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Washington, DC Update 5/18/23
Legislative Updates
Debt Ceiling
The talks continue. This Congressional Budget Office publication indicates that Congress will not be able to pay its debts as early as the first two weeks of June.

With disability-related complaints regarding air travel up 50 percent in the last year, U.S. Senators Tammy Duckworth (D-IL) and John Thune (R-SD), along with U.S. Representatives Steve Cohen (D-TN-09) and Pete Stauber (R-MN-08), introduced bipartisan, bicameral legislation to improve air travel for passengers with disabilities, notably passengers who use wheelchairs and other mobility aids. The bipartisan Mobility Aids on Board Improve Lives and Empower All (MOBILE) Act (S. 1459) would help ensure the U.S. Department of Transportation (DOT) takes additional actions to empower passengers who use mobility aids, such as manual and powered wheelchairs, to better prevent more disability-related incidents that occur far too often.

The MOBILE Act would require the Secretary of Transportation to:
  • Issue a notice of proposed rulemaking requiring air carriers and foreign air carriers to publish dimensions of cargo holds;
  • Evaluate the frequency and types of damage to wheelchairs and scooters;
  • Develop and submit to Congress a strategic roadmap on researching the technical feasibility of accommodating passengers in wheelchairs in the main cabin; and
  • If in-flight, in-wheelchair seating is determined to be technically feasible, assess the economic and financial feasibility of accommodating passengers with their wheelchairs in the main cabin during flight.

A copy of the bill one-pager is available here and a copy of the bill text is available here.
Unwinding of Medicaid Continuous Coverage
NHeLP #MedicaidTipoftheDay
There's lots of info about what state #Medicaid agencies can't do before a beneficiary’s annual renewal month. But, when can state agencies process cases before a beneficiary’s annual renewal month? There are a few events that can trigger early #MedicaidRenewals. Learn more

CMS: Frequently Asked Questions
Centers for Medicare and Medicaid Services (CMS) updated a series of frequently asked questions (FAQ) regarding changes made to the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA) by the 2023 omnibus spending bill. Key topics within these FAQs include:
  • Returned mail condition for states claiming the increased Federal Medical Assistance Percentage (FMAP) available under the FFCRA;
  • Reestablishment of premiums in Medicaid and Children’s Health Insurance Program (CHIP);
  • Renewal requirements for individuals who receive Social Security Income; and
  • Medicaid and CHIP agency capacity to share beneficiary data with enrolled providers to support renewals. 

Georgetown CCF blog: The Truth is in the Call Center Function
In this blog, Georgetown policy specialists underscore the importance of call centers in terms of not just access, but signaling when problems with unwinding may/will arise. They also detail their attempts to navigate call center systems.

NOTE: for FV Affiliates and F2Fs: Many have shared stories on regional calls about long waits when families call in to Medicaid. Keep your ears to the ground on this one!
Unwinding of the PHE
The PHE officially ended last week on May 11th. Read Secretary Becerra’s statement here.

HHS: Flexibilities that Remain/Do Not Remain
This fact sheet from HHS has a breakdown of which emergency flexibilities remain in place and which do not. It also includes a link to the letter HHS Secretary Becerra sent to the Governors about the end of the PHE.

CMS: Informational bulletin on implications for Medicaid and CHIP
A new informational bulletin from CMS details what the end of the COVID-19 Public Health Emergency and National Emergency mean for Medicaid and the Children’s Health Insurance Program (CHIP).

Key changes noted in the bulletin include:
  • The requirement for state Medicaid and CHIP programs to cover COVID-19 vaccines (and their administration), testing, and treatments without cost-sharing will end on September 30, 2024.
  • The requirement to cover the treatment of conditions that may seriously complicate the treatment of COVID-19, while a person has (or is presumed to have) COVID-19 also will end.
  • States have received 100% matching federal funds for COVID-19 vaccines and their administration. This enhanced funding will end on September 30, 2024.
  • The option to provide Medicaid coverage for COVID-19 vaccinations, testing, and treatment to uninsured individuals and receive 100% matching federal funds for coverage for those individuals expired May 11 (15 states and three territories had taken advantage of this option).
  • The bulletin also clarifies that telehealth flexibilities under Medicaid and CHIP are not tied to the PHE. These telehealth flexibilities were available before the PHE and will continue to be available after. States are encouraged to continue to cover Medicaid and CHIP services when they are delivered via telehealth and CMS has a toolkit available to help states with the continuation, adoption, or expansion of telehealth coverage.

ACL: Unwinding of Paid Family Caregiving in HCBS
Prior to the pandemic, only a few states allowed family caregivers to be paid to provide HCBS (and most only offered this option to some populations). Under PHE flexibilities, most states took advantage of opportunities to expand payment for services provided by family caregivers, and many are considering permanently incorporating these expansions into their Medicaid HCBS waiver programs.

NOTE: This link is focused solely on paid family caregiving options through HCBS waivers.

NASDDDS related HCBS and Unwinding resource: End Of Pandemic-Era Flexibilities In Medicaid HCBS

HHS: Fact Sheet Telehealth Flexibilities
This HHS fact sheet is packed with details about the state of several telehealth flexibilities upon the end of the PHE.
  • Medicaid, CHIP, and Telehealth: States have a great deal of flexibility with respect to covering Medicaid and the Children’s Health Insurance Program (CHIP) services provided via telehealth. As such, telehealth flexibilities vary by state: some are tied to the end of the COVID-19 PHE, some are tied to state PHEs and other state emergency declarations, and some had been offered by state Medicaid and CHIP programs long before the pandemic. After the end of the federal PHE, Medicaid and CHIP telehealth policies will continue to vary by state. 
  • Private Health Insurance and Telehealth: As is currently the case during the COVID-19 PHE, coverage for telehealth and other remote care services will vary by private insurance plan after the end of the COVID-19 PHE. When it covers telehealth and other remote care services, private insurers may impose cost-sharing, prior authorization, or other forms of medical management on such services. 
  • The Health Insurance Portability and Accountability Act (HIPAA) Rules and COVID-19: During the COVID–19 PHE, health care providers subject to the HIPAA Privacy, Security, and Breach Notification Rules (HIPAA Rules) sought to communicate with patients and provide telehealth services for the first time through readily available remote communications technologies that may not have fully complied with the requirements of the HIPAA Rules. However, now that the PHE has ended, so too has this flexibility. The HHS Office of Civil Rights (OCR) will continue to support the use of telehealth after the PHE by providing a 90-calendar day transition period for covered health care providers to make any changes to their operations that are needed to provide telehealth in a private and secure manner in compliance with the HIPAA Rules. During this transition period, OCR will continue to exercise its enforcement discretion and will not impose penalties on covered health care providers for noncompliance with the HIPAA Rules in connection with the good faith provision of telehealth. The transition period will be in effect beginning on May 12, 2023, and will expire at 11:59 p.m. on August 9, 2023.
  • Tele-Behavioral Health and the COVID-19 PHE Covers topics connected to: Tele-Behavioral Health in Opioid Treatment Programs, waived In-Person Physical Examinations, take Home Doses, Drug Enforcement Administration (DEA) rules and the PHE, licensure for Tele-Behavioral Health and broadband access
From the Administration
Office of the Assistant Secretary of Health: Examining the Definition of Long COVID
The National Academies of Sciences, Engineering and Medicine is conducting a series of meetings to examine the working definition for Long COVID. You can read more about the efforts and the committee members here: Examining the Working Definition for Long COVID | National Academies and additional information on how to participate: Check out the Comment portal, Focus Groups, Questionnaires, and Workshops.
Other CYSHCN Policy Related Materials
AAP and Migration Policy Institute: The Care of Unaccompanied Children
In 2022, the American Academy of Pediatrics and Migration Policy Institute came together to study unaccompanied children’s access to medical and mental health services in U.S. communities. The researchers conducted field visits to three U.S. cities (Houston, TX; Los Angeles, CA; and New Orleans, LA) and held interviews and focus groups with more than 100 professionals working with this population, as well as unaccompanied children themselves. The resulting report identifies both barriers and best practices, as well as recommendations for care improvement and access at all levels. A discussion of the report is also available at this link to a recorded webinar.

Manatt: Webinar CMS Access Proposed Rules
On April 27, 2023, the Centers for Medicare & Medicaid Services (CMS) released proposed rules that, if finalized, would reshape Medicaid’s federal regulatory landscape in several ways, including with respect to home and community-based services (HCBS). The proposed rule most relevant for HCBS—Ensuring Access to Medicaid Services—includes measures to increase transparency, oversight and public engagement regarding HCBS access and quality of care, including measures that aim to improve job quality for direct care workers who provide home-based services. Comments on the proposed rule are due by July 3.
In a new webinar on June 1, 2023 1-2pm EST, Manatt Health—joined by an expert on the caregiving needs of people with functional limitations—will review the key reforms that CMS has proposed for Medicaid HCBS. Key topics that will be covered include:
  • Medicaid’s role as the nation’s largest payer for HCBS—essential services that allow people with functional limitations to stay in their homes rather than move into long-term care facilities
  • CMS’s proposed regulatory changes that would:
  • Establish requirements for rate transparency and payment adequacy with respect to certain home care services
  • Strengthen the procedures regarding person-centered service plans
  • Standardize state approaches for monitoring access to care, quality of care, critical safety incidents and beneficiary grievances
  • Areas where CMS solicited input from the public during the public comment period

For more information and to register click here.

Other CMS Access and Managed Care Proposed Rule Information

Disability Scoop: Plea for 504 Regulations
This Disability Scoop article outlines the most recent plea by advocates urging the Administration to issue updated 504 regulations critical to be able to target discrimination in healthcare.

Manatt: Recording and Resources- Strategies for Providing Whole-Child Care
Strong evidence suggests that investing in children’s social needs leads to long-term improvements in health, economic stability and resilience. Despite this growing body of research, stakeholders have historically prioritized addressing Health-Related Social Needs (HRSN), also referred to as social drivers of health or SDOH, for adults with complex health issues due to the short-term return on investment. As programs to address non-medical factors that impact health become more prevalent, the health-related social needs of children and youth are gaining greater attention.
In a recent webinar, Manatt facilitated a panel discussion with state and national leaders who are pioneering new ways to address HRSN for children. The program reviewed recent developments and promising approaches for financing HRSN for children including 1115 waivers, “In Lieu of Services” (ILOS), and Children’s Health and Wellness Funds. Click here to view the free webinar on demand and download a free copy of the presentation. Key topics include:
  • A panel discussion about the growing activity and interest in investments in HRSNs for children and youth 
  • The factors that tend to limit investment in HRSN for children and youth, including long-term vs. short-term return on investment for health plans, providers and state Medicaid agencies
  • The actions CMS and states are taking to implement policy solutions
  • How Children’s Health and Wellness Funds offer a complementary or additional approach for financing HRSN initiatives for children, youth and their families

In addition, during the panel discussion, Dr. Kara Walker shared several key resources available through Nemours Children’s Health. Links are below:

ICYMI - Braidwood v. Becerra
A March decision by Judge O’Connor of the Northern District of Texas threatens to block preventive services nationwide. The Biden Administration is seeking a stay on the decision, however in the meantime, the Judge has deferred his ruling that blocked the federal government from enforcing preventive services requirements issued by the US Preventive Services Task Force.

Consider reading the following for more information:
  • A blog by the National Health Law Program walks through the basics of the case- where it stands procedurally, what is at issue and possible implications.
  • This case explainer document by NHeLP. This is a bit more in depth and explores the case in more detail.

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Family Voices is a national organization and grassroots network of families and friends of children and youth with special health care needs and disabilities that promotes partnership with families--including those of cultural, linguistic and geographic diversity--in order to improve healthcare services and policies for children.