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					                                      Working for Tomorrow
                                           March 2010
                 A publication of the Center for Workers with Disabilities, APHSA

FEDERAL NEWS

President Signs Health Care Reform into Law
On March 23, President Obama signed the Patient Protection and Affordable Care Act (H.R.
3590), which the House approved on March 21. The measure had earlier been passed by the
Senate on Dec. 24, 2009. The House also passed the Health Care and Education Reconciliation
Act of 2010 (H.R. 4872), which made a number of changes and additions to H.R. 3590 and was
moved under reconciliation rules that required only a simple majority in the Senate. The Senate
then approved the changes to H.R. 4872 and sent that measure back to the House on March 25.
The House passed the amended bill that same evening, and the president signed it on March 30.
Shortly after the President signed the main health care bill, 13 state attorneys general filed a joint
lawsuit challenging the legislation, while Virginia went to court separately. The lawsuits claim that
bill provisions violate state rights protected by the commerce clause in the U.S. Constitution and
will force massive new spending on state governments by requiring nearly all Americans to have
health insurance. The joint suit, led by Florida, was filed with a federal court in that state.

The Patient Protection and Affordable Care Act will require most individuals to have health
insurance beginning in 2014 or be subject to a penalty. Individuals who do not have access to
affordable employer coverage will be able to purchase coverage through a Health Insurance
Exchange, with premium and cost-sharing assistance available to some to make it more
affordable. Certain categories of individuals will qualify for an exception from the penalty,
including American Indians; individuals with religious objections; individuals who can show
financial hardship; individuals without coverage for less than three months; households with
income below 100 percent of the federal poverty level; and households that would pay greater
than 8 percent of income on premiums for the cheapest available plan.

The law will provide small businesses with the ability to purchase coverage through the
exchange. The legislation also expands Medicaid to 133 percent of the federal poverty level,
expanding eligibility to approximately 16 million nonelderly people, including childless adults,
beginning in 2014. To assist states with the cost of covering such newly eligible individuals, from
2014 through 2016 the federal government will pay 100 percent of the new cost, phasing down to
90 percent over several years. Beginning April 1, 2010, states can elect to cover individuals up to
133 percent of the federal poverty level, but would not receive the increased federal share of
costs. The law also contains important provisions effecting long-term care. These provisions
include the CLASS Act, which creates a national long-term care insurance program funded
through payroll deductions. Additionally, the legislation creates new options for community-based
long-term care through Medicaid and provides financial incentives to states to increase long-term
care in the community.

The legislation also imposes new regulations on health plans and will prohibit them from denying
coverage to people for pre-existing conditions and from charging higher premiums based on
health status and gender. The new law also increases tax credits to reduce the net cost of
insurance premiums; closes the Medicare prescription drug “doughnut hole”; provides funding to
states to assist them with increased Medicaid costs; increases the federal share of costs for



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states that expanded health care coverage prior to passage of the measure; and includes cost-
savings provisions such as additional funding to combat waste, fraud and abuse in the health
care system.

The National Association of State Medicaid Directors has updated its side-by-side chart, which
provides additional high-level information about the various provisions of this law that affect state
Medicaid programs and Children’s Health Insurance Programs; the chart is available at
http://www.nasmd.org/home/doc/draftHRsidebyside.pdf.

OPM and ODEP Announce Federal Hiring Event
The Office of Personnel Management and the Department of Labor’s Office of Disability
Employment Policy have announced a day-long Federal Hiring Event for people with disabilities
to be held on April 26. A variety of federal agencies will participate. Interested job candidates
may be invited to attend this event after submitting their resumes and other requested
documentation to OPM.

For more information, visit http://www.usajobs.gov/DisabilityHiringEvent.asp.

President Signs HIRE Act
On March 18, President Obama signed the HIRE (Hiring Incentives to Restore Employment) Act
into law (P.L. 111-147). The legislation includes several provisions intended to encourage hiring
or job creation. The bill amends the Internal Revenue Code to exempt for-profit and non-profit
employers from social security taxes in 2010 for hires that have been out of work for at least two
months. The bill also permits small businesses to write off investments made in equipment this
year. Additionally, the bill reforms municipal bonds to encourage job creation by expanding
investment in schools and clean energy projects. Along with these provisions, the HIRE Act
extends the Safe, Accountable, Flexible, and Efficient Transportation Equity Act- A Legacy for
Users legislation through the end of the year to provide continued funding for transportation
projects.

SSA Publishes 2010 Red Book
The Social Security Administration has published the Social Security 2010 Red Book. The Red
Book is a general reference tool to the Social Security Disability Insurance, Supplemental
Security Income, and other programs. It provides information on a variety of work incentives that
can support disability beneficiaries in employment. Changes documented in the 2010 version of
the Red Book include the following:

       An increase in the Substantial Gainful Activity amount for individuals with disabilities,
        other than blindness, from $980 to $1000 for 2010.
       An increase in the monthly earnings amount used to determine if a month counts for the
        Trial Work Period from$700 to $720 for 2010.
       An increase in the Medicaid While Working – i.e. 1619(b) – state threshold amounts for
        persons with disabilities. Yearly state threshold amounts are used to decide if earnings
        are high enough to replace SSI and Medicaid benefits.

For persons who are blind, the amount of earnings that indicate SGA remains at $1,640 per
month in 2010. Additionally, the SSI Federal Benefit Rates for 2010 remains $674 per month for
an eligible individual and $1,011 per month for an eligible couple.

The 2010 Red Book is available at http://www.socialsecurity.gov/redbook/index.html.

SPOTLIGHT ON MEDICAID INFRASTRUCTURE GRANTS

The Ticket to Work and Work Incentives Improvement Act of 1999 established the Medicaid
Infrastructure Grant program to provide grants to eligible states to develop and enhance Medicaid
employment supports, including the Medicaid Buy-In program, for people with disabilities, and to


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build more comprehensive systems of employment supports. This section of Working for
Tomorrow will highlight the experiences and accomplishments of various state MIG projects.
Federal funding for the MIGs expires in 2011.

Kansas
Kansas’s Medicaid agency was awarded a Medicaid Infrastructure Grant in 2001. Since that
time, Kansas has used the MIG to revitalize efforts to improve the employment opportunities for
people with disabilities across the state. At the time of the MIG’s inception, discussions about
employment were not as prominent across the state, and the issue was not always seen as a top
priority for policymakers. The Kansas MIG has used its vision statement, that “All Kansans with
disabilities who want to be competitively employed will be able to achieve this with access to
needed health care and supports, resulting in equal health, well being, integration and economic
opportunity,” to refocus the discussions about employment and to create work as an expectation
for people with disabilities.

The grant was initially used to design and implement a Medicaid Buy-in program, known as
Working Healthy. The grant was a crucial part of creating the eligibility policies, developing the
enrollment processes and procedures, and enacting the regulatory changes necessary to
establish the program. Working Healthy was established and began accepting applicants in
2002. Once the program was established, the MIG grant focused on collecting data for the Buy-
in, enacting policy improvements, and increasing the communication, collaboration, and
integration of the Kansas health care and disability employment systems.

After recognizing some limitations in Working Healthy’s service packages, MIG staff created
WORK, an innovative model that provides long-term care services to individuals in Working
Healthy. WORK provides individuals with self-direction and personal freedom. It was developed
under provisions created by the Deficit Reduction Act of 2005, and was the first program of its
kind nationwide. Participation in WORK has increased from 1 person in 2007 to over 150 people
in 2010. Individuals enrolled in the program have better health outcomes, better employment
outcomes, and have very high satisfaction with the services they receive. As one participant
stated, “My prayers were answered when they came out with Working Healthy. I couldn’t work
without it, and I love my job. Quality of life is much better.”

In addition to improving the Medicaid program’s capacity to support workers with disabilities,
Kansas’s MIG has had a strong role in improving the statewide infrastructure for people with
disabilities, health care, and employment. Kansas’s Medicaid agency, the MIG, and other
partners have collaborated to establish a network of Benefits Counselors across the state. These
Counselors provide outreach, education, and financial planning services to people with
disabilities, and they also provide training to a variety of professional staff about a broad array of
health and human service supports available to people with disabilities.

Kansas has also worked to develop partnerships and pilot projects with schools. Through this
effort, the schools have created a curriculum that includes lessons on disability awareness and
individual empowerment. These lessons also include setting personal goals and planning for
employment. Partnerships between the schools, Vocational Rehabilitation and the MIG have
developed after-school, weekend and summer job experiences to help students with disabilities
establish work experience and acquire job-related skills. By engaging schools and establishing
work-expectations early in the child’s life, the MIG is helping to change attitudes of the children,
their families, and service providers. Kansas believes that changing these attitudes and
expectations is a crucial part of ensuring that the children are empowered and self-sufficient as
they grow up. The MIG is collaborating with Kansas University to evaluate the outcomes of these
pilot projects.

Finally, the MIG is working to increase business involvement in hiring people with disabilities.
The MIG has partnered with the state’s Business Leadership Networks to help establish new
chapters and to support and strengthen existing business-to-business collaborations. Even in


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rural areas where larger business-to-business networks are difficult to establish, the MIG has
been working to establish collaborations and business partnerships across the state. Through
these partnerships, Kansas’s business community can receive unbiased, honest communication
about the benefits of hiring workers with disabilities, and can have their concerns and
misconceptions addressed by their peers.

Kansas is planning for the expiration of MIG funding by embedding policies and programs within
the state and local systems. For example, Kansas has been diligent about collecting and
analyzing data that demonstrates the positive economic impact of the Buy-in program. Research
partners at Kansas University have demonstrated that Buy-in participants have lower costs and
higher earnings than comparable Medicaid beneficiaries. The MIG has also been working to
ensure that the Working Healthy advisory council continues to operate after grant funding expires.
The council not only provides leadership to the Buy-in and the MIG, it also creates partnerships
and helps generate and share ideas to improve the employment of people with disabilities among
policymakers, advocates, and individuals with disabilities. Finally, the MIG is working to embed
new policy changes in the overall system. One such policy is an “employment first” initiative,
which emphasizes that employment is the primary desired outcome for individuals served through
state and local agencies.

For more information, visit http://www.workinghealthy.org/index.html.

NEW PUBLICATIONS AND MATERIALS

Article Explores Employment First Movement
A Journal of Vocational Rehabilitation article, “Establishing a national Employment First agenda,”
by Bob Niemiec, Don Lavin, and Laura Owens, describes the growing Employment First
movement and the elements of effective state and local initiatives. In recent years, a growing
number of states have undertaken Employment First initiatives in order to promote and implement
policies, practices, and strategies that focus on integrated, community-based employment as the
first and desired outcome for individuals with disabilities. The authors note that Employment First
initiatives also seek to raise expectations among individuals, family members, providers, and
others around integrated, community-based employment.

The authors present strategies and approaches that contribute to effective Employment First
efforts in states and communities. These practices include:
     Building a “coalition of the willing” and making sure that the Employment First “bus”
          leaves the station;
     Supporting and building on local efforts with the establishment of community action
          teams;
     Engaging businesses and schools in efforts;
     Clarifying assumptions and establishing a shared definition of employment;
     Emphasizing systems change through policy development and resource allocation;
     Promoting strength-based practices such as customized and supported employment; and
     Measuring, evaluating, and communicating outcomes and progress.

The full article is available at
http://www.worksupport.com/documents/APSEagenda%5FJVR2009%2Epdf.

Case Studies Highlight Accessible Transportation Projects
The Center for Workers with Disabilities has released Getting to Work: A Case Study Report on
Accessible Transportation Projects. This report describes Medicaid Infrastructure Grant
transportation projects in Illinois, New Jersey, Massachusetts, and Minnesota. Although MIG
grants are not intended to provide or fund direct transportation services, state MIGs may be well-
positioned to use their resources to create linkages with other agencies and entities engaged in
accessible transportation planning and service delivery. The four projects presented in this report




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also suggest a set of strategies and activities that can help advance accessible transportation in
states and in communities. These activities include:

       Convening stakeholders and providing a forum where state agencies, transportation
        entities, private transportation providers, employers, transportation brokers, state officials
        and others can engage in transportation planning.

       Identifying goals that result in a win-win situation for all.

       Using this information to plan for outcomes.

       Identifying transportation needs, gaps, and resources in the state.

       Working to address gaps and to leverage resources through transportation coordination,
        capital expenditures, and other strategies.

       Assuring consumer access to transportation information through a single point of contact
        (for example, a web-based resource, a transportation brokerage, concierge services, or
        other trip planning tools).

       Training consumers on the use of trip planning tools.

The report also includes information on federal transportation initiatives, legislation, and funding.
Access the case study report at http://cwd.aphsa.org/home/docs/CWDTransportationBrief.pdf.

NTAR Center Releases Brief on Labor Market Information
The NTAR Leadership Center has released an issue brief on Using Labor Market Data to
Improve the Job Prospects of People with Disabilities. Timely data about local, state, and
regional labor markets is important to front-line staff, jobseekers, program leaders, and
policymakers. But for many workforce providers, including those serving people with disabilities,
labor market information can be complex, overwhelming, and hard to find. Yet using and
understanding labor market data is critical to identifying available jobs as well as determining
where and what occupations are emerging for individuals seeking work. The NTAR Center brief
provides an overview of labor market information, suggests how LMI can inform and improve
state and local workforce development activities for people with disabilities, and identifies publicly
available information sources that produce the data. The brief also showcases a strategic
partnership in the state of Maine between the state labor department and disability service
providers that works to assist frontline staff in the disability employment field to understand and
integrate labor market information and tools into their practice. This partnership brought about
the creation of the Labor Market Information Academy to support frontline staff in using LMI in
their daily work.

The full brief is available at
http://www.ntarcenter.org/files/NTAR_Issue_Brief_4_Labor_Market_Data.pdf.

Start-Up USA Publishes Q&A: Braiding and Blending Funding
Start-Up USA, at Virginia Commonwealth University’s Rehabilitation Research and Training
Center on Workplace Supports and Job Retention, published a question-and-answer fact sheet
on Self-Employment Q and A: Braiding and Blending Funding for Business Start-Up. The Q&A
describes how “braiding or blending” occurs when agencies collaborate and combine resources
to support individuals with disabilities in reaching self-employment goals. Different funding
sources, such as Vocational Rehabilitation funding, education dollars, and Individual Training
Accounts, may be combined creatively to enable an individual to access the resources needed to
start a business. In many instances, case managers can assist in establishing relationships with
community agencies and help ensure access to various funds to blend and braid support for self-
employment. The question and answer fact sheet discusses the various types of and uses of
funding, and provides additional resources on the topic.


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The fact sheet is available at: http://www.start-up-usa.biz/resources/content.cfm?id=849.

Paper Summarizes Options for Integrating Care for Duals
A new policy document from the Center for Health Care Strategies describes four options for
integrating care for dual Medicare-Medicaid eligible beneficiaries. These options include: Special
Needs Plans, Program for All-Inclusive Care for the Elderly, Shared Savings Models, and States
as Integrated Care Entities (an emerging model). For each of these models, the document lays
out pros, cons, and considerations for states. Additionally, the document suggests that certain
key elements are essential to achieving the goals associated with integrated care. These
elements include, for example:

       Strong patient-centered care based in accountable primary care homes;
       Multi-disciplinary care teams that coordinate the full range of medical, behavioral, and
        long-term supports and services needs;
       Enhanced use of home- and community-based long-term care services; and
       Robust data sharing and information systems to promote care coordination.

Options for Integrating Care for Dual Eligible Beneficiaries is available at
http://www.chcs.org/usr_doc/Options_for_Integrating_Care_for_Duals.pdf.

Forum on DMIE: Preliminary Evaluation Findings
On March 18, Mathematica Policy Research held a forum to present preliminary findings from the
national evaluation of the Demonstration to Maintain Independence and Employment. The DMIE,
implemented in Kansas, Minnesota, Texas, and Hawaii, was designed to test whether an early
intervention program providing both medical and employment assistance could prevent or delay
the loss of work and independence due to a physical or mental health condition before a person
becomes disabled. Early findings from the national evaluation indicate that the DMIE had an
impact on participants applying for disability benefits. A lower percentage of individuals in the
treatment over the control group applied for disability benefits 12 months after DMIE enrollment.
Early findings do not indicate a difference in the percentage employed 12 months after
enrollment, keeping in mind that being employed at the time of enrollment was among the
eligibility criteria. Mathematica researchers also identified several lessons learned from the
DMIE. These include:

       The DMIE approach can be implemented in diverse settings to serve various target
        populations;
       Participants value person-centered case management; and
       Working adults must be recruited at the right point on the disability trajectory.

For more information, visit http://www.mathematica-mpr.com/disability/dmie.asp.

Financing Strategies for Youth Programs in Difficult Times
A new brief from The Finance Project, Cutting Costs, Keeping Quality: Financing Strategies for
Youth-Serving Organizations in a Difficult Economy, explores a set of strategies that can help
youth-serving organizations maintain quality services in a challenging fiscal environment. The
author notes that cuts in state budgets and in foundation giving are resulting in less funding for
many youth programs at the same time as the need for youth services continues to grow. Based
on interviews with experts and program leaders, the brief describes three financing strategies that
can help organizations address fiscal constraints and maintain quality service delivery. These
financing strategies are:

       Aggressively manage costs, which includes protecting core services, developing a
        contingency plan, and examining overhead costs;
       Creatively generate new revenues and support, which includes strategies such as
        engaging the board and other leaders in generating revenue, using data to communicate


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        the organization’s impact, and implementing program fees and social enterprise activities;
        and
       Forming partnerships that can provide access to volunteers and in-kind support as well
        as enabling organizations to share the costs of providing services or share administrative
        costs (through shared “back-office services” for example).

The brief illustrates these strategies with a number of program examples, and suggests that such
strategies can help organizations better finance and sustain their services during good and bad
economic times. The full brief is available at
http://www.financeproject.org/publications/CuttingCostKeepingQuality.pdf.

Final Report on United We Ride National Dialogue
The importance of access to transportation has been recognized by the federal government,
resulting in a myriad of programs designed and administered by various federal agencies. The
number and variety of programs, however, has resulted in unintended consequences, including
services that are fragmented and difficult to navigate due to inconsistent, duplicative and
restrictive federal and state regulations. In addition, there are gaps in service where
transportation is simply not available. To address these challenges, Executive Order number
13330 established the Interagency Transportation Coordinating Council on Access and Mobility,
which gave rise to the federal interagency initiative United We Ride.

The National Academy of Public Administration and Easter Seals Project ACTION developed and
hosted the first United We Ride national on-line, interactive Dialogue to help shape future policy
and inform the next CCAM strategic plan. The Dialogue addressed the question “What ideas can
improve access to affordable and reliable transportation for people with disabilities, older adults,
and people with limited income?” A panel of National Academy fellows guided and analyzed the
Dialogue using several analytic tools that facilitated the submission of ideas as well as tagging,
rating, and commenting on the ideas. The Dialogue was on-line and accessible 24 hours a day
for its two week run (November 2-13 of 2009). According to participation tracking, the Dialogue
drew: 6,808 visits from 3,851 unique visitors; participants from 1219 U.S cities and every U.S.
state; 783 registered participants; and 280 unique ideas, prompting 1,056 comments, 1,538
ratings, and 262 tags.

From the responses and the computer-enhanced analysis, four overarching themes emerged,
each with a detailed set of recommendations. The four overarching themes are as follows:
   1) The process for creating coordinated transportation plans continues to need
        improvement,
   2) Significant federal policy barriers still impede access to transportation services,
   3) Mobility management strategies are underutilized in communities across the country, and
   4) There are missed opportunities to bridge gaps between transportation and other
        community services.

To facilitate future strategic planning by the CCAM, three key strategies to continue work toward
better coordination were suggested:
    1) Use incentives to motivate needed changes (incentives such as additional grant funding,
          creation of waivers, and allowing additional points in competitive funding processes for
          those who are implementing coordination),
    2) Continue to provide education, outreach, and technical assistance , and
    3) Identify legislative and regulatory changes to facilitate coordination across eleven federal
          agencies and an even larger number of programs.

To read the full report, see
http://www.uwrdialogue.org/UWR.National%20Dialogue%20Final%20Report-1-.Feb.2010.pdf




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Brief Examines Disability and Poverty among Older Adults
A recent brief from the Urban Institute, Disability Just Before Retirement Often Leads to Poverty,
explores the prevalence of disability and poverty among adults in their 50s and 60s, and
contributing factors. The authors find that disability rates increase as individuals approach
retirement, and disability is especially common among older adults with limited income and
education. Additionally, many older adults with disabilities do not receive disability benefits, and
those that do are still likely to remain in poverty. Given the aging of the population, the authors
recommend that policymakers address limitations in the social insurance safety net for people
with disabilities. The authors also note that the recent increase in the eligibility age for full Social
Security retirement benefits from 65 to 66 will likely intensify financial challenges for people with
disabilities.

The full brief is available at http://www.urban.org/uploadedpdf/412009_disability_retirement.pdf.

Corporate Voices Releases Employer Guide to EITC
Corporate Voices for Working Families has released its 2009 Employer Guide which provides
companies with tools to help employees take advantage of tax credits including the Earned
Income Tax Credit and other benefits. The guide includes paycheck stuffers, a poster, information
on key dates in the tax filing season, and information on stored value cards. These cards, also
known as prepaid debit cards, are a potential strategy to help employees avoid refund-
anticipation loans, check cashing services, and other high-priced refund products.

To access the guide, visit http://corporatevoices.org/2009-EITC-Toolkit.

AVAILABLE GRANTS AND OTHER OPPORTUNITIES

Mental Health Transformation Grants RFA Released
The Substance Abuse and Mental Health Services Administration, Center for Mental Health
Services is accepting applications for fiscal year 2010 Mental Health Transformation Grants. This
grant program is intended to foster adoption and implementation of lasting changes in how public
mental health services are organized, managed and delivered so that they are consumer-driven,
recovery-oriented and supported through evidence-based and best practices. Funding will
support states and local governments to create or expand treatment capacity within five of
SAMHSA’s Strategic Initiatives related to prevention and wellness, trauma-informed care, military
families, housing and homelessness, jobs and the economy. In regards to this last strategic
initiative, proposals should look to create or expand capacity to increase employment and
education for adults diagnosed with mental illness to address high rates of unemployment among
this population and to promote the development of skills, aptitudes and employability. Services
should include evidence based practices such as supported employment and supported
education, implemented with fidelity to practice models, if tools are available. State and local
governments and federally recognized American Indian/Alaska Native Tribes and tribal
organizations are eligible to apply for these transformation grants, and applications are due April
30, 2010.

The Request for Applications is available at http://www.samhsa.gov/Grants/2010/SM-10-
010.aspx.

Solicitation Open for Community-Based Job Training Grants
The Employment and Training Administration at the U.S. Department of Labor has announced a
solicitation for grant applications for Community-Based Job Training grants. These grants are
designed to support workforce training for high-growth/high-demand industries through
community and technical colleges. Eligible applicants include (1) an individual community or
technical College, such as a public community college, a nonprofit community college, a Tribally
controlled college, or a Tribally controlled university; (2) a Community College District; (3) a State
Community College System; (4) a One-Stop Career Center in partnership with its Local
Workforce Investment Board, that specifies one or more community or technical colleges where


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education/training activities will occur; or (5) an applicant proposing to serve an educationally
underserved community without access to community or technical colleges. It is anticipated that
awards will range generally from $1 million to $3 million. The closing date for receipt of
applications is April 29, 2010.

For more information, see the Federal Register notice at
http://edocket.access.gpo.gov/2010/pdf/2010-5609.pdf.


CONFERENCE AND EVENT CALENDAR

Pacific Rim Conference on Disabilities 2010
Center on Disability Studies, University of Hawaii
April 12-13, 2010
Hawaii Convention Center
Honolulu, Hawaii
For more information, visit http://www.pacrim.hawaii.edu/.

Community Transportation Expo
Community Transportation Association of America
May 23-28, 2010
Long Beach, California
For more information, visit http://guest.cvent.com/EVENTS/Info/Summary.aspx?e=10309350-47f1-
49f1-bca3-c4a762599118.

21st Annual APSE International Conference
Employment First: Not Just a Slogan
June 8-10, 2010
Atlanta, Georgia
For more information, visit http://www.apse.org/training/conference.cfm.

2010 National ADA Symposium
June 20-23, 2010
Denver, Colorado
For more information, visit http://www.adasymposium.org/.

US Business Leadership Network 13th Annual Conference
September 19-22, 2010
Westin Michigan Avenue Chicago
Chicago, IL
For more information, visit http://www.usbln.org/events.html.




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