July 01, 2014

June 25 Washington DC Update

June 25 Washington DC Update

Washington DC Update 6/25/14 

{Don’t forget to check out the Family Voices/NCFPP ACA webpage, and the latest blog post: Why Oral Health is Important for Children with Special Needs & How to Access It, at http://www.fv-ncfpp.org/blog/.}

Greetings from Washington!  On Monday, the White House, in conjunction with the Center for American Progress, held a Working Families Summit on the needs of families trying to balance work and home life, including the need for paid family leave. One of the participants from around the country was from the Rhode Island Parents Information Center, which is the state’s Family Voices State Affiliate Organization and Family-to-Family Health Information Center!  (See this article in the Providence Journal.)   Read this issue of the Washington (DC) Update for more details about the White House summit – including a link for submitting your personal story about the need for family-friendly workplace policies – and other news and information.

REMINDER:   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 are 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.


[NOTE:  Some of the listings are not in chronological order; several are today, Wednesday, June 25.]


The Centers of Medicare and Medicaid Services (CMS) recently released a Funding Opportunity Announcement for Navigator grants (see below under “ACA News and Information”). Coming up for potential grant applicants:

Lessons Learned from Pioneer Behavioral Health Navigator Grantees

Wednesday, June 25, 1:00 PM - 2:30 pm ET. The National Council on Behavioral Health is sponsoring a webinar for potential navigator grant applicants to explore the experiences of and lessons learned from current navigators at Calvary Healthcare Inc. and Aurora Mental Health Center. Topics discussed will be what it takes to be a successful navigator and best practices in providing enrollment assistance. Register here.

CMS Call for Potential Navigator Grant Applicants

Tuesday, July 1, 1:30-3:00 pm ET. The Centers of Medicare and Medicaid Services (CMS) will be conducting a webinar for potential grant applicants to discuss the recent Funding Opportunity Announcement for Navigator grants (see below under “ACA News and Information”).

Audience URL: https://goto.webcasts.com/starthere.jsp?ei=1036406
Title: Navigator Funding Opportunity Announcement Pre-Application Webinar

See also: Applying for a Navigator Grant – Plan for Success, from Enroll America.


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.

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.


Lessons Learned from Open Enrollment: How MCHB Grantees Are Supporting Families
Wednesday, June 25, 2014, 1:00-2:00 pm ET
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.

Join the webcast: https://hrsa.connectsolutions.com/mchb_grantee_aca/

The ABCs about the Impact of Literacy on Affordable Care Act Efforts in the Black Community

Wednesday, June 25, 3:00-4:30 pm ET

Sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Understanding the Affordable Care Act (ACA) and health insurance may be difficult for individuals with limited literacy and health literacy. Individuals with behavioral health conditions also face barriers to accessing and receiving health care. This webinar is designed to help family members, providers, and community agencies understand and overcome literacy-related barriers related to understanding and enrolling in health coverage under the ACA. For more information, contact James Sawyer at 208-353-3826 or m.james.sawyer@yahoo.com.

To join the webinar, please use the following conference line and webinar link:

Call-in Number: 1-888-566-5920

Passcode: SAMHSA

Webinar Link: https://www.mymeetings.com/nc/join.php?i=PW2643763&p=SAMHSA&t=c

Cost Sharing Reductions for American Indians and Alaska Natives Who Enroll in Closed Panel Qualified Health Plans

Wednesday, June 25, 3:00-4:30 pm ET. CMS will host an All Tribes’ Call to obtain tribal input and advice regarding cost-sharing reductions for American Indians and Alaska Natives who enroll in closed panel Qualified Health Plans (QHPs) in the Health Insurance Marketplace. A closed panel QHP is a type of health maintenance organization (HMO) that does not cover services furnished by a provider outside of the HMO’s network of providers. Contact HHSIEA@hhs.gov with questions or concerns.

The call in number is 1-888-778-9063 and the participant code is 148483.

For more information, please visit go.cms.gov/AIANSpotlight 

Questions or Concerns? Contact HHSIEA@hhs.gov

New CMS Regulation on HCBS Settings - Implications for Employment Services

Wednesday, June 25, 3:00 - 4:30 pm ET

Sponsored by National Disability Institute - LEAD Center for workforce development professionals, policy makers, individuals with disabilities, and related stakeholders.

In the aftermath of CMS' recent regulation defining acceptable and unacceptable settings for Home and Community Based Services, states and stakeholders are now considering how to transition their service-provision systems into compliance with the new CMS requirements for greater integration. This new regulation may have a profound impact on employment services. This webinar will address the potential impact and how to influence implementation relevant to employment. Register here.

*Please note: This webinar will be captioned and a link to download the presentation will be sent to registrants prior to the webinar. To request any other reasonable accommodations, please contact Brittany Taylor at btaylor@ndi-inc.org within 48 hours of the webinar.

Latino Language Access and the ACA

Thursday, June 26, 2:00 pm ET

The Substance Abuse and Mental Health Administration will be hosting a webinar about how effective outreach and enrollment can be used to help Latino populations secure health coverage, and the challenges they face in learning about or getting covered. Register here.

Partnering with Patients, Families, & Communities to Link Interprofessional Practice and Education

Tuesday, July 22, 1:00-2:00 pm ET

The Macy Foundation will hold a web conference to discuss moving beyond what is typically thought of as “patient engagement” efforts to integrate patients and families as partners throughout the health professions education and delivery system. The webinar will address recommendations in a new report – Partnering with Patients, Families, and Communities: An Urgent Imperative for Health Caredeveloped from an April 2014 meeting of leaders in health professions education and practice, and consumer organizations. Register here.

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The Needs of Working Families

As noted above, the administration is focused on the creation of more family-friendly work environments. An op-ed post by the President appeared in Monday’s Huffington Post, and the President’s Saturday radio address was also devoted to the needs of working families (transcript). The first need mentioned was that for paid family leave, which almost every other developed country provides. A report issued this month by the President’s Council of Economic Advisers about the economics of paid and unpaid family leave can be found here.

At this White House webpage, you can provide input about how your family could benefit from paid family leave and other workplace policies that support families, and/or sign up for White House updates about this issue.

Three U.S. states have passed legislation to implement family leave – California, New Jersey and Rhode Island. As noted above, a representative of the Rhode Island Parents Information Center (Family Voices SAO and state F2F) participated in the White House summit. See this article in the Providence Journal.

Representative Rosa DeLauro (D-CT) and Senator Kirsten Gillibrand (D-NY) have introduced legislation to establish paid family leave under federal law, the Family and Medical Insurance Leave (FAMILY) Act (H.R. 3712/S.1810). See information about this legislation from the National Partnership for Women and Families.

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

Maximum 90-Day Waiting Period for Employer-Sponsored Coverage

(from Politico Pulse, 6/23/14)

Employers can't make health coverage-eligible workers wait for more than 90 days before their benefits kick in, under a final rule posted late Friday by the administration. Nor may they spend more than one month on an “orientation period” to determine whether the new employee is eligible for coverage. The rule kicks in for plan years beginning January 2015 or later. The rule: http://1.usa.gov/1lSYcjp.

Simpler Enrollment Process in November?

(from The Commonwealth Fund, Week in Review)

Some consumers signing up for insurance coverage through the federal HealthCare.gov website during the next open enrollment period – November 15, 2014, through February 15, 2015 – will be able to use a simplified application, according to a software engineer who has advised the administration. The shorter “Application 2.0” could be likened to the 1040-EZ tax form, and can be used by people with uncomplicated financial assistance needs, so it could be available to a large proportion of individuals using the site to purchase insurance. Otherwise, the website will not be significantly different, according to the consultant.

“From Coverage to Care” and Consumer “Road Map”

(from the HHS Office of Intergovernmental and External Affairs News Bulletin, 6/20/14)

This week, the Centers for Medicare & Medicaid Services (CMS) launched a national initiative “From Coverage to Care” (C2C), which is designed to help people make the most of their new health insurance benefits, including taking full advantage of primary care and preventive services. It also seeks to give health care providers the tools they need to promote patient engagement. Resources for consumers, including a 10-part video series, are available at http://marketplace.cms.gov/c2c. The videos and some of the other resources are available Spanish as well as English. Sign up here to be notified when more resources become available in Spanish (check “Minority Health” under “Outreach and Education.”) 

The launch also marks the release of the new Roadmap to Better Care and a Healthier You (pdf document), which includes 8 steps to help consumers and health care providers be informed about the diverse benefits available through their coverage and how to use it. The “Roadmap” contains information on health care coverage terms, the differences between primary care and emergency care, and the cost differences of decisions to seek care in- and out-of-network.

A HealthCare.gov blog about using health insurance, with links to more information, can be found in English and Spanish.

People with questions about the C2C initiative should write to Coveragetocare@cms.hhs.gov.

Visit HHS.gov/Healthcare and CuidadodeSalud.Gov, two consumer-focused health care websites to: find insurance options, compare care quality, and learn about the law. How is the Affordable Care Act helping you? Share your story here.


Connecting Kids to Coverage Funding Opportunity Announcement (FOA):

On May 12th, the Centers for Medicare and Medicaid Services (CMS) released the Connecting Kids to Coverage Outreach and Enrollment Grants Focused on Increasing Enrollment of American Indian/Alaska Native Children (Connecting Kids to Coverage – AI/AN Grants). A total of $4 million is available with grant awards expected in the range of $250,000 to $500,000 over a two year period.

Applications for this grant opportunity are due June 30, 2014 (3 pm ET). Grant awards are expected to be made on September 2, 2014.

The application, for this grant opportunity, can be downloaded at the Insurekidsnow website. CMS has received many questions regarding the grant opportunity through the applicant support mailbox at OAGMGrantsBaltimore@cms.hhs.gov. All questions received and the corresponding answers are also posted at the Insurekidsnow website.

Please continue to send your questions and concerns regarding this grant opportunity to OAGMGrantsBaltimore@cms.hhs.gov.

In case you missed it last week:

CMS Announces Opportunity to Apply for Navigator Grants in Federally-Facilitated and State Partnership Marketplaces

On June 10, the Centers for Medicare & Medicaid Services (CMS) announced the availability of $60 million in grants to support Navigators in Federally-facilitated and State Partnership Marketplaces in 2014-2015. The funding opportunity announcement is open to eligible individuals, as well as private and public entities, applying to serve as Navigators in states with a Federally-facilitated or State Partnership Marketplace. It is open to new and returning Navigator applicants. Applications are due July 10, 2014.

Last month, CMS finalized regulations that update the requirements applicable to Navigators. Navigators will now be required to maintain a physical presence in the Marketplace service area, so that face-to-face assistance can be provided to consumers. Navigator grant applicants will also be encouraged to perform background checks for all Navigator staff that will be handling sensitive or personally identifiable information (PII). In addition to quarterly and annual reporting, Navigators will be required to submit to CMS weekly and monthly progress reports detailing their progress and activities in their target communities. Additional information about the funding opportunity can be found here, and FAQs are available here.

To access the funding opportunity announcement, visit: http://www.grants.gov, and search for CFDA # 93.332. Contact HHSIEA@hhs.gov with questions or concerns.

Last month, CMS finalized regulations that update the requirements applicable to Navigators. The final rule is available at the Federal Register.


AHRQ Releases Toolkit to Help Consumers and Reduce Hospital Readmissions

The Re-Engineered Discharge (RED) Toolkit, funded by the Agency for Healthcare Research and Quality (AHRQ) and developed by the Boston University Medical Center, is intended to help hospitals reduce readmission rates. Part of the toolkit is the “After Hospital Care Plan” (AHCP), a term used to avoid patient and family confusion by the word “discharge.” The AHCP lists medications and upcoming appointments and tests; provides a color-coded calendar of upcoming appointments; and is designed to help the patient prepare for his/her upcoming post-discharge appointment. While developed for hospitals, the template could be used by others assisting consumers as well, and much of it – e.g., the medication schedule – would be applicable even for individuals who have not been in the hospital.

After Hospital Care Plan (AHCP) Template - English (.doc)

After Hospital Care Plan (AHCP) Template - Spanish (.doc)


The U.S. Food and Drug Administration (FDA) recently announced a new initiative, “openFDA,” which will provide ready access to FDA public data – including adverse drug reactions – and highlight projects using these data in both the public and private sector to further regulatory or scientific missions, educate the public, and save lives. The platform is currently in public beta with one featured dataset, FDA’s publicly available drug adverse event reports. In the future, openFDA will provide a platform for public challenges issued by the FDA and a place for the community to interact with each other and FDA domain experts with the goal of spurring innovation around FDA data. Read more here.

Request for Information (RFI) on Significant Disproportionality

(from the U.S. Department of Education Office of Special Education and Rehabilitative Services, 6/19/14)

The U.S. Department of Education (Department) has published a Request for Information (RFI) requesting public comment on the actions that the Department should take to address significant disproportionality based on race and ethnicity in special education.

The Department is requesting input from the public on actions the Department should take related to:

  1. significant disproportionality based on race and ethnicity in the:
    1. identification of children as children with disabilities, including identification by disability category;
    2. placement of children with disabilities in particular educational settings; and
    3. the incidence, duration, and type of disciplinary action taken with respect to children with disabilities; and
  2. ensuring that funds reserved for comprehensive, coordinated early intervening services under Part B of the IDEA are used to effectively address significant disproportionality.

The RFI includes information about how to submit public comments. Responses must be received by July 21, 2014. See the OSERS announcement here, and the full Federal Register notice here.


Applying for a Navigator Grant – Plan for Success

From Enroll America: http://www.enrollamerica.org/blog/2014/06/applying-for-a-navigator-grant-plan-for-success/

As an Immigrant in the U.S. Illegally, Can I Buy Insurance?

Read this Kaiser Health News Q&A here.

Help to Ensure that Health Insurance Marketplace Plans Have Adequate Provider Networks

Read this blog post from Families USA about federal requirements applicable to health-plan networks and how you can help by reporting consumers' problems to state and federal agencies.

Special Enrollment Toolkit for Young Adults and Others
Young Invincibles has released a new toolkit of infographics to provide information about life changes – graduation, marriage, having a baby, moving, a new job, losing employer-based coverage, or turning 26 – that make them eligible to enroll in health insurance through the marketplace during a special enrollment period.

Reducing Health Insurance Churning

(From the Commonwealth Fund)

Churning in health insurance enrollment has always been a problem, as changes in life circumstances create a cycle of losing and regaining eligibility for public coverage. While the ACA means most people can always have some sort of coverage, there will now be the potential for churning between Medicaid and subsidized marketplace enrollment. In a new 8-page issue brief (click in left margin), researchers from the George Washington University School of Public Health and Health Services discuss strategies states can use to ease coverage transitions and help keep people insured at all times, including the use of Medicaid dollars to subsidize the Copy of Washington DC Update June 18, 2014purchase of private plans through the marketplaces, and allowing adults and children to enroll in Medicaid or the Children’s Health Insurance Program continuously for 12 months.


Rights under the Health Insurance Portability and Accountability Act (HIPAA)

From MentalHealth.govhttp://www.mentalhealth.gov/blog/2014/06/understanding-hipaa-rights.html

Rights under the Mental Health Parity Law

From the American Psychological Associationhttp://www.apa.org/helpcenter/parity-guide.aspx

In case you missed it:

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 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.

CMS has also published two other EPSDT-related guides: