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Washington DC Update 5/19/2020
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Greetings from Washington, DC
Last week the House of Representatives passed, mostly along party-lines, a comprehensive Democratic bill to address the health and economic consequences of the coronavirus pandemic. Among other measures, it would provide additional funding for Medicaid. (The bill does not include additional funding for Family-to-Family Health Information Centers.) The Senate will develop its own bill, but is not expected take action until June. Meanwhile, the administration released a three-phase plan for “opening up” the country, and announced the establishment of “Operation Warp Speed,” a public-private partnership to speed the development of a coronavirus vaccine.

Read on to learn more, and be sure to check out useful resources and webinars. At the end of the Update is a summary of some key information about Economic Impact (Stimulus) Payments and links to further information.
 
Please note: In light of the COVID-19 pandemic, CMS has re-opened the comment period for responding to its “Request for Information about Coordinating Out-Of-State Medicaid Services for Children with Medically Complex Conditions.” Read more in the “Your Input Sought” section, below. Comments are due on June 3.
IN THIS ISSUE
  • Coronavirus News, Information, and Resources
  • The Courts
  • Administration
  • Congress
  • Medicaid and CHIP
  • Civil Rights for People with Disabilities--HHS Office of Civil Rights
  • Telehealth
  • Other COVID News and Resources
  • Medical, Scientific, Other Coronavirus Information
  • TRICARE and Military Health System (COVID and non-COVID issues)
  • Your Input Sought
  • Upcoming Webinars and Calls
  • Of Possible Interest
  • Additional Information from the Social Security Administration and IRS
CORONAVIRUS NEWS, INFORMATION, AND RESOUCES
The Courts
Texas v. California and California v. Texas
These two cases are those that will decide the future of the Affordable Care Act (ACA). The Court will consider the cases together during its next term, which begins in October 2020. A decision probably won’t be rendered until the spring of 2021. As reported in the May 8 Update , the administration has decided to maintain its position that the entire law should be declared unconstitutional. Deadlines have passed for submission of both the parties’ briefs and amicus curiae (friend-of-the-court) briefs. Numerous groups of organizations submitted amicus briefs in support of the law, including groups of hospitals, physicians, patient advocacy organizations, insurers, and other states. See Wide Range of Amici Support California, House in Texas Litigation (Health Affairs blog, 5/16/20). 
The Administration
The president has unveiled Guidelines for Opening Up America Again , “a three-phased approach based on the advice of public health experts.”
 
Extension of COBRA deadlines
On May 4, the Employee Benefits Security Administration, Department of Labor and the Internal Revenue Service, Department of the Treasury, issued a significant “ Notification of Relief; Extension of Timeframes .” In light of the national emergency declaration due to the coronavirus pandemic, the agencies have extended various deadlines under health-care portability laws (ERISA and COBRA) which permit individuals to purchase employer-sponsored health insurance coverage under certain circumstances, such as termination of employment. Under this new policy, the deadlines are essentially suspended until the after the national emergency has ended. Therefore, the usual 60-day deadline for COBRA enrollment will now be 60 days after the end of the national emergency. According to an article in the May 15 issue of Axios Vitals (item 5), health care providers are permitted to pay premiums on behalf of patients.

Operation Warp Speed for Vaccine Development and Farmers-to-Families Food Box Program
On March 15, the president held a Rose Garden event to announce the establishment of “ Operation Warp Speed .” This public-private initiative brings top scientists together to develop and manufacture a coronavirus vaccine as quickly as possible, and to accelerate the development of diagnostics and therapies. The project will have a chief scientist, a well-known immunologist, and an operating officer, Commander of the U.S. Army Materiel Command. See Trump touts accelerated push on coronavirus vaccines (The Hill, 5/15/20); After Sneak Peek at Early Data, Operation Warp Speed Head Slaoui 'Confident' in COVID-19 Vaccine by Year's End (Fierce Pharma, 5/15/20).

During the same event, the president announced the creation of the USDA Farmers to Families Food Box program, through which excess crops, milk, and meat will be boxed and distributed by nonprofit organizations to people who need food assistance. Infographic . 
In Congress
House passes another coronavirus bill but Senate not expected to act quickly
On Friday night, May 15, the House of Representatives passed a $3 trillion-dollar bill put forward by Speaker Nancy Pelosi (D-CA) to address the consequences of the COVID-19 pandemic. The vote was mostly along party lines. One progressive and several moderate Democrats voted against the bill; one Republican voted with the other Democrats. See House Passes Massive $3T Coronavirus Relief Package (The Hill, 5/15/20). The bill is called the “Health and Economic Recovery Omnibus Emergency Solutions Act” or “HEROES Act” ( H.R. 6800 ).

The House bill does not include any funding to help Family-to-Family Health Information Centers with extra work and expenses related to the pandemic. It does include an increase in Medicaid funding and other health-related provisions, some of which are listed below. For information about the bill’s Medicaid and CHIP provisions, see HEROES Act Includes Other Provisions Strengthening Medicaid and CHIP (Georgetown Center for Children and Families blog post, 5/14/20).

It is important to note that this bill is just the House Democrats’ opening bid for negotiations with the Senate and the administration. Senate Majority Leader Mitch McConnell (R-KY) has indicated that the Senate is not in a rush to pass another coronavirus bill, and is not interested in legislation as sweeping as the House bill, which was developed without Republican input. See House Passes Democrats' $3T Coronavirus 'HEROES' Aid: Stimulus Checks, Money for States, Rent Assistance— President Donald Trump called it "DOA," and Sen. Mitch McConnell said the bill was little more than an unrealistic wish list (NBC News, 5/15/20). Although pressure will mount on Senators to address the high unemployment rate, state revenue losses, and other consequences of the pandemic, the Senate is not expected to act before June. See Senate GOP Crafting Wishlist for Next Coronavirus Package (The Hill, 5/13/20).

The House bill includes:
  • More money to states for Medicaid (see this summary from the National Health Law Program):
  • Another increase in the federal Medicaid matching rate (FMAP), for a total of a 14- percentage-point increase (not applicable to costs related to Medicaid-expansion populations or administrative expenses). The increase would begin on July 1, 2020, and continue through June 30, 2021. If the public health emergency continues after June 30, 2021, states would continue to receive the 6.2% FMAP increase that was previously enacted. Governors had requested a total increase of 12 percentage points for a longer period of time.
  • An additional 10 percentage-point FMAP increase, capped at 95 percent of a state’s Medicaid costs, for providing specified home and community-based services (HCBS) which, among other things, can be used to raise wages, provide paid leave for home health workers, and provide HCBS to those on waiting listings, as long as the state uses the funds to supplement and not supplant existing HCBS funding.
  • An expansion in payment for treatment and vaccinations related to COVID-19 in Medicaid and CHIP, with no cost-sharing, if states elect to cover a new eligibility category for the uninsured.
  • An effective increase of 9.8 percentage points in the CHIP federal matching rate, resulting from the Medicaid FMAP increase.
  • A delay in finalizing the administration’s proposed Medicaid Fiscal Accountability Regulation;
  • COBRA subsidies to help people afford to maintain their employer-sponsored insurance coverage after they lose their jobs;
  • A special enrollment period in the ACA exchanges for uninsured Americans;
  • $75 billion for coronavirus testing, contact tracing and isolation measures, and for supporting hospitals and providers.

The bill also includes funding to help people who need internet services or help in paying their internet bills. See House Democrats Want $5.5 Billion for Pandemic Broadband Funding (The Verge, 5/12/20).

For more information, see:

Disability groups will be pushing for the Senate bill to include several provisions that were not included in the House bill (from the Center for Public Representation summary ):
 
  • Permanent reauthorization of the Money Follows the Person (MFP) program (currently extended until November 30, 2020).
  • Increased funding for Social Security and SSI.
  • 90-day refills of prescriptions and medical supplies under Medicaid.
  • Disaster relief that is responsive to the needs of the disability community.
 
Another issue expected to arise in future negotiations is the extent to which employers and health care providers should be subject to lawsuits related to COVID-19. See As Congress Weighs COVID Liability Protections, States Shield Health Providers (Kaiser Health News, 5/15/20). 
Medicaid and CHIP
State Flexibility in Payments to Managed Care Organizations
On May 14, the Center for Medicare and Medicaid Services (CMS) released a Center for Medicaid and CHIP Services Informational Bulletin (CIB) to guide states on how to temporarily modify provider-payment methodology and capitation under managed care contracts to address the pandemic crisis. The guidance lays out options that states can consider for their managed care contracts, including requiring managed care plans to temporarily boost their payments to providers.

AD vancing States Releases Medicaid Disaster Relief Reference Chart
AD vancing States has released a reference chart listing the statutory authorities available for making pandemic-related Medicaid modifications, the flexibilities and limitations of each, and the timeframe that they may be operational.

(National Academy for State Health Policy, 5/11/20)
Some examples of general state telehealth policy changes include:
  • Arkansas and Missouri recently relaxed the requirement that telehealth visits must only be conducted with previously established patients.
  • Arizona mandated that cost sharing for telehealth visits should be lower than in-person visits.
  • Oregon stipulated that cost sharing for telehealth services should not be greater than that for in-person visits.

To address immunization lags and promote access to other important preventive care, states have released  guidance  based on the needs of their own populations and provider capacity. States have also established billing codes and modifiers to track telehealth well-child visits and the subsequent follow-up visits for immunizations and other in-person services. 



WORTH REPEATING:

Civil Rights
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.
Telehealth
WORTH REPEATING: HHS Awards $20 Million to Combat COVID-19 Pandemic through Telehealth (HHS Press Release, 4/30/20)
On April 30, the U.S. Department of Health and Human Services, through the Health Resources and Services Administration, awarded $20 million to increase telehealth access and infrastructure for providers and families to help prevent and respond to COVID-19. Family Voices received $1 million to “Expand telehealth services for families of children with special health care needs through trainings for families and national family organizations on accessing telehealth, including for routine care and services they’re not accustomed to accessing virtually.” Other grantees are the American Academy of Pediatrics, the Association of Maternal and Child Health Programs, and the University of North Carolina-Chapel Hill. These funds were made available through the 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law on March 27, 2020.
The Center for Connected Health Policy provides up-to-date information on state actions and federal Medicare and Medicaid policies related to telehealth. 
Other COVID News, Information, and Resources
Hospital Visitor Policies
The following information is from the Center for Public Representation webpage on Medical Rationing (note the newly added Evaluation Framework for Hospital Visitor Policies , 5/15/20):

HHS’ OCR guidance makes clear that states and hospitals have legal requirements to provide reasonable accommodations to ensure people with disabilities have equal access. Below are state directives and examples of hospital policies that provide exceptions to “no visitor” policies when necessary for people with disabilities:
  • New York: COVID-19 Updated Guidance for Hospital Operators Regarding Visitation (4/10/20)
  • Oregon: Revised COVID-19 Visitation Guidance for Acute Care Facilities (4/23/20)
  • New Jersey: Support Person Permitted for Patient with a Disability (4/25/20)
  • Massachusetts: Rights of Disabled Persons to Accommodations During COVID-19 Crisis (4/27/20)
  • Alabama: Order of the State Health Office, Hospital visitor policy at paragraph 11 (4/28/20)
  • California: California Department of Public Health, Visitor Limitations Guidance (5/2/20)
  • Pennsylvania: Guidance on Hospitals’ Responses to COVID-19 (Updated 4/27/20)
  • North Carolina: Title II Americans with Disabilities Act (ADA) and Section 504 Rehabilitation Act (RA) Protections during the COVID-19 Pandemic (6/5/20)
  • American Academy of Developmental Medicine and Dentistry statement on visitation policies and COVID19 (April 2020)
  • Consortium for Citizens with Disabilities Hospital Visitor Policies to Governors and Hospital Administrators (4/29/20)

To assist stakeholders in evaluation their state or individual hospital visitor policies, CPR, together with CommunicationFIRST, The Arc, Autistic Self Advocacy Network and other partners put together this  Evaluation Framework for Hospital Visitor Policies (5/15/20).

FAQs by Guardians about the COVID-19 Pandemic (including visiting policies)
The National Guardianship Association, along with the American Bar Association Commission on Law and Aging, and the National Center for State Courts, recently updated their Frequently Asked Questions by Guardians about the COVID-19 Pandemic . The 18-page document is intended to help both professional and family guardians. Among other topics, the FAQs address visitation in hospitals, nursing homes, and congregate-care settings, medical decision-making, and protecting finances.

Articles:

Resources:



Medical, Scientific, Other Coronavirus Information
Regarding the coronavirus in children:

Flu Masks Failed In 1918, But We Need Them Now (Health Affairs blog, 5/12/20) [Be sure to read the comment at the end by  Janine Jagger .]

COVID-19 Presents Significant Risks for American Indian and Alaska Native People (Kaiser Family Foundation, 5/14/20) [same article as in “Other” section, above.]

Friday, May 15, 2020

Note: If you do not have a subscription to the NY Times, try going through its coronavirus page . (Not easy to find from NYT home page.) To find other periodicals’ free coronavirus articles see Media Paywalls Dropped for COVID-19 Crisis Coverage (Kottke.org, 3/16/20, final update).
TRICARE AND MILITARY HEALTH SYSTEM (COVID AND non-COVID ISSUES)

Sign up for  email alerts , and keep up with  TRICARE and COVID-19 updates .
YOUR INPUT SOUGHT
More time to provide comments on the CMS Request for Information, “Coordinating Out-Of-State Medicaid Services for Children with Medically Complex Conditions” – due Wednesday, JUNE 3.
In light of the COVID-19 pandemic, the Center for Medicare and Medicaid Services (CMS) decided to re-open the comment period on the Request for Information that it originally issued in January.

Asian American and Native Hawaiian & Pacific Islander in-language COVID-19 resources 
The Asian & Pacific Islander American Health Forum (APIAHF) has launched a crowd-sourcing project to collect Asian American and Native Hawaiian & Pacific Islander in-language COVID-19 resources. APIAHF will gather all of the responses and organize them by language here , so that people can see the variety of available resources. Please fill out the form here to submit a resource.
UPCOMING WEBINARS AND CALLS
Wednesday, May 20, 3:00 pm ET
Christopher & Dana Reeve Foundation's Paralysis Resource Center
This webinar is about the services of the Aging and Disability Networks including the Eldercare Locator.

Thursday, May 21, 1:00-2:00 pm ET
Military OneSource

Thursday, May 21, 3:00 pm ET
Maine Parent Federation

Thursday, May 21, 3:00 pm ET
National Network to Eliminate Disparities in Behavioral Health

Friday, May 22, 3:00-4:00 pm ET
Patient Family Centered Care Partners
Thursday, May 28, 2:00–3:00 pm ET
The Substance Abuse and Mental Health Services Administration
[Registration will close 60 minutes before the event start time.]

NEW NIHB Mental and Behavioral Health Webinar Series
Thursday, May 28, 3:00-4:00 pm ET
National Indian Health Board (NIHB)
Upcoming Webinars:
  • Webinar #2: Thursday, June 11, 2020 at 3:00 pm ET – Topic TBA
  • Webinar #3: Thursday, June 25, 2020 at 3:00 pm ET – Topic TBA
  • Webinar #4: Tuesday, June 30, 2020 at 3:00 pm ET – Topic TBA
Questions about the webinars may be directed to Courtney Wheeler at  cwheeler@nihb.org .

Friday, May 29, 1:00-2:00 pm ET
WellSky

» Check out the resources from the Family Voices/CAHMI webinar, “Partnering for Success: How Family Organizations and Title V Agencies can Utilize the Data Resource Center for Child and Adolescent Health.” ( slides , recording , and NSCH Redesign Manuscript from MCHB )
OF POSSIBLE INTEREST
INFORMATION ABOUT ECONOMIC IMPACT (STIMULUS) PAYMENTS
Below are excerpts from the websites of the Internal Revenue Service (IRS) and the Social Security Administration (SSA).

Key points:
  • Individuals who receive SSI, SSDI, and certain other benefits WILL receive economic impact payments. 
  • Economic impact payments will not count as income for SSI recipients, and the payments are excluded from resources for 12 months.
  • For a dependent to receive a child’s ($500) economic impact payment, they must be under age 17. Therefore, college students and adult dependents do not receive payments.
[Note: Under a House-passed bill, all dependents would be eligible for this payment, but that provision may not make it into a final law.)


Supplemental Security Income (SSI) Recipients
Please note that we will  not  consider economic impact payments as income for SSI recipients, and the payments are excluded from resources for 12 months.

Timing of payments. The IRS has processed most economic impact payments to SSI recipients who are dually entitled to SSI and Social Security, and to SSI recipients if they filed a 2019 or 2018 tax return .

SSI recipients who did not file a 2019 and 2018 return and who do not have a representative payee should receive their electronic payment from the IRS by May 13 by direct deposit or to their Direct Express card if they did not use the IRS’ Non-Filer Tool. If you used the IRS’ Non-Filer Tool, you will receive your payment by May 13 to the non-Direct Express bank account you may have provided. The IRS will begin mailing paper checks on May 15 to SSI recipients who receive their monthly SSI payment by paper check, and to SSI recipients who used the IRS’ Non-Filer Tool but left the bank account information empty.

SSI recipients who have qualifying children under age 17. Important deadlines set by the IRS have passed for people receiving Social Security (retirement, survivors, disability) or SSI who did not file a 2019 or 2018 tax return and have a qualifying child* under age 17. The IRS’ deadline to use the  IRS’ Non-Filer Tool  to enter their and their child’s information to receive $500 per qualifying child now was April 22 for Social Security and May 5 for SSI. If you missed your deadline, you must wait until next year to file a tax year 2020 tax return to receive the $500 payment. However, you will still receive your $1,200 payment now without having to wait until next year.

Very thorough table from the Social Security Administration --

Selected FAQs from the Internal Revenue Service Economic Impact Payment Information Center :

Q1. Who is eligible? (updated April 26, 2020) [Scroll down if you live in a US territory.]

A1. U.S. citizens and U.S. resident aliens will receive the Economic Impact Payment of $1,200 for individual or head of household filers, and $2,400 for married filing jointly if they are not a dependent of another taxpayer and have a work eligible Social Security number with adjusted gross income up to:
  • $75,000 for individuals if their filing status was single or married filing separately
  • $112,500 for head of household filers and
  • $150,000 for married couples filing joint returns
Taxpayers will receive a reduced payment if their AGI is between:
  • $75,000 and $99,000 if their filing status was single or married filing separately
  • 112,500 and $136,500 for head of household
  • $150,000 and $198,000 if their filing status was married filing jointly
The amount of the reduced payment will be based upon the taxpayer’s specific adjusted gross income.

For eligible taxpayers who filed tax returns for 2019 or 2018, they receive the payments automatically. Those who don’t usually file a tax return and receive Social Security retirement, survivor, or disability benefits (SSDI), Railroad Retirement benefits, Supplemental Security Income (SSI) and VA Compensation and Pension (C&P) also receive automatic payments of $1,200. While some of these groups receive Forms 1099, many in this group don't typically file tax returns. Many people in these groups are expected to see the automatic $1,200 payments later this month, with [payments for SSI and VA recipients] expected to start in May.

For people who have little or no income and didn’t file a tax return or don’t receive any of the federal benefits listed above , they are also eligible for an Economic Impact Payment. They need to register with the Non-Filer tool on IRS.gov as soon as possible so they can receive a payment.

Taxpayers likely won't qualify for an Economic Impact Payment if any of the following apply:
  • Your adjusted gross income is greater than:
  • $99,000 if your filing status was single or married filing separately
  • $136,500 for head of household
  • $198,000 if your filing status was married filing jointly
  • You can be claimed as a dependent on someone else’s return. For example, this would include a child, student, or older dependent who can be claimed on a parent’s return.
  • You do not have a valid Social Security number.
  • You are a nonresident alien.
  • You filed Form 1040-NR or Form 1040NR-EZ, Form 1040-PR or Form 1040-SS for 2019.

If you live in a US territory:
From the Social Security Administration at https://www.ssa.gov/coronavirus/#anchorA .

Special rules apply to beneficiaries living in the U.S. territories. In general, the tax authority in each territory, not the IRS, will pay the EIP to eligible residents based on information the IRS will provide to the territories. It is anticipated that beneficiaries in the territories could begin receiving their EIP in early June . People should contact their local tax authority with questions about these payments. Please note their website may use the term “Economic Impact Payment” or “stimulus payment.”
----------------------------------------------------------------------
The IRS lists rules for the qualifying child applicable to the Child Tax Credit. The child qualifies if the child:
• Is your son, daughter, stepchild, eligible foster child, brother, sister, stepbrother, stepsister, half-brother, half-sister, or a descendant of any of them (e.g., your grandchild, niece, or nephew).
• Was under age 17 at the end of 2019.
• Did not provide over half of his or her own support for 2019.
• Lived with you for more than half of 2019
• Is claimed as a dependent on your return.
• Does not file a joint return for the year (or files it only to claim a refund of withheld income tax or estimated tax paid).
• Was a U.S. citizen, U.S. national, or U.S. resident alien.
The CARES Act also requires the qualifying child have a valid Social Security Number or an Adoption Taxpayer Identification Number (ATIN).

================
NOTE: A bill that has passed the House only, the HEROES Act, would amend the rules, BUT that provision may not end up in final legislation.

HEROES Act Summary [NOT YET LAW]
Sec. 20101. Dependents taken into account in determining credit and rebates. Makes all dependents eligible for the $500 qualifying child amount in the Economic Impact Payments made under the CARES Act, previously only applicable to children below age 17. This allows households with dependents who are full-time students below age 24 and adult dependents to also receive the $500 amount. This provision is effective retroactive to the date of enactment of the CARES Act.
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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.