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 Legislative & Policy Corner

National Day of Action Raises Visibility for Home Visiting Program Reauthorization
On Tuesday Mar. 3, AMCHP joined with dozens of stakeholder organizations in coordinated grassroots and social media action calling on Congress to include an extension of the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program as part of the upcoming Medicare "doc fix" bill expected to pass by Mar. 31. The previous doc fix bill included a full FY 2015 appropriation but set a Mar. 31, 2015 deadline for reauthorization. To date no bill has been introduced, however, AMCHP continues to work with key partners to build bipartisan support for this critical investment. Additional details should be available soon.

Budget Resolutions Expected Soon
Congressional leaders are expected to soon begin crafting Budget Resolutions, which set broad instructions on spending guidelines for FY 2016. While these resolutions often don't include program level detail, they will set the upper limit caps that each appropriations committee is subject to, so in this sense will provide our first early glimpse into how tough of a budget year should be expected. AMCHP policy staff continues to make the rounds sharing information with each key appropriations committee staffer on how the Title V MCH Services Block Grant provides a foundation in every state for programs to move the needle on MCH outcomes. 

Health Reform Implementation

Nonprofit Community Health Needs Assessment & Title V
The Affordable Care Act (ACA) requires nonprofit hospitals to complete a community health needs assessment (CHNA) every three years effective Mar. 23, 2012. The flexibility of the CHNA process and the requirement to engage a state health official provides an opportunity for collaboration and coordination of efforts with a state Title V needs assessment process. This type of collaboration may help reduce duplication of efforts and activities within a region. AMCHP has developed a fact sheet that outlines the CHNA process, potential opportunities for collaboration with the Title V program, and highlights a state example from Kansas. If your state Title V program has worked with local, nonprofit hospitals on the needs assessment process, please contact policy analyst, Atyya Chaudhry at or 202-775-1474, to share your experience and insight.

HHS Final Rule: Benefit & Payment Parameters for 2016
The Centers for Medicare and Medicaid Services (CMS) has recently issued a final notice for benefit and payment parameters. "This rule seeks to improve consumers' experience in the Health Insurance Marketplace and to ensure their coverage options are affordable and accessible. This rule builds on previously issued standards which seek to make high-quality health insurance available to all Americans. The final notice further strengthens transparency, accountability, and the availability of information for consumers about their health plans (CMS 2015)." According to the rule, the next open enrollment period will begin Nov. 1, 2015 and continue for three months ending Jan. 31, 2016. In addition, the rule defines habilitative services using the definition provided in the Uniform Glossary of Health Coverage and Medical Terms. A uniform definition is a step in the right direction in minimizing variability of coverage and benefits and improving the health and well-being of children and youth with special health care needs. The rule also "requires that pediatric benefits be provided until the end of the month in which the enrollee turns 19, which aligns with current industry practice." CMS has a helpful fact sheet highlighting key policies and the full rule is available on the Federal Register. In addition, CMS posted a letter to issuers, available here. Health policy expert, Timothy Jost, wrote a three piece series on the rule analyzing consumer and provider provisions, insurance provisions, and the letter to federal exchange issuers.

King v. Burwell
On Mar. 4, the Supreme Court of the United States (SCOTUS) heard oral arguments in the King v. Burwell case. This case hinges on the legality of the advance premium tax credits (the "subsidies"). As written, the ACA states that subsidies will be provided only in states that operate their own exchanges. The Obama Administration argues that the law always intended to make the subsidies available to all, regardless of whether an exchange was state or federally run. If the Supreme Court rules that subsidies are not available in the federal exchange, it could result in loss of coverage for millions of people and destabilization of the health insurance industry, rendering coverage unaffordable and inaccessible. The National Women's Law Center estimates that nearly 6.5 million women would be at risk of losing coverage, further looking at implications by state of residence and race in a recent fact sheet. A ruling is expected in June.

Health Care Coverage: Upcoming Special Enrollment Period and Form 1095-A
CMS announced a special enrollment period (SEP) from Mar. 15 to Apr. 30, 2015. This enrollment period is "for individuals and families who did not have health coverage in 2014 and are subject to the fee or "shared responsibility payment" when they file their 2014 taxes in states which use the Federally Facilitated Marketplaces (FFM). This special enrollment period will allow those individuals and families who were unaware or didn't understand the implications of this new requirement to enroll in 2015 health insurance coverage through the FFM. For those who were unaware or didn't understand the implications of the fee for not enrolling in coverage, CMS will provide consumers with an opportunity to purchase health insurance coverage from Mar. 15 to Apr. 30. If consumers do not purchase coverage for 2015 during this special enrollment period, they may have to pay a fee when they file their 2015 income taxes. More information on eligibility and guidelines is available here.

Individuals who enrolled in a health plan through the Health Insurance Marketplace in 2014, received an important tax document, Form 1095-A. Some 1095-A forms that went out to consumers contained monthly premium rates for 2015 instead of 2014. The U.S. Department of Health and Human Services (HHS) will contact consumers who received an incorrect premium rate and have asked consumers to hold off on filing their 2014 federal income taxes. More information is available from CMS here and from HHS here.