The Individuals with Disabilities Education Act (IDEA): Selected Judicial Developments Following the 2004 Reauthorization

Nancy Lee Jones
Legislative Attorney

The Individuals with Disabilities Education Act (IDEA) is the major federal statute for the education of children with disabilities. IDEA both authorizes federal funding for special education and related services and, for states that accept these funds, sets out principles under which special education and related services are to be provided. The cornerstone of IDEA is the principle that states and school districts make available a free appropriate public education (FAPE) to all children with disabilities. IDEA has been the subject of numerous reauthorizations; the most recent reauthorization was P.L. 108-446 in 2004. Congress is currently beginning the process of identifying potential issues for the next reauthorization. Some of the issues raised by judicial decisions include the following:

• What amount of educational progress is required to meet FAPE standards? 
• What educational benefits are required to be put in an individualized education program (IEP)? 
• What use of seclusion and restraints is allowed (if any) under IDEA? 
• Are all settlement agreements enforceable in federal court or only those reached through dispute resolution or mediation? 
• Is information disclosed in a resolution session confidential? 
• What are the specific rights of a parent of a child with a disability? 
• What are the rights of a noncustodial parent of a child with a disability? 
• Does the Supreme Court’s decision in Schaffer v. Weast correctly allocate the burden of proof in IDEA cases? 
• Are compensatory educational services required for the same amount of time that the appropriate services were withheld? 
• Does the Supreme Court’s decision in Arlington Central School District v. Murphy correctly deny reimbursement for expert witness fees? 
• Does there need to be more detailed guidance on systemic compliance complaints? 

This report examines the Supreme Court decisions, and selected lower court decisions since July 1, 2005, the effective date of P.L. 108-446.


Date of Report: November 10, 2010
Number of Pages: 32
Order Number: R40521
Price: $29.95

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The Americans with Disabilities Act (ADA):Final Rule Amending Title II and Title III Regulations

Nancy Lee Jones
Legislative Attorney

The Americans with Disabilities Act (ADA) has as its purpose “to provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities.” On July 26, 2010, the 20th anniversary of the passage of the ADA, the Department of Justice (DOJ) issued final rules amending the existing regulations under ADA title II (prohibiting discrimination against individuals with disabilities by state and local governments) and ADA title III (prohibiting discrimination against individuals with disabilities by places of public accommodations). The new regulations for title II and title III are similar. They both adopt accessibility standards consistent with the minimum guidelines and requirements issued by the Architectural and Transportation Barriers Compliance Board (Access Board). In addition, the regulations include more detailed standards for service animals and power-driven mobility devices, ticketing, effective communication, and provide for an element-by-element “safe harbor” in certain circumstances. The regulations take effect March 15, 2011, but compliance with the 2010 standards for accessible design is not required until March 15, 2012. These final regulations only address issues that were in the 2008 notice of proposed rulemaking. DOJ has noted that it intends to engage in additional rulemaking in certain areas, including equipment and furniture, next generation 9-1-1, movie captioning and video description, and accessibility of websites operated by public entities or places of public accommodation.


Date of Report: November 2, 2010
Number of Pages: 9
Order Number: R41376
Price: $19.95

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Deadlines for the Secretary of Health and Human Services in the Patient Protection and Affordable Care Act (P.L. 111-148, PPACA) from Enactment to January 1, 2011

To:
The Honorable Tom Cobmn

The Honorable Orrin G Hatch

The Honorable John Cornvn

From:
Mark Newsom. Analyst in Health Financing, Coordinator

Curtis W. Copeland, Specialist in American National Government, Coordinator

CRS has issued a series of reports summarizing and analyzing the Patient Protection and Affordable Care Act (P.L. 111-148, PPACA), as amended. Many of PPACA's provisions identify the Secretary of Health and Human Services (hereafter referred to as the Secretary) as the responsible party for implementation and oversight. Generally, these provisions establish some discretionary authority for the Secretary and have flexible deadlines or no deadline at all, but some of the provisions require specific actions by the Secretary (e.g., promulgation of regulations) to be completed by a specific date. You have asked that CRS identify the provisions that require specific action by the Secretary with a specific deadline between March 23, 2010 (the date of enactment) and January 1, 2011. CRS did not therefore include deadlines imposed upon other individuals or organizations (e.g., the Comptroller General or Congress) and did not include any provisions that did not require the Secretary to take a specific action by a specific date.


Date of Report: October 1, 2010
Number of Pages: 8
Order Number: M-100110
Price: $19.95

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Variation in Analyses of PPACA’s Fiscal Impact on States

FROM:
Evelyne Baumrucker
Analyst in Health Care Financing  

Bernadette Fernandez
Specialist in Health Care Financing


TO:
General Distribution Memorandum

This congressional distribution memorandum, prepared to enable distribution to more than one congressional client, summarizes existing analyses of the impact of the new federal health reform law, the Patient Protection and Affordable Care Act (PPACA), on state costs. The memorandum identifies select coverage provisions (specifically Medicaid and private health insurance) that relate directly to state costs, and discusses the challenges to producing state-level estimates. Such challenges include the pre-reform variation across states; uncertainty about future federal guidance and regulations relating to health reform implementation; state decisions regarding such implementation; data issues; and other factors outside of the health reform law and its implementation.


Date of Report: September 8, 2010
Number of Pages: 16
Order Number: M-090810
Price: $29.95

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Accountable Care Organizations and the Medicare Shared Savings Program

David Newman
Specialist in Health Care Financing

The provision of health care in the United States has been described as fragmented, with patients seeing multiple unrelated providers. Fragmented care has been found to be, among other things, both costly, since provider payments are not linked to performance or outcomes and services can be duplicative, and of lower quality, since providers lack financial incentives to coordinate care. Section 3022 of the Patient Protection and Affordable Care Act (P.L. 111-148, PPACA), as amended, directs the Secretary of Health and Human Services (the “Secretary”) to implement an integrated care delivery model in Medicare, the Medicare Shared Savings Program, using Accountable Care Organizations (ACOs)—a model of integrated care formulated to reduce costs and improve quality.

ACOs are modeled on integrated delivery systems such as the Mayo Clinic, Geisinger Health System, Kaiser Permanente, and Intermountain Healthcare. While ACOs can be designed with varying features, most models put primary care physicians at the core, along with other providers, and emphasize simultaneously reducing costs and improving quality. The emphasis is on physicians rather than insurers or hospitals because physicians influence almost 90% of all personal health spending.

In the simplest case, the ACO contracts with payers to be accountable for the entire continuum of care provided to a defined population, and if the costs of care provided are less than targeted amounts, and certain quality measures are achieved, the ACO and the payer will share the savings generated. Under the Medicare Shared Saving Program, the Centers for Medicare & Medicaid Services (CMS) will contract for ACOs to assume responsibility for improving quality of care provided, coordinating care across providers, and reducing the cost of care Medicare beneficiaries receive. If cost and quality targets are met, ACOs will receive a share of any savings realized by CMS. The Congressional Budget Office scored the Medicare Shared Savings Program as reducing Medicare expenditures $4.9 billion in the FY2013 through FY2019 period.

PPACA Section 3022 leaves many of the design features to be determined by the Secretary, and regulations governing Medicare ACOs are expected in the fall 2010. As is often the case, the regulations will be fundamental to defining the program. For instance, while PPACA suggests a fundamental role in ACOs for physicians and providers, it does not guarantee one. In addition, PPACA leaves the contracting terms and beneficiary assignment rules to the Secretary. However, for Medicare beneficiaries, the Medicare Shared Savings Program will continue to allow Medicare beneficiaries enrolled in fee-for-service Medicare to continue to select any Medicare provider.

The Medicare Shared Savings Program is slated to begin January 1, 2012. While ACOs hold out the prospect of improving care, reducing costs, and raising quality, there are still gaps in knowledge of what existing ACOs have achieved and whether they can be widely replicated. Moreover, there may be unanticipated consequences from encouraging the formation of ACOs, such as further health provider market concentration, that could adversely affect efforts to control overall health costs. .


Date of Report: November 4, 2010
Number of Pages: 23
Order Number: R41474
Price: $29.95

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