Washington, DC Update 9/15/23

Both the Senate and the House are back in Washington, DC. The budget will be top of mind, along with plenty of other work and discussions.



Drug Shortages: On July 28, 2023, House Energy and Commerce Committee Chair Cathy McMorris Rodgers unveiled a draft bill intended to address the “root causes” of drug shortages. The House Energy and Commerce will hold a hearing to discuss this week that addresses the ongoing problem of drug shortages. This Georgetown Center for Children and Families blog discusses a bill that has been proposed. 

Manatt Health: Guidance for Individual Level Renewals

On August 30, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a State Medicaid Director Letter (SMDL) instructing states to assess whether they are in compliance with federal Medicaid regulations that require all renewal processes be conducted at the individual level. As part of its ongoing work with states to adopt and implement strategies to remediate areas of non-compliance with the federal renewal requirements and ensure that eligible individuals retain coverage during unwinding, CMS recently determined that some states may be conducting ex parte renewal processes at the household level, rather than at the individual level. The SMDL lays out immediate actions that states must take to determine if they are out of compliance with the federal renewal requirements and mitigate compliance issues.

This expert perspective summarizes the SMDL and additional considerations for states as they evaluate whether, and the extent to which, their renewal policy, processes, and systems are out of compliance with federal requirements to redetermine eligibility on an individual enrollee basis.

CMS: Medicaid and CHIP Renewals Resources

• Medicaid Unwinding Homepage: The centralized location where states and stakeholders can learn more about Medicaid and CHIP renewals and access resources
• Medicaid and CHIP Renewals Webpage: A webpage designed for people enrolled in Medicaid and CHIP to help them prepare to renew their coverage
• Outreach and Educational Resources Webpage: The Outreach and Educational Resources webpage on Medicaid.gov/Unwinding has a variety of outreach materials, such as flyers, factsheets, toolkits, and educational videos. 
• Medicaid and CHIP Renewals Communications Toolkit: The Medicaid and CHIP Renewals Communications Toolkit provides key messages and materials for states and stakeholders to use when communicating with people about Medicaid and CHIP renewals restarting. The toolkit is available in both English and Spanish. 
• Reaching Out to People with Disabilities about Medicaid and CHIP Renewals: Use this one-page handout to help reach people with disabilities and share information about Medicaid and CHIP renewals.
• Unwinding Speaking Request Form: Submit a request to have someone from HHS or CMS speak about Medicaid Unwinding at an upcoming event.

NHeLP: Unwinding Guidance and Resources

Comprehensive list of Public Health Emergency (PHE) and continuous coverage unwinding guidance and resources for advocates. Resources have been compiled from the Centers for Medicare & Medicaid Services (CMS), other federal agencies, and advocacy organizations, including the National Health Law Program. (Updated August 2023)

HHS: Proposed Rule Section 504

On Thursday, Sept. 7, the HHS Office for Civil Rights published a proposed update to the HHS regulations implementing Section 504 of the Rehabilitation Act of 1973, which prohibits disability discrimination by recipients of federal funding. This is the first comprehensive update to the regulations since they were first put in place more than 40 years ago. The proposed rule strengthens protections for people with disabilities and reflects the input and priorities of the disability community.

The Rehab Act was the first civil rights legislation protecting disabled people from discrimination. It has a broad reach, prohibiting discrimination on the basis of disability in “any program or activity receiving federal financial assistance.” Section 504 covers all health care and human services programs and activities funded by HHS, from hospitals and doctors that accept Medicare or Medicaid to states’ child welfare programs, for example. It protects disabled people of all ages – which includes older adults who need assistance with major life activities like walking, getting in and out of bed, hearing, or seeing, who may not even think of themselves as people with disabilities.

The proposed update clarifies obligations in several crucial areas that are not explicitly addressed in the current rule and improves consistency with legislative developments since the current regulations were issued. For more detailed information and resources, visit this ACL webpage that includes a link to a fact sheet that can be shared with families (in multiple languages).

CMS: Navigator Non-Compete Continuation Awards  

CMS announced it is investing $98.6 million in grant funding in 57 returning Navigator organizations for the 2024 Open Enrollment Period, to help consumers establish eligibility and enroll in coverage through the Marketplace, Medicaid, or the Children’s Health Insurance Program (CHIP). These awards will enable Navigator organizations to retain staff and add to the more than 2,300 existing Navigators who have been trained to help consumers find affordable, comprehensive health coverage. This follows a historic Open Enrollment Period in 2023 and is part of the Biden-Harris Administration’s efforts to help connect people to coverage.

HHS: Additional 988 Services for Deaf and Hard of Hearing

The U.S. Department of Health and Human Services is announcing the 988 Suicide & Crisis Lifeline’s addition of nationwide American Sign Language services for people who are Deaf and Hard of Hearing, as part of ongoing efforts to expand accessibility to behavioral health care for minority and underserved communities.

To connect directly to a trained 988 Lifeline counselor in ASL, callers who are Deaf, DeafBlind, DeafDisabled, Hard of Hearing, and Late-Deafened can click the "ASL Now" button on 988lifeline.org and follow the prompts. Direct dialing to 988 from a videophone will be available in the coming weeks, and in the meantime, ASL callers can call 1-800-273-TALK (8255) from their videophone to reach ASL services.

• 988 Suicide & Crisis Lifeline Adds American Sign Language Services for Deaf and Hard of Hearing Callers | HHS.gov
• 988 Suicide & Crisis Lifeline adopts ASL services for deaf and hard of hearing - ABC News (go.com)

NIH: Opportunity to Comment on Mission Statement

On August 25^th, The National Institutes of Health (NIH) released a Request for Information (RFI) inviting feedback on a proposed rule to update their mission statement. The NIH is the nation’s largest medical research agency. The current mission statement is “to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability.” 

In 2021, the NIH established an Advisory Committee to the Director Working Group on Diversity, with a subgroup focusing on individuals with disabilities. In 2022, the subgroup released a report that contained several recommendations to reduce ableism, including changes to the mission statement. The proposed revised mission statement is “to seek fundamental knowledge about the nature and behavior of living systems and to apply that knowledge to optimize health and prevent or reduce illness for all people.” NIH is accepting comments on the new proposed mission statement until November 24^th. 

NASHP: Toolkit to Strengthen Collaboration 

As policymakers look beyond the COVID-19 pandemic, strengthening collaboration between public health and health care system partners is critical to a modernized public health system that is robust, interconnected, and capable of promoting the health of all communities. States can harness this momentum by supporting a whole-of-government approach that aligns resources and planning across public health and the rest of health and human services (including Medicaid), while also engaging private sector partners in addressing common health priorities. This can be achieved by creating coordination mechanisms and facilitating a culture of collaboration that brings together health care delivery systems, human and social service partners, and community leaders to drive informed collective action toward improved population health.

The National Association of State Health Policy (NASHP) has created a toolkit that provides a menu of strategies and innovative practices for aligning public health and broader health care system efforts around key public health priorities.

Child Trends: Parental Leave Recommendations

The United States is one of only seven countries in the world without any kind of national paid parental leave policy, a status quo that disproportionately harms low-wage workers and workers who are Black and Hispanic. Child Trends’ new brief details the ways in which paid parental leave supports the health and economic stability of families and communities and presents a promising strategy to address the nationwide shortage of affordable, high-quality childcare.  

While the United States does not currently have any federal policies that grant universal access to paid parental leave, state and federal efforts to change the status quo have been gaining momentum in recent months. As lawmakers work to increase access to paid parental leave, they should develop policies that include the following essential elements:  

• Inclusive definitions of families and workers 
• Adequate reimbursement of workers’ wages 
• At least 12 weeks of leave 
• Job protection for all workers taking leave 
• Funding and implementation methods that advance equity  
• Outreach and communication plans 

Mathematica: Comment Opportunity Health Home Quality Measures

Each year, the Medicaid Health Home Core Sets of Health Care Quality Measures undergo a review. The Medicaid Health Home Core Sets of quality measures are key indicators of the access to—and quality of—the health care that Medicaid health home enrollees receive. The 2025 Health Home Core Sets Annual Review Workgroup was charged with reviewing the 1945 Health Home Core Set and CMS’s proposed 1945A Health Home Core Set for the new state plan option, as well as identifying gap areas and recommending changes to improve the Medicaid Health Home Core Sets.

Recommendations for Improving the Medicaid Health Home Core Sets of Health Care Quality Measures: Summary of a Workgroup Review of the 2025 Health Home Core Sets, has been released for public comment. The report is available at www.mathematica.org/features/hhcoresetreview.

Public comments may be submitted via email to [email protected] by 8 PM ET on Friday, October 13, 2023. If you wish to submit a public comment, please include “2025 Health Home Core Sets Annual Review Public Comment” in the subject line and specify whether you are commenting as an individual or on behalf of an organization.  

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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.