March 12, 2014

March 11 Washington DC Update

Washington DC Update 3/11/14


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

Greetings from Washington!  Only three weeks left until the ACA open-enrollment period ends on March 31!  The Department of Health and Human Services (HHS) is making a last-minute push to get people enrolled, so you can expect to see some “March Madness” ads and other publicity beginning this week.



Healthcare Issues for Persons with Disabilities  Wednesday, March 12, 2014, 2:00 ET. 

Sponsored by the American Public Health Association Disability Section; hosted by The ARC for People with Intellectual and Developmental Disabilities. The first part of the webinar will focus on examining the experiences of parents of children with autism in obtaining a medical diagnosis, many of whom report a negative experience – receiving inconsistent information and facing challenges communicating with professionals. The second half of the webinar will address research related to standards of care to reduce hospital-acquired infections and improve overall care for adults with intellectual disabilities. Register here.


Webinar Series:  A Practical Guide to Healthcare Reform: The ABCs of Eligibility under the ACA  This is a free webinar series offered by health care consulting firm Manatt Health Solutions. For more information and to register, click on the name of the webinar below. Each webinar is on a Wednesday, from 2:00-3:30 ET.

According to the website, if you sign up now, and you will receive an On Demand link that enables you to access all the programs, at your convenience, any time after the original air date.

Churn  Thursday, March 20, 12:00 ET. The next quarterly call of the New England Alliance for Children’s Health (NEACH), a project of Community Catalyst, will hold its next quarterly call on the issue of “churn” – cycling in and out of insurance coverage or between types of coverage. The effects of churn on children can be especially problematic – particularly those who have special health care needs – since changes in coverage can result in lack of continuity of care. NEACH has developed a churn toolkit that is designed to aid advocates in obtaining the data they need to understand the scope and causes of churn in their state's Medicaid/CHIP program(s), as well as resources to select policy approaches to resolving the causes they identify. The toolkit will be explained on the upcoming phone call. Register here. 

Webinar Series:  Fostering Partnership and Teamwork in the Pediatric Medical Home Hosted by the National Center for Medical Home Implementation and the American Academy of Pediatrics. To register for each session, click on its name below.

Access the materials from the Implementing Team Huddles webinar, presented on February 28.

Realizing Rural Care Coordination: Considerations and Action Steps for State Policy Makers  Wednesday, April 2, 2:00-3:15 ET.

The National Academy for State Health Policy/State Refor(u)m, is sponsoring this webinar featuring state officials from Colorado, Montana, and New Mexico, who will share their distinct approaches to coordinating care for rural residents. The speakers will participate in a moderated panel-style discussion to explore the development, financing, daily operations, challenges, and lessons learned of their state models. Discussion will focus on key policy decisions and action steps that states can take to implement care coordination strategies for rural populations. This webinar is supported by the Robert Wood Johnson Foundation’s State Health and Value Strategies. Register here.




President’s Budget. On March 4, the President released his FY 2015 budget proposal. It is not viewed as a blueprint that Congress will follow this year, mainly because the law enacted to implement the last budget agreement already set the spending parameters for FY 2015. Highlights of the HHS part of the budget can be found here. Unfortunately, but not surprisingly, the President’s budget did not include funding for the Family-to-Family Health Information Centers (F2F) program, which has also been the case in the past two years because the program’s authorization was set to expire by the beginning of the applicable fiscal year. Interestingly, the budget narrative states:  “The authorization for this program expires in FY 2014 and additional funds are not requested. Instead, families with Children with Special Health Care Needs can seek supports and wrap around services through state grants provided by the Maternal and Child Health Block Grant.”, page 269.

F2F Funding Outlook  (Updated)  As explained in earlier Washington Updates, legislation to change the Medicare physician-payment formula (“SGR”) has looked like a potential vehicle to extend, and even increase, F2F funding. Despite possible movement soon on SGR legislation, it is still unclear what will happen with respect to the $2.5 million more that is needed to keep F2F funding at its current level of $5 million per year for FY 2014.


As reported in previous Updates, $2.5 million for Family-to-Family Health Information Centers (F2Fs) for the current (2014) fiscal year was included in the December 2013 budget agreement, the Bipartisan Budget Act (BBA). This F2F provision was part of a package of “extenders” to continue a variety of health and human services policies through March 31 – the first six months of FY 2014. Accordingly, the $2.5 million represents half of the annual funding for the F2F program. Another provision in the BBA was a six-month “doc fix” – a delay in cuts to Medicare reimbursement for physicians.


Legislation to permanently change the Medicare physician-payment formula would be the most logical vehicle for a provision to extend F2F funding. As detailed in an earlier Washington Update, a provision to extend and increase F2F funding is included in an SGR bill reported out of the Senate Finance Committee last year. About a month ago, House and Senate negotiators announced a bipartisan agreement on how to permanently change Medicare physician-reimbursement policy. But the SGR agreement did not address how to pay for the cost of that policy change, nor was there an agreement on whether to include other health “extenders” (like the F2F funding) in such legislation.


It is expected that the House will take up a bill to implement the SGR agreement this week, possibly using as a “pay-for” a delay of the individual insurance-coverage mandate under the ACA. (See this article from Politico.)  It is unclear whether the F2F provision and other extenders would be included in that legislation. Even if the House were to pass an SGR bill, though, the Senate is unlikely to approve it if it includes a delay of the individual insurance mandate.


Meanwhile, Senate leaders are trying to figure out a way to pay for the SGR fix on their side of the Capitol. Given the difficulty of getting the House and Senate to agree on an SGR “pay-for” within the next three weeks, there is a significant likelihood that there will just be another temporary “patch” to avoid a cut in Medicare payments to physicians. It is unclear how long such a temporary solution would be, and whether the F2F provision and other extenders would also be part of such legislation.


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. As noted above, however, the future of the SGR legislation is quite unclear at this point in time, and cosponsorship of the F2F legislation is a means of expressing support for the program. The House bill (H.R. 564) recently gained another cosponsor – Rep. Chellie Pingree (D-ME) -- so it now has seven 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.] 

Continuation of Current Health Plans  The administration recently announced that consumers in some states may remain for another two years in insurance plans that do not meet ACA’s “essential health benefits” requirements. That is, state regulators and insurers will have the option of renewing plans until policy years that start no later than October 1, 2016, which means some non-compliant coverage could continue into 2017. Previously, the administration had announced that non-compliant plans could be renewed into 2014. So far, 27 states plus Puerto Rico and Guam have allowed the older plans to stay on the market.

Several other changes in ACA implementation were also announced recently. States will now have more time -- until June 15 -- to decide if they want to run their own marketplaces next year. And a recently announced rule will limit out-of-pocket costs for individuals in 2015 to $6,600 and $13,200 for families, up from $6350 for individuals and $12,700 for families in 2014.

For more details on these and other recently announced ACA policy changes, see this article from the Commonwealth Fund.


See the March 4 Washington Update for a variety of resources to help families during these last weeks of open enrollment in ACA health plans, including resources for immigrants and resources in Spanish.

National Disability Navigator Resource Collaborative  (NDNRC). NEW FACT SHEET:  “Rehabilitation and Habilitation Services and Devices”—This fact sheet is intended to help navigators and other enrollment specialists answer specific questions that people with disabilities might ask about health plans’ coverage of rehabilitation and habilitation services and supports, as well as devices such as wheelchairs, prosthetics, low vision aids and augmentative communication devices. The fact sheet and a 2-page executive summary can be found at. A list of all available and upcoming fact sheets can be found at The NDNRC “Guide to Disability for Healthcare Insurance Marketplace Navigators” can be found at


Navigator Tools for Consumers   The Answer My Questions page, from the National Health Council, is a collection of patient-focused materials and guides provided by trusted national organizations. These tools are designed to inform patients and family caregivers about health care reform and help them make good decisions about health insurance coverage. One of the resources is a worksheet to help people calculate the expected costs of their health care. Some of the resources are tailored to patients with specific chronic diseases and disabilities.


The State Health Reform Assistance Network, a program of the Robert Wood Johnson Foundation, has developed a series of consumer assistance resource guides on:

The Catalyst Center has developed two new fact sheets that explore how some provisions of the Affordable Care Act (ACA) may help reduce health insurance inequities for two subgroups of CSHCN:      

And don’t forget all the resources available on the National Center for Family/ Professional Partnerships (NCFPP) website:

Worth repeating:

“In the Loop” is a free, private online community and feedback mechanism -- coordinated by Community Catalyst and the National Health Law Program (NHeLP), with support from the Ford Foundation – to connect enrollment specialists and provide feedback to policy makers. The In the Loop website also provides links to various ACA resources which are searchable by topic or by type of enrollment assister. Register (no cost) at

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.


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 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


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