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 Legislative & Policy Corner

Future of MIECHV and CHIP Could Be Set Within Next Week
As of press time, a potential bipartisan deal is emerging in Congress to permanently fix the Medicare doctor payment issue known as the Sustainable Growth Rate (SGR) and include at least a two-year extension of the Children's Health Insurance Program (CHIP) and a two-year extension of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. As of press time, details to confirm the deal are not available but could be released soon. It is expected a vote in the House could follow shortly, with timing on Senate action to follow. There remain a number of unknowns surrounding this fluid situation – including whether there are enough votes to pass the package in both chambers. AMCHP will be issuing Action Alerts as needed and appreciates your continued support to ensure these two MCH priority programs continue on a sustainable path.

Budget Resolutions Progressing in House and Senate
Last week, both the House and Senate released budget resolutions. These resolutions do not carry the force of law and are considered more as blueprints or statements of priorities and governing philosophies. According to analysis from our friends at the Coalition for Health Funding, the House budget fails to stop sequestration in 2016, maintaining spending on programs such as public health and health research at a level 17 percent below 2010. It also cuts these and other critical domestic programs by an additional 14 percent over the next decade and redirects this funding to the Department of Defense. The House proposes block granting the Medicaid program through "State Flexibility Funds." The proposal also would combine CHIP and Medicaid into a single block grant program. The Senate budget resolution, which does not carry the weight of law, would cut $3 trillion from federal health care spending over 10 years by, among other things, repealing the ACA and the corresponding Medicaid Expansion. It appears that Senate Republicans will leave the discretionary funding levels for defense and nondefense at the post sequester level for 2016 and keep defense at the post sequester level for the remainder of the budget window (FY 2017-2025). However, they propose cutting non defense discretionary programs (NDD) – that include public health – by an additional $236 billion through 2025.

It is unclear if the House and Senate will agree on a final consolidated budget resolution. AMCHP will continue to monitor the potential impact on MCH programs.

Health Reform Implementation

Affordable Care Act (ACA)
The ACA, signed into law on Mar. 23, 2010, is approaching its five-year anniversary. The U.S. Department of Health and Human Services (HHS) recently announced that approximately 16.4 million people have gained insurance since its passage. This is the largest reduction in the uninsured in nearly four decades, according to Sec. Burwell. The reductions are due in large to several provisions of the ACA, including the expansion of Medicaid, allowing young people to stay on their parents insurance until age 26, and affordable health care options through the Health Insurance Marketplace. Many of these individuals are gaining health care coverage for the first time, they may need support connecting to primary care, as well as preventive services and understanding their benefits. The Centers for Medicare & Medicaid Services (CMS) has developed a helpful initiative called Coverage to Care that includes a variety of resources your state can use to help consumers on this journey.

King V. Burwell
Just as we are approaching the ACA's five-year anniversary, the health care law faces another challenge. 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"). 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. Currently, 34 states rely on the federally facilitated exchange. A basic explanation of the case is available here. In addition, the Urban Institute conducted a recent analysis on the consequences of cutting tax credits to those individuals in the 34 states. 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. While the ruling is anticipated in June, several lawmakers have come up with alternative plans for the ACA.

HHS Final Rule: Benefit & Payment Parameters for 2016
In the last Member Briefs, we highlighted the final rule on benefit and payment parameters for 2016. Within the final rule, there are several changes to essential health benefits (EHBs) that may have implications for MCH populations. A quick summary of key points is highlighted below, a larger summary of the changes is available through the advocacy network, the National Health Law Program.

  • Definition of habilitative services: the final rule adopts a uniform definition of habilitative services, available here, for plans that are required to include EHBs. This definition is effective Jan. 1, 2017. While states can continue to define habilitative services in a non-discriminatory manner, the definition must be comparable to the uniform definition adopted in the final rule. Additionally, issuers can no longer provide a definition for habilitative services.
  • Pediatric services: the final rule requires issuers to provide pediatric coverage to enrollees until at least the end of the month in which the enrollee turns 19. The rule encourages "issuers to cover services under the pediatric services EHB category beyond the 19th birthday month if non-coverage of those services after that time would negatively affect care"(Federal Register, 2015).
  • Benchmark process: the final rule indicates that HHS will continue to use the benchmark approach to define EHBs and states can choose a new benchmark for plan year 2017.


Special Enrollment

  • As a reminder, 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 that use the Federally Facilitated Marketplaces (FFM). This special enrollment period will allow those individuals and families who were unaware or did not understand the implications of this new requirement to enroll in 2015 health insurance coverage through the FFM. For those who were unaware or did not 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.
  • Recently, several members of Congress wrote a letter to HHS Sec. Burwell, dated Mar. 12, 2015, expressing the need for a special enrollment period for pregnant women. The members of Congress noted that pregnancy should be considered a qualifying life event that triggers special enrollment, similar to the birth or adoption of a child. The letter in its entirety is available here.