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Washington DC Update 3/13/2020
Greetings from Washington!

This issue of the Update is devoted in large part to coronavirus-related policy and information, including information about insurance coverage for testing and treatment for COVID-19, the illness that results from the virus. Top line message: It is time to start practicing “social distancing ,” especially for individuals at high risk of serious illness from the virus.

Check out the Family Voices coronavirus webpage , and the end of this Update for information and resources, including how to get extra prescription medications so you can stay away from crowded places. A couple highlights:  Apple says it’s now OK to use disinfectant wipes to clean your iPhone (but read the article for instructions); How soap absolutely annihilates the coronavirus (this might make it more interesting for your kids wash their hands); and very important: 'Flattening the curve’ may be the world’s best bet to slow the coronavirus  (STAT, 3/11). 

Quote of the week: “No matter our politics, no matter our race, creed, or color, it is at moments such as this that everything that divides us falls away, and we realize what unites every last one of us as human beings: None of us can stop touching our face.” From Preparing for the Coronavirus Disruption (National Review, 3/9/20).

IMPORTANT REMINDER: Please see the “Your Input Sought” section below for details and information about how to submit comments on Out-of-State Provision of Medicaid Services for Children with Medically Complex Conditions (part of implementing the ACE Kids Act), due March 23.

  • Coronavirus News, Information, and Resources
  • Administration Actions and Proposals
  • Federal Legislation
  • State Actions
  • Public and Private Insurance Coverage for Coronavirus Testing and Treatment
  • Courts
  • Medicaid/CHIP News, Information, and Resources
  • Medicaid Waivers
  • Other News, Information, and Resources
  • Your Input Sought
  • Upcoming Webinars and Calls
  • Additional Coronavirus Resources

You can keep up to date on this topic via the CDC's webpage on the novel coronavirus . You can also subscribe to a new  COVID-19 newsletter , and follow the CDC on social media: @CDCgov ; Facebook ; Instagram . See also the Main WHO coronavirus webpage . Links to additional resources are provided at the end of this Update.

The President’s Remarks and Proposals
On March 11, President Trump addressed the nation about the coronavirus. As summarized by the White House, he proposes a number of measures to protect Americans’ health and the economy. See White House Fact Sheet (3/11/20), which clarifies some of the statements the president made during the live remarks.
Other Administration Actions
Among other actions to facilitate appropriate responses to the coronavirus outbreak, the administration has taken the following action:

Coronavirus Bill Enacted
As reported in the March 5 Update , the House passed (by a vote of 415-2 on March 4) the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 , ( H.R. 6074 ), a bipartisan $8.3 billion supplemental funding bill to respond to the coronavirus outbreak. The funding includes:

  • $2.2 billion for prevention, preparedness, and response, of which $950 million is for state local health departments;
  • Over $3 billion for research and development of vaccines, therapeutics, and diagnostics; and nearly $1 billion “for procurement of pharmaceuticals and medical supplies, to support healthcare preparedness and Community Health Centers, and to improve medical surge capacity.”

As reported in an article from The Hill , the bill requires that any vaccines, drugs, or tests developed by private companies using taxpayer dollars be made available for purchase by the federal government at a “fair and reasonable price,” a weakened version of a provision that had been sought by Democrats. See How the Drug Industry Got Its Way on The Coronavirus (Politico, 3/5/20). In addition, the bill authorizes Medicare reimbursement for telehealth consultations. The Senate approved the bill without amendment on March 5, by a vote of 96-1, and the president signed it on March 6. See Trump Signs $8.3 Billion Coronavirus Package (The Hill, 03/06/20). Read more about the law in the House Appropriations Committee press release , and the committee’s section-by-section summary .
Congress Working on Legislation to Address Economic Impact of Coronavirus
House and Senate Democrats are working on bills to address the economic impact of the coronavirus outbreak. The 124-page House bill (H.R. 6021, the Families First 5 Coronavirus Response Act will be taken up on the House Floor as early as March 12. As summarized in the House Speaker’s press release , the bill provides for:

  • Free coronavirus testing for everyone who needs a test, including the uninsured
  • Paid emergency leave with both 14 days of paid sick leave and up to three months of paid family and medical leave
  • Enhanced Unemployment Insurance, a first step that will extend protections to furloughed workers
  • Strengthened food security initiatives, including SNAP, student meals, seniors nutrition and food banks
  • Clear protections for frontline workers, including health care workers and other workers who are in contact with those who have been exposed or are responsible for cleaning at-risk places 
  • Increased federal funds for Medicaid, as states face increased costs

Senate Democrats reportedly are considering legislation focusing on grants for community economic development and small businesses, public transit agencies, and rental assistance for low-income households. The president has proposed suspending the payroll tax that funds Social Security and Medicare, but that proposal is considered a “non-starter” by Democrats, and is not necessarily supported by Republicans either; Senate Finance Committee Chairman Chuck Grassley (R-IA) declined to endorse that proposal. See Coronavirus Stimulus Talks Ramp Up as White House Mulls Options (Roll Call, 3/11/20).

On March 11, the House Committee on Oversight and Reform held a hearing on the federal government’s coronavirus response. The government’s top health officials testified, including Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, and Dr. Robert Redfield, Director of the Centers for Disease Control and Prevention (CDC). You can watch a video of the hearing here .

(Senate HELP Committee Press release, 3/6/20)
This is a bill introduced by Democrats in the House and Senate. See also Democrats Introduce Bill to Guarantee Paid Sick Leave in Response to Coronavirus (The Hill, 3/6/20); Coronavirus Has Revived the Paid Sick Leave Debate (Governing, 3/10/20).
A blog post from the Association of State and Territorial Health Officials (ASTHO) — State Emergency Declarations and COVID-19 — discusses state declarations of emergencies, and what they empower states to do.

Healthcare Ready provides a list of 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).

See also Coronavirus Quarantines Pose Tough Issues for State and Local Officials (Route 50, 3/6/20).
Private Insurance:
Several states have taken action to address the financial barriers that may deter people from seeking medical advice and treatment for COVID-19.

California Nevada New York Oregon , and  Washington  are all requiring private insurance companies regulated by the state to waive cost-sharing for COVID-19 testing. It should be noted that state insurance commissioners do not have any legal authority over self-insured plans, which include those of many large employers; those plans are governed by federal law (ERISA).

The trade association of some of the country’s largest private health insurers, America’s Health Insurance Plans (AHIP), has announced that its members will relax certain policy provisions in order to make it easier for policyholders to obtain testing and treatment for COVID-19. According to a March 5 statement from the AHIP Board of Directors

"We will cover needed diagnostic testing when ordered by a physician. We will take action to ease network, referral, and prior authorization requirements and/or waive patient cost sharing. We will also take action so that patients will have continuous access to their regular prescription medications while at the same time avoiding potential problems such as drug shortages.

"We will develop solutions for state and federal policymakers to provide more guidance and more flexibility so that changes to preventive services, benefit design, and treatment options can help people immediately."

Actions to be taken by specific health insurers are listed in Health Insurance Providers Respond to Coronavirus (COVID-19) (AHIP blog post, 3/6/20). See also the AHIP Coronavirus Page , which includes COVID-19 Coverage: Frequently Asked Questions (3/9/20).

Public Insurance (Medicaid, CHIP, Medicare):

THIS JUST IN: COVID-19 FAQs for State Medicaid and Children's Health Insurance Program (CHIP) Agencies ( Medicaid.gov sent this bulletin at 03/12/2020 03:01 PM EDT)

Under Medicaid, testing and diagnostic services are an optional benefit category for adults, and can vary by state, but most states cover them. (Children are eligible to receive all medically necessary testing and diagnostic services.) Laboratory and X-ray services are a mandatory benefit in Medicaid and these services are covered and reimbursed in all states.

The Medicaid.gov website has a page — Coronavirus Disease 2019 (COVID-19) — with links to information and resources, including a Disaster Preparedness Toolkit for State Medicaid Agencies , and an Inventory of Medicaid and CHIP Flexibilities and Authorities in the Event of a Disaster , which explain how state Medicaid agencies have flexibility to modify certain aspects of their state plans in a disaster situation, such as benefits, deadlines for eligibility redeterminations, and other program elements. States can take certain actions without federal approval, while others require a waiver from CMS.

When the President declares a disaster or emergency under the Stafford Act or National Emergencies Act, and the HHS Secretary declares a public health emergency under Section 319 of the Public Health Service Act — which has been done in light of the coronavirus outbreak —the Secretary is given special authority. For example, under section 1135 of the Social Security Act, she may temporarily waive or modify certain Medicare, Medicaid, and CHIP requirements to ensure that sufficient health care items and services are available to beneficiaries in the emergency area. For a list of the various actions that the administration has taken in light of the coronavirus with respect to Medicare, Medicaid, and CHIP see the CMS Current Emergencies page . They include authorizing coverage of telehealth services under Medicaid and Medicare.

The Association for Community-Affiliated Plans – non-profit Medicaid managed care organizations – has announced that, “…all 74 ACAP-member Safety Net Health Plans and Marketplace Partners will offer coverage for appropriate tests of COVID-19 consistent with FDA guidance ordered by their members’ health care provider.”
(Press release from the National Health Law Program, 3/4/20):
“St. Louis, MO – Nine children with complex medical needs and their families, along with a coalition of parents and caregivers, have filed a lawsuit against the Missouri Department of Social Services to compel the State to ensure coverage of the in-home nursing care that it has found the children need.”
WORTH REPEATING: Guidance to States on Behavioral Health Coverage Benefit for Separate Children Health Insurance Programs (CHIPs)  
From Medicaid.gov bulletin, 3/2/20:
On March 2, the Centers for Medicare & Medicaid Services (CMS) released State Health Official (SHO) Letter: Access to Mental Health and Substance Use Disorder Services for Children and Pregnant Women in the Children’s Health Insurance Program , which provides guidance to states on a new congressionally-mandated behavioral health coverage benefit for separate Children Health Insurance Programs.
To track state waiver requests, see:

Congressman Tom Cole (R-OK) and Congresswoman Elaine Luria (D-VA) introduced the bipartisan TRICARE ECHO Improvement Act, which would make commonsense changes to TRICARE’s existing Extended Care Health Option (ECHO) program.

If you feel sick or need health advice, the  Military Health System Nurse Advice Line  is available 24/7, by phone, web chat, or video chat to eligible TRICARE beneficiaries. Nurses are able to screen patients for potential or suspected exposure or infection.
You can bookmark the TRICARE  coronavirus page  for updates about COVID-19. A DoD  spotlight page  also shares the latest information on the outbreak, and highlights coordination efforts with other government agencies. 

FDA Bans Electrical Stimulation Devices for Self-Injurious or Aggressive Behavior (Administration for Community Living Bulletin, 3/10/20)

From CMS Press Release, 3/9/20, which includes links to fact sheet and final rules:
“The two rules…implement interoperability and patient access provisions of the bipartisan 21st Century Cures Act (Cures Act) and support President Trump’s MyHealthEData initiative. MyHealthEData is designed to empower patients around a common aim — giving every American access to their medical information so they can make better healthcare decisions.” See New Trump Rules Aim to Fuel Sharing of Patient Health Records by Smartphone (STAT 3/9/20); Virtual Roundtable: Will HHS' Latest Interoperability Rule Truly Change Data Sharing (Fierce Healthcare, 3/9/20)

“A coalition of 17 attorneys general across the country, led by Washington State’s Bob Ferguson, have signed a letter asking the Trump administration to delay the  new public charge rule for immigrants while the coronavirus outbreak is ongoing. Ferguson is co-leading the multi-state coalition challenging the rule.”

From WrightsLaw – “IEP Season: Advocating for Your Child—Getting Started” in this issue of The Special Ed Advocate
Please pay special attention to the items marked with ***

The National Library of Medicine (NLM) is asking for public comment in its current effort to modernize ClinicalTrials.gov , the world’s largest public clinical research registry and results database. The focus of the modernization includes improving website functionality, submission processes, and use of data standards. For more information on the project in submitting a comment, click here . Send submissions to NLM by no later than Saturday, March 14, 2020, to Patient Affairs Staff (PAS), Office of the Commissioner, U.S. Food and Drug Administration, or fill out this form . (Tel: 301-796-8460.)

*** Request for Information on Out-of-State Provision of Medicaid Services for Children with Medically Complex Conditions – due March 23 ***
On January 21, the Centers for Medicare and Medicaid Services (CMS) published a Request for Information on “Coordinating Care from Out-of-State Providers for Children with Medically-Complex Conditions.” CMS is seeking public comments on:

  • Best practices for using out-of-state providers in coordinating care for children with medically complex conditions
  • How care is coordinated for such children when that care is provided by out-of-state providers including when care is provided in emergency and non-emergency situations
  • Processes for screening and enrolling out-of-state providers, including efforts to streamline these processes or reduce the burden of these processes on such providers and states

Comments are due on March 23, no later than 11:59 pm EST, and can be submitted HERE .
Traveling 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). 
Friday, March 13, 12:00-1:00 pm ET
National Health Council

Monday, March 16, 12:00 pm ET
National Academy for State Health Policy (NASHP)

Thursday, March 19 at 3:00-4:30 pm ET

Tuesday, March 24, 2:00-3:00 pm ET
Justice in Aging

Thursday, March 26, 2:00 pm ET
The Child and Family Policy Center  

Friday, April 3, 2-3 pm ET

New Date! Wednesday, April 8, 2-3:30 pm ET

Tuesday, April 14, 1:00-2:00 pm ET
Public Health Foundation

Monday, June 1, 1:00-3:30 pm ET [last in a series ]
National Quality Forum/Administration for Community Living; Centers for Medicare and Medicaid Services
[See the Family Voices coronavirus webpage and the March 5 Update for more resources. ]

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 .

Resources on Accessing Emergency or Extra Prescription Medications

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
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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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.