January 18 Washington Update
Greetings from Washington, where we are bracing for the crowds of the upcoming inauguration festivities. Among other things, this week's update will provide information about the President's proposal for addressing gun violence, a new Medicaid regulation, and the availability of new tools for helping people prepare for the implementation of health care reform.
Gun Violence Prevention
This week the President announced the administration's proposals, developed under the leadership of Vice-President Biden, intended to help prevent tragedies such as that in Newtown, CT, and other gun violence. Among the recommendations: (1) closing background check loopholes; (2) banning military-style assault weapons and high-capacity magazines; ( 3) making schools safer with more school resource officers and school counselors, safer climates, and better emergency response plans; and (4) increasing access to mental health services. Among other things, the President proposed ways to help ensure that school personnel are equipped to identify children with mental health problems and refer them for treatment, and that Medicaid and private insurers provide adequate coverage for mental health services.
With respect to insurance coverage for mental health services, the Centers for Medicare & Medicaid Services (CMS) released this week a State Health Official letter on the application of the Mental Health Parity and Addiction Equity Act to Medicaid managed care organizations, the Children's Health Insurance Program (CHIP), and alternative benefit (benchmark) plans.
President Obama also signed 23 Executive Actions to implement some of his recommendations.
In addition, HHS Secretary Kathleen Sebelius hosted a call with leaders from the health and human services community to discuss next steps. Substance Abuse and Mental Health Services Administrator Pamela S. Hyde, J.D., and National Institute of Mental Health Director Dr. Thomas R. Insel participated. A replay of the call can be heard by calling 888‑568‑0013 within the next few weeks.
During the development of the administration's recommendations, the National Council on Disability -- an independent federal agency charged with advising the President, Congress, and other federal agencies regarding policies affecting people with disabilities - wrote a letter to Vice-President Biden recommending that the administration's plan include investment in community-based mental health supports and programs, including mobile crisis services and peer supports, and warning against any actions that would stigmatize, hamper the rights of, or lead to increased institutionalization of people with mental illness.
ongress is also showing an increased interest in mental health care. The Senate Committee on Health, Education, Labor and Pensions (HELP) will hold a hearing next week. Among other witnesses will be the heads of the Substance Abuse and Mental Health Services Administration and the National Institutes of Mental Health. Other hearings in the House and Senate are expected.
ACA Education Tools
This week, HHS updated its ACA website, www.healthcare.gov, and is asking its partners to check it out and share it widely. In addition, the Department has developed a toolkit that its organizational partners can use to educate the public and small businesses about health care reform. The toolkit includes - in English and Spanish -- a brochure enumerating steps that consumers/businesses can take to prepare for ACA implementation in 2014, a "drop-in" article that organizations can use to explain the health care Marketplace (Exchange), and other educational materials.
Consumers and advocates can also sign up for email and text-message updates about ACA implementation. CMS is asking its partners, such as Family Voices, to spread the word among consumers about the HHS website, and to provide feedback and suggestions about its outreach efforts. Listserv subscribers will receive tips on choosing coverage in the new Health Insurance Marketplace (Exchange); information on new benefits; and resources to spread the word.
You can find more information and sign up for the listserv at Marketplace page for CMS partners. From that page, you can also download the CMS resource toolkit, market segmentation research, and suggestions for talking about the marketplace educational documents.
Proposed Rule on Medicaid, CHIP, Health Insurance Marketplaces
Also this week, CMS released a proposed rule to provide states with additional information on implementing ACA. Among other things, the proposed rule addresses state options for coordinating eligibility notices and appeals among Medicaid, the Children's Health Insurance Program (CHIP), and the Exchanges, Medicaid benefits, cost-sharing, appeals of eligibility determinations, and streamlining eligibility categories. Comments are due February 13, 2013. An HHS fact sheet on the proposed changes is available here.
In addition, Secretary Sebelius sent a letter to governors outlining options they currently have with respect to Medicaid benefit design, cost-sharing, and delivery systems.
The sequester and budget negotiations
As you well know, the fiscal cliff deal, the American Taxpayer Relief Act of 2012 (ATRA), extended funding for F2Fs. ATRA also postponed until March 1 the across-the-board sequester cuts that had been scheduled to take effect on January 2 pursuant to the 2011 Budget Control Act (BCA). Under the sequester, non-exempt mandatory programs (like the F2F program) would be subject to a cut of a certain number of dollars in FY 2013, estimated to be a cut of about 7.6 percent across the full fiscal year. The sequester amounts could be changed (up or down) by whatever deal, if any, is reached on modifying the sequester rules. It is unlikely, however, that the F2F program would escape a cut of some degree for this fiscal year.
Complicating the situation is the fact that the nation's borrowing capacity, or "debt limit," will likely be reached in mid-February, and a "continuing resolution," to fund the operation of the government in the absence of FY 2013 appropriations bills, expires March 27. It is expected that Congress and the White House will attempt to reach a comprehensive deal to avoid deep sequester cuts and raise the debt limit, but it is difficult to see how the parties will find common ground before March 1.
Today, House Majority Leader Eric Cantor (R-VA) announced that the House would vote next week to extend the nation's debt limit for three months. This represents a shift from the "Boehner rule," which called for spending cuts equal to any amount by which the debt-ceiling would be increased. House leaders say, though, that the debt-limit extension would be conditioned on the Senate agreeing to pass a budget by April 15. It remains to be seen what will happen.
F2F funding in the future
F2F funding for FY 2014 is dependent upon further congressional action. The first step toward that end is to thank the Members of Congress who supported the funding legislation that was just enacted. So, if you have not already done so, and if one of your Members of Congress was a cosponsor of the legislation (listed at the end of this update), please send a note of thanks for their support of F2Fs. To gain future funding, it is vitally important for Members to know that F2Fs really help their constituents, and that their constituents appreciate their support of the program.
It is possible that the next legislative "vehicle" in which to incorporate an F2F funding extension will be whatever legislation emanates from a sequester/debt-limit deal, so it is important that family leaders continue to educate their elected officials about the importance of F2Fs and how much they help children and families with the small amount of federal funding they receive.
As always, please feel free to contact us with any questions.
Best, Janis & Brooke
Brooke Lehmann, MSW, Esq.
Janis Guerney, Esq.
To reach your Members of Congress, go to http://www.congressmerge.com/onlinedb/index.htm. You can submit a message through their contact forms, and/or call their offices.
Cosponsors of Representative Pallone's bill (H.R. 4083):
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):
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