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Washington DC Update (2/22/17)

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

THE ADMINISTRATION

Rule on Insurance Stabilization Payments and Essential Benefits

Last week the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule, summarized in a CMS press release, to make changes intended to stabilize the individual and small group insurance markets. The proposed rule would amend standards relating to special enrollment periods, guaranteed availability, network adequacy, essential community providers, and actuarial value requirements. It also proposes to shorten the annual open enrollment period in the individual market for the 2018 plan year to about six weeks. According to an article in Axios the proposed rule seems to be viewed favorably by insurance companies, but not by some health-consumer advocates, as exemplified in a recent Families USA blog post. Comments on the proposed rule are due by 5:00 pm ET on March 7, 2017.

IRS Rule on Reporting about Insurance Coverage

As explained in a blog post from Reason, the IRS quietly made a decision to stop requiring people to fill out the line on the 1040 tax form that indicates whether the tax filer had health coverage during the tax year. This is a way of not enforcing the ACA’s “individual mandate.” See Trump’s IRS stages a stealth attack on Obamacare.

IDEA Website

As explained in an article from the Washington Post, disability and education advocates expressed concern about the disappearance of the part of the US Department of Education website (http://idea.ed.gov/) which provided information about the Individuals with Disabilities Education Act (IDEA). That website is now up again, but refers the user to a more updated version, at https://www2.ed.gov/about/offices/list/osers/osep/osep-idea.html.

IN CONGRESS

Nominations

CMS Administrator. The president has nominated Medicaid consultant Seema Verma to head the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, Medicaid, and the ACA. The Senate Finance Committee held her confirmation hearing on February 16. The most notable moment of the hearing was when Ms. Verma indicated that she thinks women should be able to purchase insurance plans that do not include maternity benefits. She also indicated that she does not support proposals to create Medicare vouchers, but does support per capita caps or block grants for Medicaid. Other topics addressed are reported in an article from USA Today. The committee accepts public comments on the nomination, due no later than March 2.

ACA Repeal and Medicaid Restructuring

On February 16, the House Republican leaders released a “policy brief” outlining their plan to repeal and replace the Affordable Care Act (ACA) AND drastically restructure the Medicaid program. (The ACA proposal starts on page 10 Medicaid proposal starts on page 14.) The document is very general, so it is difficult to assess how it would affect the access to affordable insurance.

ACA Replacement. This ACA replacement plan would: eliminate the penalty for failure to have health insurance coverage (individual mandate) and the employer mandate, provide refundable age-based (not income-based) tax credits for the purchase of insurance plans, including catastrophic plans, “enhance and expand” Health Savings Accounts, allow the sale of insurance across state lines, and provide “State Innovation Grants,” which states could use to make health care or insurance more affordable, including the creation of high-risk pools.

Notably, the policy brief does not mention how the plan might protect individuals with pre-existing conditions. But last week Rep. Greg Walden (R-OR), the Chairman of the House Energy and Commerce Committee, which has jurisdiction over Medicaid and many other health care issues, introduced the Pre-Existing Conditions Protection Act of 2017, which purportedly would prohibit group health-plan issuers from using an individual’s pre-existing conditions to determine eligibility for coverage, the services covered, or individuals’ premiums. But, as drafted, the bill does not seem to limit the premiums that can be charged for people buying insurance in the individual market.

It is difficult to assess the Ryan plan without knowing critical details, although, based on past experience, there are reasons to think that Health Savings Accounts, interstate insurance sales, and high-risk pools may not be effective in expanding coverage. House Speaker Paul Ryan said a bill would be released and committees would start to consider the legislation during the week of February 27, although it is quiet possible that date will slip.

Medicaid. The plan would cut federal Medicaid spending by imposing “per capita caps” on federal Medicaid payments to states. In other words, a state would receive a fixed amount per enrollee, varying by type of enrollee – “aged, blind and disabled, children, and adults.” States would have the option of taking a block grant instead, meaning they would get a fixed amount regardless of their population of Medicaid enrollees. Under either system, the starting amount each state would get (baseline) would be based on that state’s historical Medicaid payments, with some sort of annual inflation adjustment. This raises the politically thorny issue of how to treat the difference in historical payments between the states that took up the ACA Medicaid expansion option and those that did not. Under the plan outlined in the policy brief, the former group would eventually lose their enhanced matching payments for the expansion population, while the non-expansion States would be eligible to receive “additional temporary resources for safety net providers” during a transition period.

The key point is that federal payments to states would be increasingly lower than they would under current law. In exchange for receiving less federal money, states would be given more flexibility in designing their Medicaid programs – in services and supports covered, and/or in populations served. (In the paragraph on block grants, however, the brief says that states “would be required to provide required services to the most vulnerable elderly and disabled individuals who are mandatory populations under current law.”) See 5 Key Questions: Medicaid Block Grants & Per Capita Caps (Kaiser Family Foundation). The Center for Law and Social Policy has prepared a brief on how block grants have worked (or not) in other programs.

Prospects. Many House Republicans are not ready to commit to the ACA-replacement outline released by Speaker Ryan. Furthermore, it is not clear how much support there would be for this plan in the Senate, particularly for Medicaid restructuring. Additionally, some governors will be opposed to capping Medicaid payments, since states stand to lose billions of federal dollars over time. Moreover, there will be a “formula fight” (a.k.a., “food fight”) among governors over how to treat Medicaid expansion funding in determining the baseline for future federal payments.

A new tool from the Kaiser Family Foundation allows users to compare some of the different proposals to replace the ACA.

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.

State of Colorado Legislative News

See Legislative news below from our friends at the Colorado Center on Law and Policy! Have a great weekend!

CCLP Heads-Up recaps and previews developing issues of interest regarding the health, economic security and well-being of low-income Coloradans. The newsletter is published regularly by the Colorado Center on Law and Policy, a nonprofit, nonpartisan organization that advances the health and economic security of low-income Coloradans through research, education, advocacy and litigation.

Medicaid issues warrant notice

Three bills that were recommended and developed by CCLP and the Colorado Cross-Disability Coalition (CCDC) will be considered by Colorado legislators next week. House Bills 1126 and 1143 are scheduled to be heard by the House Public Health Care & Human Services Committee, Feb. 14 at 1:30 p.m. at the State Capitol. A related measure, Senate Bill 121, is slated to be reviewed by the Senate Health & Human Services Committee’s on Feb. 16 at 1:30 p.m.
The bills, which received bipartisan sponsorship, are intended to address shortcomings in client correspondence and notifications when Medicaid benefits are about to be changed or terminated. An interim committee held three hearings about Medicaid correspondence last summer, which included testimony from CCLP, CCDC, and the Colorado Department of Health Care Policy and Financing.

Currently, Medicaid recipients are supposed to receive notice with information about how to appeal changes or termination of their benefits if they believe the action is unjustified. In practice, however, these notices are often vague and confusing. Most do not specify why benefits are being terminated or reduced, so Medicaid clients don’t always know whether they should challenge the decision. Furthermore, without proper notice, those who appeal may be unable to fully prepare their case.

Sponsored by Rep. Jessie Danielson, D-Wheat Ridge, and Sen. Larry Crowder, R-Alamosa, HB 1126 would ensure that an administrative law judge reviews the sufficiency of Medicaid termination notices at the beginning of an appeal hearing. The bill also requires the judge to inform the client of his or her option to receive an improved notice with the possibility of maintaining benefits, or proceed with their hearing.

Sponsored by Rep. Lois Landgraf, R-Fountain, and Sen. Crowder, HB 1143 would direct the state to audit communications with Medicaid clients. These audits would review the notices for legal sufficiency, clarity and accuracy. Audit findings, conclusions and recommendations will be presented to legislative committees, which can then consider whether the results warrant further reforms.

Finally, SB 121, sponsored by Sen. Kevin Lundberg, R-Berthoud and Sen. Crowder, requires the Colorado Department of Health Care Policy and Financing to engage in a process to improve Medicaid client communications – including client letters and notices – that addresses denial, reduction, suspension, or termination of Medicaid benefits.

Collectively, these proposals will help ensure that Medicaid clients do not lose access to health care due to the shortcomings in the current notification process.