January 21, 2014

January 21 Washington DC Update

Washington DC Update 1/21/14

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

Greetings from Washington!   Last week a $1.1 trillion appropriations bill was enacted to fund the government through the rest of federal FY 2014 (through September 30, 2014), and the administration announced that it would extend the Pre-existing Condition Insurance Program (PCIP) for an additional two months. Read more below about these and other topics of interest.


CMS Champions for Coverage Call.  On Wednesday, January 22, at 2:00 p.m. ET, CMS will hold a webinar to provide updates to Champions for Coverage and other interested organizations on new Health Insurance Marketplace resources available to help with outreach and education on purchasing insurance through the Exchange.  The webinar link and call-in number are below.

CMS requests that any questions be submitted in advance of the call via email at Champion@cms.hhs.gov.  Please refer to “Champions for Coverage Call” in the subject line.

Conference Call: (800) 837-1935

Conference ID: 295435357

Webinar Link: https://webinar.cms.hhs.gov/c4c_01-22/

New Rule on Medicaid Home and Community-Based Services   This Thursday and next, 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. The dates/times of the webinars are:

  • Thursday, January 23, at 1:00 - 3:00 ET
  • Thursday, January 30, at 1:00 - 3:00 ET (repeat)

Youth in Custody. The Office of Juvenile Justice and Delinquency Prevention (OJJDP) in collaboration with the National Center for Youth in Custody will conduct two webinars on improving conditions of confinement for vulnerable populations. While isolation is harmful and traumatic for any youth, it can be particularly traumatic for youth with disabilities and for youth who have experienced physical, sexual, or other forms of abuse. This two-part webinar will look at the impact of isolation practices on these vulnerable populations and identify appropriate alternatives being implemented in several jurisdictions.

  • Impact of Isolation Practices on Vulnerable Youth:  Wednesday, January 22, 2:00-3:30 PM ET. Sign up here.
  • Alternatives to Isolation Practices for Vulnerable Youth:  Wednesday, February 26. Sign up here.


Appropriations Bill Enacted  Congress passed, and the President signed, a $1.1 trillion spending (appropriations) bill last week, which funds the government through the end of federal fiscal year 2014 (September 30, 2014). This bill reflects the increased amounts available for discretionary (appropriated) spending that were made available through the budget deal enacted in December, which became the Bipartisan Budget Act (BBA). Unfortunately, the law does not provide any additional funding for implementation of the Affordable Care Act (ACA).

Note: The BBA provided $2.5 million for Family-to-Family Health Information Centers (F2Fs); the appropriations bill enacted last week does not affect F2F funding since it is not an appropriated program.

F2F Funding  As you probably know by now, we 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 F2F provision in the bill approved by the Senate Finance Committee, which would extend funding for a longer period and at a higher level 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.

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.

F2F funding bills  UPDATED  At this point, the F2F provision in the Senate Finance Committee’s Medicare physician-payment bill—providing five years of additional funding at $6 million per year—is preferable to the three-year extension of $5 million in the Menendez and Pallone bills. Nevertheless, cosponsorship of one of these bills is a means of expressing support for the F2F program. The House bill (H.R. 423) gained another cosponsor this week, Rep. Andre Carson (D-IN), who also cosponsored the legislation in the last Congress. Thus, the House bill now has six cosponsors in addition to Rep. Pallone. The Senate bill (S. 423) has five cosponsors in addition Senator Menendez.


Extension of Federal Pre-Existing Condition Insurance Plan. The Obama administration has extended the Pre-Existing Condition Insurance Plan (PCIP) for an additional two months—through the end of March—to give enrollees more time to find a suitable insurance plan in the Exchange market. To retain coverage through March, PCIP enrollees must pay their February and March premiums, which will be at the same monthly rate as they paid for January 2014. To avoid a coverage gap when the PCIP program ends, enrollees must sign up (and pay premiums) for an Exchange plan by March 15.

The PCIP is a federal health insurance program for individuals who had been unable to get private insurance due to a pre-existing condition. The plan currently provides coverage to about 30,000 individuals.

Current PCIP enrollees will be notified on www.pciplan.com and by mail of this option to extend their PCIP plan through March, along with details about cost-sharing. Information about benefits, doctors, & services is available at www.pciplan.com.

Note: If a PCIP enrollee lost coverage during the past 6 months because they moved out of state, they may be eligible to re-enroll in PCIP in their new state of residence. Information is available at 1-866-717-5826 (TTY: 1-866-561-1604), Monday – Friday, 8 a.m. to 11 p.m. EST.

Problems Remaining Despite the ACA Despite the benefits of the ACA, there remain problems with the health care system. Among these are:

Habilitative services. A recent article in Kaiser Health News, discusses the problems with the federal regulations regarding coverage of “habilitative services and devices” under the ACA.

Medical debt. This story from USA Today, describes ways that medical expenses may still be unaffordable for many families, notwithstanding the limits on out-of-pocket expenses set by the ACA.

Collection of ACA Stories The administration and advocacy groups are making a concerted effort to collect anecdotes about families who have been helped by the ACA. Family Voices is collecting stories, too—both positive stories and information about problems—so that we can inform policy makers. Please share your story, and encourage others to share theirs, at http://www.familyvoices.org/action/share. Please indicate in the first line that it is a story about the ACA.


Social Security Expands List of “Compassionate Allowance” Conditions Qualifying for Expedited Processing On January 15, the Social Security Administration announced 25 new Compassionate Allowances (CA) conditions. The CA program reduces the time it takes to make decisions on disability applications filed by Americans with the most serious disabilities, so they are able to receive decisions on their claims within days, instead of months or years. The new conditions include a dozen cancers and disorders that affect the digestive, neurological, immune and multiple body systems. A list of all the CA conditions can be found at http://www.ssa.gov/compassionateallowances/conditions.htm.


Financial Assistance for Insurance According to a new national survey conducted by Enroll America and PerryUndem, a public opinion research firm, about seven in 10 (69 percent) uninsured adults are unaware of the financial assistance to purchase health insurance are available to low- and moderate-income adults. Families USA has developed a number of fact sheets and reference tables to help inform consumers about new financial assistance for health insurance:

Families USA also has a resource center for more fact sheets that can help in answering consumer questions and an “enrollment assisters network” that anyone can join. They also solicit feedback on help needed at assisters@familiesusa.org.

In a recent email, Families USA offered this list of things to keep in mind to ensure that eligible consumers get financial assistance:

  • Even if some people in a consumer’s family are not eligible for financial assistance (for example, because they have an affordable offer of health insurance through their job, or they are eligible for Medicare) the consumer can still apply for financial assistance for other family members.
  • Individuals with eligible immigration status, who cannot get Medicare or Medicaid coverage, may be able to get financial assistance to help with the cost of purchasing a private insurance plan.
  • Consumers do not need to have filed taxes in previous years to get financial assistance to help with the cost of health insurance. However, applicants must agree to file federal income taxes for 2014 to receive assistance.
  • Most of the time, married couples must agree to file their taxes jointly for 2014 in order to be eligible for financial assistance. However, individuals can file their taxes separately and still be eligible for financial assistance if they meet tax requirements to file as “head of household.” Consumers should be able to indicate this tax filing status when they apply for health insurance. If an applicant with this tax status is likely to be eligible for financial assistance but is told that they are not eligible, the applicant should file an appeal.

New FV/NCFPP ACA Blog The most recent blog posting from NJ family leader Lauren Agoratus asks “How Do Parents Know if Their Child’s Providers are in Marketplace Plans?” Families of children with special needs have raised concerns regarding continuity of care for their children with implementation of the Affordable Care Act. If it is important for your child to continue receiving the services of specific providers, you may want to first determine if a provider is part of particular plans before you sign up. Read this latest blog entry here.

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/. We welcome suggestions for resources to post on the webpage. Please send your ideas to arichey@familyvoices.org

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:

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 Children. The 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.

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.)  The Georgetown Center on Children and Families will be holding a conference call on this topic next week. (Today’s call was canceled due to bad weather in Washington.)

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/.

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 materials, or learn about partnership opportunities.


Medicaid HCBS Settings Final Rule The National Association of States United for Aging and Disabilities (NASUAD) hosted an all-state call on Friday, January 17, to discuss the Medicaid Home and Community-Based Services (HCBS) settings final rule published in the January 16 edition of the Federal Register. Among other things, the rule establishes requirements for the qualities of settings that are eligible for reimbursement under Medicaid HCBS provided under sections 1915(c), 1915(i), and 1915(k). Click here to access NASUAD's PowerPoint presentation reviewed during the call. Click here to view the final rule. Click here to access CMS's website dedicated to providing current information on the final rule.

Transitioning Newborns from NICU to Home The Agency for Healthcare Research and Quality (AHRQ) has issued a new toolkit to provide resources for hospitals to improve safety when newborns transition to home from the neonatal intensive care unit (NICU). It includes a Health Coach Program, tools for coaches, and information for parents and families of newborns who have spent time in the NICU. The kit allows Health Coaches to create customized Family Information Packets.

Disaster App—Behavioral Health Resources The Substance Abuse and Mental Health Services Administration (SAMHSA) announced its new mobile Disaster App, which allows access to critical disaster-related behavioral health resources right from one’s (Android) phone. Learn More.

Assisted Outpatient Treatment A SAMHSA blog post summarizes a December SAMHSA seminar on assisted outpatient treatment, also known as involuntary outpatient commitment. SAMHSA held this seminar to educate about and improve the understanding of this form of court-ordered treatment for people with mental illnesses. Further information and a link to the archive of the seminar can be found at http://blog.samhsa.gov/2013/12/17/samhsa-holds-seminar-on-assisted-outpatient-treatment/.

Family-Centered Child Welfare Practices The Administration for Children and Families (ACF) has updated its Child Welfare Information Gateway with information on Family-Centered Practice. The site encourages a family-focused, strengths-based approach that engages and involves children, families, and communities across the child welfare system. Learn more.


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.



Lynda Honberg


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.