April 12, 2013

April 12 Washington Update

Greetings from Washington, land of the beautiful cherry blossoms.  In this update:  the latest information about federal Navigator grants, for which guidance was released this week.  These grants could be a source of money for your organization to help families of CYSHCN navigate the new health insurance system.  Applications are due on June 7.  First, though...

F2F funding legislation.  There is now a cosponsor on the Senate bill, Senator Sheldon Whitehouse (D-RI).  Rep. David Cicilline (D-RI) has cosponsored the House bill.  (Yeah, Rhode Island!)  As reported before, the House bill (H.R. 564), sponsored by Representative Frank Pallone (D-NJ), and the identical Senate bill (S. 423, corrected number), sponsored by Senator Robert Menendez (D-NJ) - Yeah NJ! -- would extend funding for Family-to-Family Health Information Centers (F2Fs) through FY 2016 at the current funding level of $5 million per year.  If you would like to urge your Representative and/or Senators to cosponsor these bills, you can find their contact information at http://www.congressmerge.com/onlinedb/index.htm

*Navigator grants.* Under the ACA, Exchanges (a.k.a., "Marketplaces") are required to provide grants to "Navigator" entities that will help people figure out how to select insurance in a post-reform world.  Last week, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to amend and clarify standards for Navigators that were established in an earlier rulemaking.  This week, CMS issued the Funding Opportunity Announcement (FOA) for Navigator grants in states where the federal government will operate the Exchange, either alone or in partnership with the state. (In states running their own Exchanges, the state will be issuing navigator grants.)

Optional (but encouraged) Letters of Intent to apply for a Navigator grant are due on May 1.  Applications are due June 7, and awards will be made August 15. 

CMS will be holding a conference call to provide technical assistance to potential applicants on Friday, April 19, from 3:30 to 5:00 pm EDT. [Toll-free teleconference phone number: 877-267-1577; ID: 2917.]  Families USA will also be holding a call for potential applicant on Tuesday, April 16 at 3:00 pm EDT, for which registration is required.

Family Voices has created a webpage devoted to the Navigator grant application, proposed rule, and related materials.  That webpage has links to relevant CMS and other materials and a blog through which people can post questions and comments regarding the grant process and criteria.  Family Voices will keep adding to that webpage and providing more information to potential applicants in the near future.  Note that the proposed rule provides background information that should be helpful to grant applicants.  Additional information, worth reading, is available on this blog from the Georgetown Center on Children and Families.

Since F2Fs and Family Voices State Affiliate Organizations (SAOs) have experience as navigators for families whose children have special health care needs, they should consider applying for Navigator grants, either alone or in conjunction with another organization(s).  Entities from multiple states can also apply together.  Each Navigator grantee will be expected to be able to help all types of consumers and small businesses, after undergoing online training to be provided by the Department of Health and Human Services (HHS).  Therefore, it might make sense for F2Fs and SAOs to apply for a grant with another organization(s) that cover(s) a different or broader population and could use the expertise of the F2F/SAO to assist families whose children have special health care needs.

If your organization might apply for a Navigator grant, and has never registered to be a federal grant applicant, it is important to act now.  To register, go to http://grants.gov/applicants/get_registered.jsp, a process that can from a few days to a few weeks.  Registering does not obligate one to apply and there is no cost.

CHIP and the ACA.  The April State Health Policy Blog from the National Academy for State Health Policy (NASHP) includes a post, Children Need Exchange Coverage Too, which discusses ways the Children's Health Insurance Program (CHIP) could help meet Affordable Care Act (ACA) Exchange requirements while establishing good coverage for children.  Related issue briefs from NASHP might also be useful to advocates working with state policymakers on Exchange design. 

Senate bill on mental health.  (Summary from the American Academy of Pediatrics.)  This week, the Senate Health, Education, Labor, and Pensions (HELP) Committee approved the Mental Health Awareness and Improvement Act, a combination of several mental health bills that have been introduced since the Newtown shootings. The bill includes measures to improve the provision of mental health services in schools, including positive behavioral interventions and support, and also reauthorizes the Garrett Lee Smith Memorial Act, which includes suicide prevention grants and training, among other provisions.

The bill also creates grants for mental health awareness training, and reauthorizes the National Child Traumatic Stress Initiative, which supports a national network of child trauma centers, including university, hospital, and community-based centers and affiliate members.  In addition, the bill authorizes several GAO studies, including one to address barriers to integration of behavioral health with primary care and another on child mental health service utilization.

The President's budget request.  This week the President released his long-awaited budget request for FY 2014.  One of its outstanding features is a proposal to change the way Social Security cost-of-living adjustments (COLAs) are calculated -- using the "chained CPI" -- which would have the effect of reducing COLAs.  The proposal would not affect SSI, but would affect payments under the Disabled Adult Child program. The White House said, however, that the budget was offered as a compromise rather than a starting point for negotiations, and that the President would not agree to the chained CPI or other entitlement cuts without getting concessions on tax-law changes to increase revenues.  Missing from the President's budget were some cuts in Medicaid (limits on state provider taxes and the "blended FMAP") that had been included in earlier White House budget proposals.  The budget also seeks additional funding to run and oversee health care Exchanges/Marketplaces and more funding for mental health services and housing for people with disabilities.  A short discussion of the budget's Medicaid, CHIP, and ACA proposals can be found in this blog from the Georgetown Center on Children and Families.

It is not expected that the President's budget or the very different budget resolutions adopted by the Senate and House will ever be enacted as is.  It is still considered a possibility, however, that a "grand bargain" can be struck to get rid of the sequester and replace it with changes to entitlement programs and tax law.

CMS assistance to states on managed care.  Today the Center for Medicaid and CHIP Services issued an Informational Bulletin announcing a new Medicaid Managed Care Technical Assistance Center for states on Medicaid.gov.  According to the Bulletin, "CMS will provide individualized technical assistance to the states on managed care program operations, including planning and procurement, benefit design and serving the needs of complex populations, access and quality, and the use of data for program oversight and management. The Medicaid Managed Care Technical Assistance Center is part of CMS's larger efforts to provide comprehensive information and guidance on Medicaid managed care program operations."

ACA implementation information.  The Center for Medicare and Medicaid Services will be holding state-by-state calls to discuss implementation of Exchanges/Marketplaces.  The Open Door Forum page provides the tentative schedule, updates, and best point of state contacts in CMS Regional Offices.  

From CMS:  Websites where one can get information and sign up for updates are:

1.      HealthCare.gov: This site is geared towards consumers and provides general information about the Marketplace and health insurance. Consumers can sign up for email and/or text message updates.

2.      Marketplace.cms.gov: This page has a wide variety of tools and resources to help you help people prepare to apply, enroll and get coverage in 2014. You can also sign up for updates by clicking on "Get updates." After entering your email address, check the box that says "Health Insurance Marketplace (Exchange)" under the "Outreach and Education" section near the middle of the page. This is the main avenue that CMS will use to communicate with interested stakeholders on Marketplace updates.

To submit comments or make inquiries, contact partnership@cms.hhs.gov.


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

Best, Janis & Brooke

Janis Guerney, Esq.

Brooke Lehmann, MSW, Esq.