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Washington DC Update 10/9/2020
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SAMHSA’s Disaster Distress Helpline provides 24/7, 365-day-a-year crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters.

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

In this Washington Update:

  • The prospects for legislation to address the pandemic’s financial impact are very unclear at the moment, but it is still within the realm of possibility that an agreement will be reached before the election.

  • Hearings begin next week on the nomination of Judge Amy Coney Barrett to the Supreme Court. 

  • The FDA issued revised vaccine-approval guidelines that would preclude authorization to use a COVID vaccine before the election.

  • CMS issued new guidelines on nursing-home visitation.

  • The administration is requesting information about a Recommended Measure Set for Medicaid-Funded Home and Community-Based Services. Comments are due October 19.

  •  The Georgetown University Center for Children and Families released a report on the decline in children’s insurance coverage over the past three years.

PLEASE NOTE: DEADLINES FOR GETTING ECONOMIC IMPACT PAYMENTS (EIPs) (stimulus checks): Individuals who are eligible for but have not yet received an EIP must provide information to the IRS by October 15 to get the checks before filing their 2020 return.

Families who have not received their EIP of $500 per child must provide information to the IRS by September 30. 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.

National Hispanic Heritage Month is September 15 - October 15.
For Heritage Month resources, information about organ donation for Hispanics and Latinos awaiting transplants, and COVID-19 information in Spanish, see the end of this Update.

October is Health Literacy Month
For ideas about events or activities, and other resources, see the Share and Interact page of the CDC Health Literacy website. 
  • 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
  • Resources for Hispanic Heritage Month & COVID Information in Spanish
Economic Relief Legislation
In short: The situation is very fluid with respect to another bill to provide financial relief to individuals, small businesses, state and local governments, and the airlines. House Speaker Nancy Pelosi (D-CA) and Treasury Secretary Steven Mnuchin have been negotiating but, as of this writing, there is no agreement. The White House wants a “skinny bill,” while the Speaker is seeking a broader one, and the administration is sending mixed messages about what they will accept. See White House, Congress continue pressing on economic relief package but Pelosi bristles over Trump approach (Washington Post, 10/8/20, 6:28 pm ET).

Longer story: As explained in earlier Updates, the House passed a comprehensive, $3.4 trillion COVID relief bill (the HEROES Act) in mid-May, on a largely partisan basis. Many Republican Senators opposed that level of spending, so the Senate did not take up the House bill. Instead, on September 10, the Senate considered, but did not pass, the HEALS Act, which had a price tag of about $300 billion. Democratic Senators opposed that bill because, among other things, it did not provide additional funding for Medicaid or state and local governments. On October 1, the House passed a trimmed-down ($2.2 trillion) version of the HEROES Act, supported only by Democrats. (See one-pager here; section-by-section summary here; information on the state and local relief provisions of the bill here.)
Beginning in July, Treasury Secretary Steve Mnuchin and House Speaker Nancy Pelosi started negotiating to see if they could reach a compromise deal. (These are the two parties negotiating because, generally, the majority-Republican Senate will agree with the administration and the Senate Democrats will agree with Speaker Pelosi, who represents the Democratic majority in the House.)

As of early this week, the two were reportedly getting close to an agreement, but on Tuesday afternoon, the president suddenly called off the negotiations, asserting via tweet that Speaker Pelosi was not acting in good faith. Later Tuesday evening, however, the president urged Congress (via tweet) to pass “immediately” a bill providing $25 billion for airline payroll support, and $135 billion dollars for the Paycheck Protection Program for small business. Soon thereafter, he said (tweeted) that he would immediately sign a bill to provide stimulus checks ($1,200) to individuals. His tweets did not mention renewal of the $600-per-week federal addition to unemployment benefits that had been provided in the Families First Corona Virus Response Act, and which the House HEROES bills would have provided. See Trump’s erratic tweets on economic relief — over several hours — leave strategy unclear (Washington Post, 10/7/20).

On Wednesday night, it looked possible that a bill helping only the airline industry could be enacted, but on Thursday, Speaker Pelosi indicated that she would agree to a stand-alone airline bill “only if there's ‘a guarantee’ that there will also be a larger package containing aid for state and local governments, schools, testing and contact tracing, as well as unemployment assistance and workplace safety regulations.” See Pelosi: No airline aid bill without broader coronavirus relief package (Roll Call, 10/8/20, 1:10 pm ET).

Temporary Government Funding
About an hour after the end of federal FY 2020, the president signed a short-term appropriations bill (PL 116-159) to keep the government “open” through December 11, 2020, generally at current funding levels. The measure easily passed the House and Senate on a bipartisan basis. This so-called “continuing resolution” (CR) was necessary because none of the regular appropriations bills for FY 2021 has yet been enacted. Of note, the bill includes an additional $8 billion to extend certain nutrition-assistance programs through the entire fiscal year (through September 30, 2021). Among these is the Pandemic EBT program, which provides resources to families with children who would have otherwise received free or reduced-price meals in school if not for pandemic-related school closures or reduced attendance hours. That program was expanded to include children at childcare centers. Also extended through FY 2021 are waivers providing flexibility in the administration of the National School Lunch Program and the WIC program; and administrative flexibilities for states for the SNAP (food stamp) program. See section-by-section summary of the bill (House Appropriations Committee, 9/22/20.

Hearings on Supreme Court Nominee
The president has nominated federal appeals court judge Amy Coney Barrett to fill the Supreme Court seat that had been occupied by the late Ruth Bader Ginsburg. Senate Judiciary Committee Chairman Lindsey Graham (R-SC) has scheduled hearings to begin on Monday, October 12 and to last several days. The hearings can be watched online. The questioning of Judge Coney Barrett will begin on October 13. See Barrett speaks with key Senate Dems amid calls to delay her hearing (Politico, 10/7/20). 
Medicaid & CHIP
Extension of Public Health Emergency
The Secretary of Health and Human Services, Alex Azar, has extended the determination that a public health emergency exists through January 21, 2021 (90 days from the previous extension on October 23). Accordingly, there is an extension through that date of the Medicaid “maintenance of effort” (MOE) pre-requisite for an enhanced federal Medicaid match for states.

The MOE prohibits disenrollment of, or a reduction in services for any Medicaid beneficiary enrolled on or after March 18, 2020. See Secretary Azar Extends Public Health Emergency Medicaid Protections for Beneficiaries and States (Georgetown Center for Children and Families blog post, 10/5/20).
Transition after Public Health Emergency Ends
Policy analysts are starting to think about how states will transition back to “normal” when special rules for the federal Public Health Emergency expire. See:
New Guidelines on Nursing Home Visitation
On September 17, the CMS Center for Clinical Standards and Quality/Survey & Certification Group issued new guidance to State Survey Agency Directors, Nursing Home Visitation - COVID-19.

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 October 19, 2020.

Over recent weeks, there was tension between the Food & Drug Administration (FDA) and the president regarding FDA’s revised standards for Emergency Use Authorization (EUA) of a COVID-19 vaccine. (A vaccine could be disseminated under an EUA prior to final FDA approval.) Although the administration cited industry concerns, observers speculated that the White House was withholding official approval because the revised guidelines would require that vaccine-trial volunteers be followed for two months before an EUA could be issued. As a result, no vaccine could be approved before the November 3 election, as the president had predicted. Notwithstanding White House objections, the FDA unofficially released the revised guidance on October 6. FDA In Brief: FDA Issues Guidance on Emergency Use Authorization for COVID-19 Vaccines (10/6/20).

FDA Administrator Hahn has made efforts to assure the public that the agency would not bow to political pressure when it comes to vaccine approval. In a September 29 speech to the National Consumers League, he assured that “…the FDA will not authorize or approve any COVID-19 vaccine before it has met the agency's rigorous expectations for safety and effectiveness. … decisions to authorize or approved any COVID-19 vaccine or therapeutic will be made by the dedicated career staff and scientists at FDA through our thorough review processes… [and] …science will guide our decisions, FDA will not permit any pressure from anybody to change that.” Commissioner Hahn made similar assurances during an October 8 webinar sponsored by the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota. See FDA head: Outside pressures won't rush COVID vaccine (CIDRAP News, 10/8/20).

For information about the allocation of vaccines once they are developed, see the September 22 Washington Update. See also Chairman Neal Calls on Secretary Azar to Ensure Vulnerable Populations Have Access to COVID-19 Vaccines (House Ways & Means Committee Press Release, 10/8/20).
Affordable Care Act

On September 24, the president signed an Executive Order (EO), An America-First Healthcare Plan. Executive Orders do not have the force of law and cannot change existing laws or formal regulations. The EO states, “It has been and will continue to be the policy of the United States to give Americans seeking healthcare more choice, lower costs, and better care and to ensure that Americans with pre-existing conditions can obtain the insurance of their choice at affordable rates.” Neither the EO nor any other documentation provides proposals about how to achieve these goals, particularly if the Affordable Care Act is ruled unconstitutional, as the administration is urging the Supreme Court. (The Court will hear arguments about the case on November 10.) The EO also mentions surprise medical billing and care for veterans. For an analysis of the EO, see Administration Health Care Executive Order (Health Affairs blog, 9/24/20).
Other News, Information, and Resources

On October 9, the Georgetown Center for Children and Families (CCF) unveiled a detailed report on data recently issued by the Census Bureau about the decline in the rate of insurance coverage among children. Family Voices, the American Academy of Pediatrics, and other children’s health organizations released an accompanying press statement. See also Another Sign that We Can Do Better in Covering Children Who are Eligible but Not Enrolled in Medicaid (CCF blog post, 10/5/20).

October Issue of Health Affairs Devoted to Child Health
The entire October issue of Health Affairs is devoted to child health, including public policy issues. On Wednesday, October 21, at 2:00-3:30 ET, Health Affairs Editor-in-Chief Alan Weil will host a briefing – Children’s Health: Improving Equity and Access – at which a panel of the issue’s authors will discuss their articles. Family Voices Board of Directors member James Perrin, MD, is the lead author of one of the articles, Principles And Policies To Strengthen Child And Adolescent Health And Well-Being.
From the FDA: Biologics and Biosimilars Patient/Provider Information in English & Spanish

From the Social Security Administration:
TRICARE and Military Health System

The 2020 TRICARE Open Season begins on November 9 and ends on December 14, 2020.
TRICARE Young Adult (TRICARE, 10/8/20)
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. [TRICARE wants to hear your feedback. Take the publications survey, and share your thoughts about this publication.]

For other TRICARE news and information, see the TRICARE Benefits Updates and TRICARE Publications.
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.
See “Medicaid” section above about the Request for Information about Medicaid HCBS Measures.
Tuesdays and Thursdays, from September 15 through October 22,
2:00 pm ET
Health Reform: Beyond the Basics (Center for Budget and Policy Priorities) 
All webinars will be recorded and available for viewing on the Center’s website.

Wednesday, October 14, 2:00-3:30 ET
Mom Congress
Wednesday, October 21, 1:00-2:30 ET
Trust for America’s Health
Wednesday, October 21, 2:00-3:00 ET
National Academy for State Health Policy
Wednesday, October 21, at 2:00-3:30 ET
Health Affairs 
Tuesday, October 27, 3:00 ET
Manatt Health, the American Academy of Pediatrics, Family Voices and the Georgetown University Center for Children and Families

Thursday, October 29, 2:00-3:00 ET
Centers for Medicare and Medicaid Services (CMS)
American Red Cross
Resources for National Hispanic Heritage Month & COVID-19 Information in Spanish
Resources for National Hispanic Heritage Month

The Health Resources and Services Administration notes that there are more than 22,000 Hispanics and Latinos waiting for a life-saving organs, and transplants have a greater chance of success when organs are matched between people of the same racial or ethnic background. To become an organ donor, visit organdonor.gov or donaciondeorganos.gov. Stay up-to-date on Facebook @Organdonor.gov and @Donaciondeorganos.gov.

Spanish-Language Resources on COVID-19
The NIH Community Engagement Alliance Against COVID-19 Disparities (CEAL) offers guidance and resources to community leaders so they can connect Hispanic/Latino and other minority communities with important, accurate information on public health, COVID-19 vaccine clinical trials and the importance of being included in research studies. For more information about volunteering for a COVID-19 study, please visit the COVID-19 Prevention Network

The HHS Substance Abuse and Mental Health Administration (SAMHSA) has new COVID-19-related resources in Spanish: 

Salud America! at UT Health San Antonio has created Juntos, We Can Stop COVID-19, a campaign that encourages Hispanics/Latinos to work together as a community to slow the spread of COVID-19.
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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.