August 04, 2014

July 30 Washington DC Update

July 30 Washington DC Update

Washington DC Update 7/30/14 

{Don’t forget to check out the Family Voices/NCFPP ACA webpage, and the July blog post: Helping Families of Children with Special Health Care Needs Access Prevention and Wellness Care, at}

[Please note that there are several webinars today, Wednesday, July 30, beginning at noon ET. See below.]

Greetings from Washington!  It has been an eventful couple of weeks. Among other things, two appeals courts issued conflicting decisions about premium subsidies provided under the Affordable Care Act (ACA), the administration announced several ACA-related regulatory policies, the Senate Foreign Relations Committee reported out the UN Disabilities Treaty, and the President signed a bill making significant changes in employment opportunities for people with disabilities. Read more about these developments, other news, and various resources in this week’s Update.


An Overview of Coverage to Care (C2C)

Wednesday, July 30, 12-1 pm ET 

Presented by the Office of Minority Health, Centers for Medicare and Medicaid Services (CMS).

Coverage to Care (C2C) is designed to help answer questions that people may have about their new health coverage, and to help make the most of their new benefits, including primary care and preventive services. It also seeks to give health care providers the tools they need to promote patient engagement. For more information about C2C, visit Register here. 

Meaningful Consumer Engagement: Training the Consumer

Wednesday, July 30th, 2:00 – 3:00 or 3:30 pm ET

CMS is facilitating a webinar series for interested providers, health care professionals, health plans, consumers, advocates, and other stakeholders seeking to ensure that the voices of older adults, persons with disabilities, and their caregivers are heard in the design, implementation, and oversight of the state demonstrations to improve and integrate care for Medicare-Medicaid Enrollees. An expert in consumer engagement and training will discuss the approaches, tools, and training content needed as consumers join their health care delivery system’s consumer advisory committee, and a consumer with extensive experience participating on an advisory committee will share personal insights about the training and operating guidelines used to support and empower consumer advisors. Register at

Past webinars in this series addressed the benefits, return on investment, recruitment strategies, and other practical information about consumer advisory committees (archived at; and  

the use of town hall-style member meetings (archived at

This series, hosted by the Centers for Medicare & Medicaid Services (CMS) in collaboration with The Lewin Group and Community Catalyst, is based on The Meaningful Consumer Engagement toolkit, developed by Community Catalyst. The tool is available at:

Medical Diagnostics and Health Care Justice
Wednesday, July 30, 2:00 pm ET

Sponsored by The Arc, this webinar will discuss medical diagnostics and healthcare justice, with leaders from the US Access Board and the Disability Rights Education & Defense Fund. Attendees will learn updates on the current medical diagnostics rule as well as how to educate others in their communities about health care provider misconceptions and stereotypes. Register here.

Engaging the Diversity of the Black Community in ACA Outreach and Enrollment Efforts

Wednesday, July 30, 2014, 3:00 PM - 4:30 pm ET

Sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), this webinar is designed to help family members, providers, faith leaders, community agencies, and other participants understand and address subpopulation-specific barriers related to understanding and enrolling in health coverage under the Affordable Care Act (ACA). The webinar will include strategies to address these barriers through ACA outreach and enrollment practices. For more information, click here. Register here.

The New Federal Grants Supercircular: How Super Is It?

Wednesday, July 30, 3:00 PM - 3:15 [sic] pm EDT

The federal Office of Management and Budget (OMB) recently revised and consolidated the federal grants circulars into a massive guidance document called the "Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Grants," also known as the "Supercircular." There are significant modifications to the rules that govern the administration and management of all federal grants and subgrants related to time and effort reporting, sole source procurement restrictions, mandatory disclosures, and indirect cost rates. This 15-minute webinar will highlight the Supercircular's key reforms that community mental health and addiction treatment organizations (and others) receiving federal grant and subgrants should know. Register now!


Patients and Families as Partners in Care Delivery Transformation

July 31, 1:00 to 2:00 pm ET 

This webinar, hosted by the Patient-Centered Primary Care Collaborative, is an opportunity to learn how various organizations are working to include patients and their families in partnerships to transform health care delivery and work towards the Triple Aim (improve quality and satisfaction, improve health, and reduce costs). Register for the July National Briefing: Patients and Families as Partners in Care Delivery Transformation webinar

Sickle Cell Disease: Myths and Realities

Wednesday, August 6, 3:00-4:00 pm ET

This webinar will address the physical, psychological, and social aspects of Sickle Cell Disease as well as treatments and outcomes, and how to advocate as a caregiver, a patient with sickle cell disease, or as a provider, so that emergency department visits are more "successful."   After registering you will receive a confirmation email containing information about joining the Webinar. Space is limited. Reserve your Webinar seat now at


President Signs the Workforce Innovation and Opportunity Act

On July 22, the President signed the Workforce Innovation and Opportunity Act (H.R. 803), which reauthorizes the Workforce Investment Act (WIOA) and includes provisions intended to improve employment opportunities for individuals with disabilities. Specifically, it reauthorizes and updates existing federal workforce development programs, including the Rehabilitation Act, which provides for vocational rehabilitation services for people with disabilities. The legislation, widely supported by disability organizations, also limits the use of sheltered workshops.  See this article from Disability Scoop for more details.  A one-page summary of the legislation can be found here, and a section-by-section summary of the legislation can be found here

Disability Treaty Approved by the Senate Foreign Relations Committee 

On July 24, the Senate Foreign Relations Committee approved the UN Convention on the Rights of People with Disabilities (CRPD), meaning that the bill can go to the full Senate for a vote. Detailed information about the treaty can be found at The website of the National Council on Disability also provides information about the CRPD, including a history and an explanation of the treaty’s potential impact (including refutation of opponents’ claims).

Senate Committee Seeks Public Feedback on Disability and Poverty

The Senate Health, Education, Labor, and Pensions (HELP) Committee, is conducting a questionnaire on the topic of disability and poverty, a topic of major interest to Chairman Tom Harkin (D-IA). The committee would like to hear directly from people with disabilities living throughout the U.S. to learn more about their perspectives on this issue. Chairman Harkin plans to publish a report on the issue and to possibly hold a hearing before he retires in January. Members of the public can fill out the committee questionnaire at

HHS Appropriations

The Senate Appropriations Committee has released the text of the FY 2015 Labor-HHS-ED appropriations bill adopted by the subcommittee in June and the accompanying committee report. A full committee markup of the bill has not been scheduled and the outlook for full committee consideration is unlikely. Instead, it is expected that this and other appropriations bills will be folded into a continuing resolution that will fund the government at current spending levels until after the upcoming elections.

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

Courts Split on ACA Subsidies

Tuesday, July 22, was a very dramatic day for those concerned with the future of subsidies for the purchase of health insurance (premium tax credits) provided under the Affordable Care Act (ACA). First, a three-judge panel of the federal Court of Appeals for the District of Columbia (DC) Circuit ruled two-to-one, in Halbig v. Burwell, that the ACA did not authorize the provision of premium tax credits to individuals in states not operating their own exchanges. Hours later, a three-judge panel of the federal Court of Appeals for the Fourth Circuit (in Richmond, VA) unanimously reached the opposite conclusion, in King v. Burwell.

While initial decisions of federal courts of appeal are made by three-judge panels, losing parties may request that the court re-hear the case “en banc” – i.e., with all (usually) eleven judges participating. The administration intends to request an en banc hearing in the DC case, and the plaintiffs are expected to do so in the Fourth Circuit case. The request in the DC court is likely to be granted, and the re-hearing process will likely take several months. The Fourth Circuit, though, may decline to grant a hearing en banc, if one is requested, since the initial panel’s decision was unanimous. The plaintiffs have the option of appealing directly to the Supreme Court, but normally, “The Supremes” (as they are often called in legal circles – really!) do not accept cases unless there is a clear split among the circuit courts.

Meanwhile, the provision of tax credits will not actually be affected until the issue is settled, either because the various federal circuit courts of appeal ultimately agree on the law’s interpretation, or because the Supreme Court rules on the issue. Currently, there are similar cases pending in Oklahoma and Indiana. Thus, the issue may not be resolved until after the ACA’s 2015 open enrollment period.

The basis of the cases is the wording of the ACA statute, which says that premium tax credits can be awarded to eligible individuals purchasing coverage in exchanges "established by the state."  Those challenging the law contend that these credits may not be awarded to individuals in states that are using the federal exchange (“Marketplace”) rather than a state-run exchange. Basically, the DC Circuit Court has interpreted this language literally, while the Fourth Circuit Court deferred to the IRS interpretation of the law, and apparent congressional intent, under which eligible individuals may receive the subsidies regardless of whether their state runs its own exchange or uses the federal exchange. (In fact, most states that avail themselves of the federal exchange do not rely on it completely; they undertake some of the duties of exchanges themselves.)  Currently, 16 states and D.C. operate their own exchanges, while the federal government administers the remaining 36.

The opinion of the U.S. Court of Appeals for the D.C. Circuit in Halbig v. Burwell is available here. The opinion of the U.S. Court of Appeals for the Fourth Circuit in King v. Burwell is available here.  For more information, see this “Brief Consumer Guide to Health Law Court Decisions,” and this article from Kaiser Health News. See also, this article about the decision, and this article about potential state “workarounds” from Politico.

Uninsurance Fines and Other Rules Governing ACA Advance Premium Tax Credits                                                                                                      

From Kaiser Health News:

Health Law's “Uninsurance” Fine Capped At $2,448 For Individuals

From Health Affairs Blog:

On July 24, 2014 the Internal Revenue Service released final and temporary and proposed regulations addressing issues that are presented by the premium tax credit program. The IRS also released drafts of the forms that individuals, insurers, and employers will use for reporting information to the IRS necessary for reconciliation of premium tax credits and for the enforcement of the individual and employer mandate programs. Finally, the IRS set the maximum individual mandate penalty for individuals whose income is high enough that they pay the penalty as a percentage of income rather than a flat dollar amount. This amount is established by the statute as the average cost of a bronze level plan for the applicable family size for 2014 and was set by the IRS at $2,448 per individual annually, up to $12,240 for families of five or more.

Network Adequacy

From the Catalyst Center:

In an effort to keep the cost of health insurance premiums low, many insurers who sell health plans through the marketplaces have narrow networks of providers. Families who purchased marketplace plans are discovering their providers of choice are not in network. Faced with paying the full cost of services for an out-of-network provider, they must decide if they can afford continuity of care. And, as reported in this article, it is not always easy to find an in-network provider, as some are limiting the number of patients they accept with marketplace coverage. Washington State and New York have already enacted new standards to ensure network adequacy and protect consumers from out-of-pockets costs for seeking care outside of a health plan's network. The National Association of Insurance Commissioners is adding new consumer protections to its model law. In addition, the Obama administration and state insurance regulators are looking to create new network standards for marketplace plans based on Medicare network adequacy rules. (Source: To Prevent Surprise Bills, New Health Law Rules Could Widen Insurer Networks, by Robert Pear, The New York Times, July 19, 2014)   


Social Security Administration’s New Disability Coalition Seeks Comments –  Deadline: August 15

From the Social Security Administration:

We are very excited to inform you that Social Security has established a National Disability Coalition. The National Disability Coalition provides an opportunity for all interested stakeholders to share their unique insights on topics of particular interest to Social Security early in the process and directly with policy makers. Further, it provides an opportunity for stakeholders to hear from one another.

As a first step in the National Disability Coalition, we are inviting you to participate in an online comment forum on the Disability Decision Process.  The online forum is now open for public ideas and comments via IdeaScale through August 15, 2014. To participate in the online forum and submit your ideas and comments, you must register at the site. Please share this information with others in your organization and networks.

Medicaid Waiver Information on

From CMS:

We have been working to make a number of improvements to the waiver and demonstration pages on The goal was to make the information more accessible and searchable by state and by waiver authority. We hope you find the new page modern and interactive. The new page includes additional real-time search features to make it easy to find specific types of waivers or to search on multiple data points. Documents are presented in a more user-friendly way, and fewer clicks are needed to navigate the information about each waiver.

We also recently improved the 1115 public comment system. In addition to a real-time posting of comments, it’s now also possible to attach documents to comments. Those documents are available online immediately with the other public comments. Please take a moment to visit our new page at And don’t forget to update your bookmarks if you had bookmarked the old page!  You can also sign up to get automatic updates whenever a new waiver is posted for public comment. Go to the homepage (bottom right-hand corner) and enter your email address under the heading “Stay Connected.” 


From the National Disability Navigator Resource Collaborative (NDNRC):

  • Blog post on recently issued CMS guidance on the grace periods that consumers have for missing premium payments. To read our blog post on this guidance, click here.
  • Recent presentation at Georgetown University Law School’s O'Neill Institute entitled “The ACA and People with Special Health Care Needs.”
  • To view all the other prior presentations done by the NDNRC, check out the webinars and presentations page of its materials section.

Information to Provide Enrollment Assistance:

  • A recent CMS webinar offers tips and best practices for helping a consumer through the process of resolving an inconsistency in his or her application, along with links to resources with more information.
  • A new brief from the Center for Budget and Policy Priorities provides a quick overview of the issue and tips for what assisters can do to help consumers respond to requests from the marketplace. 
  • In the Loop released a shareable fact sheet with a collection of tips for assisters to help consumers navigate the process. 


August is National Children’s Eye Health and Safety Month

The NCFPP, working with the National Center for Children’s Vision and Eye Health, has put together resources to raise awareness of issues related to children’s vision and the importance of screening. Please help spread the word. Visit the media toolkit to find:

  • Sample articles and a family story to include in your newsletters
  • Materials specifically for CYSHCN to share with families
  • Sample Facebook postings and tweets
  • Posters to print to share at community events and/or clinics
  • Web buttons / graphics to post on your website

Please visit to share these resources in your communities.

CMS Oral Health Initiative and Other Oral Health Related Items

The Centers for Medicare & Medicaid Services (CMS) released an informational bulletin providing an update on the CMS oral health initiative and other oral health related items. The bulletin describes an array of CMS resources available to support states in their efforts to improve the delivery of dental and oral health services in Medicaid and CHIP, discusses how CMS policy supports dental workforce innovations, addresses the use of oral health quality measures to encourage improvement and track progress, and encourages states to adopt the use of three new risk-based dental billing codes to improve care and the use resources. Click here to view the informational bulletin. 

Briefing on Rx Response: A Disaster Response Program 

The Rx Response Program is a nonprofit that functions to help patients in areas affected by natural disasters obtain access to their medicines. The program is designed to be a one-stop shop to assist the public and private sectors and the government. A Google Map shows the disaster- affected area to indicate which pharmacies are open and which are closed. Currently, seventy-five percent of the pharmacies in the United States are live on the map. The program was vital in providing information during Hurricane Sandy in New York and New Jersey to ensure that patients would receive their prescriptions. The program has a notification system set up by states and updated by localities. Click here for more information or to sign up for notifications.