November 12, 2013

November 11 Washington DC Update

Washington DC Update 11/11/13

{Don’t forget to check out the Family Voices/NCFPP ACA webpage and ACA blog!}

Greetings from Washington, land of harsh words and hand-wringing over, and condemnation and contrition over coverage cancellation.  Read more below.


Home care rule.  The Department of Labor recently issued final regulations, effective in 2015, regarding compensation for home care providers.  The Department will be holding webinar sessions to explain the rule, and encourages participants to register for the webinar scheduled for the state where they live.  Note: The presentations will be closed-captioned and will be available to download during the webinar.  See the “Resources” section of this Update, below, for more information on the rule.

Southeast Region (KY, TN, NC, SC, GA, FL, AL, MS): Tuesday, November 12, from 2:00-3:30 p.m. Eastern Time, and 1:00-2:30 p.m.  CentralClick here to register

Southwest and Mountain Regions (LA, TX, AR, OK, NM, CO, WY, UT, MT, ND, SD): Thursday, November 14, from 2:00-3:30 p.m. Central, 1:00-2:30 p.m. Mountain. Click here to register.

[The webinars for the other regions have already taken place.  We will let you know if they become available online.]

Emergency Preparedness.  On November 12, 2013, 1:00-4:00 pm ET, the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response is holding stakeholder meeting about the development and implementation of the 2014 National Health Security Strategy. The meeting will be held at the Office of the Assistant Secretary for Preparedness and Response, Thomas P. O'Neill Federal Building, 200 C St. SW, Washington, DC 20024, and is also available via webinar.  Email for more information.

Marketplace Outreach and Education. The CMS Office of Communications, Partner Relations Group, will be holding an informational call on Thursday, November 14, at 2:00 pm ET for organizations that have joined the Champions for Coverage program as well as national stakeholders and organizations interested in helping with Marketplace outreach and education.  The call will discuss new Health Insurance Marketplace resources available to help with outreach and education in your community. There will be an opportunity to ask questions before the call via email ( and during the Q&A session.  Please refer to “Champions for Coverage Call” in the subject line if sending an email.  Conference Call Number:  (866) 501-5502; Conference ID: 99802110.  Visit the Marketplace page for CMS partners for more training resources and partnership information or to sign up for the Marketplace listserv.

Beyond the Basics.   Hold the date -- Wednesday, November 20th at 2 pm ET-- for the next in this series of webinars about the ACA presented by the Center for Budget and Policy Priorities.   Topic and registration details will be announced later.

Webinar: Helping Consumers Understand Premium Tax Credits, Avoid Re-payment Obligations, and Select PlansONovember 22, 2013, at 3:00 pm ET, Manatt Health Solutions, with support from the State Health Reform Assistance Network (State Network), will present a series of slide presentations to help states and their "assisters" address some of the issues most confusing to consumers.  Click here to register.  Click here for more information on the webinar series.  


ACA scrutiny.   See below under “ACA News.”

F2F Funding.  Federal funding for Family-to-Family Health Information Centers (F2Fs) was authorized only through FY 2013, so F2Fs will cease receiving grant funds at the end of May 2014 (the end of the FY 2013 grant cycle) unless legislation is enacted to extend funding.  Senator Robert Menendez (D-NJ) and Representative Frank Pallone (D-NJ) have introduced bills (S. 423 and H.R. 564) that would extend F2F funding at the current level of $5 million per year through FY 2016. 

The Family Voices policy team has been working with key Members of Congress to try to get an F2F funding extension included in must-pass legislation.  Over 20 national organizations have agreed to sign a letter endorsing the F2F bills, but the likelihood of the legislation’s enactment will be greatly enhanced if more Members of Congress support these bills, particularly if there is bipartisan support. 

The Senate bill currently is cosponsored by Senators Sheldon Whitehouse (D-RI), Al Franken (D-MN), Amy Klobuchar (D-MN), Elizabeth Warren (D-MA), and Christopher Coons (D-DE).  The House bill is cosponsored by Representative David Cicilline (D-RI). 

U.N. Convention on the Rights of Persons with Disabilities.  Sen. Robert Menendez (D-NJ), Chairman of the Senate Committee on Foreign Relations, and proponent of the U.N. Convention on the Rights of Persons with Disabilities (CRPD), held a hearing on the treaty on Tuesday, November 5.  A video and testimony from the hearing are available on the committee website. This article from The Hill, describes the pro- and con-ratification arguments presented by witnesses.  A second hearing scheduled for November 12 has been postponed due to a scheduled conflict.

As with other treaties, the Senate must ratify the CRPD for the U.S. to have full participation in implementation decisions.  In December, ratification failed in a close vote, but now the outlook may be different.  For more information, see, or the website of the US International Council on Disabilities, which has gathered over 750 endorsements of the treaty from national and state organizations, including Family Voices.


Please see above for information about webinars and teleconferences related to the ACA.]

This week, Secretary of Health and Human Services Kathleen Sebelius testified before another congressional committee, the Senate Finance Committee.  She revealed that the first month’s ACA enrollment numbers, to be released this week, are expected to be “very low.”  The statistics will reflect both those who signed up for health plans and for Medicaid.

Meanwhile, President Obama apologized to the public for the fact that many people are receiving notices that their insurance plans will be cancelled, notwithstanding his promises during the health care reform debate that people would be able to keep their insurance plans if they chose to do so.  In an interview with NBC News, the president said, "I am sorry that they are finding themselves in this situation based on assurances they got from me."  He implied that he would consider amendments to the ACA to ensure that people are not worse off under the law than they were before, while stressing that the many people in the individual market will eventually benefit from the law.

House leaders, following a new strategy – to fix instead of repeal ObamaCare -- announced that they would bring up H.R. 3350, the Keep Your Health Plan Act, next week.  The bill, introduced by Energy and Commerce Chairman Fred Upton (R-MI), would allow health plans currently available on the individual market to continue being sold during 2014, outside of health care Exchanges, and would treat such coverage as meeting the requirement that an individual maintain minimum essential health coverage.  The House is expected to vote on the bill on Friday, November 15.  House Democratic leaders have indicated that they will oppose the legislation. There is a similar bill in the Senate (S. 1642), introduced by Democrats Mary Landrieu (LA) and Joe Manchin (WV) and cosponsored so far by two other Democrats – Senators Kay Hagan (NC) and Mark Pryor (AR) -- putting the President in an awkward position.

In a statement, accompanied by a U.S. map illustrating the cancellation of policies in many states, Speaker of the House John Boehner said, “If the president is sincerely sorry that he misled the American people, the very least he can do is support this bipartisan effort.”  The President has been noncommittal on whether he will support that legislation.  Some experts say that it might be very hard administratively for insurance companies to continue offering current plans, and there might be negative actuarial consequences (higher premiums) if they do so.

Back at the White House, chief of staff Denis McDonough asked insurance executives to change cancellation notices so that they explain plan options and subsidies that might be available under the ACA.  And 16 Senate Democrats, most of whom are up for reelection next year, had a two-hour meeting with the President and Vice-President urging the administration to fix enrollment problems quickly, and to ensure that personal information provided to the Exchanges will be sufficiently protected.

Indian Health Services launches ACA Webpage.  The Director of the Indian Health Service (IHS) announced last week that the new IHS ACA webpage ( is now online.  It provides information specific to American Indians and Alaska Natives (AI/AN) and answers many questions being asked by these communities. 

The ACA requires AI/AN persons who are not otherwise covered by private or public insurance to either sign up for health insurance coverage, pay the shared responsibility payment, or apply for an exemption.  An exemption is available to members of federally recognized tribes and other individuals who are eligible to receive services from Indian health care providers, but is not automatically applied.  An application for the exemption can be made through

Numbers of People to Receive ACA Tax Credits.  A new Kaiser Family Foundation state-by-state analysis estimates that 17 million people nationally will be eligible for tax credits under the Affordable Care Act (ACA) next year if they purchase coverage through health insurance Exchanges. This includes 2 million in Texas, 1.9 million in California and 1.6 million in Florida -- the three states with the largest number of residents eligible for tax credits.


Final mental health parity regulations issued.  On November 8, the Departments of Health and Human Services, Labor and the Treasury jointly issued a final rule to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), which requires parity between mental health/substance use (MH/SUD) disorder benefits and medical/surgical benefits in group and individual health plans that offer these benefits.  While this the MHPAEA does not require large group health plans and their health insurance issuers to cover MH/SUD benefits, the ACA includes such benefits in the ten essential health benefits that must be covered in ACA-compliant policies.  Under the ACA’s essential health benefits rule, individual and small group health plans are required to comply with these parity regulations. 

Under the MHPAEA and this final rule, health plan features such as co-pays, deductibles and visit limits, generally may not be more restrictive for mental health/substance abuse disorder benefits than they are for medical/surgical benefits. 

The rule also includes specific additional consumer protections, such as:

  • Ensuring that parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings;
  • Clarifying the scope of the transparency required by health plans, including the disclosure rights of plan participants, to ensure compliance with the law;
  • Clarifying that parity applies to all plan standards, including geographic limits, facility-type limits and network adequacy; and
  • Eliminating the provision that allowed insurance companies to make an exception to parity requirements for certain benefits based on “clinically appropriate standards of care,” which clinical experts advised was not necessary and which is confusing and open to potential abuse.

The 206-page final rule – to be published in the Federal Register this week and effective 60 days thereafter -- was developed based on the departments' review of more than 5,400 public comments on the interim final rules issued in 2010.  A fact sheet on the law and interim final regulation is available here.  (This fact sheet does not reflect the newly finalized rule.) 

Air carrier accessibility rule.  The Department of Transportation issued new Air Carrier Access rule addressing airline website and kiosk accessibility and the stowage of manual wheelchairs on aircraft.  See “Webinars,” above, for information about a November 14 webinar discussing the new regulations.  Under the new rule, airline websites and automated airport kiosks must be made accessible to passengers with disabilities, and airlines may choose between stowing wheelchairs in a cabin compartment or strapping them to a row of seats in both old and new aircraft, an option that will ensure that two manual, folding wheelchairs can be transported at a time.  These various requirements have different effective dates and phase-in periods. Click here to read more about the new regulations. 

NICHCY is closing its doors.  As its funding from the Department of Education has ended, the National Dissemination Center for Children with Disabilities (NICHCY) is closing its doors after more than 20 years of serving as a resource for the latest information on disabilities in children and youth; programs and services for infants, children, and youth with disabilities; and the Individuals with Disabilities Education Act (IDEA). The NICHCY website and the free resources available on it will remain available until September 30, 2014.

Sharon Lewis Named as Principal Deputy Administrator of ACL.  Sharon Lewis was recently named Principal Deputy Administrator at the Administration for Community Living (ACL), as well as Secretary Sebelius' Senior Advisor on Disability Policy.  Over the past year, she has served as ACL’s Acting Principal Deputy.  The ACL Administrator is Kathy Greenlee. 

Previously, Ms. Lewis led the Administration on Intellectual and Developmental Disabilities (AIDD). Aaron Bishop has been named AIDD's new Acting Commissioner.

The ACL was created in 2012 to bring together the efforts of the Administration on Aging, the Administration on Intellectual and Developmental Disabilities, and the HHS Office on Disability. It serves as the federal agency responsible for increasing access to community supports for older Americans and people with disabilities across the lifespan. 



Reminder:  There are several ways that people can sign up for health insurance through the federal Marketplace:

The Get Covered America calculator can be used to estimate costs and start the planning process. 

State Marketplace Links can be found on, and Doctors for America has State-by-State Marketplace Contact Information and hours for the state-run exchanges, which are in  California, Colorado, Connecticut, DC, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, Oregon, Rhode Island, Utah, Vermont, and Washington.

Indian Health Services ACA Webpage.  The new IHS ACA webpage ( is now online.  It provides ACA-related information specific to American Indians and Alaska Natives (AI/AN) and answers many questions being asked by these communities. 

Doctors for America.  Doctors for America has a number of ACA resources, including a speakers bureau, Power Point presentation and state-by-state information, slides, brochures and points of contact.

Worth repeating:

NEW BLOG from Family Voices!  The first installment of the Family Voices ACA monthly blog, written by  Lauren Agoratus --  the mother of a child with multiple disabilities and the NJ Coordinator for Family Voices and the southern coordinator in her state's Family-to-Family Health Information Center -- is about How People with Disabilities can Access the Marketplace under Healthcare Reform.   This blog posting discusses lifetime caps, essential health benefits, tiered plans, accessibility standards, health plan options for special needs, and more.

Family Voices/NCFPP Webpage on the ACA.  Family Voices and the National Center for Family/Professional Partnerships (NCFPP) have a frequently updated and searchable ACA resource page which can be found at  This page offers information for both families and family leaders to help them understand the ACA's impact on CYSHCN and their families, and to help others to understand it as well.  We welcome suggestions for resources to post on the webpage.  Please send your ideas to

Indiana Family Voices ACA guide. Indiana’s Family Voices has created this resource guide to answer basic questions about purchasing insurance under the ACA and to help families choose the most suitable insurance plan for them and their children with special health care needs.

 Get Covered Calculator.”  Get Covered America, has released a “Get Covered Calculator,” which provides estimates of how much a family will have to spend to get insurance coverage based on the number of people in the household, the family income, and location.

Follow HHS.  ACA information is available from HHS via Facebook, Google + and Twitter.


The Annie E. Casey Foundation’s 2013 KIDS COUNT Data Book was issued recently.  The Data Book provides a detailed picture of how children are faring in the United States and in each state.  It ranks states on overall child well-being and in four domains: Economic Well-Being, Education, Health, and Family and Community.

Worth repeating:

Regulations on compensation of home care workers.  The Department of Labor has a webpage on the final regulation regarding compensation of home care workers, which includes Frequently Asked Questions, and other resources.  In addition, the National Employment Law Project (NELP) released a new fact sheet on the companionship exemptions in the final regulations. The new regulations become effective in January 2015.  Click here for more information on the final rules: history, summary, anticipated impact and additional resources.

National Family Caregivers Month 2013November is National Family Caregivers Month.   This year's theme is "Family Caregivers - Now More Than Ever!"  A media toolkit is available for download.  The toolkit includes:


If you have any suggestions about how to make the Update more useful to you, please let us know!  Does it provide the right amount of information?  What parts are helpful and not so helpful?  And, as always, please feel free to contact us with any questions. 

Yours truly,


Janis Guerney, Esq.


Brooke Lehmann, MSW, Esq.


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