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 Legislative & Policy Corner

The Sequester
In a recent article, The Washington Post reports that hopes are fading for a summertime “grand bargain” on the budget, which means any momentum to undo sequestration at large may be lost until the debt ceiling debate is reignited during the fall when the new fiscal year begins. Thus, many budget events will likely converge at the same time: 1) need for Congress to vote to raise the nation’s debt ceiling, 2) new fiscal year beginning on Oct 1 and 3) application of the second round of sequestration. The strategy of the administration and Congress to address all of these hot button issues at this time is unclear.

Additionally, the number one concern facing the non defense discretionary community is short term sequester fixes similar to legislation that enabled the U.S. Department of Transportation to shift money around to prevent the furlough of FAA employees. There is mounting concern that legislation will be introduced shortly to protect the National Institutes of Health (NIH) from the $1.5 billion sequester cuts slated for fiscal year 2013. Without a sufficient pay for, the potential cost to protect NIH would be borne by other agencies within the U.S. Department of Health and Human Services (HHS). AMCHP contends that individual fixes are not a long-term solution to deficit reduction and Congress should address sequestration through a balanced approach.

AMCHP will continue to work in partnership with the broader non defense discretionary community to articulate the impact sequestration has on programs and the populations they serve. As you receive additional details on specific programmatic cuts in the coming weeks, please help us help you by filling out the AMCHP survey on sequestration so we can deliver these stories to Congress and the administration.

FY 2013 Agency Operating Plans
Late last week, the Centers for Disease Control and Prevention (CDC) released its operating plan for FY 2013, which ends Sept. 30. The operating plan includes cuts due to the sequester that went into effect earlier this year. Overall, the CDC funding level in FY 2013 is $6 billion, $600 million below FY 2012 and a 10 percent cut. This is due to the sequester cut of about $303 million and a cut in the Prevention and Public Health Fund (PPHF). However, the full magnitude of this cut is minimized by an $83 million transfer of other HHS funds to CDC from the Secretary. It is important to note that the CDC budget in particular is extremely confusing. The transfers that the Secretary administered to back fill the cuts to the PPHF, which was being used to supplant funding at CDC is not readily apparent in the CDC operating plan. AMCHP will be providing additional analysis within the next couple of weeks. The bottom line is that most programs were cut roughly 5 percent; however, our understanding is some competitive grants funded through those programs may be cut even further.

Unfortunately the Health Resources and Services Administration (HRSA) operating plan has not been finalized as of press time. We are, however, anticipating the final FY 2013 allocation for the Title V Maternal and Child Health (MCH) Services Block Grant will fall below $607 million. This equates to a greater than 5 percent cut. As soon as the operating plan is finalized we will share this information.

Health Reform Implementation
On Apr. 30, the Centers for Medicare & Medicaid Services (CMS) released the finalized application for consumers to complete for determination of eligibility for health insurance programs or discounts for health insurance. The final version is much more simple than the proposed version. CMS reports that “the application for individuals is three pages, and the application for families is reduced by two-thirds, to seven pages. This is much shorter than industry standards for health insurance applications today.” To view the new applications, please see below:

AMCHP Webinar
On May 30, from 3-4:30 p.m. EDT, AMCHP will present The ABCs of ACOs for MCH. With all eyes on the implementation of the Affordable Care Act (ACA), especially the insurance marketplace, Medicaid expansion, and health insurance reforms, states also are working diligently to transform the delivery of services. Among the many initiatives included in the ACA, provisions to establish accountable care organizations (ACOs) are significant because of the potential to help achieve the “IHI Triple Aim”-- improving patient experience of care, improving the health of populations, and reducing the per capita cost of health care (Institute for Health Improvement: The Triple Aim, accessed Mar. 11, 2013). While significant focus is being placed on ACOs for the adult population the potential for pediatric populations, particularly children with special health care needs (CSHCN) remains unclear. The role of ACOs in population health and how they integrate with community-based systems of care, including public health agencies, on a range of issues, such as care coordination, is still unfolding. This webinar will highlight key considerations for maternal and child health populations, the role of public health in ACO implementation, and efforts to implement ACOs that have a focus on pediatric populations particularly CSHCN. To register, click here.