Washington DC Update (2/15/17)

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Greetings from Washington!

In the past week, the Senate has confirmed several Cabinet Secretaries, including the Secretary of Health and Human Services. On the House side, some reports indicate that the Republicans may be getting closer to proposing legislation to repeal the Affordable Care Act, either replacing it in a piecemeal fashion or repealing it on a delayed basis until a replacement plan is developed. On the regulatory front, the administration recently issued a new rule that will require home health agencies to be more responsive to patients and their caretakers, and may soon issue a rule to help insurers participating in ACA Exchanges.  And, if you ever have questions about health policy or terminology, you can turn to the new, online edition of The Essentials of Health Policy: A Sourcebook for Journalists and Policymakers.


Rule on Insurance Stabilization Payments and Essential Benefits?

According to Politico Pulse, a regulation to stabilize insurance companies participating in the ACA exchanges may be coming soon, since it recently was cleared by the Office of Management and Budget, an arm of the White House. The rule is expected to provide some of the measures requested by insurance companies to reduce their risk, including a tightening of special enrollment period qualifications.  According to Politico, some sources expect some modifications to the essential benefit package, too.



Secretary of HHS 

Despite strong Democratic opposition, Rep. Tom Price, MD (R-GA) was confirmed by the Senate last week, along a party-line vote, to be the Secretary of Health and Human Services (HHS).  Hours later he was sworn into office by Vice-President Pence.  Secretary Price has been a long-time opponent of the Affordable Care Act (ACA).  He authored a 2013 bill to repeal and replace the law, which could become a model for any administration proposal on replacement legislation. The Secretary can be followed on Twitter at @SecPriceMD.

CMS Administrator

The president has nominated Seema Verma to head the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, Medicaid and the ACA. The Senate Finance Committee will hold her confirmation hearing this week. Ms. Verma has consulted with a number of states on how to restructure their Medicaid programs under federal waivers, and developed the Indiana waiver plan under then-Governor Mike Pence. Participants in the Indiana program make contributions to special health savings accounts and can be penalized for failure to make these contributions.

ACA Repeal and Medicaid Restructuring

There are slight indications that the Republicans are moving closer to acting on their plans to “repeal and replace” the Affordable Care Act (ACA or “Obamacare”). House Republicans reportedly are meeting with the nonpartisan Congressional Budget Office (which makes the official estimate of how much a bill will cost) about the details of tax credits, high-risk pool funding, and changes to Medicaid that could be included in a repeal bill. The Hill reports that key House committees are planning to take up (“mark up”) their repeal bills by March 1, and House Speaker Paul Ryan (R-WI) has indicated that he would like the House to pass a bill by the end of March.  The legislation would take the form of a “reconciliation bill,” which would only require 51 votes in the Senate rather than the usual 60 needed to act on legislation in that chamber.

Meanwhile, Republican Senators from states that have taken up the ACA’s Medicaid expansion have begun to meet to figure out their positions on any repeal legislation.  If the Medicaid expansion part of the ACA is repealed, these states will lose many millions of federal dollars. At the same time, if the Medicaid program is restructured into a block grant or per capita cap payment system, states that did not expand Medicaid may lose out when a baseline for the block grants or caps is calculated.

The path toward ACA repeal will not be an easy one.  There have always been many thorny policy issues to be worked out, and now there is also an increasing amount of popular opposition to repeal.  Members of Congress have, in some cases, been overtaken by constituents protesting at town-hall meetings, to the point that some Republicans fear for their safety.

Other Legislation


On February 7, Representative Rosa DeLauro (D-CT) and Senator Kirsten Gillibrand (D-NY) reintroduced the Family And Medical Insurance Leave (FAMILY) Act. The legislation would provide up to 12 weeks of paid leave for a pregnancy, the birth or adoption of a child, to recover from a serious illness, or to care for a seriously ill family member, based on current Family and Medical Leave Act (FMLA) guidelines. Workers on leave would receive up to 66 percent wage-replacement. The cost would be paid for through small employer and employee contributions; the average worker would pay $1.50 per week. Benefits would be portable rather than tied to any one employer. Currently, H.R.1439 has 137 cosponsors and S.786 has 27, all Democrats.


CMS Tools and Information on Mental Health and Substance Use Disorder Parity and Children and Youth with Mental Health or Substance Use Disorders

CMS has published two new technical assistance documents to assist state policy makers with the implementation of mental health and substance use disorder parity requirements for Medicaid and CHIP programs. The Parity Compliance Toolkit provides technical guidance and tools for states to help them understand and perform the parity analysis for each of the requirements of the final parity rules. The Parity Implementation Roadmap provides policymakers a practical overview of how to approach parity implementation and compliance from a planning and operational perspective. The Medicaid.gov webpage on Behavioral Health provides additional information on mental health parity.

Policy Brief on Medicaid Cuts

The School Superintendents Association (AASA) has released a policy brief – In Cutting Medicaid: A Prescription to Hurt the Neediest Kids – about the potential impact of proposed changes to the Medicaid program on students with disabilities and students from low-income families.

WORTH REPEATING: Medicaid and Children with Special Health Care Needs

This issue brief from the Kaiser Family Foundation (January 31, 2017) describes children with special health care needs (CSHCN) and explains how they can become eligible for Medicaid, and describes the services for CSHCN that are covered by Medicaid and how much Medicaid spends on these services.

WORTH REPEATING: Title V and Medicaid/CHIP Interactive Worksheets

The Catalyst Center has developed two interactive worksheets that can be filled in to provide an overview of your state’s Title V program or Medicaid and Children’s Health Insurance Program (CHIP). Each worksheet includes resources to help users find and insert state-specific information to help demonstrate the importance of Title V, Medicaid and CHIP for children with special health care needs (CSHCN) in their state.


The worksheets were created as companion materials to the Catalyst Center’s Public Insurance Programs and Children with Special Health Care Needs: A Tutorial on the Basics of Medicaid and the Children’s Health Insurance Program (CHIP)


New Source for IDEA Information

The US Department of Education’s IDEA website is down, but the information that was on that site, including resources from the now-non-existent National Dissemination Center for Children with Disabilities (a.k.a. NICHCY) can be found on the website of the National Center for Parent Information and Resources, www.parentcenterhub.org/repository/idea.  That website also includes many other early intervention, special education, and transition resources.

New Rules on Home Health Agencies

Last month, the Centers for Medicare and Medicaid Services (CMS) issued a final rule on the Conditions of Participation (in Medicare and Medicaid) for home health agencies. It is the first major overhaul of these rules in almost 30 years. As explained in an article from Kaiser Health News, the new rules will place many new requirements on home health agencies, some of which are intended to make the agencies more responsive to patients and their caregivers. Home health agencies also will be expected to coordinate all the services that patients receive and ensure that treatment regimens are explained clearly and in a timely fashion. The new rules are set to go into effect in July, but may be delayed as the administration reviews regulations that have been drafted or finalized but not yet implemented.

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