June 11, 2014

June 11 Washington DC Update

June 11 Washington DC Update

Washington DC Update 6/11/14

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

Greetings from Washington!  This issue of the Update provides information about some real-world experiences with implementation of the Affordable Care Act, some great new EPSDT (Early and Periodic Screening, Diagnosis, and Testing) resources, and some interesting developments related to Supreme Court decisions.

The biggest news of late is probably the confirmation – by a bipartisan vote of 78-17 – of the new Secretary of Health and Human Services (HHS), 48-year-old Sylvia Mathews Burwell. On Monday, she was sworn in and began the job of overseeing the continuing implementation of the Affordable Care Act (ACA) and the more than 77,000 employees of the Department.


ACA webinars sponsored by the Center for Faith-based and Neighborhood Partnerships:

The HHS Center for Faith-based and Neighborhood Partnerships will be offering the following one-hour webinars, which all include a question and answer session. Contact ACA101@hhs.gov if you have problems registering or if you have any questions about the health care law. You may also join the webinar by telephone only. Click on the title of the webinar(s) below to register.

Special Enrollment Periods and Resources for the Uninsured 

Thursday, June 19, 2:00 pm ET

Submit questions to ACA101@hhs.gov by June 18 at 5 pm ET.

To Join By Phone Only, Dial +1 (702) 489-0008
Access Code: 433-467-823. Pin Number is the # key.

Got Coverage? Next Steps in Using Your Health Insurance

Wednesday, July 2, 4:00 pm ET

Submit questions to ACA101@hhs.gov prior to July 1 at noon ET.

To Join By Phone Only, Dial +1 (480) 297-0021
Access Code: 580-591-872. Pin Number is the # key.

Special Enrollment Periods and Resources for the Uninsured

Wednesday, July 16, 1:00 pm ET

Submit questions to ACA101@hhs.gov by July 15 at 12 pm ET.

To Join By Phone Only, Dial +1 (646) 307-1721
Access Code: 270-706-869. Pin Number is the # key.

Other webinars:

Medicaid Eligibility for Former Foster Youth Up to Age 26

Wednesday, June 18, 2:00 pm ET  

This quarterly call sponsored by Community Catalyst will address the ACA’s extension of Medicaid eligibility for former foster youth up to age 26, a provision featured in a recent blog. On the call, Community Catalyst staff will discuss the key takeaways from the report, “The ACA and Former Foster Youth: Opportunities and Challenges for States.” In addition, representatives from several states will talk about the steps they are taking to implement this provision and enroll former foster youth. There will also be time for participants to raise questions and concerns or share successes. Community Catalyst staff will also share a quick update about efforts to secure continued funding for the Children’s Health Insurance Program (CHIP). Register for the call here. See a related article about states expanding eligibility for former foster youth.

Promoting Oral Health Through the Medicaid Benefit for Children and Adolescents

Wednesday, June 18, 2:00-3:00 pm ET

The National Academy for State Health Policy is sponsoring this webinar, at which the Centers for Medicare & Medicaid Services will discuss opportunities and promising strategies for states to leverage the Medicaid’s oral health benefit to better meet the oral health needs of children. This will be followed by a conversation with Medicaid officials from Maryland and Texas about initiatives they have launched to improve delivery of children’s oral health services using this Medicaid benefit. Participants will learn about these states’ strategies for getting Medicaid-enrolled children the oral health services they need, key decision points that led states to their approaches and practical steps toward implementing them. Register here.

[NOTE:  This webinar is the third in a series on the Medicaid benefit for children and adolescents. Previous webinars in this series focused on improving care delivery to children and engaging adolescents. In conjunction with this webinar series, NASHP has launched a Resource Map on www.nashp.org to disseminate state-specific resources and information about strategies that state policymakers and Medicaid officials can use to deliver the Medicaid benefit for children and adolescents.]

Autism Spectrum Disorders: An Overview in Spanish
Saturday, June 21, 1:00-2:00 pm ET
The Autism NOW Center, a project of The Arc and the Autism Society of America, will offer a new webinar, entirely in Spanish, about autism spectrum disorders. Presenters will provide an overview of ASD; discuss steps involved in screening and diagnosis; address existing barriers for Latino families; and help connect families to resources in their community. Space is limited. Register here.  Below is an announcement in Spanish that can be shared with families:

Autismo: Una Visión General en Español
Sábado, 21 de Junio, 1:00-2:00 pm ET

Se estima que 1 de cada 68 niños tiene un trastorno del espectro autista (TEA). Las investigaciones muestran que los niños hispanos se les diagnostica a menudo más tarde del promedio nacional. Con las tasas de prevalencia en aumento, es importante que las familias de las comunidades insuficientemente atendidas tengan acceso a información de calidad y recursos.

El Autism Now Center y el Autism Society se han asociado para ofrecer un recurso gratuito para las familias de habla hispana. Únete a nosotros en este seminario, que será ofrecido completamente en español, para aprender más acerca de los trastornos del espectro autista. Los presentadores proporcionar una visión general de la CIA; discutir los pasos involucrados en la detección y el diagnóstico; abordar las barreras existentes para las familias latinas; y ayudar a conectar a las familias a los recursos disponibles en su comunidad. Registrate en este seminario web hoy mismo! Presentadores: Yuliana Diaz, el Autism Society Marisol Ramos, Vision for Equality.

El espacio es limitado. Registrate en este seminario. 

Lessons Learned from Open Enrollment: How MCHB Grantees Are Supporting Families
Wednesday, June 25, 2014, 1:00-2:00 pm ET
Join the webcast: https://hrsa.connectsolutions.com/mchb_grantee_aca/

The Maternal and Child Health Bureau will present this webcast about its grantees’ experiences in implementing the Affordable Care Act. Speakers will present enrollment data from the first open enrollment period and highlight the Statewide Parent Advocacy Network (SPAN) New Jersey and SHIELDS for Families’ efforts to educate and support families in accessing and understanding the value of health insurance. Successes and challenges will also be described.

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FREE State-Based and In-Person Advocacy Skills Trainings – Long-Term Care

Applications will run from June 2 - June 23.

As part of its Consumers for Quality Care, No Matter Where Initiative, the National Consumer Voice for Quality Long-Term Care (Consumer Voice) will be offering FREE state-based, in-person advocacy trainings for groups to make an impact on policy and contribute to the Consumer Voice's national efforts. Participants will include long-term care ombudsman programs, consumer advocacy groups, family/caregiving groups, consumer alliances, and community and senior organizations.

The trainings will involve:

  • A pre-training conference call where participants will learn how to strategize around a particular issue. 
  • On-site half-day or full-day training with Consumer Voice staff.

A full-day training will cover all topics listed below; a half-day training will include two out of the four following topics: 

  • How to craft an effective advocacy message.
  • Delivering your message in person: the nuts and bolts of meeting with a key decision maker.
  • Delivering your message: utilizing both traditional approaches and social media.
  • How to grow, support, and activate your network.

More details about the application process and the trainings will follow soon. In the interim, organizations should acquire 20 individuals who want to receive these trainings. Priority will be given to applicants who will be joined by other advocates outside their organization or program. 

Click here to contact Sara Cirba, Advocacy and Development Associate, if you are interested in receiving Consumer Voice's advocacy skills training or have any questions; or call 202-332-2275 ext. 221.


Bill to Fix the “Family Glitch”

On Thursday, Senator Al Franken (D-MN), along with 20 cosponsors, introduced legislation – the Family Coverage Act (S. 2434) – to fix the so-called “family glitch” that has resulted from the Internal Revenue Service’s interpretation of an important ACA provision. Under the ACA, health insurance offered to an employee is deemed “affordable” if the employee’s share of premiums costs less than 9.5 percent of his or her family income. If it costs more, the employee and employee’s family are eligible for tax credits to help pay premiums.

Under the current IRS rule, however, the determination about affordability of coverage is based on the cost of coverage for the employee alone, not the cost of family coverage. As a result, premium tax credits are not available to many families who, in reality, cannot afford family coverage. Without a change in the rule, up to 460,000 children could be left uncovered.

The Family Care Act would clarify that “affordability” of employer-offered insurance should be based on family coverage, not individual coverage. A summary of the bill is available here.

Mental Health Legislation

As reported in an earlier Washington Update, Rep. Tim Murphy (D-PA), a psychologist, introduced a far-reaching mental health bill – the “Helping Families in Mental Health Crisis Act” (H.R. 3717) – that proved to be quite controversial. That bill would significantly reorganize the Substance Abuse and Mental Health Services Administration (SAMHSA), increase access to psychiatric facilities, make involuntary outpatient commitment easier, and relax health privacy laws. It would also cut funding for the Protection & Advocacy for Individuals with Mental Illness program by about 85 percent. It is opposed by several major mental health organizations, although other groups support at least some of its provisions.

According to this article in The Hill, the House Republican leadership has indicated that it will now take a piecemeal approach to mental health legislation to avoid contentious legislation. The less controversial measures include training for mental health services, care coordination, and increased funding for mental health research.

A related story published this week by Kaiser Health News and aired on NPR discusses the frustration of many parents of adult children with mental illness regarding their inability to have input into their child’s care.


The “R Word”

As explained in this article from Disability Scoop, a Supreme Court opinion issued last week used the term “intellectual disability” rather than “mental retardation” for the first time. The opinion’s author, Justice Anthony Kennedy, acknowledged and explained the change in terminology, referring to the use of the updated term in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, and Rosa’s Law, a 2010 act requiring “intellectual disability” and “individual with an intellectual disability” to be used in lieu of “mental retardation” and “mentally retarded” in federal health, education and labor policy.

In the case, Hall v. Florida, the Court struck down a Florida law that applied a strict IQ cutoff for determining eligibility for the death penalty.

U.N. Convention on the Rights of People with Disabilities

Although it deals with the implementation of a chemical-weapons ban treaty, the June 2 Supreme Court ruling in Bond v. United States, has implications for the movement to ratify the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Opponents of the CRPD had argued that the outcome of this case could affect the treaty’s implementation, and therefore that the Senate should wait until that case was decided before considering its ratification.

As it turned out, the Supreme Court’s holding will not impinge on implementation of the CRPD. Accordingly, CRPD supporters, including former Senator Bob Dole (R-KS) and Senator Tom Harkin (D-IA), have called for speedy ratification of the Convention. The National Council on Disability also issued a statement urging swift ratification of the treaty, which takes a two-thirds vote in the Senate.

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

Eligibility-Verification Information for the Federal Marketplace

Last week, the Centers for Medicare and Medicaid Services (CMS) issued two blog posts relating to verification of eligibility information for people who sought insurance, tax credits or cost-sharing subsidies through the federal Marketplace, or Federally Facilitated Exchange (FFM). The need for such verification arises from situations in which the FFM was not able to immediately verify all information during the application process because a data point provided by the applicant did not match existing government records. For example, a consumer might have recently changed jobs, but the latest IRS tax return data and other data available to the Marketplace did not reflect a change in income. Those consumers were still able to enroll in Marketplace coverage, but when they enrolled, they received a notice instructing them to submit more information. CMS issued one blog about this topic for policy staff and one for consumers.

Helpful Articles on Real-World ACA Implementation:

Consumer Options When the Network Changes Mid-Year. The Georgetown University Health Policy Institute’s Center for Health Insurance Reforms (CHIR) answers questions that Navigators are getting from consumers about their coverage options. A recently posed question from Georgia illustrates one of the challenges consumers may face – a network that changes after the consumer has selected a plan. Here is the CHIR response.

Cost-sharing Reductions Inconsistently Applied. A new analysis from Avalere Health found that consumers receiving federal assistance to reduce their out-of-pocket costs may experience inconsistent reductions in spending depending on the plan they choose. Individuals with incomes between 100 and 250 percent of the Federal Poverty Level (FPL) are eligible for cost-sharing subsidies, meaning that when they choose a “silver”-level plan on an Exchange, that plan must have a higher actuarial value (AV) than other silver plans. But, plans have broad discretion in how they meet the AV targets for these plans. Avalere found that most cost-sharing plans on the federally run exchanges have lower deductibles than other plans, but less often have lower cost-sharing for other services, such as specialty drugs. On the other hand, the maximum out-of-pocket caps (MOOPs) for these plans are about 20 percent lower than required by the ACA. Unfortunately, HealthCare.gov may not make clear how the cost-sharing reductions are implemented by the different plans, so consumers may end up purchasing plans that do not actually reduce their costs much more than standard silver plans for some services. Bottom line“…Consumers who qualify for cost-sharing reductions should look closely at how the plan benefit is structured because it could have a major impact on their actual out-of-pocket costs.”

Plans Cheaper on Exchanges. A survey of 39 states found that health plans on the individual market are nearly always cheaper when purchased through an Exchange rather than on the market outside an exchange. The least-expensive plans offered by insurance companies directly (United Healthcare, Aetna, Cigna and Assurant) were more than 40 percent more expensive on average than the cheapest plans on the Exchanges.

Implementation of the Ban on Pre-Existing-Condition Exclusions. It is important that consumers understand that the ban on pre-existing-condition exclusions has a plan-year effective date. That is, the bans did not all disappear on January 1, 2014. They are prohibited for plan-years beginning on or after that date. As plans renew in 2014, their pre-existing condition exclusions will get dropped. In this article from Kaiser Health News, experienced health reporter Julie Rovner explains how a mistake in information provided by her insurance plan raised a question about a possible gap in the pre-existing-condition-exclusion ban. Perhaps more importantly, her experience reveals the importance of double checking with one’s insurance company if information they provide does not seem right!


New EPSDT Guide for States on Coverage in the Medicaid Benefit for Children and Adolescents

The Centers for Medicare & Medicaid Services (CMS) have just published a great resource for child health advocates – EPSDT - A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents – which compiles into a single document various EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) policy guidance that CMS has issued over the years. The Guide was produced in collaboration with the National Health Law Program, and is intended to help states, health care providers, and others to understand the scope of services that are covered under Medicaid’s EPSDT benefit for children.

The Guide outlines EPSDT's screening requirements, including when inter-periodic screening should be provided; the s

cope of services covered under EPSDT, including requirements governing dental, vision, and hearing services; and

permissible limitations on service coverage under EPSDT.

In addition, CMS has published two other EPSDT-related guides:

In addition, CMS and the National Academy for State Health Policy (NASHP) have published an EPSDT Compendium featuring information about states’ EPSDT implementation efforts across dimensions such as care coordination, behavioral health, data collection and reporting, oral health, medical necessity and improving access to care.


New Fact Sheet from the National Disability Navigator Resource Collaborative (NDNRC): “Medicaid Buy-In”

The latest fact sheet, “Medicaid Buy-In,” from the National Disability Navigator Resource Collaborative (NDNRC) is intended to give Navigators and Enrollment Specialists answers to the questions that people with disabilities may have about possible Medicaid Buy-In as a coverage option when they are looking into purchasing private insurance in the Marketplace. The Buy-In program is an optional Medicaid coverage group for working individuals with disabilities. The entire list of NDNRC fact sheets is available here. Links to other helpful resources are available here.

Medicaid Eligibility for Former Foster Youth

The ACA requires states to provide Medicaid coverage to individuals who were in a state's foster care system when they turned 18 until the month of their 26th birthday. Unfortunately, this coverage is guaranteed only if the individual still lives in the state where he or she was in foster care. This article discusses implementation of this ACA provision, including measures states have taken to reach out to this population, as well as the action of 11 states to extend Medicaid to former foster care youth who lived in another state at the time they were in the child welfare system.

ACA-Related Medicaid State Plan Amendments – Recommendations for Advocates

The National Health Law Program (NHeLP) recently published an issue brief about Medicaid State Plan Amendments (SPAs) to implement the ACA, which highlights some of the key state-policy decision points and provides recommendations for advocates seeking to expand Medicaid eligibility in their states.


Profile of Local Health Departments

The National Association of County and City Health Officials has launched a new website of local health department profiles, which contains information from a survey of local health departments, including data on workforce, programs, services and partnerships.


June 30 – Deadline for Former PCIP Enrollees to Enroll in a Qualified Health Plan

The Pre-existing Condition Insurance Plan (PCIP) terminated on April 30, 2014. Those who were covered under the PCIP will be eligible for a 60-day Special Enrollment Period starting on May 1, enabling them to enroll in a qualified health plan offered through the Federally-Facilitated Marketplace until June 30. State-based Marketplaces are adopting similar special enrollment periods. If the enrollee is otherwise eligible to enroll in a qualified health plan, coverage will be effective back to May 1. An HHS Fact Sheet explaining this process is available here, and the formal notice is available here.