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Washington DC Update 9/23/21
A full moon, Fall begins, and the acceleration and/or deceleration of reconciliation and infrastructure!

Before we take a look at what is happening on the Hill, let’s pause to celebrate this welcome Fall news: Pfizer will reportedly send their vaccine trial data for children ages 5-11 to the FDA by the end of the month! Here's a collection of articles on Pfizer’s COVID vaccine trials for children ages 5-11.
Full moon may make this an interesting week on the Hill

House committees marked up their portions of the Build Back Better Act last week. Each portion will be combined with those from the other authorizing committees that received reconciliation instructions for a full House vote this week. Simple, right? Maybe not. Recall the timelines in the Washington Update last week--the Infrastructure bill has officially been set for a vote on September 27. Some Democrats will not vote for infrastructure on the 27th unless they are voting for reconciliation at the same time, whereas others want reconciliation and infrastructure on different timelines. Can they both be done by the 27th?

House Speaker Pelosi can only afford to lose 3 Democratic votes on the reconciliation package. She will have to navigate the dynamic between progressive members wanting big investments and a $3.5 trillion topline, with the moderate members who want to shrink the size of the overall package (but haven’t necessarily said which programs they would cut). Will Speaker Pelosi bring it to the full House for a vote this week? The bill will not go to the Senate until it passes the House, however, several Senators are weighing in on either accelerating the votes or completely decelerating until 2022. Will Speaker Pelosi work with Senator Schumer this week to pre-conference between House and Senate democrats to keep it all moving forward?

How does this affect CYSHCN and families? Many programs for children’s health and well-being could see their size shrink to fit into a framework that is acceptable to enough Democrats to pass. Much is still being figured out. While programs such as home & community-based services, Medicaid continuous eligibility and enrollment, Permanent CHIP, Paid Medical Leave, etc., remain intact now, we can expect to see a number of changes--both in policy, amount, and the procedural rules.

ACE Kids 2.0 Update

This bill proposes to create a screening pathway for children’s hospitals to use to facilitate Medicaid approval (by the home state Medicaid agency for out-of-state providers so that kids can access care out of state that balances program integrity and needs for care). While reconciliation is the dominant issue in Washington right now, the bill has been gaining co-sponsorship and support. Senate Finance staff have been continuing to push the Congressional Budget Office (CBO) for a score (cost estimate). Additionally, there is discussion with Energy & Commerce leadership for a legislative hearing or other action/discussion on the topic.
Redesign America’s Mental and Behavioral Health System

On Sept 9, Senators Michael Bennet (D-CO) and John Cornyn (R-TX) issued a white paper outlining a framework for redesigning the nation’s mental and behavioral health system. The white paper includes recommendations to address short-term crises, like the mental health impacts of COVID-19 and the rollout of 988 systems, and outlines a national strategy to integrate mental health care into existing delivery and payment systems, strengthen the workforce, and improve how federal funds are allocated. Senators Bennet and Cornyn sent the white paper to the Senate Finance Committee, signaling their interest in working together on mental health legislation. 
Regulatory News
CMS Revises Guidance on Resuming Normal Medicaid Operations Post-Public Health Emergency (PHE)

On August 13, the Centers for Medicare and Medicaid Services (CMS) issued its highly anticipated revisions to previous guidance on the resumption of normal Medicaid operations (or “unwinding”) when the COVID-19 Public Health Emergency (PHE) expires. Key revisions to previous guidance include:

  • Extending the timeframe for completing pending eligibility and enrollment actions to up to 12 months post-PHE

  • This does not change previous guidance on resuming timely processing of applications within four months post-PHE.

  • Completing an additional redetermination for individuals determined ineligible for Medicaid during the PHE

  • This rescinds the option under previous guidance for states to rely on an eligibility action processed within six months of the date of coverage termination post-PHE. In effect, the six-month “lookback” option for an eligibility action is no longer available.

  • States must make a full redetermination prior to taking an adverse action with respect to any beneficiary.

  • CMS reiterates the requirement of 30 days for beneficiary response to state requests to verify eligibility, along with a minimum of 10 days advance notice and fair hearing rights prior to termination or other adverse action.

  • States must take steps to transition beneficiaries determined ineligible to other insurance affordability programs.
CMS Center for Medicaid & Chip Services (CMCS) Releases Guidance on ARP (American Rescue Plan) Enhanced FMAP Provisions, Beneficiary Vaccination Incentives, and Coverage of COVID Testing

On August 30, CMCS released two guidance documents on Medicaid provisions in the American Rescue Plan:

State Health Official (SHO) Letter #21-004 provides guidance on the 100% federal medical assistance percentage (FMAP) for COVID vaccine administration, temporary FMAP increases for states newly taking up Medicaid expansion, and the 100% FMAP for Medicaid services received through Urban Indian Organizations and Native Hawaiian health care entities. This SHO also includes information on how states can use administrative claiming to fund beneficiary incentives for COVID-19 and flu vaccination.

State Health Official Letter #21-003 provides guidance on mandatory COVID-19 testing coverage in Medicaid and CHIP. It also clarifies that, in light of the impact of the pandemic on schools, states may provide habilitative services to children enrolled in a section 1915(c) and/or 1915(i) program if no local resources are available to provide these services in a remote learning environment. 
Articles and Reports
In efforts to eliminate waitlists for Waivers, some states may be going too far. The following linked article outlines a recent residency requirement for waivers passed and enacted this summer by Oklahoma legislature. CMS has responded that it violates the Constitution and is impermissible. See Feds Push Back On State's 5-Year Residency Requirement For Medicaid Waivers - Disability Scoop. Similar scrutiny is being applied to waiver applications in additional states as well, such as Tennessee, Texas, and others.

Data on cost savings through family support
New Research into the Return on Investment of Family Resource Centers: The National Family Support Network and the OMNI Institute have released two new reports detailing the return on investment (ROI) to the child welfare system of Family Resource Centers (FRC). The two reports describe the ROI of a rural FRC in Teller County, Colorado, and an urban FRC in Orange County, California. The reports illustrate significant costs savings to the child welfare system because of FRCs effectiveness at supporting families to be healthy, strong, and less likely to experience child abuse and neglect.

Federal Relief Efforts Protected Millions of Children from Poverty is the focus of this article by Child Trends using recent census data to demonstrate the decrease in child poverty figures. Child Trends dives even deeper into that census data in this article to reveal that the impact for black and Hispanic children was significant.
Emergency Rental Assistance Program: Tools to Assist the People You Serve

Are you serving people at risk of eviction or who have been evicted? Are you working with landlords whose tenants are behind on rent as a result of COVID-19? Do you serve people facing housing instability or economic hardships? If you answered, “yes,” to any of those questions, then this webinar is for you!
The Emergency Rental Assistance Program (ERAP) makes funding available to states, territories, local governments, and tribes to assist households that are unable to pay rent or utilities during the COVID-19 pandemic. However, many people with disabilities and older adults who are eligible have not applied, and the aging and disability networks are needed to help to get the word out!

On Thursday, September 30, 2021, 11 am - 12 pm ET, the Administration for Community Living (ACL), in partnership with the U.S. Department of Housing and Urban Development, the U.S. Department of Treasury, and the Consumer Financial Protection Bureau, will host a webinar to provide the tools and information you need to help the people you serve to learn more about and apply for Emergency Rental Assistance resources. Register Here.

Medicaid & Telehealth Data Collection: Surveys, Studies & Advisory Group

COVID-19 has spurred Medicaid programs to expand their telehealth policies. It has also encouraged them to examine the effects and impacts of such policies and engaging stakeholders more often than before. Learn about the efforts some Medicaid programs have made in collecting data and working with other groups as they work on solidifying the next steps in their telehealth policy development.
September 24, 2021, 11 am PT / 12 noon MT / 1 pm CT / 2 pm ET Register here.
October is just around the corner...
Consider these ideas, tools, and resources to plan messaging and awareness-raising around National Disability Employment Awareness Month

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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.