National Council on Disability
Notice of Funding Opportunity for a Cooperative Agreement
NCD-20-03: Making Sufficient Oral Healthcare for People with I/DD a Cost-Effective Reality: Examining the Medicaid Reimbursement Rate
Type of Award: Cooperative Agreement
Estimated Number of Awards: 1
Maximum amount available for this project: $100,000.00
The funding amount is contingent on fiscal year 2020 funding availability.
All potential applicants are eligible to apply
Cost sharing is not required
The estimated period of performance is 10 months
Authority: Section 401, Title IV of the Rehabilitation Act of 1973, as amended
Full Proposal Deadline: 5:00 p.m. (submitter’s local time), June 18, 2019. Late applications will not be considered.
Deliver electronic Word and PDF versions of business and technical proposals to: firstname.lastname@example.org
NCD seeks to explore whether NCD should recommend to Congress and the President that increasing the Medicaid oral healthcare reimbursement rate for people with intellectual and developmental disabilities (I/DD) is fiscally cost effective policy vis-à-vis the money ultimately spent on preventable operations and in emergency rooms due to untreated dental problems, aside from being good preventative services policy and policy consistent with the objectives of the Americans with Disabilities Act and Rehabilitation Act. Further, NCD seeks to discern the extent that respective states are using unique plans as a means of providing accessible oral healthcare, that is more cost effective than increasing the Medicaid reimbursement rate, and that could potentially be adopted by the federal government.
Background and Issues
A significant oral health disparity exists for people with I/DD. Studies have shown that adults with developmental disabilities are at risk for multiple health problems including poor oral health. Further, in 2002, the U.S. Surgeon General reported that, compared with other populations, “adults, adolescents, and children with [intellectual disability (sic)] experience poorer health and more difficulty in finding, getting to, and paying for appropriate health care.” This disparity has made people with I/DD more likely to have poor oral hygiene, periodontal disease and untreated dental caries than members of the general population. Equally noteworthy is the comprehensible frustration and sense of injustice this disparity creates, a disparity created in part by insufficient Medicaid oral healthcare reimbursement rates for people with I/DD.
Approximately 60 percent of people in the United States with I/DD rely on Medicaid for their health insurance coverage; and Medicaid’s reimbursement doesn’t always suffice as a means of encouraging dentists to provide care. While comprehensive dental coverage is mandatory for children enrolled in Medicaid, dental benefits for adults vary depending on the state. Some states provide extensive coverage with more generous expenditure caps annually, while others provide limited coverage with shorter caps, and some states only provide coverage for emergency relief alone. While increasing the reimbursement rate with respect to oral healthcare for adult patients with intellectual and developmental disabilities would greatly improve access to care for persons with I/DD, cost concerns certainly cannot be ignored.
There were about two million annual emergency department visits in the United States for nontraumatic dental problems, representing 1.5% of all emergency department visits as of 2015. Studies have shown that adults with developmental disabilities are at risk for multiple health problems including poor oral health, and people with I/DD tend to have higher rates of emergency department visits when compared with people that do not have I/DD. As of November 2017, only 34 states covered services beyond medically necessary care in emergency circumstances, and only 17 offered an extensive benefit. As one state example, in 2009 California had eliminated its Medicaid dental benefits and emergency department visits per 100,000 people increased by 32.3%, and emergency department costs due to dental emergencies increased by 68%. Access to relevant state data that evaluates the cost/benefit analysis of increased Medicaid reimbursement rates of preventive services vis-à-vis the actual savings to the overall healthcare costs by keeping persons with I/DD out of emergency and operating rooms is essential. To that end, NCD is initiating a project whereby NCD is soliciting outside proposals to research and pull together this information nationally.
This project is a means to explore whether NCD should recommend to Congress and the President that increasing the reimbursement rate for people with I/DD is fiscally cost effective policy, aside from being good preventative services policy and policy consistent with the objectives of the Americans with Disabilities Act and Rehabilitation Act. Further, NCD seeks to discern the extent that respective states are using unique plans as a means of providing accessible oral healthcare, that is more cost effective than increasing the Medicaid reimbursement rate, and that could potentially be adopted by the federal government.
NCD has focused much of its work on achieving improved access to oral healthcare for people with intellectual and developmental disabilities, beginning in 2017, with publication of its policy brief, Neglected for Too Long: Dental Care for People with Intellectual and Developmental Disabilities. In that brief, NCD outlined areas through which access to improved oral health can be achieved. Those areas included required training for dental students to manage treatment of patients with I/DD; changing the American Dental Association’s Code of Professional Conduct to stipulate that dentists may not deny treatment to a patient based on the patient’s disability status, and referring the patient to a provider able to provide treatment when necessary; and designating people with I/DD as a Medically Underserved Population under the Public Health Service Act, which would involve increasing the Medicaid reimbursement rate for people with I/DD (another policy recommendation presented by NCD in its brief).
Many of these policy recommendations have been implemented. The American Dental Association has revised its professional code to state that a provider may not deny care to a patient based on a patient's disability, the Commission on Dental Accreditation now requires all US dental schools to train students to manage treatment of patients with I/DD, and a bill designating people as a Medically Underserved Population under the Public Health Service Act has been referred to the Subcommittee on Health of the US of Representatives Energy and Commerce Committee. Determining whether increasing the Medicaid reimbursement rate for patients with I/DD on a national level would ultimately save costs spent on emergency procedures is a useful component of achieving best approaches towards realizing the policy proposal of improving access to oral health preventive care for patients with I/DD.
Statement of Work
This report will collect and analyze relevant state data and evaluate the cost/benefit analysis of increased Medicaid reimbursement rates of preventive services vis-à-vis the actual savings to the overall oral healthcare costs by keeping persons with I/DD out of emergency and operating rooms. Additionally, the report will discern the extent that respective states are using unique plans as a means of providing accessible oral healthcare, that is more cost effective than increasing the Medicaid reimbursement rate, and that could potentially be adopted by the federal government.
The Report will address the following questions:
- Which states provide more generous dental care coverage through Medicaid, and which states provide more generous coverage to patients with I/DD in specific, including through waivers?
- Which states have seen an increase in dental-related hospital visits, and how does that response correlate to the respective states that provide little to no dental care coverage under Medicaid, and with respect to patients with I/DD in specific?
- Have states that provide more generous oral healthcare coverage through Medicaid seen an overall cost-savings return on their investment with respect to patients with I/DD?
- What additional costs have states paid through decreased oral healthcare coverage through Medicaid, and with respect to patients with I/DD in specific?
- State by state, have patients with I/DD visited Emergency departments with respect to oral health concerns at a rate higher than patients without I/DD in the US?
- What successes or setbacks have been experienced in the states that have increased oral healthcare coverage for people with I/DD?
- What can be learned, and potentially adopted as useful policy, from states that have unique plans regarding oral healthcare for people with IDD, including from New Mexico, South Dakota, Missouri, the District of Columbia, etc.?
- Should the Center for Medicare and Medicaid Services require state Medicaid funding to include dental services for adults with I/DD with ample reimbursements and would that ultimately be a cost saving function in the long run?
The report will be no more than 75 pages long (not including endnotes) and must include:
- A review of the literature and evidence supporting the need for and recommendations made with respect to increasing the I/DD oral healthcare Medicaid reimbursement rates;
- A description of applicable federal laws and policies, and applicable state laws if any exist;
- Recommendations to Congress, federal policymakers, relevant federal agencies, and relevant State policymakers and agencies.
With substantial involvement by NCD, the deliverables for this project will include:
Development of an invitee list and agenda for a virtual convening of stakeholders to be held early in the development of the project to ensure key stakeholders are invested in the project and able to provide meaningful and timely input. Stakeholders may include, but are not limited to, disability organizations that have conducted work on the report topic and people with disabilities who have experienced barriers to oral healthcare due to current Medicaid reimbursement rates.
A virtual convening of stakeholders early in the project term.
Twenty interviews with key stakeholders.
A detailed preliminary framing paper.
A revised framing paper.
An initial report draft incorporating findings, conclusions, and recommendations that can be drawn from the examination.
A second report draft.
A final report. that documents methodology, findings, and recommendations and must include a separate section containing recommendations, organized according to the entity to which they are directed.
A brief “Report Highlights” document that succinctly and in plain language encapsulates the report’s scope and purpose, major findings, and recommendations, and contains a link to the full report at the bottom, akin to GAO’s Report Highlights, see: https://www.gao.gov/products/GAO-19-126
All reports must fully adhere to NCD’s editorial requirements (see section on editorial requirements below).
Any methodology used to obtain stakeholder input must allow for open-ended discussions between stakeholders, as opposed to soliciting answers to specific, predetermined questions. While the use of data from existing surveys is permitted, conducting surveys for purposes of this study is strongly discouraged. The inclusion of people with disabilities must be integral to the planning, development, and execution of this project.
The awardee is responsible for reasonable accommodations at any meetings, events, forums, focus groups, etc. (i.e. sign language interpreters, CART reporters, and other such providers, as well as documents or other materials that are made available in public forums), associated with this agreement, except when making a presentation at an NCD meeting.
The awardee will co-present in person, including perhaps through an on-line venue should public health concerns require it, before NCD at a quarterly Council meeting and must factor travel expenses into the proposed budget.
Proposals that merely offer to conduct a project in accordance with the requirements of the government’s scope of work will not be eligible for award. Submissions must explain the proposed technical approach in conjunction with the tasks to be performed in achieving the project objectives.
This solicitation does not commit the government to contract for any work or services whatsoever. Respondents are advised that the Federal Government will not pay for any information or administrative costs incurred in response to this solicitation notice. All costs associated with responding to this solicitation notice will be solely at the responding party’s expense. It is the responsibility of the interested parties to monitor grants.gov and ncd.gov sites for additional information.
Proposal Information and Instructions
Proposals must be submitted in two parts: A 'Technical Proposal' and a 'Business Proposal. Each part shall be separate and complete so that evaluation of one may be accomplished independently of the other. The technical proposal must not contain reference to cost; however, resource information, such as data on labor hours and categories, materials, subcontracts, etc., must be contained in the technical proposal so that the offeror’s understanding of the scope of the work may be evaluated. It must describe the offeror’s technical approach in sufficient detail to provide a clear and concise presentation that includes, but is not limited to, the requirements of the technical proposal instructions.
Proposals must be signed by an official authorized to bind the submitting organization/s.
Alternate proposals or proposals which deviate from the requirements may be submitted; if they address the requirements in the statement of work, and if overall performance would be improved or not compromised and are in the best interest of the Government. Alternate proposals, or deviations from any requirements of this funding opportunity, must be clearly identified.
NCD will evaluate proposals in accordance with the evaluation criteria set forth in this solicitation.
The winning proposal submitted in response to this solicitation will become part of the cooperative agreement.
A detailed work plan must be submitted indicating how each aspect of the statement of work is to be accomplished. The technical approach should contain as much detail as necessary to fully explain the proposed technical approach or method.
The technical proposal must reflect a clear understanding of the nature of the work being undertaken. The technical proposal must include information on how the project is to be organized, staffed, and managed. Information must demonstrate an understanding and describe the management of important events or tasks. The technical proposal must explain how the management and coordination of consultant and/or subcontractor efforts will be accomplished.
The technical proposal must include a list of names and proposed duties of the professional personnel, consultants, and key subcontractor employees assigned to the project. Their resumes must be included and should contain information on education, background, recent experience, and specific requirement related or technical accomplishments. The approximate percentage of time each individual will work on the project must be included. The proposed staff hours for each of the above individuals must be allocated against each task or subtask for the project.
The technical proposal must provide the general background, experience, and qualifications of the organization. Similar or related contracts, subcontracts, or grants should be included and contain the name of the customer, contract or grant number, dollar amount, time of performance, and the names and telephone numbers of the contracting officer’s representative or project officer and contracting/grants officer.
The technical proposal must contain a discussion of present or proposed facilities which will be used in the performance of the contract.
The technical proposal must contain a proposed timeline and “deliverables and payment schedule” chart which will be used to guide the conduct of the research. Payments will be based on 3 deliverables - with the last payment occurring after NCD approval of the final draft of reports.
Format of Technical Proposals
1. Abstract (no more than 2 pages)
A two-page summary shall be provided abstracting the proposal contents (e.g., objectives, activities, expected outcomes) in language understandable to an informed layperson. The narrative should be limited to no more than 250 words.
2. Table of Contents
3. Introduction (no more than 10 pages)
Offerors shall summarize, in their own words, the purposes and objectives of the project to demonstrate their complete understanding of NCD’s intent and requirements. This section also should contain a specific statement of any interpretations, questions, qualifications, limitations, deviations, or exceptions to the scope of work and the extent to which the offeror’s proposal can be expected to meet the requirements set forth in the scope of work.
4. Procedural Plan (no more than 20 pages)
This section shall fully describe the theoretical and technical approaches the offeror will employ in complying with each task in the scope of work. While a general statement of strategy is appropriate, the offeror shall be specific in describing the way the overall review will be conducted, and the intended approach to the design.
Contain a proposed timeline and deliverables schedule that will be used to guide the conduct of the study and monitor the work.
5. Management Plan and Schedule (no more than 10 pages)
The management plan shall show the feasibility of implementing the offeror’s resources. The offeror shall present a time chart that specifies the amount of time (in person days) each staff member will commit to implementing each task. The plan shall present a clear description of the working relationships among personnel. Finally, the plan shall contain a method for insuring the timely and successful completion of each work task.
Personnel with major responsibilities shall be listed by name, title, position, academic background, relevant experience, responsibilities with the project, and the extent to which this commitment is assured. This section should include specific time commitments of staff to other projects, both Federal and non-Federal. Consultants who have agreed to serve on the project should be similarly identified and assurances of their commitment included. The Project Director shall be committed for no less than approximately 60 percent of the cooperative agreement. Vitae for all principal personnel, including consultants, should be appended to the proposal. Each curriculum vitae should be limited to not more than two (2) pages and should emphasize areas of experience directly relevant to this work statement.
7. Organization Experience
This section shall describe the offeror’s pertinent experience and qualification in conducting work of a similar nature. Offerors shall offer evidence of not more than five previous related assignments, including the names and telephone numbers of client project offices who would be able to comment on the offeror’s performance of those assignments. Summaries (not to exceed one page) of related work shall be included. References to products resulting from these related activities shall also be included.
This section shall identify those resources (other than personnel), facilities, and equipment (e.g., library holdings, computer hardware, and software) available for use in conducting this project.
9. Current Contractual Obligations
Each offeror will be required to outline both federal and non-federal contractual obligations existing during the time period of this award for all projects involving personnel who will be assigned to this project. Such organizations/agencies must be identified by name and the percentage of work time allotted to these projects by personnel committed to the proposed project must be provided.
10. Issues and Associated Data Items
When responding to the tasks and when identifying what should receive emphasis, careful consideration should be given to the issues identified, their associated data items, and the statement of products desired in the final reports.
All information provided by NCD must be returned to NCD upon completion of the analysis and no later than 10 working days after the completion of the cooperative agreement. The information may not be reproduced or released without the prior written permission of NCD.
11. Rights in Data, Copyright, and Disclosure
a. Data – The term data as used here includes written reports (progress, draft, and final), electronic format and work of any similar nature that is required under any resulting Cooperative Agreement to perform this project. It does not include the awardee’s financial reports, or other information incidental to awardee administration. Data submitted to and accepted by the NCD under the cooperative agreement shall be the property of the NCD, and NCD shall have full and unlimited rights to use such data for any purpose in whatever manner deemed desirable and appropriate, including making it available to the public. Such use shall be without any additional payment to the awardee. Data may be published as the property of NCD without giving authorship to the awardee.
b. Copyright – The awardee relinquishes all copyrights and/or privileges developed under the Cooperative Agreement. The awardee shall not include in the data any copyrightable matter without the written approval of NCD, unless the awardee provides NCD with the written permission of the copyright owner for the NCD to use the matter.
c. Disclosure – The awardee agrees not to divulge or release any information, reports or recommendations developed or obtained with the performance of any cooperative agreement with NCD, and not otherwise available to the public, without the prior approval of the NCD.
d. Final approval of deliverables
All final deliverables are the product of NCD and require acceptance and approval by NCD prior to payment. NCD reserves the right to make substantive edits to all deliverables.
12. Award Information
NCD will make an award to the responsible offeror(s) whose proposal conforms to the solicitation and is most advantageous to the Federal Government.
Upon notification of intent to award, the offeror will be expected to consult with NCD to:
Finalize a mutually agreeable timeline and deliverables schedule that will be used to guide the conduct of the study and monitor the work;
Develop a payment schedule chart to be used for installment payments of the award based on 3 deliverables;
Meet with select NCD staff and board members at a pre-award meeting.
Throughout the project, the awardee and the NCD Agreement Coordinator will conduct mutually agreed upon monthly conference calls to include other project staff members, NCD staff and, as appropriate, selected project advisors and NCD council members.
The awardee will provide monthly electronic progress reports to the NCD Contracting Officer’s Representative three days prior to the monthly conference calls.
The business proposal shall contain a detailed budget for the project and the certifications and representations required by OMB Circular A-110.
Note: For each type of entity, there is a set of Federal principles for determining allowable costs. Allowable costs shall be determined in accordance with the cost principles applicable to the entity incurring the costs. Thus, allowable costs incurred by State, local or federally-recognized Indian tribal governments is determined in accordance with the provisions of OMB Circular A–87, “Cost Principles for State and Local Governments.” The allowable of costs incurred by non-profit organizations is determined in accordance with the provisions of OMB Circular A–122, “Cost Principles for Non-Profit Organizations.”
The allowable costs incurred by institutions of higher education is determined in accordance with the provisions of OMB Circular A–21, “Cost Principles for Educational Institutions.” The allowable costs incurred by hospitals is determined in accordance with the provisions of appendix E of 45 CFR part 74, “Principles for Determining Costs Applicable to Research and Development under Grants and Contracts with Hospitals.” The allowable costs incurred by commercial organizations and those non-profit organizations listed in Attachment C to Circular A–122 is determined in accordance with the provisions of the Federal Acquisition Regulation (FAR) at 48 CFR part 31.
Technical Evaluation Criteria
Evaluation criteria will score proposals with a maximum of 100 points, divided as follows:
1. A clear understanding of the nature of the work (20 points)
The proposal presents a clear understanding of the tasks required and the importance, quality and reliability of those tasks. The proposal will present the rationale and/or interpretation of the project approach.
2. Procedural Plan (30 points)
The proposal contains evidence of a fully described technical approach to comply with each of the tasks in the scope of work. The proposal is consistent with the goals, objectives, compliance requirements, and is practical in terms of producing needed information, analysis and recommendations.
3. Management Plan and Schedule (20 points)
The degree to which the project team, including any use of consultants, is organized, managed, and motivated to accomplish effective and efficient implementation of all tasks to be completed. The proposal budget is appropriate to the administration of the project. The time frame is realistic. Plans and schedules to assure smooth cooperation with the NCD staff involved are evident. The proposal clearly identifies who will be key personnel and includes a table showing the number of person-days by tasks for each of the key personnel.
4. Personnel (15 points)
The proposal provides evidence of the specific qualifications and skills of staff and consultants to be assigned to this project, and their experience and familiarity with the topic, including relevant laws, regulations, procedures and practices in the Federal Government. Skills in writing and conducting research should also clearly demonstrated.
5. Organizational Experience (15 points)
The proposal describes to which the overall experience and past performance of the offeror in executing similar projects should be described. Evidence of related assignments should be detailed. Offeror shall present evidence of related assignments, including the names and telephone numbers of previous project officers who would be able to comment on the offeror’s performance of those assignments.
Proposal Review Information
Reviews of proposals submitted to NCD are solicited from peers with expertise in the substantive area of the proposed project. Reviewers are selected by the NCD staff overseeing the review process. A conflict check is conducted to ensure that reviewers have no conflicts that prevent a review of offeror’s proposal. Special efforts are made to recruit reviewers from non-academic institutions, minority-serving institutions, or adjacent disciplines to that principally addressed in the proposal. Reviewers score and comment on each proposal. Reviews are treated as confidential documents. The NCD staff overseeing the review examines the scores and comments and formulates a recommendation.
Notice of Award
NCD will notify the offeror by telephone, e-mail, and/or letter. This will begin negotiations for a cooperative agreement. The notification is not authorization to begin performance. Notification of the award will be made by Amged M. Soliman, NCD Attorney Advisor. Organizations whose proposals are declined will be advised as promptly as possible. A summary of the strengths and weaknesses identified by reviewers, of each declined proposal, not included identifying names or information about proposal reviewers, will be made available upon request.
Project Start and End Dates
The projected start of the Cooperative Agreement is August 1, 2020. The projected end date will be June 1, 2021. The projected due date for final drafts is one month prior to the end of the cooperative agreement.
Final drafts must be professionally edited before they are submitted to NCD.
Citations & Style Guide for NCD Reports
NCD requires awardees to utilize the Chicago Style Manual for reports and papers and employs the documentary note system of citation (otherwise known as notes and bibliography). An explanation of this style of citation can be found at: http://library.williams.edu/citing/styles/chicago1.php and http://www.chicagomanualofstyle.org/tools_citationguide.html.
Accessibility of Reports
NCD reports must be totally accessible to all people with disabilities at all iterative stages of its drafting and editing. All graphs and charts must have full text descriptions embedded as alt-text and ensure that it is Section 508 compliant. All drafts and final versions must be submitted in electronically in Word and PDF format.
About the National Council on Disability
Overview and Purpose
The National Council on Disability (NCD) is an independent federal agency comprised of a team of Presidential and Congressional appointees, an Executive Director appointed by the Chair, and a full-time professional staff. The purpose of NCD is to promote policies, programs, practices, and procedures that guarantee equal opportunity for all people with disabilities regardless of the nature or significance of the disability and to empower people with disabilities to achieve economic self-sufficiency, independent living, and inclusion and integration into all aspects of society.
The current statutory mandate of NCD includes the following:
Reviewing and evaluating, on a continuing basis, policies, programs, practices, and procedures concerning individuals with disabilities conducted or assisted by federal departments and agencies, including programs established or assisted under the Rehabilitation Act of 1973, as amended, or under the Developmental Disabilities Assistance and Bill of Rights Act, as well as all statutes and regulations pertaining to federal programs that assist such individuals with disabilities, to assess the effectiveness of such policies, programs, practices, procedures, statutes, and regulations in meeting the needs of individuals with disabilities.
Reviewing and evaluating, on a continuing basis, new and emerging disability policy issues affecting individuals with disabilities in the Federal Government, at the state and local government levels, and in the private sector, including the need for and coordination of adult services, access to personal assistance services, school reform efforts and the impact of such efforts on individuals with disabilities, access to health care, and policies that act as disincentives for individuals to seek and retain employment.
Making recommendations to the President, Congress, the Secretary of Education, the Director of the National Institute on Disability, Independent Living, and Rehabilitation Research and other officials of federal agencies about ways to better promote equal opportunity, economic self-sufficiency, independent living, and inclusion and integration into all aspects of society for Americans with disabilities.
Providing Congress, on a continuing basis, with advice, recommendations, legislative proposals, and any additional information that NCD or Congress deems appropriate.
Gathering information about the implementation, effectiveness, and impact of the Americans with Disabilities Act of 1990 (ADA) (42 U.S.C. § 12101 et seq.).
Advising the President, Congress, the Commissioner of the Rehabilitation Services Administration, the Assistant Secretary for Special Education and Rehabilitative Services within the Department of Education, and Director of the National Institute on Disability, Independent Living, and Rehabilitation Research on the development of the programs to be carried out under the Rehabilitation Act of 1973, as amended.
Providing advice to the Commissioner of the Rehabilitation Services Administration with respect to the policies and conduct of the administration.
Making recommendations to the Director of the National Institute on Disability, Independent Living, and Rehabilitation Research on ways to improve research, service, administration, and the collection, dissemination, and implementation of research findings affecting people with disabilities.
Providing advice regarding priorities for the activities of the Interagency Disability Coordinating Council and reviewing the recommendations of this council for legislative and administrative changes to ensure that such recommendations are consistent with NCD’s purpose of promoting the full integration, independence, and productivity of individuals with disabilities.
Preparing and submitting to the President and Congress an annual report titled National Disability Policy: A Progress Report.
In 1995, NCD was designated by the Department of State to be the U.S. government’s official contact point for disability issues. Specifically, NCD interacts with the special rapporteur of the United Nations Commission for Social Development on disability matters.
Consumers Served and Current Activities
Although many government agencies deal with issues and programs affecting people with disabilities, NCD is the only federal agency charged with addressing, analyzing, and making recommendations on issues of public policy that affect people with disabilities regardless of age, disability type, perceived employment potential, economic need, specific functional ability, veteran status, or other individual circumstance. NCD recognizes its unique opportunity to facilitate independent living, community integration, and employment opportunities for people with disabilities by ensuring an informed and coordinated approach to addressing the concerns of people with disabilities and eliminating barriers to their active participation in community and family life.
NCD plays a major role in developing disability policy in America. In fact, NCD originally proposed what eventually became the ADA. To view our past and current key issues, and for general information about NCD, please visit our website at www.ncd.gov
NCD was established in 1978 as an advisory board within the Department of Education (P.L. 95-602). The Rehabilitation Act Amendments of 1984 (P.L. 98-221) established NCD as an independent agency.
 42 U.S.C. § 12101.
 29 U.S.C. § 794.
 National Council on Disability. 2009. “The Current State of Health Care for People with Disabilities.” 86.
 Slashcheva, Lyubov, Rick Rader, MD, and Stephen B. Sulkes, MD. 2016. “Would People with Intellectual Disabilities Benefit from Being Designated ‘Underserved’?” American Medical Association Journal of Ethics 18(4): 424.
 National Council on Disability. 2009. “The Current State of Health Care for People with Disabilities:” 86, 87, 89. See also Morgan, et al. 2012. “The Oral Health Status of 4,732 Adults with Intellectual and Developmental Disabilities.” Journal of the American Dental Association: 839.
 Center for Health Care Strategies, Inc. 2017. “Medicaid Adult Dental Benefits: An Overview.” 1.
 Centers for Disease Control and Prevention. National Hospital Ambulatory Medical Care Survey: 2010 emergency department summary tables. 2012. Available at: http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2010_ed_web_tables.pdf. Accessed March 17, 2020.
 National Council on Disability. 2009. “The Current State of Health Care for People with Disabilities.” 86.
 S. Chazin. “Medicaid Adult Dental Benefits: An Overview.” Center for Health Care Strategies, Updated May 2017. Available at: https://www.chcs.org/resource/medicaidadult-dental-benefits-overview/.
 Center for Policy and Evaluation, Administration for Community Living. “Oral Health’s Relationship to Disease and Options for Expanding Services for Older Adults and Adults who Have Disabilities,” Jne Tilly, DrPh (2016).
 42 U.S.C. § 12101.
 29 U.S.C. § 794.
 H.R.2417 – The Healthcare Extension and Accessibility for Developmentally Disabled and Underserved Population Act (“HEADs UP Act”), 116th Congress (2019-2020).