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Health Care
Changes to Medicaid Equal Access
The proposed rule - Methods for Assuring Access to Covered Medicaid Services-Exemptions for States With High Managed Care Penetration Rates and Rate Reduction Threshold - would change the process for states to document whether Medicaid payments in fee-for-service (FFS) systems are enough to create a system where people have access to providers and care that Medicaid covers. AUCD is concerned that implementation of the proposed rule may lead to a significant decline in access to quality care, particularly for beneficiaries who are covered by FFS Medicaid in states exempted from medical assistance access monitoring requirements. The proposed rule would also significantly weaken CMS's ability to monitor and enforce access to covered services in state Medicaid programs, by exempting many states and most rate cuts from rigorous reporting requirements. Moreover, the changes would be in effect before CMS has had a chance to evaluate whether the current process is effective for addressing access. See Tuesdays with Liz below for background on Managed Care.
- Action Item: We encourage advocates in high managed care penetration state (>85% in managed care: TN, HI, NE, NJ, KS, DE, AZ, IA, FL, LA, TX, KY, RI, MD, OR, NM, OH, DC) to comment on the impact of the rule in your state's FFS system, especially highlighting carved out populations and services in your states.
- Action Item: We also encourage advocates in a state with managed care penetration between 75 - 85 % (UT, NY, PA, IN, WV, CA, MN, VA, MO, SC) to comment that CMS should not lower the threshold even further; with focus on the implications in your state FFS program.
- Action Item: Lastly, we encourage all advocates to comment on the proposed definition of "nominal" for the purpose of FFS cuts (4% for one year, or 6% over two years) by providing examples about the past impact of rate cuts of under 4%, or what they expect such cuts to cause in terms of access problems.
- Action Item: Submit public comments for this proposed rule by 5pm on May 22.
Opioid
Congress continues work to pass bipartisan bills to Combat the Opioid Crisis. See archived webcast, 7 bills, additional markup materials, and list of amendments here.
- Action Item: Contact your congressional delegation and share how the Opioid Crisis is impacting your community and your work.
Electronic Visit Verification (EVV)
On May 16, Centers for Medicare and Medicaid Services released guidance on EVV. Section 12006(a) of the 21st Century Cures Act mandates that states implement EVV for all Medicaid personal care services (PCS) and home health services (HHS) that require an in-home visit by a provider. States must require EVV use for all Medicaid-funded PCS by January 1, 2019 and HHCS by January 1, 2023. Please visit Medicaid.gov for more information. Disability leader continue to be concerned about gaps in guidance that would protect privacy and civil rights of consumers. Congressional intent was that EVV was only to be used for PCS and HHS provided in a person's own home. Gaps and guidance leave states struggling with important privacy decisions; for example:
- Whether a service is subject to EVV just because the provider meets the individual at their home to provide a service elsewhere in the community;
- How EVV requirements apply when services are provided in multiple locations during a shift.
Public Health
The Senate Health, Education, Labor and Pensions (HELP) Committee introduced the "Pandemic and All-Hazards Preparedness and Advancing Innovation Act" (S. 2852). The bill, which authorizes $685 million for the public health emergency preparedness program and $385 million for the hospital preparedness program, is scheduled to be marked up in committee on May 23.
Education
Career and Technical Education Act
AUCD supports the letter that CCD sent to Chairman Alexander and Ranking Member Murray (of the Senate Health Education and Labor Committee) regarding reauthorization of the Carl D. Perkins Career and Technical Education (CTE) Act. The letter provides 12 recommendations to improve outcomes for individuals with disabilities and support their transition to career training and/or postsecondary education. HR 2353 - Strengthening CTE for the 21st Century Act - reauthorizes through FY2023 and increases funding levels for Department of Education grants to states, national programs, and tribal postsecondary CTE institutions under the Carl D. Perkins CTE Act of 2006 to support CTE programs for secondary and postsecondary students. See more information from CBO here and from the Committee here.
- Action Item: Share work you are doing around apprenticeships, and other technical education training programs with your Senators. Information would most effectively be directed to the Legislative Assistant (LA) who focuses on education or employment. Contact Rylin if you need help finding the current LA email address.
Significant Disproportionality Rule
At least 15 states (Alaska, Arizona, Connecticut, Indiana, Maryland, Michigan, Nevada, New York, North Dakota, Oklahoma, Oregon, Rhode Island, Tennessee, Washington and Wisconsin) plan to move forward with an Obama-era special education rule this summer. States were supposed to comply by July with the "significant disproportionality" rule - aimed at tackling racial disparities in special education; however, Education Secretary DeVos has proposed a two-year delay, citing "possible federal overreach". See previous In Brief for background.
- Action Item: Advocates are encouraged to share their comments and thoughts with your state Education Leadership. This can be the same information you submitted to the Department of Education during the public comment period.
Farm Bill Update
Background: Introduced by Rep. Conaway (R-TX), the Agriculture and Nutrition Act of 2018 (also known as the "Farm Bill") includes sweeping changes to nutrition benefit programs and reduces or cuts SNAP for millions of people across the U.S., including many people with disabilities and low-income families. Update: the House Rules Committee accepted amendments on the bill, H.R. 2, through May 11 and then held two hearings that took place on May 17 and 18. Outcome: The bill failed on the House floor by a vote of 198-213.
- Action Item: AUCD will continue to monitor this bill as sponsors are expected to regroup, but in the meantime, celebrate your great advocacy, review the vote of your Representative and follow-up to thank them or express your continued concerns.
Tax Hearing
On May 23, House Committee on Ways and Means Tax Policy Subcommittee (Chairman Vern Buchanan, R-FL) Subcommittee will hold a hearing on how tax reform is "helping small businesses grow their operations and invest in local communities and workers". The hearing will be the second in a series on the effects of tax reform. In view of the limited time to hear witnesses, oral testimony at this hearing will be from invited witnesses only. However, any individual or organization may submit a written statement by June 6 for consideration by the Committee and for inclusion in the printed record of the hearing.
- Action Item: Please click here to submit a statement or letter for the record.
Administration
On May 16, the Senate approved (50-to-48 vote along party lines) Mick Zais to be deputy secretary at the Department of Education. Zais is a retired Army brigadier general and former state superintendent of South Carolina schools. Prior to serving as South Carolina's superintendent, Zais was president of Newberry College for 10 years. He has also served as president of the American Philatelic Society, the world's largest nonprofit stamp-collecting organization. More information here.
The White House announced it plans to nominate Scott Stump of Colorado, to be Assistant Secretary for Career, Technical, and Adult Education at the Department of Education. Mr. Stump is the Chief Operating Officer for Vivayic, Inc., a learning solutions company based in Lincoln, Nebraska. Previously, he served as the Assistant Provost for CTE with the CO Community College System. In 2014, Mr. Stump served as President of the National Association of State Directors of CTE consortium, now called Advance CTE.
Tuesdays With Liz
This week we are revisiting Liz's interview with John Tschida about the background and purpose of managed care.
For more from AUCD, follow @AUCDNews and like AUCD on Facebook
For updates from our Executive Director Andy Imparato, follow @AndyAUCD.
For definitions of terms used in In Brief, please see AUCD's Glossary of Legislative Terms
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