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Congressional Schedule
The Senate is in session this week, working on several of the President's nominations for administration and judicial positions, the Bipartisan Budget Act, and the national defense authorization bill. The House has already begun the holiday recess and the Senate plans to adjourn at the end of the week.
Budget
Late on Tuesday, December 10, the chairs of the House and Senate Budget Committees - Representative Paul Ryan (R-WI) and Senator Patty Murray (D-WA) - announced that they had come to an agreement to set spending levels and partially repeal the sequester for the next two years (see also last week's In Brief). The Bipartisan Budget Act sets overall discretionary spending for FY2014 (the current fiscal year) at $1.012 trillion. This is lower than the $1.058 trillion proposed by the Senate and higher than the $967 billion proposed by the House. If the bill is passed by both the House and Senate, the appropriations committees can begin work crafting bills for current-year spending before the continuing resolution expires on January 15. The bill would also set spending levels for FY2015, jumpstarting next years' appropriations process and decreasing the likelihood government shutdown in 2014. The bill provides for $63 billion in sequester relief over 2014 and 2015, split evenly between defense and non-defense spending and reduces the deficit by approximately $20 billion.
The bill pays for the partial sequester repeal with many small changes, including changes to the retirement system for new federal employees and a $5 increase in fees charged per airline ticket. It also would make changes to how Medicaid collects payments from third parties, such as health coverage available from a non-custodial parent or awarded in liability claims. Disability advocates have some concerns that these changes could place a higher burden on providers seeking reimbursement for treatment of Medicaid beneficiaries and allow state Medicaid offices to collect more settlement money from people who are or become Medicaid beneficiaries as a result of injury or medical malpractice. Overall, AUCD joins CCD and NDD United (a coalition of organizations supporting non-defense discretionary programs) in supporting the legislation for its partial sequester repeal but urges Congress to do even more to correct the sequester cuts.
The House passed the Bipartisan Budget Act 332-94 on Thursday of last week and the Senate is expected to take it up this week. For more information see this summary and section-by-section analysis prepared by the budget committees, and this analysis from the Center on Budget and Policy Priorities.
Affordable Care Act
Days Remaining in Open Enrollment: 105
Last week, the administration announced several small changes to the deadlines to enroll in the Health Insurance Marketplace before the end of the year. While open enrollment will remain open until March 31, these deadlines apply to those seeking to obtain coverage by January 1 - the earliest date that coverage can start - or who are participating in the Pre-Existing Condition Insurance Plan.
- The Pre-Existing Condition Insurance Plan (PCIP) has been extended to January 31, 2014. Originally, and as reported in last week's In Brief, the PCIP was scheduled to expire on December 31, meaning that enrollees needed to select a new plan by December 23 (extended from December 15) for uninterrupted coverage. The new change gives PCIP enrollees one more month of PCIP coverage, and enrollees now must sign up for a new plan by January 15 for their new coverage to start February 1, 2014.
- HHS will encourage health insurers to allow consumers until December 31 to pay the first premium for coverage beginning January 1. Consumers must still enroll by December 23 (a date that has already been extended from December 15) but have a few more days to make the first premium payment.
- HHS will also strongly encourage insurers to treat consumers' out-of-network providers as in-network and cover prescriptions made before January to ensure continuity of care for people switching plans. Insurance companies are not required to comply with this change and most have not yet announced their plans.
Medicare Physician Payments/Medicaid Demonstration Amendment
On December 12, the Senate Finance Committee approved a bill to create a long-term solution to the formula that sets physician payment rates in Medicare. While the Bipartisan Budget Act (see "Budget" above) would create a short-term fix to the scheduled payment cuts (mandated by the sustainable growth rate formula or SGR), the House Ways and Means and Senate Finance Committees have been working on a long-term solution (see December 2 In Brief). The bill would repeal the SGR, freeze current fee-for-service payments for 10 years, create incentive payments under a new consolidated value-based program, and encourage doctors to join alternative payment models like accountable care organizations (ACOs).
The committee adopted an amendment proposed by Senators Rockefeller (D-WV) and Brown (D-OH) that will give states the option to expand an existing program (Transitional Medical Assistance) that extends Medicaid coverage for people who become ineligible due to income changes. The committee did not adopt an amendment introduced by Senators Grassley (R-IA) and Wyden (D-OR) (and supported by the National Council on Disability) that would have created Medicaid demonstration projects to increase opportunities for youth with disabilities to transition toward employment and independent living. The House Ways and Means Committee passed a similar SGR measure earlier on December 12.
Mental Health
Helping Families in Mental Health Crisis Act
Last week, Representative Tim Murphy (R-PA) introduced the "Helping Families in Mental Health Crisis Act of 2013." The bill contains many provisions, including the creation of an assistant secretary for mental health and substance-use disorders in the Department of Health and Human Services, changes to regulations regarding medical disclosure, and increased funding to NIH for mental health research. The bill also increases funding for involuntary outpatient commitment, through which a court can mandate adherence to a specific treatment plan, and would cut funding for the Protection and Advocacy for Individuals with Mental Illness program by about 85%. The National Disability Rights Network and Bazelon Center for Mental Health Law oppose the bill, while organizations like the National Alliance on Mental Illness and American Psychological Association have written letters of support.
Excellence in Mental Health Act
Last week the Senate Finance Committee approved an amendment to Medicare legislation that would create a demonstration project based on the bipartisan mental health legislation sponsored by Senators Debbie Stabenow (D-MI) and Roy Blunt (R-MO). In the December 12 markup, the Finance Committee accepted Senator Stabenow's amendment to implement part of her Excellence in Mental Health Act (S 264). The amendment would create a 10 state demonstration to create higher standards for community mental health providers and increase access to outpatient mental health care, including 24-hour crisis centers, funded through Medicaid and provided regardless of ability to pay.
Family Medical Leave
On December 12 Reps. Rosa DeLauro (D-CT) and Sen. Kirsten Gillibrand (D- NY) introduced the Family and Medical Insurance Leave (FAMILY) Act (S. 1810), a bill designed to ensure people have some income during family or medical leave, including families caring for family members with disabilities or special health care needs. Unlike the Family and Medical Leave Act of 1993, the new FAMILY Act allows all workers to be eligible for benefits, including part-time, younger, and lower-wage employees. The FAMILY Act expands the existing FMLA to :
- Provide workers with up to 12 weeks of partial income when they take time for their own serious health condition, including pregnancy and childbirth recovery; the serious health condition of a child, parent, spouse or domestic partner; the birth or adoption of a child; and/or for particular military caregiving and leave purposes.
- Enable workers to earn 66 percent of their monthly wages, up to a capped amount.
- Cover workers in all companies, no matter their size. Younger, part-time, lower-wage and contingent workers would be eligible for benefits.
- Be funded by small employee and employer payroll contributions of two-tenths of one percent each (two cents per $10 in wages), or about $1.50 per week for a typical worker.
- Be administered through a new Office of Paid Family and Medical Leave within the Social Security Administration. Payroll contributions would cover both insurance benefits and administrative costs.
The bill was referred to the Senate Finance Committee. There are no other co-sponsors and there is no companion bill in the House at this time.
National Defense Authorization and Autism
The House passed the National Defense Authorization Act on a 350-69 bipartisan vote. It now goes to the Senate, which is expected to vote on it this week. The House and Senate bills were merged in a bipartisan deal after the Senate's version stalled due to disagreement about the amendment process. Unfortunately, the bipartisan deal stripped all amendments, including one supported by AUCD (Murray-Gillibrand TRICARE amendment) that would have made it easier for military families with children with developmental disabilities, including autism, to get behavioral support treatments (see December 2 In Brief).Thanks to those of you who wrote letters and made calls in support of this amendment. Sens. Murray and Gillibrand have assured us that they will continue to work on this issue in the future.
New from the AUCD legislative staff: 7 Reasons Why You Are Absolutely Required to Educate Policymakers.
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For definitions of terms used in In Brief, please see AUCD's Glossary of Legislative Terms.
For copies of this and previous issues of Legislative News In Brief please visit the Public Policy Page of the AUCD website: http://www.aucd.org/template/page.cfm?id=164
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