February 04, 2014

February 4 Washington DC Update

Washington DC Update 2/4/14

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

Greetings from Washington!  Not much to report from Congress – aside from the retirement announcement of a great health champion – but this week’s update will tell you about new webinars on topics related to the Affordable Care Act (ACA), a number of non-ACA news items from the administration, and resources on the ACA and other topics. Read more below.


Enrolling Families that Include Immigrants  The next webinar in the “Beyond the Basics” series from the Center for Budget and Policy Priorities (CBPP) will take place on Wednesday, February 5, at 2:00-3:30 ET. It will focus on the application experience for households that include immigrants, and will present several scenarios illustrating complexities that arise when such families apply for insurance coverage and subsidies under the Affordable Care Act (ACA). This webinar will be presented in partnership with the National Immigration Law Center (NILC) and the Georgetown Center for Children and Families (CCF). You can prepare for this webinar by reviewing the eligibility rules for immigrants under health reform law from this webinar (http://ccf.georgetown.edu/ccf-resources/health-insurance-for-immigrant-families/) presented by CCF and NILC.

Space is limited. Reserve your seat now at https://www4.gotomeeting.com/register/857817327. After registering you will receive a confirmation email containing information about joining the webinar.

Improving Care Delivery for Children: Leveraging the Medicaid Benefit for Children and Adolescents  On Wednesday, February 5, from 3:00-4:30 ET, the National Academy for State Health Policy (NASHP) will hold a webinar on how states around the country are actively working to improve service delivery under the Medicaid EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) benefit for children and adolescents. Speakers from Iowa, the District of Columbia, and Minnesota will discuss strategies for improving access and service delivery for Medicaid-enrolled children, with an emphasis on their efforts to better coordinate care, use public health resources to deliver benefits, collect data on and improve quality, and enhance access and delivery of behavioral health services. This webinar is the first in a series on the Medicaid benefit for children and adolescents; future webinars will delve more deeply into oral health, adolescent health, and care coordination. If you have any questions regarding this webinar, please contact Mike Stanek at mstanek@nashp.org. You can download the agenda here, and register here.

Introduction to the National Disability Navigator Resource Collaborative On Thursday, February 6, from 3:00-4:00 p.m. ET, the National Information and Referral Support Center will host a webinar on the National Disability Navigator Resource Collaborative (NDNRC), a cross-disability resource coalition designed to assist anyone involved in enrolling individuals with disabilities in the healthcare marketplaces and/or other health insurance plans. The webinar will introduce the NDNRC, and highlight resources available throughout its website. Funded by the Robert Wood Johnson Foundation, the NDNRC provides expertise and assistance to navigators and enrollment specialists on disability information related to enrolling in the correct healthcare plan under the ACA. The presenter will be Karl Cooper, a Project Associate at The American Association on Health and Disability (AAHD), which is the implementing organization for the NDNRC and one of seven national disability organizations that have partnered to form the collaborative. Click here to access the visual component at the start of the webinar. To get audio, it is also necessary to dial 888-346-3659, Passcode: 382574.

Webinar Series:  “A Practical Guide to Healthcare Reform: The ABCs of Eligibility under the ACA”  A series of seminars is being offered every Wednesday, beginning March 5, from 2:00-3:30 ET, to the KidsWell Campaign network and its partners on a pro bono basis by Manatt Health Solutions. Intended for community-based organizations, in-person assisters, Navigators and others seeking to help individuals understand their health insurance options, this five-part educational program will help organizations navigate the complex eligibility and enrollment rules under the ACA. Presenters will walk through the rules that govern individual eligibility for Medicaid, premium tax credits and cost sharing reductions, and suggest strategies to inform consumers’ decisions when exploring their health coverage options. Manatt is also available to offer free trainings to groups of 50 or more on any of the five topics listed below. For more information or to schedule a training session, contact Arielle Traub at 212-790-4551 or atraub@manatt.com. Register for each session below.

  • Affordable Care Act Primer (March 5) Learn how the ACA is transforming healthcare coverage, including how Medicaid and CHIP are changing — and how those changes fit within the broader context of healthcare reform. Topics include an overview of the new Marketplaces, Advance Premium Tax Credits (APTCs), Cost-Sharing Reductions (CSRs), private insurance reforms and the shared responsibility payment. Register for the March 5 webinar or request a webinar.
  • Medicaid 101 (March 12) Understand the Medicaid eligibility and enrollment changes under the ACA. Review which states have decided to expand Medicaid and the implications of this decision. Understand the new benefit requirements for adults covered as a result of the Medicaid expansion. Find out how Medicaid fits within the continuum of coverage opportunities available under the ACA. Register for the March 12 webinar or request a webinar.
  • Advance Payments of Premium Tax Credits (APTCs) and Cost-Sharing Reductions (CSRs): A Practical Guide (March 19)  Learn about the financial and nonfinancial eligibility criteria for APTCs and CSRs. Gain insights into the options for using APTCs to purchase plans. Learn the two ways APTCs can be received. Take a detailed look at how the APTC is calculated. Get an in-depth view of the income measure (Modified Adjusted Gross Income) used to evaluate eligibility and calculate the size of APTCs and CSRs. Register for the March 19 webinar or request a webinar.
  • Advance Payment of the Premium Tax Credit Reconciliation (March 26) Understand what reconciliation is, how it works, and how to calculate it through real-world examples. Discover effective strategies for minimizing APTC repayment, including accurately projecting household size and income, taking less tax credit in advance and promptly reporting household and income changes. Get a step-by-step guide to obtaining and reconciling APTCs. Register for the March 26 webinar or request a webinar.
  • Qualified Health Plan Selection: The Keys to Choosing the Right Option (April 2) Learn about the factors to consider when selecting a Qualified Health Plan. Identify the key considerations to take into account beyond cost, including provider networks and formulary designs. Explore the interplay between premiums and cost-sharing across metal levels, as well as for catastrophic coverage. Walk through specific, real-life examples that demonstrate the implications of premium and cost-sharing options for consumers, depending on their ages, incomes and health needs. Register for the April 2 webinar or request a webinar.


Congressman Waxman to Retire  One of the greatest champions of children’s health care in Congress – Rep. Henry Waxman (D-CA) – has announced that he will not run when his term is over at the end of this year. At that point he will have served for 40 years in the House. He served as Chairman, and is now the Ranking Minority Member of, the House Energy and Commerce Committee, which has jurisdiction over Medicaid, the Maternal and Child Health (MCH) Block Grant, regulation of pharmaceuticals, the Family-to-Family Health Information Centers (F2F) grant program, and other health care issues. He has also been an advocate for extending the length and scope of the program to fund F2Fs. For more on Rep. Waxman’s legacy, see this article from the Commonwealth Fund.

Next in line for top Democrat (Ranking Minority Member) on the Energy and Commerce Committee is Rep. John Dingell (D-MI), who has served in that position and chairman in the past. He has not yet decided whether he will take on that role. If he does not, then the position will be open for Rep. Frank Pallone (D-NJ), sponsor of the current House bill to extend funding for F2Fs. On the Senate side, there will also be a change in leadership of the committee with jurisdiction over the F2F program, Medicaid, and the MCH Block Grant. Sen. Max Baucus (D-MT), Chairman of the Senate Finance Committee, will be retiring within the next couple months, as he is expected to become the next US ambassador to China. His successor will be Sen. Ron Wyden (D-OR).

The retirement of Congressman Waxman will come at the same time as that of other great advocates on children’s health, and disability issues – Rep. George Miller (D-CA), Sen. Jay Rockefeller (D-WV), and Sen. Tom Harkin (D-IA).

New Bills to Modify the ACA  House Republicans have introduced two new bills to amend the ACA. The first, sponsored by Rep. Todd Young (R-IN), would change the law’s definition of “full-time employee” to cover those who work an average of 40 hours per week, instead of the current 30 hours per week. It is based on the concern that the current definition may lead some employers reduce people's hours to avoid providing them with health insurance. (See this blog post from the Center on Budget and Policy Priorities for a contrary view.)  The second bill, sponsored by Rep. Lou Barletta (R-PA), would nullify an IRS ruling that municipalities treat volunteer firefighters as employees who must be offered health insurance. The bills could see action on the House Floor, but it is unclear whether they will clear the Senate. See more in this article from The Hill.

F2F Funding   [Updated short explanation.]  As explained in detail below, a provision to extend and increase F2F funding is included in a bill reported out of the Senate Finance Committee that addresses Medicare physician reimbursement (“SGR” bill). The F2F provision is part of a package of health and human services “extenders” to extend provisions that would otherwise expire. Behind-the-scenes staff negotiations to resolve differences between House and Senate versions of the SGR legislation are reportedly progressing quickly. The fate of the Senate bill’s F2F provision is now dependent on bigger factors – mainly, whether the House and Senate can agree on how much to spend on extenders and how to pay for them. Below is a detailed status report on legislation to extend F2F funding:

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. In all likelihood, the legislation will be passed by March 31, when the temporary physician payment fix expires.

F2F Funding Bills 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) now has six cosponsors in addition to Rep. Pallone. The Senate bill (S. 423) has five cosponsors in addition Senator Menendez.

ACA NEWS and INFORMATION  [See below for ACA resources.]

[Repeat] 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. More information 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.


Department of Justice Will Fund Tracking Devices For Children with Autism  According to a report in Disability Scoop, Attorney General Eric Holder said in a Senate hearing last week that the Justice Department will make funding available immediately to provide free electronic tracking devices for children at risk of wandering due to autism or other developmental disabilities. Police departments can apply for funding immediately so that they can buy and distribute tracking devices to families who want them. A few days earlier, Sen. Charles Schumer (D-NY) had announced that he would introduce legislation to allocate $10 million to the Justice Department to create a grant program to provide tracking devices to families wishing to monitor their children due to wandering concerns. Schumer said he will still try to advance his legislation in order to ensure that a permanent funding source is established for the program.

CDC Resource on Sickle Cell Disease for School Staff and Parents of Affected Children  The CDC has developed a customizable booklet, Tips for Supporting Students with Sickle Cell Disease  for teachers, students, and caregivers to read and tailor for their use. The booklet includes the following sections:  About Sickle Cell Disease; Tips for Teachers, Nurses, and School Administrators; Tips for Parents and Other Caregivers. The booklet describes ways Sickle Cell Disease (SCD) may impact a student’s daily life and describes how school staff can make accommodations (to the classroom or in instruction methods) to meet the needs of children who may experience health problems associated with SCD during the school day. The CDC is asking that organizations help them share this booklet in the following ways:

  • Highlighting it in an upcoming print or electronic newsletter
  • Tweeting about it
  • Featuring it at meetings, community events, and conferences/conventions

HHS Strengthens Patients’ Right to Access Lab Test Reports  On February 3, the Department of Health and Human Services (HHS) announced a final rule that will ensure that a patient or patient’s designee will have a means of direct access to the patient’s completed laboratory test reports. The final rule amends the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations. While patients can continue to get access to their laboratory test reports from their doctors, these changes give patients a new option to obtain their test reports directly from the laboratory while maintaining strong protections for patients’ privacy. The final rule is issued jointly by three agencies within HHS: the Centers for Medicare & Medicaid Services (CMS), which is generally responsible for laboratory regulation under CLIA; the Centers for Disease Control and Prevention (CDC), which provides scientific and technical advice to CMS related to CLIA; and the Office for Civil Rights (OCR), which is responsible for enforcing the Privacy Rule under the Health Insurance Portability and Accountability Act (HIPAA).

Department of Justice Issues Notice of Proposed Rulemaking to Amend Regulations on the Americans with Disabilities Act  On January 30, the US Department of Justice released a notice of proposed rulemaking (NPRM) to amend the Americans with Disabilities Act (ADA) regulations. The NPRM amends the definition of disability, which was broadened by the ADA Amendments Act of 2008, and expands the definition of “major life activities” by including major bodily functions. The NPRM includes examples of impairments, such as intellectual disability, that should easily be found to substantially limit a major life activity and make the necessary individualized assessment of the impairments simple and straightforward. The NPRM is open for comment until March 31, 2014.


First Fact Sheet from the National Disability Navigator Resource Collaborative: “Comparing Health Plans’ Benefits and Coverage Summaries” The National Disability Navigator Resource Collaborative (NDNRC) has released its first fact sheet – “Comparing Health Plans’ Benefits and Coverage Summaries” – which is designed to inform navigators and other enrollment specialists about what people with disabilities need to look for in the Summary of Benefits and Coverage sections on HealthCare.gov. The fact sheet was authored by the Disability Rights Education and Defense Fund (DREDF), one of the seven national disability organizations that comprise the NDNRC, which is funded through a grant from the Robert Wood Johnson Foundation. The list of upcoming fact sheets is available here.

The NDNRC website (http://www.nationaldisabilitynavigator.org/) also has news and resources designed to support groups providing enrollment assistance to consumers with disabilities, including the “Guide to Disability for Healthcare Insurance Marketplace Navigators.”

Are Families of Medicaid-enrolled Children with Disabilities Eligible for Subsidized Marketplace Coverage?  As reported in last week’s update, there has been some confusion about whether certain groups of children covered under Medicaid waivers can also receive subsidies when their families purchase private insurance policies through the Exchanges established under the Affordable Care Act (ACA). For a discussion of this issue, see the Catalyst Center’s issue brief "Your Questions Answered: Are Families of Medicaid-enrolled Children with Disabilities Eligible for Subsidized Marketplace Coverage?, which has been updated to include new information about Section 1115 Demonstration Projects.

EPSDT Benefits for Young Adults in States with 1115 Waivers to Expand Medicaid  In the last few months, the Centers for Medicare and Medicaid Services (CMS) has approved 1115 waiver demonstrations as a means for Arkansas, Iowa and Michigan to expand Medicaid. Pennsylvania has a draft 1115 waiver proposal as well. A post in the blog of the Georgetown Center on Children and Families addresses the question of how states will continue to provide EPSDT (Early and Periodic Screening, Diagnosis and Treatment) and other benefits to 19 and 20 year olds who are part of the expansion population.

Assessment of Network Adequacy  A conversation on “State Refor(u)m,” the blog of the National Academy for State Health Policy (NASHP), involves how states are assessing network adequacy. To post a comment, or read those posted, click here.

Medicaid Appeals  Another NASHP blog post involves how states using the Federally Facilitated Marketplace (FFM) are handling Medicaid eligibility appeals. NASHP's Jackie LeGrand reviews the options that states have when setting up an appeals process and takes a closer look at the process in Montana, Illinois, and New Hampshire.

CMS Slides on ACA Webinars  CMS has released slides from a number of its weekly webinars, including those on:

  • Best Practices for Assisting Consumers with Applications, Including Multi-tax Households
  • Assisting Consumers with Paper Applications
  • Overview of Marketplace Eligibility Appeals Process
  • Tax Impacts of Health Insurance Coverage for Individuals and Families in 2014
  • Medicaid in 2014: Background and Tips for Navigators and Certified Application Counselors (CACs)

These and other resources to help consumers enroll for health insurance coverage can be found at http://marketplace.cms.gov/help-us/2-partner-with-us.html.

New Information on the Medicaid.gov Website  The Centers for Medicaid and CHIP Services (CMCS, part of CMS) has updated its Medicaid.gov homepage with State Highlights. This feature is intended to call attention to the positive steps states are taking to implement the Medicaid and CHIP provisions of the Affordable Care Act, including strategies to streamline the enrollment of eligible individuals, efforts to ensure easy access to care, measures to help states achieve program efficiencies, and other activities. The Medicaid.gov website also has a new search function for its Frequently Asked Questions page so that users can sort by topic or by entering in key words. In addition, there is a new top navigation bar that includes a tab for the Basic Health Program and one called About Us to provide information about CMCS and its leadership team.

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 .

FV/NCFPP ACA Blog  The most recent blog posting from NJ family leader Lauren Agoratus can be found on this page.

Outreach and Education Materials in English and Spanish Families USA has the following materials available:

  • A checklist in English and Spanish that gives consumers the basic information they need to apply for coverage and tells them how to get started.
  • A brochure in English and in Spanish that defines basic insurance terms and outlines key factors to consider when selecting a health plan.
  • A brochure to help in conducting outreach to Latino consumers in English and Spanish,
  • A brochure that can help with outreach to African American consumers.

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.)

Financial Assistance for Insurance  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.

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.


Video in Spanish about Tracking Children’s Milestones  The National Center on Birth Defects and Developmental Disabilities has released a new video, Desarrollo Infantil: Es Mejor Saber (Child Development: It’s Better to Know). In the 5-minute video, Spanish-speaking parents share their experiences recognizing developmental milestones in their children and highlight what to do if there is a concern about a child’s development. The video can be used it in clinical and parent education settings and/or shared on your website. For more information, see www.cdc.gov/ActEarly or www.cdc.gov/Pronto. If you have questions, email ActEarly@cdc.gov.

The “Guide Me” Tool on Disability.gov  The federal Disability.gov website is intended to help people find the information needed by people with disabilities and their families as quickly and efficiently as possible, without having to search on numerous sites. Essentially, it is a huge directory of resources from government agencies, academic institutions and nonprofit organizations with nearly 9,000 unique links to resources and information. A few months ago, the website launched the “Guide Me” tool to make searching on the site easier.

[Repeat] New Rule on Home and Community-based Services Settings  As reported in the January 14 Washington Update, 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. On January 17, the National Association of States United for Aging and Disability (NASUAD) held a webinar on the final rule, the slides from which can be found here. Click here to access CMS's website about the final rule.

[Repeat] 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.


Collection of ACA Stories  Family Voices is collecting anecdotes about people’s experiences with the ACA – 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.


Please help us 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.