FEDERAL DISABILITY POLICY FRAMEWORK: OUR NATION'S GOALS FOR PEOPLE WITH DISABILITIES INTRODUCTION A. BACKGROUND AND PURPOSE OF THE REPORT Society has historically imposed barriers-attitudinal barriers (such as fear, ignorance, prejudice, and stereotypes), physical barriers (such as architecture, transportation, and communication), and institutional barriers (such as policies, practices, and procedures), that subject persons with disabilities to lives of unjust dependency, segregation, exclusion, and paternalistic treatment.1 Sometimes these barriers are intentional; they are the result of deep-seated prejudice. More often, however, they are the result of thoughtlessness, indifference, and lack of understanding.2 In addition, our Nation's public policy is too often based on the "old paradigm" under which people with disabilities are perceived as "defective" and in need of "fixing." 3 Recognizing these barriers over the last quarter of a century, our Nation's policymakers have enacted new laws and amended existing laws designed to break down these barriers and replace them with ramps of opportunity for persons with disabilities.4 The centerpiece of this effort is the Americans with Disabilities Act of 1990 (ADA).5 The signing of the ADA on July 26, 1990 gave our country an omnibus civil rights statute, often referred to by Senator Tom Harkin (D. Iowa), chief sponsor of the ADA, as the "20th century emancipation proclamation for people with disabilities".6 The ADA, however, is more than a civil rights statute. From a Federal public policy perspective, the enactment of the ADA reflects a rejection of the "old paradigm" and an endorsement of the "new paradigm" of disability, which is based on a social construct that focuses on the functioning of the person with a disability in an environmental context. In other words, disability is a product of the interaction between characteristics of the individual (e.g., conditions or impairments, functional status, or personal or social qualities) and characteristics of the natural, built, cultural, and social environments.7 The ADA also articulates our Nation's goals regarding public policy relating to people with disabilities as: * Equality of opportunity * Full participation * Independent living * Economic self-sufficiency.8 The purpose of this paper is twofold. The first purpose is to describe the basic conceptual framework of Federal legislation affecting persons with disabilities and their families (the Federal disability policy framework). This framework consists of Federal civil rights statutes and disability-specific legislation that reflect our Nation's public policy goals relating to people with disabilities. The second purpose of this paper is to articulate general questions for analyzing the extent to which disability-specific and generic programs9 and policies reflect the Federal disability policy framework. In other words, the Federal disability policy framework described in this paper serves as a lens, guidepost, or benchmark for evaluating, expanding, and improving the design and implementation of public policies affecting persons with disabilities.10 This paper is targeted at five audiences. First, this paper provides Federal, State, and local policymakers with a conceptual framework for designing, implementing, and assessing the extent to which disability-specific and generic programs and policies reflect the Federal disability policy framework. Second, this paper provides researchers with a policy framework for studying the extent to which disability-specific and generic programs and policies reflect the Federal disability policy framework. Third, this paper provides individuals with disabilities, their families, and their representatives with tools that can be used to assess the adequacy of programs and policies developed at the Federal, State, and local levels from a disability policy perspective. Fourth, the document may be used by service providers to design, implement, and evaluate the delivery of services to persons with disabilities. Finally, this document may be helpful to university professors teaching courses that include disability policy. B. RESEARCH APPROACH AND ACTIVITIES The research methodology applied in developing the Federal disability policy framework involved a comprehensive review and analysis of authoritative materials on disability policy, including statutes, regulations, and legislative and regulatory histories. The purpose was to discern the fundamental values, principles, and policies inherent in these laws and regulations and the extent to which they are consistent with the fundamental goals of disability policy as articulated in the ADA. In order to validate the framework, analysis and interpretations were subject to peer review by key stakeholders in the outcomes of disability policy. This paper reflects input from many stakeholders, including policy makers at the Federal and State levels, researchers, persons with disabilities, their families and their representatives, service providers, and other experts in disability policy. C. REPORT STRUCTURE This report has nine sections. Throughout the paper, references are made to specific laws. These references are not intended to be exhaustive; rather they are intended to be illustrative of a particular point. The specific examples selected provide exemplary illustrations from various contexts e.g., civil rights, education, employment. Section I is the introduction. Section II describes the categories of laws affecting persons with disabilities. Section III describes statements of findings for key laws described in this report. Section IV describes statements of the core precept and overarching goals of disability policy as articulated in the Americans with Disabilities Act. Section V describes definitions of disability used to determine eligibility in various Federal policy frameworks. Section VI describes the core policies included in the Federal policy frameworks reflecting the goals of disability policy as articulated in the ADA. Section VII describes the methods for administration contained in these Federal policy frameworks designed to effectuate the core precept, goals, and core policies. Section VIII describes model support programs included in these Federal disability policy frameworks. Section IX is the conclusion. Using the Federal disability policy framework described in the other sections of the paper, this section includes general questions for analyzing the extent to which disability-specific and generic programs or policies reflect the precept, goals, definitions, and core policies, methods of administration, and program supports set out in Federal disability policy framework. In other words, this section of the paper serves as a lens, guidepost, or benchmark for evaluating, expanding, and improving the design and implementation of public policies affecting persons with disabilities. Appendix 1 sets out in a narrative outline form many of the key components of the Federal disability policy framework described in the main body of the paper. The Appendix also reiterates general questions for analyzing the extent to which disability-specific and generic programs and policies address the needs of persons with disabilities. The Appendix is designed for use as a free-standing document. Thus, the Appendix includes its own table of contents. Appendix 2 describes major disability-related legislation enacted between 1956 and 1999. Appendix 3 includes descriptions and references to websites for Federal disability-related legislation, regulations, and court cases. Appendix 4 includes a glossary of acronyms used throughout the paper. CATEGORIES OF LAWS AFFECTING INDIVIDUALS WITH DISABILITIES A. OVERVIEW Current laws affecting people with disabilities can be arranged into five general categories: 1) Civil rights statutes; 2) Entitlement programs; 3) Discretionary grant-in-aid programs; 4) Regulatory statutes; and 5) Miscellaneous category that includes appropriations, tax legislation, and loans. Some laws may be categorized in more than one way. For example, part B of the Individuals with Disabilities Education Act (IDEA) is both a civil rights statute and a discretionary grant-in-aid program. B. CIVIL RIGHTS STATUTES The first category of laws includes Federal civil rights statutes that prohibit covered entities (e.g., State or local governments, businesses) from discriminating against individuals on the basis of or by reason of disability. These laws are permanent in nature -- they do not expire as of a certain date. Federal agencies play a key role with respect to the administration of civil rights statutes, including policy development, complaint resolution, monitoring, and enforcement. Nothing in these Federal civil statutes preclude a State or local community from adopting additional protections. Examples of civil rights statutes include: * The Americans with Disabilities Act (ADA), which prohibits discrimination on the basis of disability in employment, public services (including transportation), public accommodations, and Telecommunications.11 * Section 504 of the Rehabilitation Act of 1973 (Section 504), which prohibits discrimination by recipients of Federal aid.12 * The Fair Housing Act of 1968 as amended in 1988, which extends the protections afforded by the legislation to people with disabilities.13 * Part B of the Individuals with Disabilities Education Act (IDEA), which guarantees all children with disabilities a free appropriate public education in accordance with the equal protection clause of the 14th Amendment to the U.S. Constitution.14 C. ENTITLEMENT PROGRAMS The second category of laws affecting people with disabilities is "open and close ended" entitlement programs. "Open-ended" entitlement programs guarantee eligible individuals a specified level of benefits. As more people become eligible for the program, costs automatically rise. These programs are often referred to as "mandatory spending" because Congress must appropriate sufficient funds to pay for the benefits. Examples include: * Title II of the Social Security Act authorizes a program of Federal disability insurance benefits for workers who have contributed to the Social Security Trust Fund and became disabled (or blind) before retirement age. Spouses with disabilities and dependent children of fully insured workers also are eligible for benefits upon the retirement, disability or death of the primary beneficiary. This program, which is commonly referred to as "the Social Security Disability Insurance" program (SSDI), is administered by the Social Security Administration.15 * Title XVI of the Social Security Act establishes the Supplemental Security Income (SSI) program, a Federally administered cash assistance program for individuals who are aged, blind, or disabled and meet a financial needs test (income and resource limitations).16 * Title XVIII of the Social Security Act establishes the Medicare program, which authorizes health insurance benefits for elderly persons and certain persons with disabilities (e.g., workers with disabilities receiving Social Security Disability Insurance). Title XVIII is divided into three parts. Part A authorizes hospital insurance benefits; Part B provides for supplemental medical insurance benefits. Part C contains miscellaneous provisions, including coverage for end-stage renal disease.17 * Title XIX of the Social Security Act establishes the Medicaid program.18 Medicaid is the nation's major public financing program for providing health and long-term coverage to low-income persons. Medicaid is a means-tested entitlement program financed by the State and Federal governments and administered by the states. Within Federal guidelines, states set their own income and asset eligibility criteria for Medicaid. Federal assistance is provided to states for coverage of specific groups of people and benefits through Federal matching payments based on the state's per capita income. Medicaid covers a broad range of services to meet the needs of beneficiaries. Federally mandated services include: inpatient and outpatient hospital, physician, midwife and certified nurse practitioner, laboratory and x-ray, nursing home and home health care, early and periodic screening, diagnosis, and treatment (EPSDT) for children under age 21, family planning, and ambulatory services offered by rural health clinics and federally qualified health centers.19 States have the option to cover additional services such as prescription drugs, personal assistance services, prosthetic devices, hearing aids, and intermediate care facilities for the mentally retarded.20 States may limit the amount, duration, and scope of such services as long as adequate care is provided. The Secretary is authorized to grant waivers to allow a state to, among other things, offer Medicaid-reimbursable home and community-based services and supports (other than room and board) to individuals who, in the absence of such services, would require institutional care as long as costs (in the aggregate) under the waiver do not exceed the cost of providing institutional care to the target population.21 A "close-ended" entitlement program does not create an individual guarantee or entitlement to assistance; rather it provides a state or other entity fixed allotment of funds over a specified period of time. In other words, individuals receive benefits only to the extent that funds are available. Examples include: * Title I of the Rehabilitation Act of 1973 which assists states in operating a comprehensive, coordinated, effective, efficient, and accountable program of vocational rehabilitation for persons with disabilities.22 States are entitled to at least last year's appropriation plus an inflationary increase.23 * Title XXI of the Social Security Act, the State Children's Health Insurance Program (CHIP) under which Congress guaranteed $40 billion to states over the next 10 years to provide health insurance for low-income children who do not qualify for Medicaid, including children with disabilities.24 D. DISCRETIONARY GRANT-IN-AID PROGRAMS Discretionary grant-in-aid programs are the third category of laws affecting people with disabilities. These programs provide supplementary Federal financial assistance to support specified activities carried out by other entities such as public agencies (State and local) and private agencies. Some discretionary grant programs are specifically targeted at meeting the needs of persons with disabilities; others are generic and are targeted at specified populations or purposes, which include, but are not limited to, meeting the needs of persons with disabilities. There are two types of discretionary grant-in-aid programs -- formula and competitive grant programs. Both types of grant programs are subject to annual appropriations by Congress. These programs are referred to as "discretionary" because Congress may appropriate whatever amount of funds it deems necessary or appropriate. 1. Formula Grant Programs. Formula grant programs support ongoing activities of and foster systemic change by agencies of state or local governments or nonprofit organizations within a state. A "formula" is devised and specifies the exact amount of funds each entity will receive. Examples of formula grant programs to agencies of state and local governments that are targeted specifically at meeting the needs of individuals with disabilities include: * Public Education Part B of IDEA, which provides financial assistance to state and local educational agencies to help these agencies meet their constitutional responsibilities to provide a free appropriate public education to children with disabilities.25 * Early Intervention Part C of IDEA, which assists states in the implementation of a statewide, comprehensive, coordinated, multidisciplinary, interagency system of early intervention services for infants and toddlers with disabilities and their families.26 * Employment Services Part B of title VI of the Rehabilitation Act of 1973, which assists States in developing collaborative programs with appropriate entities to provide supported employment services for individuals with the most significant disabilities who require ongoing support services to enter or retain competitive employment.27 * Independent Living Services Part B of title VII of the Rehabilitation Act of 1973, which assists states in providing, expanding, and improving the provision of independent living services.28 * State Developmental Disabilities Councils Part B of the Developmental Disabilities Assistance and Bill of Rights Act, which supports State Developmental Disabilities Councils in each state to promote the independence, productivity, and integration and inclusion into the community for individuals with developmental disabilities.29 Some formula grant programs allocate a specified amount to a state and then target funds to nonprofit organizations within each state focusing exclusively on meeting the needs of persons with disabilities. Examples include: * Statewide Networks for Centers for Independent Living Part C of title VII of the Rehabilitation Act of 1973, which provides financial assistance to develop and support statewide networks for centers for independent living.30 * Protection and Advocacy Systems Part C of the Developmental Disabilities Assistance and Bill of Rights Act, which supports protection and advocacy systems in each State to protect the legal and human rights of individuals with developmental disabilities.31 Example of generic formula grant programs that include specific references to or set-asides for individuals with disabilities include: * Job Training Title I (Workforce Investment Systems) of the Workforce Investment Act of 1998 which provides workforce investment activities, (e.g., job training) through statewide and local workforce investment systems, that increase employment and enhance the productivity and competitiveness of the Nation.32 * School Reform School reform legislation (such as Goals 2000: Educate America Act) which encourages comprehensive State and local school reform based on high expectations and standards.33 * Early Childhood Education Early childhood education such as the Head Start program which provides comprehensive services to economically disadvantaged preschool children and their families.34 Recipients must ensure that at least ten percent of program participants are children with disabilities. * Social Services The Social Service block grant program (under Title XX of the Social Security Act), which enables participating states to, among other things, provide special services to persons with disabilities and reduce or prevent inappropriate institutional care.35 * Maternal and Child Health The Maternal and Child Health block grant (under Title V of the Social Security Act)36 which, among other things, enables states to provide and promote family centered, community- based coordinated care, particularly for children with special health care needs. 2. Competitive Grant Programs. A second category of discretionary grant-in-aid programs is awarded on the basis of competition rather than on the basis of a formula. Competitive grants allow entities to develop a better understanding of a problem, create new knowledge, or train persons to provide necessary services. In addition, the need for Federal assistance can best be determined by considering specific information provided in grant applications. Examples include: * Rehabilitation Research Research funded by the National Institute on Disability and Rehabilitation Research (NIDDR)37 established under Title II of the Rehabilitation Act of 1973. * Technology-Related Assistance The Technology-Related Assistance for Individuals with Disabilities Act of 1988, which provides assistance to states to develop and implement a consumer responsive comprehensive statewide program of technology-related assistance for individuals with disabilities.38 * University Affiliated Programs Part D of the Developmental Disabilities Assistance and Bill of Rights Act, which provides grants to university affiliated programs to promote independence, productivity, and integration and inclusion into the community of individuals with developmental disabilities through, among other things, interdisciplinary training and information dissemination.39 * Medical Research Research funded by the National Institutes of Health authorized under Title IV of the Public Health Services Act.40 * ADA Technical Assistance ADA authorizes provision of technical assistance to individuals with disabilities and covered entities. NIDRR funds ten Disability and Business Technical Assistance Centers.41 * Training of Educators Subpart 2 of part D of IDEA, which supports preservice and inservice training of general educators as well as special educators, related services personnel, and early intervention personnel.42 * Training of Parents Section 682 of IDEA, which supports parent training and information centers.43 * Work Incentive Outreach Program Section 1149 of the Social Security Act, as added by the Ticket to Work and Work Incentives Improvement Act44 directs the Commissioner of the Social Security Administration to establish a community-based work incentives planning and assistance program for the purpose of disseminating accurate information to individuals on work incentives. Sometimes programs start small as competitive grant programs and are then amended to become formula grants when the appropriation increases. An example is: * Section 509 of the Rehabilitation Act of 1973 provides assistance to support a system in each state to protect the legal and human rights of individuals with disabilities who need services and are ineligible for other similar programs. The program changed from a competitive to a formula grant when appropriations exceeded $5.5 million.45 E. REGULATORY STATUTES The fourth category of laws affecting people with disabilities includes regulatory legislation that provides minimum protections for a class of persons (including, but not limited to persons with disabilities). Examples include: Voter Registration The National Voter Registration Act of 1993 requires states to provide enhanced voter registration services at locations where driver's licenses, public assistance, and state disability-related services are provided.46 Family Leave The Family and Medical Leave Act, which, among other things, allows workers to take up to 12 weeks of unpaid leave to care for newborn and adopted children and family members with serious health conditions or to recover from serious health conditions.47 Telecommunications Section 225 of the Telecommunications Act of 1996 requires that telecommunications equipment and services be accessible to persons with disabilities if readily achievable.48 F. MISCELLANEOUS CATEGORY OF LAWS, INCLUDING APPROPRIATONS, TAX LEGISLATION, AND LOANS The fifth category of laws affecting people with disabilities includes appropriations bills that provide the funding for various programs. These bills and the accompanying reports often target or direct various departments and agencies to spend discretionary funds in a specified fashion, including the needs of persons with disabilities. In addition, the tax code is sometimes used to enhance opportunities for individuals with disabilities directly or to provide incentives for covered entities to comply with existing responsibilities. Examples include: * The Disabled Access Tax Credit,49 which provides tax credits to small businesses for expenses incurred to comply with the Americans with Disabilities Act. * The Targeted Jobs Credit50 which provides tax credits for hiring new employees with disabilities referred by vocational rehabilitation and other specified agencies. STATEMENT OF FINDINGS AND HISTORICAL CONTEXT Every major piece of disability-specific legislation enacted into law since 1975 includes a "Statement of Findings." The "Findings" sections of disability legislation are critical because they generally describe the historical context of the legislation. The "Findings" section describes: * the historical treatment of persons with disabilities * the nature of the problem addressed by the legislation * why the issue is important and why change is needed * the role of the Federal government. For example, the ADA (civil rights legislation) includes the following in the Statement of Findings:51 "(1) some 43 million Americans have one or more physical or mental disabilities, and the number is increasing as the population as a whole is growing older; (2) historically, society has tended to isolate and segregate individuals with disabilities, and, despite some improvements, such forms of discrimination against individuals with disabilities continue to be a serious and pervasive social problem; (3) discrimination against individuals with disabilities persists in such critical areas as employment, housing, public accommodations, education, transportation, communication, recreation, institutionalization, health services, voting, and access to public services; (4) unlike individuals who have experienced discrimination on the basis of race, color, sex, national origin, religion, or age, individuals who have experienced discrimination on the basis of disability have often had no legal recourse to redress such discrimination; (5) individuals with disabilities continually encounter various forms of discrimination, including outright intentional exclusion, the discriminatory effects of architectural, transportation, and communication barriers, overprotective rules and policies, failure to make modifications to existing facilities and practices, exclusionary qualification standards and criteria, segregation, and relegation to lesser services, programs, activities, benefits, jobs, or other opportunities; (6) census data, national polls, and other studies have documented that people with disabilities, as a group, occupy an inferior status in our society, and are severely disadvantaged socially, vocationally, economically, and educationally; (7) individuals with disabilities are a discrete and insular minority who have been faced with restrictions and limitations, subjected to a history of purposeful unequal treatment, and relegated to a position of political powerlessness in our society, based on characteristics that are beyond the control of such individuals and resulting from stereotypic assumptions not truly indicative of the individual ability of such individuals to participate in and contribute to, society; and (8) the Nation's proper goals regarding individuals with disabilities are to assure equality of opportunity, full participation, independent living, and economic self-sufficiency for such individuals; (9) the continuing existence of unfair and unnecessary discrimination and prejudice denies people with disabilities the opportunity to compete on an equal basis and to pursue those opportunities for which our free society is justifiably famous, and costs the United States billions of dollars in unnecessary expenses resulting from dependency and unproductively." In employment, when Congress enacted the Rehabilitation Act it included, among other things, the following findings:52 "(1) Work is a valued activity, both for individuals and society, and fulfills the need of an individual to be productive, promotes independence, enhances self esteem, and allows for participation in the mainstream of life in the United States; (2) As a group, individuals with disabilities experience staggering levels of unemployment and poverty; (3) Individuals with disabilities, including individuals with the most significant disabilities, have demonstrated their ability to achieve gainful employment in integrated settings if appropriate services and supports are provided; (4) Reasons for the significant number of individuals with disabilities not working, or working at a level not commensurate with their abilities and capabilities, include: * discrimination * lack of accessible and available transportation * fear of losing health coverage under the Medicare and Medicaid programs or fear of losing existing private health insurance * lack of education, training, and supports to meet job qualification standards necessary to secure, retain, regain, or advance in employment." In education, Congress included, among other things, the following Findings in the Individuals with Disabilities Education Act:53 "(1) Before the enactment of the Education for All Handicapped Children Act of 1975 (Public Law 94-142)- * the special education needs of children with disabilities were not being fully met; * more than one-half of the children with disabilities in the United States did not receive appropriate educational services that would enable such children to have full equality of opportunity; * 1,000,000 of the children with disabilities in the United States were excluded entirely from the public school system and did not go through the educational process with their peers. (2) The implementation of IDEA has been impeded by low expectations, and an insufficient focus on applying replicable research on proven methods of teaching and learning for children with disabilities. (3) While States and local educational agencies are responsible for providing an education for all children with disabilities, it is in the national interest that the Federal government have a role in assisting state and local efforts to educate children with disabilities and to ensure equal protection of the law. (4)The Federal government must be responsive to the growing needs of an increasingly more diverse society." STATEMENT OF CORE PRECEPT AND OVERARCHING GOALS In addition to the inclusion of a "Findings" section, most major disability-specific legislation enacted into law since 1975 includes statements of policy. Sometimes these statements are part of the "Findings" section; other times they are included as a separate section. The Statements of Policy are critical because they enunciate the core precept, goals, values and guiding principles of the legislation. When there is uncertainty as to the congressional intent of a certain provision, courts, Federal agencies, recipients of aid, and other entities covered by the legislation often refer to the Statements of Policy for guidance. The core precept of disability policy is that "disability is a natural part of the human experience that in no way diminishes the right of individuals to- * Live independently * Enjoy self-determination * Make choices * Contribute to society * Pursue meaningful careers and * Enjoy full inclusion and integration in the economic, political, social, cultural, and educational mainstream of American society."54 The ADA includes the following statement of policy articulating our Nation's goals regarding people with disabilities: "The Nation's proper goals regarding individuals with disabilities are to assure equality of opportunity, full participation, independent living, and economic self-sufficiency for such individuals."55 The Rehabilitation Act of 1973, as amended, includes important statements of policy that are applicable to all disability policy, not just vocational rehabilitation:56 These statements are consistent with the goals of disability policy articulated in the ADA (1) The goals of the Nation properly include the goal of providing individuals with disabilities with the tools necessary to- * make informed choices and decisions, and * achieve equality of opportunity, full inclusion and integration into society, employment, independent living, and economic and social self-sufficiency for such individuals. (2) All programs must be carried out in a manner consistent with the principles of: * respect for individual dignity, personal responsibility, self-determination, and pursuit of meaningful careers based on informed choice, of individuals with disabilities; * the inclusion, integration, and full participation of the individuals; * support for the involvement of an individual's representative i.e., parent, a family member, a guardian, an advocate, or an authorized representative if an individual with a disability requests, desires or needs such support; and * support for individual and systemic advocacy and community involvement." The IDEA includes, among other things, the following statements of policy that focus both on the rights of children with disabilities as well as the rights of parents.57 "Over 20 years of research and experience has demonstrated that the education of children with disabilities can be made more effective by: * having high expectations for such children * strengthening the role of parents and ensuring that families of such children have meaningful opportunities to participate in the education of their children at school and at home." The Developmental Assistance and Bill of Rights Act includes important statements of policy applicable to persons with developmental disabilities and their families that are consistent with the goals articulated in the ADA:58 "(c) POLICY. ---It is the policy of the United States that all programs, projects, and activities receiving assistance under this Act shall be carried out in a manner consistent with the principles that--- (1) individuals with developmental disabilities, including those with the most severe developmental disabilities, are capable of achieving independence, productivity, and integration and inclusion into the community, and often require the provision of services, supports and other assistance to achieve independence, productivity, and integration and inclusion; (2) individuals with developmental disabilities and their families have competencies, capabilities and personal goals that should be recognized, supported, and encouraged, and any assistance to such individuals should be provided in an individualized manner, consistent with the unique strengths, resources, priorities, concerns, abilities, and capabilities of such individuals; (3) individuals with developmental disabilities and their families are the primary decisionmakers regarding the services and supports such individuals and their families receive and play decisionmaking roles in policies and programs that affect the lives of such individuals and their families; (4) services, supports, and other assistance are provided in a manner that demonstrates respect for individual dignity, personal preferences, and cultural differences; (5)specific efforts must be made to ensure that individuals from racial and ethnic minority backgrounds enjoy effective and meaningful opportunities for full participation in the developmental disabilities service system; (6)recruitment efforts within developmental disabilities at the level of preservice training, community training, practice, administration and policymaking must focus on bringing larger numbers of racial and ethnic minorities into the field in order to provide appropriate skills, knowledge, role models, and sufficient manpower to address the growing needs of an increasingly diverse population; (7)with education and support, communities can be responsive to the needs of individuals with developmental disabilities and their families and are enriched by the full and active participation and the contributions by individuals with developmental disabilities and their families; and (8) individuals with developmental disabilities should have access to opportunities and the necessary support to be included in community life, have interdependent relationships, live in homes and communities, and make contributions to their families, community, State, and Nation." DEFINITIONS OF DISABILITY In addition to Statements of Findings and Statements of Policy, legislation also includes definitions of key terms. The definition of disability included in specific legislation is carefully drafted to accomplish the purposes of the legislation. The definition of disability included in the ADA and Section 504 of the Rehabilitation Act (civil rights statutes) is broad enough to reflect the three types of discrimination that people with disabilities face -- discrimination based on one's impairment, discrimination based on a history of having an impairment (even though the individual no longer has the impairment), and being regarded as having an impairment (even though the individual doesn't actually have that impairment). Thus, the definition of "disability" in the ADA includes three prongs to reflect the three types of discrimination. The ADA specifies that the term "disability" means, with respect to an individual,-59 "a physical or mental impairment that substantially limits one or more of the major life activities of such individual; a record of such an impairment; or being regarded as having such an impairment." The identical definition is applicable to section 504 of the Rehabilitation Act.60 The ADA also includes definitions of the term "qualified individual with a disability." For purpose of Title I of the ADA (relating to employment), the term means "an individual with a disability who, with or without reasonable accommodation, can perform the essential functions of the employment position that such individual holds or desires."61 For purpose of Title II of the ADA (public services), the term means "an individual with a disability who, with or without reasonable modifications to rules, policies, or practices, the removal of architectural, communication, or transportation barriers, or the provision of auxiliary aids and services meets the essential eligibility requirements for the receipt of services or the participation in programs or activities provided by a public entity."62 The definition of disability for an adult in the Supplemental Security Income program (income support for low-income individuals with disabilities) is:63 "(3)(A) An individual shall be considered to be disabled for purposes of this title if he is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted for a continuous period of not less than twelve months (or, in the case of an individual under the age of 18, if he suffers from any medically determinable physical or mental impairment of comparable severity). (B) For purposes of subparagraph (A), an individual shall be determined to be under a disability only if his physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would be hired if he applied for work. For purposes of the preceding sentence (with respect to any individual), "work which exists in the national economy" means work which exists in significant numbers either in the region where such individual lives or in several regions of the country. (C) For purposes of this paragraph, a physical or mental impairment is an impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques." The definition of disability for children under the Supplemental Security Income program is:64 "(C)( i) An individual under the age 18 shall be considered disabled for the purposes of this title if that individual has a medically determinable physical or mental impairment, which results in marked and severe functional limitations, and which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. (ii) Notwithstanding clause ( i ), no individual under the age 18 who engages in substantial gainful activity (determined in accordance with regulations prescribed pursuant to subparagraph (E)) may be considered to be disabled." The definition included under part B of the Individuals with Disabilities Education Act under which a child is entitled to special education and related services necessary to address his or her unique needs is limited to a child:65 "( i ) with mental retardation, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance (hereinafter referred to as 'emotional disturbance'), orthopedic impairments, autism, traumatic brain injury, other health impairments, or specific learning disabilities; and ( ii ) who, by reason thereof, needs special education and related services. "(B) CHILD AGED 3 THROUGH 9.---The term 'child with a disability' for a child aged 3 through 9 may, at the discretion of the State and the local educational agency, include a child--- "( i ) experiencing developmental delays, as defined by the State and as measured by appropriate diagnostic instruments and procedures, in one or more of the following areas: physical development, cognitive development, communication development, social or emotional development, or adaptive development; and "(ii) who, by reason thereof, needs special education and related services." The definition included under title I of the Rehabilitation Act of 1973 (the vocational rehabilitation program) is limited to an individual with a disability who:66 "has a physical or mental impairment which for such individual constitutes or results in a substantial impediment to employment, and can benefit in terms of an employment outcome from vocational rehabilitation services." The definition of disability included in Title I of the Rehabilitation Act (vocational rehabilitation) specifies that "the term individual with a disability means any individual who has a physical or mental impairment which for such individual constitutes or results in a substantial impediment to employment and can benefit in terms of an employment outcome for vocational rehabilitation services provided..."67 Under Title I of the Rehabilitation Act, an individual is eligible for services if the individual "is an individual with a disability and requires vocational rehabilitation services to prepare for, secure, retain, or regain employment."68 The term "developmental disability" under the Developmental Disabilities Assistance and Bill of Rights Act (supports Developmental Disabilities Councils, Protection and Advocacy Systems, and University Affiliated Programs) is:69 "The term "developmental disability" means a severe, chronic disability of an individual 5 years of age or older that--- (A) is attributable to a mental or physical impairment or combination of mental and physical impairments; (B) is manifested before the individual attains age 22; (C) is likely to continue indefinitely; (D) results in substantial functional limitations in three or more of the following areas of major life activity--- (i) self-care; (ii) receptive and expressive language; (iii) learning; (iv) mobility; (v) self-direction; (vi) capacity for independent living; and (vii) economic self-sufficiency; and (E) reflects the individual's need for a combination and sequence of special, interdisciplinary, or generic services, supports, or other assistance that is lifelong or extended duration and is individually planned and coordinated, except that such term, when applied to infants and young children means individuals from birth to age 5, inclusive, who have substantial developmental delay or specific congenital or acquired conditions with a high probability of resulting in developmental disabilities if services are not provided." CORE POLICIES This section of the paper describes the core policies included in Federal laws and implementing regulations that effectuate i.e., accomplish the four goals of disability policy, as articulated in the ADA- * Equality of opportunity * Full participation (empowerment) * Independent living * Economic self-sufficiency. A. EQUALITY OF OPPORTUNITY The first goal of disability policy articulated in the ADA is equality of opportunity. For purposes of this paper, the goal is accomplished through four broad categories of policies: * Individualization and interdisciplinary assessments; * Genuine, effective, and meaningful opportunity-accommodations, auxiliary aids and services, and program accessibility; * Genuine, effective, and meaningful treatment-modifications of policies and procedures; and * Treatment in the most integrated setting appropriate. 1. Individualization and Interdisciplinary Assessments. A fundamental concept in disability policy is a focus on the individual and the individual's unique needs. Decisions must be based on the unique strengths, resources, priorities, concerns, abilities, and capabilities of each person with a disability, including individuals with the most significant disabilities. Decisions must be based on facts relevant to the individual and objective evidence, not generalizations about all people with disabilities or all people with a particular disability. Thus, individualized, fact-specific, case-by-case inquiry is a core principle of disability policy. Similarly, if an individual with a disability and a nondisabled person both need and are eligible for a service, the person with a disability should not be denied the services because he or she has a disability. People with disabilities must be judged on the basis of objective criteria and facts, not fear, ignorance, prejudice, or stereotypes. In other words, agencies must use definitions and eligibility criteria that result in even-handed treatment between a person with a particular disability and other similarly situated individuals, including nondisabled persons and persons with other disabilities. Generic programs (such as job training, welfare, child care, Head Start), must provide universal access i.e., serve individuals with disabilities and not simply refer all people with disabilities to disability-specific programs when individuals with disabilities meet the nondiscriminatory eligibility criteria for the generic services. Accurate fact-specific, case-by-case inquiries often require individualized assessments and evaluations. In turn these assessments and evaluations often require interdisciplinary approaches performed on a timely basis by teams of qualified individuals. To ensure the effectiveness and reliability of these assessments, they must be conducted across multiple environments, including "real" settings where the individual functions as well as clinical settings. In making these fact-specific decisions, it is necessary to use information provided by the individual with a disability and the person's family or representative. Once goals, objectives, services, and accountability measures are identified and agreed to by the stakeholders, this agreement is set out in an individualized plan. In the civil rights context, under the ADA and Section 504 the concept of individualization means that "no qualified individual with a disability shall, by reason of his disability, be excluded from participation in or denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity.70 In addition, the ADA regulation71 and the Section 504 coordination regulation72 specifies that a public entity, in providing any aid, benefit, or service, may not, on the basis of disability: * deny a qualified individual with a disability the opportunity to participate in or benefit from the aid, benefit, or service * unequally treat a qualified individual with a disability in participating in or benefiting from the aid, benefit, or service * otherwise limit a qualified individual with a disability in the enjoyment of any right, privilege, advantage, or opportunity enjoyed by others receiving the aid, benefit, or service. In the employment context, under title I of the Rehabilitation Act, an individualized plan for employment is required.73 These plans are jointly agreed to and signed by eligible individuals with disabilities (or their representatives in appropriate situations) and vocational rehabilitation counselors. These plans are based on assessments performed by qualified personnel and existing data, including data provided by the individual with a disability. In the educational context, under IDEA, individualized determinations means providing special education and related services to a child with a disability in accordance with an individualized education program developed by a team of persons, including the parents of the child and the child, when appropriate.74 These decisions are based on comprehensive individualized evaluations completed by interdisciplinary teams performed in multiple environments.75 The evaluation must determine whether the individual has a disability and is in need of special education and related services, as well as the types of services needed.76 In the context of health care under the Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT),77 states must adopt a comprehensive process through which individual children are screened for health deficiencies, diagnosed, and treated (to the extent medically necessary services are required to treat the condition). Screening services include, among other things, a comprehensive health and developmental history (including assessment of both physical and mental health development and a comprehensive, unclothed, physical exam). Another key concept in disability policy is to serve all individuals with disabilities, including individuals with the most significant disabilities and to give priority to those persons when funds are limited. Historically, persons with the most significant disabilities were excluded by public and private entities from receiving services made available to nondisabled persons and persons with moderate disabilities. A prime example was the exclusion, by many states, of children with significant disabilities from public education. For example, the state of Maine had a policy that authorized the local school Superintendent of schools to exclude "any child whose physical or mental condition make it inexpedient for him to attend."78 In 1975, (the year the Maine statute was repealed) IDEA was enacted and included a "zero reject" policy under which all children with disabilities, including those with the most significant disabilities, are entitled to a free and appropriate public education. 79 Congress adopted this policy to conform to the Equal Protection Clause of the 14th Amendment to the U.S. Constitution, under which all children with disabilities should enjoy the same right to receive a free public education enjoyed by all nondisabled children. For children with the most significant disabilities, "education" is defined broadly to include care, treatment, habitation, and rehabilitation. The vocational rehabilitation program presumes that all persons with disabilities, including those with the most significant disabilities, can benefit in terms of an employment outcome from vocational rehabilitation services. To deny services, a state agency must demonstrate by clear and convincing evidence (the highest standard of proof used in civil procedures) that an individual is incapable of benefiting from vocational rehabilitation services.80 When a state is unable to serve all eligible individuals, it must adopt an "order of selection" under which it first serves those individuals with the most significant disabilities.81 Entitlement programs, such as the Supplemental Security Income program,82 (income support for low-income individuals with disabilities) have always targeted individuals with the most significant disabilities as intended beneficiaries. 2. Genuine, Effective, and Meaningful Opportunity: Accommodations, Auxiliary Aids and Services, Program Accessibility. Eliminating gross exclusions and denials of the same treatment to all individuals is not sufficient to assure genuine, effective, and meaningful opportunity for certain individuals with disabilities. For some individuals with disabilities, adjustments to regular programs, separate or different treatment, or the provision of support services may be necessary in order to ensure that an opportunity is genuine, effective, and meaningful for the individual. It may be necessary to provide services based on the unique needs of the individual; rather than on the basis of the needs of the "average" person. For example, it may be the "same" opportunity to provide verbal directions to a person who is deaf and to a nondisabled person. The opportunity, however, is not genuine, effective, and meaningful unless there is an accommodation to ensure that the person who is deaf receives the communication (e.g., is provided a qualified sign language interpreter). In the civil rights context, the ADA regulation83 and the Section 504 coordination regulation 84generally sets out the concept of "effective and meaningful opportunity." A covered entity may not, on the basis of disability, provide a qualified individual with a disability with a benefit or service that is not as effective as that provided to others. When action is necessary to provide qualified individuals with disabilities with benefits or services that are as effective as those provided to others, it is acceptable to provide different or separate treatment. Specific applications of the "effective and meaningful" standard are also included in the ADA and Section 504 coordination regulations: * A reasonable accommodation must be provided to employees unless it would result in an undue hardship to the employer.85 * Programs in existing facilities must be accessible and new buildings must be readily accessible to and usable by individuals with disabilities.86 * Appropriate auxiliary aids and services by covered entities, including communication accessibility and the provision of materials in accessible formats.87 In addition, an entity cannot place a surcharge on a particular individual with a disability or any group of individuals with disabilities to cover the cost of measures, such as the provision of reasonable accommodations, auxiliary aids and services.88 Furthermore, the regulations include a provision that an individual with a disability is not required to accept an accommodation, aid, service, opportunity, or benefit provided under the ADA.89 In the education context, the concept of "effective and meaningful opportunity" is reflected in IDEA as the right of every child with a disability, regardless of the nature or severity of the disability, to receive a free and appropriate public education (FAPE).90 This right includes, among other things, the right to be taught by educators who have the skills and knowledge necessary to meet the needs of the children with disabilities and the adoption by local school districts of promising practices, materials, and technology to aid children with disabilities.91 In the employment context, to ensure "effective and meaningful opportunity" to benefit from vocational rehabilitation, the title I of the Rehabilitation Act of 1973 describes a broad range of vocational rehabilitation services that must be provided to an individual with a disability served by the program. Examples of services include: rehabilitation technology services, interpreter services, on the job or other related personal assistance services provided while an individual with a disability is receiving vocational rehabilitation.92 In the health care context, the EPSDT program requires that children receive all medically necessary services required to treat a medical condition.93 3. Genuine, Effective, and Meaningful Treatment: Modifications of Policies and Procedures. Public policy set out in legislation establishes specific rules and procedures of general applicability. But what happens when the rule itself or the application of a rule has the effect of denying an individual with a disability genuine, effective, and meaningful opportunity to benefit from the program, service, or activity, on the basis of the individual's disability? Another important tenet of disability policy is that rules must be modified to take into consideration the unique needs of individuals with disabilities (rather than be based on needs of the "average" person) unless the modification would fundamentally alter the nature of the service, program, or activity. To apply this tenet, it is critical to look behind a rule of general applicability and ascertain its purposes, functions, and policy objectives, and determine whether a reasonable modification to the rule will enable the individual with a disability to satisfy the underlying purposes, functions, and policy objectives of the rule. It may also include adopting separate or different rules when necessary to ensure genuine, effective, and meaningful opportunity. In other words, it is critical that there be a "level playing field" for both individuals with disabilities and nondisabled individuals, not to provide advantages. In the civil rights context, the ADA regulation94 and the Section 504 coordination regulation 95specifies that a public entity shall make reasonable modifications to its policies or procedures when the modifications are necessary to avoid discrimination on the basis of disability unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program, or activity. For example, an entity adopts a rule specifying that it will only cash checks for persons who have valid driver's licenses. The purpose of the rule is to ascertain that the persons cashing the check are who they purport to be. Since people who are blind cannot drive and therefore do not have driver's licenses, this rule has the effect of denying them a genuine opportunity to take advantage of the check-cashing service. The ADA and Section 504 requires that the entity modify its rule, for example, by accepting a different form of photo identification. Or, if an entity adopts a "no animal" rule in its facility, the rule must be modified to allow for "service dogs" that assist persons with disabilities unless the service dog could be shown to pose a direct threat to the health of others. In the educational context, the modification of rules for disciplining children with disabilities must ensure that such children are not inappropriately excluded, segregated, and denied services on the basis of their disabilities.96 At the same time the modified rule must ensure that the underlying functions and purposes of these rules (for example, keeping the schools safe and conducive to learning, holding children responsible for their actions, and preventing inappropriate behavior from recurring) are not fundamentally altered. 4. Treatment in the Most Integrated Setting Appropriate. Maximum appropriate integration and inclusion of an individual with a disability consistent with the individual's unique needs is another fundamental tenet of disability policy. In the civil rights context, the ADA statute recognizes that "historically, society has tended to isolate and segregate individuals with disabilities...and such forms of discrimination against individuals with disabilities continue to be a serious and pervasive social problem."97 The ADA regulation specifies that although special treatment or different programs may be required in some instances in order to ensure genuine opportunity, the provision of unnecessarily separate or different services is discriminatory.98 For example, a person who can benefit from the generic jobs program in a state cannot be automatically sent to the vocational rehabilitation program if the individual qualifies, with the provision of reasonable auxiliary aids, for services in the generic program. The ADA regulation also specifies that a public entity must administer services, programs, and activities in the "most integrated setting appropriate" to the needs of qualified individuals with disabilities.99 The preamble to the title II regulations defines this requirement to mean "a setting that enables individuals with disabilities to interact with nondisabled persons to the fullest extent possible."100 The Section 504 coordination regulation includes a provision that is identical to the provision in the ADA regulations.101 In the education context, IDEA specifies that:102 "to the maximum extent appropriate, children with disabilities are educated with children who are not disabled, and special classes, separate schooling, or other removal of children with disabilities from the regular educational environment occurs only when the nature or severity of the disability of a child is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily." The IDEA regulations require that services be provided in the least restrictive environment (continuum of program options be provided) consistent with the unique needs of the child with a disability.103 In the social services context, the Developmental Disabilities Assistance and Bill of Rights Act defines "inclusion and integration" to mean:104 * The use by individuals with developmental disabilities of the same community resources that are used by and available to other citizens; * Living in homes close to community resources, with regular contact with citizens without disabilities in their communities; and * The full and active participation by individuals with developmental disabilities in the same community activities and types of employment as citizens without disabilities, living, learning, working and enjoying life in regular contact with citizens without disabilities; and * Having friendships and relationships with individuals and families of their own choosing. Under the Medicaid program, states may apply for a waiver to allow home and community-based placements in lieu of placement in institutional settings.105 B. FULL PARTICIPATION (EMPOWERING INDIVIDUALS AND FAMILIES) The second goal of disability policy articulated in the ADA is full participation by individuals with disabilities, their families, and representatives in decisions affecting their lives at the individual and systems level. Full participation is achieved through empowering individuals with disabilities and their families and advocates. Empowerment includes the concepts of self-determination, self-advocacy, real and informed choice, and active participation in the decision making process. At the individual level, full participation includes involvement in decisions concerning, among other things, whether, when, and where to receive services and supports, which services to receive, from whom services should be provided, and the measures of progress used. At the systems level, the concept of full participation requires various forms of citizen participation in the design, implementation, and evaluation of programs and policies, including public hearings, consideration of public comment, and the use of advisory committees/councils. The trend in Federal legislation is to provide these advisory committees with more consumer direction and control. In fact, in some cases, legislation includes consumer-controlled councils (consisting of a majority of persons with disabilities) and making individuals with disabilities equal decision-making partners with professionals and agency officials e.g., joint responsibility with the government agency for the development of a state plan. In the vocational rehabilitation program under title I of the Rehabilitation Act, an individualized plan for employment must be jointly agreed to and signed by the individual with a disability (or as appropriate the individual's representative) and a qualified vocational rehabilitation counselor. The individual must be afforded the opportunity to exercise informed choice in selecting an employment outcome, the specific vocational rehabilitation services to be provided under the plan, the entity that will provide the vocational rehabilitation services, and the methods used to procure the services.106 Title I of the Rehabilitation Act also directs the establishment of a State Rehabilitation Council. The functions of the Council include, in partnership with the designated state unit, developing, agreeing to, and reviewing state goals and priorities and evaluating the effectiveness of the vocational rehabilitation program and reports of progress.107 A majority of Council members must be persons with disabilities. Under title VII of the Rehabilitation Act, the state vocational rehabilitation director and the chair of the statewide independent living council must jointly develop the state plan relating to independent living services and centers for independent living.108 In the social security context, the Ticket to Work and Self-sufficiency program109 provides a "ticket" to specified recipients of the Social Security Disability Income program and the Supplemental Security Income program to obtain vocational rehabilitation. The disabled recipient may assign the "ticket" to any service provider (employment network) of their choice that is willing to accept the assignment. In addition, the Ticket to Work and Work Incentives Improvement Act establishes a Ticket to Work and Work Incentives Advisory Panel.110 In the educational context, part B of IDEA requires that parents become partners in the process of developing their child's individualized education program (IEP) and participate in the child's placement process.111 Whenever appropriate, the IEP team must also include the child with a disability.112 A state may provide for the transfer of rights under IDEA from parents to children with disabilities when children reach the age of majority.113 Part B also requires that the state advisory committee consist of a majority of persons with disabilities or parents of children with disabilities.114 Under part C of the IDEA,115 infants and toddlers and their families are entitled to a family-directed assessment of the resources, priorities, and concerns of the family and the identification of the supports and services necessary to enhance the family's capacity to meet the developmental needs of the infant or toddler. The individualized family service plan must be developed by a multidisciplinary team, including the parents. The philosophy of self-determination is articulated in the Developmental Disabilities Assistance and Bill of Rights Act.116 The term "self-determination" means "activities that result in individuals with developmental disabilities, with appropriate assistance, having- * The ability and opportunity to communicate and make personal decisions; * The ability and opportunity to communicate choices and exercise control over the type and intensity of services, supports, and other assistance the individuals receive; * The authority to control resources to obtain needed services, support and other assistance; The opportunity to participate in, and contribute to, their communities; and * Support, including financial support, to advocate for themselves and others, to develop leadership skills, through training in self-advocacy, to participate in coalitions, to educate policy makers, and to play a role in the development of public policies that affect individuals with developmental disabilities."117 Under the Protection and Advocacy for Mentally Ill Individuals Act118 "family members of individuals with mental illness play a critical role in being advocates for the rights of individuals with mental illness where the individuals are minors, the individuals are legally competent and choose to involve the family members, and the individuals are legally incompetent and the legal guardians, conservators, or other legal representatives are members of the family." In the Medicaid program, real choice is still not available in many states for those individuals with disabilities who prefer services (such as personal assistance services) in community-based settings rather than in institutions. This is because personal assistance services is an optional benefit under Medicaid and thus, many states do not provide these services at all or do not provide these services on a statewide basis. Most states, however, are increasing choice by taking advantage of the "home and community-based" waiver option for providing community-based services to targeted groups, often on less than a statewide basis.119 C. INDEPENDENT LIVING The goals of "full participation" and "independent living" are closely related and overlap to some degree. As used in this paper, full participation or empowerment focuses on the role of the individual and the family with respect to the provision of services and supports by public and nonprofit agencies. For purposes of this paper, the goal of fostering independent living articulated in the ADA includes enabling the individual to live in the community and participate in community activities through support for independent living skills development and specialized planning, support for long-term services and supports, including personal assistance services and supports, and the provision of cash assistance. The philosophy of independent living includes a philosophy of consumer control, peer support, self-help, self-determination, equal access, and individual and system advocacy.120 1. Independent Living Skills Development and Specialized Planning. In order to enhance opportunities for persons with significant disabilities to live independently in the community and effectively participate in community activities, Federal programs provide training, resources, and peer counseling and support. Title VII of the Rehabilitation Act establishes centers for independent living and provides support for State efforts to provide, expand and improve the provision of independent living services.121 Independent living services, as defined in The Rehabilitation Act, include:122 * Training in individual and systems advocacy * Services related to securing housing or shelter, including services related to community group living and adaptive housing services * Mobility training * Training in the use of assistive technology devices and services and other supportive services and supports * Training in the management of personal assistance services * Training in the use of public transportation * Training to develop skills specifically designed for youth with disabilities to promote self-awareness and esteem, develop self-empowerment skills, and explore career options. In the education context, the Individuals with Disabilities Education Act was amended in 1997 to include preparation for "independent living" as one of the primary purposes of the legislation.123 The child's individualized education plan and transition plan must include strategies for preparing children with disabilities for independent living.124 The Developmental Disabilities Assistance and Bill of Rights Act sets forth as one of its primary purposes supporting efforts to enhance the "independence" of persons with developmental disabilities.125 2. Long-Term Services and Supports, Including Personal Assistance Services and Supports. Long-term services and supports are necessary to enable certain persons with disabilities to live in the community. Personal Assistance services and supports are a significant form of long- term services. "Personal assistance services" include a range of services, provided by one or more individuals, designed to assist an individual with a disability to perform daily living activities on or off a job that such individual would typically perform if such individual did not have a disability. Such services must be designed to increase such individual's control in life and ability to perform everyday activities on or off such job.126 In the employment context, Title I of the Rehabilitation Act authorizes the expenditure of funds to support personal assistance services while the individual is receiving other vocational rehabilitation services.127 In the health care context, personal assistance services may be provided (optional, not mandatory benefit) to individuals with disabilities under the Medicaid program128 and frequently are included as part of Home and Community Based Services waivers.129 3. Cash Assistance and Other Programs of Assistance. The provision of cash assistance under the SSI and SSDI programs is designed in part to enable a person to remain in the community rather than live in an institution.130 Additional examples include assistance for housing131and Food Stamps.132 D. ECONOMIC SELF-SUFFICIENCY The fourth goal of disability policy, as articulated in the ADA, is to foster economic self-sufficiency, i.e., economic security, stability and productivity of persons with disabilities. Federal legislation accomplishes this goal through * Systems providing employment-related skills (education and training) * Cash assistance programs that include work incentive provisions * Tax policy that provides incentives to employers to hire persons with disabilities and deductions and credits for disability-related expenditures that enable a person with a disability to work. 1. Systems Providing Employment-Related Services and Supports. In the education context, the Individuals with Disabilities Education Act was amended in 1997 to include preparing youth with disabilities for "employment" as one of the primary purposes of the legislation.133 In the employment context, Title I of the Rehabilitation Act provides assistance to enhance the employability of individuals with disabilities through the provision of vocational rehabilitation services.134 Recent amendments to Title I require that the vocational rehabilitation program be an integral component of a statewide workforce development system under the Workforce Investment Act.135 2. Cash Assistance Programs and Other Programs of Assistance That Include Work Incentives. SSI law includes incentives for SSI beneficiaries with disabilities to work, including earned income disregards and permission for these individuals to retain eligibility for Medicaid (which in some states enables these individuals to continue to receive personal assistance services).136 1997 Amendments to the law allow states to increase the income limit for Medicaid coverage of certain SSI beneficiaries (families with income up to 250% of the federal poverty guidelines) and enable these individuals to buy-into" Medicaid by paying a portion of premium costs.137 Under the Ticket to Work and Work Incentives Improvement Act, states may establish one or two new optional Medicaid eligibility categories under which individuals can "buy into" Medicaid.138 Under the first option, States may cover individuals who, except for earnings, would be eligible for SSI. If a state provides Medicaid coverage to individuals described in the first option, the State may also provide coverage to employed persons with disabilities (aged 16-64) whose medical condition has improved but who continue to have a severe medically determinable impairment. Under both of these options, states may establish uniform limits on assets, resources, and earned and unearned income (or both) for this group that differ from the Federal SSI requirements. In addition, P.L. 106-170 authorizes a state to apply to the Secretary of Health and Human Services for approval of a demonstration project under which a specified maximum number of individuals who are workers with a potentially severe disability can buy into Medicaid.139 3. Tax Policy. The Disabled Access Tax Credit provides tax credits to small businesses for expenses incurred to comply with the ADA.140 The Targeted Jobs Credit141 provides tax credits for hiring new employees with disabilities referred by vocational rehabilitation and other specified agencies. METHODS OF ADMINISTRATION In addition to including a common core of substantive concepts, many of the laws addressing the needs of individuals with disabilities (or the regulations implementing these laws) include a core set of administrative/accountability provisions. These administrative/accountability provisions are designed to maximize the likelihood that the rights afforded in the civil rights statutes are realized and the services made available under entitlement and grant-in-aid programs are provided and implemented in accordance with best practices. A. METHODS OF ADMINISTRATION, IN GENERAL The criteria and methods used for administering a program, service, or activity (i.e., official written policies and the actual practices of an entity) must be consistent with the rights and needs of individuals with disabilities and their families. In the civil rights context, the ADA regulation specifies142 that an: "entity may not, directly or through contractual or other arrangements, utilize criteria and or methods of administration that have the effect of subjecting qualified individuals with disabilities to discrimination on the basis of disability or that have the purpose or effect of defeating or substantially impairing accomplishment of the objectives of the public entity's program with respect to individuals with disabilities or that perpetuates the discrimination of another public entity if both public entities are subject to common administrative control or are agencies of the same state." This provision prohibits both blatantly exclusionary policies or practices and nonessential policies and practices that appear neutral but have the effect of denying genuine, effective, and meaningful opportunity. A similar provision is set out in the Section 504 coordination regulation.143 Regulations issued by the Department of Labor implementing section 504 of the Rehabilitation Act (as well as other civil rights statutes) include, in the job training context a provision describing the obligations to develop "Methods of Administration" which must be in writing and reviewed and updated on a periodic basis.144 The Methods of Administration at a minimum must describe how the State and recipients will: * Appoint equal opportunity officers * Provide notice and communications * Provide data information collection, maintenance and quantifiable analysis of records and data kept * Review policies, practices, procedures, and implementation, * Conduct and carry out investigations, oversight, monitoring (including development of monitoring instruments) and enforcement (including prompt corrective action, or , as necessary, applying sanctions when noncompliance is found) * Carry out complaint processing * Conduct equal opportunity training B. STATE AND LOCAL PLANS, APPLICATIONS, WAIVERS State entitlement programs and many grant-in-aid programs, particularly formula grant programs require the submission of state and local plans or applications, which describe how the public agency plans on satisfying the program's applicable requirements in the form of grant terms and conditions.145 Waivers provide exemptions or alternative methods of implementation, including testing new or innovative strategies for providing services.146 C. MONITORING AND ENFORCEMENT BY GOVERNMENT AGENCIES Federal laws specify monitoring and enforcement responsibilities of public agencies. In several instances, Congressional concern over past or potential noncompliance by state and local grantees has prompted the inclusion of special monitoring and enforcement directives and procedures in the statute. These procedures apply to enforcement by the Federal government with respect to compliance by the state as well as to enforcement by state agencies with respect to compliance by local agencies. For example, the 1997 amendments to IDEA provide the Secretary of Education with authority to withhold all or some funds (including withholding funding of administrative salaries) when violations by state educational agencies are found.147 The Secretary of Education may refer the matter to the Department of Justice for appropriate enforcement action (including failure to comply with the terms of any agreement to achieve compliance between the Secretary and a state within timelines specified in the agreement).148 Authority to withhold funds in whole or in part is also provided to state educational agencies.149 In addition, IDEA requires that the public be notified when enforcement action is contemplated by the state educational agency.150 Further, local educational agencies must make available to parents of children with disabilities and the general public all documents relating to compliance by the agency.151 Section 504 of the Rehabilitation Act of 1973 is administered by an Office for Civil Rights in each Federal department or agency. The agency has authority to, among other things, investigate and resolve individual complaints and conduct monitoring reviews of compliance by recipients of Federal aid.152 The agency may also order agencies to take remedial action.153 Comparable authority exists for Federal agencies, such as the Department of Justice and the Equal Employment Opportunity Commission, responsible for enforcing the ADA.154 D. PROCEDURAL SAFEGUARDS Many of the laws covering individuals with disabilities, particularly civil rights laws (such as the ADA, Section 504 of the Rehabilitation Act, and IDEA) include procedural safeguards to ensure that means exist for remedying violations of an individual's guaranteed rights. Procedural safeguards include: * The right to receive a notice of rights.155 * The right to examine records.156 * The right to file a complaint157 * Mediation and other forms of nonadversarial dispute resolution158 * Administrative due process hearings and administrative review159 * Redress through a private right of action in court, including damages and the awarding of attorneys fees to prevailing parties160 Entitlement programs also include procedural protections. For example, the Supplemental Security Income program provides for an administrative review, appeal to Federal district court, and limited attorneys fees for the prevailing claimant.161 Under the Medicaid program, Medicaid beneficiaries have a right to a hearing before an impartial decision-maker concerning denials, reductions, termination's, or delays in the Medicaid benefits; the right to a written decision within 90 days; and a right to appeal to a state court.162 E. ACCOUNTABILITY FOR RESULTS (OUTCOME MEASURES) Many programs require that grantees report program performance as part of an annual evaluation. In the education context, the 1997 amendments to IDEA go a step further by requiring the establishment of specific performance goals and objectives163 that promote the purposes of the Act and are consistent, to the maximum extent appropriate, with other goals and standards for nondisabled children established by the state. IDEA also ensures that individuals with disabilities are included in general state and districtwide assessments,164 with appropriate modifications, where necessary. IDEA also provides that a child's individualized education program must include a statement of how the child's progress toward the annual goals will be measured and how the child's parents will be regularly informed by such means as periodic report cards.165 In the employment context, Title I of Rehabilitation Act directs the Commissioner of the Rehabilitation Services Administration to establish standards and performance indicators for vocational rehabilitation programs.166 The legislation also authorizes the Commissioner to withhold funds if a state falls below established standards until the state agrees to enter into an approved program improvement plan.167 Accountability provisions may also require specific information that are of particular concern to policy makers. For example, the 1997 amendments to IDEA require reporting of expulsion and suspension rates for children with disabilities compared to nondisabled children to determine whether there are significant discrepancies among school districts that may result from failure to implement the law.168 These amendments also specifically require the reporting of information about disproportionate identification and placement of children with disabilities on the basis of race.169 Some generic programs are also beginning to include specific outcome measures for persons with disabilities. For example, the School-To-Work Opportunities Act of 1994 provides for the establishment of a system of performance measures for assessing state and local school-to-work programs that requires, among other things, reporting of outcomes disaggregated for students with disabilities.170 The Workforce Investment Act specifies that each state must prepare an annual report on its progress in achieving state performance measures, including performance indicators for individuals with disabilities.171 The Workforce Investment Act also includes incentives for states that exceed expectations.172 Many states have adopted school reform measures in recent years that include, among other things, statewide performance goals and objectives as well as state and district-wide assessments. The law requires that these reforms must include goals for individuals with disabilities. In many states the methods for administering these programs failed to address the needs of children with disabilities. In 1997, IDEA was amended to ensure that states adopted performance goals and objectives and that state and district-wide assessments included children with disabilities, and provided appropriate accommodations, where necessary.173 F. REPRESENTATION AT THE INDIVIDUAL AND SYSTEMS LEVEL Congress has provided for the establishment of and support for entities whose responsibilities include advocating for and representing persons with disabilities whose rights have been abridged. Every state has a protection and advocacy system for persons with developmental disabilities authorized under the Developmental Disabilities Assistance and Bill of Rights Act.174 In addition to these protection and advocacy systems for persons with developmental disabilities, Federal law also provides protection for: * Persons with mental illness under the Protection and Advocacy for Mentally Ill Individuals Act175 * Persons with disabilities not otherwise eligible for assistance under the Protection and Advocacy of Individual Rights under Section 509 of the Rehabilitation Act of 1973176 * Persons needing assistive technology under a set-aside included in the Technology-Related Assistance for Individuals With Disabilities Act177 * Disabled SSI and SSDI beneficiaries178 * Person with disabilities who are clients or applicants for assistance under the Rehabilitation Act (Client Assistance Program).179 Advocacy and individual representation is also authorized to be provided by centers for independent living under part C of Title VII of the Rehabilitation Act of 1973.180 Parent training and information centers are authorized under IDEA to, among other things, assist parents in understanding their rights under the Act and participating in decisionmaking processes.181 G. SINGLE LINE OF RESPONSIBILITY/COORDINATION AND COLLABORATION AMONG AGENCIES Many programs place accountability for their administration on a single agency to avoid "buckpassing" and prescribe the type of organizational structure that must be established. For example, under the Medicaid program, every state must designate a single agency responsible for implementing the program.182 The state educational agency must administer the IDEA program,183 and the state must designate a sole state agency to administer the vocational rehabilitation program under the Rehabilitation Act of 1973.184 At the same time, many of these programs provide mechanisms for ensuring interagency coordination and linkages. Linkages are particularly critical between programs targeted at persons with disabilities and generic systems that include persons with and without disabilities as program beneficiaries. These provisions are designed to ensure that no one "falls between the cracks." Legislation also includes provisions for ensuring that all agencies (including those who are not the agency responsible for implementing a particular program) pay their fair share for services, which an individual may be entitled to under multiple funding authorities. For example, the 1997 amendments to IDEA spell out in painstaking detail, the responsibility of the Governor to ensure the development of mechanisms for, among other things, sharing financial responsibility for services required under IDEA that may also be required under other legislation.185 Title I of the Workforce Investment Act and the recent amendments to the Rehabilitation Act also specify in detail the need to develop memoranda of understanding spelling out the respective roles of various agencies providing job training and employment-related services for persons with disabilities.186 In 1988, the Medicaid legislation was amended clarifying the circumstances under which Medicaid reimbursement would be available for covered services that were included in a child's "individualized education program" or "individualized family service program" for infants and toddlers with disabilities under IDEA.187 H. SERVICE COORDINATON Often individuals with disabilities and their families require a comprehensive array of services and supports. These services and supports, however, may be authorized under separate Federal or State programs, which have distinct eligibility rules. This array of requirements often places a burden on individuals and families. It is critical that the focus of public policy be on service coordination and the provision of case management to assist and enable individuals with disabilities and their families to receive the rights, procedural safeguards, and authorized services under the various programs. For example, part C of IDEA provides for the identification of the service coordinator in the individualized family service plan for infants and toddlers with disabilities and their families. The coordinator is chosen from the profession most immediately relevant to the child's or family's needs. The service coordinator may also be another person who is otherwise qualified to carry out all applicable responsibilities under part C. "Service coordination" is used in lieu of "case management" because many families resent the latter term. They view themselves as people requiring assistance; not as "cases" that need "managing." The service coordinator is responsible for the implementation of the Individualized Family Service Plan and coordination with other agencies and persons.188 Specifically the regulations189 define "service coordination" to mean: "(a)(1) ... the activities carried out by a service coordinator to assist and enable a child eligible under this part and the child's family to receive the rights, procedural safeguards, and services that are authorized to be provided under the State's early intervention program. (2) Each child eligible under this part and the child's family must be provided with one service coordinator who is responsible for--- * Coordinating all services across agency lines; and * Serving as the single point of contact in helping parents to obtain the services and assistance they need. (3) Service coordination is an active, ongoing process that involves--- * Assisting parents of eligible children in gaining access to the early intervention services and other services identified in the individualized family service plan; * Coordinating the provision of early intervention services and other services (such as medical services for other than diagnostic and evaluation purposes) that the child needs or is being provided; * Facilitating the timely delivery of available services; and * Continuously seeking the appropriate services and situations necessary to benefit the development of each child being served for the duration of the child's eligibility. (b) Specific service coordination activities. Service coordination activities include--- (1) Coordinating the performance of evaluations and assessments; (2) Facilitating and participating in the development, review, and evaluation of individualized family service plans; (3) Assisting families in identifying available service providers; (4) Coordinating and monitoring the delivery of available services; (5) Informing families of the availability of advocacy services; (6) Coordinating with medical and health providers; and (7) Facilitating the development of a transition plan to preschool services, if appropriate." In 1985, the Medicaid program was amended to provide for case management services, although on less than a statewide or comparable basis to targeted groups.190 Case management services must be provided under the EPSDT program when they are medically necessary.191 The Medicaid program also authorizes Medicaid agencies to enter into cooperative arrangements with State Maternal and Child Health agencies when waiver services are provided to children.192 I. FINANCING SERVICE DELIVERY In order to ensure that agencies do not adopt schemes for financing service delivery that have the effect of denying equal opportunity or the accomplishment of other goals of disability policy, legislation includes specific rules prescribing and proscribing agency conduct. In the education context, the IDEA includes several provisions which ensure that educational agencies adopt criteria and methods of administration that achieve policy objectives set out in the legislation as well as in other laws. For example, over the years several states adopted criteria and methods for reimbursing local school districts for serving students with significant disabilities requiring services that cost substantially more than services provided to nondisabled students. These states were providing significant reimbursement to local school districts for placing children with significant disabilities in schools outside the district. The same district, however, received little or no reimbursement if it served the same children with significant disabilities in community schools. The policy had the effect of violating the requirement that children with disabilities be educated in the most integrated setting appropriate. IDEA was amended in 1997 to make such state reimbursement policies illegal.193 J. PRIVACY, CONFIDENTIALITY ACCESS TO RECORDS, INFORMED CONSENT Provisions protecting confidentiality of records194 and requiring informed consent195 before entities take certain actions affecting persons with disabilities are typically found in legislation. In the advocacy context, protection and advocacy systems can be thwarted in their efforts to ascertain whether allegations of abuse and neglect of residents with disabilities residing in residential facilities are real if they are not provided reasonable access to individuals with disabilities and their records. Thus, the legislation provides for access by protection and advocacy systems, at reasonable times and locations, to any resident of a facility that is providing services, supports, and other assistance to such resident as well as access to necessary information.196 K. COMPREHENSIVE SYSTEM OF PERSONNEL DEVELOPMENT AND PERSONNEL STANDARDS Most of the state formula grant programs require that state and local entities responsible for implementing the law implement comprehensive systems of personnel development to ensure that personnel providing services to persons with disabilities are knowledgeable about state-of-the-art practices.197 These programs also require that personnel satisfy certain minimum qualification standards.198 L. RACIAL, ETHNIC, AND LINGUISTIC DIVERSITY The trend in disability policy is to recognize and be responsive to the growing needs of an increasingly more diverse society. For example, the law specifically requires the reporting of data to determine if significant disproportionality based on race is occurring in a state with respect to identification and placement.199 Under Title I of the Rehabilitation Act200 the Commissioner of the Rehabilitation Services Administration must develop a policy to "mobilize the resources of the Nation to prepare minorities for careers in vocational rehabilitation, independent living, and related services" and develop an outreach plan to enhance the capacity of historically black colleges and universities and other similar entities. The state plan must describe outreach procedures to identify and serve individuals who are minorities.201 Under part B of the Developmental Disabilities Assistance and Bill of Rights Act, Developmental Disabilities Councils must, among other things, develop a coordinated "array of culturally competent services."202 The term culturally competent means "services, supports, or other assistance that are conducted or provided in a manner that is responsive to the beliefs, interpersonal styles, attitudes, language and behaviors of individuals who are receiving services, and in a manner that has the greatest likelihood of ensuring maximum participation in the program.203 M. FISCAL PROVISIONS Most Federal programs prohibit grantees from lowering the fiscal support they previously provided for an activity before they received Federal funds. For example, IDEA includes both "supplement, not supplant"204 as well as maintenance of effort205 provisions. The supplanting provision prohibits an entity from replacing state and local funds with Federal funds. The maintenance of effort provision requires that an entity allot at least the amount of funds it allotted in the previous year for a specified purpose. In addition, several laws include "payor-of-last-resort" provisions requiring public agencies to exhaust other funding streams before using funds authorized under a particular program.206 N. FINANCIAL MANAGEMENT AND REPORTING PROVISIONS Grantees must comply with provisions of an administrative nature designed to ensure that grant funds are spent in an effective and efficient fashion. Provisions include fiscal control and fund accounting, periodic reporting of financial transactions, recordkeeping, and access for auditors.207 MODEL PROGRAM SUPPORTS The previous sections describe the core substantive, administrative implementation and enforcement provisions included in key Federal disability legislation. This section describes core program support components, i.e., competitive grants that are national in nature which support systemic change, training of personnel and persons with disabilities and their families, research, demonstrations, and technical assistance. These provisions are included in Federal legislation to ensure that the program's infra-structure remains "state-of-the-art." A. SYSTEMIC CHANGE Grants designed to support systemic change include: * The Technology-Related Assistance for Individuals with Disabilities Act of 1988, which provides assistance to states to develop and implement a consumer-responsive comprehensive statewide program of technology-related assistance for individuals with disabilities.208 * Subpart 1 of part D of IDEA, which assists state educational agencies and their partners in reforming and improving their systems for providing educational and early intervention to improve educational results for children with disabilities.209 * Section 672 of IDEA, which authorizes support for statewide projects designed to improve the quality of special education and related services for children with significant disabilities.210 * Parts B, C, and D of the Developmental Disabilities Assistance and Bill of Rights Act, which supports systemic change by Developmental Disabilities Councils, Protection and Advocacy Systems and University Affiliated Programs.211 * Part C of Title VII of the Rehabilitation Act of 1973, which supports systemic change by Centers for Independent Living.212 * Section 203 of the Ticket to Work and Work Incentives Improvement Act,213 which authorizes the Secretary of the Department of Health and Human Services to develop and establish State infrastructures to support working individuals with disabilities. B. TRAINING OF PERSONS WITH DISABILITIES AND THEIR FAMILIES Grant programs that support training of persons with disabilities and their families include Section 682 of IDEA which supports training and information centers for parents of children with disabilities,214 as well as the Developmental Disabilities Assistance and Bill of Rights Act which supports Developmental Disabilities Councils, protection and advocacy systems, and Centers for Independent Living described above. In addition the Ticket to Work and Work Incentives Improvement Act establishes a community-based work incentives planning and assistance program under the Social Security Act for the purpose of disseminating accurate information to individuals on work incentives.215 In addition, the Commissioner of the Social Security Administration is authorized to make grants to protection and advocacy systems for work incentives assistance to disabled beneficiaries.216 C. PERSONNEL PREPARATION AND TRAINING Grant programs also support personnel preparation and training. Examples include: * Part D of the Developmental Disabilities Assistance and Bill of Rights Act, which supports university affiliated programs to provide interdisciplinary programs operated by universities or by public or nonprofit entities associated with a college or university. It also provides a leadership role in the promotion of independence, productivity, and integration and inclusion into the community of individuals with developmental disabilities.217 * Subpart 2 of part D of IDEA, which supports pre-service and inservice training of general educators as well as special educators, related services personnel and early intervention personnel.218 * Title III of the Rehabilitation Act of 1973, which provides training to ensure that skilled personnel are available to provide rehabilitation services to individuals with disabilities.219 D. RESEARCH, DEMONSTRATIONS, TECHNICAL ASSISTANCE, DISSEMINATION OF INFORMATION Grant programs also support research, demonstrations, technical assistance, and dissemination of information. Examples include: * Title II of the Rehabilitation Act of 1973, which establishes the National Institute on Disability and Rehabilitation Research (NIDDR).220 * Part D of IDEA.221 * Research funded by the National Institutes of Health authorized under Title IV of the Public Health Services Act.222 CONCLUSION Using the Federal disability policy framework described in the other sections of the paper, this section includes general questions for analyzing the extent to which disability-specific and generic programs or policies reflect the precept, goals, definitions, and core policies, methods of administration, and program supports set out in Federal disability policy framework. In other words, this section of the paper serves as a lens, guidepost, or benchmark for evaluating, expanding, and improving the design and implementation of public policies affecting persons with disabilities. Answering these questions may entail, among other things, a review of previous studies and reports, reviewing data, conducting analyses of proposed and final policy pronouncements, and conducting surveys of stakeholders. Not all questions articulated in this part are applicable to all programs and policies, e.g., some questions may only be applicable to generic programs serving persons with and without disabilities. A. QUESTIONS RELATING TO STATEMENT OF FINDINGS AND HISTORICAL CONTEXT * Is the program longstanding, undergoing major reform, or new? If new does it replace an existing program? * How sound was the premise on which the program was based? * Is there a history of exclusion from the program of persons with disabilities or specific categories of persons with disabilities, e.g., a policy, procedure, or accepted practice of disqualifying persons with significant disabilities from receiving services or a policy, procedure or accepted practice by a generic program of automatically referring all persons with disabilities to disability-specific programs? * Is there a history of segregation of persons with disabilities into specific slots or components of the program? * Is there a history of denial of genuine, effective and meaningful services in the program? * Is there a history of ensuring that people with disabilities enjoy choice in assessments, planning, services provided, selection of service providers, and measures of progress? * Is there history of fostering independent living and ensuring self-sufficiency? * What efforts have been made to ascertain the prevalence of persons with disabilities among the prospective pool of eligible recipients of a generic program? * What efforts have been made to ascertain the scope of unmet need? * Is the public agency taking into consideration the historical treatment of persons with disabilities in the development of new policies and procedures and the methods of administration it uses? B. QUESTIONS RELATING TO CORE PRECEPT * Does the program include a statement articulating the core precept on which it is based? Is the core precept of the program consistent with the precept of disability policy that disability is a natural and normal part of the human experience that in no way diminishes a person's right to fully participate in the program, consistent with the unique strengths, resources, priorities, concerns, abilities, and capabilities of the individual? C. QUESTIONS RELATING TO OVERACHING GOALS * Do the goals of the program reflect the goals of Federal disability policy articulated in the ADA--equality of opportunity, full participation (empowerment), independent living and economic self-sufficiency for persons with disabilities? D. QUESTIONS RELATING TO DEFINITION OF DISABILITY * Does the definition of disability reflect the purposes of the particular legislation? * How does the definition of disability relate to definitions used in other programs and under Section 504 and the ADA? E. QUESTIONS RELATING TO CORE POLICIES 1. QUESTIONS RELATING TO EQUALITY OF OPPORTUNITY a. Individualization. Do the policies and procedures governing eligibility and application for and delivery of services under the program: * Take into accounts the unique strengths, resources, priorities, concerns, abilities, and capabilities of each person with a disability, including individuals with significant disabilities? * Take into account the added dimension of poverty? * Use definitions and eligibility criteria that result in even-handed treatment between a person with a particular disability and other similarly situated individuals, including nondisabled persons and persons with other disabilities? * Ensure universal access to generic programs for persons with disabilities satisfying the broad, nondiscriminatory eligibility criteria? * Treat a person with a disability as an individual based on facts and objective evidence; not on the basis of generalizations, stereotypes, fear, ignorance, or prejudice? * In making fact-specific decisions, use interdisciplinary assessments performed by qualified personnel, conduct timely assessments across multiple environments, and use information provided by the individual with a disability and the person's family or representative? * Use individualized plans to identify and describe needs, goals, objectives, services, and accountability measures? b. Genuine, Effective, and Meaningful Opportunity. Do the policies and procedures governing eligibility and application for and delivery of services under the program offer opportunities that are genuine, effective, and meaningful? This includes: * Providing "appropriate" services and supports designed to meet the unique needs of the individual, not the needs of the "average" person. * Making reasonable modifications to policies, practices, and procedures unless it would fundamentally alter the nature of the program. * Providing auxiliary aids and services unless it would result in an undue hardship to the covered entity. * Providing reasonable accommodations to employees unless it would result in an undue hardship to the covered entity. * Making a program physically accessible. * Providing for communication accessibility. c. Inclusion and Integration. * Do the policies and procedures governing eligibility and application for and delivery of services under the program foster the inclusion and integration of persons with disabilities or do the policies and procedures unnecessarily or unjustifiably isolate or segregate persons with disabilities? 2. QUESTIONS RELATING TO FULL PARTICIPATION Do the policies and procedures governing the program foster the empowerment of persons with disabilities, real and informed choice, and active participation in decision-making process at the individual and system level (including self-advocacy)? More specifically, do the policies and procedures governing the program foster: * Active involvement and real and informed choice of the individual with a disability in areas including: * Opportunity to receive information about policies that affect the individual. * Assessments. * Planning. * Services provided. * Selection of service providers. * Measures of progress. * Active involvement and real and informed choice of family members and other representatives (under appropriate circumstances) in decisions affecting the individual with a disability and the family, including: * Opportunity to receive information about policies that affect the individual. * Assessments. * Planning. * Services provided. * Selection of service providers. * Measures of progress. * Active involvement in policy decisions at the system level (respecting the design, implementation and evaluation of a program), including: * Consideration of input from consumers. * Participation on governing boards and councils. * Joint sign-off on policies by governing board/council. 3. QUESTIONS RELATING TO INDEPENDENT LIVING Do the policies and procedures governing the program foster the ability and capabilities of individuals with disabilities to live independently through support for independent living skill development, including: * Training in individual and systems advocacy. * Service related to securing food, clothing, and shelter. * Training the management of personal assistants and the use of assistive technology. * Specialized planning for transitioning to independent living. * Do the policies and procedures governing the program enable the person with a disability to live independently through the provision of long-term services and supports, e.g., consumer-directed personal assistance services and supports and assistive technology devices and services? * Do the policies governing the program enable the person with a disability to live independently in the community through cash assistance or other forms of assistance? 4. QUESTIONS RELATING TO ECONOMIC SELF- SUFFICIENCY Do the policies and procedures governing the program foster the economic security, stability, and productivity of persons with disabilities consistent with their actual (not perceived) capabilities, strengths, needs, interests, and priorities through support for: * Systems that include universal access to generic services as well as access to specialized services and supports as an integral component of the system. * Training, education, and employment of choice (including self-employment). * Ongoing supports on-the-job. * Specialized planning (e.g., transition planning for children in high school). * Cash assistance programs that reflect the goal of maximizing economic self-sufficiency, including policies that provide incentives to work e.g., waive or modify income and resource limits, and retain eligibility for acute and long-term services and supports. F. QUESTIONS RELATING TO METHODS OF ADMINISTRATION 1. QUESTIONS RELATING TO STATE AND LOCAL PLANS, APPLICATIONS, WAIVERS * Does the plan/application include specific policies and procedures governing implementation for persons with disabilities? * Do waiver requests have the effect of enhancing or diminishing opportunities for persons with disabilities? For example, is a waiver request designed to test new strategies for delivering services that reflect the goals of disability policy articulated in the ADA? Or is the waiver request based on "perceptions" that individual's with disabilities cannot succeed or participate in the program or assessment generally applicable to nondisabled persons? * Does the plan/application explain how people with disabilities and their representatives were involved in the process of completing the plan/application? * In addition to the inclusion of an assurance of nondiscrimination, does the plan/application include specific policies and procedures relating to implementation of the program consistent with Section 504 of the Rehabilitation Act and ADA? 2. QUESTIONS RELATING TO MONITORING AND ENFORCEMENT BY GOVERNMENT AGENCIES * What are the respective roles and responsibilities of Federal agencies, State agencies, local agencies for monitoring and enforcement? * Does the monitoring instrument developed by the government agency include specific inquiries related to persons with disabilities? What are they? * Does the government agency use a monitoring instrument for ascertaining compliance with Section 504 of the Rehabilitation Act and the ADA? If so, what is included? * Do on-site monitoring reviews include assessments relating to meeting the needs of persons with disabilities and ensuring nondiscrimination? * What sanctions are available and used? Under what circumstances? * What incentives are available and used? * How are findings of noncompliance used by the agency? Are findings of noncompliance used for purposes of ongoing continuous quality improvement reviews? * What remedies are available? * Is there a complaint resolution procedure that includes complaints involving discrimination on the basis of disability? 3. QUESTIONS RELATING TO PROCEDURAL SAFEGUARDS FOR INDIVIDUALS, THEIR FAMILIES AND REPRESENTATIVES Do the policies and procedures governing the program provide for: * Notice of rights? * Examination of records? * The right to file a complaint? * The use of mediation and other forms of dispute resolution? * Administrative due process hearings and administrative review? * Redress through private right of action in court, including remedies and the awarding of attorneys' fees to prevailing parties? 4. QUESTIONS RELATING TO ACCOUNTABILITY FOR RESULTS (OUTCOME MEASURES) * Does the agency include outcome measures that address issues of specific relevance to persons with disabilities? * Does the agency disaggregate data so the agency can determine whether its program is meeting the needs of persons with disabilities or persons with specific categories of disabilities as part of a process of continuous improvement? 5. QUESTIONS RELATING TO REPRESENTATION AT THE INDIVIDUAL AND SYTEMS LEVEL * Does the public agency provide support for representation and advocacy at the individual and systems level, including support for systems providing protection and advocacy, and self-advocacy training? 6. QUESTIONS RELATING TO SINGLE LINE OF RESPONSIBILITY/COORDINATION AND LINKAGES AMONG AGENCIES * Is there a single agency (State or local) responsible for implementation of the program for all beneficiaries, including persons with disabilities? If not how does the agency ensure compliance for persons with disabilities? * Does the agency require the assignment of an individual who will be responsible for ensuring implementation of the program for persons with disabilities, particularly with respect to implementation of the program consistent with Section 504 of the Rehabilitation Act and the ADA? * Has the agency developed policies and procedures for collaboration among agencies to ensure meaningful and effective delivery of necessary services to persons with disabilities, including cost sharing arrangements? 7. QUESTIONS RELATING TO SERVICE COORDINATION (CASE MANAGEMENT) * Has the agency developed policies and procedures for service coordination to ensure that individuals with disabilities, particularly those with the most significant disabilities, receive the services they need, particularly where services are provided by multiple agencies? 8. QUESTIONS RELAING TO FINANCING SERVICE DELIVERY * Does the system for allocating funds among agencies and service providers facilitate or thwart accomplishment of the goals articulated in the ADA and the policies that effectuate the goals? For example, does the outcome-based reimbursement scheme used to pay service providers recognize and reward those who serve persons with the most significant disabilities who cost more than the average recipient of services (risk adjustment)? * Is the network of service providers adequate to address the needs of persons with disabilities eligible for assistance under the program? * Is the financing system for services (e.g., personal assistance services, assistive technology), consumer-directed? 9. QUESTION RELATING TO PRIVACY, CONFIDENTIALITY, ACCESS TO RECORDS, INFORMED CONSENT * Does the agency include specific policies and procedures protecting the rights of persons with disabilities to privacy? Confidentiality? Access to Records? * Does the agency include specific policies and procedures requiring informed consent? 10. QUESTIONS RELATING TO COMPREHENSIVE SYSTEM OF PERSONNEL DEVELOPMENT * Does the agency include specific training components regarding the implementation of its program (e.g., policy, "promising practices," and resource allocation) for persons with disabilities? * Does the agency include specific training for its personnel regarding implementation of its program consistent with Section 504 of the Rehabilitation Act and the ADA? 11. QUESTIONS RELATING TO RESPONSIVENESS TO CULTURAL DIVERSITY * Does the agency include policies and procedures that address the special needs of persons with disabilities from diverse cultural backgrounds? 12. QUESTIONS RELATING TO FISCAL PROVISIONS * Do the "supplement, not supplant" and "maintenance of effort" provisions ensure continuation of funding from state and local sources for services provided to persons with disabilities? 13. QUESTIONS RELATING TO FINANCIAL MANAGEMENT AND REPORTING * Do the fiscal control and fund accounting procedures enable oversight with respect to the provision of funding for persons with disabilities consistent with legislative intent? G. QUESTIONS RELATING TO PROGRAM SUPPORT * To the extent an agency supports efforts to improve the quality of services provided through initiatives such as systems change grants, training, research, technical assistance, demonstrations, information dissemination, do these initiatives include specific components or specific initiatives that address the unique needs of persons with disabilities? 1 See e.g., Section 2(a) of the Americans With Disabilities Act (42 U.S.C. 12101(a)). See also Senate Report No. 101-116 at pages 5-20. 2 Senate Report No. 101-116 at pages 5-7. 3 See e.g., National Institute on Disability and Rehabilitation Research, Notice of Final Long-Range Plan for Fiscal Years 1999-2004 at 64 FR 68578 (December 7, 1999). 4 See e.g., The Individuals with Disabilities Education Act (20 U.S.C. 1400 et. seq.) and the Rehabilitation Act (29 U.S.C. 701 et seq.). 5 42 U.S.C. 12101 et seq. 6 136 Cong. Rec. S.9689 (Daily Edition, July 13, 1990). 7 National Institute on Disability and Rehabilitation Research, Notice of Final Long-range Plan for Fiscal Years 1999-2004 (64 FR 68578 (December 7, 1999)). 8 Section 2(a)(8) of the ADA (42 U.S.C. 12101(a)(8)). 9 Generic programs include persons with and without disabilities among the beneficiaries of assistance. An example of a generic program is the recently enacted Workforce Investment Act which establishes an integrated workforce investment preparation and employment system for all job seekers, including individuals with disabilities. 29 U.S.C. 2801 et seq. 10 Re-Charting the Course-First Report of the Presidential Task Force on Employment of Adults with Disabilities (November 15, 1998) at page 5. 11 42 U.S.C. 12101 et seq. 12 29 U.S.C. 794. Pursuant to Executive Order 12250, the Department of Justice is responsible for coordinating the implementation of section 504 by the various Federal agencies. The Section 504 coordination regulations are set out in 28 CFR Part 41 (hereinafter referred to as the "Section 504 coordination regulations." Each Federal agency is responsible for promulgating its own regulations implementing, Section 504. For example, the Department of Health and Human Services Section 504 regulations are codified in Part 84 of Title 45 of the Code of Federal Regulations. 13 42 U.S.C. 3604(f). 14 20 U.S.C. 1411-1419. 15 42 U.S.C. 401 et seq. 16 42 U.S.C. 1381-1383c. 17 42 U.S.C. 1395 et seq. 18 42 U.S.C. 1396 et seq. 19 42 U.S.C. 1396d(a)(10)(A). 20 42 U.S.C. 1396(a)(10); 1396d(a). 21 42 U.S.C. 1396n( c ). 22 29 U.S.C. 720-753a. 23 29 U.S.C. 730. 24 Balanced Budget Act of 1997 (Title IV-J of P.L. 105-33). 25 20 U.S.C. 1411-1419. 26 20 U.S.C. 1431-1445. 27 29 U.S.C. 795j-795q. 28 29 U.S.C. 796e-796e-3. 29 42 U.S.C. 6021 et. seq. 30 29 U.S.C. 796f-796f-6. 31 42 U.S.C. 6041-6043. 32 P.L. 105-220. 33 20 U.S.C. 5801 et seq. 34 42 U.S.C. 9831 et seq. 35 42 U.S.C. 1397 et seq. 36 42 U.S.C. 701 et seq. 37 29 U.S.C. 760-765. 38 29 U.S.C. 2201 et seq. 39 42 U.S.C. 6061 et. seq. 40 42 U.S.C. 281 et seq. 41 Section 506 of the ADA (42 U.S.C. 12206). 42 20 U.S.C. 1461-1474. 43 20 U.S.C. 1482. 44 P.L. 106-170. 45 29 U.S.C. 794e. 46 Pub. L. No. 103-31. 47 Pub. L. No. 103-3 (codified at 29 U.S.C. 2601-654). 48 P.L. 104-104. 49 26 U.S.C. 44. 50 26 U.S.C. 51. 51 Section 2(a) of the ADA (42 U.S.C. 12101(a)). 52 Section 100(a) of the Rehabilitation Act (29 U.S.C. 720(a)). 53 Section 601(c) of IDEA (20 U.S.C. 1400(c )). These findings were updated in the 1997 amendments to IDEA (P.L. 105-17). 54 Section 2(a)(3) of the Rehabilitation Act (29 U.S.C. 701(a)(3)); Section 101(a)(2) of the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6000(a)(2)). See also, Section 601(c)(1) of IDEA (20 U.S.C. 1400(c)(1)). 55 Section 2(a)(8) of the ADA (42 U.S.C. 12101(a)(8)). 56 Section 2 (a) and (c) of the Rehabilitation Act (29 U.S.C. 701(a) and (c)). 57 Section 601(c)(5) of IDEA (20 U.S.C. 1400( c )(5)). 58 Section 101(c) of the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6000(c )). 59 Section 3(2) of the ADA (42 U.S.C. 1210 2(2). 60 Section 6(20) of the Rehabilitation Act (29 U.S.C. 705(20)). 61 Section 101(8) of the ADA (42 U.S.C. 12111(8)). 62 Section 201(2) of the ADA (42 U.S.C. 12131(2)). 63 Section 1614 (a)(3)(A) of the Social Security Act (42 U.S.C. 1382 c (a)(3)(A)). 64 Section 1614(a)(3)(C) of the Social Security Act (42 U.S.C. 1382c(a)(3)( C )). 65 Section 602(3) of IDEA (20 U.S.C. 1401(3)). 66 Section 6(20) of the Rehabilitation Act (29 U.S.C. 705(20). 67 Section 6(20) of the Rehabilitation Act (29 U.S.C. 705(20). 68 Section 102(a)(1) of the Rehabilitation Act (29 U.S.C. 722(a)(1). 69 Section 102(8) of the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6001(8)). 70 Section 202 of the ADA (42 U.S.C. 12132); Section 504 of the Rehabilitation Act (29 U.S.C. 794). 71 28 CFR 35.130. 72 28 CFR 41.51(b)(1). 73 Section 102 of the Rehabilitation Act (29 U.S.C. 722). 74 Section 614( c ) of IDEA (20 U.S.C. 1414( c )). 75 Section 614(a) of IDEA (20 U.S.C. 1414(a)). 76 Id. 77 See 42 CFR 441.50-441.62. 78 11 Maine Rev. Stats. Ann., Title 20, Section 911. 79 Section 612(a) of IDEA (20 U.S.C. 1412(a)). 80 Section 102 of the Rehabilitation Act (29 U.S.C. 722). 81 Section 101(a)(5)(A) of the Rehabilitation Act (29 U.S.C. 721(a)(5)(A)). 82 See Title XVI of the Social Security Act (42 U.S.C. 1381-1383c). 83 28 CFR 35.130. 84 28 CFR 41.51(b). 85 29 CFR 1630.9; 28 CFR 41.53. 86 28 CFR 35.149-.151; 28 CFR 41.57. 87 28 CFR 35.160-.164; 28 CFR 41.51(b) and 41.51(e). 88 28 CFR 35.103(f). 89 28 CFR 35.130 (e). 90 Section 612(a)(1) of IDEA (20 U.S.C. 1412(a)(1)). 91 Section 612(a)(14) of IDEA (20 U.S.C. 1412(a)(14)). 92 Section 103 of the Rehabilitation Act (29 U.S.C. 723). 93 Section 1905(r) of the Social Security Act (42 U.S.C. 1396d( r )). 94 28 CFR 35.130. 95 28 CFR 41. 51(b). 96 Section 615(k) of IDEA (20 U.S.C. 1415(k)). 97 Section 2(a)(2) of ADA (42 U.S.C. 12101(a)(2)). 98 28 CFR 35.130. 99 28 CFR 35.130(d). 100 28 CFR Part 35, Appendix A , page 450 (1998). 101 28 CFR 41. 51(d). 102 Section 612(a)(5) (20 U.S.C. 1412(a)(5)). 103 34 CFR 300.550-.551. 104 Section 102(15) of the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6001(15)). 105 Section 1915(c) of the Social Security Act (42 U.S.C. 1396n( c )). 106 Section 102 of the Rehabilitation Act (29 U.S.C. 722). 107 Section 105 of the Rehabilitation Act (29 U.S.C. 725). 108 Section 704(a)(2) of the Rehabilitation Act (29 U.S.C. 796c(a)(2)). 109 Section 1148 of the Social Security Act, as added by P.L. 106-170. 110 Section 103(f)(3) of the P.L. 106-170. 111 Section 614(d) and (f) of IDEA (20 U.S.C. 1414(d) and (f)). 112 Section 614(d)(1)(B) of IDEA (20 U.S.C. 1414(d)(1)(B)). 113 Section 615(m) of IDEA (20 U.S.C. 615(m)). 114 Section 612(a)(21) (20 U.S.C. 1412(a)(21)). 115 20 U.S.C. 1431 et seq. 116 Section 101(a)(2) of the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6000(a)(2)). 117 See Section 102(2) of S. 1809, the Developmental Disabilities Assistance and Bill of Rights Act of 1999. 118 Section 101 of PAMIIA (42 U.S.C. 10801(2)). 119 Section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c )). 120 Section 701 of the Rehabilitation Act (29 U.S.C. 796). 121 Parts B and C of Title VII of the Rehabilitation Act (29 U.S.C. 796e and 796f). 122 Section 6(18) of the Rehabilitation Act (29 U.S.C. 705(18)). 123 Section 601(d)(1) of IDEA (20 U.S.C. 1400(d)(1)). 124 Section 614 of IDEA (20 U.S.C. 1414). 125 Section 101(b) of the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6000(b)). 126 Section 6(28) of the Rehabilitation Act (20 U.S.C. 705(28); Section 102(18) of the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6001(18)). 127 Section 103(a)(9) of the Rehabilitation Act (29 U.S.C. 723(a)(9)). 128 42 U.S.C. 1396d. 129 Section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)). Additional categories of long-term services and supports may be provided under the Waiver program. 130 Title XVI of the Social Security Act (42 U.S.C. 1381-1383c), See also Title II of the Social Security Act (42 U.S.C. 401 et seq.). 131 See e.g., Section 8 of the Housing Act of 1937 (42 U.S.C. 1437f(o)). 132 The Food Stamp Act of 1977 (7 U.S.C. 2011 et seq.). 133Section 601(d)(1) of IDEA (20 U.S.C. 1400(d)(1)). 134 29 U.S.C. 720-753a. 135 P.L. 105-22. 136 P.L. 99-643 made permanent Section 1619 of the Social Security Act (42 U.S.C. 1382h). See also Section 1905 (q) of the Social Security Act (42 U.S.C. 1396d(q)). 137 Balanced Budget Act of 1997, P.L. 105-33. 138 These options are authorized under 201 of P.L. 106-170, which adds sections 1902(a)(10)(A)(ii)(XV) and (XVI) to the Social Security Act. 139 Section 204 of P. L. 106-170. 140 26 U.S.C. 44. 141 26 U.S.C. 51. 142 28 CFR 35.130. 143 28 CFR 41. 51(b)(3). 144 29 CFR 37.54. 145 See e.g., Section 612 (State eligibility) and Section 613 (local educational eligibility) of IDEA (20 U.S.C. 1412, 1413); Section 101 of the Rehabilitation Act (29 U.S.C. 721) Section 1902 of the Social Security Act (Medicaid State Plan) (42 U.S.C. 1396a). 146 See e.g., waiver provisions in Section 1115 of the Social Security Act (42 U.S.C. 1215) and Section 1915( c ) of the Social Security Act (42 U.S.C. 1396n( c )). 147 Section 616(a)(1) of IDEA (20 U.S.C. 1416(a)(1)). 148 Section 616(a)(1) of IDEA (20 U.S.C. 1416(a)(1)). 149 Section 613(d)(1) of IDEA (20 U.S.C. 1413(d)(1)). 150 Section 613 (d)(2) of IDEA (20 U.S.C. 1413(d)(2)). 151 Section 613(a)(7) of IDEA (20 U.S.C. 1413(a)(7)). 152 See e.g., Subpart G of the Section 504 regulations issued by the Department of Health and Human Services, incorporating by reference the compliance and enforcement regulations implementing Title VI of the Civil Rights Act of 1964 (45 CFR 84.61) 153 See e.g., 45 CFR 84.6. 154 For Department of Justice regulations pertaining to State and local government agencies see 28 CFR 35.170-190; See EEOC Compliance and Enforcement procedures are describing entitled "Technical Assistance on the Employment Provisions (Title I of the ADA - Explanation of Key Provisions." 155 See e.g., 28 CFR 35.105; Section 615(b)(3) of the IDEA (20 U.S.C. 1415(b)(3)). 156 See e.g., Section 615(b)(1) of IDEA (20 U.S.C. 1415(b)(1)). 157 See e.g., Section 615(b)(6) of IDEA (20 U.S.C. 1415(b)(6); Section 102(d) of the Rehabilitation Act (29 U.S.C. 722 (d); and regulations implementing ADA (State and Local governments (28 CFR 35.170-35.190). 158 See e.g., Section 615(e) of IDEA (20 U.S.C. 1415(e)) and Section 513 of the ADA (42 U.S.C. 12212). 159 See e.g., Section 615(f) of IDEA (20 U.S.C. 1415(f)). 160 See e.g., Section 615( i )(2) of IDEA (20 U.S.C. 1415( i )(2)); Section 505 of the Rehabilitation Act (29 U.S.C. 795); Section 203 of the ADA (42 U.S.C. 12133). 161 Section 1631 of the Social Security Act (42 U.S.C. 1383). 162 42 U.S.C. 6041-6043. 163 Section 612(a)(16) of IDEA (20 U.S.C. 1412(a)(16)). 164 Section 612 (a)(17) of IDEA (20 U.S.C. 1412(a)(17)). 165 Section 614(d)(1)(a)(viii) of IDEA (20 U.S.C. 1414(d)(1)(A)(viii)). 166 Section 106(a) of the Rehabilitation Act (29 U.S.C. 726(a)). 167 Section 106(c) of the Rehabilitation Act (29 U.S.C. 726( c )). 168 Section 612(a)(22) of IDEA (20 U.S.C. 1412(a)(22)). 169 Section 618(c)(2) of IDEA (20 U.S.C. 1418( c )(2)). 170 20 U.S.C. 6192(a)(5). 171 Section 136(d)(2)(F) of WIA (29 U.S.C. 2871(d)(2)(F)). 172See 20 CFR 666.200. 173 Section 612(a)(16) of IDEA (20 U.S.C. 1412(a)(16)). 174Part C of the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6041-6043). 175 42 U.S.C. 10801-10851. 176 29 U.S.C. 794e. 177 29 U.S.C. 2212(e)(20)(E). 178 Section 1150 of the Social Security Act, as added by P.L. 106-170. 179 Section 112 of the Rehabilitation Act (29 U.S.C. 732). 180 29 U.S.C. 796f-4. 181 Section 682 of IDEA (20 U.S.C. 1482). 182 Section 1902(a)(5) of the Social Security Act (42 U.S.C. 1396a(a)(5)). 183 Section 612(a) (11) of IDEA (20 U.S.C. 1412(a)(11)). 184 Section 101(a)(1) of the Rehabilitation Act (29 U.S.C. 721(a)(1)). 185 Section 612(a)(12) of IDEA (20 U.S.C. 1412(a)(12)). 186 Section 121(c) of WIA (29 U.S.C. 2841(c)); Section 101(a)(11) of the Rehabilitation Act (29 U.S.C. 721(a)(11)). 187 The Medicare Catastrophic Coverage Act of 1988 (P.L. 100-360). 188 Section 635 of IDEA (20 U.S.C. 1435). 189 34 CFR 303.23. 190 Section 1905(a)(19) of the Social Security Act (42 U.S.C. 1396d(a)(19)) and Section 1915(g) of the Social Security Act (42 U.S.C. 1396n(g)). 191 Section 1905(r)(5) of the Social Security Act (42 U.S.C. 1396d( r )(5)). 192 Section 1902(a)(11) of the Social Security Act (42 U.S.C. 1396a(a)(11)). 193 Section 612(a)(5) of IDEA (20 U.S.C. 1412(a)(5)). 194 See e.g., Section 617(c) of IDEA (20 U.S.C. 1417(c); Section 102(c)(3) of the ADA (42 U.S.C. 12112( c )(3)). 195 See e.g., Section 614(a)(1)( c ) of IDEA requiring informed consent before a local school district conducts an initial evaluation of a child (20 U.S.C. 1414(a)(1)). 196 See e.g., Section 142 of the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6042(g)). 197 See e.g., Section 612(a)(14) of IDEA (20 U.S.C. 1412(a)(14)) and Section 101(a)(7)(A) of the Rehabilitation Act (29 U.S.C. 721(a)(7)(A)). 198 See e.g., Section 612(a)(15) of IDEA (20 U.S.C. 1412(a)(15)); Section101(a)(7)(B) of the Rehabilitation (29 U.S.C. 721(a)(7)(B)). 199 Section 618(c) of IDEA (20 U.S.C. 1418( c )). 200 Section 19 of the Rehabilitation Act (29 U.S.C. 718(b)). 201 Section 101 of the Rehabilitation Act (29 U.S.C. 721). 202 Section 121 of the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6021). 203 Section 102 of the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6001(7)). 204 State level supplement, not supplant provision is found at Section 612(a)(18) of IDEA (20 U.S.C. 1412(a)(18)). The local level provision is set out at Section 613(a)(2) of IDEA (20 U.S.C. 1413(a)(2)). 205 The State-level maintenance of effort provision is set out at Section 612(a)(19) of IDEA (20 U.S.C. 1412(a)(19)) the local level provision is at Section 613(a)(2) of IDEA (20 U.S.C. 1413(a)(2)). 206 Section 101(a)(8) of the Rehabilitation Act (29 U.S.C. 721(a)(8)) and Section 612(a)(12) of IDEA (20 U.S.C. 1412(a)(12)). 207 See e.g., The General Education Provisions Act. 208 29 U.S.C. 2201 et seq. 209 20 U.S.C. 1451-1456. 210 20 U.S.C. 1472. 211 42 U.S.C. 6021-6030, 6041-6043 and 6061-6066. 212 29 U.S.C. 796f-796f-6. 213 P.L. 106-170. 214 20 U.S.C. 1482. 215 Section 121 of P.L. 106-170 adds a new section 1149 to the Social Security Act. 216 Section 122 of P.L. 106-170 adds a new section 1150 to the Social Security Act. 217 42 U.S.C. 6061-6066. 218 20 U.S.C. 1461-1474. 219 29 U.S.C. 770-777f. 220 29 U.S.C. 760-765. 221 20 U.S.C. 1451-1474. 222 42 U.S.C. 281 et seq. 1