September 24 Washington DC Update
Washington DC Update 9/24/14
Greetings from Washington! Congress is out of session again, until after the mid-term elections. In their desire to get out of town fast, members of Congress passed, among other bills, a “continuing resolution” (CR) to keep the government funded until December 11, and reauthorization of the Emergency Medical Services for Children Program. Read more about these developments and more in this week’s Update.
UPCOMING WEBINARS AND CALLS
Mental Illness, Violence, and Guns: The Importance of Early Intervention
Wednesday, October 1, 7:00-8:00 pm ET
The International Bipolar Foundation will sponsor this webinar to discuss the actual data regarding mental illnesses and their link with violence, and the importance of early intervention in addressing such a link. Register here.
A Conversation about Telehealth and Children with Special Health Care Needs
Wednesday, October 8, 3:00-4:00 pm ET
Family Voices of California is presenting this webinar, at which speakers from The Children's Partnership, Center for Connected Health Policy, and UC Davis Children's Hospital will discuss the definition of telehealth, how it can be used to improve care for children with special health care needs, and how advocates can help promote its wider adoption. Learn more and register here.
By the way: Stories Sought on Children Who Received Health Care through Telehealth: The Children's Partnership would like to interview families of children with special health care needs who have experience with telehealth/telemedicine. With a grant from the Lucile Packard Foundation for Children's Health, the Partnership is working with the Center for Connected Health Policy and UC Davis to examine how telehealth can be used to improve care for children with special health care needs. Families willing to share their story should contact Jacob Vigil at firstname.lastname@example.org, or (310) 260-1220.
“Beyond the Basics” Review Series
As detailed below, the Center for Budget and Policy Priorities (CBPP) is conducting refresher webinars from its “Beyond the Basics” series. These webinars are intended for those working on the implementation of the Affordable Care Act (ACA) including navigators, assisters, Certified Application Counselors (CACs), and others assisting consumers apply for coverage in a Marketplace. Register here for any of the webinars below.
Reviewing Beyond the Basics: Eligibility for Coverage Programs
Thursday, October 9, 2:00-3:30 ET
This webinar will provide an overview of ACA coverage options and requirements, will broadly explain how eligibility and enrollment in the Marketplace works for new applicants, and will describe the renewal process for premium tax credits, cost-sharing reductions and qualified health plans.
Reviewing Beyond the Basics: Premium Tax Credits
Thursday, October 16, 2:00-3:30 ET
This webinar will cover eligibility for premium tax credits and how offers of employer-sponsored insurance can affect eligibility. We will also discuss how premium tax credits are calculated, how they are recalculated when circumstances change and how the reconciliation process will work.
Reviewing Beyond the Basics: Tax Rules and Determining Eligibility
Thursday, October 23, 2:00-3:30 ET
This webinar will cover the tax-based rules used to determine eligibility for premium tax credits and Medicaid. The webinar will detail how these rules are applied to determine household size and what counts as income through the use of real-life examples.
Reviewing Beyond the Basics: Plan Design
Thursday, October 30, 2:00-3:30 ET
This webinar will cover the cost-sharing charges in marketplace plans, eligibility for cost-sharing reductions, and how cost-sharing reductions affect costs for consumers. The webinar will also cover how to evaluate marketplace plans based on cost-sharing and other elements and will walk through the plan selection process.
Please note only the first 1,000 people who sign into each webinar can be accommodated. Those unable to participate can access a video recording of the webinar at the CBPP Beyond the Basics website at www.healthreformbeyondthebasics.org, which also provides other resources.
On September 18, the Senate approved the House-passed “continuing resolution” (CR). The President signed the bill the next day. (See “What’s a Continuing Resolution and Why Does it Matter?” from the White House blog.) This CR will keep discretionary programs of the government (including the Maternal and Child Health Block Grant) funded until December 11. Each program will receive roughly "level funding," i.e., the same amount of funding it received during the previous fiscal year. However, the law includes $88 million in new funding to address the Ebola outbreak in Africa, necessitating a .06 percent across the board cut of existing programs to stay within previously established spending caps. Upon the expiration of the CR, Congress (which will include "lame ducks" -- those not returning in the next session due to retirement or loss of re-election) will either pass appropriations legislation to last the rest of the 2015 fiscal year (through September 2015), or pass another CR lasting long enough to let the newly elected Congress decide what to do in January. See this story from The Hill for more information and political background.
Emergency Medical Services for Children
On September 16, the House voted to reauthorize the Emergency Medical Services for Children Program, which the Senate had already approved. The 30-year-old program provides grants and other support for special equipment and research needed for pediatric emergency care, including care for children with special health care needs. The legislation now goes to the President’s desk, and he is expected to sign it.
UN Convention on the Rights of Persons with Disabilities
On September 17, retiring Senator Tom Harkin (D-IA) asked the Senate for “unanimous consent” (UC) for the Senate to debate for two hours and vote up or down on a resolution to recommend ratification of the U.N. Convention on the Rights of Persons with Disabilities (CRPD). The United States and over 150 other countries have already signed the treaty, but it also requires ratification. (Technically, the Senate cannot “ratify” a treaty; it approves or rejects a resolution of ratification. See this explanation from the Senate website.) Unfortunately, Senator Mike Lee (R-UT) expressed objection, so the CRPD resolution could not come up for debate and a vote. To approve ratification of the treaty would take a two-thirds vote of the Senators present. In the last Congress, the same UC offer was agreed to and a vote was taken, but the resolution failed. In this Congress, the Senate Foreign Relations Committee again considered and recommended, by a 12-6 vote, that the treaty be ratified. You can watch Senator Harkin’s remarks and exchange with Senator Lee here (click “Watch this session from the beginning,” and go to hour: minute 2:41:25). For more information on the treaty, including some of the arguments against it (in “FAQs” and “Myths and Facts”) see this webpage from the United Nations and/or this website on the treaty. Family Voices has endorsed the CRPD, which is based largely on the Americans with Disabilities Act.
Hearing on CHIP Reauthorization
Last week, Senator Jay Rockefeller (D-WV) – a leading child health advocate who is retiring at the end of this Congress* – convened his last hearing as the chairman of the Senate Finance Committee’s Subcommittee on Health. The topic was the reauthorization of the Children’s Health Insurance Program (CHIP), which is funded only through FY 2015 (ending September 30, 2015). Child advocates have been pushing Congress to extend funding for the program before the new Congress convenes in January (when it may be more politically difficult to get the legislation passed). On Sunday, September 22, the New York Times ran an editorial advocating the same position. Senator Rockefeller has introduced a bill to fund the program through FY 2019. See this article from the Commonwealth Fund for more information about the hearing. Testimony and a video of the hearing can be found here.
* The term "Congress" is used in two ways. More commonly, it refers to the whole body made of up the U.S. Senate and House of Representatives (legislative branch of government). It can also be used to refer to the specific body elected for a given two-year period, identified by a number representing how many Congresses there have been since 1789. The Congress beginning in January 2015 will be the 114th Congress. (As you may recall from school days, all House members are elected every two years. Senators are elected for six-year terms, so about one-third of that "chamber" is elected every two years.) Each Congress has two one-year "sessions." See https://beta.congress.gov/help/legislative-glossary#c.
Hearing on Overcoming Persistent Barriers to Economic Self-Sufficiency for People with Disabilities
Last week, retiring Senator Tom Harkin (D-IA) – a long-time advocate for people with disabilities – held his last hearing as the chairman of the Senate Committee on Health, Education, Labor, and Pensions (HELP). The topic was “Fulfilling the Promise: Overcoming Persistent Barriers to Economic Self-Sufficiency for People with Disabilities.” Earlier, the committee had solicited public input on this topic. Visit the HELP Committee website for more information, including testimony and a video of the hearing. Family Voices honored Senator Harkin for his lifetime of work on disabilities issues at its DC meeting in May.
7.3 Million Enrolled through the ACA Exchanges
On September 19, Centers for Medicare and Medicaid Administrator Marilyn Tavenner told the House Oversight and Government Reform Committee that there are currently 7.3 million people enrolled in health insurance plans on the Obamacare exchanges. This is the first update that the administration has provided since May. At that time, it was estimated that about 8 million people had enrolled on the exchanges, but, as predicted, some who enrolled did not end up paying premiums. The figure is higher than some critics and the Congressional Budget Office had predicted. Read more in this story from Politico.
Important Information about Enrollment and Re-Enrollment in ACA Plans and Medicaid
Dates. The administration is gearing up for the next open enrollment period under the ACA, which begins on November 15 and ends on February 15. Here are the important dates to keep in mind:
- November 15, 2014. Open Enrollment begins to apply for, keep, or change coverage.
- December 15, 2014. Enroll by the 15th for new coverage that begins on January 1, 2015. To change plans, enroll by the 15th to avoid a lapse in coverage.
- December 31, 2014. Coverage ends for 2014 plans. Coverage for 2015 plans can start as soon as January 1st.
- February 15, 2015. This is the last day to apply for 2015 coverage before the end of Open Enrollment.
For more information about enrollment dates, effective dates and special enrollment periods, click here.
Renewals. This postfrom the Georgetown University Center for Children and Families (CCF) “Say Ahhh!” blog provides a detailed discussion about a recently finalized rule from the Centers for Medicare and Medicaid Service (CMS) regarding renewals of health plans purchased through ACA Exchanges and redetermination of premium tax credits. As Tricia Brooks writes, “the good news is that the final rules provide an opportunity for consumers to be automatically re-enrolled in the same or a similar plan without taking action. The downside is that the renewal is based on the consumer’s 2014 premium tax credit using the 2013 federal poverty thresholds.” Ms. Brooks goes on to note that advocates have concerns about the way that issuers can substitute one plan for another they are discontinuing. In addition, she explains why individuals who are receiving tax credits to purchase insurance should not just let their policies renew without taking any action.
Medicaid. While individuals with ACA insurance plans may see automatic renewal of their coverage, that is not the case for Medicaid beneficiaries. As explained in this article from the Commonwealth Fund, many individuals are not aware of the ACA’s requirement that they re-apply for Medicaid annually even if their circumstances have not changed.
Toolkit for CACs
Enroll America has developed a toolkit for Certified Application Counselors (CACs), a type of in-person assister who can help people secure insurance under the ACA. The new toolkit offers resources for existing and new CAC organizations and includes information about training and recruiting CACs, requirements for CAC-supervising organizations, and promising enrollment practices.
Consumer Assistance/Navigator Resources
The National Academy for State Health Policy (NASHP) has archived its September 9 webinar on Care Coordination under the Medicaid Benefit for Children and Adolescents. The webinar provided a federal perspective from the Centers for Medicare & Medicaid Services on opportunities and promising strategies for states to coordinate care for children and adolescents enrolled in Medicaid. In addition, presenters from North Carolina and Oregon spoke about strategies their states are using to bridge multiple systems for Medicaid-enrolled children. This was the the fifth and final in a series of webinars on the Medicaid benefit for children and adolescents (EPSDT). In conjunction with this webinar series, NASHP 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. Click to see the summary, speakers, and slides, and here to listen to the webinar.
See also this 2010 article, “Managing the ‘T’ in EPSDT,” by Kay Johnson.
Medicaid Managed Care
The National Health Law Program (NHeLP) recently released a set of four issue briefs on Medicaid Managed Care (addressing network adequacy, among other topics), plus a special edition of their newsletter, Health Advocate, which includes NHeLP's model recommendations on modernizing the Federal regulations that govern Medicaid managed care programs.
Lauren Agoratus, from NJ’s Statewide Parent Advocay Network (the Family Voices State Affiliate Organization and Family-to-Family Health Information Center) has authored this helpful article in the magazine Exceptional Parent Magazine: Health Coverage Options for Children with Special Health Care Needs: What Happens When They Age Out of Children's Plans? (PDF).
Home Care and Labor Law
Action Steps for Consumers and Advocates Regarding the New Home Care Rule: How to Prevent Service Cuts and Protect Consumer-Directed Programs (PDF)
Bazelon Center for Mental Health Law.