representatives v. Price, No. 16-5202, a case that concerns subsidy payments under the Affordable Care Act, in order to defend those payments. Finding that the states clearly have standing since they will be dramatically affected by a decision to block the payments, the panel went on to find: "[T]he States have raised sufficient doubt concerning the adequacy of the Department’s [HHS's] representation of their interests. Indeed, the Department nowhere argues in its intervention papers that it will adequately protect the States’ interests or even continue to prosecute the appeal." Order at 2.
   Read the Order Granting Intervention.
   Read the Motion for Intervention filed by the State A.G.s.

Congressional Budget Office Issues Cost Estimate of the New Senate Version of a Health Care Bill
June 27, 2017. The Congressional Budget Office has issued its cost estimate for the Health Care Bill advocated by the Senate majority which is the current effort to replace the Affordable Care Act.
   Read the Full CBO Cost Estimate.
   Read the CBO Summary
   Access the Draft as scored by the CBO "H.R. 1628 Better Care Reconciliation Act of 2017 An Amendment in the Nature of a Substitute [LYN17343] as Posted on the Website of the Senate Committee on the Budget on June 26, 2017."

Congressional Budget Office Issues Cost Estimate of American Health Care Act
May 25, 2017. The nonpartisan Congressional Budget Office has issued its cost estimate for the revised American Health Care Act which passed the House of Representatives in an effort to replace the Affordable Care Act. That bill has not yet gone to the Senate.
   Read the Full CBO Cost Estimate.
   Read the CBO Summary

White House Announces FY2018 Budget Proposal
May 23, 2017. The White House has released the President's budget request for FY 2018. Along with the full budget request and the budget overview document, the White House has issued the "Major Savings and Reforms for FY 2018" document, the "Analytic Perspectives" document which provides the economic and policy assumptions behind the budget, agency by agency fact sheets, and the "Appendix" which is the document that contains the very detailed information on agency budgets and funds.
   Also posted below are the budget-in-brief documents which contain detailed program by program information for the Department of Health and Human Services, Department of Education, and the Environmental Protection Agency.
   Download the FY 2018 Budget proposal as a single .pdf document, including the President's Message to Accompany the FY 2018 Budget.
   Download the FY 2018 Budget Overview.
   FY 2018 Budget Fact Sheets.
   Access the Major Savings and Reforms for FY 2018 document.
   Access the Web Site for the FY2018 Budget Appendix -- All detailed information about agencies and funds.
   Access the FY2018 Budget Appendix as a single .pdf.
   Access the FY 2018 Budget Analytic Perspectives document (economic and budget assumptions).
   Access the U.S. Department of Education, Fiscal Year 2018 Budget Summary and Background Information.
   Access the U.S. Department of Health and Human Services, Fiscal Year 2018 Budget-in-Brief.
   Access the U.S. Environmental Protection Agency, Fiscal Year 2018 Budget-in-Brief.
   Access USASpending.gov

State Attorneys General Seek to Intervene in Key Affordable Care Act Case
May 19, 2017. The attorneys general from California, New York, Connecticut, Delaware, Hawaii, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Minnesota, New Mexico, Pennsylvania, Vermont, and Washington as well as the District of Columbia have filed a motion seeking to intervene in an important Affordable Care Act case concerning the funds that are to be paid to insurers that serve to reduce rates for health insurance for those who must purchase that insurance through an exchange. The states took action partly out of concern that although the Department of Justice vigorously defended the ACA provisions and administration actions during the Obama administration, it is not clear that the current justice department will do so since the administration knows that, if upheld, the injunction would dramatically undermine the ACA.
   Judge Rosemary M. Collyer of the U.S. District Court for the District of Columbia ruled in May 2016 that the Obama administration practice of funding subsidies to insurers under the Affordable Care Act violated constitutional spending requirements. Judge Collyer explained: “This case involves two sections of the Affordable Care Act: 1401 and 1402. Section 1401 provides tax credits to make insurance premiums more affordable, while Section 1402 reduces deductibles, co-pays, and other means of “cost sharing” by insurers. Section 1401 was funded by adding it to a preexisting list of permanently-appropriated tax credits and refunds. Section 1402 was not added to that list. The question is whether Section 1402 can nonetheless be funded through the same, permanent appropriation. It cannot.” U.S. House of Representatives v. Burwell, Slip op. at 1. In so doing, she rejected both the administration's argument that the plaintiffs lacked standing to sue and also its reading of its spending authority. She stayed her injunction pending appeals in the case.
   However, she stayed her injunction pending appeal by either or both parties. That appeal is now pending before the D.C. Ciruit.
   Read the Motion to Intervene.
   Read the District Court Opinion.

GAO Issues New Report on Transitions for Youth with Autism
May 5, 2017. The Government Accountability Office has issued a new report on challenges of transition for young people in autism.
   Read the report.

House Passes Bill Intended to Repeal the Affordable Care Act
May 4, 2017. The House of Representatives today voted 217-213 to pass H.R. 1628, the American Health Care Act of 2017 intended to repeal the Patient Protection and Affordable Care Act of 2010. The bill now goes to the Senate. The bill passed after an amendment offered by Representative Upton which went to the House late Wednesday.
   Read the bill before two key amendments.
   Read the MacArthur Amendment.
   Read the Upton Amendment.

Supreme Court Issues New IDEA Opinion
March 24, 2017. In a unanimous opinion by Chief Justice Roberts, the Supreme Court has revisited a decades old precedent on the requirements of the Individuals with Disabilities Education Act (IDEA). The Chief Justice began: "Thirty-five years ago, this Court held that the Individuals with Disabilities Education Act establishes a substantive right to a “free appropriate public education” for certain children with disabilities. Board of Ed. of Hendrick Hudson Central School Dist., Westchester Cty. v. Rowley, 458 U. S. 176 (1982). We declined, however, to endorse any one standard for determining “when handicapped children are receiving sufficient educational benefits to satisfy the requirements of the Act.” Id., at 202. That “more difficult problem” is before us today. Ibid" The Court rejected a de minimis standard for determining what is adequate and concluded: "We will not attempt to elaborate on what “appropriate” progress will look like from case to case. It is in the nature of the Act and the standard we adopt to resist such aneffort: The adequacy of a given IEP turns on the unique circumstances of the child for whom it was created. This absence of a bright-line rule, however, should not be mistaken for “an invitation to the courts to substitute their own notions of sound educational policy for those of the school authorities which they review.” Rowley, 458 U. S., at 206. At the same time, deference is based on the application of expertise and the exercise of judgment by school authorities. The Act vests these officials with responsibility for decisions of critical importance to the life of a disabled child. The nature of the IEP process, from the initial consultation through state administrative proceedings,ensures that parents and school representatives will fully air their respective opinions on the degree of progress a child’s IEP should pursue. See §§1414, 1415; id., at 208–209. By the time any dispute reaches court, school authorities will have had a complete opportunity to bring their expertise and judgment to bear on areas of disagreement. A reviewing court may fairly expect those authorities to beable to offer a cogent and responsive explanation for their decisions that shows the IEP is reasonably calculated to enable the child to make progress appropriate in light of his circumstances." Endrew F. v, Douglas County School District RE-1, Slip op. at 15-16.
   Read the opinion.

Congressional Budget Office Issues Cost Estimate of American Health Care Act
March 14, 2017. The nonpartisan Congressional Budget Office has issued its cost estimate for the American Health Care Act put forward by the house Republican leadership as a repeala dn replacement for the Affordable Care Act.
   Read the Full CBO Cost Estimate.
   Read the .CBO Summary

House Majority Pressing American Health Care Act to Replace the Affordable Care Act
March 9, 2017. The House Republican leadership has introduced what it calls the American Health Care Act designed to replacec the Affordable Care Act. The bill is currently in markup in the House Energy and Commerce Committee.
   Read the legislation as announced.
   Access the web page announcing the legislation.

National Academy of Science Panel Looks to a Future with "Human Genome Editing" Clinical Trials
February 14, 2017. The National Academy of Sciences has announced a new report entitled "Human Genome Editing: Science, Ethics, and Governance." In its press release on the report, the Academy noted: "Clinical trials for genome editing of the human germline – adding, removing, or replacing DNA base pairs in gametes or early embryos – could be permitted in the future, but only for serious conditions under stringent oversight, says a new report from the National Academy of Sciences and the National Academy of Medicine. The report outlines several criteria that should be met before allowing germline editing clinical trials to go forward. Genome editing has already entered clinical trials for non-heritable applications, but should be allowed only for treating or preventing diseases or disabilities at this time."
   Read the Press Release on the Report.
   Visit the National Academies Press for purchase or download of the report.

OMB Issues Statement on Budget Impacts of Major Executive Orders
January 26, 2017. The director of the Office of Management and Budget has issued statements on the White House estimates of the budgetary impacts of a number of the most significant executive orders issued by President Trump thus far in his administration, including the Affordable Care Act (ACA). For more information see the Public Law, Policy, and Public Administration page of this website.
   Read the Statement on Budget Impacts of EO on the Affordable Care Act

President Trump Reinstates and Expands "Mexico City" Policy Regarding Funding of Family Planning Services
January 24, 2017. President Trump has issued a presidential memorandum which reinstated the so-called Mexico City policy which bars U.S. foreign assistance funds to any organization which provides information on abortion as part of family planning services. This policy was originally issued by president Reagan, then rescinded by President Clinton, reinstated by President George W. Bush, and rescinded again by President Obama. In addition, President Trump's memorandum expands the coverage of the policy. He stated: " I direct the Secretary of State, in coordination with the Secretary of Health and Human Services, to the extent allowable by law, to implement a plan to extend the requirements of the reinstated Memorandum to global health assistance furnished by all departments or agencies. I further direct the Secretary of State to take all necessary actions, to the extent permitted by law, to ensure that U.S. taxpayer dollars do not fund organizations or programs that support or participate in the management of a program of coercive abortion or involuntary sterilization."
   Access the memorandum.

President Trumpt Issues Executive Order Calling for Executive Action to Blunt Requirements of the Affordable Care Act
January 21, 2017. (Updated January 24, 2017) As one of his first actions after taking the oath of office, President Trump signed an executive order entitled "Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal." That order has now been posted to the White House website.
   Access the order.

Congressional Budget Office Publishes Estimates of Impacts from Repeal of Affordable Care Act
January 17, 2017. The Congressional Budget Office has issued a report on the impacts of a repeal of the Affordable Care Act. The CBO found that: "In brief, CBO and JCT estimate that enacting that legislation would affect insurance coverage and premiums primarily in these ways: [1] The number of people who are uninsured would increase by 18 million in the first new plan year following enactment of the bill. Later, after the elimination of the ACA’s expansion of Medicaid eligibility and of subsidies for insurance purchased through the ACA marketplaces, that number would increase to 27 million, and then to 32 million in 2026. [2] Premiums in the nongroup market (for individual policies purchased through the marketplaces or directly from insurers) would increase by 20 percent to 25 percent—relative to projections under current law—in the first new plan year following enactment. The increase would reach about 50 percent in the year following the elimination of the Medicaid expansion and the marketplace subsidies, and premiums would about double by 2026." Press release
   Read the Report.
   Read the CBO Press Release.

National Center for Health Statistics Report A Decline in Life Expectancy
December 8, 2016. The CDC's National Center for Health Statistics has issued a new report Mortality in the United States, 2015. It found for the first time in years that there was a decline in life expectancy in the U.S. "In 2015, life expectancy at birth was 78.8 years for the total U.S. population—a decrease of 0.1 year from 78.9 years in 2014 (Figure 1). For males, life expectancy changed from 76.5 years in 2014 to 76.3 years in 2015—a decrease of 0.2 years, and for females, life expectancy decreased 0.1 year from 81.3 years in 2014 to 81.2 years in 2015." Report, p. 1.
   Read the report.

AARP Sues EEOC to Challenge Wellness Program Rules
December 4, 2016. The American Association of Retired Persons (AARP) has filed suite against the U.S. Equal Employment Opportunity Commission challenging rules issued earlier this year concerning employer operated wellness programs under which employers provide an incentive of up to 30 percent of their healthcare premiums if they participation in wellness programs that provide health information and sometimes subject workers and their families to medical testing. The AARP charges that what is claimed as an incentive program has become a coercive program that violates both the Americans with Disabilities Act and the Genetic Information Discrimination Act..
   Read the complaint in AARP v. EEOC.
   Read the AARP press release on the suit.
   Access the EEOC final rule.

Surgeon General Issues Report on Alcohol, Drugs, and Health
November 19, 2016. A new Surgeon General's Report entitled "Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health" was issued this week. In annoucning the report, the Surgeon General noted that "Nearly 21 million Americans – more than the number of people who have all cancers combined – suffer from substance use disorders." Press release. However, Surgeon General Dr. Vivek Murthy asserted, “Most Americans know someone who has been touched by an alcohol or a drug use disorder. Yet 90 percent of people with a substance use disorder are not getting treatment. That has to change.” Id. This is the first Surgeon General's report to address substance misuse and related disorders.
   Read the full report.
   Read the Executive Summary.
   Access the Surgeon General's press release on the report.

Government Accountability Office Publishes Report on Transition Services for Youth with Autism Spectrum Disorder
November 17, 2016. The GAO held a panel conference with 24 panel members in March 2016 on the question of transition for youth with ASD. GAO describes its findings in a report entitled "Youth with Autism: Roundtable Views of Services Needed During Transition Into Adulthood." It summarized its report. "Youth with Autism Spectrum Disorder (ASD) transitioning to adulthood may need a wide range of services and supports to help them achieve their goals, according to a panel GAO convened in March 2016. ASD is a highly individualized condition with characteristics that vary in degree and type from person to person. Autism characteristics may hinder or help youth achieve their goals—such as postsecondary education and community integration. For each goal, the panel described services and supports that youth (ages 14-24) with ASD transitioning to adulthood may need to address autism characteristics and other health conditions that affect their ability to attain the goal. GAO grouped these services into 14 broad categories."
   Read the Report.

Texas Education Officials Face Federal Inquiry Into Alleged Cap on Special Education Programs
October 21, 2016. A Houston Chronicle investigative report by Brian M. Rosenthal entitled "Denied: How Texas keeps tens of thousands of children out of special education," which alleged that Texas education officials set a 8.5% limit on the number of students who were to be provided with services under the Individuals with Disabilities Education Act (IDEA), has prompted a U.S. Department of Education inquiry and demand that the state respond to questions about its policy, discontinue the use of any such quota to limit access to services, and demonstrate that it is meeting the Child Find requirements of the IDEA.
   Read the Houston Chronicle Investigative Report that Started the Investigation.
   Read the Letter from Department of Justice to Texas Demanding Response to Charges of Artificial Quota Constraints on IEPs.
   Access the Texas Performance Standard Document that Identifies the 8.5% limit as the standard.

HHS Issues Rule to Limits Mandated Arbitration and Ensures Right to Sue for Long Term Care Residents
September 29, 2016. The Center for Medicare and Medicaid Services in the Department of Health and Human Services has issued a final rule on long term care facilties and the 1.5 million residents who reside in the more than 15,000 long-term care facilities regulated by CMMS. The CMMS explained that the one of the key provisions of the new rule included: (1) Strengthening the rights of long-term care facility residents, including prohibiting the use of pre-dispute binding arbitration agreements. The center explained that this is the first significant revisiion of the rules in this field since 1991. The proposal for the new rule was announced, along with a number of other initiatives in other agencies, at the White House Conference on Aging in July 2015. In releasing the new rule CMMS explained on its blog that: "Historically, many facilities require residents to agree to binding arbitration clauses when they are admitted to these facilities. These clauses require the resident to settle any dispute that may arise using arbitration rather than the court system. Effective November 28, 2016, our final rule will prohibit the use of pre-dispute binding arbitration agreements. This means that facilities may not require residents to sign pre-dispute arbitration agreements as a condition of admission to that long-term care facility."
   The CMMS added that the other important elements of the new rule aimed at: (2) Ensuring that long-term care facility staff members are properly trained on caring for residents with dementia and in preventing elder abuse. (3) Ensuring that long-term care facilities take into consideration the health of residents when making decisions on the kinds and levels of staffing a facility needs to properly take care of its residents. (4) Ensuring that staff members have the right skill sets and competencies to provide person-centered care to residents. The care plans developed for residents will take into consideration their goals of care and preferences. (5) Improving care planning, including discharge planning for all residents with involvement of the facility’s interdisciplinary team and consideration of the caregiver’s capacity, giving residents information they need for follow-up after discharge, and ensuring that instructions are transmitted to any receiving facilities or services. (5) Allowing dietitians and therapy providers the authority to write orders in their areas of expertise when a physician delegates the responsibility and state licensing laws allow. (6) Updating the long-term care facility’s infection prevention and control program, including requiring an infection prevention and control officer and an antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use.
   Read the Center for Medicare and Medicaid Services Press Release.
   Read the Final Rule as Submitted to Federal Register.
   Read the CMMS Blog post on "Commitment to Person-Centered Care for Long-Term Care Facility Residents."
   Read the Final Report of the 2015 While House Conference on Aging.
   Access the Proposed Rule Published on July 16, 2015.

Federal District Court Strikes Key Financing Provision of the Affordable Care Act
May 13, 2016. Judge Rosemary M. Collyer of the U.S. District Court for the District of Columbia has ruled that the Obama administration practice of funding subsidies to insurers under the Affordable Care Act violated constitutional spending requirements. Judge Collyer explained: “This case involves two sections of the Affordable Care Act: 1401 and 1402. Section 1401 provides tax credits to make insurance premiums more affordable, while Section 1402 reduces deductibles, co-pays, and other means of “cost sharing” by insurers. Section 1401 was funded by adding it to a preexisting list of permanently-appropriated tax credits and refunds. Section 1402 was not added to that list. The question is whether Section 1402 can nonetheless be funded through the same, permanent appropriation. It cannot.” U.S. House of Representatives v. Burwell, Slip op. at 1. In so doing, she rejected both the administration's argument that the plaintiffs lacked standing to sue and also its reading of its spending authority. She stayed her injunction pending appeals in the case.
   Judge Collyer explained that: “If the statutory language is plain, we must enforce it according to its terms.” King v. Burwell, 135 S. Ct. 2480, 2489 (2015). Although the “meaning—or ambiguity—of certain words or phrases may only become evident when placed in context,” id., the statutory provisions in this case are clear in isolation and in context. The Affordable Care Act unambiguously appropriates money for Section 1401 premium tax credits but not for Section 1402 reimbursements to insurers. Such an appropriation cannot be inferred. None of Secretaries’ extra-textual arguments—whether based on economics, “unintended” results, or legislative history—is persuasive. The Court will enter judgment in favor of the House of Representatives and enjoin the use of unappropriated monies to fund reimbursements due to insurers under Section 1402. The Court will stay its injunction, however, pending appeal by either or both parties.” Id. at 1-2. She then found that the spending actions of the administration violate the Audits and Accounts Clause of the Constitution. "Congress is the only source for such an appropriation, and no public money can be spent without one. See U.S. Constitution, Art. I, § 9, cl. 7 ('No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law . . . .')."
   On September 9, 2015 Judge Collyer issued a preliminary ruling, finding that House members had standing to challenge the administration's use of funds under the Affordable Care Act. As the judge explained, "The House sues, as an institutional plaintiff, to preserve its power of the purse and to maintain constitutional equilibrium between the Executive and the Legislature. If its non-appropriation claims have merit, which the Secretaries deny, the House has been injured in a concrete and particular way that is traceable to the Secretaries and remediable in court. The Court concludes that the House has standing to pursue those constitutional claims." Slip op. at 2. The Congress alleged that the administration improperly used money to fund the cost-sharing offsets under the act from other funds supporting a different part of the legislation rather than obtaining the temporary appropriations required to fund the offsets.
   Read the District Court Opinion.
   Read the September 2015 Opinion on standing.
   Read the Brief Filed by House Members.
   Read the Government's Reply Brief.

GAO Issues Report on Problems in Hospital Compliance with Evidence-Based Practices to Ensure Patient Safety
February 25, 2016. The Government Accountability Office has issued a new report entitled "Patient Safety: Hospitals Face Challenges Implementing Evidence-Based Practices," GAO-16-308, February 2016. The report explains that it was designed to address three questions: "1. What key factors affect selected hospitals’ implementation of evidence-based patient safety practices and what are their reported effects on adverse events, including related costs? 2. What types of programs do payers use to promote hospital patient safety and what are their reported effects on adverse events, including related costs? 3. What gaps, if any, do patient safety researchers and other experts report in the available information related to patient safety practices?" p. 2. In response, GAO explained that: "Officials from selected hospitals identified the following challenges in implementing patient safety practices: 1) Obtaining data to identify adverse events in their own hospitals. According to hospital officials, obtaining useful information on adverse events can be challenging because, substantial time and resources are required to gather the necessary data, among other things. 2) Determining which patient safety practices should be implemented. Officials noted that they face challenges identifying which evidence-based patient safety practices should be implemented in their own hospitals, such as when only limited evidence exists on which practices are effective. For example, officials from one hospital told GAO that the hospital tried several different practices in an effort to reduce patient falls without knowing which, if any, would prove effective. 3) Ensuring that staff consistently implement the practices over time. Officials from the selected hospitals told GAO that the hospitals face challenges ensuring that hospital staff consistently implement the hospitals’ patient safety practices; for example, hospitals must constantly monitor results to detect potential implementation problems."
   Read the report.

HHS Release First Implementation Report on the Action Plan to Reduce Racial and Ethnic Health Disparities
November 11, 2015 The Department of Health and Human Services Office of Minority Health has published the first report on the implementation of the HHS Disparities Action Plan which was developed in 2011. The implementation report covers the period from 2011 through 2014.
   Read the HHS Action Plan to Reduce Racial and Ethnic Health Disparities: Implementation Progress Report 2011-2014.
   Read HHS Action Plan to Reduce Racial and Ethnic Health Disparities .
   Access the HHS Office of Minority Health Website for the HHS Disparities Action Plan.

GAO Testifies on Undercover Testing of Eligibility for Insurance under the ACA
October 23, 2015. The Government Accountability Office has released the testimony of Seto Bagdoyan, Director, Forensic Audits and Investigative Service following undercover testing for coverage in the federal healthcare marketplace and in two state marketplaces under the Affordable Care Act. The testimony was prepared for the Health Subcommittee of the House Energy and Commerce Committee.
   Read the Report.

Federal District Court Allows Congressional Suit Against Administration of ACA to Move Forward
September 9, 2015. U.S. District Judge Rosemary M. Collyer issued her ruling in U.S. House of Representatives v. Burwell today, finding that House members had standing to challenge the administration's use of funds under the Affordable Care Act. As the judge explained, "The House sues, as an institutional plaintiff, to preserve its power of the purse and to maintain constitutional equilibrium between the Executive and the Legislature. If its non-appropriation claims have merit, which the Secretaries deny, the House has been injured in a concrete and particular way that is traceable to the Secretaries and remediable in court. The Court concludes that the House has standing to pursue those constitutional claims." Slip op. at 2. The Congress alleged that the administration improperly used money to fund the cost-sharing offsets under the act from other funds supporting a different part of the legislation rather than obtaining the temporary appropriations required to fund the offsets.
   For more information on the case, see the posting for July 1 on this webpage.
   Read the Opinion.
   Read the Brief Filed by House Members.
   Read the Government's Reply Brief.

Compton California Students Sue District for Failure to Address the Consequences of Trauma in Their Educational Policies and Practices.
August 20, 2015. "Public Counsel," a Calfornia-based pro-bono lawfirm, has filed a class action suit in the U.S. District Court for the Central District of California on behalf of students in Compton, California alleging that the school district's programs and policies have not addressed the fact that so many students have experienced trauma in the community. The complaint is alleges violations of Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act, and U.S. Department of Education regulations. It does not specifically assert a claim under the Individuals with Disabilities Education Improviement Act, but it does allege violations of DOEd regulations on the requirements of a Free and Appropriate Public Education which stem from IDEA. In announcing the suit, Public Counsel, said: "The lawsuit seeks a remedy centered on the adoption of proven models being adopted by districts across the country, from the state of Massachusetts to the city of San Francisco, which recognizes the impact of traumatic experiences and helps both students and educators become more resilient in the face of adversity and trauma. The model includes: Adequate mental health and counseling service for the highest need students; Trauma-informed training and support for all educators and school staff; Teaching children skills to cope with their anxiety and emotions; and Implementing positive school discipline and restorative strategies that keep children in school and create a safe and welcoming environment." Press Release.
   Read the Complaint.
   Access the Public Counsel Press Release.

Department of Justice Announces Actions at the Anniversary of Passage of the ADA
July 27, 2015.The Disability Rights section of the U.S. Department of Justice Civil Rights Division has announced a number of actions that come just as the nation marks the twenty-fifth anniversary of the passage of the Americans with Disabilities Act. In particular, DOJ announced agreements reached with various communities as part of the Civic Access Project. There are several documents intended to explain the project and provide both best practices and first steps for cities and counties to ensure access for all residents. The Fact Shee webpage also provides a chronological listing of agreements reached with various communities to ensure ADA compliance.
   In addition, the Department of Justice has announced agreements reached with cruise ship lines, a university, and several healthcare providers on ADA access issues. The Disability Rights section explained: "The new settlement agreements—entered into by the U.S. Attorney’s Office for the Eastern District of Virginia and the U.S. Attorney’s Office for the Eastern District of Michigan—address the requirements of the ADA for health care providers, such as hospitals, medical clinics, nursing homes, mental health facilities and doctor’s offices, to, among other things, provide effective communication to people who are deaf or have hearing disabilities in the provision of medical services. In addition, the U.S. Attorney’s Office for the Southern District of New York recently filed a lawsuit against, Emmanuel Asare, M.D. and Springfield Medical Aesthetic PC d/b/a Advanced Cosmetic Surgery of New York for failures to provide medical treatment for an individual with HIV. 'Eliminating disability-based discrimination in health care is a priority for the department under the Americans with Disabilities Act,' said head of the Civil Rights Division, Principal Deputy Assistant Attorney General Vanita Gupta. 'Twenty five years after the passage of the ADA, we fully expect that all health care providers will provide equal access to people with disabilities.'"
   The White House has also released a "Fact Sheet" on the anniversary discussing a range of steps that are being taken by different executive branch agencies to mark the mark the anniversary, the administration says, with actions rather than just rhetoric. At the same time, the president has issued a proclamation on the 25th anniversary of the act's passage which was July 26.
   Access the Project Civic Access "Fact Sheet."
   Read Project Civic Access guide entitled "Cities and Counties: First Steps Toward Solving Common ADA Problems."
   Read the ADA Best Practices Tool Kit for State and Local Governments.
   Access the Project Civic Access Homepage.
   Read the DOJ Announcement of the Agreements with Healthcare Providers for ADA Compliance.
   Read the presidential proclamation on the anniversary of the ADA.
   Access the White House "Fact Sheet: Celebrating the 25th Anniversary of the ADA" a summary of actions taken by federal agencies as part of that celebration.
   Access the Disability Rights Section of the DOJ Civil Rights Division Website.

House Republicans Seek to Use Recent Supreme Court Ruling to Help Their ACA Challenge to Obama Administration
July 1, 2015. Jonathan Turley, representing House Republicans in their challenge to Obama Administration implementation decisions on the Affordable Care Act, has filed a new argument asserting that the Supreme Court's recent ruling in the Arizona redistricting case (see post for June 29 below) supports the claim that the congressional plaintiffs have standing to maintain their suit.
   Read the Notice of New Authority filed June 30.
   Read the DOJ Memorandum in Support of the Motion to Dismiss filed in January 2015.
   Read the complaint filed in November 2014.
   Read the IRS Regulations issued February 12, 2014 that are the focus of part of the case concerning delayed application of ACA requirements and coverage.

GAO Issues Updated Report on Funding for Autism Funding
The Government Accountability Office has issued an update on the nature, extent, and focus of federal autism research funding. The report, entitled Federal Autism Research: Updated Information on Funding from Fiscal Years 2008 through 2012, updates the data and provides additional explanation following on a November 2013 repost on the subject.
   Access the report June 30 GAO Update Report.
   Read the 2013 Base Report

Supreme Court Allows Tax Subsidies for Purchases on Federal Exchanges under the Affordable Care Act
June 25, 2015. In a 6-3 opinion by Chief Justice Roberts, the Court today in King v. Burwell accepted the administration's interpretation of the Affordable Care Act that allows tax subsidies for insurance purchased on federal as well as state established exchanges. The battled flowed from language in the statute that referred to exchanges “established by the state.”
   The Chief Justice wrote: “If the statutory language is plain, we must enforce it according to its terms. . . . But oftentimes the “meaning—or ambiguity—of certain words or phrases may only become evident when placed in context.”. . . So when deciding whether the language is plain, we must read the words “in their context and with a view to their place in the overall statutory scheme.” Our duty, after all, is “to construe statutes, not isolated provisions.” Slip op. at 8-9. The Court then examined key elements of the statute and found that: “These provisions suggest that the Act may not always use the phrase “established by the State” in its most natural sense. Thus, the meaning of that phrase may not be as clear as it appears when read out of context. Id. at 11. He continued: “The upshot of all this is that the phrase “an Exchange established by the State under [42 U. S. C. §18031]” is properly viewed as ambiguous. The phrase may be limited in its reach to State Exchanges. But it is also possible that the phrase refers to all Exchanges—both State and Federal—at least for purposes of the tax credits.” Id. at 12-13.
   However, the Chief Justice chastised the Congress and the President for the way the legislation was put together, leading to a host of problems in the final product. “The Affordable Care Act contains more than a few examples of inartful drafting. . . . Several features of the Act’s passage contributed to that unfortunate reality. Congress wrote key parts of the Act behind closed doors, rather than through “the traditional legislative process.”. . . And Congress passed much of the Act using a complicated budgetary procedure known as “reconciliation,” which limited opportunities for debate and amendment, and bypassed the Senate’s normal 60-vote filibuster requirement. As a result, the Act does not reflect the type of care and deliberation that one might expect of such significant legislation. Anyway, we “must do our best, bearing in mind the fundamental canon of statutory construction that the words of a statute must be read in their context and with a view to their place in the overall statutory scheme.”. . . After reading Section 36B along with other related provisions in the Act, we cannot conclude that the phrase “an Exchange established by the State under” is unambiguous. Id. at14-15. The Court also considered the effects of a ruling against a literal interpretation. “The combination of no tax credits and an ineffective coverage requirement could well push a State’s individual insurance market into a death spiral.” Id. at 17.
   In the end, he wrote: “Reliance on context and structure in statutory interpretation is a “subtle business, calling for great wariness lest what professes to be mere rendering becomes creation and attempted interpretation of legislation becomes legislation itself.”. . . For the reasons we have given, however, such reliance is appropriate in this case, and leads us to conclude that Section 36B allows tax credits for insurance purchased on any Exchange created under the Act. Those credits are necessary for the Federal Exchanges to function like their State Exchange counterparts, and to avoid the type of calamitous result that Congress plainly meant to avoid. Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter. Section 36B can fairly be read consistent with what we see as Congress’s plan, and that is the reading we adopt.” Id. at 21.
   Justice Scalia wrote for the dissenters joined by Justices Thomas and Alito, charging that the majority’s interpretation of the ACA statute was “quite absurd, and the Court’s 21 pages of explanation make it no less so.” Slip op. at 1. He went to declare that “Words no longer have meaning. . . .” if the plain language in the statute that addresses exchanges established by the state is read as the majority reads it. Id. at 2.
   Read the opinion.

U.S. District Judge in Washington Holds Compentency Examination Delays for Incarcerated Persons Violate Due Process
April 3, 2015. U.S Federal District Judge Marsha Pechman has issued an opinion and permanent injunction in A.B. by and through Trueblood v. Washington Department of Social and Health Services finding that waiting times for competency examinations criminal cases in excess of seven days violates due process of law. She issued a permanent injunction requiring that the examinations be provided within seven days and indicated that she would appoint a court monitor to follow the implementation of the requirements. For full details on the ruling and the opinion, see the Civil Rights page of this website.

Farm to School Act of 2015 Introduced in House and Senate
March 13, 2015. Senators Patrick Leahy (D, VT) and Senator Thad Cochran (R, Miss.) and Representatives Marcia Fudge (D, OH) and Jeff Fortenberry (R, Neb.) have introduced the Farm to School Act of 2015 in their respective houses. The House Bill is H.R.1061 and it has been assigned to the Committee on Education and the Workforce. The Senate Bill is S.569 and has been assigned to the Committee on Agriculture, Nutrition, and Forestry. The bill, designed to be part of the reauthorization of the Child Nutrition Act (CNA), (which is required by the end of September of this year), will reauthorize and expand the Farm to School Programs adopted in the last version of the CNA. The new proposal is meant in particular to deal with the fact that the previous version was only funded at $5 million and would increase that to $15. Only 20% of the requests under the previous act could be funded at that 5 million level. In addition, the new version would expand the programs eligible to participate to include preschools, after-school programs and summer food service sites.
   Access H.R. 1061
   Access S. 569
   Access the Fact Sheet on the Bill Prepared by the National Farm to School Network.
   Read Senator Leahy's News Release on the Bill.
   Read Senator Cochran's New Release on the Bill.
   Read Represenative Fudge's News Release on the Bill.
   Read Representative Fortenberry's News Release on the Bill.
   Access the National Farm to School Network Website.

Supreme Court Hears Oral Argument Today in Another Affordable Care Act Case
March 4, 2015. The U.S. Supreme Court today hears oral argument in King v. Burwell, No. 14-114, another challenge to the Affordable Care Act that focuses on the tax credits available to those purchasing insurance through exchanges. This case comes from the Fourth Circuit, King v. Burwell,759 F.3d 358 (4th Cir. 2014), and was taken to the Supreme Court in part on the argument that there is a conflict between that ruling and a decision issued by a panel of the U.S. Circuit Court of Appeals for the D.C. Circuit, Halbig v. Burwell, 758 F.3d 390 (D.C. Cir. 2014). The issue goes to whether the tax credits are available under the Affordable Care Act to those purchasing insurance on the federal government exchanges as compared to the state exchanges.
   As an earlier posting on this page noted, just after a panel of the U.S. Circuit Court of Appeals for the D.C. Circuit rejected IRS rules about tax credits for those purchasing healthcare coverage from federal exchanges under the Affordable Care Act, a panel of the Fourth Circuit issued a ruling upholding those same rules. The Fourth Circuit ruling came in King v. Burwell. In its decision he D.C. Circuit explained, "Specifically, the regulation provided that a taxpayer may receive a tax credit if he 'is enrolled in one or more qualified health plans through an Exchange,' 26 C.F.R.§1.36B-2(a)(1), which the IRS defined as 'an Exchange serving the individual market for qualified individuals. . . , regardless of whether the Exchange is established and operated by a State (including a regional Exchange or subsidiary Exchange) or by HHS.' 45 C.F.R. §155.20" Halbig v. Burwell, No. 1:13-cv-00623, Slip op. at 7. The challengers argue that the statute only allows the premium tax credits for state-operated exchanges. The federal government argues that that the federal exchanges used in the state are state specific markets and they fit within the language and intent of the ACA. This is particularly important since federal exchanges now operate in some 34 states as compared to state exchanges.
    The main briefs of the parties as well as the lower court opinions are provided below. The transcript and streaming audio will be posted as soon as they become available. More than 50 amicus curiae briefs were filed in the case and those are available on the ABA Supreme Court briefs page at the link indicated below.
   Listen to the Supreme Court Oral Argument Audio.
   Read the Supreme Court Oral Argument Transcript.
   Read the Brief for the Petitioners.
   Read the Brief for Respondent Secretary of HHS.
   Access the Amicus briefs.
   Read the D.C. Circuit opinion.
   Read the Fourth Circuit opinion.
   Read the Health Insurance Premium Tax Credit Rules of May 23, 2012.

Government Accountability Office Assesses CMS Transition to ICD-10
February 6, 2015. The Government Accountability Office has issued a report on the efforts of the Centers Medicare & Medicaid Services (CMS) to transition to the 10th revision of the International Classification of Diseases (ICD-10) codes, which are used for documenting patient medical diagnoses and inpatient medicaid by the October 1, 2015 deadline. GAO contacted 28 stakeholders to sample views on CMS efforts to prepare for the ICD-10 and the report provides a synthesis of their views as well as GAO's own analysis. Among the interested points noted by the stakeholders was that: "Stakeholders also recommended that CMS expand its in-person training and develop additional specialty-specific materials. CMS officials said the agency has added in-person training in additional states with plans to also offer more video trainings, and planned to develop additional specialty-specific materials. Additionally, stakeholders recommended that CMS do more to engage covered entities through non-electronic methods and to make its Medicare FFS contingency plans public." GAO, International Classifcation of Diseases: CMS’s Efforts to Prepare for the New Version of the Disease and Procedure Codes," Highlights page.
   Read the GAO Report.
   Access the Centers for Medicare & Medicaid Services ICD-10 Website.

White House Announces FY2016 Budget Proposal
February 2, 2015. The White House has released the President's budget request for FY 2016. Along with the full budget request and the budget overview document, the White House has issued the "Cuts, Consolidations, and Savings for FY 2016" document, the "Analytic Perspectives" document which provides the economic and policy assumptions behind the budget, agency by agency fact sheets, and the "Appendix" which is the document that contains the very detailed information on agency budgets and funds.
   Also posted below are the budget-in-brief documents which contain detailed program by program information for the Department of Health and Human Services, Department of Education, and the Environmental Protection Agency.
   Access the President's message to accompany the FY2016 Budget.
   Download the FY 2016 Budget proposal as a single .pdf document.
   Download the FY 2016 Budget Overview.
   Download the FY 2016 Budget Website with Individual Agency Budget proposals.
   Access the Cuts, Consolidations, and Savings for FY 2016
   Access the Web Site for the FY2016 Budget Appendix -- All detailed information about agencies and funds.
   Access the FY 2016 Budget Analytic Perspectives document (economic and budget assumptions).
   Access the U.S. Department of Education, Fiscal Year 2016 Budget Summary and Background Information.
   Access the U.S. Department of Health and Human Services, Fiscal Year 2016 Budget-in-Brief.
   Access the U.S. Environmental Protection Agency, Fiscal Year 2016 Budget-in-Brief. Not Yet Available
   Access USASpending.gov

Congressional Republicans Sue Obama Administration Over Affordable Care Act Executive Actions
November 21, 2014. The House of Representatives has filed House of Representatives v. Burwell, Case 1:14-cv-01967, in the U.S. District Court for the District of Columbia, alleging executive actions taken in implementation of the Affordable Care Act were illegal. Inaddition to the Secretary of Health and Human Services, the complaint names the Secretary of the Treasury and both HHS and the Treasury Department. The complaint alleges that: "Defendants Sylvia Mathews Burwell, Secretary of the United States Department of Health and Human Services, Jacob J. Lew, Secretary of the United States Department of the Treasury, and the respective Executive Branch departments they head, have violated, and are continuing to violate, the Constitution by directing, paying, and continuing to pay, public funds to certain insurance companies to implement a program authorized by the ACA, but for which no funds have been appropriated. Such unconstitutional payments are estimated to exceed $3 billion in Fiscal Year 2014, and total approximately $175 billion over the ten succeeding Fiscal Years. Defendants’ expenditure of taxpayer funds, absent a congressional appropriation, plainly is unconstitutional as it violates Article I of the Constitution; it also violates statutory law, in particular, 31 U.S.C. § 1324, the ACA, and the Administrative Procedure Act, 5 U.S.C. §§500 et seq." Complaint at 3. The complaint goes on to charge that: "Defendants Lew and the United States Department of the Treasury also have violated the Constitution by issuing a regulation that effectively amends ACA provisions that impose mandates on certain employers and establish a deadline by which such employers must comply with those mandates. These unconstitutional actions are estimated to cost federal taxpayers at least $12 billion." Id. at 4. It asks the court for to declare these actions unlawful and for an injunction against them.
   Read the complaint.

Supreme Court Will Hear Another Affordable Care Act Case
November 13, 2014. The U.S. Supreme Court has agreed to hear King v. Burwell, No. 14-114, another challenge to the Affordable Care Act that focuses on the tax credits available to those purchasing insurance through exchanges. This case comes from the Fourth Circuit, King v. Burwell,759 F.3d 358 (4th Cir. 2014), and was taken to the Supreme Court in part on the argument that there is a conflict between that ruling and a decision issued by a panel of the U.S. Circuit Court of Appeals for the D.C. Circuit, Halbig v. Burwell, 758 F.3d 390 (D.C. Cir. 2014). However, that D.C. Circuit ruling is still pending the completion of an en banc review in that circuit. The U.S. government asserts that until that matter is resolved, it is not clear that there will be a conflict and the Supreme Court should not hear the case. Even so, the Supreme Court has agreed to take the case. The issue goes to whether the tax credits are available under the Affordable Care Act to those purchasing insurance on the federal government exchanges as compared to the exchanges.
   As an earlier posting on this page noted, just after a panel of the U.S. Circuit Court of Appeals for the D.C. Circuit rejected IRS rules about tax credits for those purchasing healthcare coverage from federal exchanges under the Affordable Care Act, a panel of the Fourth Circuit issued a ruling upholding those same rules. The Fourth Circuit ruling came in King v. Burwell. In its decision he D.C. Circuit explained, "Specifically, the regulation provided that a taxpayer may receive a tax credit if he 'is enrolled in one or more qualified health plans through an Exchange,' 26 C.F.R.§1.36B-2(a)(1), which the IRS defined as 'an Exchange serving the individual market for qualified individuals. . . , regardless of whether the Exchange is established and operated by a State (including a regional Exchange or subsidiary Exchange) or by HHS.' 45 C.F.R. §155.20" Halbig v. Burwell, No. 1:13-cv-00623, Slip op. at 7. The challengers argue that the statute only allows the premium tax credits for state-operated exchanges. The federal government argues that that the federal exchanges used in the state are state specific markets and they fit within the language and intent of the ACA. This is particularly important since federal exchanges now operate in some 34 states as compared to state exchanges.
   Read the Petition for Certiorari.
   Read the U.S. Government Brief Opposing Certiorari.
   Read the D.C. Circuit opinion.
   Read the Fourth Circuit opinion.
   Read the Health Insurance Premium Tax Credit Rules of May 23, 2012.

New Report on Creating a "Culture of Health"
October 23, 2014. Hospitals in Pursuit of Excellence (HPOE) has posted a new report entited Hospital-based Strategies for a Creating Culture of Health. As the HPOE website explains, it "provides background on the Robert Wood Johnson Foundation’s vision to build a Culture of Health and discusses how hospitals are contributing to community health improvement. The guide reports the findings of HRET’s review of 300 community health needs assessments, provides strategic considerations for hospital engagement in community health improvement and offers a model of the hospital’s role in building a culture of health."
   Read the Report.
   Robert Wood Johnson Website.

Two U.S. Circuit Courts of Appeals Issue Conflicting Opinions on Affordable Care Act Tax Credits and Federal Exchanges
July 22, 2014. Just after a panel of the U.S. Circuit Court of Appeals for the D.C. Circuit rejected IRS rules about tax credits for those purchasing healthcare coverage from federal exchanges under the Affordable Care Act, a panel of the Fourth Circuit issued a ruling upholding those same rules. The Fourth Circuit ruling came in King v. Burwell, No. 14-1158. The D.C. Circuit explained, "Specifically, the regulation provided that a taxpayer may receive a tax credit if he 'is enrolled in one or more qualified health plans through an Exchange,' 26 C.F.R.§1.36B-2(a)(1), which the IRS defined as 'an Exchange serving the individual market for qualified individuals. . . , regardless of whether the Exchange is established and operated by a State (including a regional Exchange or subsidiary Exchange) or byHHS.' 45 C.F.R. §155.20" Halbig v. Burwell, No. 1:13-cv-00623, Slip op. at 7. This is particularly important since federal exchanges now operate in some 36 states as compared to state exchanges.
   Read the D.C. Circuit opinion.
   Read the Fourth Circuit opinion.
   Read the Health Insurance Premium Tax Credit Rules of May 23, 2012.

Governor Releases Report on Cover Oregon Failure
Oregon 21, 2014. Governor Kitzhaber released today the report of the state's consultant First Data on the failure of the Cover Oregon project. His press release at the time of the release listed a variety of steps being taken by the state to address problems with the project.
    Access the Full Report.
    Read the Governor's Press Release at the Time of the Presentation of the Report.

Obama Administration Offers Options for People With Cancelled Health Policies
December 19, 2013. The Obama administration has issued a new policy through the Centers for Medicare and Medicaid Services for those who have had their health insurance policies cancelled as a result of changes resulting from the Affordable Care Act that allows those whose carriers will not renew or extend their policies two options apart from enrolling in a health care insurance program through the ACA. The statement from CMS indicates: "If you have been notified that your individual market policy will not be renewed, you will be eligible for a hardship exemption and will be able to enroll in catastrophic coverage." As the policy statement indicated, this follows an earlier action by the administration to allow more time for those on the policies to transition, but some states have not approved those plans to operate any longer. Because some consumers were finding other coverage options to be more expensive than their cancelled plans or policies, President Obama announced a transition period allowing for the renewal of cancelled plans and policies between January 1 and October 1, 2014, under certain circumstances." For those people who do not have coverage the new policy offers an exemption from the individual manadate and an option of catastrophic coverage.
   Access The CMA Options Available Document.

HHS Issues Rules Requiring Mental Health Parity
November 8, 2013. The Department of Health and Human Services today announced that it has issued final rules implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act and requiring mental health parity. Although the HHS announcement indicates that the rules are available in the Federal Register, they have not yet been published. They will be posted here as soon as they become available. Press reports indicate that Medicaid is not directly addressed in the new rules and neither is Medicare. Medicaid was addressed in previous guidance issued by HHS on the application of the mental health parity act as indicated below.
   Read the HHS Press Release.
   Access the HHS Fact Sheet on the Mental Health Parity Rule.
   Read the HHS Guidance on Application of Mental Health Parity in Medicaid.
   Read Office of the HHS Assistant Secretary for Planning and Evaluation Issue Brief "Affordable Care Act Expands Mental Health and Substance Use Disorder Benefits and Federal Parity Protections for 62 Million Americans."

FDA Launches Actions Against Trans-Fats
November 7, 2013. The Food and Drug Administration has taken the first step toward banning Trans fats in food. In announcing this action, the FDA said: "The U.S. Food and Drug Administration announced its preliminary determination that partially hydrogenated oils (PHOs), the primary dietary source of artificial trans fat in processed foods, are not “generally recognized as safe” for use in food. The FDA’s preliminary determination is based on available scientific evidence and the findings of expert scientific panels. . . . Following a review of the submitted comments, if the FDA finalizes its preliminary determination, PHOs would be considered “food additives” and could not be used in food unless authorized by regulation. If such a determination were made, the agency would provide adequate time for producers to reformulate products in order to minimize market disruption. The FDA’s preliminary determination is only with regard to PHOs and does not affect trans fat that naturally occurs in small amounts in certain meat and dairy products." FDA Press Release. Along with this announcement, the FDA has provided a number of additional resources on the agency's actions and intentions.
   Read the FDA Press release.
   Read the Formal Notice in the Federal Register
   Read the FDA Consumer Update on FDA targeting of Trans-Fats.
   Read the statement of Michael R. Taylor is FDA’s Deputy Commissioner for Foods and Veterinary Medicine.

Institute of Medicine Publishes Report on Financing Services For Persons with Disabilities and Older Adults
November 7, 2013. The Institute of Medicine has published the results of a workshop entitled "Financing Long-Term Services and Supports for Individuals with Disabilities and Older Adults." The starting point for the work of that session and what is to follow is the scope and likely growth of the need for and cost of long term services for adults with disabilities and other impairments. The report notes: "At least 11 million adults with disabilities, limitations, and functional impairments in the United States receive long-term services and supports – such as assistance with eating, bathing, and dressing – in order to live independently. The financing of long-term services and supports has become a major issue in the United States. While much of this care is provided by family and friends without compensation, in 2011, more than $210 billion was spent on long-term services and supports, accounting for about 9.3 percent of health care spending. With the projected aging of the U.S. population, the number of individuals needing long-term services and supports is expected to increase substantially."
   Read the Institute of Medicine announcement of the report.
   Access the report online.

Oregon Joins Other States in Implementing the Common Core Standards for K-12 Education
September 22, 2013. The Common Core curriculum standards for K-12 education first released in 2010 are now at the stage in which schools are to fully implement those standards with evaluations to be fully in place by 2014. A group created by the National Governors Association (NGA Center) and the Council of Chief State School Officers (CCSSO) called the Common Core Standards Initiative has released its draft K-12 education standards. Some forty-eight states, the District of Columbia, and three territories have joined in the process to create these standards which the Obama administration quickly indicated would be important in guiding nationwide evaluation standards. These standards are designed to be rigorous and their implementation is already causing stress among economically strapped schools. The implementation present a range of impacts including for children with disabilities and those who are English Language Learners in addition to all other students. Even so, there has not been much discussion or information about the standards outside of state education agencies and schools. Many parents and clinicians are as yet unaware of the standards or their meaning for schools, children, and families.
   There is a Translation Project with the task of providing materials in Spanish. There is a website for that project and a PowerPoint presentation that provides comparisons in English and Spanish for part of the materials. The webpage that is supposed to contain the standards in Spanish is currently not working, but this site will post that link as soon as it is working.
   Access Oregon the Common Core Standards Website.
   Access the Oregon Common Core Standards and Students with Disabilities Website.
   Access a PowerPoint Presidentation "Considerations for Students with Disabilities" in Oregon.
   Access the National Common Core Standards.
   Access the Common Core Standards Initiative Website.
   Read "Application to Students with Disabilities."
   Read "Applicatioin of the Standards for English Language Learners."
   Access the Common Core Translation Project Website
   Access a PowerPoint Entitled "The Common Core en Español"

Finding Accessible Playgrounds
August 28, 2013. National Public Radio has launched an accessible playgrounds page that allows people to locate accessible playground facilities near them. It allows users to add playgrounds to the page. The page provides a pictorial guide to useful elements in accessible playgrounds. These are suggestions and not requirements, but it is an interesting resource. This information accompanied a story on implementation and remaining gaps in the 2010 ADA design requirements.
   For those interested in the more formal materials put out by the Department of Justice ADA accessible design information and the guidance material is posted below.
   Finally, the Cornelius Committee: A Vision for an Accessible Community Comité de Cornelius: Una Visión para una Comunidad Accesible, Cornelius, Oregon, has produce a brief guide entitled "Recreation Programs, Facilities, and Professionals Family Recommended Best Practices and Key Questions" which is posted below as well.
   Access the Accessible Playgrounds NPR Website.
   Access the ADA Standards for Accessible Design.
   Access the U.S. Department of Justice Guidance on the ADA Standards for Accessible Design.
   Cornelius Committee: A Vision for an Accessible Community Comité de Cornelius: Una Visión para una Comunidad Accesible, Recreation Programs, Facilities, and Professionals Family Recommended Best Practices and Key Questions.

Treasury Assistant Secretary Explains Delay in ACA Implementation to House Energy and Commerce Committee
July 9, 2013. Assistant Secretary Mark J. Mazur and sent a letter to Representative Fred Upton, Chairman of the House Committee on Energy and Commerce in response to a request to explain the basis for the administration's decision to delay implementation of provisions of the Affordable Care Act by a year beyond the statutory deadline.
   Read the Letter.

Supreme Rejects Patent Claim for Human Genes as Naturally Occurring Segments of DNA
June 13, 2013. The Supreme Court has rendered its decision in Association for Molecular Pathology v. Myriad Genetics. Justice Thomas, writing for the Court, explains that: This case involves claims from three of them and requires us to resolve whether a naturally occurring segment of deoxyribonucleic acid (DNA) is patent eligible under 35 U. S. C. §101 by virtue of its isolation from the rest of the human genome. We also address the patent eligibility of synthetically created DNA known as complementary DNA (cDNA), which contains the same protein-coding information found ina segment of natural DNA but omits portions within the DNA segment that do not code for proteins. For the reasons that follow, we hold that a naturally occurring DNA segment is a product of nature and not patent eligiblemerely because it has been isolated, but that cDNA ispatent eligible because it is not naturally occurring." Id. at 1.
   Read the opinion.

New Research Warns of Increased Dangers of Distracted Driving from Hands Free Auto Systems
June 13, 2013. With some 3000 highway fatalities a year in the U.S. attributed to distracted driving and with traffic accidents providing, according to the World Health Organization, the most frequent cause of unintentional injury or death to children, the need for careful study of the subject led the AAA to support research on the increasing use of hands free technology in vehicles. The AAA Foundation for Traffic Safety has released a new study finds that hands free systems for accessing the Internet and other electronics that are increasingly being installed in new vehicles posed serious dangers of distracted driving even if the driver's hands are still on the wheel and eyes are on the road. The study entitled Measuring Distracted Driving in the Automobile and found that: "Even when a driver's eyes are on the road and hands are on the wheel, sources of cognitive distraction cause significant impairments to driving, such as: Suppressed brain activity in the areas needed for safe driving; Increased reaction time (to peripheral detection test and lead vehicle braking); Missed cues and decreased accuracy (to peripheral detection test); and Decreased visual scanning of the driving environment (tunnel vision, of sorts). Driver interactions with in-vehicle speech-to-text systems (such as the infotainment offerings in many new vehicles) create the highest level of cognitive distraction among the tasks assessed." Fact Sheet, p. 2.
   Read the study.
   Access the PowerPointPresentation on the Study.
   Access the Fact Sheet on the study.
   Access the Foundation Press Release on the Study.

GAO Study Finds Need to Target Racial and Ethic Overrepresentation in Special Ed
March 29, 2013. The Government Accountability Office has provided a report that addresses an ongoing concerning that minority children tend to be identified for special education. The report, entitled "Standards Needed to Improve Identification of Racial and Ethnic Overrepresentation in Special Education."
   Read the Report.
   Access the GAO Highlights page on the report.

U.S. Department of Education Office of Civil Rights Issues Letter on Access to Sports for Students with Disabilities
March 7, 2013. The Office for Civil Rights of the U.S. Department of Education has issued a guidance document for schools and post-secondary institutions on access to extracurricular athletics which is intended to alert educators to the requirements of Section 504 of the Rabilitation Act and DOEd regulations concerning the prohibitions on discrimination against students with disabilities in extracurricular athletics as well as the obligation to provide equal access to sports programs. "In response to the GAO's recommendation, this guidance provides an overview of the obligations of public elementary and secondary schools under Section 504 and the Department's Section 504 regulations, cautions against making decisions based on presumptions and stereotypes, details the specific Section 504 regulations that require students with disabilities to have an equal opportunity for participation in nonacademic and extracurricular services and activities, and discusses the provision of separate or different athletic opportunities. The specific details of the illustrative examples offered in this guidance are focused on the elementary and secondary school context. Nonetheless, students with disabilities at the postsecondary level must also be provided an equal opportunity to participate in athletics, including intercollegiate, club, and intramural athletics." Id. at 2. In its press release about this guidance, the Office for Civil Rights states: "In addition to explaining those legal obligations, the guidance urges school districts to work with community organizations to increase athletic opportunities for students with disabilities, such as opportunities outside of the existing extracurricular athletic program." The guidance document sets a caveat: "Of course, simply because a student is a 'qualified' student with a disability does not mean that the student must be allowed to participate in any selective or competitive program offered by a school district; school districts may require a level of skill or ability of a student in order for that student to participate in a selective or competitive program or activity, so long as the selection or competition criteria are not discriminatory." Guidance document, at 3.
   In issuing this guidance, the Office for Civil Rights was following up on a report issued in 2010 by the Government Accountability Office entitled Students with Disabilities: More Information and Guidance Could Improve Opportunities in Physical Education and Athletics.
   Read the Letter from the Acting Assistant Secretary.
   Read the Office for Civil Rights Press Release.
   Read the 2010 GAO Report.

Portland and U.S. Department of Justice Civil Rights DivisionSettle on Police Issues But Challenges are Pending
December 20, 2012. The City of Portland and the Civil Rights Division of the United States Department of Justice have filed a order on consent with the U.S. District Court for the District of Oregon which is the culmination of a ODJ investigation and negotiations with the city regarding police use of force and other procedures with particular attention to situations involving persons with mental illness or developmental delays. For more information and relevant documents, please see the Oregon page of this website.

New England Compounding Center Now in Tainted Drug Investigation Had Received Previous FDA Warnings
October 27, 2012. The Food and Drug Administration conducted inspections of the New England Compounding Center currently at the center of a major health problem with fungal meningitis allegedly linked to contaminationed drugs from the firm from September 2004 to January 2005 and issued a warning letter to the firm on a number of problems. These included producing Copies of Commercially Available Drug Products; Developing, Producing and Marking Anesthetic Drug Products; and Repackaging and Selling of Drugs. As the warning makes clear, this was not a complete list of issues. In its warning letter, FDA said: "Through the exercise of enforcement discretion, FDA historically has not taken enforcement actions against pharmacies engaged in traditional pharmacy compounding. Rather, FDA has directed its enforcement resources against establishments whose activities raise the kinds of concerns normally associated with a drug manufacturer and whose compounding practices result in significant violations of the new drug, adulteration, or misbranding provisions of the FDCA." It then references it Compounding Compliance Guide which also provided the FDA's enforcement policy with respect to compounding.
   Read the FDA 2006 Warning to New England Compounding Center.
   Read the FDA Compounding Compliance Guide referenced in the warning letter.

FDA and Massachusetts Regulators Release Inspection Documents on New England Compounding Center in Tainted Drug Investigation
October 27, 2012. The Food and Drug Administration has issued the FDA 483 form on its inspection of the New England Compounding Center whose methylprednisolone acetate was found to be contaminated which has allegedly been responsible for deaths and illnesses in many people injected with the drug. The FDA explains that: "The FDA considers the 483 along with an Establishment Inspection Report (EIR), prepared by FDA investigators, and any other relevant information, including any responses received by the company. The agency then considers whether further action, if any, is appropriate. The inspection report for NECC has not been completed and is not being shared at this time." Press release.
    The Massachusetts Board of Pharmacy Registration has also issued a preliminary report of its investigation into the firm and health crisis. That report as well as the statement of state officials at the time it was issued are provided below.
   Read the FDA press release on the inspection.
   Read the FDA Form 483 Inspectional Observation Report for the New England Compounding Center in October 2012.
   Read the FDA Fungal Meningitis Updates with cautions for patients and other information.
   Read the Massachusetts Bd. of Pharmacy Registration Prelimination Investigation Report 10/23/2012.
   Read the State of Governor Deval Patrick at the Delivery of the MA Bd. of Pharmacy report.
   Read the Comments of Dr. Madeleine Biondillo, Director of the Bureau of Health Care Safety and Quality.

GAO Reports on State Implementation of the Patient Protection Act
August 2, 2012. The Government Accountability Office has issued a report on a study of the implementation of the Medicaid expansion provisions of the Patient Protection Act. The GAO did a survey of fiscal impact issues for all 50 states with a 76% response rate. Topics and questions included: "Medicaid Expansion, State Budget Cycle, Costs and Savings from Implementing Medicaid Expansion, Maintenance of Effort, Enrollment Rates, State Budget Development, Implementation Challenges and Opportunities, and Open ended comments." The questions and discrete results for each question are provided in a special "E-Supplement" posted below. It also considers actions taken by the federal CMS to date in this area. The report includes more in depth analysis of implementation in six states.
   Read the GAO Report.
   Read "E-Supplement" on the 50 State Survey.

Supreme Court Decides Patient Protection and Affordable Care Act Cases
June 28, 2012. The Supreme Court today issued its opinion upholding the challenged provisions of the Patient Protection and Affordable Care Act in National Federation of Independent Business v. Sebelius. Chief Justice Roberts wrote for the Court finding that the taxing power is enough to uphold the minimum coverage provisions but that the commerce clause does not authorize it. The Court upheld the Medicaid provisions as a valid use of the taxing and spending power, but limited the federal government's ability to take back Medicaid funds from existing levels as a penalty for noncompliance with the terms of the expansion. He concluded that the amendments to Medicaid in the Patient Protection and Affordable Care Act amounted to a new program and not just changes to the existing program. Justice Ginsburg wrote for four justices concurring in part, concurring in the judgment, and dissenting in part would up hold the individual mandate on commerce clause grounds and would not place restrictions on the Medicaid extension. She also criticized the Chief Justice because, having explained a basis in congressional taxing power for upholding the statute, he should not have reached further to address the commerce power. Four dissenters, Justices Scalia, Kennedy, Thomas, and Alito issued a joint opinion. They would have have ruled against the government on all issues.
   Although the Patient Protection Act survives, if the interpretations provided by Lyle Denniston are correct, this decision is likely to provide the basis for challenges to other federal programs on both commerce clause and taxing and spending powers, particularly those with significant conditions on receipt of federal funds with potential enforcement through removal of federal dollars. While attention is clearly on the specifics of the healthcare law for many observers, these other elements of the case are, in the long run, even more significant.
   Access the opinion

GAO Reports on Federal Government Progress in Hiring Persons with Disabilities
May 25, 2012. The Government Accountability Office has issued a report assessing progress by the federal government in efforts to increase employment opportunities for persons with disabilities in federal agencies. In particular, the GAO report focuses on efforts to meet expectations set by Executive Order 13548 issued in 2010.
   Read the Report.
   Access the Executive Order.

Supreme Court Oral Argument Audio and Transcripts Issued in Patient Protection Act Cases
March 28, 2012.The Supreme Court has now made the audio and transcripts for the three days of oral argument in the Patient Protection Act cases. Today the Court heard first the argument on the severability of the minimum coverage provision of the Patient Protection Act. This afternoon it heard challenges to the Medicaid provisions in that act.
   On March 27, the Court heard argument on the question whether the Congress exceeded its powers under Article I in enacting the minimum coverage provision of the Patient Protection Act.
   On March 26, the Court heard argument on the question whether the Anti-Injunction Act precludes review of the Patient Protection Act at this time. Both the Department of Justice and the opponents of the Patient Protection Act agreed that the Court should hear the case now and that the Anti-Injunction Act does not prevent review. Therefore, the Supreme Court appointed Attorney Robert A. Long an amicus curiae to argue the other side of the issue. The audio and transcript of yesterday's argument are posted below.
   The primary briefs in the three cases and other relevant materials are provided in the previous post for March 25 below.
   Listen to the audio of the oral argument in Department of Health and Human Services v. Florida Docket No., 11-398, Monday, March 26 (Anti-Injunction Act Issue -- Can the case be heard at this point?).
   Read the transcript of the oral argument in Department of Health and Human Services v. Florida Docket No., 11-398, Monday March 26 (Anti-Injunction Act).
   Listen to the audio of the oral argument in Department of Health and Human Services v. Florida Docket No., 11-398, Tuesday, March 27 (Minimum Coverage Provision).
   Read the transcript of the oral argument in Department of Health and Human Services v. Florida Docket No., 11-398, Tuesday March 27 (Minimum Coverage Provision).
   Listen to the audio of the oral argument in National Federation of Independent Business v. Sebelius and Florida v. Department of Health and Human Services Docket No., 11-393 and Docket No., 11-400 (Severability), Wednesday, March 28.
   Read the transcript of the oral argument in National Federation of Independent Business v. Sebelius and Florida v. Department of Health and Human Services Docket No., 11-393 and Docket No., 11-400 (Severability), Wednesday, March 28. [Will be posted as soon as it is available.]
   Listen to the audio of the oral argument in Florida v. Department of Health and Human Services Docket No. 11-400 (Medicaid), Wednesday, March 28.
   Read the transcript of the oral argument in Florida v. Department of Health and Human Services Docket No. 11-400 (Medicaid), Wednesday, March 28.[Will be posted as soon as it is available.]

Supreme Court Hears Oral Arguments in Patient Protection Act Cases
March 25, 2012. The Supreme Court will hear three days of oral argument this week in the cases challenging the Patient Protection and Affordable Care Act for March. The Court not only scheduled extra time, as it sometimes does in very important and complex cases, but has set arguments for three days. The Court has consolidated three cases that challenge the Patient Protection and Affordable Care Act, including No. 11-393 National Federation of Independent Business v. Sebelius; 11-400 Florida v. Department of Health & Human Services; and 11-398 Department of Health & Human Services v. Florida The following provides information and documents for the three cases.
    The Court has announced that it will post the audio of the oral arguments each day following the arguments. That audio will be posted on this page as soon as it becomes available. The transcripts for the arguments will also be posted as they become available.
   The Court issued directions as to how the cases will be argued are numerous. The Court ordered: "The petition for a writ of certiorari is No. 11-400 is granted limited to the issue of severability presented by Question 3 of the petition. The cases are consolidated and a total of 90 minutes is alloted for oral argument. Question 3 states: "Does the Affordable Care Act's mandate that virtually every individual obtain health insurance exceed Congress's enumerate powers and, if so, to what extent (if any) can the mandate be severed from the remainder of the Act?" In 11-398 "The petition for a writ of certiorari is granted. In addition to Question 1 presented by the petition, the parties are directed to brief and argue the following question: 'Whether the suit brought by respondents to challenge the minimum coverage provision of the Patient Protection and Affordable Care Act is barred by the Anti-Injunction Act, 26 U.S.C. Section 7421(a)." A total of two hours is alloted for oral argument on question 1. One hour is alloted for oral argument on the additional question." Question 1 is: "Whether Congress had the power under Article I of the Constitution to enact the minimum coverage provision." The additional question that the Court directed the parties to argue was suggested by the Justice Department in its cert. petition. In 11-400 Florida v. Department of H&HS "The petition for a writ of certiorari is granted limited to Question 1 presented by the petition." Question 1 is: "Does Congress exceed its enumerate powers and vilate basic principles of federalism when it coerces States into accepting onerous conditions that it could not impose directly by threatening to withhold all federal funding under the single large grant-in-aid program, or does the limitation Congress's spending powers that this Court recognized in South Dakota v. Dole, 483 U.S. 203 (1987), no longer apply?"
   Since there are three cases involved, there are a number of briefs by the parties to the cases and many amicus curiae briefs. The briefs for the parties are posted below. The American Bar Association "Preview" website provides the amicus briefs as well as the merits briefs. Links to the ABA preview pages for the three cases are also posted below.
   The petitions for certiorari in the three cases brought to the Court are posted on this page in an entry on November 14, 2011.
   Access the schedule for the sessions at which the arguments will be heard.
   Read the Brief for Petitioners Department of Health and Human Services, et al. in Department of Health and Human Services v. Florida Docket No., 11-398 (Minimum Coverage Provision).
   Read the Brief for State Respondents Department of Health and Human Services, et al. in Department of Health and Human Services v. Florida Docket No., 11-398 (Minimum Coverage Provision).
   Read the Brief for Court-Appointed Amicus Curiae Supporting Vacatur Department of Health and Human Services v. Florida Docket No., 11-398 (Anti-Injunction Act).
   Read the Brief for Petitioners in Department of Health and Human Services v. Florida Regarding the Anti-Injunction Act.
   Read the Brief for Private Respondents in Department of Health and Human Services v. Florida on the Anti-Injunction Act.
   Read the Brief for State Respondents in Department of Health and Human Services v. Florida on the Anti-Injunction Act.
   Read the Brief for Private Petitioners on Severability National Federation of Independent Business v. Sebelius and Florida v. Department of Health and Human Services Docket No., 11-393 and Docket No., 11-400 (Consolidated on Severability) .
   Read the Brief for State Petitioners on Severability National Federation of Independent Business v. Sebelius and Florida v. Department of Health and Human Services Docket No., 11-393 and Docket No., 11-400 (Consolidated on Severability) .
   Read the Brief for Respondents on Severability National Federation of Independent Business v. Sebelius and Florida v. Department of Health and Human Services Docket No., 11-393 and Docket No., 11-400 (Consolidated on Severability) .
   Read the Brief for Private Petitioners on Severability National Federation of Independent Business v. Sebelius and Florida v. Department of Health and Human Services Docket No., 11-393 and Docket No., 11-400 (Consolidated on Severability) .
   Read the Brief for State Petitioners on Severability National Federation of Independent Business v. Sebelius and Florida v. Department of Health and Human Services Docket No., 11-393 and Docket No., 11-400 (Consolidated on Severability) .
   Read the Brief for Respondents on Severability National Federation of Independent Business v. Sebelius and Florida v. Department of Health and Human Services Docket No., 11-393 and Docket No., 11-400 (Consolidated on Severability) .
   Access the "Preview" page for National Federation of Independent Business v. Sebelius and Florida v. Department of Health and Human Services Docket No., 11-393 and Docket No., 11-400 (Consolidated on Severability).
   Access the "Preview" page for Florida v. Department of Health and Human Services Docket No. 11-400 (Medicaid).
   Access the "Preview" page for Department of Health and Human Services v. Florida Docket No., 11-398 Anti-Injunction Act.
   Access the "Preview" page for Department of Health and Human Services v. Florida Docket No., 11-398 (Minimum Coverage Provision).

Social Determinants of Health
March, 2012. An increasing number of national and international organizations are producing websites and organizing research on the social determinants of health. Although this is by no means a new field of world, it is receiving renewed attention under this more recent label of the subject. Some of the key sites and documents are posted below.
   Access HealthyPeople 2020 website on Social Determinants of Health.
   Access WHO website on Social Determinants of Health.
   Access Report of the WHO Commission on the Social Determinants of Health.
   Access the Executive Summary of the WHO Commission on Social Determinants of Health Report.
   Access The Centers for Disease Control and Prevention Social Determinants of Health website.
   Access CDC White Paper on Social Determinants of Health.
   Access CDC Health Disparities and Social Determinants of Health Resources website (Documents and Reports).
   Access CDC Document "Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health."

Supreme Court Presses Preemption of Federal Arbitration Act Against State Wrongful Death Ruling
February 22, 2012. The U.S. Supreme Court has once more ruled in strong terms that state laws that limit the use of arbitration in various types of contractual agreements are pre-empted by the Federal Arbitration Act (FAA). The Court said that includes actions for personal injury or wrongful death in a case brought against a West Virgina health care facility. For full information on the case, Marmet Health Care Center v. Brown, including the opinion, see the Public Law, Policy, and Public Administration page of this website.

White House Announces FY2013 Budget Proposal
February 13, 2012. The White House has released the President's budget request for FY 2013. Along with the full budget request and the budget overview document, the White House has issued the "Cuts, Consolidations, and Savings for FY 2013" (This replaces what had been called the Terminations, Reductions, and Savings document in previous years.) document, the "Analytic Perspectives" document which provides the economic and policy assumptions behind the budget, agency by agency fact sheets, and the "Appendix" which is the document that contains the very detailed information on agency budgets and funds.
   The so-called budget-in-brief documents which contain detailed program by program information for the Department of Health and Human Services, Department of Education, and the Environmental Protection Agency will be provided below as soon as they are posted.
   This year's budget annoucement and numbers must be read against the backdrop of the deficit reduction and budget control agreements announced in the second half of last year. Postings on all of those developments have been provided over the course of the past several months on this page. However, the key bills are listed in a separate posting to follow this FY 2013 budget materials presentation.
   Access the FY2013 Budget Overview.
   Download the FY 2013 Budget proposal as a single .pdf document.
   Download the FY 2013 Budget Website with Individual Agency Budget proposals.
   Access Agency by Agency Fact Sheets for the FY2013 Budget.
   Access the Cuts, Consolidations, and Savings for FY 2013 (This replaces what had been called the Terminations, Reductions, and Savings document in previous years.)
   Access the Web Site for the FY2013 Budget Appendix -- All detailed information about agencies and funds.
   Access the Analytic Perspectives Document (economic and budget assumptions).
   Access the U.S. Department of Education, Fiscal Year 2013 Budget Summary and Background Information.
   Access the U.S. Department of Health and Human Services, Fiscal Year 2013 Budget-in-Brief.
   Access the U.S. Environmental Protection Agency, Fiscal Year 2013 Budget-in-Brief.
   Access USASpending.gov

Robert Wood John Research Network "Salud America" Publishes Findings on Overweight and Obesity Among Latino Children and the Influences of the Media on those Conditions and Resulting Medical Challenges
February 10, 2012. The Robert Wood Johnson Foundation Research Network to Prevent Obesity Among Latino Children, Salud America, has issued a report entitled "Addressing Nutrition, Overweight, and Obesity Among Latino Youth" and another entitled "Influence of Media on Overweight and Obesity Among Latino Youth." Both present important data about the significant numbers of Latino children who are or are at risk for being obese or sufficiently overweight to suffer a series of related conditions. "According to current estimates, more than 38 percent of Latino youth ages 2-19 in the United States are overweight and almost 21 percent are obese.1 The higher prevalence of overweight and obesity among Latino youth places them at greater risk for developing health and psychological problems such as cardiovascular disease, asthma, type 2 diabetes, liver disease, sleep apnea, depression, anxiety and psychological stress." Addressing Nutrition, p. 3. The report on media influence explains some of those difficulties with evidence of the amount of targeting advertising on television and the Internet directed at Latino children and other factors that suggest important impacts from media practices.
   Read "Addressing Nutrition, Overweight, and Obesity Among Latino Youth"
   Access "Influence of Media on Overweight and Obesity Among Latino Youth.".

Program Evaluation Resources
February 2, 2012. The GAO has released the 2012 edition of Designing Evaluations guide to program evaluation. It is a useful basic resource paper with helpful references. Another resource that is available on the Internet published by the Northwest Health Foundation is Sherril B. Gelmon, Anna Foucek, and Amy Waterbury, Program Evaluation: Principles and Practices, 2nd Ed. (Portland, OR: Northwest Health Foundation, 2005).
   Access Designing Evaluations.
   Access Program Evaluation: Principles and Practices.

Oregon Groups Sue State in Challenge to Sheltered Workshops
January 27, 2012. United Cerebral Palsy and Disability Rights Oregon have filed suit in federal court against the state in a case styled Lane v. Kitzhaber, claiming that the use and operation of sheltered workshops for persons with disability violate the Americans with Disabilities Act and §504 of the Rehabilitation Act of 1973. The complaint names the Governor, the Director of the Department of Human Services, the Administrator of the Office of Disability Services, and the Administrator of the Office of Vocational Rehabilitation Services.
   Read the complaint.
   Read the press release issued by Disability Rights Oregon.
   Access a fact sheet released by Disability Rights Oregon on Sheltered Workshops.

Supreme Court Rejects Application of Americans with Disabilities Act to Church School Employee
January 12, 2012. In an opinion for a unanimous Supreme Court, Chief Justice Roberts, citing both the free exercise and establishment clauses of the First Amendment, rejected the efforts by an employee of a church school to bring an action under the Americans with Disabilities Act. For more information and the opinion, see the Civil Rights page of this website.

HRSA Report Finds "Children with special health care needs more likely to have health care access problems"
January 5, 2012. The Health Resources and Services Administration (HRSA) has released a new report entitled "Children with Special Health Care Needs in Context: A Portrait of States and the Nation 2007." As the title indicates, the report is based upon 2007 data as are other reports, so-called Chart Books produced by HRSA. The report found that "many CSHCN (Children with Special Health Care Needs) are: more likely than other children to have consistent insurance; however, that insurance is less likely to meet their needs, and they are less likely than non-CSHCN to receive care that meets the criteria for having a medical home; less likely to be engaged in school, and more likely to repeat a grade and miss more than two weeks of school due to illness; more likely to be overweight or obese than children without special health care needs; and more likely than children without special health care needs to be exposed to secondhand smoke at home." The full report and the other reports on children's health are provided below.
   Read the press release on the report.
   Read the full report "Children with Special Health Care Needs in Context: A Portrait of States and the Nation 2007."
   Read the full report "Health and Well-Being of Children: A Portrait of States and the Nation 2007."
   Read the full report "Mental and Emotional Well-Being of Children: A Portrait of States and the Nation 2007."
   Read the full report "The Health and Well-Being of Children in Rural Areas: A Portrait of the Nation 2007."

HHS Secretary Overrules FDA Decisions on Plan B
December 8, 2011. The Secretary of Health and Human Services has overruled an FDA scientific panel and has directed the FDA Commissioner to reverse the agency's announced policy that would have made Plan B contraceptive available over the counter without a prescription to all women of childbearing age. Secretary Kathleen Sebelius issued a statement indicating that in her opinion, there was not sufficient research to support making the drug available to young women without a prescription.
    FDA Commissioner Dr. Margaret A. Hamburg explained in her press release in response to the secretary that: "I reviewed and thoughtfully considered the data, clinical information, and analysis provided by CDER, and I agree with the Center that there is adequate and reasonable, well-supported, and science-based evidence that Plan B One-Step is safe and effective and should be approved for nonprescription use for all females of child-bearing potential. However, this morning I received a memorandum from the Secretary of Health and Human Services invoking her authority under the Federal Food, Drug, and Cosmetic Act to execute its provisions and stating that she does not agree with the Agency's decision to allow the marketing of Plan B One-Step nonprescription for all females of child-bearing potential. Because of her disagreement with FDA's determination, the Secretary has directed me to issue a complete response letter, which means that the supplement for nonprescription use in females under the age of 17 is not approved. Following Secretary Sebelius's direction, FDA sent the complete response letter to Teva today. Plan B One-Step will remain on the market and will remain available for all ages, but a prescription will continue to be required for females under the age of 17."
   Access the secretary's public statement on rejecting the FDA panel recommendation.
   Secretary Sebelius' letter to FDA Commissioner Margaret A. Hamburg.
   Access the public statement of FDA Commissioner Margaret A. Hamburg.

Supreme Court Agrees to Hear Patient Protection Act Cases
November 14, 2011. The Supreme Court has indicated in its Order List for today that it will hear the cases involving challenges to the Patient Protection and Affordable Care Act, including No. 11-393 National Federation of Independent Business v. Sebelius; 11-400 Florida v. Department of Health & Human Services; and 11-398 Department of Health & Human Services v. Florida. It's directions as to how the cases will be argued are numerous. It is interesting to note with respect to the Florida cases that the Court ordered: "The petition for a writ of certiorari is No. 11-400 is granted limited to the issue of severability presented by Question 3 of the petition. The cases are consolidated and a total of 90 minutes is alloted for oral argument. Question 3 states: "Does the Affordable Care Act's mandate that virtually every individual obtain health insurance exceed Congress's enumerate powers and, if so, to what extent (if any) can the mandate be severed fromt he remainder of the Act?" In 11-398 "The petition for a writ of certiorari is granted. In addition to Question 1 presented by the petition, the parties are directed to brief and argue the following question: 'Whether the suit brought by respondents to challenge the minimum coverage provision of the Patient Protection and Affordable Care Act is barred by the Anti-Injunction Act, 26 U.S.C. Section 7421(a)." A total of two hours is alloted for oral argument on question 1. One hour is alloted for oral argument on the additional question." Question 1 is: "Whether Congress had the power under Article I of the Constitution to enact the minimum coverage provision." The additional question that the Court directed the parties to argue was suggested by the Justice Department in its cert. petition. In 11-400 Florida v. Department of H&HS "The petition for a writ of certiorari is granted limited to Question 1 presented by the petition." Question 1 is: "Does Congress exceed its enumerate powers and vilate basic principles of federalism when it coerces States into accepting onerous conditions that it could not impose directly by threatening to withhold all federal funding under the single larged grant-in-aid program, or does the limitation Congress's spending powers that this Court recognized in South Dakota v. Dole, 483 U.S. 203 (1987), no longer apply?"
   Read the Court's Order List for November 14 with the information on certiorari approval in the healthcare cases.
   Read the Petition for Certiorari in No. 11-398, Department of Health and Human Services v. Florida.
   Read the petition for a writ of certionari in No. 11-393 National Federal of Indepedent Business v. Sebelius.
   Read the petition for certiorari in No. 11-400 Florida v. Department of Health and Human Services.

D.C. Circuit Panel Joins Courts Rejecting Challenges to the Patient Protection Act
November 8, 2011. Judge Laurence Silberman, writing for a panel of the U.S. Circuit Court of Appeals for the D.C. Circuit in Seven-Sky v. Holder, has joined the other courts that have rejected challenges to the Patient Protection and Affordable Care Act, P.L. 111-148. Circuit Judge Brett Kavanaugh issued a dissenting opinion. As the previous posting indicates, the Justice Dpartment has already petitioned the Supreme Court to consider the Patient Protection Act decision from the Eleventh Circuit. The D.C. Circuit opinion adds to the evidence of a division among the circuits which usually prompts Supreme Court review. Indeed, Judge Silberman notes at the outset of the opinion that "so much has already been written by our sister circuits about the issues presented in this case -- which will almost surely be decided by the Supreme Court." Slip opinion, at 6.
   Read the D.C. Circuit Opinion in Seven-Sky v. Holder.

Justice Department Asks Supreme Court to Review Patient Protection Act Case
September 27, 2011. The U.S. Solicitor General has filed a petition for a writ of certiorari, asking the U.S. Supreme Court to take up the Forida v. HHS opinion issued by the Eleventh Circuit which struck down the Patient Protection Act. The petition styles the case as Department of Health and Human Services v. Florida, No. 11-398.
   Read the Petition for Certiorari .
   Access the Appendix to the Cert. Petition.
   Access the Eleventh Circuit Florida v. HHS opinion.

WHO Issues World Disability Report.
September 22, 2011. The World Health Organization has issued the first World Report on Disability. In its release of the report, the WHO said: "The report shows that people with disabilities are more than twice as likely to find healthcare provider skills inadequate to meet their needs, and nearly three times more likely to report being denied needed health care. In low-income countries people with disabilities are 50% more likely to experience catastrophic health expenditure than non-disabled people. Children with disabilities are less likely to start school than non-disabled children and have lower rates of staying in school. In Organisation for Economic Co-operation and Development (OECD) countries, the employment rate of people with disabilities (44%) is slightly over half that for people without disabilities (75%)."
   The WHO also references recent research by the World Bank on "Disability and Poverty in Developing Countries: A Snapshot from the World Health Survey." The report has been released, but there is a conference scheduled by the World Bank for October 12 to present and discuss the report.
   Access the World Disability Report.
   Read the WHO press release on the report.
   Read the World Bank Report.
   Read the World Bank Announcement of Its Upcoming October 12 Conference on the report.

Fourth Circuit Court Rejects Challenges to the Patient Protection Act as Supreme Court Review Nears.
September 9, 2011. Judge Diana Gribbon Motz has written an opinion for a panel of the U.S. Circuit Court of Appeals for the Fourth Circuit rejecting the Virginia Attorney General's claim that the commonwealth had standing to challenge the Patient Protection Act and vacating the district court's ruling against the health care statute. Judge Motz also issued an opinion for the same three judge panel in a second case also involving a challenge to the act, Liberty University v. Geithner. In this case also, the panel vacated the lower court ruling with one judge concurring and another dissenting. In this case, the panel rejected the challenge to tax provisions in the law on grounds that it pre-enforcement review is barred. That leaves open the opportunity for a challenge after the tax provisions have actually been enforced.
   Access the Virginia v. Sebelius opinion.
   Access the Liberty University v. Geithner opinion.

U.S. Eleventh Circuit Court Rules Against the Patient Protection and Affordable Care Act, Setting Up Supreme Court Review.
August 13, 2011. A panel of the U.S. Circuit Court of Appeals for the Eleventh Circuit has ruled in favor of a challenge by 26 states to the Patient Protection and Affordable Care Act, setting up a conflict with the ruling of the Sixth Circuit and virtually ensuring a review by the U.S. Supreme Court. The panel found that the Congress "exceeded its commerce power in enacting its individual mandate" for the purchase of coverage. Florida v. HHS, Slip Opinion at 5.
   Access the opinion.

Oregon Legislature Passes the Healthcare Transformation Bill
June 29, 2011. The Oregon legislature has approved H.B. 3650 known the the Health System Transformation bill. Among a variety of other things, the bill, as the legislation explains, "Establishes Orgeon Integrated and Coordinated Health Care Delivery System to replace managed care systems of medical assistance by 2014."
   Access the H.B. 3650.

U.S. Circuit Court for the Sixth Circuit Rejects Challenge to the Patient Protection and Affordable Care Act.
June 29, 2011. A panel of the U.S. Circuit Court of Appeals for the Sixth Circuit has rejected a challenge to the Patient Protection and Affordable Care Act brought by the Thomas More Law Center. The panel concluded that "the minimum coverage provision is a valid exercise of legislative power by Congress under the Commerce Clause." Thomas More Law Center v. Obama, No. 10-2388, Slip Opinion at 3. Other cases are pending elsewhere in the federal court system, including a case already argued in the Fourth Circuit.
   Access the opinion.

Food Pyramid Replaced by USDA's MyPlate
June 2, 2011. The USDA has launched its effort to replace the food pyramid with something it calls MyPlate and, like many new releases, it comes complete with a new website http://www.choosemyplate.gov/. The new icon provides a different array and apportionment of foods with a set of materials to explain each of these. In an effort to facilitate use, the USDA has also released the new MyPlate icon in jpeg file form.
   Access the MyPlate website.
   Read the USDA press release on the MyPlate initiative.
   Access the MyPlate icon.

Vermont Governor Signs Healthcare Reform Bill Launching Single Payer System
May 26, 2011. Vermont Governor Peter Shumlin has signed H. 202 into law, creating the nation's first single payer health care program to be known under the legislation as "Green Mountain Care."
   Read Vermont governor's press release on the signing of the new single payer health care bill.
   Read H. 202 as it passed the House and Senate.

Another Round of New Oregon Health Care Legislation Under Consideration
May 17, 2011. After adopting fundamental change in Oregon's health programs, the state legislature is considering additional new policies in the current term, including HB 3650 (a health care transformation bill) and SB 99 (a health insurance exchange bill).
   Read HB 3650.
   Read SB 99.

National Council on Disability Issues Report Anticipating Reauthorization of DD Act
March 24, 2011. The National Council on Disability has recently issued a report entitled Rising Expectations: The Developmental Disabilities Act Revisited in anticipation of action by Congress on reauthorization of the Developmental Disabilities Assistance and Bill of Rights Act. As the NCD explains, it is "time to consider recommendations to ensure the Act is structure appropriately in relation to the new realities and expectations of people with developmental disabilities, their families, and the goals of our nation for all Americans. The recommendations in this report are intended to address key issues and offer a way forward the when the Developmental Disabilities Act reauthorization process begins" (p. 2).
   Read the report.

New ADA Rules Take Effect
March 17, 2011. The U.S. Department of Justice announced that new regulations under the Americans with Disabilities Act would take effect on March 15. The rules concern Nondiscrimination on the Basis of Disability in State and Local Government Services and Nondiscrimination on the Basis of Disability by Public Accommodations and in Commercial Facilities. The DOJ explained that: "The revised rules are the department's first major revision of its guidance on accessibility in 20 years. The regulations apply to the activities of more than 80,000 units of state and local government and more than seven million places of public accommodation, including stores, restaurants, shopping malls, libraries, museums, sporting arenas, movie theaters, doctors' and dentists' offices, hotels, jails and prisons, polling places, and emergency preparedness shelters. The rules were signed by Attorney General Eric Holder on July 23, 2010, and the official text was published in the Federal Register on September 15, 2010."
   Read the Justice Department Press Release on the New Regulations.
   Access the new rules on Nondiscrimination on the Basis of Disability in State and Local Government Services.
   Access the new rules on Nondiscrimination on the Basis of Disability by Public Accommodations and in Commercial Facilities.
   Read the DOJs new regulations on Nondiscrimination on the Basis of Disability by Public Accommodations and in Commercial Facilities.
   View the 2010 standards for Accessible Design.
   Access the Justice Department ADA Website.

White House Announces FY2012 Budget Proposal
February 14, 2011. The White House has released the President's budget request for FY 2012. Along with the budget overview document, the White House has issued the traditional "Terminations, Reductions, and Savings" document, the Analytic Perspectives document which provides the economic and policy assumptions behind the budget, agency by agency fact sheets, and the Appendix which is the document that contains the very detailed information on agency budgets and funds.
   The so-called budget-in-brief documents which contain detailed program by program information for the Department of Health and Human Services, Department of Education, and the Environmental Protection Agency are also provided below.
   Access the Web Page for the FY2012 Budget Overview with Links for Each Federal Agency.
   Download the FY 2012 Budget as a single .pdf document.
   Access Agency by Agency Fact Sheets for the FY2012 Budget.
   Access Terminations, Reductions, and Savings for FY 2012.
   Access the Web Site for the FY2012 Budget Appendix -- All detailed information about agencies and funds.
   Access the Analytic Perspectives Document (economic and budget assumptions).
   Access the U.S. Department of Education, Fiscal Year 2012 Budget Summary and Background Information.
   Access the U.S. Department of Health and Human Services, Fiscal Year 2012 Budget-in-Brief.
   Access the Environmental Protection Agency, Fiscal Year 2012 Budget-in-Brief.
   Access USASpending.gov

Governor's Budget Calls for Major Reorganization of Children's Programs
February 3, 2011. In addition to the overall budget discussion following Governor Kitzhaber's delivery of his proposed budget, there is a particular focus area that he identified not only for funding changes but also for dramatic reorganizations of programs and agencies dealing with children, ranging from health care to education and, more broadly, in health care programs supported by the state.
   First, the governor appointed a transition team to produce an Early Childhood and Family Investment Transition Report, which the governor's office published along with the budget. That report recommended creation of an Early Leaning Council to consolidate a wide range of programs from other departments and change the operation of those programs. The governor's budget states that: "The Governor has proposed the creation of a single transparent 0-20 education investment budget, the Oregon Education Investment Fund, which will be administered by a new Oregon Education Investment Board. Under this board will be created a Council of Early Learning which will focus on ensuring that children enter school ready to learn, enter the first grade ready to read, and leave the first grade reading. . . . The Council of Early Learning is created in this budget to bring together those programs focused on primary and secondary prevention. The following programs are included: * Early Intervention and Early Childhood Special Education; Headstart and Early Headstart; Oregon Pre-kindergarten; Even Start; and Special Education for infants with disabilities, and pre-school grants from the Department of Education; * Healthy Start; Relief Nurseries; Community Schools; Children, Youth and Families; Great Start; Family Preservation and Support; and statewide system development and planning from the State Commission on Children and Families; * The Childcare Division and Childcare Commission from the Employment Department; * Ready to Read from the Oregon State Library; * Maternal and Child Health Programs; and Women Infants and Children from the Oregon Health Authority; and * Employment Related Daycare and the Children's Wrap-around Initiative from the Department of Human Services.
   In the first year of the biennium, the Governor's Early Childhood System Director will oversee a design team to re-engineer and transform the early childhood system to produce measurable outcomes and cost benefit analyses on a regional basis through performance-based contracting with local providers. The design team will also recommend a process to transition to the new delivery model in the second year of the biennium. Although the budget and positions for the existing programs are moved to the Council of Early Learning, the programs themselves will continue to operate in their current form for this first year of the biennium. Beginning the second year of the biennium, the programs will operate under the new system design with unified efforts and streamlined administrative services.
   In addition to the programs directly focused on early learning, the following programs from the State Commission on Children and Families have been transferred to the Council of Early Learning: Court Appointed Special Advocates; Youth Investment; the Runaway and Homeless Youth Initiative; and Juvenile Crime Prevention.
   Second, the budget specifically calls for the transfer of "Babies First, Maternal and Childhood Block Grant, and Women, Infants and Children (WIC) to the new Early Learning Council." (Governor's Proposed Budget, C-15).
   Third, the Oregon Health Policy Board has chartered what is termed the "Health Systems Transformation Team, that will meet in Salem from February through April. As the Transition Team's website states, "The Health Systems Transformation Team, chartered by the Oregon Health Policy Board at the request of Governor Kitzhaber, will develop a common vision and guidance for planning a new, integrated health and services delivery system for Oregon's Medicaid programs, which can then be built upon for broader statewide markets. The aim of the plan is to better coordinate all benefits for our Medicaid clients, including physical health, mental health and addiction services, oral health, long-term care and social support services, through more integrated care." They add: "We face an unprecedented budget shortfall and the cost of health care for state publicly funded health care is an estimated 16 percent of the general fund budget. The current fiscal climate calls for bold action to design a new, more sustainable platform my fundamentally restructuring our delivery system as an innovative model to deliver better care, better health and lower costs.." The meetings will be held in Salem and, while they will be open to the public, they will not take public testimony at those hearings. Instead, there are instructions on the team's website as to how to provide input. Unfortunately, the meetings of the team began on February 2, so the process is already underway.
   Access the Early Childhood and Family Investment Transition Report.
   Access the Oregon Governor's Proposed Budget.
   Access Health Systems Transformation Team website.

U.S. District Court in Florida Rules Against Patient Protection Act
February 1, 2011. Federal District Judge Roger Vinson of the U.S. District Court for the Northern District of Florida has issued his opinion in Florida v. HHS, Case No. 3:10-cv-91-RV/EMT, in which 26 states challenged the Patient Protection Act. He concluded that: "The individual mandate is outside Congress' Commerce Clause power, and it cannot be otherwise authorized by an assertion of power under the Necessary and Proper Clause. It is not Constitutional." (Slip opinion at 63). He then found that since that provision of the bill is not severable, the entire statute must fall. (Id. at 74). However, the judge did not issue an injunction against the statute's application at this time.
    This decision is the second ruling against the statute, while two other district courts have rejected challenges to the new law. See the information and links for these opinions in the December 13 posting, below.
   Read the opinon.

Congress Passes Pedestrian Safety Law to Deal with Electric Cars Problem
December 23, 2010. The House of Representatives passed S. 841 the Pedestrian Safety Enhancement Act of 2010 which requires that electric vehicles emit an alert sound that may be heard by pedestrians in order to avoid near silent vehicles to come upon pedestrians, and particular visually impaired pedestrians. There is a bipartisan agreement on this bill and it is moving forward with the support of the automobile manufacturers.
   Read S. 841.

Congress Passes Reduction of Lead in Drinking Water Act
December 17, 2010. The House of Representatives today S. 3874 Reduction of Lead in Drinking Water Act . The bill passed the Senate yesterday and now goes to the president for signature.
   Read S. 3873.

Federal District Court in Virginia Strikes Down Part of the Patient Protection Act While Two Others Reject Challenges to the Legislation
December 13, 2010. Federal District Judge Henry E. Hudson, of the U.S. District Court for the Eastern District of Virginia, has issued his opinion in Commonwealth of Virginia v. Sebelius, Civ. No. 3:10CV188-HEH, striking down Section 1501 of the Patient Protection Act which requires Minimum Essential Coverage and issued an injunction against its enforcement.
   Judge Norman K. Moon of the U.S. District Court for the Western District of Virgina has issued his opinion in Liberty University v. Geithner, rejecting the challenge to the Patient Protection Act. District Judge George Caram Steeh issued an opinion in another case challenging the Patient Protection Act, Thomas More Law Center v. Obama, also rejecting the attack on the new law. A variety of other cases are pending in other district courts around the nation.
   Read opinion in Commonwealth of Virginia v. Sebelius, Eastern District of Virginia.
   Read opinion in Liberty University v. Geithner, Western District of Virgina.
   Read the opinion in Thomas More Law Center v. Obama, Eastern District of Michigan.

House Adopts Child Nutrition Legislation
December 2, 2010. The House of Representatives has voted on some key legislation related to child nutrition. First the House adopted H.R. 6469 which requires programs receiving federal school lunch money to ensure background checks for employees. The House then moved on to S. 3307, the Healthy, Hunger-Free Kids Act of 2010 which passed 264-157. This legislation has already passed the Senate and will now go to the president for signature. It reauthorizes child nutrition programs such as the WIC and school lunch programs, changes the required nutrition standards, and includes programs to encourage improved nutrition in school lunch programs, including such efforts as farm to school lunch programs.
   Read the S. 3307.
   Read the H.R. 6469.

AMCHP Summarizes Impacts of New Health Care Law for Families with Children who have Disabilities
November 19, 2010. The Association of Maternal and Child Health Programs has developed a web page that provides a "Fact Sheet" that addresses what the organization sees as the impact of the recent federal health care reform legislation on families who have children with disabilities.
   Access the AMCHP website on Health Care Reform.
   Access the AMCHP Homepage.

Oregon Autism Commission Issues Report
October 26, 2010. The Oregon Commission on Autism Spectrum Disorders has released its draft report. The Commission, created by executive order, was tasked with producing a report that sets out a ten year agenda for addressing the challenges and system problems confronting those with autism spectrum disorders and their families. The final report is due in December and the Commission is now seeking comments on the draft. The commission website and the report provide further information on the feedback process and other information.
   Read the Draft Report.
   Access the website of the Commission on Autism Spectrum Disorders.

GAO Report Examines Respite Funding
October 23, 2010. The Government Accountability Office has issued a report entitled "Respite Care: Grants and Cooperative Agreements Awarded to Implement the Lifespan Respite Care Act." The act is P.L. 109-442, 120 Stat. 3291 and was intended to provide grants and cooperative agreements to develop state level respite programs and facilitate national resource and coordination efforts.
   Read the GAO report.
   Access the Lifespan Respite Care Program of the Administration on Aging.
   Access the ARCH National Respite Network and Resource Center.
   Access the Lifespan Respite Care Act of 2006.

Justice Department Issues New Publication on Medical Care for Persons with Mobility Disabilities
September 3, 2010. The Civil Rights Division of the U.S. Department of Justice with the U.S. Department of Health and Human Services has issued a new document entitled Access to Medical Care for Individuals with Mobility Disabilities. It seeks to answer commonly asked questions about the obligations of providers under the Americans with Disabilities Act and Section 504 of the Rehabilitation Act of 1973. It addresses facilities, but also staff training and other significant issues.
   Read Access to Medical Care for Individuals with Mobility Disabilities.
   Access the DOJ Project Civic Access webpage.
   Access the Department of Justice ADA.gov website.

GAO Publishes Report of a Forum on Increasing Work Particiation for Adults with Disabilities
August 3, 2010. The Government Accountability Office has published a report on a forum held in March on "Actions that could Increase Work Participation for Adults with Disabilities. In addition to the report of the presentations, the GAO document provides information on a survey conducted leading up to the forum and recommendations for actions going forward to enhance workplace opportunities.
   Access the GAO report.

President Signs Executive Order Encouraging Federal Hiring of Persons with Disabilities
July 31, 2010. On Monday, July 26, the twentieth anniversary of the enactment of the Americans with Disabilities Act, President Obama issued Executive Order 13548 entitled Increasing Federal Employment of Individuals With Disabilities calling on the Office of Personnel Management and federal agencies to take more steps toward recruiting and retaining federal employees with disabilities. The president also issued Proclamation 8542 on the Anniversary of the Americans with Disabilities Act 2010 and declaring July 26, 2010 a day of celebration of that anniversary.
   Read the Executive Order.
   Read the Proclamation.

British Government Proposes Dramatic Changes in National Health Care System
July 28, 2010. The recently installed government of Britain has proposed major changes in the structure and operation of the national health care system. The Secretary of State for Health has outlined the proposed changes in a white paper just submitted to Parliament entitled Equity and Excellence: Liberating the NHS.
   Access the White Paper.

Oregon Health Authority Launches Healthykids.gov website
July 8, 2010. The Office of Healthy Kids of the Oregon Health Authority has launched its Healthykids.gov/Hijos Saludable Oregon website. The Health Kids program was created with the passage in 2009 of HB 21126 and is intended to expand health care coverage to 95% of the state's children.
   Access the Healthy Kids site.
   Para accesar Hijos Saludable Oregon.
   Access HB 2116.

Federal Government Launches Healthcare.gov
July 1, 2010. The Department of Health and Human Service has launched a new website intended to be the primary portal to provide information on the health care reform, primarily but no solely related to the recently enacted health care reform bill, P.L. 111-148. The site's creators announced: "It's the first website to collect both public and private health insurance options across the nation in a single place. Even better, our insurance options finder automatically sorts through this huge catalog of options to help you identify the ones that may be right for you." The site invites comments from those who access the site for improvement.
   The site promises that a Spanish language version will be available soon, but it is currently available only in English.
   Access the Healthcare.gov website.
   Go to the video tour of the website.

HHS Secretary Announces Transitional Plan to Deal with Pre-existing Conditions
July 1, 2010. Health and Human Secretary has announced today the launching of a Pre-existing Condition Insurance Plan (PCIP). As Secretary Sebelius explains it: "Created under the Affordable Care Act, the Pre-Existing Condition Insurance Plan is a transitional program until 2014, when insurers will be banned from discriminating against adults with pre-existing conditions, and individuals and small businesses will have access to more affordable private insurance choices through new competitive Exchanges." Further information on the policy is provided on Healthcare.gov.
   Read the HHS Secretary's News Release on the Pre-existing Condition Insurance Plan (PCIP).
   Access information about the Pre-existing Condition Insurance Plan (PCIP) via Healthcare.gov.

House and Senate Considering Farm to School and Related Nutrition Programs
April 7, 2010. The House Education and Labor Committee has been holding hearings on the school nutrition programs. During that discussion, several members and witnesses raised questions about programs to bring healthy food choices, particularly fruits and vegetables to school both for breakfast or lunch meals and also for snacks as alternatives to junk food either purchased in school or brought from home. There are four pieces of legislation pending presently on this subject. The current lead bills are H.R. 4710, the "Farm to School Improvments Act of 2010" and S. 3123, the Growing Farm to School Programs Act of 2010." H.R. 4710 was introduced by Representative Rush Holt (D-NJ) and currently has 20 co-sponsors. The Senate "Growing Farm to School Programs Act of 2010" was introduced by Senator Patrick Leahy (D-VT) and has 17 co-sponsors.
   Access H.R. 4333 the "Children's Fruit and Vegetable Act."
   Access H.R. 4710 the "Farm to School Improvements Act of 2010.
   Access S. 3123 the "Growing Farm to School Programs Act of 2010."
   Access S. 3144 the "Healthy Food in Schools Act of 2010."

State Attorneys General File Suit Challenging the Constitutionality of Federal Health Reform Legislation
April 1, 2010. The attorneys general of 13 states, led by the Attorney General of Florida, have filed suit in the United States District Court for the Northern District of Florida challenging the constitutional validity of the recently enacted federal health care legislation, the Patient Protection and Affordable Care Act. The complaint alleges, inter alia, that "the Act exceeds the powers of the United States under Article I of the Constitution and violates the Tenth Amendment to the Constitution. In addition, the tax penalty required under the Act, which must be paid by uninsured citizens and residents, constitutes and unlaw capitation or direct tax, in violation of Article I, sections 2 and 9 of the Constitution of the United States. Complaint at 4. The states that have filed include, Florida, South Carolina, Nebraska, Texas, Utah, Louisiana, Alabama, Michigan, Colorado, Pennsylvania, Washington, Idaho, and South Dakota. The case is styled Florida v. Department of Health and Human Services, Case No. 3:10-cv-91.
   The Attorney General of Virginia has filed in a case styled as Commonwealth of Virginia v. Sebelius in the Eastern District of Virginia.
   The Attorney General of Oregon has announced that he will file briefs in support of the new federal legislation and it is expected that other states will join that effort.
   Access the Complait Filed the Attorneys General in the Florida case.
   Access the Complaint filed by the Attorney General of Virginia in the Eastern District of Virginia.
   Read the Florida Attorney General's Announcement of the Challenge to the Federal law.
   Read the Oregon Attorney General Release on the Intent to Defend the Federal law.

Health Care Package Completed with Signing of Reconciliation Act
March 30, 2010. The president has now signed the Reconciliation Act of 2010 (now P.L. 111-152) which contains additions and changes to the Patient Protection and Affordable Care Act, P.L. 111-148 (H.R. 3590) which was signed last week. The Reconciliation Act, H.R. 4872 also contains a number of key provisions on student loans.
   Access H.R. 3590 as approved.
   Access the Congressional Research Service Summary of the provisions of H.R. 3590.
   Access H.R. 4872.
   Access the technical amendments to H.R. 4872.

President Issues Executive Order on Abortions
March 24, 2010. The president has issued the executive order that he promised during the debate over the health care reform bill in the House that reiterates the bar to the use of federal funds to support abortions.
   Access the Executive Order.

President Signs Health Care Legislation
March 23, 2010. The president has signed into law H.R. 3590, The Patient Protection and Affordable Care Act, which was passed by Senate on December 24, 2009 and by the House on March 21, 2010. The Reconciliation Act of 2010, H.R.4872, which is the other bill approved by the House on March 21, is in the Senate where debate begins today. Information on that legislation is provided in the posting below.
   Access H.R. 3590.

House Passes Health Care Bills
March 22, 2010. The House voted 219 to 212to pass the Senate health care bill that had passed that body on Christmas Eve. The House also passed additions and changes to the health care plan in the context of the budget reconciliation act. The Senate bill, H.R. 3590, now goes to the president for signature. The Reconciliation Act of 2010, H.R.4872, which passed by a vote of 220 to 211, now goes to the Senate where it can pass with a majority vote. The legislation is posted below.
   The Congressional Budget Office issued a spending and revenue estimate for the health care proposal in the Reconciliation Act on March 18 and a modifed version of the report on March 20. Both are posted below.
   Access H.R. 3590.
   Access H.R. 4872 as passed by the House.
   Access the Original CBO Report.
   Access the Revised CBO Report on March 20.
   Access CBO Director's posting on the original spending report.
   Access CBO Director's posting on the revised 3/20 spending report.
   House Rules Committee Analyses and documents on the legislation.

FDA Issues New Tobacco Regulations Under Recently Adopted Congressional Authority
March 19, 2010. The Food and Drug Administration has issued it new regulations on advertising and sales of tobacco products aimed at children under the Family Smoking Prevention and Tobacco Control Act enacted in June of 2009. For more information about the legislation and the new regulations, go to the Public Law, Policy, and Public Administration page of this website.

GAO Report Critical of Lack of EPA Attention to Children's Health
March 18, 2010. The Government Accountability Office has issued a report critical of the lack of focused attention by the Environmental Protection Agency on children's health risks. GAO concludes that "EPA has developed policies and guidance to consider children, but it has not maintained attention to children through agency strategies and priorities. In 1996, EPA created a national agenda on children's health, and its 1997 and 2000 strategic plans highlighted children's health as a key cross-agency program. As a result, the agency's research advanced the understanding of children's vulnerabilities. However, EPA has not updated the agenda since 1996, and the focus on children is absent from the 2003, 2006, and September 2009 draft strategic plans." (GAO report summary, p.1) The report goes on to make a number of recommendations for improvement at EPA as well as calling on Congress to reinstate a cross-government task force on children's environmental health. GAO Director of Natural Resources and Development, John B. Stephenson, testified about the GAO findings before the Senate Committee on Environment and Public Works on March 17.
   Access the GAO report.
   Access the Stephenson testimony.

Common Core Standards Initiative Issues Draft K-12 Education Standards
March 10, 2010. A group created by the National Governors Association (NGA Center) and the Council of Chief State School Officers (CCSSO) called the Common Core Standards Initiative has released its draft K-12 education standards. Some forty-eight states, the District of Columbia, and three territories have joined in the process to create these standards which the Obama administration has already indicated may be helpful in creating nationwide evaluation standards. The CCSI will be taking public comments on the proposed draft through April 2.
   Access Draft Common Core Standards.
   Access the Common Core Standards Initiative Website.
   Access College and Career Readiness Standards.
   Access the U.S. Department of Education "Race to the Top" Website.

White Releases Health Care Proposal for Summit Discussion
February 22, 2010. The Obama administration has released its proposals for discussion at the bipartisan health care summit.
   Access the President's Proposal for Health Care Reform Website.
   Access the President's Proposal for Health Care Reform in .pdf file.

Proposed DSM 5 Revisions Posted for Comment
February 10, 2010. The American Psychiatic Association has published its "Proposed Draft Revisions to DSM Disorders and Criteria" on the association's DSM5 website. These are published for comment and will be open for comment until April 20, 2010. Publications of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is expected in May 2013.
   Access the American Psychiatric Association DSM 5 Development website with Proposed Changes.
   Access APA News Release on Proposed Changes.

Senate Passes Health Care Bill
December 24, 2009. The Senate approved H.R. 3590 by a vote of 60-39. The bill now goes to a long-awaited conference committee with House representatives.
   The House has already passed its version of health care legislation in H.R. 3962.
   Access H.R. 3590 as it passed the Senate.
   Access H.R. 3962 as it passed the House.

District Court Rules on Forest Grove Special Education Case After Supreme Court Decision
December 14, 2009. U.S. District Judge Michael W. Mosman has ruled on remand that a family that had taken the Forest Grove school district to the U.S. Supreme Court, seeking reimbursement for private school tuition because of its failure to qualify their son for an individual education program under the Individuals with Disabilities Education Act should not receive that money. News reports indicate that while the district did not have to pay some $65,000 in tuition and fees, it has spent nearly $500,000 in litigating the case thus far. For more information and links to the opinion and news article, go to the Oregon page of this website.

Native American Health Issues Raised at White House Tribal Nations Conference
December 2, 2009. .
   The House has already passed its version of health care legislation in H.R. 3962.
   Access President Obama's Message at the Opening of the Tribal Nations Conference.
   Access the Secretary of Interior's Statement to the Conference.
   Access President Obama's Message at the Closing of the Tribal Nations Conference.

Genetic Information Nondiscrimination Act Takes Effect
November 23, 2009. The Genetic Information Policy Act (GINA) took effect on November 21. For more information and access to key documents, see the Civil Rights page of this website.

U.S. Preventive Services Task Force Issues Controversial Recommendations
November 19, 2009. The U.S. Preventive Services Task Force (USPSTF) has issued a controversial set of new recommendations on breast cancer screening, including mammograms and self-examinations. The Secretary of Health and Human Services has indicated that there is no expected change in policy from the federal government as a result and a number of insurance companies have indicated their intention to support the existing policies. The following posts include the new recommendation summary and the articles and evidence issued in support. Also posted is the HHS Secretary's statement in response. Finally, there is the USPSTF website and the membership of the task force.
   Read the Recommendation Summary.
   Read the Supporting Article.
   Read the Evidence Update.
   Read the Previous Recommendation.
   Read the HHS Secretary's Statement in Response to the Recommendation.
   Access the Task Force Website.
   Access the List of Members of the Task Force.
   Access the Task Force Members' biographical sketches.

UNICEF Issues Report on Maternal and Child Nutrition
November 15, 2009. A report released this week by UNICEF warns of critical problems of malnutrition among children and their mothers The report, entitled Tracking Progress on Child and Maternal Nutrition: A Survival and Development Priority, warns that more than 200 million children under 5 suffer from chronic undernutrition and a third of all dealths of children under 5 result from that cause.
   Read the UNICEF Report.

Oregon Health Authority Announcement on Transition Rules and Procedures
November 13, 2009. The Oregon Health Authority has announced rulemaking processes for "Transition Period Roles & Responsibilities" and for Procedural Rules with hearings and comment deadlines set for December. For details and links to the Notices of Proposed Rulemaking go to the Oregon page of this website.

CPSC Issues Notice on Recall of Children's Toy for Lead Content
November 13, 2009. The Consumer Product Safety Commission has announced a voluntary recall by the MacPherson’s firm of Emeryville, CA of a product, manufactured in China, known as the Young Adult Easel. The CPSC announcement states that: "The chalkboard surface coating contains high levels of lead, violating the federal lead paint standard."
   The State of Oregon DHS has a website with information on Lead-related warnings and recalls.
   Access the CPSC Announcement.
   Access Oregon DHS Website on Lead-Related Warnings.

House Debates Health Care Legislation
November 7, 2009. The House of Representatives is now debating H.R. 3962 and a related bill which is the major health care legislation offered by House Democrats and related Medicare legislation
   Access the H.R. 3962.
   Access the H.R. 3921.

House Leaders Announce Consolidated Health Care Proposal
October 29, 2009. The Speaker of the House has announced a revised version of the House health care plan offered by the Democrats known as the Affordable Health Care for America Act.
   Access the Proposal As Announced by the Speaker on 10/29/2009.

GAO Releases Report on Higher Education and Disabilities
October 29, 2009. In response to a congressional request the Government Accountability Office has produced a report entitled Higher Education and Disability: Education Needs a Coordinated Approach to Improve It's Assistance to Schools in Supporting Students. Among other things, the report finds that: "In 2008, students with disabilities represented an estimated 11 percent oof all postsecondary students, and this population appears to have grown over the past decade." p. 8 The study also concludes that there are wide variations in the ways that universities and colleges address the support needs of these students whose challenges are significantly different in several respects from students at the primary and secondary level. The report calls for efforts to enhance communication and coordination across agencies to share information.
   Read the Report.

Major Oregon Health Policy and Administration Shift Moves to Implementation
October 17, 2009. The implementation process for H.B. 2009 which dramatically changed the organization and operation of health policy in the state is now underway. For details, organizational information, and implementation documents go to the Oregon page of this website.

U.S. EPA Provides Children's Health Resources
October 9, 2009. The U.S. EPA offers a website entitled "Protecting the Environment: Children's Health" with a wide range of materials and resources to address environmental threats to children's health. There is a separate page on "What You Can Do to Protect Children from Environmental Risks" available in Spanish, Chinese, Vietnamese, and Korean in addition to English. These and other materials are provided by the EPA's Office of Children's Health Protection.
   Access the U.S. EPA Protecting the Environment: Children's Health site.
   Access the What You Can Do to Protect Children from Environmental Risks page.
   Access the What You Can Do page in Spanish. Cómo Proteger a los Niños de los Riesgos Ambientales.
   Access the Office of Children's Health Protection website.

Baucus Bill Scheduled for Vote
October 8, 2009. Following an extended set of markup debates on the health care proposal offered by the Chair of the Senate Finance Committee, Max Baucus (D-MT), entitled the America's Healthy Future Act of 2009, the proposal will move to a committee vote on Tuesday, October 13. The proposal is very different from either the House proposals or the legislation that has passed out of the Senate Health, Education, Labor, and Pensions. The Senate Finance Committee Site presents the legislation and proposed amendments as well as financial estimates for consideration during markup. Those other pieces of legislation and related documents are provided in other entries on this web page. Also included is the Congressional Budget Office cost estimate for the Chairman's mark as amended.
   Access the Chairman's Mark as Amended as of October 2, 2009.
   Read Senator Baucus' press release on the legislation.
   Senate Finance Committee website on the legislation and amendments to it.
   Access Congressional Budget Office Cost Estimates for the Chairman's Mark as Amended.

Federal Court Finds New York in Violation of ADA and Section 504 for Institutionalization in "Adult Homes"
September 8, 2009. Judge Nicholas G. Garaufis of the U.S. District Court for the Eastern District of New York, citing Olmstead v. L.C., 527 U.S. 581 (1999), has issued a ruling in a case brought against New York officials by a disability advocacy group. His memorandum and order in Disability Advocates, Inc. v. Patterson, 03-CV-3209 (NGG), finds that "approximately 4,300 individuals with mental illness, are not receiving services in the most integrated setting appropriate to their needs," in violation of Title II of the Americans with Disabilities Act and Section 504 of the Rehabilitation Act of 1973. Slip opinion at 2-3. These individuals had been placed in so-called "adult homes" which are for-profit residences of some 120 clients each. The court found that the adult homes do not "'enable interactions with nondisabled persons to the fullest extent possible,' especially compared to supported hoursing." Id. at 12. This case involved 28 adult homes in New York City had more than 100 residents and seven of which had over 200. These are, the court found, institutions which segregate individuals with mental illness from others and are treated in virtually all respects as if they were institutionalized in a mental institution. Judge Garaufis has ruled that the plaintiffs are entitled to injunctive relief, but did not issue a remedial order at this time. (NOTE: This is a 210 page opinion and a substantial .pdf file.)
   Read the opinion.

GAO Issues Report on Teacher Preparation for Working With Children with Disabilities
August 18, 2009. The Government Accountability Office has issued a report entitled "Multiple Federal Education Offices Support Teacher Preparation for Instructing Students with Disabilities and English Language Learners, but Systematic Departmentwide Coordination Could Enhance this assistance." The report examined available federal programs, but also followed through with field studies in four states. The results show varied standards and training. The Department of Education has accepted the recommendations from the study and is considering mechanisms for coordination across teacher preparation programs.
   Read the GAO report.

Judge Orders Disclosure of Documents that Show Supportive Journal Articles Ghostwritten for Drug Company
August 5, 2009. Judge William R. Wilson of the U.S. District Court for the District of Arkansas Western Division has issued an order unsealing material that was provided in discovery in a case against a drug manufacturer in which there are allegations that the company employed ghostwriters for articles published in medical journals supporting the use of hormone replacement therapy. The Public Library of Science (PLOS) and the New York Times intervened in the case, In re Prempro Products Liability, MDL Docket No. 4:03CV1507WRW, seeking to have the material unsealed. The court granted the motion to intervene and for disclosure, setting aside the designation of the material by the company as "confidential." The New York Times has published some of the released materials on its website.
   Read the Court's Order Granting Discovery of Ghostwritten Material.
   Read PLOS Memorandum in Support of its Motion to Intervene and to Unseal.
   Access copies of the released documents on ghostwritten articles via the New York Times.

President Commits U.S. to Sign U.N. Convention on the Rights of Persons with Disabilities
July 26, 2009. President Obama has issued a proclamation commemorating the enactment of the American with Disabilities Act (ADA), proclaiming July 26 to be the anniversary of the Act, and committing the U.S. to sign the U.C. Convention on the Rights of Persons with Disabilities.
   Read the Proclamation on the Anniversary of the Americans with Disabilities Act.
   Acces U.N. Enable, the Website on the Convention on the Rights of Persons with Disabilities.
   Read Convention and Optional Protocol.

Health Bill Passed Out of House Committee
July 19, 2009. The recently introduced health care bill, H.R. 3200 (see full information below) passed the House Education and Labor Committee (26-22) and has been referred to the House Oversight and Government Reform and House Budget Committees.
   Access the House Education and Labor Committee website on the bill .
   Read Committee Announcement of Amendments and Passage of the Bill.

New Health Care Plan Introduced in House and Senate Committee Moves on Bill
July 15, 2009. Representatives Henry Waxman, Chair of the House Energy and Commerce Committee, Charles Rangel, Chair of the House Ways and Means Committee, and George Miller, Chairman of the House Education and Labor Committee, have introduced H.R. 3200 America's Affordable Health Choices Act of 2009. The Senate Committee on Health, Education, Labor, and Pensions passed out of committee the Affordable Health Choices Act which is the Senate version of the legislation that Senators Edward Kennedy, Chris Dodd, and Tom Harkin are moving in that body. While the bill has passed out of committee, it does not yet have a Senate bill number. The Obama Administration announced support for the legislative action. (NOTE: The files are substantial for the legislation. The House version is 1,017 pages in length and the Senate 615 pages.)
   Read the bill text.
   Access the Bill Summary.
   Access the House Committee on Energy and Commerce website on the legislation with additional information.
   Read the Senate Committee Press Release with Section by Section Analysis of the Bill.
   View the Senate Committee Markup of the America's Affordable Health Choices Act.
   Read the Senate Bill.
   Read the White House release on the House bill.
   Read the White House release on the Senate Committee Action.

Obama Administration's Food Safety Working Group Announces Proposed Actions
July 8, 2009. The Food Safety Working Group, created by President Obama in March, has issued findings and an indication of forthcoming steps to be taking primarily by the Department of Agriculture and the Department of Health and Human Services to address concerns over the safety of the food supply.
   Read the White House press release on the announcement of the FSWG findings and proposed actions.
   Read FSWG "Key Findings" document.
   Access FSWG Fact Sheet.
   Access the Food Safety Working Group website.
   Read President's Statement on Creation of the FSWG.
   Access the FDA Final Rule on Egg Safety.

Supreme Court Issues Major Ruling Limiting Remedial Authority of Federal Courts in Arizona English Language Learners Case
June 26, 2009. A sharply divided Supreme Court has issued an opinion in Horne v. Flores, a case that originally came from English language instruction in the school district of Nogales, Arizona. However, the focus of the case as it came to the Supreme Court was not on ELL, but actually on the judge's continuing rulings about the remedy for the problem. As the Justice Alito put it, writing for the majority, "the question at issue in these cases in not whether Arizona must take 'appropriate action' to overcome the language barriers that impede ELL students. Of course it must. But petitioners argue that Arizona now is fulfilling its statutory obligation by new means that reflect new policy insights and other changed circumstances." Slip opinion at 2.
   The court of appeals upheld the federal district court's actions in the face of demands by some state officials, most notably the Superintendent of Public Instruction and the Speaker of the House and President of the Senate of the Arizona legislature, that the court should end its role in the case. Ironically, the State of Arizona and the Arizona State Board of Public Education filed a brief in support of the family in the case, as did a number of the state's other school districts. The United States filed as amicus curiae also in support of the family.
   The Supreme Court, in an opinion by Justice Alito for a five person majority found that the judge had indeed exceeded his authority. Four justices dissented in an opinion written by Justice Breyer. The importance of the case as a precedent for the future is more about the manner in which judges exercise remedial authority in cases than it is just about the particular facts of the Arizona dispute. The Court's language warns judges in "institutional reform" cases to return control to state and local officials as soon as possible once there is a remedy in place or circumstances have changed. The majority found that, in this case, the lower court did not "fairly consider" the changes that had taken place in the education policy that gave rise to the legislation. However, writing for the dissenters, Justice Breyer disputed both the Court's interpretation of the law governing the judge's remedial authority and the facts of the case. He argued that the focus of the case in the lower court at the time of this ruling was not on how to teach ELL students, but whether the state and school district had provided the resources essential to meet the conditions that were central to the ELL problem in the first place and the proposed state and local response to it. As to the majority's application of a new standard, he warned: "insofar as the Court goes beyond the technical reord-based aspects of this case and applied a new review framework, it risks problems in future cases. The framework it applies is incomplete and lacks clear legal support or explanation. And it will be difficult for lower courts to understand and apply that framework, particularly if it rests on a distinction between 'institutional reform litigation' and other forms of litigation." Slip opinion at 44. And to the degree it meant to be an even wider statement, there are additional difficulties. "[T]he Court may mean its opinion to express an attitude, cautioning judges to take care when the enforcement of federal statutes will impose significant financial burders upon states. An attitude, however, is not a rule of law. . . . I do not see how this Court can now require lowere court judges to take yet greater care, to proceed with even greater caution, while at the same time expecting those courts to enforce the statute as Congress intended. " Id. at 44-45.
   Both the majority's discussion of the law that must control efforts by lower courts to remedy civil rights violations and the focus on limiting judicial rulings affecting financial aspects of the problem are likely to be broadly applicable to a variety of cases involving state institutions and services.
   Read the Horne v. Flores opinion.
   Read the oral argument transcript.
   Read the Brief for Petitioner Horne, State Superintendent of Public Instruction.
   Read the Brief for Petitioner, Speaker of the Arizona House.
   Read Brief for Respondents State of Arizona and Arizona State Board of Education.
   Read Brief for Respondent Flores.
   Read Brief of the United States as Amicus Curiae in support of Repondent.

Supreme Court Decides Forest Grove IDEA Challenge
June 23, 2009. The Supreme Court has rejected the claim that the Individuals with Disabilities Education Act (IDEA) bars suits by parents to reimburse costs of private tuition if the child had not been receiving special education services in the public schools. The case arose came from Forest Grove, Oregon where a family sought reimbursement for tuition for sending their child to a private school. The district argued that the family had acted unilaterally and in the absence of a finding of eligibility for IDEA services. The parents contended that they had repeatedly tried to get the district to recognize and address their son's disabilities. The case is Forest Grove School District v. T.A., No. 08-305. The United States filed an amicus brief in support of the family, arguing that the fact that the student had not been receiving IDEA services before his removal to the private school was irrelevant.
   Read the Supreme Court Opinion.
   Read the oral argument transcript.
   Read Brief for Petitioners.
   Read the Brief for Respondents.
   Read the Brief Amicus Curiae of the U.S..

Legislature Passes Health Care Bills
June 12, 2009. The Oregon legislature has passed H.B. 2116 designed to increase the number of children covered under state health care programs and provide for revenue measures to support that program and H.B. 2009 which reorganizes health care administration and deals with insurance premium rates. The bills are much more complex than this brief comment suggests. The governor has lauded both measures and his signature is expected shortly.
   Access H.B. 2009.
   Access H.B. 2116.

Obama Administration Establishes Office of Health Reform
April 10, 2009. The President has issued an executive order, creating an Office of Health Reform in the Executive Office of the President. The order calls upon that new office to "provide leadership to the executive branch in establishing policies, priorities, and objectives for the Federal Government's comprehensive effort to improve access to health care, the quality of such care, and the sustainability of the health care system." The order also directs the Secretary of Health and Human Services to establish a similar office in that agency to coordinate with the White House office.
   Access the Executive Order.

National Institute for Early Education Research (NIEER) Releases State of PreSchool Report Report
April 8, 2009. The National Institute for Early Education Research (NIEER) at Rutger's University has issued its report entitled The State of PreSchool 2008: State Preschool Yearbook which provides a national summary of the Pre-K education situation in the U.S. and state by state data as well. The report's authors are W. Steven Barnett, Ph.D., Dale J. Epstein, Ph.D., Allison H. Friedman, Ed.M., Judi Stevenson Boyd, Ed.M., and Jason T. Hustedt, Ph.D. The full report is a large file, but pieces can be downloaded from the report homepage.
   Access the Report homepage.
   Access the Executive Summary.
   Access the full Report.

Senate Finance Committee Hearings on Health Care Reform in FY 2010 Proposal and Beyond
March 10, 2009. One of the important ways in which health care reform is being address in policymaking is through discussions on the fiscal 2010 budget proposal. Today's hearing focused on proposals in President Obama's FY 2010 budget proposal focused on testimony by Office of Management and Budget director Peter Orszag. The committee will hold hearing on March 12 on "Workforce Issues in Health Care Reform." The committee provides live streaming video and audio from its hearings website. See link below.
   The Senate Finance Committee has held a series of hearings over the past year on key aspects of health reform and health care finance. Topics included: "Health Care Reform: An Economic Perspective," "High Health Care Costs: A State Perspective," "Covering the Uninsured: Making Health Insurance Markets Work," "Aligning Incentives: The Case for Delivery System Reform," "Improving Health Care Quality: An Integral Step Toward Health Reform," "Health Benefits in the Tax Code: The Right Incentives," and "The Right Care at the Right Time: Leveraging Innovation to Improve Health Care Quality for All Americans." Links to the testimony and records for those hearings are provided below.
   A focus of the current hearings and some of the previous hearings as well is the work of the Dartmouth Center for Health Policy Research. The report that was the central focus of the current hearing was entitled "The Policy Implications of Variations in Medicare Spending Growth." A paper from that research was published in the New England Journal of Medicine by Elliott S. Fisher, Julie P. Bynum, and Jonathan S. Skinner and entitled "Slowing the Growth of Health Care Costs: Lessons From Regional Variation." The link to the Dartmouth Center and to the NEJM article are provided below.
    Link to Senate Finance Hearings Page for Video and Audio as well as links to individual hearings..
    Access Testimony and Materials for The President’s Fiscal Year 2010 Health Care Proposals.
    Access Testimony and Materials for Workforce Issues in Health Care Reform.
    Access Testimony and Materials for Health Care Reform: An Economic Perspective .
    Access Testimony and Materials for High Health Care Costs: A State Perspective .
    Access Testimony and Materials for Covering the Uninsured: Making Health Insurance Markets Work.
    Access Testimony and Materials for Aligning Incentives: The Case for Delivery System Reform.
    Access Testimony and Materials for Improving Health Care Quality: An Integral Step Toward Health Reform.
    Access Testimony and Materials for Health Benefits in the Tax Code: The Right Incentives.
    Access Testimony and Materials for The Right Care at the Right Time: Leveraging Innovation to Improve Health Care Quality for All Americans.
    Access Testimony and Materials for The President's Fiscal Year 2010 Health Care Proposals.
    Access the Darmouth Center for Health Policy Research.
    Access the Dartmouth Report "The Policy Implications of Variations in Medicare Spending Growth."
    Access the New England Journal Of Medicine Study "Slowing the Growth of Health Care Costs: Lessons From Regional Variation."

House Voting on FY09 Omnibus Spending Package
February 26, 2009. The House of Representatives has passed H.R. 1105, the Omnibus Appropriations Act, 2009. This bill seeks to wrap up the budget for the current fiscal year which is presently on a continuing resolution scheduled to terminate on March 6. It is another very large omnibus bill.
   Access H.R. 1105.

OMB Issues Implementation Guidance for the Stimulus Package
February 23, 2009. The Office of Management and Budget has issued a memorandum to executive agencies and departments entitled "Initial Implementing Guidance for the American Recovery and Reinvestment Act of 2009.
   The House and Senate passed the American Recovery and Reinvestment Act of 2009 and it has been signed by the president as P.L. 111-5. The final bill is a modified version of the Collins-Nelson Amendment (570) which was an amendment in the nature of a substitute which completely replaced the legislation that previously passed theU.S. House of Representatives. The GPO has not yet published P.L. 111-5 in public law format, but the law is available in the bill number format as adopted by both houses and signed by the president.
   Access the OMB Initital Implementation Guidance.
   Access the bill as passed by the house and Senate.

CMS Projects Major Increase in Public Spending as Leading Health Spender
February 26, 2009. A recent CMS study suggests that public spending for total health care will account for more than half of all spending by 2016.
   Access NHE Projections 2008-2018 Report.
   Access CMS Press Release on Medicaid Projections report.
   Access CMS Medicaid Projections.

Three Rulings Against Claims that Vaccine Caused Autism
February 12, 2009. Three federal special masters for the U.S. Court of Federal Claims have ruled against parties who claimed that vaccines administered to children caused autism and other conditions. Three different special masters in the three different cases ruled that the parties had failed to demonstrate that the vaccines caused their children's medical conditions. The decision in the Cedillo case concluded that: "The overall weight of the evidence is overwhelming contrary to the petitioners' causation theories." (Emphasis in original) Slip opinion, at p. 172.
   Access the Cedillo v. Secretary of Health Human Services ruling.
   Access ruling in Hazlehurst v. Secretary of Health and Human Services.
   Access ruling in Snyder v. Secretary of Health and Human Services.

President Obama Signs SCHIP Bill into Law and Rescinds Bush Administration Restriction
February 6, 2009. Congress has passed and president has signed H.R. 2, the Children's Health Insurance Program Reauthorization Act of 2009 with amendments. Immediately thereafter, the president issued a memorandum calling upon the Centers for Medicare & Medicaid Services (CMS) of the Department of Health and Human services withdraw a policy letter initially issued by the George W. Bush administration on August 17, 2007 and reissued on May 7, 2009 concerning requirements for states that sought to expand coverage.
   The earlier policy was posted on this page at the time of its issuance in 2007 with the following information. Dennis G. Smith, Director of the Center for Medicaid and State Operations, issued a letter on August 17, 2007 to state directors of State Childrens' Health Insurance Programs (SCHIP) that placed conditions on the discretion of the states to increase SCHIP coverage over 250 percent of the poverty level that included requirements for proof that those covered have been uninsured for at least a year and that "Monitoring and verification must include information regarding coverage provided by a noncustorial parent." (See letter p. 2.) The letter also required the states to provide "Assurance that the State has enrolled at least 95 percent of the children in the State below 200 percent of the FPL who are eligible for either SCHIP or Medicaid (including a description of the steps the State takes to enroll these eligible children." It also mandated "Assurance that the number of children in the target population insured through private employers has not decreased by more than two percentage points over the prior five year period." (Id.) These actions were explained in the letter by the administration's efforts to avoid "crowd out" actions in which public coverage is allegedly crowds out private alternatives. (NOTE: The 2007 letter is still on the CMA website as of the date of this posting, but is likely to be taken down soon in response to the president's memorandum.)
   Access the H.R. 2.
   Access the Presidential Memorandum of February 6, 2009.
   Read the August 21, 2007 letter.

FDA Releases Inspection Report on Peanut Problem
January 30, 2009. The Food and Drug Administration has released its inspection report on the Peanut Corporation of America's Blakely, Georgia facility that has been linked to a serious salmonella outbreak. It has also established a webpage with a variety of documents on the outbreak and the peanut products linked to it.
   Access the FDA inspection report
   Access the FDA page on the salmonella outbreak and the peanut products associated with it.

Institute of Medicine Issues Global Health Report
January 26, 2009. The Institute of Medicine has issued a report entitled The U.S. Comitment to Global Health: Recommendations for the New Administration. The report is available free of charge at the site indicated below.
   Former Surgeon General Richard H. Carmona testified in July 2007 before a House committee concerning political interference in the operation of his office, including allegations of efforts to block presentation of medically significant information on political grounds by political appointees without expertise in the field. One of the specific examples was a 2006 draft "Surgeon General's Call to Action on Global Health." That draft report was made available via the Washington Post website. No final Surgeon General's Call to Action on Global Health was issued.
   . Read the Draft 2006 Surgeon General Call to Action on Global Health via the WashingtonPost site.
   . Read IOM U.S. Comitment to Global HealthReport.

Health Policy Legislation Introduced as Oregon Legislature Begins Work
January 16, 2009. Two significant pieces of health related legislation have been introduced as the Oregon legislative session gets underway. The first, H.B. 2009, is a broad proposal for health care reform. The second, H.B. 2347, addresses a variety of issues associated with the powers of clinician regulatory bodies. For links to these bills, go to the Oregon page of this website.

FDA Inspector General Finds a Lack of Adequate Conflict of Interest Information for Clinical Trial Investigators
January 12, 2009. The Inspect of the Food and Drug Administration has issued a report indicating that the agency has not collected and investigated conflict of interest information that is required to be obtained and produced by sponsoring organizations of new drugs or medical devices concerning possible conflicts of interests in those persons who are involved in conducting clinical trials prior to FDA approval.
   Access the FDA IG Report.

GAO Reports on Local and State Government Fiscal Challenges from Health Care Issues
November 19, 2008. The Government Accountability Office has provided testimony to the Senate Finance Committee on the threats to state and local government fiscal well-being from health care costs. Stanley Czerwinski, Director of the GAO Strategic Issues unit provided evidence to Congress that "Rapidly rising health care costs are not simply a federal budget problem. Growth in health-related spending also drives the fiscal challenges facing state and local governments. The magnitude of these challenges presents long-term sustainability challenges for all levels of government." Summary p. 1. The testimony provides an analysis on long -term and as well as near-term issues.
   Read the GAO testimony.

Agency for Healthcare Research and Quality Show Continuing and Growing Problems
October 20, 2008. The Agency for Healthcare Research and Quality has published its reports on 2007 data. The National Health Disparities 2007 Report shows worsening trends across a range of measures for many minorities. The National Healthcare Quality 2007 Report shows that quality is improving but that the rate of improvement is declining.
   Access National Health Disparities 2007 Report in .pdf.
   Access National Healthcare Quality Report for 2007.

Mental Health Parity Act Passes as Part of Bailout Bill
October 9, 2008. When Congress passed and the president signed the Emergency Economic Stabilization Act, H.R. 1424, they also included the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. The legislators chose to use that bill for a variety of procedural reasons to be the vehicle to carry the bailout package. That is why the mental health legislation is actually buried in Subtitle B, of Title V, of Division C of the new legislation which now carries the proper designation of P.L. 110-343. The easy way to find it is to click on the link below and then use you Adobe search tool and type in mental health. It will get you to the mental health parity part.
   Access P.L. 110-343.

GAO Reports Major Gaps in Dental Care for Children
September 24, 2008. The Government Accountability Office has issued a report entitled "Extent of Dental Disease in Children Has Not Decreased, and Millions Are Estimated to Have Untreated Tooth Decay" which indicates a serious lack of dental care particularly for children not covered by private insurance. "Nationally representative data from the 2004 through 2c005 MEPS survey -- which asks participants about the receipt of dental care for household members -- indicate that only one in three children in Medicaid ages 2 through 18 had received dental care in the year prior to the survey. Similarly, about one in eight children reportedly never sees a dentist. More than half of children with private health insurance, by contrast, has received dental care in the prior year. Children in Medicaid also fared poorly when compared to national benchmarks, as the percentage of children in Medicaid who received any dental care -- 37 percent -- was far below the Healthy People 2010 target of having 66 percent of low-income children under age 19 receive a preventive dental service." Report summary, p. 1.
   Access the report.

Congress Passes the ADA Amendments Act of 2008
September 19, 2008. Congress has passed and President Bush has promised to sign S3406, the ADA Amendments Act of 2008. The legislation was designed to reverse a number of U.S. Supreme Court rulings that limited eligibility for Americans with Disabilities Act protections and a variety of other purposes.
   Read S. 3406 as approved by the House and Senate.

Consumer Product Safety Improvement Act of 2008 Becomes Law
August 28, 2008. Congress has enacted and the president has signed H.R. 4040, the Consumer Product Safety Improvement Act of 2008 which is now P.L. 110-314. The new statute responds to broad criticism of the Consumer Product Safety Commission and the fact that the agency lacked authority and resources to do its work. The criticism and congressional investigations followed revelations of numerous toys and other children's products that were imported into the U.S. from China with high lead levels. The new legislation not only reauthorizes the CPSC and makes changes to the commission's authority and operations, but Title I of the act, entitled Children's Product Safety also specifically addresses a range of issues concerning toys and other products designed for children, including "Children's products containing lead; lead paint rule; Mandatory third party testing for certain children's products; Tracking labels for children's product; Standards and consumer registration of durable nursery products; Labeling requirements for advertising toys and games; Mandatory toy safety standards; Study of preventable injuries and dealths in minority children related to consumer products; and Prohibition on sale of certain products containing specified phthalates."
   Read H.R. 4040.

Inspector General Finds that Its Contractor Found that a HHS Contractor Missed Errors
August 26, 2008. The Office of Inspector General of the U.S. Department of Health and Human Services has released a report assessing error rates in inappropriate payments for durable medical equipment in which it found inappropriate payments by the Centers for Medicare and Medicaid Services (CMS). In addition to the substantive findings, it is interesting to note that the Inspector General hired its own contractor to assess the work of the contractor hired by CMS to check for errors in CMS payment programs. The HHS IG concluded that "Based on the 20 errors that both the CERT contractor and KePRO found and the additional 73 errors that KePRO found, we estimated that the error rate in the FY 2006 CERT DME sample was 28.9 percent." Id., p. 2. For further information and link to the HHS IG report see the Public Contract Management page of this website.

GAO Examines Transition Issues for Young Adults with Mental Illness
June 30, 2008. The U.S. Government Accountability office has issued a report on transition challenges for young adults with serious mental illness entitled Young Adults with Serious Mental Illness: Some States and Federal Agencies Are Taking Steps to Address Their Transition Challenges. The report looked into programs in four states and the federal government designed to address the special needs of these young adults.
    The GAO study published in 2006 is still an interesting and useful document in its own right in discussing challenges of coordination of transition services at the state and federal levels. That report stemmed from a conference convened by GAO to examine challenges in transitions for youth with disabilities to work or postsecondary education at the state and local level which used California as a case study.
   Access June 2008 GAO report on transition and serious mental illness.
    Read the GAO 2006 Transition Report.

Genetic Information Nondiscrimination Act of 2008 Signed Into Law
May 28, 2008. Congress has passed and the president has signed H.R. 493, the Genetic Information Nondiscrimination Act of 2008. One title of the act addresses discrimination by insurance companies on the basis of genetic information and the other major title deals with disrimination by employers based on genetic information about employees.
   Access H.R. 493.

Oregon LEND Program Multilingual Resources on Disabilities Page
May 28, 2008. Trainees in the Oregon LEND (Leadership Education for Neurodevelopmental and Related Disabilities) program have created a multilingual web resource on disabilities and development.
    Access the LEND site.

D.C. Circuit Strikes Rules that U.S. Paper Currency Violates the Rehabilitation Act
May 20, 2008, 2008. The U.S. Circuit Court of Appeals for the D.C. Circuit has ruled that the current manner in which U.S. paper money violates Section 504 of the Rehabilitation Act of 1973. The panel ruling rejects the position of the Department of the Treasury that the fact that all bills are the same size does not violate the statute because of the difficulties faced by blind or severely visually impaired persons in using the money. Even if it does, Treasury argued, the judiciary should limit its response because of the costs and burdens imposed in changing the paper currency. However, the D.C. Circuit panel rejected both arguments.
   Access the opinion.

Legislation Introduced to Increase Regulation of Human Growth Hormone
March, 2008. Following on recent publicity about the abuse of human growth hormone, legislation has been introduced to add this drug to Schedule III of the Controlled Substances Act. The legislation was introduced by Representative Stephen Lynch (D, MA). The House Government Oversight Committee, Chaired by Henry Waxman (D, CA), held hearings in February on the "Myths and Facts about Human Growth Hormone, B-12, and Other Substances. These hearings are also related to other hearings on the use of performance enhancing substances in sports. The proposed legislation and the video or transcripts of the February hearing are provided below.
   Access H.R. 4911.
   Access House Oversight Committee Hearing.

FDA Publishes Guidance on Publicity by Drug Companies of Off-Label Uses of Drugs
February 16, 2008. The Food and Drug Administration has published a proposed new guidance document on the ways in which drug companies can use reprints from existing journal articles to promote off-label uses of currently licensed drugs. The FDA accounced this proposed guidance on its website on February 15, but publication is still pending in the Federal Register.
   Read the Press Release.
   Read the Proposed Guidance in the Federal Register.
   Read the Proposed Guidance as published on the FDA website.

Administration Medicaid Rule to Eliminate Key Reimbursable Expenses to Schools for Children Disabilities
February 3, 2008. The administration has issued a final rule that prohibits reimbursements to school districts for special transportation for children with special needs, the costs of enrollment of those children in Medicaid and related programs, and for service coordination. The rule was to go into effect in February but Congress placed a moratorium on it until June. Action is also being taken in Congress to invoke the Congressional Review Act, but the joint resolution required by that legislation to block the rule faces a veto threat.
   Read the Medicaid final rule.

Study Points to Genetic Findings on Chromosome 16 and Autism
January 10, 2008. The New England Journal of Medicine has published online an article by researchers for the Autism Consortium. The article entitled, "Association between Microdeletion and Microduplication at 16p11.2 and Autism," by Lauren A. Weiss and colleagues, presents findings about a relationship between some persons with autism and a Chromosome 16 issue.
   Access the article.

Oregon Supreme Court Rules on OHSU Liability Cap
January 8, 2008. The Oregon Supreme Court has issued its long awaited ruling in the case testing the validity of the Oregon Tort Claims Act liability cap asserted by Oregon Health Science University. The provision was challenged under Article I, Section 10 of the state constitution. For more information a link to the opinion, click on the Oregon page of this website.

Head Start Program Reauthorized
December 13, 2007. The Congress has passed and the president has signed the "Improving Head Start for School Readiness Act of 2007," H.R. 1429. The president praised the fact that the bill "increased competition among Head Start providers, improved coordination of early childhood delivery systems, and stronger educational performance standards." He was not happy that it authorized more funds and that it did not provide for faith-based provider hiring autonomy.
   . Access H.R. 1429.
   Access the President's statement on signing H.R. 1429.

Congress and President at Deadlock Over Health Spending Continues
December 13, 2007. President Bush has vetoed H.R. 3963, the "Children's Health Insurance Program Reauthorization Act of 2007 which is the latest effort by Congress to reauthorize the SCHIP program. The last effort, H.R. 3043, the "Labor, Health and Human Services, and Education, and Related Agencies Appropriations, 2008" was vetoed by President Bush in November. At this point the relevant agencies are operating under continuing resolutions. At this point it is not clear whether the administration and congressional leaders will resolve this matter through negotiations or whether there will be an omnibus spending bill adopted later. The following links take the teader to the both versions of the legislation as they passed both houses of the Congress and to the veto messages issued by President Bush.
   . Access H.R. 3963.
   . Access the President's veto message on H.R. 3963.
   . Access H.R. 3043.
   . Access the President's veto message.

Urban Indian Health Commission and Robert Wood Johnson Foundation Issue Report "Invisible Tribes" Report
December 5, 2007. The Urban Indian Health Commission has issued a report entitled Invisible Tribes: Urban Indians and Their Health in a Changing World. With chapter on "A Population in Crisis; Urban Indian access to Health Care; Challenges in data Collection; Depression among Urban Indians; Type 2 diabetes among Urban Indians; Cardiovascular disease among Urban Indians; and Models of success, the report offers a variety of findings regarding a population often ignored in discussions of health disparities.
   Access the Report

National Early Intervention Longitudinal Study Published
November 29, 2007. The National Early Intervention Longitudinal Study was published in 2007. The study, entitled Early Intervention for Infants and Toddlers with Disabilities and their Families: Participants, Services, and Outcomes, tracked 3,338 children who entered early intervention between September 1997 and November 1998. The study identifies the key questions for the study as follows: "Who are the children and families receiving EI services? What EI services do participating children and families receive? What are the costs of the EI services? What outcomes do participating children and families experience? How do outcomes relate to variations in child and family characteristics and services received?" The study was funded by the Office of Special Education Programs of the U.S. Department of Education and conducted by SRI International in collaboration with the Frank Porter Graham Child Development Institute at the University of North Carolina Chapel Hill, RTI International, and the American Institutes for Research. SRI International.
   . Access the NEILS Report.
   . Access the NEILS Website.

GAO Issues Report on VA Health Care Contracting
October 31, 2007. The Government Accountability Office has issued a report to the Chair and Ranking Member of the House Veterans' Affairs Committee entitled "VA Health Care: Status of Inspector General Recommendations for Health Care Services Contracting." The report examines the recommendations made by the VA Inspector General for fiscal years 2004, 2005, and 2006. For more information and a link to the report see the Public Contracting Management page of this website.

National Academy Releases PTSD Report
October 19, 2007. The Committee on Treatment of Posttraumatic Stress Disorder of the National Academy, Institute of Medicine's Board on Population Health and Public Health Practice has issued a report entitled Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence. The report, requested by the Veterans Administration, assesses existing evidence on treatments for Post-Traumatic Stress Syndrome in the wake of national debate on services available to returning veterans of the Iraq and Afghanistan wars.
   . Access the PTSD report.

Government Accountability Office Publishes Study of Pediatric Drug Research
October 19, 2007. The U.S. Government Accountability Office has published a study of the experience thus far under the 2002 Best Pharmaceuticals for Children Act. The legislation was enacted because of the fact that most drugs prescribed for children were only tested on adults.
   . Access the GAO report.

President Vetoes SCHIP Reauthorization Act
October 3, 2007. President Bush has vetoed the SCHIP reauthorization bill H.R. 976. He asserted in part that: "If this bill were enacted, one out of every three children moving onto government coverage would be moving from private coverage." He also claimed that the bill would not produce enough revenue to support the expanded coverage of SCHIP.
   . Read the president's veto message.
   . Read H.R. 976.

GAO Provides Report on Federal Global Health -- Infectious Disease Surveillance Programs
October 4, 2007. The Government Accountability Office has issued a report on the operation of the four major U.S. global health -- infectious disease surveillance programs, including Global Disease Detection (CDC); the Field Epidemiology Training Programs (CDC, USAID); Integrated Disease Surveillance and Response (WHO's Regional Office for Africa with CDC and USAID); Globale Emerging Infections Surveillance and Response System (DOD) .
   . Access the GAO Global Health report.

U.S. Government Accountability Office Holds Forum on Moderning Federal Disability Policy
August 13, 2007. The U.S. GAO has published the highlights of a forum entitled "Moderning Federal Disability Policy" that was convened in April of this year and involved representatives of some twenty federal agencies operating programs concerned with persons with disabilities.
   . Read the GAO Forum HIghlights.

Federal Appeals Court Rejects Demands by Terminal Patients for Access to Research Drugs
August 8, 2007. A panel of the U.S. Circuit Court of Appeals for the D.C. Circuit rejected a challenge to the Food and Drug Administrations restrictions on experimental drugs where those seeking the medications are under a terminal diagnosis. In affirming the district court ruling, the D.C. Circuit panel concluded: "that there is no fundamental right 'deeply rooted in this Nation's history and tradition' of access to experimental drugs for the terminally ill." The challenges had argued that there is such a right and that it is protected by the due process clause of the Fifth Amendment.
   . Read the Abigail Alliance v. von Eschenbach.

GAO Finds Loss of Coverage for Patients Believed Qualified Under Citizenship or Immigration Status Proof Requirements
July 29, 2007. The Government Accountability Office has issued a report finding that significant numbers of persons whom the state governments considered should have been eligible under the proof of citizenship of immigration status requirements imposed on Medicaid by the Deficit Reduction Act of 2005 could not receive benefits because of problems of proof and implementation issues. States reported significantly increased costs and difficulties with particularly burdensome requirements of the statute and implementing regulations such as the requirements "(1) that documents must be originals and (2) the list of acceptable documents was complex and did not allow for exceptions."
   . Read the GAO Report.

Oregon and Other State Education Departments Develop New IDEA Rules Based on New U.S. Department of Education Regulations.
May 17, 2007.Oregon and other state education departments are completing rulemaking processes to put in place new rules, following the issuance in August of 2006 by the U.S. Department of Education of final regulations implementing the Individuals with Disabilities Education Improvement Act of 2004.
    Access the U.S. Department of Education IDEA regulations.
    Access the 2004 IDEA Legislation.
    Access the Oregon Department of Education IDEA page Regarding Rulemaking.
    Read Oregon Proposed IDEA Rules.
    Read current Oregon IDEA rules OAR 251-015.

GAO Finds More Work Still Needed on FDA Postmarket Drug Assessments
May 10, 2007. The U.S. Government Accountability Office has issued the second in a series of reports on improvements needed in the Food and Drug Administrations processes for postmarket assessment of drugs. While the report finds progress underway in three areas of its previous recommendations, there is still work to be done as well as a need for careful implementation of the recent initiatives at the regulatory agency.
   Read the GAO Report.

Report Finds One in Five Latinos in the U.S. Faces Food Insecurity
December 20, 2006. The National Council of La Raza has issued a report entitled Sin Provecho: Latinos and Food Insecurity. Among the conclusions reached by the report is the finding that: "Nearly one in five Latinoes (19.6%) faces food insecurity each year, which compromises their health and well-being. If the trends of food insecurity within the Latino community persist, the impact of insufficient nutrition will greatly increase the risk that the next generation will become even less healthy." p. iii.
   Read full report.
   Read the executive summary.

Senator Wyden Proposes National Health Care Policy
December 14, 2006. Senator Ron Wyden (D-OR) has announced a broad new national health policy proposal that he has entitled the Healthy Americans Act to be introduced in the new Congress. In announcing the proposal, Wyden indicated that the plan will "guarantees private health care coverage that cannot be taken away for all Americans; provides benefits for all Americans equal to those of Members of Congress; provides incentives for individuals and insurers to focus on prevention, wellness and disease management; provides tough cost containment and saves $1.48 trillion over 10 years; and is fully paid for by spending the $2.2 trillion currently spent on health care in America." Press Release at URL below.
   Read the press release.
   Read the "Cost and Coverage Estimates" for the Wyden proposal.
   Read the Full Text of the proposed Healthy Americans Act
   Read a "Section by section explanation of the legislation."

Oregon Senate Interim Commission on Health Care Access and Affordability Announces Plan to Introduce a Comprehensive Health Plan for the State in the Upcoming Legislative Session
December 14, 2006. The Senate Interim Commission on Health Care Access and Affordability created by Oregon Senate President Peter Courtney held a news conference recently to announce a plan for a comprehensive health care program for the state. A formal report has not yet been issued, but members of the commission announced that a bill would be forthcoming in time for the upcoming state legislative session.
   Read Senator Courtney's Release at Creation of the Interim Commission.
   Read the Portland Oregonian article announcing the Commission's proposal.

Institute of Medicine "Future of Drug Safety" Report Challenges Food & Drug Administration Practice
September 23, 2006. The Institute of Medicine is releasing a study entitled the "Future of Drug Safety: Promoting and Protecting the Health of the Public" that criticizes the Food & Drug Administration's drug oversight activities. This report follows on a lengthy period of criticism of FDA practices that has been intensified as a number of high visibility lawsuits have suggested a series of issues first with the licensing of drugs, but later and more particularly with the lack of monitoring of evidence showing serious problems in previously licensed drugs. As the executive summary of the report indicates; "In response to growing public concern with health risks posed by approved drugs, the FDA had requested that the IOM concene an ad hoc committee of experts to conduct an independent assessment of the current system for evaluating and ensuring drug safety postmarketing and make recommendations to improve risk assessment, surveillance, and the safe use of drugs." Executive Summar, S-3. The study was done at the request of the FDA Acting Commissioner. The study group was called the "Committee on the Assessment of the U.S. Drug Safety System." The executive summary of the report is available in a standard pdf format while the full report is only available at present for purchase on the IOM website. However, it can be read chapter by chapter without charge on the site. The Committee has also published online a report brief entitled ""The Future of Drug Safety: Action Steps for Congress."
   Read the executive summary of the Institute of Medicine Report.
   Read the report brief "Action Steps for Congress."
   Read the full Institute of Medicine Report Chapter by Chapter.
   Read the FDA Acting Commissioner's Press Release in Response to the IOM Study.

U.S. Department of Education Inspector General Issues Report Critical of the Department's Administration of the "Reading First" Program
September 24, 2006. The Department of Education Inspector General has issued a report sharply critical of the administration of the "Reading First" program. Among other things, the IG found that the program's administrators "Developed an application package that obscured the requirements of the statute; Took action with respect to expert review panel process that was contrary to the balanced panel composition envisioned by Congress; Intervened to release an assessment review document without the permission of the entity that contracted for its development; Intervened to influence a State's selection of reading programs; and Intervened to influence reading programs being used by local educational agencies (LESs) after the application process was completed. These actions demonstrate that the program officials failed to maintain a control environment that exemplifies management integrity and accountability." The Reading First Program's Grant Application Process: Final Inspect Report at 2.
   Read the IG Report.

GAO Reports Vulnerabilities in Medicare and Medicaid Data Networks
September 6, 2006.The Government Accountability Office has issued an additional report on vulnerabilities in data communications networks for Medicare and Medicaid both with respect to the agencies themselves and contractors. This comes as these agencies are seeking to increase networked operations.
    Read the GAO Report.

Federal Report Identifies Concerns with Medicare, Medicaid, and Tricare contractors Outsourcing to Offshore Operations Involving Health Care Records
September 6, 2006.The Government Accountability Office has issued a report on the fact that many of these programs have outsourced services with organizations that, in turn, have outsourced some aspects of their work to offshore firms such that health care records are placed at risk for breaches of privacy. The report is entitled, Privacy: Domestic and Offshore Outsourcing of Personal Information in Medicare, Medicaid, and TRICARE. The GAO then notes that: "In responding to our survey, over 40 percent of the federal contractors and state Medicated agencies reported that they experienced a recent privacy breach involving personal health information. By survey group, 47 percent of Medicare Advantage contractors reported privacy breaches with the past 2 years, as did 44 percent of Medical agencies, 42 percent of Medicare FFS contractors, and 38 percent of TRICARE contractors." (p. 5.)
    Read the GAO Report.

GAO Issues Report on Implementation of National Health IT Policy
September 1, 2006.The Government Accountability Office has issued its latest report on progress toward implementation of the National Health IT policy which is a priority of the Bush administration. The report finds that the Office of the National Coordinator for Health IT and HHS have made progres and have awared contracts in five areas of the policy effort: "(1) defining certification criteria for and certifying electronic health records, (2) identifying interoperability standards to facilitate the exchange of patient data, (3) defining requirements for the development of prototypes for the Nationwide Health Information Network, (4) addressing privacy and security issues associated with the nationwide exchange of health information, and (5) taking steps to integrate public health into a nationwide health information exchange." (Health Information Technology, p. 2)
    Read the GAO Health IT Report.

Oregon Department of Human Services Issues Medicaid Citizenship Verification Policy
August 8, 2006. The Oregon Department of Human Service has issued policy guidance to Medicaid services as to the way in which the citizenship verification requirements of the Deficit Reduction Act will be implemented in the state beginning on September 1, 2006. (CAF -- Children, Adults, and Families] [SPD Seniors and People with Disabilities]
    "CAF Child Welfare Policy and Procedures."
    "CAF Self-Sufficiency Policy and Procedures".
    "SPD Policy and Procedures."
    " Process Flow Chart."
    "Questions and answers."

GAO points to a Need for Coordination in Federal Autism Program Activities
August 8, 2006. The Government Accountability Office has published a report on federal autism programs in which is indicates that there a number of useful programs and increased resources to support them operated by such federal agencies as HHS, the Department of Education, CDC, and NIH. However, GAO also contends that more effective coordination is needed among those agencies, nothwithstanding the fact that interagencies committees already exist. The DOEd and HHS disagree with GAO's assessment, but the report provides an interesting study of coordination issues in this complex field.
    Read the GAO Federal Autism Activities Report.

New Medicaid Proof of Citizenship Requirements Go Into Effect July 1
June 30, 2006. The new policy requirement poof of citizenship to obtain Medicaid benefits goes into effect on July 1, presenting a wide variety of challenges to service providers and state agencies. These requirements originated with the Deficit Reduction Act of 2005 (DRA) P.L. 109-171, actually passed earlier this year. The Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services has posted policy guidance and related materials for those who must participate in implementing the new law. In particular, CMS has issued a June 9 policy letter to state Medicaid directors that specifies the requirements and the acceptable forms of identification and a "fact shee" to add further explanations. A reading of the policy guidance letter and examination of the charts provided in it provides and indication of some of the many complexities that will be involved in implementing the law.
    Access the citizenship requirement portion of the Deficit Reduction Act
    Access the CMS Guidance Letter of June 9, 2006 explaining the policy.
    Access the CMS Fact Sheet on the citizenship identification policy.

U.S. GAO Publishes Report on Transition from Secondary School to Work or Postsecondary Education for Youth with Disabilities
June 22, 2006. The U.S. Government Accountability Office has published a report on findings and recommendations from a conference convened by GAO to examine challenges in transitions for youth with disabilities to work or postsecondary education at the state and local level. The conference was held in San Francisco and used California as a case study. "First, they noted that the education system as they experience it in California does not provide adequate training in vocational and life skills or transition preparation for students with disabilities. While acknowledging the importance of academic studies, the panelists noted that for those youths who will not pursue postsecondary education, there are few vocational programs in high school and inadequate time during school to study vocationald and life skills. Second, panelists indicated that lack of coordination and differences in program structure between organizations responsible for assisting these youths hind the seamless provision of services." p. 3 The brief report (only 27 pgs) was prepared for the Senate Health, Education, Labor, and Pensions Committee and the House Committee on Education and the Workforce as well as the House Rules Committee.
    Read the GAO Transition Report.

Institute of Medicine Issues Reports Finding the Nation's Emergency Room Care In Critical Condition
June 14, 2006. The Institute of Medicine has issued three reports on the dramatically stressed condition of the nation's emergency medical services. These reports were produced by the Committee on the Future of Emergency Care in the United States Health System created by the Institute in 2003. While the first of the reports has drawn considerable media attention, the reports are best understood together. The third report specifically addresses emergency services for children and considers "The role of pediatric emergency services as an integrated component of the overall health system; System-wide pediatric emergency care planning, preparedness, coordination, and funding; Pediatric training in professional education; and Research in pediatric emergency care."
    Access the "Hospital-Based Emergency Care: At the Breaking Point" Report.
    Access the "Emergency Medical Services At the Crossroads" Report.
    Access the "Emergency Care for Children: Growing Pains" Report.

"Lessons Learned for Protecting and Educating Children after the Gulf Coast Hurricanes"
May 11, 2006. The Government Accountability Office has issued a report on concerning the lessons that were learned about protecting children from the experiences of the Hurricanes that struck the Gulf Coast in the fall of 2005. This brief report provides a number of thought-provoking findings such as: (1) the four states hit by the hurricanes had high rates of children in poverty, ranging from 20.5% to 27%; (2)2,000 of Louisiana's foster children were displaced by the hurricanes of whom 370 were displaced outside the state; (3) 900 employees of the Louisiana Deparment ot Social Services were diverted to emergency shelters for five weeks and only then were able to return to full-time child welfare assignments; and (3) 29 Louisiana schools "were destroyed and half of the state's schools were damaged" while for Mississippi "29 schools were destroyed."
    Read the GAO Report.

CDC's National Center on Birth Defects and Developmental Disabilities Releases Autism Report
May 5, 2006. The CDC has released its MMWR (Morbidity and Mortality Weekly Report) which provides results of recents studies on autism entitled "Parent-Reported Estimates of Autism Prevalence." The report was released in a webcast yesterday. The CDC Autism Research Fact Sheet notes that: This study presents parent-reported data from two national surveys. Estimates of diagnosed autism were 5.7 per 1,000 school-aged children from the National Health Interview Survey and 5.5 per 1,000 school-aged children from the National Survey of Children's Health. Together, these two national surveys of parents suggest that at least 300,000 school-aged children had autism in 2003-04." (Autism Research Fact Sheet, p. 1)
    MMW Report for May 5 containing the Autism Study.
    Read the Autism Research Fact Sheet.
    Read the Fact Sheet: MMWR -- Parental Report of Diagnosed Autism in Children Aged 4-17 Years, United States, 2003-2004"

GAO Report Raises Questions About the Role of Infant Formula Advertising in Level of Breastfeeding for Mothers in the WIC Program and Those Who Are Not
Fenruary 9, 2006. The Government Accountability Office has issued a PowerPoint report to Congress considering several questions raised recently regarding the relationship between rates of breastfeeding as encouraged by Healthy People 2010 and the marketing of infant formula. Specifically the study considered: "(1) What are the estimated breastfeeding rates for infants in the general population and for infants on WIC, and how do these rates compare to recommended breastfeeding rates? (2) How is infant formulat market to women in general and to women on WIC in particular? (3) What is known about the impact of infant fomular marketing on the breastfeeding rates of women in the general population and women on WIC?" (p.2)
    Read the GAO Report.

Government Accountability Office Report Raises Concerns About Lack of Testing to Protect Against Children's Exposure to Lead in Drinking Water
January 26, 2006. After elevated levels of lead were found in the drinking water in Washington, D.C., Congress asked he U.S. Government Accountability Office (GAO) to do a national study to determine whether there were risks that children might be exposed to lead in their drinking water. The GAO has published a report calling upon the U.S. Environmental Protection Agency to do more to ensure protection against such exposures, particularly with respect to schools and day care facilities. While the GAO found that the EPA reported progress in eliminating lead from drinking water over the years, there had been little reporting of any systematic test results from the states to the federal regulator. "On the basis of the limited data available, it appears that few schools and child care facilities have tested their water for lead, either in response to the Lead Contamination Control Act of 1988 or as part of their current operating practices. In addition, no focal point exists at either the national or state level to collect and analyze test results. Thus, the pervasiveness of lead contamination in the drinking water at schools and child care facilities -- and the need for more concerted action -- is unclear." Highlights, p. 1.
    Read the GAO Report.

U.S. Supreme Court Decides Two Important Health Care Related Cases
January 20, 2006. The U.S. Supreme Court has handed down rulings in two recent cases that are important for health care. The first opinion rejected the claims by the U.S. Attorney General to authority under the Controlled Substances Act to block the Oregon Death With Dignity act. The second recognized the challenge to the New Hampshire parental notification law in abortion cases because it lacked exceptions for situations involving serious health risks to the patient, but narrowed the authority of courts in fashioning a remedy for that problem which struck down the entire statute.
   Read the Opinion in the New Hampshire Case.
   Read the Death with Dignity Opinion.

Government Accountability Office Releases Study on the Implementation at the State Level of the Family, Infant, Toddler Program with Oregon as a Primary Research Site
December 14, 2005. The U.S. Government Accountability Office (GAO) today released a study on the implementation of the Family, Infant, Toddler program, Part C of IDEA, at the state level with attention to variations among states and also attention to transitions from FIT program to the Part B program in schools. While the study draws on nation-wide data, it is primarily based on on-site studies in seven states of which Oregon was one. The study provides a good deal of useful descriptive information on FIT as well as interesting comparisons of differences in program operation across states. "GAO recommends that Education provide states with additional guidance on transition planning and services, especially for children who would enter Part B during the summer." Summary, p. 1.
    Read the GAO Study.

NIH Announces Study Challenging Presumed Unwillingness of Minorities to Participate in Health Studies
December 6, 2005. The NIH has just announced that a group of researchers, David Wendler, Raynard Kington, Jennifer Madans, Gretchen Van Wye, Heidi Christ-Schmidt, Laura A. Pratt, Otis W. Brawley, Cary P. Gross, and Ezekiel Emmanuel has published a study entitled: "Are Racial and Ethnic Minoriies Less Willing to Participate in Health Research?" in the on-line journal PlosMedicine which concludes: "These findings . . . suggest that racial and ethnic minorities in the US are as willing as non-Hispanic whites to participate in health research. Hence, efforts to increase minority participation in health research should focus on ensuring access to health research for all groups, rather than changing minority attitudes." p. 1.
    Access the article in pdf format.
    Access the article in html.

U.S. Supreme Court Rules that the Burden of Proof in IDEA Hearings Rests on the Family Challenging an IEP
November 14, 2005. Writing for the majority in Shaffer v. Weast Docket No. 04-698, Justice Sandra O'Connor rejected a call by parents that the burden of proof in a due process hearing challenging the adequacy of an Individual Education Plan under the Individuals with Disabilities Education Act (IDEA) should be on the school district. Justices Breyer and Ginsburg dissented.
    Read the Schaffer v. Weast Opinion.

U.S. Education Departmet Issues Guidance on New or Changed Elements in Reauthorized IDEA.
October 13, 2005. The U.S. Department of Special Education Office of Special Education Programs has published guidancde materials on processes and requirements that have changed under the provisions of the reauthorized IDEA enacted last December (see item below on New IDEA rules). They are relatively brief documents and do not provide the full language of the statute or the rules, but indicate the agency's understanding of new directions. There are a variety of items here that are very new and will likely surprise those who have been involved with IDEA programs in one way or another previously. One of the key features of the new approach by the DOE is to integrate IDEA implementation with the No Child Left Behind initiatives.
   "Alignment with the No Child Left Behind Act" Read the Document.
   "Changes in Initial Evaluation and Reevaluation" Read the Document.
   "Children Enrolled by Their Parents in Private Schools" Read the Document.
   "Discipline" Read the Document.
   "Disproportionality and Overidentification" Read the Document.
   "Early Intervening Services" Read the Document.
   "Highly Qualified Teachers" Read the Document.
   "Individualized Education Program (IEP), Team Meetings and Changes to the IEP" Read the Document.
   "Individualized Education Program (IEP)" Read the Document.
   "Local Funding" Read the Document.
   "National Instructional Materials Accessibility Standard (NIMAS)" Read the Document.
   "Part C Amendments in IDEA 2004" Read the Document.
   "Part C Option: Age 3 to Kindergarten Age" Read the Document.
   "Procedural Safeguards: Surrogates, Notice and Consent" Read the Document.
   "Procedural Safeguards: Mediation and Resolution Sessions" Read the Document.
   "Procedural Safeguards: Due Process Hearings" Read the Document.
   "Secondary Transition" Read the Document.
   "State Funding"
   Read the Document.
   "Statewide and Districtwide Assessments" Read the Document.

U.S. Department of Education Has Already Opened and Closed Opportunities for Input on New IDEA rules.
October 6, 2005. The U.S. Department of Education published notice of proposed rulemaking for rules to implement the Individuals with Disabilities Education Act (IDEA), reauthorized by Congress late last fall, on June 21, 2005 in the Federal Register. It then set a closing date for comments and participation of September 6, less than 60 days after the publication of the notice. The public meetings that were scheduled to discuss the notice of proposed rulemaking took place in only 7 cities, including D.C. and began on June 17, before the publication, and ended with a meeting in D.C. on July 12, a surprisingly short period for a policymaking action as complex and significant as this one.
   The legislation was signed on December 3, 2004. The agency gave notice on December 29 that it would hold public meetings in January and February about the new law. However, it did not publish its notice of proposed rulemaking until June 21.
   Read the Notice of Proposed Rulemaking.
   Read the Individuals with Disabilities Improvement Act of 2004

U.S. Surgeon General Issues Call to Action document to "Improve the Health and Wellness of Persons with Disabilities"
October 6, 2005. The U.S. Surgeon General has issued one of the Call to Action documents sometimes issued by that office. This one focuses on current findings about and strategies for improving the health and wellness of persons with disabilities.
    Read the Call to Action document

GAO Reports Health Care Access Problems in the Indian Health Service
October 6, 2005. The Government Accountability Office has reported that there are a number of factors making access to health care difficult for Native Americans, even at Indian Health Service facilities.
    Read the GAO report

Budget and Finance

White House Announces FY2016 Budget Proposal
February 2, 2015. The White House has released the President's budget request for FY 2016. Along with the full budget request and the budget overview document, the White House has issued the "Cuts, Consolidations, and Savings for FY 2016" document, the "Analytic Perspectives" document which provides the economic and policy assumptions behind the budget, agency by agency fact sheets, and the "Appendix" which is the document that contains the very detailed information on agency budgets and funds.
   Also posted below are thebudget-in-brief documents which contain detailed program by program information for the Department of Health and Human Services, Department of Education, and the Environmental Protection Agency.
   Access the President's message to accompany the FY2016 Budget.
   Download the FY 2016 Budget proposal as a single .pdf document.
   Download the FY 2016 Budget Overview.
   Download the FY 2016 Budget Website with Individual Agency Budget proposals.
   Access the Cuts, Consolidations, and Savings for FY 2016
   Access the Web Site for the FY2016 Budget Appendix -- All detailed information about agencies and funds.
   Access the FY 2016 Budget Analytic Perspectives document (economic and budget assumptions).
   Access the U.S. Department of Education, Fiscal Year 2016 Budget Summary and Background Information.
   Access the U.S. Department of Health and Human Services, Fiscal Year 2016 Budget-in-Brief.
   Access the U.S. Environmental Protection Agency, Fiscal Year 2016 Budget-in-Brief. Not Yet Available
   Access USASpending.gov

Disability Law

Americans with Disabilities Act
U.S. Department of Justice ADA page provides a great deal of information on the act and regulation.
    Access the DOJ page on the Americans with Disabilities Act
    Read the ADA

Individuals with Disability Education Act
   Read P.L. 108-446 the Individuals with Disabilities Improvement Act of 2004

The Developmental Disabilities Assistanceand Bill of Rights Act of 2000 (DD Act)
   Read the DD Act

Rehabilitation Act of 1973
   Read the Act.

Health Insurance Portability and Accountability Act (HIPAA)
U.S. Department of Health and Human Services has a website with a range of resources on HIPAA law, regulations and guidance documents.
    Access the HHS website on HIPAA
    Access the HIPAA
    Read the HIPAA Regulatons.

Constitution of the United States
   Access the U.S. Constitution via Cornell Legal Education Insittute.

Executive Orders
   Executive Order 13160 To Prohibit discrimination because of "Race, Sex, Color, National Origin, Disability, Religion, Age, Sexual Orientation, and Status as a Parent in Federally Conducted Education and Training Programs"
   Read EO 13160.
   Executive Order 13145 [.pdf format] To Prohibit Discrimination in Federal Employment Based on Genetic Information
   Read EO 13145
   Executive Order 13166 Required Access to Federally Funded Programs for Persons With Limited English Proficiency
   Read EO 13166

Cultural Competency and Equity Issues in Disability and Development Policy

Oregon LEND, OIDD, and CDRC Provide Multi-Lingual Web Resources Site for Disabilities Questions
    The Oregon Leadership Education for Neurodevelopmental and Related Disabilities (LEND), the Oregon Institute on Disability and Development, and the Child Development and Rehabilitation Center of Oregon Health Sciences University have provided a website that features multilingual resources that provide information on a wide range of disabilities.
   Access the multilingual resources page.

National Standards for Culturally and Linguistically Appropriate Services in Health Care
    The national standards for culturally and linguistically appropriate services in health care were developed and explained in detail in the Final Report: National Standards for Culturally and LinguisticallyAppropriate Services in Health Care issued by the U.S. Department of Health and Human ServicesOffice of Minority Health in March 2001. (Note: it is easiest to download the file and then open it offline.} The standards themselves are provided on the website of the Office of Minority Health.
   Access the CLAS Standards National Standards for Culturally and LinguisticallyAppropriate Services in Health Care.
   Access the Final Report.
   Access the Oficina de Salud de law Minorías en español.

Addressing Language Access Issues in Your Pratice: A Toolkit for Physicians and Their Staff Members, from the California Academy of Family Physicians
   The California Academy of Family Physicians has created a website to assist clinicians in understanding and addressing issues of culturally competent care. Part of that site is a "toolkit" for dealing with language issues in practice and also a document offered by Molina HealthCare and the California Academy on the problems of medical jargon and the difficulties that poses for clear communications.
    Access the Multicultural Health Site.
    Access the California Medical Leadership Council on Cultural Proficiency site.
    Access the Toolkit.
    Access Medical Jargon & Clear Communication.

National Center for Cultural Competency
   Georgetown University Center for Child and Human Development (one of the University Centers for Excellence in Developmental Disabilities See AUCD below under Professional Associations and Family Support Organizations)).
   Access the National Center for Cultural Competency Site.
   Access the National Center for Cultural Competency Site, en espanol Language.

Health Resources and Services Administration (HRSA) Cultural Competence Resources for Health Care Providers
    Access the HRSA Cultural Competency Site.
    Access the HRSA "Indicators of Cultural Competence in Health Care Delivery Organizations: An Organizational Cultural Competence Assessment Profile."
    Access the HRSA "And the Journey Continues... Achieving Cultural and Linguistic Competence in Systems Serving Children and Youth with Special Health Care Needs and their Families."

Oregon LEND (Leadership Education for Neurodevelopmental and Related Disabilities) Multilingual Resources on Disabilities Page
    Access the LEND site.

Medline
    Medline en español.
    Medline in English.

KidsHealth.org for "Parents"
    KidsHealth.org en español.
    KidsHealth.org in English.

MCHB Maternal and Child Health Bureau
    MCHB Health Resources en español.
    MCHB Health Resources in English.

Oregon Health Sciences University Center for Research on Occupational and Environmental Toxicology
    OHSU CROET
    Recursos en español

U.S. Department of Education, Office of Special Education and Rehabilitation, Resources/Publications
    Publications
    Recursos en español

National Council on Disabilities Studies and Resources for Native American Communities
    Access the 2004 Summary of the Native American Forum: "Disability Matters in Tribal Communities".
    People with Disabilities on Tribal Land: Education, Health Care. Vocational Rehabilitation, and Independent Living.
    Understanding Disabilities in American Indian and Alaska Native Communities:Toolkit Guide.

Proceedings of the Oregon Cultural Competency Summit
   Access the Summit Report

Environmental Health Issues in Disability and Development

University of California at Berkeley Center for Children's Environmental Health Research
    US Berkeley Center for Children's Env. Health

Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS)/El Centro de Evaluación de la Salud de las Madres y los Niños de Salinas
    CHAMACOS in English
    Educational Materials in English
    CHAMACOS en español
    Material Educativo en español

Center for Children's Environmental Health, University of California, Davis
    UC Davis Center for Children's Env. Health.

U.S. Environmental Protection Agency Children's Environmental Health Centers
    EPA CEHC

U.S. National Institute of Environmental Health Sciences, Centers for Children's Environmental Health & Disease Prevention Research
    NIEHS Centers Children's Environmental Health & Disease Prevention Research
    NIEHS
    Health & Education Materials
    Kid's Pages

Oregon Health Sciences University Center for Research on Occupational and Environmental Toxicology
    OHSU CROET
    Recursos en español

U.S. Centers for Disease Control, Environmental Health
    CDC Environmental Health Website
    CDC en español
    National Agricultural Safety site
    Recursos en español
    Health & Education Materials

U.S. Agency for Toxic Substances & Disease Registry
    ATSDR
    STSDR en español

"Toxic Children 2006" Report Issued Causing Concern and Rapid Official Response in Canada"
June 2, 2006. A Canadian environmental group issued a report this week entitled "Polluted Children, Toxic Nation: A Report on Pollution in Canadian Families (2006)." It reported the results of a study carried out to determine the current levels of environmental pollutants in children. Although it was a very small study, the number of chemicals found in these otherwise healthy young people caused alarm and prompted Health Canada to promise that a study would be done next year on 5,000 Canadians. The current study indicated an average of 23 toxic chemicals in the children tested, including PCBs that had been banned in Canada three decades ago. The release of the findings prompted the Ministers of Health and Environment to agree to participate as subjects in the study.
    Read the "Polluted Children Report.

Governmental Bodies in Disability and Development Policy

Civil Rights Division, U.S. Department of Justice
The Civil Rights Division of the U.S. Department of Justice has a number of responsibilities in the area of disabilities. It also provides an online quarterly news source.
    http://www.usdoj.gov/crt/
    Access the "Disability Rights Home Page."
    Access the "Disability Rights Online News."

Administration on Developmental Disabilities (ADD)
The ADD is part of the Administration for Children & Families of the U.S. Department of Health and Human Services.
    http://www.acf.hhs.gov/programs/add/

Agency for Healthcare Research and Quality (AHRQ)
The AHRQ, among other things, publishes the National Health Care Disparities Report.
    AHRQ Home Page.
    Access National Health Care Disparities Report 2006.

National Institute of Mental Health
The ADD is part of the Administration for Children & Families of the U.S. Department of Health and Human Services.
    http://www.nimh.nih.gov/

DisabilityInfo.gov
This site is operated by the president's New Freedom Initiative.
    http://www.disabilityinfo.gov/digov-public/public/DisplayPage.do%3fparentFolderId=500

Title V Block Grant Programs for State for Mothers, Infants, Children, Adolescents, and Children with Special Health Needs
Title V programs are administered by the Maternal and Child Health Bureas of the U.S. Department of Health and Human Services.
    http://mchb.hrsa.gov/programs/default.htm

National Council on Disability
    http://www.ncd.gov/

U.S. Department of Education, Office of Special Education and Rehabilitation
    http://www.ed.gov/about/offices/list/osers/osep/index.html

Health Resources and Services Administration (HRSA)
    Access the HRSA Site.

Maternal and Child Health Bureau (MCH)
    http://mchb.hrsa.gov/

Oregon Institute on Disability & Development
The Institute is part of the Child Development and Rehabilitation Center of the Oregon Health and Sciences University (OHSU).
   http://www.ohsu.edu/oidd/

National Center on Birth Defects and Developmental Disabilities
The Center is part of the U.S. Centers for Disease Control (CDC).
   http://www.cdc.gov/ncbddd/default.htm

State Councils on Developmental Disabilities
These are state councils whose members are appointed by the governors that receive financing through Subtitle B of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (DD Act). The U.S. Administration on Developmental Disabilities explains that: "State Councils pursue systems change (e.g., the way human service agencies do business so that individuals with developmental disabilities and their families have better or expanded services), advocacy (e.g., educating policy makers about unmet needs of individuals with developmental disabilities), and capacity building (e.g., working with state service agencies to provide training and benefits to direct care workers) to promote independence, self-determination, productivity, integration and inclusion of people with developmental disabilities in all facets of community life.
   http://www.acf.dhhs.gov/programs/add/states/ddcs.html

Oregon Council on Developmental Disabilities
One of the state councils on developmental disabilities.
   http://www.ocdd.org/

Professional Assocations and Family Support Organizations in Disability Policy

Association of University Centers on Disabilities
   http://www.aucd.org/

University Centers for Excellence in Developmental Disabilities Education, Research, and Service (UCEDs)
   http://www.acf.dhhs.gov/programs/add/states/ucedds.html

OHSU Global Health Center
   Access the Global Health Center Home Page.

Data Resource Center for Child & Adolescent Health
   Access the homepage.

Family Voices
   http://www.familyvoices.org/
   Access the Family Voices "Title V Tookkit" for families

The Sibling Support Project
"The Sibling Support Project is a national effort dedicated to the life-long concerns of brothers and sisters of people who have special health, developmental, or mental health concerns."
   http://www.siblingsupport.org/

The ARC
"The Arc is the national organization of and for people with mental retardation and related developmental disabilities and their families. It is devoted to promoting and improving supports and services for people with mental retardation and their families. The association also fosters research and education regarding the prevention of mental retardation in infants and young children."
   http://www.thearc.org/about.htm

Sources on Children and Environmental Health
EnviroHealthAction, operated by Physicians for Social Responsibility.
   http://www.envirohealthaction.org/children
Children's Environmental Health Network.
   http://www.cehn.org/
Children's Health Enviornmental Coalition.
   http://www.checnet.org/

DisabilityCompass.org
Disabilitycompass.org is an information site operated by Community Vision, Inc., of Portland, OR. The organizations describes its site as follows: "Disability Compass is a web-based resource center containing disability-related information and referrals. This site has been specifically crafted to serve Oregonians with disabilities and their families."
   http://www.disabilitycompass.org/

Native American Youth and Family Center
   Access the NAYFC Homepage

Disability Policy and Terms Glossary

U.S. Department of Health and Human Services Glossary of Terms in Disability, Aging, and Long Term Care
    Connect to HHS Glossary