October 1 Washington DC Update
Washington DC Update 10/01/14
Greetings from Washington! Congress remains in recess, but there are still things happening in Washington, particularly in preparation for the next open enrollment season under the Affordable Care Act (ACA), which begins in 45 days (on November 15)! Also, the Center for Medicare and Medicaid Services (CMS) has issued two sets of important “Frequently Asked Questions” (FAQs) – one regarding Medicaid coverage of services for Autism Spectrum Disorder (ASD) and another on coordination of benefits between Medicaid/CHIP and other third-party payers. (See “Other Resources” below.) In other news, CMS has reported that an additional 8 million people have enrolled in Medicaid since the last open enrollment season began, for a total of over 67 million people in the program.
UPCOMING WEBINARS AND CALLS
[Please note that the webinars are not all listed in chronological order, as some are part of a series, so some earlier ones may follow later ones.]
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.
Enroll America Webinar Series on Open Enrollment
To address questions about the upcoming open enrollment period, Enroll America is sponsoring a series of webinars this month:
Round Two: Prepare for Success in the Second Open Enrollment Period (OE2)
Thursday, October 2, 2:00 pm ET
This webinar will prepare participants with the must-know information and key messages to help consumers get covered and stay covered during the second open enrollment period. How will OE2 be different from OE1? What are the most effective messages for engaging consumers? What outreach and enrollment resources will Enroll America provide for partners in the coming weeks and months? This webinar is appropriate for all partners working on outreach and enrollment. Click Here to Register.
Outreach 2.0: Applying Lessons Learned When Connecting With Specific Uninsured Communities (Young Adult, Latino, and African American)
Wednesday, October 8, 2:00 pm ET
This webinar will address effective outreach and “in-reach” strategies identified during the first open enrollment period (OE1). Presenters will provide examples of data-informed tactics and unique solutions to challenges when conducting in-reach and outreach work. This webinar will focus specifically on how to engage young adult, Latino, and African American populations. Click Here to Register.
Successful Recipes to Reach Rural Communities
Tuesday, October 14, 4:00 pm ET
This webinar will cover things to consider when conducting rural outreach and will highlight practicable and replicable outreach strategies used during the first open enrollment period to engage the rural uninsured. Click Here to Register.
Building Capacity: Partner Engagement and Grassroots Organizing
Save the Date: Thursday, October 16, 1:00 pm ET
Grassroots organizing was a key factor in connecting individuals to marketplace, Medicaid, or Children’s Health Insurance Program coverage during the first open enrollment period (OE1). This webinar will present data-driven grassroots and partner engagement strategies to help maximize outreach and enrollment efforts, including how to build and sustain a volunteer program, increase in-person help in your community, and multiply your effect through innovative partner engagement work. This webinar is appropriate for community organizations working on outreach and enrollment.
Health Insurance Literacy: Key Considerations for Enrollment Stakeholders
Save the Date: Monday, October 20, 2014, at 2:00 pm ET
Working with Agents and Brokers
Save the Date: Thursday, October 23, 2014, at 4:00 pm ET
Enroll America’s Communicator’s Guide: How to Message Get Covered, Stay Covered
Save the Date: Monday, October 27, 2014, at 2:00 pm ET
Plan for Success! Monitor and Measure for Guidance
Save the Date: Wednesday, October 29, 2014, at 2:00 pm ET
Enroll America will also be sponsoring a blog series at #Ready4OE2.
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 email@example.com, 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 pm 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 pm 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 pm 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 pm 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.
SAMHSA Listening Session: Improving Community Mental Health Services
Save the Date: Wednesday, November 12, 9:00 am – 5:00 pm ET
The Substance Abuse and Mental Health Services Administration (SAMHSA) will be holding a listening session about criteria development for the Demonstration Programs to Improve Community Mental Health Services, established under Section 223 of the Protecting Access to Medicare Act of 2014. The law seeks to create certified community behavioral health clinics to focus on improving outcomes by increasing access to community-based behavioral health care, expanding the availability and array of services, and improving the quality of care delivered to people with mental and/or substance use disorders. Participants can attend the listening session in person or via webcast. Registration is required; registration information is forthcoming. Location: SAMHSA, Sugarloaf Conference Room, 1 Choke Cherry Road, Rockville, MD 20857
Senate Agreement on the ABLE Act
As approved in July by the House Ways and Means Committee, an amended version of the “Achieving a Better Life Experience (ABLE) Act” would create tax-favored savings accounts for people with disabilities that would not count toward the $2,000 individual asset limits that apply to the Supplemental Security Income (SSI) and Medicaid programs. Contributions would be capped at $14,000 a year and the accounts would be available only to individuals who acquired their disability before age 26. (For more details, see this publication from the Joint Committee on Taxation.) The Ways and Means Committee did not decide how to pay for the bill, and negotiations on that point have been taking place ever since. Meanwhile, in a recent statement, Senate negotiators announced that they have reached an agreement on how to proceed with the bill in that chamber. Although no details have come to light, and it is not known whether an agreement has been reached on the “pay-for,” the statement indicates that the key Senators - Ron Wyden (D-OR), Orrin Hatch (R-UT), Bob Casey (D-PA), and Richard Burr (R-NC) - are hopeful that a bill will pass both the House and Senate during the upcoming lame-duck session of Congress.
The Federal Marketplace
There are several items of interest concerning the Federally-Facilitated Marketplace (FFM) created to help people purchase insurance pursuant to the Affordable Care Act (ACA):
- The Federally-Facilitated Marketplace (FFM) website, www.healthcare.gov, will be getting an overhaul, making it easier for first-time users to sign up for health insurance. According to the Patient Services, Inc., (PSI) Government Relations Health Care Reform Update of September 22, 70 percent of consumers will be able to use a shorter and simpler online application format. There will be fewer screen pages, mouse clicks, and questions to navigate. The streamlined format will be available only for first-time applicants, however, and not for those that have previously obtained coverage through the FFM. It is also not intended for those with “complicated” household situations. An initial set of questions will determine whether the new or old format is suitable for each applicant, including questions about citizen status, whether everyone in the household lives at the same permanent address and whether dependents live with a parent but are not on their tax return. In addition, HHS is adding a “backward navigation” feature so that consumers can correct information on previous screens without having to start over. See also this article from the New York Times.
- There will be a number of new insurers selling plans on the federal Marketplace this year. According to this press release from the Department of Health and Human Services (HHS), the number of insurance companies offering plans in the 36 states that use the FFM is growing from 191 last year to 249 this year, a 25 percent increase. See also this article from the Commonwealth Fund. But…
- There may be waning interest in purchasing plans through the marketplace. According to this article about a poll conducted by “The Morning Consult,” fewer voters plan to purchase insurance on the exchanges this year compared to last year. The poll found that 47 percent of voters say they are not at all likely to purchase health insurance through an online exchange this year. At the start of open enrollment in 2013, only 28 percent of voters said they were not at all likely to purchase insurance on the exchange. The Congressional Budget Office estimates, though, that 13 million people will be enrolled on the exchanges in 2015, an increase of 5.7 million people from the current enrollment numbers. The Morning Consult poll also found that, among those who have already purchased insurance on the exchanges, 43 percent plan to keep their insurance plan, 29 percent plan to shop for a new plan, and 25 percent are undecided about what they will do.
- Most people found Marketplace plans to be affordable. According to a new Commonwealth Fund survey, 61 percent of people who paid premiums for a plan they purchased found it very or somewhat easy to pay them. More than two-thirds of adults with low-to-moderate incomes (defined as under $28,725 for an individual) had a premium of less than $125 a month for single coverage, similar to people with employer coverage. But, …
- Almost 2 million people will be caught in the “family glitch.” According to an analysis by the American Action Forum, about 1.93 million Americans will not have access to affordable health insurance coverage because of the ACA's so-called "family glitch.” Under the ACA, individuals in a family are eligible for subsidies to purchase insurance if their family incomes are above the Medicaid eligibility level and below 400 percent of the Federal Poverty Level, and they do not have access to “affordable” employer-based insurance. The “family glitch” has resulted from the Internal Revenue Service (IRS) interpretation of an ambiguity in the law. Under IRS regulations, the availability and affordability of employer-based coverage only considers the availability of and cost to the employees for individual – not family – policies, so individuals in a family are not eligible even if the cost of family coverage actually exceeds the threshold for “affordability” (9.5 percent of family income) or the employer does not offer family coverage. Based on Census data, the researchers estimate that 947,000 spouses, 402,000 children under 19, and 582,000 dependents between 19 and 26 are affected. If CHIP funding is not renewed, another 2.3 million children could fall into the glitch. During the rulemaking process, child health advocates urged the IRS to consider the cost of family coverage, rather than only the employee’s coverage, in determining affordability but were not successful. Unless the IRS should change its policy, a change in the law will be required to fix the family glitch.
- Provider networks are narrower, but there are few complaints. A study of six states by the Georgetown Center for Health Insurance Reforms, funded by the Robert Wood Johnson Foundation, found that insurers significantly revamped their networks ahead of ACA implementation, and many offer narrower networks than they did in the past. In Colorado, Maryland, New York, Oregon, Rhode Island, and Virginia, consumers and providers experienced some confusion about which networks included which providers, but ultimately there were few consumer complaints about the ability to obtain in-network services. While three of the six states have taken action to improve provider directories, the researchers concluded that it is unlikely that state legislatures, officials and regulators will dramatically change network adequacy standards, at least in the short-term.
Finally, WORTH REPEATING (from last week’s Update): People who already have insurance through the federal Markteplace will be automatically re-enrolled (for better or worse, as discussed below), while those enrolled in Medicaid will have to re-enroll. See below.
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 that is being discontinued. 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 Re-Enrollment. 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.
AND REMEMBER these important dates:
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.
OTHER NEWS AND INFORMATION
Funding for Youth Mental Health
HHS announced $99 million in new grants, including $34 million to train 4000 additional mental health professionals and over $48 million help teachers recognize signs of trouble in young people and get them the services they need. There will also be $16.7 million provided to support 17 new Healthy Transitions grants to improve access to treatment and support services for youth and young adults ages 16 to 25 that either have, or are at high risk of developing, a serious mental health condition. These grants are part of the administration's "Now Is the Time" initiative to reduce gun violence. For more information and a list of grantees, see the HHS announcement.
Orphan Drug Coverage Varies among Health Plans
A study by Avalere Health, published in the Journal of Managed Care & Specialty Pharmacy, found that insurance coverage of a sample of drugs used to treat rare diseases varied within and across states, and that bronze plans were far less likely than silver plans to cover the 11 products included in the analysis. Results also showed that select drugs identified as the only FDA-approved product indicated for a certain rare disease experienced relatively robust coverage (at least 65% of plans) but often included some form of utilization management. The researchers, funded by Novartis Pharmaceuticals, found that coverage of selected rare disease therapies also is complicated by the fact that plans cover certain products under the medical benefit versus the pharmacy benefit. The drugs studied are used to treat various rare diseases, including Huntington disease, Gaucher disease, sickle cell anemia, hydatidosis, and advanced soft tissue
sarcomas. The study surveyed 84 formularies for lower-tier bronze and silver plans in 15 states that are expected to account for more than 60 percent of total Marketplace enrollment nationwide (including California, Florida, Texas, New York, New Jersey, Ohio, Pennsylvania, and Virginia). The researchers concluded that “with limited treatment options and the potential for cost sharing and utilization-management barriers, increased data transparency to assist patients in navigating formularies will be a critical step for patients to fully understand their access to needed therapies in each plan.”
Medicaid Enrollment Up by 8 Million
According to the latest figures from CMS, about 8 million people signed up for Medicaid since last year's open enrollment began, and the program now serves over 67 million people. The number of people enrolling increased nearly 14 percent over the average monthly enrollment for July through September of last year.
Which Issuers Overlap Between CHIP and Marketplaces?
Consumer advocates have been concerned about insurance coverage “churn” – when an individual’s coverage shifts back and forth between Medicaid and private insurance due to changes in family income. The effects of such churning for children can be reduced if the child remains with the same managed care plan in both the public and private sectors. The National Academy for State Health Policy (NASHP) has produced an updated map showing the overlap between health insurers offering managed care plans in a state's Children's Health Insurance Program (CHIP) and those offering plans in a state's insurance marketplace. A full list of marketplace and separate CHIP issuers by state is available here. This information complements a report, issued by the Association for Community Affiliated Plans, which analyzes the extent of overlap between marketplaces and Medicaid managed care issuers by state. Since issuers may change in 2015, NASHP researchers would like state advocates to let them know about any changes made in 2015 CHIP and marketplace issuers in their states by contacting Keerti Kanchinadam at firstname.lastname@example.org.
CMS FAQs: Identification of Medicaid Beneficiaries’ Third Party Resources and Coordination of Benefits with Medicaid and CHIP (updated September 11, 2014). http://medicaid.gov/Federal-Policy-Guidance/Downloads/FAQ-09-04-2014.pdf
CMS FAQs: Medicaid Coverage of Autism Services. These FAQs, released last week, relate to Medicaid services for Autism Spectrum Disorder (ASD), and help to explain the July 2014 guidance issued by CMS on Medicaid coverage of services for people with ASD. To see the FAQs and additional information about Medicaid and ASD, see http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Population/Autism-Services.html.
Best Practices in Patient and Family Engagement (PFE). The Caregiver Action Network (CAN) announced the results of its recognition program, Advancing Excellence: Best Practices in Patient and Family Engagement (PFE). CAN identified “25 of the Nation’s Best Practices” from across the United States – including examples of patients, caregivers, hospital staff and hospital systems creating innovative programs to help ensure healthier outcomes for patients. Information about outstanding best practices, descriptions of each of the top 25 programs, and the final report can be found here.