December 10, 2012

December 7 Washington Update

Greetings from Washington!  Most of the city is just waiting impatiently for a deal to avert the "fiscal cliff" - the tax increases and spending cuts that will automatically kick in after the new year unless current law is amended.  Negotiations are going on - or are not going on, depending on which rumors you hear - between the President and House Speaker John Boehner (R-OH).  It is expected that the Democratic Senate will follow the President's lead.  Meanwhile...

U.N. Convention on the Rights of Persons with Disabilities (CRPD).   On December 4, the U.S. voted against ratification of the CRPD.  A two-thirds majority of the Senate (66 votes) was needed to ratify the treaty, which was signed by the US in 2009.  Former Republican Senator Bob Dole (R-KS), who has a war-related disability and was a strong proponent of disability rights during his Senate career, returned to the Senator Floor to urge ratification.  Still, the 61-38 vote broke mostly on party lines.  Eight Republicans voted with the Democrats and Independents in favor of ratification.  About 300 disabilities organizations strongly supported the treaty, as did Family Voices.  Those opposed to the treaty, including former Senator Rick Santorum (R-PA), were concerned that it would limit US sovereignty, parental rights, and the rights of people with disabilities, although mainstream international legal scholars seemed to disagree with this view.  Senate Majority Leader Harry Reid said he would bring the treaty before the Senate next year for reconsideration.  For more information about the treaty and its text, see

F2F Funding.  As discussed earlier, we are hoping to get the F2F funding extension incorporated into a piece of legislation that is likely to become law.  Candidates for such a legislative "vehicle" include the "doc fix," to prevent a reduction in Medicare reimbursement to physicians, and legislation to implement any sort of budget deal that is reached in the coming weeks or months. 

At this point, we are suggesting that constituents contact only targeted Members of Congress to ask them to support the funding legislation.  We will let you know if you are represented by one of the key lawmakers who still need to be approached.  Also, please thank those who have already cosponsored the bill (listed at the end of this update).

ACA implementation.  As reported last week, the Department of Health and Human Services (HHS) recently issued several proposed rules.  One of these governs the implementation of the Essential Health Benefits (EHB) requirements of the Affordable Care Act (ACA). 

There will be a Family Voices webinar on the proposed EHB rule on Thursday, December 13 at 2:30 PM Eastern Time.  (Connection information to be announced.)  We urge all SAOs to submit comments on the EHB provisions this proposed rule.  Family Voices will be working to develop comments and to provide assistance for SAOs to do so as well.   

Essential Health Benefits.  As explained in earlier updates, the Affordable Care Act (ACA) requires that all new, non-grandfathered plans in the individual and small group markets, both inside and outside the Exchanges, offer a standard package of benefits known as "Essential Health Benefits" (EHB).  The ACA listed 10 categories of benefits that must be included in the EHB package.  Of particular interest to CYSHCN, these benefit categories include "mental health and substance use disorder services, including behavioral health treatment," "rehabilitative and habilitative services and devices," and "pediatric services, including oral and vision care." 

Pursuant to a bulletin issued by the US Department of Health and Human Services (HHS) last year, states can determine the type and scope of benefits that will be offered in each category based on one of several types of "benchmark" plans from which they can choose.  If a state does not choose a benchmark, the default plan will be the largest small group plan in the state.  States have until December 26 to finalize their benchmark plan choices.  To see what plan your state has selected as a benchmark, if any, see this Kaiser Family Foundation report, which also provides a good explanation of the EHB determination process.

As reported last week, HHS recently issued a Notice of Proposed Rule Making  (NPRM) to govern states' creation of their EHB packages.  Comments on the proposed rule are due on December 26.  A summary of the proposed rule can be found here.  HHS also provided information on the proposed EHB-benchmark plans for each of the 50 states and the District of Columbia, along with a Guide to Reviewing the State Benchmarks.  The blog of the Georgetown Center for Children and Families discusses how the proposed rule might affect children and families.


Habilitation Services.  One of the significant features of the proposed rule is that, at least from 2014 to 2016, states will have the authority to define the "habilitation" benefit if the chosen benchmark plan does not cover such services (e.g., OT, PT, speech therapy for people to acquire or retain skills).  If a state does not define habilitation benefits, then the health plan must either; (1) cover habilitation benefits that provide parity with rehabilitation benefits - i.e., are "similar" in amount, duration and scope to rehabilitation benefits; or (2) determine its own set of habilitation benefits and report on those benefits to HHS.  (See Proposed Rule §156.110(f) and §156.115.)  Advocates are concerned that this proposal will lead to insufficient coverage of habilitation services.

Mental Health/Substance Abuse Services and Behavioral Health Treatment.  Another category for which the ACA requires coverage as an EHB is "Mental health and substance use disorder services, including behavioral health treatment."  The proposed rule states that these services "must be provided in a manner that complies with the parity standards implementing the Mental Health Parity and Addiction Equity Act of 2008.  That is, the coverage must provide parity in treatment limitations between medical and surgical benefits and the mental health and substance use disorder benefits. 

NOTE:  Also of interest, Voices for America's Children will be hosting a webinar on Tuesday, December 11, 2012 at 2:00 p.m. EST -- "State-Based Advocacy for Health Reform & Kids: Hit the Ground Running in 2013" to help prepare state-based advocates for next year's health care reform activities.

Coverage and Service Design Opportunities for Individuals with Mental Illness and Substance Use Disorders.  On December 3, the Center for Medicaid and CHIP Services (CMCS) in the Centers for Medicare and Medicaid Services (CMS), HHS, released an Informational Bulletin to provide information regarding services and good practices for individuals with a behavioral health disorder (a mental or substance use disorder).  The Information Bulletin provides links to many related resources, including a description of the various options available to states to cover behavioral health services. 

New additions to list of conditions qualifying for Compassionate Allowances.  Compassionate Allowances (CAL) are a way of quickly identifying diseases and other medical conditions that trigger an expedited determination of eligibility for the Social Security Disability Insurance or Supplemental Security Income programs.  On December 6, the SSA announced 35 additions to the list of Compassionate Allowances conditions, for a total of 200 conditions on the list. 


As always, please feel free to contact us with any questions. 

Brooke Lehmann, MSW, Esq.



Janis Guerney, Esq.



NOTE:  Past issues of the Washington update can be found on the Family Voices home page by scrolling down in the "News Feed" section.


Cosponsors of Representative Pallone's bill (H.R. 4083), as of 12/6/12:

Rep Carson, Andre [IN-7] - 4/26/2012
Rep Cicilline, David N. [RI-1] - 2/17/2012
Rep Engel, Eliot L. [NY-17] - 2/17/2012
Rep Green, Gene [TX-29] - 3/5/2012
Rep Hanabusa, Colleen W. [HI-1] - 7/18/2012
Rep Langevin, James R. [RI-2] - 2/17/2012
Rep Michaud, Michael H. [ME-2] - 2/17/2012
Rep Norton, Eleanor Holmes [DC] - 2/17/2012
Rep Pingree, Chellie [ME-1] - 2/17/2012
Rep Rangel, Charles B. [NY-15] - 3/8/2012
Rep Roybal-Allard, Lucille [CA-34] - 3/20/2012
Rep Waxman, Henry A. [CA-30] - 7/9/2012
Rep Welch, Peter [VT] - 11/16/2012

Cosponsors of Senator Menendez's bill (S. 2123), as of 12/6/12:

Sen Akaka, Daniel K. [HI] - 6/4/2012 
Sen Bingaman, Jeff [NM] - 2/17/2012 
Sen Conrad, Kent [ND] - 2/17/2012 
Sen Franken, Al [MN] - 6/5/2012 
Sen Inouye, Daniel K. [HI] - 8/2/2012 
Sen Kerry, John F. [MA] - 3/13/2012 
Sen Klobuchar, Amy [MN] - 5/8/2012 
Sen Lautenberg, Frank R. [NJ] - 2/17/2012 
Sen Schumer, Charles E. [NY] - 9/21/2012 
Sen Snowe, Olympia J. [ME] - 2/17/2012 
Sen Whitehouse, Sheldon [RI] - 2/17/2012 
Sen Wyden, Ron [OR] - 9/19/2012