March 18, 2014

March 18 Washington DC Update

Washington DC Update 3/18/14

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

Greetings from Washington!  There is some good news about F2F funding, although the outcome is still unclear; the administration has announced that people in the federal Pre-existing Condition Insurance Plan (PCIP) can stay enrolled through April, and has issued a number of policy pronouncements and proposals related to the Affordable Care Act (ACA). And, there are only 13 days left until the ACA open-enrollment period ends on March 31! 


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. The first webinar (Medicaid 101) was on March 12. Remaining sessions:

According to the website, if you sign up now, 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.

ACA Outreach & Enrollment with the National Disability Navigator Resource Collaborative  On Thursday, March 20, 3:00-4:00 pm ET, the National Center for Family and Professional Partnerships (NCFPP) and the Maternal and Child Health Bureau (MCHB) are sponsoring this webinar to introduce the National Disability Navigator Resource Collaborative (NDNRC), which provides expertise and assistance to navigators and enrollment specialists on disability information related to enrolling in the right healthcare plan under the Affordable Care Act. This webinar will highlight valuable resources available through the NDNRC website, and cover what navigators and enrollment specialists need to know in order to assist families who are comparing and choosing health plans for people with disabilities. This webinar is for family organizations and others assisting with enrollment in the Healthcare Marketplace to ensure that people with disabilities select the most appropriate plan. Webinar link:
CALL-IN: (866) 214-9397;  PIN:  5058724774      

PLEASE NOTE:  If you have not recently joined one of our webinars on your current system, we HIGHLY RECOMMEND that you use the following link to test the process of joining a Microsoft Live Meeting. After clicking on the link, click the "Join Meeting" button. Click here to test joining a Live Meeting.  If the test is successful, you will enter a blank Live Meeting room. If you have trouble with the test, please contact Ashlee Richey prior to Thursday and we will be happy to help troubleshoot.

ACA Basics (Good for consumers)  The HHS Center for Faith-based and Neighborhood Partnerships will present several webinars on ACA basics that would be appropriate for consumers and consumer assisters. Register by clicking on the title of the webinar below.

  • Health Care Law 101 – Health Insurance Marketplace: March 19 at 7:00-8:00 pm ET. To join by phone only, dial 646-307-1706, Access Code: 281-771-511 (Pin Number is the # key). Information on the Health Insurance Marketplace, how to enroll in health insurance and key websites with resources on the law will be shared. A question and answer session will follow. Please send questions to prior to March 19 at Noon ET. 
  • Questions and Answers on the ACA: March 20 at 4:00-5:00 pm ET. For Phone Only, Dial 702-489-0001, Access Code: 141-130-345 (Pin Number is the # key). Presenters will answer questions that have been submitted in advance as well as new questions asked during the webinar. Please send questions by March 20 at 10 am ET to
  • Health Care Law 101 – Health Insurance Marketplace:  March 26 at 7:00-8:00 pm ET. For Phone Only, Dial 646-307-1705, Access Code: 603-316-464 (Pin Number is the # key). [See description above.]

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 – which can be especially problematic for children 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.

Exemptions and Special Enrollment Periods  On Wednesday, March 26, 2:00 - 3:30 PM ET, the Center on Budget and Policy Priorities will present its next “Beyond the Basics of Health Reform” webinar, which will focus on how the penalties for not having coverage are calculated, how people can qualify for exemptions from the penalty, and triggers and timing for special enrollment periods. Space is limited. Register at

Supporting People with Disabilities Who Experience Sexual Violence. On March 27, at 1:30 PM ET, The Arc’s National Center on Criminal Justice and Disability’s Join will present a webinar “Can You Hear Me? Connecting the Dots and Building Collaboration to Support People with Disabilities Who Experience Sexual Violence.”  Participants will learn how “word choice” can impact the type of sexual assault services victims receive, the importance of “touch” as a proactive strategy for reducing risk of sexual victimization and understand how survivors with complex communication needs can testify in court. Registration for this webinar and archived copies of past webinars are available on the Justice Center website. Direct any questions to

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.


F2F Funding Outlook  (Updated since last week.)  The legislation to provide future funding for F2Fs has made it through another necessary, but not sufficient, step:  the new chairman of the Senate Finance Committee, Sen. Ron Wyden (D-OR), introduced legislation to fix the Medicare physician payment problem, and that bill includes the (very good) F2F provision from an earlier iteration of that bill – an extension of funding through FY 2018 at $6 million per year. While this is very good news, the ultimate outcome is still unclear.

Memory Refresher:  The Bipartisan Budget Act enacted in December 2013 provided $2.5 million for F2Fs for the part of federal fiscal year 2014 ending March 31 (six months). The F2F provision, and various other “extenders” of current Medicare and other health law provisions, were packaged with the so-called “doc fix” (“SGR”) section of the law, which delayed a cut in Medicare physician payments through March 31.

In December, the Senate Finance Committee, under the leadership of then-Chairman Max Baucus, approved an SGR bill that included an F2F extension for 5 years at $6 million per year. That bill was not voted on by the full Senate. The House version of the SGR bill did not include the F2F provision or any other “extenders.” 

Current Situation:  Last week, new Finance Committee Chairman Wyden introduced his version of the SGR legislation (S. 2110). It includes the same F2F provision that was in the Baucus SGR bill -- $6 million per year through FY 2018. Through application of a certain Senate rule, that bill will bypass the Finance Committee and can be taken directly to the Senate Floor.

Outlook:  Unfortunately, it does not look like the House and Senate will be able to agree on whether or how to pay for a permanent SGR fix before the March 31 expiration of the temporary fix. The House voted last week to pay for the SGR fix by postponing the Affordable Care Act’s individual insurance mandate for five years, but it is clear that the Senate will not agree to this provision. The House and Senate are both in recess this week. (For more details on the machinations behind the SGR legislation, see this story from Politico.)

Therefore, it is looking increasingly likely that another temporary SGR “patch” will be needed.

We hope that such a patch will also be applied to the extenders (including the F2F provision).

It is not clear how long such a patch would be in effect. It could be a matter of weeks or as long as nine months. If, indeed, the F2F provision were included in such legislation, it would almost certainly provide the current level of funding ($5 million annually), rather than $6 million. It is also unlikely that it would provide funding beyond either the end of FY 2014 (September 30, 2014), or the end of the temporary SGR patch.

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 now has seven cosponsors in addition to Rep. Pallone. The Senate bill (S. 423) has five cosponsors in addition Senator Menendez.

Funding for Pediatric Research  In a rare show of bipartisan agreement, the Senate last week, in a unanimous voice vote, passed a House-approved, Republican-sponsored bill (HR 2019) that will shift $126 million in federal funds originally slated for political party conventions to federal pediatric research at NIH over 10 years. The President is expected to sign the bill. For an interesting piece on the background politics of the bill, see this story from Roll Call.

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

Policy Pronouncements and Proposals  On March 14, the administration issued a slew of regulations, proposed regulations and sub-regulatory guidance regarding various provisions of the ACA. These include:

  • An announcement that individuals currently enrolled in the federal Pre-existing Condition Insurance Plan (PCIP) will be able to remain in this plan until April 30 by sending in their April premium payment. See also this article in Kaiser Health News.
  • A proposed rule on a number of ACA implementation issues, including: 
    • changes that may be made in an insurance plan without the plan being “cancelled,”  thereby allowing consumers to stay enrolled in certain plans that would otherwise not be compliant with all ACA standards (see below). For a critical view of this announcement, see this Wall Street Journal editorial.
    • regulation of navigators, certified application counselors (CACs) and other consumer assisters (to protect navigators from restrictive state laws, and to protect consumers from certain navigator practices, including revelation of private information).

For more information on this lengthy proposed rule, see this Health Affairs blog post by Timothy Jost.

  • A bulletin setting forth certain notices that must be used when insurers terminate or renew a health plan. HHS is requesting comments on the draft notices, which must be submitted by April 18, 2014, and may be submitted electronically to
  • A final “Letter to [insurance plan] Issuers in the Federally Facilitated Marketplaces” which spells out requirements related to network adequacy (page 17), consumer support, and other requirements for a plan to be considered a Qualified Health Plan or certified Stand-Alone Dental Plan under the ACA (applicable to the 2015 benefit year and beyond). For more information, see this HHS fact sheet and/or this Health Affairs blog post by Timothy Jost.
  • An interim final rule (IFR) with comment period requiring Qualified Health Plans (QHPs) to “accept premium and cost-sharing payments made on behalf of enrollees by the Ryan White HIV/AIDS Program, other Federal and State government programs that provide premium and cost sharing support for specific individuals, and Indian tribes, tribal organizations, and urban Indian organizations.”  The rule took effect upon its release for public inspection on March 14; it is scheduled to appear in the Federal Register on Wednesday, March 19, and comments will be due 60 days thereafter. A related FAQ document issued on February 7, 2014, clarified that insurers may accept premium assistance payments from certain nonprofit foundations as well. For more information, see this Health Affairs blog post by Timothy Jost.
  • Answers to frequently asked questions about coverage of same-sex spouses.

Continuation of Current Health Plans  In case you missed it in last week’s Update, the administration announced, in a March 5 bulletin, 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. For more details on these and other recently announced ACA policy changes, see this article from the Commonwealth Fund.

ACA Cost-Sharing Reduction Subsidies to be Protected from the Sequester  The ACA provides two types of subsidies to individuals below certain income levels – one to help families pay premiums to purchase health insurance plans (Advanced Premium Tax Credits, or APTCs) and the other (available to a smaller set of people) to help offset the costs of deductibles and copayments. The latter type of subsidy, which goes directly to insurers, was originally subject to the across-the-board budget cuts (sequester) instituted by a 2011 budget agreement. The APTCs were not subject to the sequester because they are administered as tax credits. Last week, the administration announced that both types of subsidies will now be administered together, so neither will be subject to the sequester. This is expected to restore about $10 billion in subsidy payments. See this article from The Hill.

Some States Seeking More Time to Enroll People in Health Plans  See this

“Wonkblog” post from the Washington Post.

Experts Predict Problems with “Churning” See this article from the Commonwealth Fund.


Quality Measures and Reporting in §1915(c) Home and Community-Based Waivers  On March 12, the administration issued a document providing information on modifications to the quality assurance systems needed to meet the assurances for §1915(c) waivers. The changes are intended to strengthen the oversight of beneficiary health and welfare and realign the waiver reporting requirements. The National Association of States United in Aging and Disability (NASUAD), National Association of State Directors of Developmental Disabilities Services (NASDDDS) and National Association of Medicaid Directors (NAMD), along with waiver administrators from eleven states and the National Quality Enterprise worked for over a year with the Center for Medicare and Medicaid Services (CMS) to develop and refine these changes. Other stakeholders also had opportunity to comment through conference and webinar sessions.


How to Help Residents in States That Are Not Expanding Medicaid  See this blog post from Families USA.

Bilingual Checklist to Help Consumers Prepare to Apply for Health Insurance (Families USA)
This simple checklist provides:

  • Questions on the application that consumers need to prepare to answer
  • Information consumers need to bring with them when they apply
  • Information about how to apply for health insurance through the marketplace

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

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

Worth repeating:

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 two-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:      

“In the Loop” is a free, private online community and feedback mechanism 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.

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.