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Washington DC Update 5/28/2020
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Greetings from Washington, DC
Since May 15, when the House passed its most recent coronavirus bill, is has been fairly quiet in the DC health-policy world. The Centers for Disease Control and Prevention (CDC), released a 60-page document which outlines its actions and resources in response to COVID-19 and provides guidance on implementing the president’s plan, Opening Up America Again. This week’s Update provides links to a number of pandemic-related resources, including: summaries of the new federal paid sick- and family-leave benefits and instructions and forms for claiming them, and a 10-page Q & A document regarding disability nondiscrimination rights. Read about these issues and more in this week’s Update.
 
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 Administration
  • Congress
  • Medicaid and CHIP
  • Private Insurance and Affordable Care Act
  • Civil Rights
  • Paid Leave (Excellent Resources)
  • State Information
  • Other COVID News, Information, 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
CORONAVIRUS NEWS, INFORMATION, AND RESOUCES
The Administration
CDC Releases Resources to Assist States to Open (CDC Media Statement, 5/20/20)
The Centers for Disease Control and Prevention (CDC) has issued a 60-page document, CDC Activities and Initiatives Supporting the COVID-19 Response and the President’s Plan for Opening America Up Again. The document summarizes CDC’s actions and resources to support the government response to COVID-19, and provides guidance on Opening Up America Again, which was issued by the White House in April. The CDC also released a set of health considerations to be used by  summer camps,  schools,  youth sports organizations,  institutes of higher education, and  restaurants and bars that are opening.

 
WORTH REPEATING: 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. 
Congress
As detailed in the May 19 Washington Update, the House passed another bill last week to address the coronavirus pandemic - the “Health and Economic Recovery Omnibus Emergency Solutions Act” or “HEROES Act” ( H.R. 6800). It was approved largely along party lines. (More on its content below.)
 
The House bill represents the opening bid in a negotiating process that will involve both parties, both houses of Congress, and the president. It is expected that, ultimately, another coronavirus bill will be enacted, but negotiations within the Senate may not even begin until mid-June. See McConnell: Talking about Fifth Coronavirus Bill 'in the Next Month or So' (The Hill, 5/26/20); GOP Faces Internal Conflicts on Fifth Coronavirus Bill (The Hill, 5/24/20). Agreement between the House and Senate is likely to be more difficult that it was on previous coronavirus legislation, as Senate Majority Leader Mitch McConnell (R-KY) considers the House bill to be too large. 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 .
 
The House bill would provide an increase in Medicaid funding and other Medicaid and CHIP provisions. The bill does not include any additional funding to help Family-to-Family Health Information Centers with extra work and expenses related to the pandemic. The House bill both includes and omits various provisions sought by disability organizations.

For more information, see:
Medicaid and CHIP

CMS Updates Blanket Waivers
The Center for Medicare and Medicaid Services (CMS) has authority to waive certain provisions of law during declared public health emergencies. Accordingly, it has issued “blanket waivers” to help healthcare providers address and prevent the spread of COVID-19. The waivers have a retroactive date of March 1, 2020. The agency recently updated (as indicated by red text) its list of these blanket waivers. [Please see “Civil Rights” section, below, about the agency’s reminder to states that they must avoid institutionalization or segregation of people with disabilities.)

States Facing Funding Shortfalls, Poised to Make Medicaid Cuts
As reported in the May 19 Update, States Face Looming Crisis over Medicaid Growth, Which Could Trigger Changes for Providers and Payers (Fierce Healthcare, 5/15/20). Unfortunately, the manner in which the Center for Medicare and Medicaid Services (CMS) initially distributed congressionally mandated financial aid to health care providers largely bypassed children’s hospitals and other providers that do not serve a large number of Medicare patients. See States Fret Over Covid-19 Medicaid Relief as HHS Plays Catch-Up (Bloomberg Law, 5/13/20). As a result of decreased revenues from taxes, and an increase in the numbers of people eligible for Medicaid due to loss employer-sponsored insurance, States Brace for 'Nearly Certain' Medicaid Budget Shortfalls amid COVID-19 (Healthcare Dive 5/18/20). See also Children's Hospitals Are Losing $1 Million a Day. The CARES Act Doesn't Begin to Cover it. (CNN Business, 5/7/20) - Opinion piece by Mark Wietecha, president and CEO of the Children's Hospital Association.

WORTH REPEATING:
 
  • 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.

  • ADvancing States Releases Medicaid Disaster Relief Reference Chart: ADvancing 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.


  • CMS Updates Medicaid & CHIP COVID-19 FAQs for State Medicaid and CHIP Agencies (CMS News Alert, 5/7/20): The updated FAQs cover a variety of Medicaid and CHIP topics, including emergency preparedness and response, benefit, financing, eligibility and enrollment flexibilities, information technology, and data reporting. For more details, see the May 8 Washington Update.
Private Insurance and Affordable Care Act

Healthcare.gov Offers Screener to Determine Eligibility for Special Enrollment Periods
In light of the COVID pandemic, some states with their own exchanges re-opened their open-enrollment periods for enrolling in health insurance plans. Although some of these state open-enrollment periods have ended, some are still open. Regardless of their state, individuals are eligible to enroll in an ACA plan if they or anyone in their household either lost qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days. See the Healthcare.gov page about Special Enrollment Periods.

Employers May Change their Open Enrollment Periods for Insurance and Cafeteria Plans (child care, Flexible Spending Accounts)
Pursuant to an Internal Revenue Service (IRS) Notice issued on May 12 - COVID-19 Guidance under §125 Cafeteria Plans and Related to High Deductible Health Plans (IRS Notice 2020-29) - the IRS will permit employers to let employees to change their insurance coverage and make changes in their flexible spending and child care accounts outside the usual open-enrollment period. See Employers Can Let Workers Change Health Plans Without Waiting - The I.R.S. is giving companies flexibility to allow those decisions, and on pretax accounts for medical expenses and child care, outside an enrollment period. (New York Times, 5/12/20).
 
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).
 
 
CMS Finalizes NBPP for 2021
On May 14, the Center for Medicare and Medicaid Services (CMS) issued the final Notice of Benefit and Payment Parameters (NBPP) for the 2021 plan year (a very long and technical document). The NBPP governs the operation of the federally facilitated marketplace (Healthcare.gov) and the CMS “issuers letter” establishes rules for insurers selling plans in the federally facilitated marketplace. See:

See also The Final 2021 Notice of Benefit and Payment Parameters: Implications for States (Blog of the Georgetown Center on Health Insurance Reforms, 5/14/20)

Also from the Georgetown Center on Health Insurance Reforms:


Civil Rights

Questions & Answers from the Disability Rights Education and Defense Fund

CMS Recognizes ADA and Olmstead Requirements in Recent Update of Blanket Waivers
The Center for Medicare and Medicaid Services (CMS) recently updated the list of “blanket waivers” it has issued to help states and health care providers address the coronavirus pandemic. In one of these updates, regarding the physical environment of certain health care facilities, CMS noted, “States are still subject to obligations under the integration mandate of the Americans with Disabilities Act, to avoid subjecting persons with disabilities to unjustified institutionalization or segregation.” The accompanying footnote (page 5) cites the Americans with Disabilities Act (ADA) and the Olmstead case.

WORTH REPEATING:
 

  • 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, intended to help both professional and family guardians.

  • NOTE: 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.
Paid Leave (Excellent Resources)

Guide and Forms for Requesting Leave or Accommodations
The Center for WorkLife Law has issued Guides for Requesting Leave or Accommodations Needed Because of the Coronavirus Pandemic. From that page, you can click through specific topics to find fillable forms with all the information required legally required for an employer to grant a leave request. EXAMPLE: Request for Paid Sick Leave – for Caring for an Individual Who Has Been Advised to Stay Home or Self-Quarantine Because of Coronavirus.

Compilation of Families First and CARES Act paid leave benefits:



  • Annotated chart (most detail) This comprehensive chart includes full details explaining who is - and who is not - included in benefits, as well as an overview of the benefits.

The above were developed by the Ohio Women's Public Policy Network, Policy Matters Ohio, PL+US, and Innovation Ohio, but are applicable nationwide. They are current as of April 30, 2020, and will be updated as needed based on additional legislative measures or rules. No applicable federal legislation has been enacted since then.

See also Paid Sick Days and Paid Leave Provisions in FFCRA and CARES Act [ online; PDF] (Center for Law and Social Policy, 5/6/20)
State Information

New COVID-19 State Bill Tracking Database (National Conference of State Legislatures)
This multi-issue database provides real-time information about state bills related to and responding to COVID-19.
Other COVID News, Information, and Resources

Update on Economic Impact (Stimulus) Payments
On Friday, the Social Security Administration announced it had begun issuing Economic Impact Payments to individuals whose finances are handled by representative payees, both SSI and Social Security recipients.
 
Getting a Phone and Assistance with Cell Phone and Internet Costs
Some individuals, including those receiving Medicaid, SNAP, SSI, and housing assistance, may be eligible to get a free cell phone and minutes. See http://medicaidcellphone.com . In addition, they may be eligible for assistance with the cost of phone and internet through Lifeline ( www.lifelinesupport.org ), a federal benefit through which eligible individuals can receive up to $9.25 per month towards home or mobile phone service or high-speed broadband. Those living on Tribal lands can receive up to $34.25 per month.

This website provides information for patients and the organizations that serve them, including toolkits for individuals and patients, state-level insurance emergency orders on prescription refills, tips to protect oneself from COVID-19, and telehealth coverage policies for COVID-19. Among the resources:


 
You can contact Healthcare Ready with any inquiries about additional resources or unmet needs in your communities. For COVID-19, Healthcare Ready is also releasing weekly “Situation Reports” to partners. To sign up, visit http://alerts@healthcareready.org .
 
Sign up to receive other alerts from Healthcare Ready  here.
 
Lucile Packard Foundation for Children’s Health
The foundation has a COVID-19 webpage with information for families, caregivers, state agencies, and advocates of children with special health care needs. Resources are updated regularly. 
Medical, Scientific, Other Coronavirus Information

Which Kids Get Sickest from COVID-19? The ‘Medically Complex,’ Study Finds – from NBC News, based on a study published in JAMA Pediatrics (5/11/20)
 
 
From the Food & Drug Administration (FDA)



WORTH REPEATING:
 
CDC Websites and Mailing Lists:

·        Main CDC COVID-19 Page
·        What’s New? Features a running list of web pages that have been updated.
 
COVID-19 Materials Developed for Tribal Use (Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health)
TRICARE AND MILITARY HEALTH SYSTEM (COVID AND non-COVID ISSUES)

 
Using mobile mental health apps to cope during social isolation (Military Health System Communications Office, 5/22/20)
From this article:
  • Connected Health has developed mobile health tools and published several articles and research on the benefits of using digital health in clinical care, including guidelines on integrating mobile mental health tools into clinical practice.
  • The [Defense Health Agency’s] mobile apps, listed here, are free and available for anyone to download from app stores for Android and Apple devices. There are apps that enhance self-care, and others that are a companion to treatment with a health care provider.

Sign up for  email alerts , and keep up with  TRICARE and COVID-19 updates .
YOUR INPUT SOUGHT
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
Friday, May 29, 1:00-2:00 pm ET
WellSky

NEW Virtual Conversation: Health & Safety Considerations for Reopening K-12 Schools
Tuesday, June 2, 2:00 pm ET
PolicyLab at Children’s Hospital of Philadelphia
  • To join via web browser for this event on June 2 at 2 p.m. EST, click here.
  • Visit our website for more information on joining via mobile device or phone. [NOTE: The website refers to another event that occurred on May 26. Scroll down for June 2 info.]
  • Can’t join us live? Visit the PolicyLab website on Wednesday, June 3 for a link to the archived video. 
 
Wednesday, June 10, 2:00-3:30 pm ET
Systems of Care Leadership Learning Community 

Thursday, June 18, 2:00-3:15 pm ET
The Arc
 
Tuesday, June 30, 2:30-4:00 pm ET
Systems of Care Leadership Learning Community 
OF POSSIBLE INTEREST
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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.