February 01, 2013

February 1 Washington Update

Greetings from Washington.  This week's update focuses on some regulations implementing health care reform, but includes the usual legislative information as well.  At the end of the update are links to announcements of two SAMHSA grants that may be of interest.

Special requests: 

1.     If you are coming to DC for the AMCHP conference, have time to make congressional visits, and have not already told us about your plans, please contact Brooke or me.

2.     We are looking for a family member who might be willing to come to DC to participate in a briefing for congressional staff about the importance of the Medicaid program.  To illustrate that any family can suddenly find themselves caring for a child with special health care needs, we are hoping to find a family who relies on Medicaid for services to a child who suffered an unexpected injury or illness resulting in significant or long-term special health care needs.  If you think you could help us find such a family, please contact Brooke or me.

ACA Implementation - Individual Mandate, Premium Tax Credits and "Family Glitch"

Under the Affordable Care Act (ACA), some individuals with incomes below 400 percent of the federal poverty level will be eligible for tax credits to help them afford health insurance premiums, including premiums for insurance offered by their employers.  Individuals do not qualify for premium tax credits if their premium contribution for employer-sponsored insurance is considered affordable (9.5 percent or less of the household income). 

On Wednesday, the IRS issued a final rule regarding eligibility for premium tax credits.  To the disappointment of child health advocates, the final rule considers only the premium cost of an individual (self-only) health insurance plan when determining affordability, even if the individual would actually be purchasing more expensive family coverage.  Thus, some families will not be eligible for a premium tax credit even if their actual premiums cost more than 9.5 percent of household income.  See Kaiser Health News story at http://capsules.kaiserhealthnews.org/index.php/2013/01/some-families-will-be-ineligible-for-insurance-subsidies-under-final-rule/.  

This week the IRS and the Center for Medicare and Medicaid Services (CMS) also issued proposed rules (IRS proposed rule; CMS proposed rule) regarding the ACA's "individual mandate" (or "shared responsibility provision").  Among other things, the proposed rules explain what is considered "minimum essential coverage" and who is exempt from the requirement.  A fact sheet on the policies can be found at http://www.treasury.gov/connect/blog/Pages/Fact-Sheet-on-Proposed-Affordable-Care-Act-Regulations.aspx, and a helpful Q&A document can be found at http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision.

Proposed Rule on Medicaid, CHIP, Health Insurance Marketplaces -- Comment date extended; special conference call with CMS

As noted last week, CMS released a proposed rule to provide states with additional information on implementing ACA.  The proposed rule addresses state options for coordinating eligibility notices and appeals among Medicaid, the Children's Health Insurance Program (CHIP), and the Exchanges (now called "Marketplaces"); and Medicaid benefits, cost-sharing, appeals of eligibility determinations, and streamlining of eligibility categories. 

The Georgetown Center for Children and Families will be holding a special state partner call on these proposed regulations on Monday, February 4, at 4:00 ET.  CMS officials will be on the call to help explain the rule and respond to questions.

An HHS fact sheet on the proposed changes is available here.  Detailed explanations are also available from the Administration on Aging and HealthReformGPS (George Washington University).  Comments are due February 21, 2013, and may be submitted electronically at www.regulations.gov.

CMS seeking comments on draft applications for insurance in the Exchanges/Marketplaces

As you may be aware, comments are being sought on the online and paper applications that people and small businesses will use to apply to Medicaid, CHIP and private insurance through the health insurance Exchanges/Marketplaces to be set up under the ACA. 

Given your experience in helping people with the application process, you probably have some very valuable insights about how these proposed applications will work for consumers, so please consider commenting and/or sending your thoughts to me so that we can pass them along to HHS.

The comment period closes on February 28.  Comments should be submitted to:  

OMB, Office of Information and Regulatory Affairs

Attention: CMS Desk Officer

Fax Number: (202) 395-6974

E-mail: OIRA_submission@omb.eop.gov

As explained by the Centers for Medicare and Medicaid Services (CMS):

CMS is seeking public comment on the new single, streamlined application for health insurance and the SHOP [small business] applications in preparation for the launch of a new Health Insurance Marketplace next fall. 

The individual application is a single point of entry to purchase private insurance on the Marketplace and assess eligibility for assistance including, Medicaid, CHIP, and the Advanced Payment of Tax Credits.  People are asked to review the paper and online applications.  To demonstrate how users may interact dynamically with the online application, CMS has posted two videos of the application being completed.  One follows a family of three and the other an individual.  The video demonstrations are available at http://www.youtube.com/user/CMSHHSgov.  

Note:  the links below will take you to CMS website pages from which you can download a zip file.  In the zip file will be the draft application and explanatory documents for commenters.

Individual Application

Data Collection to Support Eligibility Determinations for Insurance Affordability Programs and Enrollment through Affordable Insurance Exchanges, Medicaid and Children's Health Insurance Program Agencies (CMS-10440) http://cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10440.html

SHOP [small business] Employer Application

Data Collection to Support Eligibility Determinations and Enrollment for Small Businesses in the Small Business Health Options Program (CMS-10439) http://cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10439.html

SHOP [small business] Employee Application

Data Collection to Support Eligibility Determinations and Enrollment for Employees in the Small Business Health Options Program (CMS-10438) http://cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10438.html

Budget negotiations -- FY 2013 F2F funding and Medicaid "per capita cap" proposal

This week the Senate passed the House-passed bill to suspend the nation's debt limit until May 19, and Obama is expected to sign it shortly.  Under this legislation, the House and Senate each must pass a budget resolution by April 15, or have their pay held in escrow either until they pass a budget resolution, or until the end of the 113th Congress in January 2015.  See Politico story at http://www.politico.com/story/2013/01/senate-passes-debt-ceiling-no-budget-no-pay-bill-87018.html.

This debt-limit legislation deals with only one aspect of the total federal budget picture.  Still remaining to be addressed by Congress are the automatic budget cuts (sequester) scheduled to take effect March 1 in the absence of an alternative deal, and the expiration of the current "continuing resolution" that is providing appropriations needed to run the federal government until March 27. 

Whether or not a new deal is reached to avoid or modify the sequester, it is likely that the FY 2013 funding for F2Fs will be reduced somewhat, which would affect grants beginning in June. 

Child health advocates are concerned that Medicaid and SSI could be targets of cuts and/or "structural reforms" during the budget talks, and will be working to defend these programs. 

This week, Senator Orrin Hatch (R-UT), the Ranking Republican on the Senate Finance Committee (which has jurisdiction over Medicaid) proposed several changes to Medicare and a proposal to institute "per capita caps" for the Medicaid program.  Although details have not been provided, Sen. Hatch proposed setting the caps by beneficiary eligibility categories, adjusted for patient health condition, and working "with the states to set clear, transparent goals and then monitor specific metrics on quality, access, and coverage."  

Under previous per capita cap proposals, beneficiary categories for determination of caps have been:  people with disabilities, seniors, children, and adults.  Child health advocates will oppose the per capita cap concept because it is intended to reduce federal spending for the program, and thereby shift costs to states.  Even if the caps were set at a generous amount at first, such a structure it would make it very easy for Congress to cut the federal share of the program in the future.

F2F funding beyond FY 2013

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.

SAMHSA announces grants for Statewide Family Networks and Statewide Consumer Networks

From the SAMHSA press release at http://www.samhsa.gov/newsroom/advisories/1301175742.aspx:

The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting applications for Statewide Family Network to create state capacity and infrastructure that will enable families to act as catalysts for mental health and other system change by developing community-based, family-driven and youth-guided systems of care for children and adolescents with serious mental health needs.  These grants will provide information, referrals, and support to families who have a child with a serious mental health need and create a mechanism for families to participate in state and local mental health services planning and policy development.  Domestic public and private nonprofit entities that meet the criteria for consumer-controlled organizations are eligible to apply. Applications are due on March 7, 2013. 

From the SAMHSA press release at http://www.samhsa.gov/newsroom/advisories/1301175800.aspx:

The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting applications for Statewide Consumer Network grants to enhance statewide consumer-run organizations to promote service system capacity and infrastructure development that is recovery-focused and resiliency-oriented.  For the purposes of this funding opportunity, this program seeks to promote activities related to wellness, integrated care, health care reform, and a trauma-informed approach.   Domestic public and private nonprofit entities that meet the criteria for consumer-controlled organizations are eligible.  Applications are due on March 8, 2013.


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

Best, Janis & Brooke

Janis Guerney, Esq.

Brooke Lehmann, MSW, 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 [retired]
Sen Bingaman, Jeff [NM] - 2/17/2012 [retired]
Sen Conrad, Kent [ND] - 2/17/2012 [retired]
Sen Franken, Al [MN] - 6/5/2012 
Sen Inouye, Daniel K. [HI] - 8/2/2012 [retired]
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 [retired]
Sen Whitehouse, Sheldon [RI] - 2/17/2012 
Sen Wyden, Ron [OR] - 9/19/2012