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Washington DC Update 9/22/2020
1-800-273-8255 or Chat

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
Rest in Peace
Ruth Bader Ginsburg

Both houses of Congress are back in session after their August break, but have made no progress on another pandemic-relief bill. As of this writing, it seems unlikely, but not impossible, that a bill will be passed before the election. In other news…

  • Medicaid Regulations: The administration -- (1) will withdraw the proposed “Medicaid Fiscal Accountability Regulation” that would have restricted states’ ability to fund their share of their Medicaid programs; (2) issued a proposed “Good Guidance” rule that, in effect, could rescind many federal policies governing state Medicaid programs.

  • Vaccines: HHS announced that it would permit pharmacists to order and administer routine childhood immunizations to children ages 3-18; preliminary plans for the allocation and distribution of a COVID-19 vaccine have been released.

  •  The Census Bureau released data showing the largest annual increase in the number of uninsured children in more than a decade.

  • The Centers for Disease Control and Prevention (CDC) issued a national moratorium on rental evictions through the end of the year.

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. 

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.
  • Non-Coronavirus News, Information, and Resources
  • The Supreme Court
  • Congress
  • Medicaid & Chip
  • Affordable Care Act
  • Coronavirus News, Information, and Resources
  • Telehealth
  • Childhood Vaccines & COVID-19 Vaccines
  • Other COVID News, Information, & 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
The Supreme Court

California v. Texas and Texas v. California
The death of Justice Ruth Bader Ginsburg has implications for the future of the Affordable Care Act (ACA). The constitutionality of the Act is being challenged by a number of Republican state attorneys-general, and defended by a number of Democratic state attorneys-general and the U.S. House of Representatives. The administration has sided with the challengers of the Act. The Court is scheduled to hear oral arguments in the case on November 10.

As summarized by “Scotusblog,” the issues in the case are:
(1) Whether the individual and state plaintiffs in this case have established Article III standing to challenge the minimum-coverage provision in Section 5000A(a) of the Patient Protection and Affordable Care Act (ACA) [“individual mandate”];

(2) whether reducing the amount specified in Section 5000A(c) [tax for not having insurance] to zero rendered the minimum-coverage provision unconstitutional; and

(3) if so, whether the minimum-coverage provision is severable from the rest of the ACA. For a full discussion of how the situation could play out, see The Health 202: Obamacare's chances of surviving Supreme Court diminished with RBG's death (The Health 202, Washington Post blog, 9/21/20), and Justice Ginsburg’s Loss, What A New Court Could Mean For The ACA (Health Affairs blog, 9/20/20).

As explained in the August 7 Update, the House had passed a comprehensive COVID relief bill (the “HEROES Act”) in mid-May. The Senate took up, but failed to pass a more modest bill (the HEALS Act”) on September 10. See Senate Democrats block Republican Covid relief proposal (Politico, 9/10/20). 

Unlike the House bill, the Senate bill did not include any boost in Medicaid funding. A new bill is not expected to emerge before the election unless it is passed before the Senate adjourns in order to campaign, as it was expected to do at the end of this week. The death of Justice Ginsburg may change that schedule, however, since the Senate is likely to hold hearings as soon as possible on the president’s new appointee, which he is expected to announce at the end of this week. It is always possible that a last-minute deal will be reached, but as of this writing, the two sides are far apart on how much to spend so a compromise seems unlikely. See Trump says he can talk GOP into going for 'larger' virus aid, including stimulus checks (AP, 9/18/20)

Funding the government beyond September 30
Federal Fiscal Year 2020 ends on September 30, 2020. In the absence of final appropriations legislation to fund government departments and agencies, Congress often relies on short-term spending bills called “continuing resolutions,” (or CRs), and it will do so again this year. (The alternative is a government shut-down.) It was reported on Friday that an apparent deal between House Speaker Nancy Pelosi (representing House Democrats) and Treasury Secretary Steve Mnuchin (representing the administration) had broken down over farm subsidies, so the outlook now is uncertain.

Both sides seem to agree, however, that they want a “clean” CR, meaning one that would not include other provisions, such as COVID-19 relief, and that, with some exceptions, the CR would provide funding at FY 2020 levels. It has also been reported that the CR will last through December 11, although Speaker Pelosi had sought a February end-date. See Stopgap funding talks bleed into weekend amid farm aid pushback (Roll Call, 12/18/20).  
Medicaid & CHIP

CMS withdraws Medicaid Fiscal Accountability Rule (MFAR)
In good news for state Medicaid programs, the Administrator of the Centers for Medicare and Medicaid Services (CMS), Seema Verma, announced in a September 14 Tweet that the proposed “Medicaid Fiscal Accountability Rule (MFAR) would be withdrawn from the agency’s regulatory agenda. See Trump administration pulls controversial Medicaid fiscal accountability rule (Fierce Healthcare, 9/14/20).

Proposed Rule on “Good Guidance”
On August 20, the Department of Health and Human Services (HHS) issued a proposed rule (with August 26 corrections) -- applicable to all of HHS except the Food & Drug Administration -- to implement presidential Executive Order 13891, which requires that all federal agencies conform with certain procedures for issuing guidance applicable to regulated entities. Although the rationale for the proposed rule is to ensure greater transparency in agency implementation of laws, it would have the opposite effect in the short term; HHS could rescind all current “guidance” -- without any opportunity for public comment -- by omitting it from a newly created database as of November 16, 2020. “Guidance” includes State Medicaid Directors letters (as in the next news item), FAQs, Informational Bulletins, and any other form of direction to states about how to implement their Medicaid programs.

Although such guidance does not officially have the force of law, it has been the basis for numerous Medicaid policies throughout the decades. In the future, “significant guidance documents,” as defined in the proposed rule, would be subject to a public comment period and, once approved, would be posted on the public database to be established by November 16.


MACPAC Child and Adult Core Set Quality Measure Dashboard
The Medicaid and CHIP Payment and Access Commission (MACPAC) has launched a new interactive dashboard that offers an overview of trends in state reporting and performance rates for the Child and Adult Core Set health care quality measures established by the Centers for Medicare and Medicaid Services (CMS). If you click on the dashboard’s “Performance” tab, you can find state-specific data about a variety of quality measures within five broad domains: behavioral health care; care of acute and chronic conditions; maternal and perinatal care; oral and dental care; and primary care access and preventive care.

The MACPAC website also has information about Medicaid’s Response to COVID-19

For information about Medicaid and telehealth, see the “Telehealth” section, below. For information about Medicaid and the COVID vaccine, see the “Vaccines” section, below.
For a complete and updated list of CMS actions, guidance, and other information in response to the COVID-19 virus, see the Current Emergencies Website. CMS has also launched a dedicated, Medicaid.gov, COVID-19 resource page that will be continually updated with relevant information. 
Affordable Care Act

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

See https://www.healthcare.gov/blog/open-enrollment-2021-dates/. For a refresher on coverage and benefits, see the September 10 blog post on Healthcare.gov, Marketplace health benefits & coverage: What to know.

Telehealth and Disabilities: Challenges and Opportunities for Care – A policy brief from the National Health Law Program considers the benefits and limitations of telehealth for individuals with disabilities covered by Medicaid.

Report from Taskforce on Telehealth Policy
The Taskforce on Telehealth Policy (TTP) – a joint effort of the National Committee for Quality Assurance (NCQA), the Alliance for Connected Care, and the American Telemedicine Association recently issued its Findings and Recommendations. The Taskforce considered over 300 written public comments and conducted a virtual town hall attended by nearly 1000 stakeholders. The TTP concluded that policymakers should make certain telehealth policies permanent, including the lifting of geographic restrictions and limitations on originating sites.

As outlined in a September 15 blog post, Retail Telehealth Isn’t the Call Policymakers Should Answer, the American Academy of Family Physicians takes issue with some of the TTP’s recommendations, including the idea of piloting the "virtual medical home."

HHS Authorizes Pharmacists to Administer Childhood Vaccines and COVID-19 and Related Vaccines to Children
To address the decline in childhood immunizations during the pandemic, the Department of Health and Human Services (HHS) announced in August that it would permit certain licensed pharmacists and pharmacy interns to administer routine childhood vaccines to children ages 3 through 18. See August 24 Federal Register. This authorization is subject to a number of requirements.

Among these, the licensed pharmacist must complete a practical training program of at least 20 hours, and must inform the childhood-vaccination patients and child’s adult caregivers of the importance of a well-child visit with a pediatrician or other licensed primary-care provider, and refer patients as appropriate. The American Academy of Pediatrics opposes the HHS policy. See American Academy of Pediatrics Opposes HHS Action on Childhood Vaccines; Calls It ‘Incredibly Misguided’ (AAP News Release, 8/19/20). According to an article in Medpage Today, the American Academy of Family Physicians also opposes the HHS decision, as does Tricia Brooks, of the Georgetown University Center for Children and Families, while Georges Benjamin, MD, executive director of the American Public Health Association, agrees with the HHS position, “with some caveats.” 
Vaccine Development

Vaccine Allocation and Distribution

Administration’s Preliminary Allocation and Distribution Plans for a COVID-19 Vaccine. As announced in a September 16 HHS press release, the Department of Health and Human Services (HHS) and the Department of Defense (DoD) released two documents and an infographic related to the distribution of a COVID-19 vaccine:

The 57-page COVID-19 Vaccination Program Interim Playbook for Jurisdiction Operations (Version 1.0, September 16, 2020), developed by the CDC, “serves as an interim playbook for state, territorial (including the US-affiliated Pacific Islands…), and local public health programs and their partners on how to plan and operationalize a vaccination response to COVID-19 within their jurisdictions.”

  • National Academies Preliminary Framework. As explained in its September 1 new release, the National Academies of Sciences, Engineering, and Medicine (NASEM) released a “discussion draft of a preliminary framework to assist policymakers in planning for equitable allocation of a vaccine against COVID-19.” The committee that developed the draft framework was formed in July in response to a request to the National Academy of Medicine from the National Institutes of Health and Centers for Disease Control and Prevention. While the committee co-chairs said that committee values public input, the public comment period was only three and half days.

Of relevance to children and youth with special health care needs (CYSHCN) and their families, the report (p. 57) includes an illustration of the four proposed phases for vaccine allocation.

Those who would get the vaccine in Phase 1a (the “jumpstart” phase), would be first responders and “high-risk workers in health care facilities,” which would include home health care workers. Phase 1b would include, among others, people of all ages with comorbid or underlying conditions that put them at significantly higher risk, while Phase 2, would include people of all ages with comorbid or underlying conditions that put them at moderately higher risk. Other children and young adults without high risks would get the vaccine in Phase 3.

The preliminary framework does not recommend priority vaccination of family caretakers or other nonprofessionals caring for high-risk individuals.

The Consortium for Citizens with Disabilities (CCD) provided comments to the NASEM committee expressing several concerns, which they also conveyed in a September 9 letter to Roger Severino, the Director of the Office of Civil Rights at the Department of Health and Human Services (HHS). The letters recommend that people of all ages living in congregate or overcrowded settings should be prioritized equally, rather than giving higher priority to “older adults,” as the preliminary framework suggests. CCD also recommends that “individuals who receive services at home should receive priority for a vaccine when, as a result of disability, they are unable to effectively distance from others outside their household.”
Other News, Information, and Resources

Temporary Halt in Residential Evictions To Prevent the Further Spread of COVID-19 (Federal Register, 9/4/20): The Centers for Disease Control and Prevention (CDC), announced the issuance of an Order under Section 361 of the Public Health Service Act to temporarily halt residential evictions to prevent the further spread of COVID-19. This Order is effective September 4 through December 31, 2020.

Census Data Show Largest Annual Increase in Number of Uninsured Children in More Than a Decade (Georgetown Center for Children and Families blog post, 9/15/20)

Asian American and Native Hawaiian & Pacific Islander In-language COVID-19 Resources - Ongoing

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.
[Webinars are listed in chronological order, based on the first webinar in the case of a series (meaning some calls taking place earlier will be listed after the series calls).]

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, September 23, 1:00 - 2:00 ET
The National Institute for Health Care Management (NIHCM) Foundation
Wednesday, September 23, 2:00-3:00 ET
Connecting Kids to Coverage National Campaign, Centers for Medicare and Medicaid Services
Thursday, September 24, 3:00 ET
Immunize Nevada

Thursday, September 24, 3:00 ET
Aligning for Health and American Hospital Association
NEW Education & Mental Health Challenges During COVID-19 for Families of CSHCN, Part 2, Service Provision and Advocating for Your Rights
Friday, September 25, 4:00 ET
Family Voices of California
Tuesday, September 29, 11:00 ET
Infectious Diseases Society of America (IDSA), the HIV Medicine Association (HIVMA) and the Pediatric Infectious Diseases Society (PIDS) 
Tuesday, September 29, 2:30-4:00 ET
Sponsored by Nemours Children's Health System
Wednesday, September 30, 3:00-4:00 ET
Association of Maternal and Child Health Programs, National Academy for State Health Policy, and the Lucile Packard Foundation for Children’s Health
Wednesday, September 30, 3:00-4:00 ET
The National I&R Support Center at ADvancing States

Thursday, October 1, 12:00-1:00 ET
Public Health Communications Collaborative
Please submit questions in advance to patricia.clemente@gmmb.com. Select questions will be addressed.

Thursday, Oct 8, 1:00 ET
National Health Law Program

Thursday, October 8, 2:00-3:00 ET
The Arc

American Red Cross
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.