Having trouble viewing this email? Click here
Washington DC Update 4/10/2020
Greetings from Washington!

Once again, the policy world is all about the coronavirus – what laws and regulatory changes are needed to help individuals, health care providers, states, and businesses in this novel and extremely challenging environment. Keep reading for news and resources.

Really, though, the biggest question on people’s minds is, What day is it??? (Don’t get confused; this short video is accurate only once a week!)

NOTE: The Treasury Inspector General for Tax Administration (TIGTA) today urged taxpayers to be on high alert for potential scams related to government assistance to taxpayers impacted by the coronavirus. See:

  • Coronavirus Legislation
  • Other Coronavirus News
  • Medicaid and CHIP
  • Private Insurance Companies
  • Civil Rights for People with Disabilities--HHS Office of Civil Rights
  • HIPAA Privacy Rights during Public Health Emergency
  • Paid Sick Leave and Expanded Family Leave
  • Additional Coronavirus News and Resources
  • State Actions
  • TRICARE and Military Health System
  • Your Input Sought
  • Upcoming Webinars and Calls
Having passed three coronavirus relief bills to date, Congress is preparing to pass a fourth package (“Phase 4”), but it will take some negotiating among the Senate’s majority Republicans and the administration on the one hand, and the House and Senate Democrats on the other. On Thursday morning, there was an unsuccessful effort to pass a “Phase 3.5” bill in the Senate in order to enhance the last bill’s financial assistance for small businesses. Senate Majority Leader  Mitch McConnell  (R-KY) offered legislation to provide an additional $250 billion for the Paycheck Protection Program. Democrats, who claimed there had been no effort to negotiate, offered an amendment to include $100 billion for hospitals, $150 billion for state and local governments, and an expansion of food assistance, in addition to the small-business funding. Each party rejected the other’s proposal. See Senate Blocks Dueling Coronavirus Relief Plans (The Hill, 4/9/20).

House Speaker Nancy Pelosi has indicated that in the next Coronavirus relief legislative package (Phase 4), House Democrats would like to expand on what was done in the last bill, providing more money for individuals, businesses, states, and health care systems. See Consensus Starts to Grow on 'Phase 4' Coronavirus Relief (Politico, 4/3/20). The House and Senate are in recess this week, but negotiations will continue. Meanwhile, advocates are developing their “asks” for the next bill. Child advocates and others will join the National Governors Association in requesting an additional 5.8 percentage point increase in the Medicaid Federal Matching Assistance Percentage (FMAP), added on to an earlier 6.2 percentage point increase for the duration of Public Health Emergency declarations.
The CDC issued new interim guidance that allows employers to require essential workers who have been exposed to COVID-19 to continue to work following exposure, provided they remain asymptomatic and adhere to specified precautions.

The Indian Health Service announced its expansion of telehealth across IHS federal facilities, consistent with telehealth policy changes issued earlier by the administration ( CMS Expansion of Medicare Telehealth  and HHS Office for Civil Rights HIPAA-rule enforcement changes ). Beginning on April 8, IHS service units and their clinicians who are using the system may obtain verbal consent from patients who meet with their provider via a telehealth appointment. Health care providers are required to verify the patient at the beginning of each encounter and are not authorized to record the session.

At the end of March, the Center for Medicare and Medicaid Services (CMS) clarified that hospitals and critical access hospitals that have emergency departments must conduct a medical screening examination of all individuals who come to the hospital (by ambulance or walking in) including those who are suspected of having COVID-19.
Access to Medications
In the last coronavirus relief bill, the CARES Act , Congress authorized a 90-day supply of medication in Medicare. Private plans and many state Medicaid programs have also relaxed prescription-refill procedures so that people can get 90-day supplies of their medications. However, work remains in Medicaid, private payers, and for controlled substances. More states, without CMS approval, can relax their refill limits or use of mail order pharmacies. For controlled substances, DEA has put out extensive guidance , and has made clear that remaining limits are regulated at the state level. The American Association of People with Disabilities has developed template letters for use with state Insurance Commissioners and Governors and Attorneys General .

New Resources:
From the Beyond the Basics initiative of the Center for Budget and Policy Priorities (CBPP):

States Modify Medicaid Home- and Community-Based Waivers to Respond to COVID-19 (National Academy for State Health Policy, 3/31/20)

How Insurers Are Covering COVID-19 (HealthcareDive, tracker of large insurer policies regarding COVID-19 testing and treatment, updated 4/8/20)
OCR Reaches Early Case Resolution with Alabama after It Removes Discriminatory Ventilator Triaging Guidelines (4/8/20 Press Release, Office of Civil Rights, Department of Health and Human Services)

A bipartisan group of House members wrote a letter to Secretary Azar and Attorney General Barr about guidance on crisis standards of care and impacts on people with disabilities.

COVID-19 Communication Rights Toolkit (CommunicationFIRST) – A toolkit that: (1) explains your communication rights; (2) provides tips on advocating for them, and (3) has an accommodation request form you can bring to the hospital (in English & Spanish; Chinese coming soon).

WORTH REPEATING – Guidance on Rationing of Medical Care:
The Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) issued a Bulletin last weekend “to ensure that entities covered by civil rights authorities keep in mind their obligations under laws and regulations that prohibit discrimination on the basis of race, color, national origin, disability, age, sex, and exercise of conscience and religion in HHS-funded programs.” — BULLETIN: Civil Rights, HIPAA, and the Coronavirus Disease 2019 (COVID-19) (HHS Office of Civil Rights, March 28, 2020)

Based on this Bulletin, disability advocates have developed a document to provide more specific direction:

For more information on medical rationing, see the website of the Center for Public Representation .

See also:

If you become aware of any instances of discrimination based on disability or medical condition, or of state or facility policies that seem discriminatory, you can file a complaint with the HHS Office of Civil Rights.
BULLETIN: HIPAA Privacy and Novel Coronavirus (HHS Office of Civil Rights
February 2020)

HHS Issues COVID-19 HIPAA Waivers (from Manatt Health, 3/19/20 – describes temporary waiver of certain HIPAA requirements for all hospitals that have instituted a disaster protocol.) 
Background: The Families First Corona Virus Response Act (referred to as Families First or FFCRA) extended emergency paid family leave to caregivers who need to stay home because their children’s school or other regular source of care is unavailable due to the coronavirus situation. DOL’s recently published temporary rule implementing the paid leave provisions of the Family First Act extended emergency paid family leave to parent caregivers who need to provide care to an adult family member with a disability or an older adult because their care worker is sick or their day program has closed.

The rule did not , however, provide emergency expanded family leave to caregivers who need to stay home to care for people who are at home because they are under orders to self-isolate due to a disability or other underlying health condition. As of now, such caregivers are only eligible for paid sick leave. Advocates are pushing for this to be changed, along with rules permitting the use of intermittent sick and family leave.

Please see the “Your Input Sought” section below for an opportunity to provide input to DOL on interpreting and communicating about the emergency paid leave provisions of the recent laws. Comments are due TODAY (Friday, 4/10).


KNOW YOUR RIGHTS: The Families First Coronavirus Response Act FAQ (A Better Balance, updated 4/8/20) – good Q&A about the new paid sick and family leave benefits.

(national Partnership for Women and Families, 4/9/20)


Families First Coronavirus Response Act: Questions and Answers (very thorough explanations of the new temporary rules). Note that DOL has decided to allow paid family leave for parents caring for adult children who need a caregiver because their regular source of care is not available due to the coronavirus situation.

See the April 3 Washington Update for additional resources.

[See the March 5 Update , March 27 , and April 3 Updates for more resources.]


Information for General Public:
State Materials on COVID-19 (ADvancing States)
Resources and guidance produced by state health departments and agencies.

What Are State Officials Doing to Make Private Health Insurance Work Better for Consumers During the Coronavirus Public Health Crisis? ( To the Point blog, Commonwealth Fund, 3/20/20) — includes a table showing state-by-state information on state policies related to coronavirus testing and benefits (including prescription refills and telehealth).

State Emergency Declarations and COVID-19 — discusses state declarations of emergencies, and what they empower states to do (Association of State and Territorial Health Officials, 3/5/20). 
From TRICARE Benefits Updates

Military Health Care ( www.health.mil ) (4/8/20)

Coronavirus Information for Our Military Community —Military OneSource resources —links to good tips for families—not just military families—including emotional health issues 
The U.S. Department of Labor (USDOL) invites you to participate in a national online dialogue called " Providing Expanded Family and Medical Leave and Paid Sick Leave to Employees Affected by COVID-19 National Online Dialogue " (Idea Scale site). You're invited to share your ideas on how USDOL can help employers and employees understand their responsibilities and rights, respectively, under the expanded family and medical leave and paid sick leave provisions of the Families First Coronavirus Response Act (FFCRA). The family leave and sick leave provisions are not available under the same circumstances and lengths of time.

Action Steps:
  • Submit your comment: by Friday April 10, 2020.
  • Click on "register" at the top of the page (or "log in" if you already have an account)
  • You will receive an email with a link
  • Click on "Submit your Idea”
  • Select the group or groups under which you want to comment (e.g., "Employees and Employee Groups")
  • Provide a short title for your comments.
  • Insert comments
  • Questions or problems submitting comments? Email the Department of Labor at [email protected].

CMS has issued a Request for Information (RFI) to seek public comments about ways to improve healthcare access, quality, and outcomes for women and infants in rural communities before, during, and after pregnancy, as well as information regarding the readiness of providers, including emergency medical services (EMS), to handle obstetric emergencies (i.e., emergencies related to pregnancy, birth, and after birth) in rural areas. Comments are due by 11:59 pm EST on April 12, 2020, and can be submitted by sending an email to [email protected] .

Submit Stories about How Medicaid Has Helped You to “That’s Medicaid”
Through its “ That’s Medicaid ” initiative, the Robert Wood Johnson Foundation is publicizing stories about how Medicaid has helped people in various situations. These stories might be helpful as you educate policymakers and the public about Medicaid. People can submit their own Medicaid stories here (scroll down).
Friday, April 10, 1:30-2:30 pm ET
Justice in Aging (This webinar will discuss the changes that the Social Security Administration (SSA) has made to its policies and procedures in response to the COVID-19 pandemic. Participants will learn tips for interacting with SSA under these new rules.) 

Friday, April 10, 3:00-4:00 pm ET
National Genetics Education and Family Support Center (Family Center)
Tuesday, April 14th, 1:00-2:00 pm ET
Public Health Foundation

Tuesday, April 14, 2:00 pm ET
The Prevention Institute

Tuesday, April 14, 12:00 pm ET
Center for Budget and Policy Priorities (Open forum for questions about eligibility and enrollment in marketplace coverage, in light of the COVID-19 pandemic and recent federal legislation meant to address it.)

Wednesday, April 15, 12:00 pm ET
National Partnership for Women & Families (This webinar will focus on the Black maternal health crisis, the current COVID-19 pandemic, and the intersections of race, equity, and reproductive justice.)

Thursday, April 16, 2:00 - 3:30 pm ET
Shriver Center on Poverty Law

Thursday, April 16, 3:00-4:00 pm ET
Child and Adolescent Health Measurement Initiative and Family Voices/Leadership in Family and Professional Partnerships

Thursday, April 23, 1:00-2:00 pm ET
InCrowd (Physician and patient perspectives on the pandemic)

Thursday, April 23, 2:00 pm ET
Child and Family Policy Center Integrated Care for Kids (InCK) Marks webinars

Thursday, April 23, 3:00 ET
National Network to Eliminate Disparities in Behavioral Health (About efforts to reduce the anxiety and mental health stressors associated with COVID-19 among diverse populations.)

ADvancing States (formerly National Association of States United for Aging and Disabilities)
This free course is designed to help Information and Referral/Assistance (I&R/A) professionals to improve services and resources provided to people with intellectual and developmental disability (I/DD) and their families, and to integrate cultural and disability competence into their work with this population. To take the course, log in to ADvancing States iQ and search for the course, "Strengthening Disability and Cultural Competence in Information and Referral/Assistance (I&R/A) Work with People with I/DD and their Families." If you are new to the iQ learning center, you will need to create an account first. Click here to log in or create an account.
Not subscribed to the Washington Update? | SIGN UP HERE

Thank you for subscribing to the Washington DC Update newsletter. Please feel free to contact Family Voices Policy Director, Janis Guerney , with any questions. Past issues of the Update appear on the  Family Voices website . If you wish to unsubscribe, you can do so via the "SafeUnsubscribe" link below.

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.