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September is National Suicide Prevention Awareness Month. The Centers for Disease Control and Prevention (CDC) has created a new webpage for coping with stress in the difficult times resulting from the COVID-19 Pandemic.

Greetings from Washington, DC, where everyone’s mind is on

THE ELECTION: The upcoming election could change both the presidency and control of the U.S. Senate, where the leadership of the entire Senate and each committee is controlled by the majority party. Currently, the Senate is controlled by a slim majority of Republicans (53/100). As always, about one-third of the Senate seats are up for election. Every House seat is subject to the election, but Democrats are expected to retain the majority (now 232/435).

www.vote.gov.

HealthyVoting.org and HealthyVoting.org in Spanish

To view the presidential candidates’ responses to a questionnaire on disability issues, see the American Association of People with Disabilities & #CripTheVote webpage.

ECONOMIC IMPACT PAYMENTS (stimulus checks) -- DEADLINE EXTENDED:

Individuals who are eligible for but have not yet received an a stimulus check must provide information to the IRS by November 21 at Midnight ET to get the checks this year.

To help families get their payments, see Helping Consumers Claim the Economic Impact Payment: A guide for intermediary organizations, prepared by the Consumer Financial Protection Bureau, which also has information for consumers about managing finances during the pandemic. 

The next Open-Enrollment Period begins on Sunday, November 1, and runs through Tuesday, December 15, 2020. Coverage begins January 1, 2021.

If someone doesn’t enroll in a plan by December 15, they can’t get 2021 coverage unless they qualify for a Special Enrollment Period. Visit HealthCare.gov

For a refresher on coverage and benefits, see the September 10 blog post on Healthcare.gov, Marketplace health benefits & coverage: What to know.

Steps to Take When Trick or Treating (from the Centers for Disease Control and Prevention)

The ten Democrats on the committee boycotted the meeting as an expression of opposition to the nomination and confirmation process. Instead, they placed pictures of people who benefit from the Affordable Care Act (ACA) in their chairs, to express their concern that, as a Justice, Coney Barrett would vote to overturn the ACA. Speaking of which…

On November 10, the newly constituted Supreme Court will hear one hour of oral argument in Texas v. California, in which the lower court had found the entire ACA to be unconstitutional. It is not likely that the Court will render a decision before next June. More details on the case will be provided in the next Update.

Despite negotiating for weeks, House Speaker Nancy Pelosi (D-CA) on behalf of House Democrats, and Treasury Secretary Steven Mnuchin, on behalf of the White House, were not able to reach an agreement on another COVID-relief bill. Even if the House and White House head reached a deal, however, the Senate likely would not have been able to pass it.

It remains to be seen whether a deal can be reached after the election, but Speaker Pelosi has said that it may be possible. See Pelosi signals Covid deal possible before January (Politico, 10/29/20); Coronavirus relief likely on pause until after election as Trump promises 'best stimulus package': White House, Democrats trade blame over latest impasse in virus relief talks (Fox Business, 10/27/20).

On Wednesday, October 28, the Departments of Health and Human Services (HHS), Treasury, and Labor issued an interim final rule with request for comments (IFC). As discussed in the “Vaccine Payment” section below, part of the rule addresses how payment will be made for vaccination against COVID-19. 

In addition, the rule re-interprets the part of the Families First Coronavirus Response Act that provides an additional 6.2 percentage-point increase in a state’s Medicaid match rate (Federal Medical Assistance Percentage, or FMAP) during the COVID Public Health Emergency (PHE), IF the state meets certain conditions. As CMS previously interpreted these “Maintenance of Effort” (MOE) conditions, states were not permitted to disenroll, or reduce the benefits or cost-sharing requirements of any Medicaid beneficiary enrolled on or after March 18, 2020, unless the individual died, moved out of the state, or requested disenrollment. These conditions were specified in the form of frequently asked questions released in April, May and June of 2020. 

The new MOE interpretation is detailed in the CMS-9912 Interim Final Rule with Comment Factsheet on Updated Policy for Maintaining Medicaid Enrollment during the Public Health Emergency for COVID-19. Under the new rule, states may get the enhanced match if they maintain the Medicaid enrollment of “validly enrolled beneficiaries” in one of three tiers of coverage (or a more robust tier of coverage). A beneficiary is “validly enrolled” unless their eligibility determination was incorrect due to agency error, or beneficiary fraud or abuse. The Factsheet (p. 2) also notes, “Individuals receiving coverage during a presumptive eligibility period are not considered validly enrolled beneficiaries for purposes of section 433.400 [the new rule on the MOE].”

For example, if a child ages out of EPSDT coverage, they can now be switched to another eligibility category offering fewer services, as long as that category is in the same tier – in that case, Tier 1, which provides “Minimal Essential Coverage” pursuant to the Affordable Care Act. (See page 73 of the interim final rule.) If a beneficiary would otherwise become completely ineligible for Medicaid during the PHE, states must keep them enrolled, but can move them to another category within their tier or to a tier with more robust benefits.

On Wednesday, October 28, the Departments of Health and Human Services (HHS), Treasury, and Labor issued an interim final rule with request for comments (IFC). The rule provides for Medicare and Medicaid beneficiaries, privately insured individuals, and uninsured individuals to receive a COVID vaccination (vaccine and its administration) without cost. See CMS Press release; CMS Fact Sheet; Medicare, Medicaid will cover costs of future COVID-19 vaccine under new policy (The Hill, 10/28/20).

In addition, CMS released a set of toolkits for providers, states and insurers that are intended ensure the swift administration of the vaccine, once available, by increasing the number of providers that can administer it through expedited provider enrollment procedures, ensuring adequate Medicare reimbursement for vaccine administration, and clarifying the responsibility of private insurers and Medicaid programs to cover the vaccine at no charge to beneficiaries. CMS is also taking action to increase reimbursement for any new COVID-19 treatments that are approved or authorized by the FDA. The details of the CMS plan are set forth in an interim final rule explained in this Fact Sheet.

The first COVID-19 vaccines will not be available to children because they have not been tested in children until recently. As explained in a recent Associated Press article, pharmaceutical companies have begun to test vaccines in teenagers, but not in younger children, and it is not clear how long it will take to develop and verify the safety of a pediatric vaccine. See Next up in hunt for COVID-19 vaccine: Testing shots in kids (Associated Press, 10/21/20); When can kids get a coronavirus vaccine? 'Maybe not in 5 years.' (Advisory Board’s Daily Briefing, 10/12/20).

On September 29, 2020, the president of the American Academy of Pediatrics (AAP), Sara “Sally” H. Goza, M.D., FAAP, sent a letter to HHS Secretary Azar and FDA Commissioner Hahn urging that children be included in vaccine trials. Among other things, the letter also recommends standards by which to judge the safety and efficacy of vaccines, and urges that vaccines to be used in the U.S. be tested on Americans, including people reflecting the country’s racial and ethnic diversity. See AAP News article summarizing letter.

On October 22, Vaccines and Related Biological Products Advisory Committee of the Food & Drug Administration (FDA) met in open session to discuss the development, authorization and/or licensure of vaccines to prevent COVID-19. Meeting materials. See CDC's distribution road map, safety monitoring plans plus other takeaways from FDA's big COVID-19 vaccine meeting (Fierce Pharma, 10/22/20)

4 takeaways from FDA's Covid-19 vaccine meeting (Politico, 10/22/20).

FDA shows signs of cold feet over emergency authorization of COVID-19 vaccines (STAT, 10/23/20): “The problem stems from thorny ethical questions about whether — once a vaccine has been cleared for use by the FDA — the people who were randomly assigned to receive a placebo in its clinical trial must be informed and offered vaccine. Vaccinating the people who received placebo injections — the trial’s control arm — would end the ability to continue to compare the two groups after what would have been a short trial.”

Vaccine Makers Can Skip U.S. Inspections (Bloomberg, 10/26/20); FDA won't require manufacturing inspections for emergency COVID-19 vaccine use: Bloomberg (Fierce Healthcare, 10/26/20).  

Who Will Get the Covid Vaccine First? A New Tool Aims to Help States Decide (Route 50, 10/28/20). 

The Vaccine Allocation Planner for COVID-19 allows policymakers to look at region-specific data, estimate the size of high-risk populations, consider factors like particular community’s vulnerabilities, and run scenarios based on an estimated number of vaccine doses available. 

See also States Race to Create COVID-19 Vaccination Distribution Plans (National Academy for State Health Policy, 10/12/20). 

According to the CDC webpage How CDC Is Making COVID-19 Vaccine Recommendations (updated 10/13/20), if the Food and Drug Administration (FDA) authorizes or approves a COVID-19 vaccine, the CDC’s Advisory Committee on Immunization Practices (ACIP) will quickly hold a meeting to review all available data about that vaccine, then vote on whether to recommend the vaccine and, if so, who should receive it. Included in ACIP’s recommendations will be guidance on who should receive the vaccines first if supply is limited. Recommendations must go to the director of CDC for approval before becoming official CDC policy. The ACIP is meeting on October 28-30, 2020; a discussion of COVID vaccine issues is scheduled for October 30.

See Meeting Webcast Link; Presentation Slides; Agenda. No registration is required to join the webcast.

Various groups have developed different proposals for vaccine allocation, given that there will likely be a scarcity of vaccines when one or more are first approved. See Experts propose how to equally distribute COVID-19 vaccine (Fierce Healthcare, 10/27/20).

The 2021 Open Enrollment Period is November 1 to December 15, 2020, with coverage beginning on January 1, 2021.

See the 2021 Open-Enrollment Fact Sheet for more information. If someone doesn’t enroll in a plan by December 15, they can’t get 2021 coverage unless they qualify for a Special Enrollment Period. For a refresher on coverage and benefits, see the September 10 blog post on Healthcare.gov, Marketplace health benefits & coverage: What to know.

Starting on November 1, consumers can log in to www.HealthCare.gov or www.CuidadodeSalud.gov, or call 1-800-318-2596 to fill out an application and enroll in a 2021 Exchange health plan.

The Georgetown University Center on Health Insurance Reforms (CHIR) has updated and improved its Navigator Resource Guide. The Guide includes 300 FAQs on topics such marketplace eligibility, premium and cost-sharing assistance, the individual mandate, and post-enrollment issues for individuals. Features added to the Guide this year include:

Navigator Guide FAQs of the Week: I Need Health Insurance. Where Should I buy it? (CHIRblog, Georgetown Center on Health Insurance Reforms, 10/26/20)

What’s New for 2021 Marketplace Enrollment? (CHIRblog, Georgetown Center for Health Insurance Reforms, 10/19/20)

Hospital Bills For Uninsured COVID-19 Patients Are Covered, But No One Tells Them (Kaiser Health News, 10/29/20)

Brief: The Role of State Medicaid and Title V Program Definitions of Children and Youth with Special Health Care Needs in the Provision of Services and Supports,

National Strategy Needed to Close Health Care Gaps, Protect Children’s Health and Well-Being (Blog of the Georgetown Center for Children and Families, 10/29/20), which is based on the brief, Urgent Action Needed to Address Children’s Unmet Health Care Needs During the Pandemic (Urban Institute, 10/22/20).

Family Voices has created a two-part toolkit, a checklist and worksheet, to help prepare for telehealth visits.  Broken down by “Before, During, and After” with spaces for questions and notes, the documents help guide each appointment and provide clear follow up steps.  

Worth Repeating

The American Academy of Pediatrics (AAP) interim guidance, Caring for Children and Youth With Special Health Care Needs During the COVID-19 Pandemic, highlighted the importance of Shared Decision Making (SDM) between families and providers in navigating COVID-19. Family Voices has created the SDM Tool for families, which provides more information about this concept, and some examples of how parents can initiate conversations with their child’s care team.

2020 TRICARE Open Season is November 9 to December 14, 2020.

TRICARE Young Adult (TYA) is available for purchase by certain family members under the age of 26 who have lost or will lose TRICARE eligibility due to age. Qualified adult children can purchase TYA coverage after regular TRICARE coverage ends at: 

See the TRICARE Young Adult Program Fact Sheet to learn more about who qualifies for TYA and how to purchase TYA coverage.

To keep up with TRICARE and COVID-19 updates, sign up for email alerts.

Download the latest TRICARE East Region or TRICARE West Region newsletter at www.tricare.mil/publications.

On September 18, the Centers for Medicare & Medicaid Services (CMS) published a Request for Information (RFI) on a Recommended Measure Set for Medicaid-Funded Home and Community-Based Services. The RFI seeks feedback on potential benefits of and challenges that could result from a nationally available set of recommended quality measures for voluntary use by states, managed care organizations, and other entities engaged in the administration and/or delivery of Medicaid-funded home and community-based services (HCBS).

Comments should be submitted electronically to HCBSMeasuresRFI@cms.hhs.gov no later than November 18, 2020. See the Measuring and Improving Quality in Home- and Community-Based Services webpage for more background and information.

Due Nov. 30, Comments on Maternal Child Health Bureau's (MCHB)

Draft Blueprint for Change: Guiding Principles for Advancing the System of Services for Children and Youth with Special Health Care Needs (CYSHCN) and Families

MCHB invites public comments on the draft Blueprint and how this work can be operationalized at the community, state and federal levels. Please submit comments via email to CYSHCN@hrsa.gov and reference "CYSHCN Blueprint RFI" in the subject line.

The deadline to respond is Monday, November 30, 2020, by 11:59 p.m. Eastern Time. Please share widely.

As health care providers ramp up the use of telemedicine, Family Voices is interested in improving families’ access to and use of telehealth. They are asking families to complete a survey describing their access to telehealth, and their confidence in and concerns about virtual services. Take the anonymous survey in English or Español.

NEW Social Determinants of Health: Culturally Adapted for AI/AN Communities

NEW COVID-19 and Native American Health, How Tribal Leaders Are Beating Back the Virus

NEW COVID-19 Vaccine Distribution and Safety Overview

NEW Medicaid Supports for Family Caregivers

NEW ACL/CMS HCBS Innovation During COVID--Medicaid HCBS Payers & Providers

NEW Post-Election Analysis and Discussion with AUCD

Virtual Workshop for Tribes: “Introducing Telehealth to Rural and Indigenous Communities”

For more information, contact Lilia Salazar at 214-767-3073 or at LSalazar@hrsa.gov 

Psychological First Aid: Supporting Yourself and Others During COVID-19 (Online Course)

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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.