December 17, 2013

December 17 Washington DC Update

Washington DC Update 12/17/13

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

 Greetings from Washington!  We have great news regarding funding for Family-to-Family Health Information Centers (F2Fs)…but there is still more work to be done!   Meanwhile, the website seems to be improving steadily, but there is less than one week left for people to sign up for insurance coverage that begins on January 1. Read more below.


Champions for Coverage call. On Wednesday, December 18, at 2:00 p.m. ET, the Center for Medicare and Medicaid Services (CMS) is expected to hold another informational call for organizations that have joined the Champions for Coverage program and for national stakeholders and organizations interested in helping with Marketplace outreach and education. Watch your email inbox for an announcement.

Beyond the Basics webinar. The next webinar in this series from the Center for Budget and Policy Priorities (CBPP) is expected to take place on January 15, 2014, at 2 pm ET. More information to come.


F2F Funding. UPDATED On December 12, the Senate Finance Committee “marked up” legislation to address the Medicare physician payment formula (a.k.a. the “doc fix” or SGR bill) and the so-called “health extenders” – various health care provisions that need to be extended. As part of these health care extenders, the Chairman’s “mark” (bill under consideration) included an F2F extension for five years at $6 million per year, and would amend the law to make territories eligible for F2F grants. The bill was approved by the committee.

Although the Senate Finance Committee bill still needs to be passed by the full Senate, and reconciled with two similar House bills, this is a big step forward in efforts to secure an extension of F2F funding. (The Menendez and Pallone bills would have extended funding for three years at $5 million per year.)  Details about the bill and a video of the mark-up are available at (Check out Sen. Menendez’s statement about F2Fs (in amendment number 9) at about 2:38 on the video.)

Short term fix. Since the doc-fix bills will not be passed in time to forestall a January 1 cut in Medicare physician reimbursement, a temporary doc fix, including the health care extenders, was attached to the budget bill passed by the House on Thursday (more below). That legislation provides for a 3-month doc fix AND $2.5 million for F2Fs (representing the first half of FY 2014 funding). The Senate will vote on that bill on Tuesday, December 17. It is expected, but not a sure thing, that the Senate will pass the measure. If it does, the President has indicated that he will sign it.

What next?  On the House side, two committees have approved doc-fix bills, neither of which includes the F2F provision. At some point, either the full House or Senate (or both) will need to pass a doc-fix bill, and both chambers will have to agree on a single version, most likely via a House-Senate conference committee. Moreover, the committees need to figure out a way to pay for the cost of fixing the physician payment problem permanently.

To increase the chances that the final legislation will include the Senate Finance Committee’s provision on F2F funding, Family Voices policy staff will be working with family leaders around the country to gain broad congressional support for the Senate provision.

If the budget bill including the 3-month doc fix is enacted, a final version of the doc-fix legislation is not likely to be settled upon much before the end of that time period, March 31. Most likely, though, staff will begin negotiating once the next session of Congress begins in January.

Budget Deal Representative Paul Ryan (R-WI) and Senator Patty Murray (D-WA), the co-chairs of a committee created to reach a budget agreement, announced their agreement last week, and the House approved it on Thursday by a large, bipartisan margin before adjourning for the year. The Senate is expected to vote on the House bill on December 17. While most observers think it will pass the Senate, that outcome is not certain. If the Senate does pass the bill, the President has indicated that he will sign it. The bill would set “top line” federal spending levels for the next two years. It would provide more money for “discretionary spending” – both defense and non-defense. Appropriators will still need to determine how the funds are allocated before January 16, when a temporary appropriations law (“continuing resolution”) expires.

In general, the budget deal is welcomed by disability organizations because it would make more funding available for special education, housing and other programs that help people with disabilities, and does not reduce spending on Medicaid or Social Security programs. There is one provision that raises concerns, however. Under current law, Medicaid is able to recoup individuals’ disability-related medical malpractice or other settlements from third-parties, to the extent such funds are earmarked for health expenses. It appears that the budget deal would change the law so that Medicaid would be able to recoup all settlement funds. See this newsletter article from The Arc.

Mental Health Legislation

Senate doc-fix bill. The doc fix bill reported out of the Senate Finance Committee (see above) includes a provision - the Excellence in Mental Health Act, sponsored by Senators Debbie Stabenow (D-MI) and Roy Blunt (R-MO) – intended to expand the supply of community mental health providers and ensure their quality. According to a press release issued by Senator Stabenow’s office, the provision would establish criteria for certified community behavioral health clinics to ensure the providers cover a broad range of mental health services, including 24-hour crisis care, increased integration of physical, mental. and substance abuse treatment, and expanded support for families of people living with mental health issues.

Murphy bill. Last week, Representative Tim Murphy, Ph.D. (R-PA), a clinical psychologist, introduced the Helping Families in Mental Health Crisis Act. According to the Congressman’s press release, the bill would clarify federal privacy rules to allow physicians to provide information to parents and caregivers when a loved one’s mental health is in crisis; increase access to and the number of inpatient psychiatric beds; create more outpatient options and alternatives to institutionalization; advance medical research into serious mental illness and self- or other-directed violence; close gaps in care and coverage for adults and children with serious mental illnesses; and promote models of care that are proven to have positive outcomes and steer federal funding in those directions.

Although the press release states that the American Psychological Association, the American Psychiatric Association, and the National Sheriffs’ Association have expressed support for the bill, some mental health advocacy groups have strongly criticized it, saying that the bill does not represent the mainstream of national thought, practice and research regarding mental illness. Among their concerns:  the bill would establish a grant program to expand involuntary outpatient commitment, would jeopardize a number of programs administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), and would drastically cut the federally mandated Protection and Advocacy programs, which, together with the Client Assistance Programs, provide legal services to people with disabilities.

An analysis of the bill, prepared by Scott Bryant-Comstock, President and CEO of the Children’s Mental Health Network, can be found at

Administration’s Mental Health Initiatives. See below for information about mental health funding announced by the administration.

Paid Family Leave Bill On December 12, Senator Kirsten Gillibrand (D-NY) and Congresswomen Rosa DeLauro (D-CT) introduced legislation that would create paid family and medical leave, the Family and Medical Insurance Leave (FAMILY) Act. The legislation would create an independent trust fund within the Social Security Administration, funded by employee and employer contributions of 0.2 percent of wages each. Benefit levels, modeled on existing programs in New Jersey and California, would equal 66 percent of an individual’s typical monthly wages up to a capped monthly amount that would be indexed for inflation.

The current Family and Medical Leave law provides unpaid, job-protected leave for serious health related events, but only about half of the workforce qualifies for this unpaid leave, and many of those who qualify cannot afford to take the leave because it is unpaid. Under the FAMILY Act, paid leave would be available to every individual who has had sufficient earnings and work history, regardless of the size of their current employer or whether such individual currently works for an employer, is self-employed or is unemployed. See the press releases of Senator Gillibrand and Representative DeLauro.


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

NOTE:  Consumers only have until December 23 to enroll for coverage beginning January 1. They have until December 31 to pay their premiums (some plans may set a later deadline).

On December 12, the administration announced several ways that it is attempting to ensure that people will be able to have health insurance coverage beginning on January 1:

Pre-existing Condition Insurance Plan (PCIP). Although it had been set to expire at the end of this year, the federally-run Pre-Existing Condition Insurance Plan (PCIP) will now offer transitional coverage through January 31, 2014, to people currently enrolled in the PCIP who have not yet secured other health insurance by that time. Current enrollees will be notified by mail of the offer to extend their PCIP plan for an additional month, along with details about cost-sharing. Eligible enrollees can purchase PCIP transitional coverage by sending in a January premium payment; this will be the same monthly rate that they paid for December 2013. There are currently about 85,000 people covered through the PCIP. Contact with questions.

Additional Measures The administration had already pushed the deadline to enroll from December 15 to December 23, but it formally codified that change last week. In addition, the Department of Health and Human Services (HHS) said it would consider moving that deadline to a later date “should exceptional circumstances pose barriers to consumers enrolling on or before December 23,” or allowing issuers to offer retroactive coverage for people who sign up after January 1. In addition, HHS announced that it was:

  • Requiring insurers to accept payment through December 31 for coverage that will begin January 1.
  • Urging issuers to give consumers additional time (beyond December 31) to pay their first month’s premium and still have coverage beginning Jan. 1, 2014. (Aetna has agreed to extend the deadline for premium payment to January 8.)
  • Strongly encouraging insurers to treat out-of-network providers as in-network to ensure continuity of care for acute episodes or if the provider was listed in their plan’s provider directory as of the date of an enrollee’s enrollment.
  • Strongly encouraging insurers to refill prescriptions covered under previous plans during January.
  • Working with health insurers on options to smooth this transition such as allowing people who come in after December 23 to get coverage starting January 1 or sooner than February 1;
  • Working with insurers and consumers to make sure that they know whether their doctor or prescriptions are covered before they choose a plan, and how to get care they need during the transition (e.g., receiving a drug not covered by a plan if one’s doctor deems it medically necessary);
  • Educating consumers who recently received cancellation notices about the possible option to extend their old policy or enroll in a new plan;
  • Continuing outreach to consumers who began the application process through the Marketplace and experienced technical difficulties.

See also this story from Kaiser Health News.

Insurance limitations on prescription drugs. As reported before, concerns have emerged about the scope of provider networks under some of the health plans being offered in the exchanges. See this Kaiser Health News story about some plans in California. Now advocates for people with chronic diseases are expressing concern about the adequacy of drug formularies in health plans sold under the ACA, and the possibility that insurers are restricting formularies in order to deter certain people from selecting their plans. As reported by the Washington Post:

“The fear is that they are putting discriminatory plan designs into place to try to deter certain people from enrolling by not covering the medications they need, or putting policies in place that make them jump through hoops to get care,” said John Peller, vice president of policy for the AIDS Foundation of Chicago.

“As the details of the benefits offered by the new health-care plans become clear, patients with cancer, multiple sclerosis, rheumatoid arthritis, and autoimmune diseases also are raising concerns,” said Marc Boutin, executive vice president of the National Health Council, a coalition of advocacy groups for the chronically ill.

“The easiest way [for insurers] to identify a core group of people that is going to cost you a lot of money is to look at the medicines they need and the easiest way to make your plan less appealing is to put limitations on these products,” Boutin said.

An analysis from Avalere Health found that many people with chronic illnesses will be underinsured under many of the plans sold in the Exchanges. According to the Avalere report, chronically ill individuals who are enrolled in less generous plans (e.g., Bronze or Silver) are likely to reach their out-of-pocket (OOP) maximums each year, and will thus be underinsured, according to the definition of the Commonwealth Foundation. For instance, a man earning $23,000 (just over 200% of poverty) will have a reduced OOP cap of $5,200, representing 23 percent of his annual income, or more than twice the Commonwealth Foundation’s definition of underinsurance.


Funding for mental health services. On December 10, Vice President Biden announced that the administration would be making $100 million available to increase access to mental health services in community health centers and in rural areas.

Through funds made available through the Affordable Care Act, $50 million will be provided for mental health services at community health centers to help them establish or expand behavioral health services for people living with mental illness or substance addiction. The money is expected to help about 200 community health centers around the country.

In addition the Department of Agriculture plans to finance $50 million for the construction, expansion, or improvement of mental health facilities in rural areas over the next three years. These funds will be made available through the Department’s Community Facilities direct loan program, and can be used to improve or construct mental health service facilities or employ innovative tools, such as telemedicine, to expand access to mental health services at rural schools, community centers, hospitals, and other community-based settings.

In addition, the administration has launched a new website featuring easy-to-understand information about basic signs of mental health problems, how to talk about mental health, and how to find help.


The Center for Budget and Policy Priorities (CBPP) has posted the slide deck and recording of the most recent webinar from its “Beyond the Basics” series, which provided answers to some of the most frequently asked questions on cost-sharing charges, plan selection, and determining household size and income. The slide deck can be found here, and the recording of the session can be found here. All to the webinars and FAQs from the Beyond the Basics series can be found at, as can the “Question of the Day” feature. The CBPP’s Judy Solomon also tweets the questions (and answers) from her Twitter handle, @JudyCBPP.


From Blog: New and more robust tools to help you enroll

Some of the new features on

  • More robust window shopping. You can now see detailed information about each Marketplace health insurance plan offered in your area before you apply. This new tool will allow you to see plan prices displayed much more accurately, based on the household information you supply. You can compare plans, covered benefits, physician and hospital networks, and more. No login or application required. Just answer a few simple questions to see plans and prices in your area. You will still need to complete the application to find out how you can get lower costs, but this is a much enhanced version of earlier information and one more way you can get the information you need to help you get ready to enroll and find a plan that fits your needs and budget.
  • You can remove problem applications. If you’ve experienced problems filling out your online application, you can start over with a brand new application. To do this, you’ll first need to log in to your account; select your current application; and then choose to “Remove” the application. You will then need to close out your web page and then log back in using your same account. You can then start a brand new application.
  • Get help enrolling online, on the phone, or in person. You can get help where and when you need it. For example: You can start an application online and then call 1-800-318-2596 (TTY: 1 855-889-4325) 24 hours a day, 7 days a week to get help enrolling over the phone. You can also find in–person help from certified assisters in your area. Just enter your zip code to get started.
  • You can apply offline and continue your enrollment online. If you submitted a paper application or applied over the phone, you can create a Marketplace account to pull up your eligibility determination and complete your enrollment. To do this, you’ll need your application identification number, and you can contact the call center to get it if you don’t know it.
  • Direct enrollment in a Marketplace plan. Many insurers are now offering the opportunity for you to enroll directly in a Marketplace plan with that company, whether through the insurance company’s website, an agent or broker, or an online health insurance seller.

These new functionality improvements are in addition to the hardware and software improvements they’ve made over the past eight weeks to improve the consumer experience, increase capacity, and ensure that you can successfully move through the entire enrollment process.

They will continue to make improvements to in the weeks and months ahead, and encourage you to come back and explore your new coverage options. You have until December 23 to enroll in health coverage that can start as soon as January 1, 2014, and the Marketplace Open Enrollment period runs until March 31, 2014. Here are some shopping tips to get you started.


Kaiser Health News: What Obamacare Means For You. Information about a variety of topics related to health care reform can be found on this webpage.


From the National Women’s Law Center:  You can remind your adult children to enroll in a health plan via Facebook, Twitter, or email at A graphic to share on Facebook lets other moms know how to get the word out to their kids.

Worth repeating:

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.

Follow HHS. ACA information is available from HHS via Facebook, Google + and Twitter. You can sign up here for Marketplace email and text message updates, or visit the Marketplace page for CMS partners to sign up for Marketplace email updates geared towards partners and to download CMS resources, training, or learn about partnership opportunities.


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.


NOTE:  The Washington Update will not be coming out during the holiday season / Congressional recess, so the next one will be issued on January 14.

We hope you have a wonderful, safe, and healthy holiday season with friends and family!

Yours truly,


Janis Guerney, Esq.


Brooke Lehmann, MSW, Esq.


NOTEPast issues of the Update appears can be found on the home page of the Family Voices website  by scrolling down the "News Feed" items.