June 07, 2013

June 7 Washington Update

Greetings from Washington, DC!  This week's Update reports on the White House's National Conference on Mental Health and a new government website, www.mentalhealth.gov.  Also included is information on some new ACA implementation resources. But first, see the cool new "handicapped" icon for New York City...

‘Handicapped' Symbol Gets Facelift [Due to technical problems, you will have to click on a link to see the icon.]

A recent article in Disability Scoop reported that New York City will be adopting a redesigned "handicapped" icon (Courtesy: www.accessibleicon.org) that displays an active, in-motion version of life with a physical disability.  The new design was spearheaded by a philosophy professor at Gordon College in Massachusetts, and it is hoped that its adoption by NY will lead to more widespread use of the design.


Health Care Innovation Grants, Round 2.  On Wednesday, June 12, 2013 at 1:30pm - 3:00pm EDT, the CMS Innovation Center will hold a webinar on two of the four innovation categories for which Round-2 awards will be made:  rapid reductions in Medicare, Medicaid and/or Children's Health Insurance Program (CHIP) costs in outpatient and/or post-acute settings; and improvement of care for populations with specialized needs. This webinar is primarily intended for potential applicants interested in submitting proposals for innovative service and delivery payment models in the specified categories.  For more information and to register, go to http://innovation.cms.gov/resources/HCIA-Two-OverviewCat1-2.html.

Premium rates.  On Friday, June 14 at 1pm ET, the Center on Budget and Policy Priorities, the Georgetown University Center for Children and Families, Community Catalyst and Families USA will hold a conference call about recent releases of premium rates and their impact on health insurance Exchanges and the public's perception of the Affordable Care Act (ACA).  An update on the disproportionate share hospital regulations will also be provided. RSVP here

ACA cost-reduction provisions.  The Center for Budget and Policy Priorities (CBPP) has tentatively scheduled a webinar for Wednesday, June 19 at 1 pm ET to explain how health reform's cost-sharing reductions work.  Sign-up information is not yet available but we will pass it on when we get it. 

UPDATED: Health Insurance Marketplaces (Exchanges).  CMS has announced series of training webinars about Exchanges to be held in June, July and August.  There will be two levels, basic and advanced.  Space is limited, but the webinars are offered on multiple dates.  The schedule and registration links are at the end of this update.  Note that some new dates have been added.


ABA in TRICARE.  In July 2012, U.S. District Judge Reggie Walton ordered that Applied Behavioral Analysis (ABA) therapy for people with autism be covered under TRICARE, the military health insurance program for active-duty and retired military personnel and their families.  This week, the judge ordered an unusual reversal of his previous ruling and remanded the case to the Department of Defense (DoD) for reconsideration of their policy not to cover ABA under the basic TRICARE plan.  (It had already been covered under a special plan, ECHO, available only to dependents of active-duty personnel.)  It is possible that the DoD will choose to cover ABA on its own accord after taking into account literature published since the agency last considered the matter.  A news article about the case can be found at http://www.kentucky.com/2013/06/06/2668550/judge-giveth-and-judge-taketh.html.  The 21-page opinion can be found here.


The sequester, the budget, and appropriations.  The "sequester" that went into effect a few months ago has forced across-the-board cuts in government programs in the current federal fiscal year (FY 2013), and will force additional cuts in future years.  Some in Congress have suggested that the President be given discretion to shift spending from one program to another this year, but the administration would prefer not to do so since it will be difficult politically to favor one program over another, and since increasing funds to some of the more popular programs might take pressure off Congress to negotiate an alternative to the sequester.

At this point, however, agreement on a sequester alternative does not look likely, either for this year or the next fiscal year (FY 2014).  Negotiation of a "budget resolution"- broad outline for spending and revenues - could have been a vehicle for crafting a budget deal that would replace the sequester.  But, while each chamber has passed its own FY 2014 budget resolution, neither has appointed conferees to work out a compromise.  Indeed, a compromise seems unlikely since the approaches of the majority-Democratic Senate and the Republican-controlled House are so different. 

In May, the House Appropriations Committee approved a plan to divide up FY 2014 discretionary funding among the 12 appropriations subcommittees in a manner that would shift tens of billions of dollars from "domestic discretionary" programs to defense and other security programs.  (For more detailed information, see this analysis from the Center for Budget and Policy Priorities.)  This week, the House passed the first appropriations bills following this scheme, prompting a veto threat from the administration. 

The White House Statement of Administration Policy said, "These cuts could result in hundreds of thousands of low-income children losing access to Head Start programs, tens of thousands of children with disabilities losing Federal funding for their special education teachers and aides, ... and thousands of scientists without medical grants, which would slow research that could lead to new treatments and cures for diseases like cancer and Alzheimer's, and hurt America's economic competitiveness." 

The next point at which Congress will be under pressure to pass any budget-related legislation is when the debt limit needs to be increased, which is expected to occur in October.  That legislation may serve as the vehicle for a "grand bargain" on future spending and (maybe) revenues.  (It might also serve as a vehicle for F2F funding legislation.)

F2F funding legislation.  There are no new cosponsors of the F2F funding bills.  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


National Conference on Mental Health and new mental health website.  On June 3, the White House hosted the National Conference on Mental Health, intended to increase understanding and awareness of mental health.  Video clips from the conference can be viewed here.  In conjunction with the conference, the administration launched a new website - www.mentalhealth.gov - which provides tools to help with the basics of mental health, the signs of mental illness, how to talk about mental health, and how to get help.  The website also includes videos featuring celebrities and others whose lives have been touched by mental illness.  

In addition, the Substance Abuse and Mental Health Services Administration (SAMHSA) released an Information Brief -- Toolkit for Community Conversations About Mental Health -- to support communities interested in holding discussions about mental health.  This free document can be ordered in print or downloaded.

The administration recruited a number of companies and national organizations, representing media, educators, health care providers, faith communities, and foundations, to help increase understanding and awareness of mental health through:

1) Launching new efforts to raise public awareness through television, radio, social media campaigns, and other platforms.

2) Teaching students about mental health and helping adults who work with youth recognize early signs of mental health problems and refer kids to treatment.

3) Giving health care providers tools to screen for mental health problems and encouraging them to lead efforts to raise awareness in their communities.

4) Convening experts, philanthropic and civic leaders to identify innovative ways to reduce negative attitudes and perceptions about mental illness and improve access to treatment at the local level.

5) Launching new conversations in houses of worship and other faith-based institutions to help people recognize mental health problems and access the treatment they need.


Specialty Care in Medicaid.  Access to specialists for Medicaid beneficiaries may be an ever-growing problem after Medicaid expansions in certain states.  The Commonwealth Fund issued a report about creative, collaborative approaches taken by safety-net hospitals, community health centers, specialists, state Medicaid programs, and health plans to ensure specialty-care access for Medicaid beneficiaries. Some of the strategies involve using video and other technologies that allow specialists to treat patients remotely, while others focus on training primary care providers to treat certain specialty conditions or employing "access coordinators" to help arrange for specialty care services.  The authors note that sustaining, expanding, and replicating these models may require changes in Medicaid payment methods.

Habilitative Services in ACA plans.  The Lucile Packard Foundation for Children's Health commissioned an issue brief, examining coverage of habilitative services for children under the "essential health benefits" provisions of the Affordable Care Act.  The issue brief offers recommendations that may be useful to advocates monitoring state regulation of health plans.  The same issue is addressed in a public radio report, "For Kids with Chronic Conditions, a Looming Insurance Battle."  

Family Voices, has been active in trying to strengthen regulations governing coverage of the ACA-mandated "habilitative services" benefit, both on its own and as part of the "HAB Coalition." The HAB Coalition is conducting a survey of consumer experiences in getting coverage of habilitative services under their insurance plans.

Medicaid for former foster youth up to age 26.  The ACA allows children up to age 26 to remain on their parents' health insurance policies, and allows former foster youth of the same ages to retain eligibility for Medicaid if they were in foster care and were enrolled in Medicaid when they turned 18.  A post from the blog of the Georgetown Center on Children and Families discusses the various issues involved in implementing this provision for former foster youth.  More information on ACA provisions of potential help to former foster youth can be found in a paper co-authored by (Family Voices Public Policy Co-Director) Brooke Lehmann, of which a summary can be found here.


Premium Tax Credits.  The Center on Budget and Policy Priorities held a webinar on June 5 about premium tax credits under the ACA.  A recording of the session (with synched slides) is available on YouTube, and the slides alone can be found here.  The Center has also prepared a fact sheet on Frequently Asked Questions about premium tax credits.    

Navigators and In-Person Assisters: 

Families USA has created a Navigator and In-Person Assister Resource Center and people can sign up to receive updates on this topic.  Also available:

This week's blog of the Georgetown Center on Children and Families includes a post about training and other elements needed for an effective consumer assistance system.  This outline could be helpful to advocates attempting to shape a state's policy with respect to consumer assistance training and support.

From CMS: Helping Consumers Apply and Enroll Through the Marketplace (explains the different types of "navigators," "assisters" and "application counselors")

StateRefor(u)m, a project of the National Academy for State Health Policy (NASHP) and the Robert Wood Johnson Foundation, has a wealth of information on state ACA implementation, including draft/final regulations on consumer assistance plans in California and Minnesota.

Eligibility and Enrollment:

A new issue brief from the Kaiser Family Foundation's Commission on Medicaid and the Uninsured identifies five key lessons based on a review of existing research on previous outreach and enrollment experience in Medicaid and the Children's Health Insurance Program.  

Available here is a webcast of a session held by Families USA and Enroll America that discusses: (1) tactics for successfully engaging uninsured people, particularly communities of color, to get them enrolled in health insurance, and (2) best practices for raising public awareness about the health insurance options available under the ACA. 

The Continuity of Medicaid Coverage is a report from George Washington University explaining the benefits of minimizing disruptions for Medicaid enrollees.  It includes an updated analysis of rates of continuity of coverage in each state and recommendations for states to address churn by such methods as easing the yearly renewal process and using electronic income verification.  Eligibility, Enrollment and Churn Recommendations, are recommendations adopted by the District of Columbia exchange board for easing eligibility processes and reducing churn through such tactics as not requiring reporting of income changes of less than $150 per month; requiring QHPs to have transition plans for enrollees moving on or off the plans; and granting "good faith" extensions of deadlines to resolve inconsistencies in an application.

MAGI rules for Medicaid Eligibility, provides three versions of a flow chart designed to map the steps for determining a person's eligibility for Medicaid under the new MAGI rules. Find the charts and post your comments here.

Exchanges and Qualified Health Plans (from StateRefor(u)m):

State Approaches to Qualified Health Plan Certification Chart, which shows how much authority each exchange or partnership state has in the various domains related to certifying health plans to be sold in an exchange. Includes links to source documents.  The recording and slides from a webinar on three states' certification methods, including Q & A, are also available.

State and Partnership Exchange Policy Decisions Chart, which identifies various decisions states must make with respect to Exchange implementation, such as with the eligibility system will include Medicaid, how to approach consumer assistance; how to finance the exchange; and how much authority over insurance plans they will have.  Includes links to source documents.

Exchange Blueprint Chart/Where States Stand on Exchanges Map, two documents providing information  about which type of exchange will be in each state, some of the background on how each state came to that decision, and any future plans to change status.

ACA information and subscription to updates can also be found at:

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.




[NOTE:  There are two lists of webinars below.  The second provides additional dates/times for the "Level 1" webinars plus a "Q & A" webinar in Spanish.]

 CMS is happy to announce the availability of Health Insurance Marketplace webinars throughout the months of June and July.  These training opportunities are broken into two levels:

  • Level 1: Health Insurance Marketplace 101 (basic) - A one-hour high-level webinar overview of the accomplishments of the Affordable Care Act and a basic introduction to the Marketplace (Exchanges) highlighting who is eligible and how the Marketplace will work.
  • Level 2: Understanding the Health Insurance Marketplace (advanced) - A two-hour detailed review of the Marketplace (Exchanges), including eligibility, enrollment, plan structure, Medicaid expansion, and the streamlined application.

Select the webinar that best suits your needs and then select the Registration Link that corresponds with the date to register for the webinar.  Please note that there is a limit of 200 people for each of the webinars and will be filled on a first come first serve basis; so we ask that you be flexible with your selected date.  However, more webinars will be added if demand is shown. The following tables list the available dates and times for the webinars:

Level 1: Health Insurance Marketplace 101


1:00 - 2:00 pm ET




1:00 - 2:00 pm ET




1:00 - 2:00 pm ET




1:00 - 2:00 pm ET




1:00 - 2:00 pm ET




1:00 - 2:00 pm ET




1:00 - 2:00 pm ET




1:00 - 2:00 pm ET




1:00 - 2:00 pm ET




1:00 - 2:00 pm ET




Level 2: Understanding the Health Insurance Marketplace


1:00 - 3:00 pm ET




1:00 - 3:00 pm ET




1:00 - 3:00 pm ET




1:00 - 3:00 pm ET




For more information on these and other events hosted by the Centers for Medicare & Medicaid Services, email the CMS National Training Program at training@cms.hhs.gov.  Marketplace information and training materials for partners is available at Marketplace.cms.gov.

Click on the title of the webinar you prefer and fill out the registration form. After registering you will receive an e-mail confirmation containing information about joining the webinar. Please contact us at ACA101@hhs.gov  if you have problems registering or if you have any questions about the health care law. All webinars are one hour.

Please note that the first 1,000 people who join each webinar at the start time are able to attend. If there is significant interest in a webinar, we will do our best to schedule another session for the following month. If possible, please use your computer speakers to listen to the audio portion of the webinar.

 Q and A on the ACA (in Spanish) 

June 12 at 3:00 pm ET

If you have questions about the health care law (the Affordable Care Act), this is the webinar for you! We will answer questions that have been submitted in advance as well as new questions asked during the webinar. Please send your questions for the webinar, with your name and organization listed, by close of business June 11 to ACA101@hhs.gov. Note that this webinar is in Spanish.


NEW - The Health Care Law - Health Insurance Marketplace 101

June 19 at 12:30 pm ET

A presentation on the main provisions in the health care law (the Affordable Care Act) and how to access care in your community. Topics include the Health Insurance Marketplace, how to enroll in health insurance, and how to receive updates on implementation of the law. A brief question and answer session will provide answers to commonly asked questions.


NEW - The Health Care Law - Health Insurance Marketplace 101

July 11 at 2:00 pm ET


NEW - The Health Care Law - Health Insurance Marketplace 101

August 7 at 3:00 pm ET