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Washington DC Update 3/27/2020
Greetings from Washington!

It won’t be a surprise that this issue of the Update is devoted to the coronavirus pandemic. As of this writing, two federal coronavirus-related bills have been enacted, and a third is (hopefully) close to enactment. It is expected that there will be more legislation to come. The new laws, and policy changes made by the administration, have significantly changed Medicaid rules, or allowed states to make or request changes. Among these: under federal law, states are not permitted to disenroll anyone from Medicaid until after the public health emergency has ended. States will also be receiving a greater share of Medicaid funding from the federal government, and federal and state policies have been changed to promote the use of telehealth. Read on for more information about these policy changes.
 
Check out the Family Voices coronavirus webpage for information and resources, and 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 .

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. 

IN THIS ISSUE

  • Coronavirus Legislation
  • Administration Actions
  • State Actions
  • Concerns about Civil Rights of People with Disabilities
  • Nonprofit Issues
  • Other Issues
  • TRICARE
  • Your Input Sought
  • Upcoming Webinars and Calls
  • Additional Coronavirus Resources

CORONAVIRUS LEGISLATION
So far, two laws have been enacted to address the health and economic consequences of the coronavirus pandemic, and a third – the CARES Act – may be enacted by the time this Update is published. In chronological order, here is the legislation to date:

The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020
( H.R. 6074 ; Public Law 116-123; enacted 3/6/20)
This law provided additional funding for federal health agencies and authorized the use of funds to reimburse federal agencies, states, localities, territories, tribes, tribal organizations, and health service providers to tribes for costs related to coronavirus preparedness and response activities prior to the bill’s enactment. The bill also 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,” and authorizes Medicare reimbursement for telehealth consultations. See House Appropriations Committee  press release , and the committee’s  section-by-section summary .

Families First Coronavirus Response Act
( H.R. 6201 ; Public Law 116-127; enacted 3/18/20)
Among other things, this law contains several new Medicaid and CHIP policies, effective March 18, 2020, until the end of the COVID-19 public health emergency period  declared by the Secretary of Health and Human Services:
  1. A temporary increase in the federal Medicaid matching rate (FMAP) by 6.2 percentage points for all states and the territories
  2. A requirement that states cover COVID-19 testing in Medicaid and CHIP without cost-sharing
  3. A new option for states to extend Medicaid coverage for testing to uninsured individuals at federal expense
  4. A prohibition on states 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. See Families First Coronavirus Response Act Freezes Disenrollment in Medicaid (blog post, Georgetown Center for Children and Families, 3/23/20).

The Families First Act also includes provisions relating to Family and Medical Leave and Paid Sick Leave . See explanations of these provisions on the Department of Labor website .

See also:

(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.

(Health Affairs blog, 3/16/20).

From Medicaid.gov (CMS):

From the Georgetown University Center for Children and Families:

CARES Act (Coronavirus Aid, Relief, and Economic Security Act , H.R. 3548 )
On Wednesday night, the Senate passed (96-0) the third bill to address the health and economic consequences of the COVID-19 pandemic -- the $2.2 trillion CARES Act. House Democratic and Republican leaders agreed to take up the bill Friday morning, holding a voice vote so that Members would not have to return from their districts to vote in person. As of this writing, however, one Member, Rep. Thomas Massie (R-KY), has threatened to object to the voice vote, causing leadership to advise Members to return to DC . The president has said he will sign the bill.

The CARES Act includes health provisions, and provisions to expand the availability of family leave and sick leave to more individuals. A March 26, 2020, blog post from Health Affairs discusses the key health-coverage provisions of the CARES Act. 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:

ADMINISTRATIVE ACTIONS
(The Hill, 3/26/20).

CMS has taken several recent actions in response to the Coronavirus Disease 2019 (COVID-19), as part of the ongoing White House Task Force efforts. A summary of recent CMS activities can be found here .
 
To keep up with the important work the Task Force is doing in response to COVID-19, go to www.coronavirus.gov . For information specific to CMS, please visit the CMS News Room and Current Emergencies Website.

This USA.gov webpage has a list of all federal agency actions on the coronavirus.

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.
 
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.)

CMS Halts Issuance of Proposed Rule on Medicaid Eligibility
On March 25, the Center for Medicare and Medicaid Services (CMS) withdrew from consideration a draft proposed rule that was under review by the White House Office of Management and Budget (OMB), which reviews proposed rules before they are released by a department or agency. CMS could, however, decide to re-submit the draft proposed rule to OMB in the future. The draft proposed rule, titled “Strengthening the Program Integrity of the Medicaid Eligibility Determination Process,” was expected to make it more difficult for individuals to enroll in their states’ Medicaid programs. Several advocacy organizations, including children’s health groups, had met with OMB staff to educate them about the potential harms of creating more “red tape” in the Medicaid enrollment process. See Statement by the Executive Director of the Georgetown University Center for Children and Families, Joan Alker, on Withdrawal of the Proposed Rule (Georgetown Center for Children and Families, 2/25/20).
STATE ACTIONS
( 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).

(National Conference of State Legislatures, updated daily).

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).

For more information, see the end of this Update.
CONCERNS ABOUT CIVIL RIGHTS OF PEOPLE WITH DISABILITIES
Disability-rights advocates are very concerned about the possibility that state, local or hospital policies regarding the allocation of scarce resources will discriminate against people with disabilities or chronic health conditions. See:


NONPROFIT ISSUES
OTHER ISSUES
TRICARE
YOUR INPUT SOUGHT
NEW FAMILY AND MEDICAL LEAVE AND PAID SICK LEAVE – TALK TO THE DEPT. OF LABOR
From now through March 29, 2020, 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 ." 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).

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 ruralmaternalrfi@cms.hhs.gov .

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).
UPCOMING WEBINARS AND CALLS
Friday, March 27, 12:00-1:00 pm ET
National Health Council

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.
ADDITIONAL CORONAVIRUS RESOURCES
[See the Family Voices coronavirus webpage and the March 5 Update for more resources. ]

GENERAL RESOURCES

NEW 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 .

MEDICAID & CHIP

 

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

TELEHEALTH

From Medicaid.gov:


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 ” 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.