February 15, 2013

February 15 Washington Update

Greetings from Washington.  Two weeks until the sequester kicks in and everything is still up in the air.  HHS announced the suspension of enrollment in Pre-existing Condition Insurance Plans, and there is still time to comment on the "single streamlined application" for public and private insurance and premium tax credits that will be used when the ACA is implemented in 2014.  The consumer voice is needed to improve this application!

CMS seeking comments on a draft application to be used for private insurance, Medicaid, CHIP and premium tax credits  -- DEADLINE IS THURSDAY, FEB. 28

As noted last week, comments are being sought on the online and paper applications that people and small businesses will use to apply for Medicaid, CHIP, private insurance offered by health insurance Exchanges/Marketplaces, and premium tax credits.  (See description and links to documents and video, below.)

Given your personal and professional experience with various applications for public and private insurance coverage, you probably have some very valuable insights about how these proposed applications will work for consumers.   Also, the application's questions for determining whether someone has a disability are weak.  Please consider sending in your own comments, with a copy to me, or sending your thoughts to me so that we can pass them along to HHS.  The comment period closes on February 28. 

Application questions on disability status.  Under the ACA, states may offer substantially different Medicaid benefits for beneficiaries in different eligibility categories.  People with disabilities may have a better benefits package than others, so it is important to determine whether an applicant is eligible based on a disability.  The proposed application includes two questions about disability status that probably are not very useful, so your feedback on that issue would be especially helpful.  A Kaiser Family Foundation report issued this week discusses aspects of the proposed application in comparison to existing state Medicaid and CHIP applications.  See pages 17-18 of that report for a discussion of the proposed disability questions and potential alternatives from existing state applications.

Proposed application and supporting materials.  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.  The individual and small business employee applications are the ones of greatest relevance to us.

Do not be daunted by all the materials.  It would be helpful for you to comment, even if you look only at the application itself and have only a limited number of suggestions.

Individual Application (CMS-10440) http://cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10440.html

SHOP [small business] Employee Application (CMS-10438) http://cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10438.html

SHOP [small business] Employer Application (CMS-10439) http://cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10439.html

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

Or by going to http://www.regulations.gov/#!submitComment;D=CMS_FRDOC_0001-1121

F2F funding legislation As reported last week, Representative Frank Pallone (D-NJ) introduced a bill (H.R. 564) to extend funding for Family-to-Family Health Information Centers through FY 2016 at the current funding level of $5 million per year.  We also expect a Senate companion bill to be introduced by Sen. Menendez (D-NJ) again. 

It will be up to family leaders around the country to get their Members of Congress to cosponsor this legislation.  The more cosponsors there are, the greater the likelihood that the bills will be enacted.  It would be especially helpful if we could get some Republican cosponsors so the bills will be bipartisan.  To find your Representative and his/her contact information, see www.house.gov.  

Hill visits.  We were pleased that a number of people attending the AMCHP conference this week made visits to Capitol Hill.  If you haven't done so already, please let us know the name of the staffers with whom you met in each office, what you discussed (Title V, F2F funding, both?), and any feedback you got.

ACA-related news and information

Pre-existing Condition Insurance Plan (PCIP) Program - enrollment suspended in states with federally administered plans.  Announced today by HHS:  Beginning February 16, 2013, the federally-run Pre-Existing Condition Insurance Plan (PCIP) is suspending acceptance of new enrollment applications until further notice.  State-based PCIPs may continue accepting enrollment applications through March 2, and will then suspend acceptance of new enrollment applications until further notice. PCIP will continue providing coverage to more than 100,000 people currently enrolled nationwide. View more information here.

The Affordable Care Act (ACA) created the PCIP program for people with pre-existing conditions who have been uninsured for at least six months.  Such a program will not be necessary after 2014, when insurance companies can no longer refuse to cover people with pre-existing conditions.  A fixed sum of $5 billion was provided for the PCIP program.  Some states elected to operate their own PCIPs, but 23 states and the District of Columbia have a federally-administered program.

Although fewer people than expected have enrolled in a PCIP, expenses have been greater than expected.  To avoid running out of money before 2014, CMS recently instituted cost-cutting measures for the plans that it administers, including an increase in the maximum out-of-pocket limit from $4,000 to $6,250 for in-network services.  See Kaiser Health News report at http://capsules.kaiserhealthnews.org/index.php/2013/02/obama-administration-cuts-benefits-to-those-in-high-risk-pools/.

Table on immigrant eligibility for ACA and public programs.  This week the National Immigration Law Center distributed a table to help people figure out the myriad of eligibility criteria for ACA and other public programs for immigrants in various situations.  The table is attached to the Washington Update e-mailed on Feb. 15.

Explanation of ACA insurance-mandate exemptions.  This week's blog from the Georgetown Center for Children and Families includes a post that simply explains who is exempt from the ACA-created "mandate" that people have insurance coverage or pay a penalty.

Frequently Asked Questions about ACA Implementation.  CMS has posted a set of frequently asked questions about ACA-related issues, including changes in Medicaid eligibility (under the "Eligibility Policy" category.)

Patient Navigators, Assisters, and Certified Application Counselors.  F2Fs should be exploring ways that they can get more funding by serving as one of the types of consumer-assistance entities created to implement the ACA.  See blogs about this topic from Community Catalyst  and the Georgetown Center for Children and Families.  See also this recent Washington Post article about navigators.

SAMHSA 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.