The Assister Bulletin is a technical assistance resource supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreement number U58CS06812, State and Regional Primary Care Associations for the total amount of $1,109,444.  This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsement be inferred by HRSA, HHS or the U.S. Government.

~ July 27, 2018 ~

NOV. 1 - DEC. 15, 2018 !
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The VA Mission Act of 2018 consolidates VA's community care programs, including VA Choice, into a new Veterans Community Care Program that will ensure veterans receive timely, appropriate care. The program allows veterans to receive services outside of the current VA system and from private health care providers, including health centers. Health centers interested in learning more should read the fact sheet. 
Puerto Rico's own records list so many cases of the bacterial disease leptospirosis that officials should have declared an "epidemic" or an "outbreak" after Hurricane Maria instead of denying that one occurred. A Puerto Rico mortality database -- which CNN and CPI sued the island's Demographic Registry to obtain -- lists 26 deaths in the six months after Hurricane Maria that were labeled by clinicians as "caused" by leptospirosis, a bacterial illness known to spread through water and soil, especially in the aftermath of storms. That's more than twice the number of deaths as were listed in Puerto Rico the previous year, according to an analysis of federal records.  CNN 
A resolution to encourage breast-feeding was expected to be approved quickly and easily by the hundreds of government delegates who gathered this spring in Geneva for the United Nations-affiliated World Health Assembly. Based on decades of research, the resolution says that mother's milk is healthiest for children and countries should strive to limit the inaccurate or misleading marketing of breast milk substitutes. Then the United States delegation, embracing the interests of infant formula manufacturers, upended the deliberations.  New York Times  
The prime-time announcement required Mr. Trump to set aside misgivings about Judge Kavanaugh's ties to the George W. Bush administration that Mr. Trump has frequently criticized, according to people familiar with the process. He also restrained an impulse to make a flashier choice, these people said. Mr. Trump settled on the pick after a rapid-fire search that opened on June 27, when 81-year-old Justice Anthony Kennedy told the president he was stepping down, creating the second vacancy on the court during Mr. Trump's presidency.  Wall Street Journal 
The health department has quietly dipped into tens of millions of dollars to pay for the consequences of President Donald Trump's border policy, angering advocates who want the money spent on medical research, rural health programs and other priorities. The Department of Health and Human Services has burned through at least $40 million in the past two months for the care and reunification of migrant children separated from their families at the border - with housing costs recently estimated at about $1.5 million per day.  Politico  
Voters in Idaho will get to decide in November whether the state will expand Medicaid, Secretary of State Lawerence Denney announced Tuesday. Denney certified that an activist group collected the required 56,192 signatures needed to place the measure on the ballot. The Hill 
Republicans for years have proclaimed the federal government's decades-old War on Poverty a failure. "Americans are no better off today than they were before the War on Poverty began in 1964," House Speaker Paul D. Ryan (R-Wis.) wrote in his 2016 plan to dramatically scale back the federal safety net. Now the Trump administration is pitching a new message on anti-poverty programs, saying efforts that Republicans had long condemned as ineffective have already worked.  Washington Post  
President Donald Trump handed an influential business advocacy group what should have been a historic lobbying victory when he recently rolled out new rules encouraging small businesses to band together to offer health insurance. Trump, who's touted the expansion of so-called association health plans as a key plank in his strategy to tear down Obamacare, even announced the rules at the 75th anniversary party of the National Federation of Independent Business last month, claiming the group's members will save "massive amounts of money" and have better care if they join forces to offer coverage to workers.  Politico 
Nearly half of respondents in a new poll said they are now finding it more difficult to afford health care than they were a year ago, according to a poll released Thursday. The Navigator poll found 49 percent of respondents said it's more difficult to afford prescription drugs, insurance premiums and doctor visits compared to last year. Additionally, 78 percent of those surveyed said they believe the government should be doing more to make health care more affordable. The Hill 
The Trump administration, in an abrupt reversal, said Tuesday that it would restart a program that pays billions of dollars to insurers to stabilize health insurance markets under the Affordable Care Act. The administration suspended the program less than three weeks ago, saying it was compelled to do so by a federal court decision in New Mexico. But the administration said Tuesday that it would restore the program because otherwise health plans could become insolvent or withdraw from the market, causing chaos for consumers. New York Times 

The White House's plan to indefinitely detain immigrant families together threatens the care of young children, experts worry, by placing them with an agency with little experience in handling such complex needs. Previously, the administration's "zero-tolerance" immigration stance meant splitting children from parents, including 2,322 children 12 and under, and placing the children in facilities run by the Department of Health and Human Service. Kaiser Health News 
The 1-year-old boy in a green button-up shirt drank milk from a bottle, played with a small purple ball that lit up when it hit the ground and occasionally asked for "agua." Then it was the child's turn for his court appearance before a Phoenix immigration judge, who could hardly contain his unease with the situation during the portion of the hearing where he asks immigrant defendants whether they understand the proceedings. "I'm embarrassed to ask it, because I don't know who you would explain it to, unless you think that a 1-year-old could learn immigration law," Judge John W. Richardson told the lawyer representing the 1-year-old boy.  Associated Press  
A federal judge on Monday temporarily halted the deportations of families that have been recently reunited after being separated by the Trump administration. San Diego-based Judge Dana Sabraw granted a request from the American Civil Liberties Union (ACLU) at the top of a status hearing on the administration's efforts to reunite children over 5 years old with their parents. The Hill 
Health and Human Services Secretary Alex Azar, whose department has recently become entangled in the fight over separating undocumented children from their families, is pushing to keep focus on his agenda. Mr. Azar took office in January with a set of explicit goals after his predecessor, Dr. Tom Price, resigned under an ethics cloud. Since HHS is charged with caring for underage illegal immigrants, the agency has been pulled into the immigration debate. Now Mr. Azar is trying to keep his agenda moving ahead by relying on a close-knit team of top policy advisers. Wall Street Journal 
Click here, to review the HHS Flowchart on Unaccompanied Children (UAC).

It's been 3 years since the Florida Legislature last debated - and overwhelmingly rejected - Medicaid expansion under the Affordable Care Act. Republicans - who have controlled the governor's office and both legislative chambers for nearly all of the past two decades - have shown no interest since then in pursuing the policy that would make about 660,000 uninsured adults eligible for the government insurance program for the poor. While Democrats are expected to gain statehouse seats in the midterm elections, it's unlikely they can capture enough to make a difference. That's especially true in the House where the GOP holds a 76-41 majority, with three seats vacant. Six GOP House members don't even face an opponent. Miami Herald

Use the correct & complete CAC & NAV # on all applications!
***13 characters (FLCAC or FLNAV + A/B/C/D + 2 digit contract # + 5 digit CAC or NAV # ***
*** CAC or NAV # is issued by your employer***

In May, the IRS released the applicable percentage table and employer-sponsored coverage required contribution percentage for tax year 2019. Both of these resources are used to determine eligibility for and the appropriate amounts of financial assistance that consumers may qualify for. These resources are also used by the Federal Data Services Hub to calculate eligibility for advance payments of the premium tax credit (APTC) and help consumers and the Marketplace to evaluate whether employees have an offer of affordable Employer-Sponsored coverage (ESC). The new percentage tables are below:
In addition, for plan years beginning in 2019, the required contribution percentage for employee self-only coverage is 9.86 percent of annual household income. Employees whose share of the cost for an employer-based plan covering the employee only (and not his or her dependents) is less than 9.86 percent of their annual household income will not be eligible for APTC or cost-sharing reductions (CSRs) through the Marketplace, assuming the plan meets minimum value standards. If the cost of the employee-only plan exceeds 9.86 percent of consumers' annual household income, or does not meet minimum value standards, they may be eligible for APTC or CSRs through the Marketplace. This is an increase from the 2018 level, which was 9.56 percent.   
The IRS needs volunteers who want to help provide free tax preparation in communities across the nation during the 2019 tax season. It might seem far off, but people who want to volunteer can start taking action now. The IRS sponsors the   Volunteer Income Tax Assistance and the Tax Counseling for the Elderly programs each year. Both offer free tax help across the country for people with low-to-moderate incomes, senior citizens, persons with disabilities, and those who speak limited English. Last year, VITA and TCE volunteers prepared more than 3.5 million federal tax returns for qualified taxpayers at no cost. Anyone interested in volunteering can visit the   sign-up page on 
The Centers for Medicare & Medicaid Services (CMS) is refreshing the certified application counselor (CAC) program by implementing an enhanced application and renewal process. If your certified application counselor designated organization (CDO) re-applies and is approved during the CAC program refresh, your organization will need to recertify individual CACs (using the new CDO#) before the CACs complete the annual CMS assister certification training for PY2019. It is important to note that the organization must wait 14 days from the date of the designation notice before awarding staff new CAC#s and training. Any organization seeking to provide CAC enrollment assistance to consumers for Plan Year 2019 must apply to become a CDO. Existing CDOs that fail to reapply during the CAC Program re-application window will be de-designated and will not be permitted to certify CACs or assist consumers thru Dec. 31, 2019.  Click here for the link to the CDO Application Refresh Process.  
The PY2019 Certified Application Counselor and Non-Navigator Assister Certification Training is available beginning July 9, 2018 . The training is hosted by the Marketplace Learning Management System (MLMS); the online web-based training platform for assisters providing application and enrollment assistance to consumers in Federally-Facilitated Marketplaces (FFMs). CACs should wait to take the 2019 CAC training until they have been issued their new CAC ID number by their organization. CACs should enter their new CAC ID number as the username on the MLMS training registration page. CACs in good standing may continue to assist consumers while awaiting their new CAC ID number. The required training consists of only 4 modules and can be accessed through the CMS Enterprise Portal by logging on as a New Users or  Existing UserA webinar on this training and certificate was held on July 11th. To view the slide deck,  click here.  To view additional training presentations and additional resources, click here.  
It should be of little surprise that entire sections about the ACA have been removed from the official site, its hub for the Center for Medicaid and CHIP Services. Of the 13 pages dedicated to the ACA that were overhauled, eight redirect to another page with similar information, but on only two do the words "Affordable Care Act" appear, according to the Sunlight Foundation. (The report can be read here.) Additionally, another page that explained the coordination between Medicaid and the ACA  exchanges was also removed and now redirects to an "Error: Page Not Found" note. It's hard to say how consequential it is that these pages no longer exist. But it certainly is symbolic of the systematic efforts to make Obamacare disappear. Washington Post  
Under the latest cuts, so called navigators who sign up Americans for the ACA, also known as Obamacare, will get $10 million for the year starting in November, down from $36.8 million in the previous year according to the Centers for Medicare and Medicaid Services (CMS). This follows a reduction announced by CMS last August from $62.5 million, along with an even bigger cut to advertising for enrollment, and represents the latest in a series of moves to weaken the ACA by the administration of President Donald Trump. Reuters 
A grace period is an extension of 3 consecutive months a health insurer adds to the due date for a monthly premium payment ONLY if a consumer receives APTC and has made a timely first monthly premium payment ("binder payment"). The past due premium must be paid before the end of the grace period for the consumer to maintain coverage. During the grace period, the consumer's plan must pay all appropriate claims for the first month, but may pend claims during the second and third months until premium payment is made. If a consumer fails to pay all outstanding premiums by the end of the grace period, the consumer may be terminated from a plan for non-payment. The consumer would then have to wait until Open Enrollment to enroll in a plan unless they qualify for a Special Enrollment Period (SEP). For more information on grace periods, click here . For more information on terminations due to nonpayment, click here.  
The biggest week of the year for America's health centers is almost here! We're a month and a half closer to National Health Center Week. Now is the time to post your Health Center Week celebrations and events on the NHCW website. Posting events is critical to catching the eyes of sponsors who are looking for events around the country. Posting events also attracts visits from Members of Congress and media opportunities for maximum exposure. Please be as detailed as possible when posting events. The more information provided, the more likely you are to be matched with a sponsor that can truly enhance the reach of your celebration. We've made it easy to join the National Health Center Week conversation on social media. Utilize our  social media tools and the official hashtags: #NHCW18 and  #CHCSuperPower when promoting the big week on social media. Another simple way to spread the word about NHCW online is to participate in the third annual  Thunderclap Campaign. The NHCW Thunderclap allows you to automatically share a single support message for NHCW on Monday, August 13th at 9:00AM ET. By joining the Thunderclap, health center advocates will share the same message, at the same time, spreading a call to action through Facebook, Twitter, and Tumblr that cannot be ignored. Don't forget to submit nominations for the National Health Center Week Health Center Hero Award. There are only a few weeks left! Nomination forms must be sent to Marisol Murphy- Ballantyne by July 27th at 11:59 PM. A reminder for health centers looking to purchase the items from the NHCW Store: the deadline is August 1, 2018. The NHCW store has everything you need to market your events including a media kit with high resolution images, banners, signs, stickers, t-shirts and more! Don't delay, place your orders as soon as possible while supplies last and to avoid extra costs for shipping and handling. Planning to participate in the  NHCW Picture & Video Contest? If yes, join our upcoming webinar to hear more about the rules, prizes and tips for winning submissions on July 25th at 3:00PM ET.  RSVP here. Huge thanks to our sponsors for their support in making Health Center Week possible. We are excited to make NHCW the biggest celebration of the summer!
Questions about NHCW programming or event submission? Contact:
8th Annual CHW Coalition Summit
Touching Lives, Promoting Equity and Transforming Communities
Sept. 14-15, 2018
Holiday Inn Orlando International Airport
5750 T.G.Lee Blvd., Orlando FL

Click here to book your hotel at the group rate.
Click here to register with the $35 Early Bird Registration Fee before 8/30/18.

Many of you became Certified Community Health Workers at my encouragement. However, in 2016, centers only reported 20.70 CHW FTEs in the whole state!  In 2017, that number was even less! I know, that there are many CCHWs in our centers. But the Uniform Data System does not reflect that. The same goes for Medical Interpreters.  Please help me figure this out by completing this 2018 CHW-CMI Staffing Survey.

 All Plan Year 2018 Florida Enrollment Assistance Personnel
    2018 Database   

I have a consumer who lives in Sarasota County and is already enrolled in a Marketplace health plan with Advanced Premium Tax Credits. She informed me today that her son, who lives in Boston, is also going to claim her as a tax dependent in 2018.
If this consumer is already enrolled in a Marketplace health plan with APTC, she has committed to filing an independent tax return for 2018. That means she cannot be her son's tax dependent unless she gives up her health plan and APTC. What is she going to do for healthcare?
PY2019 On-line training for CACs was released on July 9th. What do we do if our organization has not completed the CDO Application Refresh process?
On-line training for CACs is still annual and mandatory. However, the CDO Application Refresh process has complicated matters. Originally, CMS expected that the entire process would be completed by July. But many Florida FQHCs still have not yet been awarded a new CDO#.  
CACs should not begin their PY2019 training until their employer receives a new CDO# and issues them a new CAC#. They may continue to assist consumers with PY2018 issues until September when all current CAC#s expire. Please note that FQHCs that fail to complete this process will be "de-designated" and no longer authorized to assist consumers.
My consumer has Medicare Part A. Can he obtain Marketplace coverage?
It is illegal for a consumer to have both Medicare and Marketplace coverage because they are both tax-payer subsidized coverage plans. Medicare Part A is limited to hospitalization but is considered Medically Essential Coverage (MEC). Consumers who have Medicare Part A do not need to have additional insurance to meet the requirements of the ACA. However, if they choose to obtain coverage for doctor visits, drugs, etc. they may be wise to explore enrolling in other parts of Medicare during Open Enrollment or, Medigap coverage through a private agent/broker. 
Is there a cost associated with becoming a Certified Designated Organization?
One of the requirements of the CAC program, which is the cornerstone of the CDO process, is that all enrollment assistance services be provided by nonprofit organizations at no cost to the public. Therefore, there is no cost associated with becoming a CDO.   
Are financial counselors able to complete the Marketplace training at this time?
Absolutely not!  Your staff may be financial counselors but, their credential is that of a Certified Application Counselor. No one can take the PY2019 training until 14 days after the organization has received its new CDO# and the staff been given new CAC#s by the employer.

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