July 21, 2013

July 19 Washington Update


Revised ACA webpage. We would also like to announce a new and improved ACA webpage to serve as a repository for information and resources about the Affordable Care Act (ACA). This page will reside on the website of the National Center for Family and Professional Partnerships. Eventually, we hope that this ACA webpage will serve as a spot where families, family leaders, and others can can go to find all the information they need to understand the ACA's impact on children with special health care needs and their families, and to help others to understand it as well. We welcome suggestions for resources to post on the webpage.

The Washington Update will continue to provide news about the ACA, and information about upcoming webinars, teleconferences and select resources. Please note that past issues of the Update can be found by scrolling down the "Latest News" on the homepage of the Family Voices website.

This week in Washington...
The President spoke about rebates that some consumers have received as a result of the ACA requirement that insurers spend 80 percent of premium revenues on benefits. Meanwhile, policy analysts and advocates continued to study the complex final regulation issued two weeks ago to implement many of the ACA's provisions regarding Medicaid, CHIP and the Exchanges. (More on that below.)


Health Insurance Marketplaces (Exchanges). CMS has announced series of training webinars about Exchanges. There will be two levels, basic and advanced. Space is limited, but the webinars are offered on multiple dates. See the end of this update to register.

Federally Facilitated and State Partnership Marketplaces. The next round of CMS quarterly calls about the operation of Marketplaces (Exchanges) will begin the week of July 29, 2013, in each state with a Federally-facilitated (FFM) or State Partnership Marketplace (SPM). Individuals and organizations that will interact with and utilize the Marketplace are encouraged to join these calls. CMS will provide an update on the implementation of the Marketplaces and listen to feedback. View dates and sign-up information here.

Eligibility for premium tax credits and Medicaid. On Wednesday, July 24 - 2:00-3:30 PM ET, the Center for Budget and Policy Priorities (CBPP) will continue its "Beyond the Basics" series with a webinar on how household size will be calculated for purposes of determining eligibility for Medicaid and premium tax credits. Register here.

The next webinar in the series will take place on Wednesday, August 7 at 2 pm Eastern (11 am Pacific), and will cover how household income is calculated. Registration information will be provided later.

How the CMS Rule Impacts Behavioral Health. On Wednesday, July 24, 1:00 pm - 2:00 pm ET, the National Council for Behavioral Health will be holding a webinar on how the recently published final rule implementing some of the Medicaid provisions of the ACA will impact the provision of behavioral health services for people with mental illnesses and substance abuse disorders. Register FREE at https://www2.gotomeeting.com/register/791175866

Health Insurance Marketplaces: Preparing to Assist People with Disabilities. On Wednesday, August 7, 3pm - 4pm ET, the Friends of NCBDDD (National Center for Birth Defects and Developmental Disabilities) will hold a webinar aimed at answering some of the most frequently asked questions regarding health insurance Marketplaces and their impact on coverage and access to care for people with disabilities. For more information and registration go to https://www1.gotomeeting.com/register/239265048. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


Final Rule on Medicaid, CHIP and Health Insurance Marketplaces

As reported last week, the Centers for Medicare and Medicaid Services (CMS) has issued a final rule implementing numerous provisions of the Affordable Care Act (ACA) related to eligibility, enrollment, and benefits in Medicaid, the Children's Health Insurance Program (CHIP) and the Health Insurance Marketplaces. (Click on the PDF link on the right side of the page for a more compact view .)

We and other advocates are still trying to digest all the details of this extremely long and complex rule, but at this point we can identify some of its significant aspects. In general, the rule gives states a lot of flexibility with respect to determining Medicaid "Alternative Benefit Plans," including coverage of "habilitative services" benefits, and other matters. Thus, state advocates will have many opportunities to try to influence state implementation decisions.

One particular policy to note is that the final rule scales back states' options with respect to CHIP waiting periods. While advocates are disappointed that CMS did not eliminate waiting periods, the final rule limits waiting periods to a maximum of 90 days. Of the 34 states that impose waiting periods, 19 currently have waiting periods exceeding this maximum. See this post of the Georgetown Center on Children and Families (CCF) blog for more information on this issue.

The Georgetown Center on Children and Families (CCF) blog also has posts providing an overview of the rule, and addressing income verification, and state Medicaid premium assistance plans such as the Arkansas proposal.

For a comprehensive and comprehensible discussion of the rule, see these Health Affairs blog posts of Timothy Jost, a professor at the Washington and Lee School of Law: Part 1; Part 2.

Final Rule on Navigators and Certified Application Counselors

As reported last week, the Centers for Medicare & Medicaid Services (CMS) also issued a final rule outlining the standards for Navigators in Federally-Facilitated and State Partnership Marketplaces. (Click on the PDF link on the right side of the page for a more compact view.) The rule also outlines the standards for certified application counselors, including training, qualifications, and requirements.

While states running their own Exchanges will have flexibility regarding training and some other aspects of Navigator programs, their Navigator licensure and certification requirements must not prevent the application of the ACA. What this will mean in practice is still unclear.

Under the final rule, every state also must have Certified Application Counselors (CACs) to help people select and enroll in Qualified Health Plans (QHPs) and determine their eligibility for Medicaid, CHIP, advance premium tax credits and/or cost-sharing subsidies. Unlike Navigators, CACs will not have to undertake outreach and education activities or refer consumers to entities that will help them resolve grievances. In addition to the rule, CMS issued guidance (2 pp.) on the qualifications and designation of CACs in Federally Facilitated Exchanges and State-Partnership Exchanges. CMS has decided that it will designate organizations to serve as CACs, and these organizations will certify their staff and/or volunteers to serve as individual counselors. State-run Exchanges may choose to adopt the federal designation procedures or may establish their own, and may choose to designate individuals as well as organizations to serve as CACs.

A very readable explanation of the rule and guidance by health law professor Timothy Jost can be found on the blog of Health Affairs at http://healthaffairs.org/blog/2013/07/13/implementing-health-reform-the-final-navigator-rule/.

Self-attestation of income and health insurance status

Last week we reported that the administration announced that it would significantly scale back the health law's requirements that insurance marketplaces verify consumers' income and health insurance status, instead allowing state-run Exchanges to rely more heavily on consumers' self-reported information until 2015, when stronger verification systems should be in place. While this is true, the policy announced is actually more limited than described in many media reports. See this article from CNN Money and this CCF blog post. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 


Guide on Family Involvement in Hospital Care

The Agency for Healthcare Research and Quality recently developed a Guide to Patient and Family Engagement in Hospital Quality and Safety, a tested, evidence-based resource to help hospitals work as partners with patients and families to improve quality and safety.

The Guide provides information for hospitals about:

  • How patient and family engagement can benefit a hospital.
  • How senior hospital leadership can promote patient and family engagement.
  • How hospitals can work with patients and family members as advisors at the organizational level.
  • Improving communication among patients, family members, clinicians, and hospital staff from the point of admission.
  • Supporting the safe hand-off of care between nurses by involving the patient and family in the change-of-shift report for nurses.
  • Discharge planning to help reduce preventable readmissions by engaging patients and family members in the transition from hospital to home.

Emergency Preparedness for Families with Special Needs

On July 3, an article discussing emegency preparedness for children with special needs was published in the CDC's Public Health Matters blog by Dr. Georgina Peacock, a developmental pediatrician with the National Center for Birth Defects and Developmental Disabilities (NCBDDD).

New White House Adviser on Disability Policy

This week the White House Office of Public Engagement announced the appointment of a new liaison to the disability community, Claudia Gordon. Ms. Gordon, a Jamaica native, is considered to be the first deaf African-American female attorney in the United States. She replaces Kareem Dale, who was the first-ever special assistant to the president for disability policy.

Ms. Gordon has a very impressive background in working for the rights of people with disabilities. Among other accomplishments, she was the primary author of an Executive Order on Individuals with Disabilities in Emergency Preparedness when she served at the Department of Homeland Security's Office for Civil Rights and Civil Liberties.



F2F Funding

Current cosponsors of the Senate bill (S. 423), sponsored by Senator Robert Menendez (D-NJ), are Senators Sheldon Whitehouse (D-RI), Al Franken (D-MN), Amy Klobuchar (D-MN), and Elizabeth Warren (D-MA). The House bill (H.R. 564), sponsored by Congressman Frank Pallone (D-NJ), is cosponsored by Representative David Cicilline (D-RI). If you would like to contact your Representative and/or Senators to urge them to cosponsor one of these bills, you can find their contact information at http://www.congressmerge.com/onlinedb/index.htm. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


The Catalyst Center. This website offers a huge amount of excellent information about the financing of care for children with special health care needs, including a section on health care reform.

Health Affairs Blog. The website of the long-standing health policy periodical Health Affairs has a blog that includes posts from Washington and Lee University Law School professor Timothy Jost, who provides helpful summaries and analyses of many of the regulations implementing the ACA.

REGTAP. Not really new, but not widely known, is a resource called REGTAP -- for Registration for Technical Assistance Portal -- which can be found at https://www.regtap.info/index.php. This portal serves as an information hub for CMS technical assistance related to Marketplace and Premium Stabilization programs. Much of the information seems to be highly technical, and geared toward program administrators and insurers, but it might be helpful to others trying to get detailed information about ACA implementation. Access requires registration, but it is simple and free.



  • [NOTE: There are two lists of webinars below, from different sources within HHS. The second provides additional dates/times for the "Level 1" webinars.] 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.

NOTE: In the fields asking for agency and division/group, enter 'NA'. Although I understand that some people are able to register without a problem, I had technical difficulty registering last week. Today I was successful, so if you've had problems, you might want to try again also.

Level 1: Health Insurance Marketplace 101

July-24 1:00 - 2:00 pm ET https://webinar.cms.hhs.gov/himp072413/event/registration.html

July-31 1:00 - 2:00 pm ET https://webinar.cms.hhs.gov/himp073113/event/registration.html

August 7 at 3:00 pm ET The Health Care Law - Health Insurance Marketplace 101

Level 2: Understanding the Health Insurance Marketplace

July-25 1:00 - 3:00 pm ET https://webinar.cms.hhs.gov/mp072513/event/registration.html

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.