February 25, 2013

February 22 Washington Update

Greetings from Washington.  Although Congress has been on recess this week, the administration is still working hard on regulations to implement the Affordable Care Act (ACA).  Please consider providing feedback on its proposed "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!  Details about how to comment are below.

Sequestration.  It is just one week until the across-the-board cuts of the sequester will in and everything is still up in the air about what will happen.  The common wisdom is that the sequester will go into effect, increasing pressure on all sides to reach an agreement to reduce, modify, and/or delay the cuts.  The Senate is expected to vote next week on both Democratic and Republican proposals to avoid the sequester, but they are not likely to pass.  Although the cuts officially are effective March 1, there will probably be delays in actual effects, like the furloughing of federal employees and reductions in program funding.  Thus, it is not clear whether, when or how much the funding for Family-to-Family Health Information Centers (F2Fs) will be affected.  For an article about how the sequester would affect various health programs, see http://www.kaiserhealthnews.org/stories/2013/february/20/sequester-health-cuts.aspx.

IMPORTANT:  CMS seeking comments on a draft application to be used for private insurance, Medicaid, CHIP and premium tax credits -- DEADLINE 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.)

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.  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, as explained below. 

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

Notethe 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 can be submitted to electronically by going to http://www.regulations.gov/#!submitComment;D=CMS_FRDOC_0001-1121.  Or they can be faxed or emailed to:

OMB, Office of Information and Regulatory Affairs
Attention: CMS Desk Officer
Fax Number: (202) 395-6974
E-mail: OIRA_submission@omb.eop.gov

Final rules issued on Essential Health Benefits and guaranteed coverage and insurance premiums

Essential Health Benefits.  On Wednesday, HHS issued the final rule on the "Essential Health Benefits" that must be included in all non-grandfathered individual and small group health insurance plans, Medicaid benchmark and benchmark-equivalent plans, and Basic Health Programs in states that choose to have them.  The final rule does not differ substantially from the proposed rule, in that it still allows each state to determine its own EHBs based on one of four types of benchmark plans sold in that state (see Washington Update of November 30, 2012.)  For more information about the final rule, see the HHS fact sheet or press release, this article in the New York Times, or this blog post from the Georgetown Center on Children and Families.

One of the issues that Family Voices commented on in response to the proposed rule was the definition of "habilitative services" (e.g., OT, PT, speech therapy for people to acquire or retain these skills).  Under the proposed rule, a state would have the authority to define the habilitative services benefit if its chosen benchmark plan did not cover such services.  If a state did not define these services, then the insurer would determine what habilitation benefits to cover. Notwithstanding comments by Family Voices and others opposing this approach, the final rule is the same as the proposed rule on this point.  HHS plans to examine how the states and insurers define habilitative services over the next few years, and then revisit the issue.

On a more positive note, the Department estimates that, as a result of ACA implementation through the EHB rule, 32.1 million Americans will gain access to coverage that includes mental health and/or substance use disorder benefits that comply with federal parity requirements, and an additional 30.4 million Americans who currently have some mental health and substance abuse coverage will benefit from the federal parity protections in the rule's application of the Mental Health Parity and Addiction Equity Act, which requires that mental health and substance use disorder coverage be comparable to general medical and surgical coverage in a given

Insurance Market Rules.  Today HHS released a final rule on Insurance Market Rules and Rate Review.  The rule addresses consumer protections such as guaranteed coverage and premium rating standards.  For more information on this final rule, see this HHS press release or  this HHS fact sheet.

Cost sharing and preventive services.  This week, HHS issued FAQs about these issues, which can be found here.

Promoting Readiness of Minors in Supplemental Security Income (PROMISE) Program.  The Promoting Readiness of Minors in Supplemental Security Income (PROMISE) program is a joint effort of the Departments of Education (ED), Health and Human Services (HHS), and Labor (DOL), and the Social Security Administration (SSA).  Its purpose is to fund model demonstration projects in States to promote improved outcomes for children who receive SSI and their families.  Such projects will be required to form strong and effective partnerships among State agencies responsible for programs that play a key role in providing services to child SSI recipients and their families. They must also provide coordinated services and supports designed to improve the education and employment outcomes of these children and their families. The Department of Education has posted a Public Input Notice (PIN) inviting interested persons and organizations to provide input on this new competitive grant program.  Governors' offices, the State agencies identified as required partners in the PIN, and other organizations and agencies that may be interested in participating in partnerships are particularly encouraged to familiarize themselves with the Public Input Notice posted at www.ed.gov/PROMISE, participate in the upcoming public webinars, and provide written comments on the PIN.  Webinars will be held on:

  • Feb 27th - 3:00-4:30pm eastern
  • Feb 28th - 3:00-4:30pm eastern
  • March 5th - 3:00-4:30pm eastern

Click here to join one of the webinars.  The teleconference can be joined at any time by dialing: 1 800-503-2899 and typing in the following Access Code when prompted: 4036828.

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.  

ABLE ActThe Achieving a Better Life Experience Act of 2013 (ABLE Act; S. 313, H.R. 647) was introduced last week in the House and Senate.  This bipartisan legislation would allow the establishment of tax-advantaged savings accounts for individuals with disabilities, so that they, or their families on their behalf, could save for expenses, like education, housing, and transportation. ABLE accounts would be disregarded when determining eligibility for Medicaid, Supplemental Security Income (SSI) programs, and other means-tested programs. The legislation has 59 original House cosponsors and 16 original Senate cosponsors.

Miscellaneous new information

New ACL Website.  The Administration for Community Living (ACL) has launched a new website, www.ACL.gov. ACL, created in 2012, brought together three agencies within the Department of Health and Human Services: the Administration on Aging, the Administration on Intellectual and Developmental Disabilities, and the Office on Disability.  The new website offers resources about the programs, services and issues facing persons with disabilities, older adults, and family caregivers.

Webinar Series on the Affordable Care Act.  The Administration for Community Living is continuing its series of webinars on the Affordable Care Act and its impact on older adults, people with disabilities and the aging and disability networks. The webinar, Managed Long-Term Services and Supports: Measuring Outcomes, will take place on February 26 from 3-4:30 PM EST. It will examine the core principles and criteria for selecting and building infrastructure to monitor the quality of managed long-term services and supports. Click here to register.

FEMA Seeks Applicants for National Advisory Council. The Federal Emergency Management Agency is seeking individuals interested in serving on the National Advisory Council (NAC), an advisory committee established to ensure effective and ongoing coordination of federal preparedness, protection, response, recovery, and mitigation for natural disasters, acts of terrorism, and other man-made disasters. The NAC will have positions open for applications and nominations in a number of disciplines including functional accessibility (one representative appointment) and emergency response (one representative appointment for a one-year term).  The deadline for applications is Friday, March 8, 2012, 5:00 p.m. EST.  For more information, see www.fema.gov/national-advisory-council.

Information worth repeating

Frequently Asked Questions about ACA Implementation.  CMS has posted a set of frequently asked questions about Medicaid and CHIP issues related to the ACA, 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.