Category Archives: Family Voices News

Washington DC Update (2/15/17)

If you want to read the full newsletter or past issues please click here …  Washington DC Update Past Issues.

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.

THE ADMINISTRATION

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.

IN CONGRESS

Nominations

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

The FAMILY Act

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.

MEDICAID/CHIP NEWS, INFORMATION, AND RESOURCES

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.

Worksheets:

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)

OTHER NEWS AND INFORMATION

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.

Washington DC Update

Greetings!

As an elected member of the Family Voices National Board of Directors and Member of the Policy Committee my responsibilities include working closely with the Washington DC based Family Voices Policy Team on issues impacting families. When Congress is in session The Policy Team distributes “Washington DC Update” on a weekly basis.  As you probably know the new administration and congress are making many legislative decisions that will impact families who have a family member with disabilities.  It is my intent to post relevant information from the update on a regular basis. Below are excerpts from the Washington DC Update published on January 25, 2017.  If you want to read the full newsletter or past issues please click here …  Washington DC Update Past Issues.                                                                                                            

Best Regards,                                                                                        

Tom Rose, Executive Director – Family Voices Colorado

WASHINGTON DC UPDATE –  1-25-17

THE ADMINISTRATION

ACA Executive Order

Hours after his inauguration, the new president issued an Executive Order directing the Secretary of Health and Human Services and other applicable agency and department heads to “exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications.”

ACA legal experts have come to differing conclusions (LA Times) about how much can be done by executive branch officials to thwart the operation of the ACA – that is, what actions ultimately would survive court challenge. Some think some quick changes could result, while others are just confused (Vox, 1/20).

The phrase “waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act,” may prompt administration officials to more liberally grant exemptions from the mandate for individuals to have insurance, or to waive or defer penalties for those who do not have insurance (i.e., undo the individual mandate) or for businesses that fail to provide it for employees when required to do so. In fact, a top presidential advisor indicated that the administration may, in fact, quash the individual mandate. Other experts are concerned that the very uncertainty created by the Order will cause insurers to pull out of the marketplace, ultimately causing premium increases and result in more uninsured individuals.

Another part of the Executive Order directs applicable agency and department heads to “exercise all authority and discretion available to them to provide greater flexibility to States and cooperate with them in implementing healthcare programs,” which may be a signal to provide much greater flexibility to states in implementing the Medicaid expansion, such as allowing them to impose work requirements or premium payments on newly covered beneficiaries.

Some observers have commented that what was done through executive power to interpret and implement that ACA can be undone by executive power. It is true that sub-regulatory guidance to insurers or state agencies (such as memoranda or FAQs) can be undone rather quickly. But changes to formal regulations – such as those implementing the law’s “Essential Health Benefits” provision – must follow the requirements of the Administrative Procedure Act, which requires time-consuming notice and comment periods.

These articles provide helpful analysis about the potential impact of the Executive Order: Trump Executive Order On ACA: What It Won’t Do, What It Might Do, And When (Timothy Jost, Health Affairs Blog, 1/20/17);  How Trump can use Obamacare to kill Obamacare (Politico, 1/22/17); Here’s what Trump’s executive order really means for Obamacare (Los Angeles Times, 1/21/17); How Trump’s executive order impacts future of ‘Obamacare’ (Associated Press, 1/21/17). And this just in (long list of things that the administration could do if it’s very aggressive: Executive actions Trump could take to change the ACA.

 

 

IN CONGRESS

ACA Repeal

Repeal legislation. As reported last week, the House and Senate both adopted a concurrent budget resolution (which does not need to be signed by the president), which is the first step in the ACA repeal process. The resolution instructs the House and Senate committees with jurisdiction over health care policy to develop legislation that will “reconcile” current law with the resolution – in this case, legislation to repeal parts to the ACA. This is supposed to happen by January 27, but that date could slip. The committee legislation will be compiled into a “reconciliation” bill.

A reconciliation bill can include only certain types of provisions to pass the Senate – those that are primarily budgetary in nature. In the case of the ACA, this includes the individual and employer mandates, the premium tax credit, cost-sharing subsidies, the Medicaid expansion, and the Prevention and Public Health Fund, which helps to fund many public health programs. Provisions that probably could not be included are some of the ACA’s consumer protections, such as the ban on pre-existing condition exclusions (that is, “guaranteed issue” of insurance), the ban on coverage caps, and the provision allowing children to stay on parents’ health plans until they are 26. But, there are no black and white rules about what can be included in a reconciliation bill; it will be up to the Senate parliamentarian to decide.

For example, it is not clear whether the ACA’s “Essential Health Benefits” can be repealed in a reconciliation bill. Notably, “habilitation services” (therapies to help children gain or retain skills, including behavioral therapies for children with autism) are among the benefits guaranteed by the ACA that were not customarily included in many insurance plans before the law’s enactment. The ACA benefit “Pediatric services, including oral and vision care” is also at risk.

Another important feature of a reconciliation bill is that it can be approved by the Senate with a simple majority (51 votes) rather than the 60 votes usually needed to advance legislation on which there is not unanimous consent. Since there are 52 Republican Senators, the reconciliation bill will pass if all of them vote for it. But, if all the Democrats and Independents vote against repeal, as expected, then the bill will fail if at least three Republicans oppose it. (Three must oppose it because the President of the Senate -Vice-President Pence – can vote to break a tie.)

Outlook. At this point it is unclear when the Republican leadership will take up the reconciliation bill to repeal the ACA, in part due to predictions about detrimental consequences of doing so, and in part due to political pressure. Various experts, including the American Academy of Acturies, the Urban Institute, and (just last week) the Congressional Budget Office (CBO), have predicted significant increases in the number of uninsured and the cost of insurance if the ACA’s mandate to have insurance is repealed while consumer protections (especially the ban on pre-existing condition exclusions) are kept in place. CBO estimates that 18 million people would lose insurance in the first year after repeal, and premiums in the non-group market would spike by 20 percent to 25 percent. Their estimate is based on repeal legislation that Congress passed in 2015 but President Obama vetoed.

Members of Congress have also been influenced by constituents, many of whom have been mobilized by various national and state health care, consumer and labor organizations, such as the Service Employees International Union (SEIU), Families USA, and Community Catalyst. Through these organizations and other sources, constituents have access to information about how ACA repeal would affect them directly (How the Republican plans to replace Obamacare could affect you, Washington Post, 1/17/17) or affect their states’ residents in general (Families USA fact sheets on the impact of ACA repeal on each state).

Recently, House Speaker Paul Ryan indicated that repeal and replacement would happen together within the first hundred days of the new administration, but was vague on exactly when (and how) that would be done. The president has indicated that a replacement should be put in place when or shortly after the ACA is repealed. Some House Members, have voiced concerns about repealing the ACA without simultaneously replacing it, and at least 10 Republican Senators are now on the record expressing concern, including: Sen. Alexander, Sen. Collins, Sen. Corker, Sen. Cotton, Sen. Flake, Sen. Isakson, Sen. Johnson, Sen. McCain, Sen. Murkowski, Sen. Paul, and Sen. Sullivan. At least 8 of the Republican Governors are warning Congress about the consequences of repeal, including: Utah Gov Herbert, Massachusetts Gov. Baker, Arizona Gov. Ducey, Michigan Gov. Snyder, Ohio Gov. Kasich, Arkansas Gov. Hutchinson, Nevada Gov. Sandoval,and Kentucky Gov. Bevin. (See positions of specific Republican governors.)

Replacement. Republicans have not yet coalesced around any replacement plan. The president told the Washington Post over a week ago that his team is almost finished drafting replacement legislation, but he doesn’t expect to unveil it until the Secretary of Health and Human Services (HHS) is confirmed. This may not come until mid- to late February. The president did not reveal any specifics about his proposed plan. It is possible that it will be based on a plan put forward by HHS Secretary-nominee Rep. Price in 2014 or a similar plan put forward by House Speaker Paul Ryan (R-WI) in his “Better Way” health care proposal. Among other things, both plans would provide tax credits to purchase insurance, encourage the creation of Health Savings Accounts (from which pre-tax dollars could be used to purchase health care), and allow the sale of health insurance plans across state lines.

Cassidy-Collins bill. On January 23, Senators Bill Cassidy, MD (R-LA), Susan Collins (R-ME), Shelley Moore Capito (R-WV) and Johnny Isakson (R-GA) released legislative text for the Patient Freedom Act of 2017, a comprehensive replacement plan for Obamacare. The bill would repeal the ACA’s individual and mandates, the actuarial value requirements related to the four “metal” categories of health plans, age-band limitations, and the benefit mandates. It would keep the ACA’s essential consumer protections, including the prohibitions on annual and lifetime limits, pre-existing condition exclusions, and discrimination, and would retain coverage for mental health and substance use disorders. It would also preserve guaranteed issue and guaranteed renewability and allow young adults to stay on their parents’ plan until age 26. States could choose to: (1) Essentially retain the ACA, and receive federal premium tax credits, cost-sharing subsidies, and Medicaid dollars, to the extent that such subsidies do not exceed the contributions that would have been made under Option 2. (2)Choose a new state alternative, a new market-based system, and receive funding equal to 95% of federal premium tax credits, cost-sharing subsidies and the federal match for Medicaid expansion in the form of per beneficiary grants or advanced refundable tax credits, which in both cases would be deposited in a Roth Health Savings Account (HSA) directed by the consumer; or (3) Design an alternative solution without federal assistance. For more details, see Senator Collins’ website.

Senate Democratic Leader Chuck Schumer (D-NY) indicated that Senate Democrats would be willing to work with Republicans to develop an ACA replacement plan, but would do so only before repeal of the ACA.

A recent op-ed in the New York Times poses seven questions that policymakers should address about a replacement plan before repealing the ACA. A blog post from Health Affairs provides an overview of ACA, how it’s working, how it can be repealed (or not) by Congress and/or effectively repealed by the administration, and what replacement plans might look like.

Medicaid Block Grants

As explained in this article from CNN, Senior Donald Trump adviser Kellyanne Conway confirmed on Sunday that part of the administration’s plans for repealing and replacing Obamacare would include converting federal funds for Medicaid into block grants to states. The administration and many Republican Members of Congress have asserted that, in giving states greater flexibility, block grants would allow states to innovate in ways that would serve beneficiaries more efficiently. A recent paper from the Center for Budget and Policy Priorities, however, posits that block grants or per capita caps on Medicaid payments to states would allow states to cut Medicaid benefits and would actually stymie innovation. While governors historically have supported the concept of block grants, because they would like greater flexibility in administering the Medicaid program, some state officials are beginning to have second thoughts, according to this article from Modern Healthcare.

Nominations

The Senate is responsible for confirming Cabinet nominees, and its various committees are now holding confirmation hearings. Despite controversies surrounding many of the nominees, they are all expected to be confirmed.

Secretary of HHS. Rep. Tom Price, MD (R-GA), a former orthopedic surgeon and long-time opponent of the Affordable Care Act, has been nominated to be the Secretary of Health and Human Services. He had a courtesy hearing (watch the hearing) before the Senate Health, Education, Labor and Pensions (HELP) Committee last week (see The Hill’s Five takeaways from Price’s confirmation hearing) and a formal nomination hearing before the Senate Finance Committee on January 24. (That committee has primary jurisdiction over the nomination since it oversees Medicare, Medicaid, Social Security, and welfare programs.) Although Rep. Price has been endorsed by the American Medical Association, he is not universally supported by the medical community.

Secretary of Education. Last week, the Senate Health, Labor, Education and Pensions (HELP) Committee held a confirmation hearing for the nominee to be the Secretary of Education, Betsy DeVos, a long-time proponent of charter schools and vouchers that can be used for private schools. The nearly four-hour hearing included a series of questions related to the Individuals with Disabilities Education Act (IDEA), to which Ms. DeVos hesitated to provide concrete answers. (Watch the archived hearing; the IDEA discussion begins at the 3 hour and 31 minute mark.) To give Ms. DeVos more time to answer written questions, and committee members time to review them, HELP Committee Chairman Lamar Alexander (R-TN) has postponed the committee vote on her nomination to January 31. On Monday, however, he refused Democrats’ request for a second hearing on DeVos. After the hearing, some of the members of the Consortium of Citizens with Disabilities (CCD), including Family Voices, sent a letter to Chairman Alexander and Ranking Member Patty Murray (D-WA) to request that a vote on the nomination be postponed until Ms. DeVos answers additional questions (specified in the letter) regarding her views on policies affecting students with disabilities.

Attorney General. Senator Jeff Sessions (R-AL), has been nominated to be the U.S. Attorney General. His nomination has been controversial and is opposed by many advocates. Based on the Senator’s record of opposing protections for people with disabilities as the Alabama Attorney General and as a Senator, several disability groups have sent a letter to the Judiciary committee opposing the nomination. Nonetheless, at this point it is expected that the Senate will approve his nomination.

Budget and Appropriations

The Hill has reported that the Trump administration is preparing a budget that would drastically reduce federal spending– by $10.5 trillion over ten years – following proposals developed by the Heritage Foundation and the Republican Study Committee. The President’s budget outline is expected to be transmitted to Congress in mid-February, with a more detailed version to follow a month or two later. The House and Senate appropriations subcommittees will then develop appropriations bills that may or may not follow the president’s recommendations.

The Arc Seeking Caregivers for FINDS Survey

With the new year comes a new Family and Individual Needs for Disability Supports (FINDS) Survey. The Research and Training Center on Community Living at the University of Minnesota, in collaboration with The Arc, is seeking caregivers to share their perceptions on a range of life-span issues impacting individuals with I/DD. The Arc invites people aged 18 years or older who provide frequent primary support to a person with I/DD to participate. Take the survey here.

 

 

 

 

FamilyVoiceCO.org has a new look

Family Voices Colorado has recently welcomed a new enthusiastic volunteer who will be managing FVC’s social media. That volunteer is me, Hannah Mitchell! black and white tera seville 3I am a twenty-six year old woman with physical disabilities who knows just how tough navigating health care can be! I am going to school for Disability Advocacy, and hope that one day I can work closely with families to better the opportunities for people and children with disabilities.

Family Voices Colorado is dedicated to providing you information that is accessible and easily obtainable! I hope that I can maintain that standard!

My goal is to put more up-to-date and useful information directly at your fingertips, so we have given FamilyVoicesCO.org a brand new look!

We have included a page dedicated to our popular “Fast Facts”, a newly refreshed resources and links page, and a page with resources and fact sheets from National Disability Navigator Resource Collaborative (NDNRC)!  All of these new resources are platformed on a new and accessible format with easy navigation!

Should we make improvements? Leave a comment and we will get to work trying to meet your needs!