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 Legislative & Policy Corner

The Federal Budget Update
During the past week, Congress approved legislation that would suspend the debt limit through May 18, 2013, thus taking the debt limit off the table for the current discussions about reducing the federal deficit through additional spending reductions. This legislation also ties congressional pay to the completion of a budget plan by suspending salaries of the members of the House or Senate if either chamber does not adopt a resolution by Apr. 15, 2013. Unfortunately, this legislation does not repeal, replace or delay sequestration scheduled to occur on Mar. 1, 2013 or funding the federal government through the remainder of the fiscal year. As the federal budgeting process moves forward, below are some key dates to keep in mind. All of these events will have a profound impact on spending:

Mar. 1: Sequestration
Mar. 27: Expiration of the continuing resolution
End of March or Early April: Release of President Obama’s FY14 budget request
Apr. 15: Budget resolution
May 19: Debt ceiling will need to be raised

Sequestration
In the past couple of weeks, Congress has largely remained silent about efforts to avoid sequestration scheduled to occur on Mar. 1, 2013. Based on estimates by the Center on Budget and Policy Priorities, non-defense discretionary accounts would be cut by 5.1 percent compared to the 8.2 percent under the original sequestration. For the Title V Maternal and Child Health (MCH) Services Block Grant, sequester will result in a cut of $32 million for fiscal year 2013. It is important to note that states would have to absorb this cut during the second half of the fiscal year which would substantially impact their ability to provide needed supports and programs to vulnerable populations. However, according to an article in CQ Healthbeat, the Office of Management and Budget could, “Soften the blow of the spending cuts by using a process called apportionment to delay them until later in the year.” Additionally, the expiring continuing resolution may prove to be an opportunity to address sequestration. Recognizing the complex nature of sequestration, AMCHP encourages our members to discuss any technical questions with project officers. We will continue to monitor developments at the federal level and translate our understanding of the current law. 

AMCHP continues to work with the broader community articulating the impact sequestration will have on maternal and child health programs and urge Congress to address the deficit through a balanced approach.

Budget Resolution
Incoming Budget Committee Chair Sen. Patty Murray (D-WA) recently released a memo to her colleagues outlining the work Congress completed during the past two years to reduce the deficit by $2.4 trillion and that moving forward in order to address the deficit it needs to be through a balanced approach via spending cuts and new revenue. The Senate budget committee, along with the House Budget committee, is tasked with developing a budget resolution every year which provides a blueprint of spending priorities for the next year. The budget resolution may provide instructions to the relevant committees to find savings in various federal programs while at the same time it could reduce the overall amount of funding available for discretionary programs. 

The development of the budget resolution will begin in earnest during the spring.

President’s Fiscal Year 2014 Budget Proposal
The latest rumors in Washington, DC state that President Obama’s fiscal year 2014 budget proposal will not be released until late March or early April due to uncertainty about the fiscal year 2013 budget. This means that the fiscal year 2014 budget process will be condensed into a couple of weeks this spring when Congress begins deliberations and develops the fiscal year 2014 appropriations bills.

Health Reform Implementation

Are You a Beta Tester? Of Course You Are.
On Jan. 28, the Centers for Medicare & Medicaid Services (CMS) put out a request seeking public input on a single, streamlined, application for insurance on the health insurance marketplace (formerly health insurance exchange). The application will be put into use this fall when open enrollment begins. The individual application “is a single point of entry to purchase private insurance on the marketplace and assess eligibility for assistance including, Medicaid, CHIP, and the Advanced Payment of Tax Credits.” CMS created two videos of the application as a demonstration for reviewers. The applicable form for Individual, Medicaid and CHIP programs can be found here.

CMS Announces 2013 Children’s Core Set of Health Care Quality Measures
On Jan. 24, CMS sent a letter to State Health Officials and State Medicaid Directors announcing the core set of pediatric quality measures for voluntary use by State Medicaid and CHIP programs. Forty-eight states and the District of Columbia voluntarily reported on at least one or more of the FY 2011 indicators. In adherence to federal law, this letter “provides an overview of the steps undertaken to improve the Initial Children’s Core Set, identifies changes to the Initial Children’s Core Set, and presents the timing for the implementation of the 2013 Children’s Core Set.” The letter also outlines the process for determining new indicators to add and others to drop from the set. The CHIPRA legislation requires that improvements to the initial core set of children’s health care quality measures be issued annually beginning in January 2013.

Back-to-Back Kaiser Family Foundation Reports
On Jan. 24, Kaiser released “The Public's Policy Agenda for the 113th Congress” The report highlights public opinion on priorities for, and views on, a wide range of health and health policy issues.

On Jan. 23. KFF Medicaid and CHIP report provided insights on states’ progress toward implementation of the major portions of the Affordable Care Act, and that “many states are moving into high gear to prepare for implementation of the major provisions of the law, including a new streamlined Medicaid enrollment system and, at states' option, the expansion of Medicaid. Nearly all states are pressing forward with information technology and process improvements to develop faster, streamlined Medicaid enrollment systems as required under the ACA, whether or not the state elects to expand Medicaid coverage under the law.”