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Washington DC Update 10/30/2020
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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).

For information on how and where to vote, see
For consumer information about voting safely, see
and other resources at the end of this Update.

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

In this Update:

  • The administration has issued an interim final rule weakening the “Maintenance of Effort” requirement that states must meet to receive an enhanced Medicaid match during the COVID Public Health Emergency. States may now reduce beneficiary benefits and increase cost-sharing during the pandemic.

  • The above-mentioned interim final rule also ensures that vaccines will be administered with no cost to consumers, regardless of their insurance type or status. There has been much discussion about the approval of a vaccine for COVID-19, and how it will be distributed.    

  • Efforts to enact a COVID-relief package before the election failed, but it is possible that a deal can be reached in the “lame duck” session after the election.

  • The Senate confirmed Judge Amy Coney Barrett to serve on the Supreme Court. She has been sworn in and is ready to consider cases. Oral argument in the Affordable Care Act case is scheduled for November 10.

  • ACA open enrollment season begins November 1, and there are links in this Update to some new resources to help consumers.

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. 

Open Enrollment Period
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 Courts
  • Congress
  • Medicaid & Chip
  • Vaccines
  • Affordable Care Act
  • Other News, Information and Resources
  • TRICARE and Military Health System (COVID and non-COVID issues)
  • Your Input Sought
  • Upcoming Webinars and Calls
  • Of Possible Interest
The Courts
Confirmation of Justice Coney Barrett
On October 26, the Senate voted to confirm Judge Amy Coney Barrett to be an Associate Justice on the Supreme Court. All Democrats voted against her confirmation and all Republicans for it, other than Sen. Susan Collins (R-ME) (who is up for re-election). The previous Thursday, the 12 Republicans on the Senate Judiciary Committee had voted to advance Judge Coney Barrett's nomination.

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…

Texas v. California
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.
COVID Economic Relief Legislation
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).
Medicaid & CHIP
Changes to Medicaid Maintenance of Effort Requirements for Enhanced Medicaid Match during Public Health Emergency
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].”

In other words, states can now change a beneficiary’s eligibility category, and thereby benefits, as long as the new category is in the same coverage “tier,” which is based on the “benefits package” to which the beneficiary is entitled. States will now be permitted to make changes to beneficiary coverage, cost sharing and post-eligibility treatment of income. They can cut optional benefits, impose utilization management restrictions (such as prior authorization) and increase cost-sharing (but not premiums).

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.
Payment for COVID-19 Vaccination
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.

COVID-19 Vaccine for Children
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.

Vaccine Approval
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)

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.”

In related news

State Allocation Policies

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). 

National Allocation Policies
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).
Affordable Care Act
Healthcare.Gov “Window Shopping” and Open Enrollment
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.

As of October 26, consumers and those assisting them can “window shop” for 2021 healthcare plans and prices on HealthCare.gov without logging in, creating an account, or filling out the official application.

HealthCare.gov has also added a new planning resource for consumers to estimate their yearly income.

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.

ACA Resources
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)
Worth Repeating
What’s New for 2021 Marketplace Enrollment? (CHIRblog, Georgetown Center for Health Insurance Reforms, 10/19/20)
Other News, Information, and Resources

The Catalyst Center at the Boston University School of Social Work’s Center for Innovation in Social Work & Health, and the National Academy for State Health Policy (September 2020).  This issue brief describes how states define CYSHCN within Medicaid and Title V CYSHCN programs, ex­plores policy implications of these definitions, and discusses the potential impact of aligning definitions across the two pro­grams.

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.
(Please share with your networks via email or social media posts, and let us know how you have used this tool with your children or families you work with.)
TRICARE and Military Health System
2020 TRICARE Open Season is November 9 to December 14, 2020.

Worth Repeating
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: 
  • Age 21
  • Age 23 (if enrolled in college full time or at a college graduation, whichever comes first)

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.
Due Nov. 18, Request for Information about Medicaid HCBS Quality Measures
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)
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.

Family Voices Survey on Telehealth
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.
Thursday, November 5, 12:00-1:00 ET
Tele-Behavioral Health Center of Excellence

Monday, November 9, 1:00-2:00 ET

Monday, November 9, 2:00 ET
Family Voices of California

Monday, November 9, 3:00 ET
Centers for Disease Control and Prevention (CDC)

Thursday, November 12, 1:00-2:00 ET
National Academy for State Health Policy’s (NASHP) RAISE Family Caregiver Resource and Dissemination Center 

Thursday, November 12, 3:00-4:30 ET
Administration for Community Living and Centers for Medicare and Medicaid Services 
Friday, November 13, 4:00-5:00 ET
Association of University Centers on Disabilities

Wednesday, November 18 - Thursday, November 19, 2020
The Health Resources and Services Administration, Office of Regional Operations - Regions 6, 7, and 8, Heartland, Southwest, and the Great Plains Telehealth Resource Centers, North Dakota Department of Health, and the Spirit Lake Tribe
*There is no registration fee.*
For more information, contact Lilia Salazar at 214-767-3073 or at LSalazar@hrsa.gov 

Thursday, November 19, 2:00 ET
Alliance for Justice

American Red Cross
From the Association of State and Territorial Health Officials
To keep yourself safe while voting:

  • Wash your hands before and after voting. Avoid touching your eyes or face.
  • Wear a mask, even if you are outside.
  • Do your best to maintain a physical distance of at least six feet from others.
  • Avoid doing anything that may tempt you to remove your mask. This includes eating or talking.
  • Observe signs to help you move safely around the polling place.
  • Look for single use voting supplies to limit your contact with public surfaces.
  • Do not disinfect or wipe down the voting equipment yourself.
  • Leave your kids at home with a responsible guardian while you vote.
  • Speed the process by reviewing a sample ballot and being prepared.
  • Vote at off-peak times to avoid crowds.
  • If you don’t feel well, contact local election officials about your voting options.
  • Check HealthyVoting.org for more information about healthy voting in your state.

Check out the following for resources to share with the public and 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.