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Washington DC Update 9/9/22
Legislative Updates
The Senate is back in session this week and the House reconvenes next Tuesday after the August recess. There is a lot of legislative business at hand, and many members have already turned their focus to the November election.

The government is currently funded until September 30, 2022. The House is already in conversations about temporarily extending funding levels until December 16 (the House’s target date for adjournment for the year--the Senate’s target date is December 21). They are expected to try to quickly move to vote on a continuing resolution upon their return next week. If you recall, last year government spending was not resolved until the spring, so specific conversations and movements in this way signals intent to get an omnibus appropriations package completed before the new Congress is seated in January.

In Case You Missed It: House Energy and Commerce Committee Release Request for Information on Disability Policies
House Energy and Commerce Republicans released a report and request for information (RFI) titled Disability Policies in the 21st Century: Building Opportunities for Work and Inclusion.  

The report outlines three main goals to removing barriers faced by people with disabilities: 
  • Ensuring access to long-term services and supports by eliminating waiting lists for such care in Medicaid and making coverage options more affordable for those not covered by Medicaid. 
  • Making communities and daily life more accessible for people with disabilities by supporting access to assistive technologies and enforcing accommodation requirements in the Americans with Disabilities Act (ADA) and section 504 of the Rehabilitation Act of 1973 in health care settings. 
  • Moving the workforce toward integrated employment by eliminating programs that pay workers with disabilities wages lower than state and federal minimums, and by providing supports and funding opportunities for accommodations in the workplace. 
Feedback on the RFI is due no later than 9/26/22. 
From the Administration
In Case You Missed It: HHS: Public Health Emergency Renewal Likely in October  
The U.S. Department of Health and Human Services has repeatedly committed to providing 60-days advance notice prior to the end of the COVID-19 public health emergency (PHE). Medicaid Directors have not received that 60-day notice, indicating that there will be another renewal of the COVID-19 PHE in mid-October. This means that the COVID-19 PHE will likely extend until at least January 2023, absent Congressional action.  

CMS: Behavioral and School-Based Health Guidance
August was anything but a recess for the Center for Medicaid and CHIP Services. CMS released the two guidance documents:

They do not create new policy, but aim to help states, managed care organizations, and providers meet health care needs more effectively.

The third related announcement was a Notice of Proposed Rulemaking for Child Health Core Quality Set that would standardize quality measures across Medicaid and CHIP (which have thus far been optional but will be come permanent in 2024). Comments for this proposed rule are due 10/21/22.

For more information and breakdown of these guidance and NPRM, consider reading these blog posts and materials from Georgetown Center for Children and Families:

CMS: Proposed Rule for Streamlining Enrollment
This proposed rule seeks to streamline application and enrollment, improve retention rates, remove barriers specific to CHIP, and enhance program integrity. Specifically, it would:
  • remove barriers and facilitate enrollment of new applicants, particularly those dually eligible for Medicare and Medicaid;
  • align enrollment and renewal requirements for most individuals in Medicaid;
  • establish beneficiary protections related to returned mail;
  • create timeliness requirements for redeterminations of eligibility in Medicaid and CHIP;
  • make transitions between programs easier;
  • eliminate access barriers for children enrolled in CHIP by prohibiting premium lock-out periods, waiting periods, and benefit limitations;
  • modernize recordkeeping requirements to ensure proper documentation of eligibility and enrollment.

Comments are due by November 7, 2022.

This great blog post by Georgetown Center for Children and Families provides a more detailed and digestible breakdown of the proposed rule.

CMS Data: Medicaid and Children’s Health Insurance Program (CHIP) Enrollment
As of May 2022, 88,978,791 people are enrolled in Medicaid and CHIP. This is an increase of 677,711 since the last report.
  • 81,904,569 are enrolled in Medicaid
  • 7,074,222 are enrolled in CHIP

For more info on Medicaid/CHIP enrollment, including enrollment trends, click here.

HHS: Proposed Rule to Strengthen Nondiscrimination Protections in Health Care
The U.S. Department of Health and Human Services (HHS) announced a proposed rule implementing Section 1557 of the Affordable Care Act (ACA) which prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities. 
  • This proposed rule restores and strengthens civil rights protections for patients and consumers in federally funded health programs and HHS programs, after the 2020 version of the rule limited its scope and power to cover fewer programs and services.
  • This proposed rule affirms protections against discrimination on the basis of sex, including sexual orientation and gender identity, consistent with the U.S. Supreme Court’s holding in Bostock v. Clayton County, and reiterates protections from discrimination for seeking reproductive health care services. 
  • Strengthening this rule is part of the Biden-Harris Administration’s commitment to advancing gender and health equity and civil rights as laid out in President Biden’s executive orders on Preventing and Combatting Discrimination on the Basis of Gender Identity or Sexual OrientationProtecting Access to Reproductive Healthcare Services, and Advancing Racial Equity and Support for Underserved Communities
  • The proposed rule includes language in the preamble that discusses how non-discriminatory benefit design could impact the provision and reimbursement of Medicaid and CHIP services, including but not limited to home and community-based services. 

CMS encourages stakeholders to review the proposed rule and submit public comment by 9/22/22.

View HHS’s press release here.

A fact sheet on the proposed rule is available in English and 16 languages here.

CMS: Health Home for Children with Medically Complex Conditions
Through a Letter to State Medicaid Directors, CMS unveiled guidance on a new Medicaid health home benefit for children with medically complex conditions. This new optional benefit helps state Medicaid programs provide Medicaid-eligible children who have medically complex conditions with person-centered care management, care coordination, and patient and family support. CMS anticipates that the new benefit will help these children receive the care they need, including across state lines.

Children with medically complex conditions — including serious health concerns like cerebral palsy, cystic fibrosis, blood diseases, and mental health conditions that can severely impact a child’s ability to function — often require tremendous care coordination and highly specialized treatment. Finding needed services often requires traveling well beyond a family’s home, and often care is only available for these children out-of-state. The new health home services are expected to give these children and their families help in coordinating and managing care.

“CMS and our state partners are doing all that we can to provide whole-person care through Medicaid and the Children’s Health Insurance Program (CHIP),” said CMS Administrator Chiquita Brooks-LaSure. “This new state plan option is about ensuring that children and families can get coordinated, high-quality care — particularly children with complex medical conditions. CMS is committed to working with states interested in pursuing this option to ensure they can quickly and efficiently get kids the care they need.”

As outlined in the letter, states will have the option to offer the new health home services benefit for children with medically complex conditions beginning October 1, 2022. The services provided under the new benefit include providing access to the full range of pediatric specialty and subspecialty medical services, including services from out-of-state providers, as medically necessary.

The guidance provides information to states about the new health home benefit, including about payment methodologies, provider standards, provider and state reporting, state monitoring, and state assurance requirements. States with approved Medicaid state plan amendments (SPAs) to cover the new health home benefit will receive a 15 percentage point increase in federal matching for their expenditures on health home services during the first two fiscal year quarters that the SPA is in effect. CMS also has committed to offer ongoing technical assistance to states about implementation of the new benefit.

HHS: Expand HCBS Access 5 states
The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), awarded approximately $25 million in planning grants to five new states and territories to expand access to home and community-based services (HCBS) through Medicaid’s Money Follows the Person (MFP) demonstration program. With these awards, 41 states and territories across the country will now participate in MFP.

Awards of up to $5 million are being announced for Illinois, Kansas, and New Hampshire, as well as for American Samoa and Puerto Rico – the first time MFP grants have been made available to territories. These awards will support the early planning phase for their MFP programs. This includes:
  • Establishing partnerships with community stakeholders, including those representing diverse and underserved populations, Tribal entities and governments, key state and local agencies (such as state and local public housing authorities), and community-based organizations;
  • Conducting system assessments to better understand how HCBS support local residents;
  • Developing community transition programs;
  • Establishing or enhancing Medicaid HCBS quality improvement programs; and
  • Recruiting HCBS providers as well as expert providers for transition coordination and technical assistance.

A new report from CMS also describes how MFP has helped facilitate more than 107,000 transitions out of institutional settings since 2008. 

The administration estimates that this change will ultimately result in $25 billion in increased funding, allowing states to develop innovative ways to address existing HCBS workforce and structural issues, expand the capacity of critical services, and begin to meet the needs of people with disabilities, family caregivers, and providers. In June 2022, HHS notified states - PDF that they now have an additional year – through March 31, 2025 – to use this critical funding made available by the American Rescue Plan. For more information on MFP, visit Medicaid.gov.
Policy Related Reports of Interest
State Health and Value Strategies: Public Health Emergency Unwinding
This landing page for Public Health Emergency (PHE) unwinding contains resources created by the State Health and Value Strategies (SHVS), an RWJF funded program at Princeton University. It includes links to recent articles about communication with enrollees, continuity of care considerations, and leveraging existing authorities amidst the PHE unwinding. NOTE for Family-to-Family Health Information Centers (F2Fs): This guidance is directed at state health officials, but offers great insight and tools for F2Fs to use in conversations and partnership with those state officials.

NASHP: State Approaches to Serve Children and Youth in Home and Community-based Services
According to CMS guidance, states may direct funds from the increased Medicaid Federal Medicaid Assistance Percentage (FMAP) under the American Rescue Plan Act (ARPA) to introduce, expand, or strengthen home and community-based services (HCBS) benefits, including respite and family caregiver support. This report documents these activities. Three states (CO, ID, and WV) plan to use their enhanced Medicaid HCBS FMAP under APRA to support respite care for children’s caregivers through a variety of strategies.

Seven states (Arizona, Delaware, Hawaii, Idaho, Iowa, Michigan, Minnesota, and West Virginia) propose efforts to provide training and peer support for family caregivers, particularly those with children with complex health care needs. Three states (AZ, MN and IL) have proposed using the increased FMAP funds under ARPA to enhance access to HCBS by providing reimbursement specifically for family caregivers of children.

State Policy Roadmap for Family Caregivers: Engagement of Family Caregivers in Health Care Systems
This NASHP report documents steps states have taken to improve family caregiver engagement in care delivery and planning, which is one of the recommendations from the RAISE Family Caregiving Advisory Council. State Medicaid agencies have developed services, such as structured family caregiving programs, to help family caregivers deliver and coordinate care by providing the caregiver with payment, training, and ongoing input into care planning. The report outlines and describes additional strategies already in use by states to implement the RAISE Family Caregiving Advisory Council recommendation to engage family caregivers in health care and long-term services and supports.

NASHP: Advancing Children’s Mental Health Through Workforce Supports
States have responded the national crisis in children’s mental health by expanding children’s mental health services and supports, including initiatives to enhance school-based services, crisis intervention services, and recruitment and support of pediatric mental health providers. In the first six months of 2022, 30 states enacted laws to address workforce shortages in children’s mental health services. Over half of states enacted laws in their recent legislative sessions (from January through June 2022) to address mental health provider workforce shortages for youth. Approaches include assessing workforce gaps and vacancies, enhancing recruitment and support of providers, establishing trainings and resources for behavioral health professionals, and modifying policies around the provision of mental health services. This NASHP article provides a great overview and highlights specific approaches. Be sure to check out the table in the article to see if your state has enacted any such laws!

Community Catalyst: Q & A with State Advocates for Cover All Kids Campaign
In 2020, 4.3 million children under the age of 19 living in the United States had no access to health coverage. That same year we observed the largest jump in uninsured children in more than a decade. As a response to longstanding gaps in health care access and the impact on immigrant communities, many states have introduced Cover All Kids legislation. Cover All Kids refers to a state-funded, comprehensive, Medicaid-like program for income-eligible children and adolescents regardless of their citizenship or immigration status. At the start of 2020, five states plus the District of Columbia offered Cover All Kids. Since then, five more states have achieved legislative or budgetary victories for Cover All Kids to ensure health care is accessible to all children.
Check out the August 30 and August 31 blog posts by Community Catalyst featuring Q & A with state advocates from (MA, VA, MD, CO, NJ, CT) working to ensure all kids are covered. 

Robert Wood Johnson Foundation (RWJF): Raising the Bar
Last month marked the release of Raising The Bar, an actionable framework supported by the Robert Wood Johnson Foundation, which offers practical guidance to help healthcare leaders meet their mission of advancing health equity. In addition to the framework, Raising the Bar has already begun to roll out resources!

  • How Advocates Can Play a Role in Motivating Healthcare Organizations to commit to promoting equity and excellence: Consumer and Community Advocate guide
  • A recording from the July 26 Raising the Bar panel, How Healthcare Organizations Can Get Meaningful, Measurable Leadership Buy-in to Health Equity Initiative, is here 

Consider the schedule for the ongoing webinar series below and register today!

Tuesday, September 13 from 2-3 pm ET: How Advocates Can Influence Healthcare to Advance Equity 
Join health leaders and patient advocates for an insightful Raising the Bar discussion on healthcare's role in engaging individuals and organizations in the community.

  1. Jocelyn Frye – President, National Partnership for Women & Families (moderator)
  2. Catherine Baase, MD – Board Chairperson, Michigan Health Improvement Alliance
  3. Uma R. Kotagal, MBBS, MSc – Executive Leader, Population and Community Health, and Senior Fellow, Cincinnati Children's Hospital Medical Center
  4. Final panelist pending

Thursday, September 29 from 1:30-2:30 pm ET: Models for Strategic Planning to Coordinate Equity Efforts
Raising the Bar principles provide a framework for thinking differently about the work organizations do to drive transformative change and advance Equity and excellence.

  1. Ruth Shim, MD, MPH – Member of the Board of Trustees, Robert Wood Johnson Foundation; Luke & Grace Kim Professor in Cultural Psychiatry and Professor of Clinical Psychiatry in the Department of Psychiatry and Behavioral Sciences, University of California, Davis; and Associate Dean of Diverse and Inclusive Education at the University of California, Davis, School of Medicine
  2. Rick Gilfillan, MD, MBA – Independent Consultant; Former President and CEO, Trinity Health
  3. Rachel Gonzales-Hanson – Interim CEO and President, National Association of Community Health Centers
  4. J. Nadine Gracia, MD, MSCE – President and CEO, Trust for America's Health 

A panel of healthcare leaders and equity experts will highlight the sector's role in employing and supporting a diverse health workforce.

  1. Karen DeSalvo, MD, MPH, MSc – Co-Founder, National Alliance to impact the Social Determinants of Health (moderator)
  2. Adia Harvey Wingfield, Ph.D. – Vice Dean of Faculty Development and Diversity, Professor of Sociology, Washington University in St. Louis
  3. Alan Nevel, MBA – Senior Vice President and Chief Equity Officer, MetroHealth
  4. Denise Octavia Smith, MBA, CHW, PN – Founding Executive Director, National Association of Community Health Workers
Policy Related Webinars of Interest
Disabled BIPOC: Disrupting Danger in Crisis Response
Tuesday, September 13, 2022, 10:30 am - 4:30 pm, register HERE

Join The Arc of the United States for a free, virtual conference about the intersection of race, disability, and law enforcement.

Too often, people with disabilities in crisis have nowhere to turn and call 911, many times resulting in bad outcomes. In some instances, family or friends call 911, only escalating the situation. Research shows people with mental health conditions are 16 times more likely to be killed by law enforcement, people with disabilities make up 33% of people killed by law enforcement, and these risks increase for Black people and other people of color (Policing and Racial Injustice: A Disability Rights Perspective Impacts and Solutions, Disability Rights Ohio).

Taking Public Health Action for Family Caregivers
September 14, 2022, 10 am ET, Register HERE

Join the National Alliance for Caregiving and the National Association of Chronic Disease Directors for the release of a new public health framework designed to guide the public health community’s efforts to support the growing needs of America’s 53 million family caregivers. Experts will share insights into the caregiving issues relevant to public health and outline actions public health professionals can take to safeguard the health of family caregivers.

NASHP: National Caregiving Strategy
October 3, 2022, 2 pm ET, Register HERE

NASHP is hosting this webinar to discuss the opportunities within the newly released National Family Caregiving Strategy and how it can provide a roadmap for states that are interested in developing and expanding supports for family caregivers. A federal official, state administrator, and philanthropic expert will give an overview of the first-of-its-kind National Family Caregiving Strategy and will highlight how the state of Delaware is listening to family caregivers to better support their needs. NASHP’s RAISE Act Family Caregiver Resource and Dissemination Center is holding this webinar, with generous support from The John A. Hartford Foundation and RRF Foundation for Aging.

Thank you for subscribing to the Washington DC Update newsletter. Please feel free to contact the Family Voices Director of Public Policy and Advocacy, Cara Coleman, 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 "Unsubscribe" 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.