January 14, 2014

January 13 Washington DC Update

Washington DC Update 1/13/14

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

Greetings from Washington, and best wishes for a happy, health new year!  Upon the first day of 2014, some important parts of the Affordable Care Act (ACA) went into effect.  And in the two weeks since, the Department of Health and Human Services (HHS), and the Departments of Education and Justice all issued publications of special significance to children with special health care needs.  Read more below about these and other topics of interest. 


Beyond the Basics webinar.   The next webinar in this series from the Center for Budget and Policy Priorities (CBPP) will take place on Wednesday, January 15, 2014, at 2:00 ET, and will provide an in-depth look at the Marketplace application and enrollment process.   Presenters will walk through the process of determining eligibility and selecting a health plan under three different family scenarios, and there will be time for questions.

Medicaid for former foster youth.  On Tuesday, January 21, at 1:00 ET, the Georgetown Center on Children and Families (CCF) will host a State Partner Call about the provision of the ACA that makes former foster youth eligible for Medicaid until age 26.  CMS officials will be on the call to will review the provision, proposed rule and related FAQs (second topic in document), and will answer questions.  Call-in: (866) 256-9239.

New rule on Medicaid home and community-based services.   On Thursday, January 23, 2014 at 1:00 - 3:00 ET, and Thursday, January 30, 2014 at 1:00 - 3:00 ET, CMS will be holding (identical) public webinars explaining the new final rule regulating the permissible settings and other aspects of home and community-based services under Medicaid waivers and state options.  Registration information will be posted soon.  Check http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Home-and-Community-Based-Services/Home-and-Community-Based-Services.html.  


F2F Funding.  UPDATED  As you probably know by now, we have had two great developments at the end of the year in our efforts to get continued funding for F2Fs. 

Short-term funding in budget bill.  A law reflecting the budget deal reached in December, the Bipartisan Budget Act of 2013, includes a temporary “doc fix” (through March 31) to avoid a cut in Medicare reimbursement to physicians and, along with that, several “health extenders.”  One of these extenders is for F2F funding.  It provides $2.5 million in funding for F2Fs for the first six months of FY 2014.  Thus, the F2Fs should have funding to last for at least another six months of the next grant cycle.  HRSA must still figure out how to disseminate this funding.

Long-term provision in “doc fix” bill.  On December 12, the Senate Finance Committee approved legislation to address the Medicare physician payment formula on a permanent basis.  Included in the bill was a provision to extend F2F funding for five years at six million dollars per year, and to amend the law so that territories can be eligible for F2F grants.   The bill (S. 1871) can now be considered by the full Senate. 

In the House, two committees have approved other bills to address the physician payment problem, but neither one includes the F2F provision or any of the other “health extenders.”  On January 9, 2014, the health subcommittee of the House Energy and Commerce Committee held a hearing on the future of these provisions, including the F2F program.  Representative Pallone (D-NJ), sponsor of the House bill to extend F2F funding (H.R. 564), spoke highly of the F2F program in his opening remarks and expressed his support for the Senate F2F provision, which would extend funding longer than Rep. Pallone’s own bill.   Dr. Michael Lu, director of the federal Maternal and Child Health Bureau, also praised the work of F2Fs in his testimony before the committee and in response to friendly questions from Rep. Pallone.  The rest of the hearing was focused on Medicare, Medicaid and other provisions usually included in the extenders package.

F2F funding bills.  The House bill (H.R. 423) has several new cosponsors – Representatives Colleen Hanabusa (D-HI), Jan Schakowsky (D-IL), and Michael Michaud (D-ME) – for a total of five in addition to Rep. Pallone.   The Senate bill (S. 423) also has five cosponsors in addition Senator Menendez.  

What next?  At some point, the full House, Senate, or both will vote on the physician payment bills reported out of their respective committees.  Then both chambers will have to agree on a single version, most likely via a House-Senate conference committee.  In all likelihood, the legislation will be passed by March 31, when the temporary physician payment fix expires.

After consulting further with congressional aides, the Family Voices policy team will advise family leaders about what they can do to ensure that the F2F extension is incorporated into the final physician payment legislation.


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

Affordable Care Act.  Important consumer protections became effective for health policies and plans effective on or after January 1, 2014.  Except as noted below, insurers may not:


  • Deny, charge more for, or limit coverage for anyone based on a pre-existing condition.  (This prohibition became effective for children in 2010.) 
  • Impose annual dollar limits on benefits defined in the ACA as “essential health care benefits.”  Insurers are still allowed to put yearly and lifetime dollar limits on services that are not considered essential health benefits, and may still place limits on the number of visits for services.


Note:  Exceptions to both of these protections are provided for grandfathered health plans purchased in the individual market.

Medicaid for former foster youth.  At the end of December, the Centers for Medicaid and Medicaid Services (CMS) issued a set of Frequently Asked Questions that address (beginning on page 3) the provision of the ACA that makes former foster youth eligible for Medicaid until age 26.  See Upcoming Webinars and Calls, above, for information about a conference call on which CMS officials will discuss his issue.


Medicaid home and community-based services.  On January 10, the administration announced a new final rule regarding Medicaid home and community-based services (HCBS) provided through waivers and state plan options.  Under the rule, all HCBS settings must:  be integrated in and support full access to the greater community; be selected by the individual from among setting options; ensure individual rights of privacy, dignity and respect, and freedom from coercion and restraint; and optimize autonomy and independence in making life choices.  The final rule also requires that service planning for participants in Medicaid HCBS programs must be developed through a person-centered process that is directed by the individual receiving services and reflects his/her preferences and goals, and may include a representative and others freely chosen by the individual. 

The new rule will take effect March 17, 60 days after publication in the Federal Register, which is scheduled to take place on January 16.  (It will then be available in a shorter -- single-spaced, smaller-font -- format at http://federalregister.gov/a/2014-00487.)

More information is available at http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Home-and-Community-Based-Services/Home-and-Community-Based-Services.html.   Click here for an article about the new rule in Disability Scoop.

School Discipline Guidance.  On January 8, 2014, the U.S. Department of Education (ED) and U.S. Department of Justice (DOJ), released a resource package to provide guidance for states, school districts and schools in developing discipline practices and strategies to enhance the school climate and ensure compliance with federal law.  The guidance is intended to address the problems of school absences due to suspensions and expulsions, even for minor rule infractions, and the fact that students of color and those with disabilities are disproportionately impacted by discipline procedures.  Citing the federal guidance, an article in Disability Scoop reports that students in special education represent just 12 percent of all the nation’s students, but account for roughly 20 percent of suspensions and expulsions and nearly a quarter of school-related arrests.  The Departments also launched an online tool with information about applicable laws and regulations nationwide.  A press release about the guidance can be found at http://www.ed.gov/news/press-releases/us-departments-education-and-justice-release-school-discipline-guidance-package-


Information on HealthCare.gov. The homepage of HealthCare.gov now features a prominent link to consumer information about how to use their new private or public insurance coverage, and also provides a link to information about how to verify coverage and pay premiums

The website also provides information for consumers who might have questions about their Medicaid or CHIP coverage, particularly for those who may not have yet received their official Medicaid card.   The FAQs are available at https://www.healthcare.gov/what-if-i-have-new-medicaid-or-chip-coverage/.

Network adequacy for children.  In order to assist state advocates working to ensure network adequacy in health insurance plans, a group of federal child health organizations, including Family Voices, recently released an issue brief -- Ensuring Adequate Marketplace Provider Networks: What’s Needed for ChildrenThe other groups that developed the brief, written by Michael Odeh of Children Now, were First Focus, the Georgetown Center for Children and Families, the Children’s Hospital Association, and the Children’s Defense Fund.   The brief explains why children need a robust provider network and how those networks can be developed and assessed over time.  A First Focus blog post also discusses this issue.

Enrollment resources for those assisting people with disabilities.  The National Disability Navigator Resource Collaborative (NDNRC) recently released the “Guide to Disability for Healthcare Insurance Marketplace Navigators,” which is designed to inform Navigators and other enrollment specialists about the special considerations faced by people with disabilities as they shop for healthcare coverage.  The Guide can be found at http://www.nationaldisabilitynavigator.org/ndnrc-materials/disability-guide/.  (A free registration is required to access the content).

The NDNRC has also launched a website (http://www.nationaldisabilitynavigator.org/) with news and resources designed to support groups providing enrollment assistance to consumers with disabilities.  In the near future, the NDNRC website will also publish 17 fact sheets with more information regarding specific disability-related issues and state specific information. 

The NDNRC, funded by the Robert Wood Johnson Foundation, is comprised of seven national disability organizations – the American Association on Health and Disability (AAHD), the American Association of People with Disabilities (AAPD); the Disability Rights Education and Defense Fund (DREDF); the National Alliance on Mental Illness (NAMI); the National Multiple Sclerosis Society (NMSS); The Arc; and the United Spinal Association.  

For further information, contact Karl Cooper, AAHD Project Associate at kcooper@aahd.us or (301) 545-6140, ext. 204.

Other resources for assisters.  CMS provides a number of resources for those helping consumers to enroll for health insurance coverage at http://marketplace.cms.gov/help-us/2-partner-with-us.html.  Among the most recently posted are:

Medicaid for former foster youth.  Under the ACA, former foster youth are eligible for Medicaid until they reach the age of 26.  CMS recently issued a set of Frequently Asked Questions about this provision, among others.  (The foster care section begins on page 3.)  CMS officials will be on a conference call to discuss Medicaid coverage for former foster youth on January 21 (see above, under Upcoming Webinars and Calls). 

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 http://www.fv-ncfpp.org/tools-and-resources/aca/.  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 PeggyCurran@familyvoices.org.

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.


In this new year, we are especially anxious to hear any suggestions you might have about how to make the Update more useful to you.  Does it provide the right amount of information?  What parts are helpful and not so helpful?  Please let us know!

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

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.