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Washington DC Update 4/3/2020
Greetings from Washington!

This issue of the Update once again focuses on the coronavirus pandemic, particularly on the regulatory changes that the Center for Medicare and Medicaid Services (CMS) has authorized in the Medicaid program and for health care providers, and the recently enacted paid sick leave and expanded family and medical leave laws.

PLEASE NOTE:  Until April 10, you have the opportunity to influence how the Department of Labor interprets and implements these provisions of the law. Please see the “Your Input Sought” section, below, for how to do so.

Check out the latest Family Voice Resource eBlast newsletter for family-oriented COVID-19 resources.  See “ Coronavirus Resources,” at the end of this Update for additional information, including how to get extra prescription medications so you can stay away from crowded places. You can keep up to date on this topic via the CDC's webpage on the novel coronavirus

  • Coronavirus Legislation
  • Administration Actions
  • State Actions
  • Nonprofit Issues
  • Your Input Sought
  • Upcoming Webinars and Calls
  • Additional Coronavirus Resources

At the time the last Update was written, Congress was on the verge of passing a third package of bills to address the COVID-19 pandemic. That legislation was, in fact, enacted. The second and third packages are the ones of most interest to families of CYSHCN. (These bills are explained in more detail in the March 27 Update ).

  • First package: Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, (H.R. 6074; Public Law 116-123; enacted 3/6/20). See House Appropriations Committee press release , and the committee’s section-by-section summary.

  • Second package: Families First Coronavirus Response Act (H.R. 6201; Public Law 116-127; enacted 3/18/20). Provides a temporary increase in the federal Medicaid matching rate (FMAP) by 6.2 percentage points for all states and the territories; prohibits states receiving the increased FMAP from disenrolling any beneficiary who was enrolled in Medicaid as of March 18, 2020, or anyone who newly enrolls, until after the national emergency declaration has been lifted, unless they move out-of-state or request voluntary termination; requires states to cover COVID-19 testing in Medicaid and CHIP without cost-sharing; creates a new option for states to extend Medicaid coverage for testing to uninsured individuals at federal expense; includes paid sick leave and paid family leave provisions. See below for more information on paid leave. Department of Labor website.

  • CARES Act (Coronavirus Aid, Relief, and Economic Security Act, H.R. 748; Public Law No: 116-136, enacted 3/27/20). [PLEASE NOTE: The March 27 Update provided an incorrect bill number and link to the final version of the CARES Act.] The CARES Act includes health-related provisions, and provisions to expand the availability of family leave and sick leave to more individuals. Among other things, it widens the coverage provisions in the Families First bill related coverage for COVID-19 testing. It also includes an extension of funding for community health centers and other public health programs until to the end of November 2020 (from May 22, 2020), and provides an additional $1.32 billion in funds for community health centers during this fiscal year. In addition, the bill further delays, until December 1, 2020, payment reductions to disproportionate share hospitals, and increases Medicaid funding to states that choose to cover uninsured individuals for COVID-19 testing. The CARES Act would also ensure that access to testing and a coronavirus vaccine (once one is developed) would be covered without cost-sharing on a permanent basis (rather than until the public health emergency is over).

See also:

The Families First Coronavirus Response Act: Summary of Key Provisions (Kaiser Family Foundation, 3/23/20) – summary of all provisions including: Division C—Emergency Family And Medical Leave Expansion Act; Division E—Emergency Paid Sick Leave Act; Division F—Health Provisions; Division G—Tax Credits For Paid Sick And Paid Family And Medical Leave.

From the Georgetown University Center for Children and Families:

From other sources:
This Coronavirus (COVID-19) Partner Toolkit provides educational materials for a variety of audiences.

This USA.gov webpage has a list of all federal agency actions on the coronavirus.
Medicaid & CHIP – Center for Medicare and Medicaid Services (CMS)
The Center for Medicare and Medicaid Services (CMS) has issued an interim final rule to make temporary changes to federal regulations for the duration of the coronavirus emergency declaration. Among other things, these changes will allow hospitals and health systems to deliver services at other locations to make room for COVID-19 patients in their main facility. Also see background information on the waivers and rule changes, and a list of coronavirus-related regulatory changes, including the interim final rule, at CMS COVID-19 flexibilities webpage.

These actions, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.


CMS toolkit Federal Disaster Resources (List of 1135 waivers granted to states)

WORTH REPEATING: Medicaid & CHIP Policy Changes
Section 1135 of the Social Security Act authorizes the Secretary of Health and Human Services (HHS) to make changes to Medicare, Medicaid and CHIP rules when the Secretary has declared a Public Health Emergency, which he did on January 3, AND the president declares an emergency or natural disaster under the National Emergencies Act or Stafford Act, which he did on March 13. Under this authority, HHS Secretary Azar announced some changes to Medicare, Medicaid, and CHIP rules to make it easier for people to get benefits needed to address the coronavirus epidemic. See COVID-19 Emergency Declaration Health Care Providers Fact Sheet (3/13/20; pp. 3-4 for Medicaid/CHIP section). See Medicaid.gov 11135 waivers list; Medicaid Emergency Authority Tracker: Approved State Actions to Address COVID-19 (Kaiser Family Foundation, 3/25/20); Approved 1135 Waivers and State Plan Amendments for COVID-19 (Georgetown Center for Children and Families, updated 3/24/20). For more details about changes that can be made to Medicaid and CHIP rules, see “Medicaid & CHIP Emergency Changes” at the end of this Update.
WORTH REPEATING: Public Charge Determinations Will Not Consider COVID-Related Care
The US Citizenship and Immigration Services (USCIS) has posted an alert announcing that it “encourages all those, including aliens, with symptoms that resemble Coronavirus Disease 2019 (COVID-19) (fever, cough, shortness of breath) to seek necessary medical treatment or preventive services. Such treatment or preventive services will not negatively affect any alien as part of a future Public Charge analysis.” (Emphasis added.)

Affordable Care Act – CMS
Most states and the District of Columbia, which run their own health insurance exchanges, have reopened enrollment in recent weeks, but the administration has decided not to re-open enrollment for people in states using the federal exchange. (However, the president and vice-president have both indicated they are looking at the possibility of using Medicare and Medicaid to close coverage gaps. Trump Hints at Using Federal Programs to Provide Coverage after Obamacare Decision (Politico, 4/1/20).)
Civil Rights for People with Disabilities – HHS Office of Civil Rights (OCR)
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)

See also:

HIPAA Privacy Rights During Public Health Emergency – HHS OCR

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.)

Paid Sick Leave and Expanded Family Leave – Department of Labor (DOL)

Excerpts from press release:
WHD [Wage & Hour Division] offers a number of plain-language compliance assistance materials to explain FFCRA’s benefits and requirements. Tools include a  Fact Sheet for Employees and a  Fact Sheet for Employers, available in both English and Spanish, and an expansive list of  Questions and Answers addressing the questions WHD has most frequently received from stakeholders to date. Available guidance also includes two new posters, one  for federal workers and  one for all other employees, available in both English and Spanish, that will fulfill notice requirements for employers obligated to inform employees about their rights under this new law,  Questions and Answers about posting requirements, and  a Field Assistance Bulletin describing WHD’s 30-day non-enforcement policy.

WHD provides additional information on common issues employers and employees face when responding to COVID-19 and its effects on wages and hours worked under the Fair Labor Standards Act and job-protected leave under the Family and Medical Leave Act.

The Wage & Hour Division (WHD) will post a recorded webinar on Friday, April 3, 2020 , to provide interested parties a more in-depth description and help them learn more about the FFCRA.

Explanations from the Department of Labor, Wage & Hour Division:

Other resources:
Education Issues

Other Coronavirus News and Resources

Regarding Policy:

Information for General Public:

(See also the Coronavirus section at the end of this Update.)


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). See table summarizing the Act’s provisions .
From The Arc and the Center for Public Representation:
The Families First Act extended emergency paid sick leave to many people, but the provisions do not explicitly extend to caregivers who need to take sick days to provide care to an adult family member with a disability or an older adult because that individual’s care worker is sick or their day program has closed. The legislative text is also slightly vague if “concerns related to COVID-19” include when someone has been instructed by a health care provider to self-isolate during the coronavirus pandemic because of a pre-existing condition or illness . These are issues that it would be helpful to address with the DOL during this dialog .

T raveling by Air with Service Animals – due April 6
On January 22, the Department of Transportation issued a proposed rule on traveling by air with service animals. As explained in the department’s press release , and this news article , the proposed rule would, among other things: define a service animal as a dog that is individually trained to do work or perform tasks for the benefit of a person with a disability; no longer consider an emotional support animal to be a service animal; consider a psychiatric service animal to be a service animal and require the same training and treatment of psychiatric service animals as other service animals. Comments are due on April 6 and can be submitted here .

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).
To be posted Friday, April 3, 2020
Department of Labor’s Wage & Hour Division
This recorded webinar will provide an in-depth description of the provisions of the Families First Coronavirus Response Act.

Friday, April 3, 12:00-1:30 pm ET
American Association of People with Disabilities
[This webinar will be recorded and made available for viewing after the live presentation.]

Friday, April 3, 2:15-3:00 pm ET
Justice in Aging

Monday, April 6, 1:00-2:30 pm ET
Centers for Disease Prevention and Control

Tuesday, April 7, 1:00 pm ET
Georgetown Center for Children and Families

Tuesday, April 7, 2:00 pm ET
University of Pittsburgh's Center for Family Support

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

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

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.
an account.
[See the the March 5 Update for more resources.]


Library of Congress Law Library includes links to congressional, administration, state, and international resources. (This is intended as a guide to laws, regulations, and executive actions in the United States, at both the federal and the state level, and in various countries with respect to the new coronavirus and its spread. We are also including links to Congressional Research Service (CRS) reports that provide information to Congress about the novel coronavirus. In addition, we provide links to relevant federal agency websites. We intend to update this guide on at least a weekly basis for the immediate future.)

COVID-19 Resources Page from ADvancing States (formerly the National Association of States United for Aging and Disabilities)
ADvancing States has launched a COVID-19 Resources page on its website, which includes links to resources from federal agencies , including ACL, CMS, and the CDC, and links to relevant state agencies .



See also the Medicaid.gov webpage on Coronavirus Disease 2019 , which includes:


From Medicaid.gov:


You May Have a Legal Right to Emergency Refills of Life-Essential Prescription Drugs , which explains that 20 states have passed Kevin's Law (fact sheet), which allows a pharmacist to dispense an emergency supply of a chronic maintenance drug if a doctor cannot be reached to authorize a prescription. States that have passed Kevin’s Law include: Ohio and Florida in 2016; Arkansas, Arizona, Illinois, and Wisconsin in 2017; Idaho, Oregon, Pennsylvania, South Carolina, and Tennessee in 2018; and Colorado, Indiana, Kentucky, Oklahoma, Utah, and West Virginia in 2019.

Healthcare Ready is a resource from drug manufacturers, distributors, and dispensers/providers. Its website includes a page on coronavirus resources , which, among other things provides:

When a state governor declares an emergency or public health emergency, it triggers certain changes to laws or regulations, or gives the governor power to waive them. For example, in Florida in counties where a state of emergency has been declared, or in certain other circumstances, any health insurer, managed care organization or other entities licensed by the Office of Insurance Regulation must waive the "refill too soon" restrictions on prescriptions.

Healthcare Ready provides a list of CoV state emergency declarations on its COVID-19 Resources for the Healthcare and Public Health Community page (scroll down), and another list — State Level Insurance Emergency Orders — with summaries about what these orders mean, on its at Patient Resources page (scroll down). The only summaries that mention Rx refills are those for CO, MD, and WA, but there may be others.
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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.