On May 16, the Centers for Medicare and Medicaid Services (CMS) issued guidance on implementation of electronic visit verification (EVV) required in the 21st Century Cures Act. Congress directed CMS to issue this guidance at least one year before the implementation deadline of January 19, 2019. The statute requires EVV for personal care services and home health services. However, the guidance provides a very expansive interpretation that includes any service where assistance with activities of daily living or instrumental activities of daily living is provided in part in the home. Furthermore, it leaves many decisions with privacy implications up to states. The Arc believes the short time frame is insufficient for states to engage with stakeholders to implement these requirements in a way that does not put an undue burden on providers and does not violates the privacy of beneficiaries.
On March 15, Representatives Debbie Dingell (D-MI) and Brett Guthrie (R-KY) introduced the Ensuring Medicaid Provides Opportunities for Widespread Equity, Resources, and Care (EMPOWER Care) Act (H.R. 5306). This bipartisan bill reauthorizes the Money Follows the Person Demonstration Program, which provides grants to states to transition people from institutions to community based settings. According to a report from the U.S. Department of Health and Human Services, this program has helped over 63,000 people transition into the community and saved almost $1 billion for Medicare and Medicaid as of 2013. The Arc strongly supports this legislation.
On January 17, the Senate Finance Committee voted 15-12 to recommend that the full Senate confirm Alex Azar as Secretary of Health and Human Services (HHS). All Republicans and Senator Tom Carper (D-DE) voted in favor. All other Democrats voted against confirmation. HHS is the cabinet level department that administers most federal health and social service programs, including Medicare, Medicaid, Affordable Care Act programs, Developmental Disabilities Act programs, Head Start, and Temporary Assistance for Needy Families. Additionally, it oversees the Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health. Visit the Committee web site for more information or to view archived video of the hearing.
The Arc and other disability rights organizations joined the offices of Representative Jan Schakowsky (D-IL), Representative Jim Langevin (D-RI), and Senator Tammy Duckworth (D-IL) in hosting a briefing on January 11 for Congressional staff titled “Community Integration for People with Disabilities: Policy Opportunities and Challenges.” Julia Bascom, Executive Director of the Autistic Self Advocacy Network, moderated the briefing. Panelists were Cathy Ficker Terrill, national disability services expert and parent; Alison Barkoff, Director of Advocacy, Center for Public Representation; Nicole Jorwic, Director of Rights Policy, The Arc of the United States; Ken Capone, Public Policy Director, People on the go Maryland; and Pam Wright, a parent advocate.
On January 9, the Senate Finance Committee held a hearing on the nomination of Alexander Azar to be Secretary of Health and Human Services (HHS). During the hearing, Azar stated that he supported elements of last year’s health care bills, including the repeal of Medicaid expansion and per capita caps on traditional Medicaid. HHS is the cabinet level department that administers most federal health and social service programs, including Medicare, Medicaid, Affordable Care Act programs, Developmental Disabilities Act programs, Head Start, and Temporary Assistance for Needy Families. Additionally, it oversees the Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health. Visit the committee web site for more information, including archived video of the hearing.
On January 11, the Center for Medicare and Medicaid Services (CMS) issued guidance about how states can require some Medicaid recipients to work in order to receive coverage. While the guidance requires states to exclude some people with disabilities from the requirement, it acknowledges that such an exception will not cover all people with disabilities. To learn more, read The Arc’s statement on the guidance.
On December 14, Senators Maria Cantwell (D-WA) and Rob Portman (R-OH) introduced the Ensuring Medicaid Provides Opportunities for Widespread Equity, Resources, and Care (EMPOWER Care) Act (S. 2227). This bill reauthorizes the Money Follows the Person Demonstration Program, which provides grants to states to transition people from institutions to community based settings. According to a report from the U.S. Department of Health and Human Services, this program has helped over 63,000 people transition into the community and saved almost $1 billion for Medicare and Medicaid as of 2013.
Last week, Senate Majority Leader Mitch McConnell (R-KY) cancelled plans to hold a vote on the Graham-Cassidy bill. With Fiscal Year (FY) 2017 having ended on September 30, Congress can no longer use that fiscal year’s budget reconciliation process to pass the bill with a simple majority vote. It now requires 60 votes. This victory would not have been possible without the disability community. Had this bill become law, it would have:
- Capped growth in per capita Medicaid spending at below the cost of providing services;
- Replaced premium tax credits and Medicaid Expansion funds with a block grant that grows more slowly than current law and expires after 2026;
- Redistributed funds away from states that accepted Medicaid expansion; and
- Allowed states to let insurers sell plans that cover fewer services and charge more based on health status or disability.
The Senate Finance Committee hearing on the Graham-Cassidy-Heller-Johnson Proposal on September 25 was marked by high attendance of disability advocates. Protesters from ADAPT started a chant of “No cuts to Medicaid, save our liberty” and their arrests delayed the start of the hearing by 15 minutes. Senator Robert Casey (D-PA) mentioned The Arc’s advocacy and showed the stack of letters with stories from our advocates across the country.
While the cancellation of the vote on the “Graham-Cassidy” bill closed the door on Congress’s best opportunity to pass this legislation for now, there are still major challenges ahead. The 115th Congress can write two more budgets, one each for FY 2018 and FY 2019. With each budget, there is an opportunity for one reconciliation bill which requires only a simple majority to pass in the Senate. The reconciliation bill for FY 2018 will most likely focus on tax cuts. It is possible that Congress will attempt to cut Medicaid, Medicare, Supplemental Security Income, or other programs that pay for basic livings needs of people with disabilities as a way to offset revenue reductions. Additionally, Congress could attempt to pass an Affordable Care Act Repeal with Medicaid per capita caps and major tax legislation in one package. In summary, fewer pathways now exist to cut program that cover basic living expenses, but threats still remain. See article above for Congressional efforts to develop a new budget resolution similar to the most recent efforts which allowed for consideration of major Medicaid cuts and repeal of the Affordable Care Act in 2017.
The growing Senate interest in the Graham-Cassidy-Heller-Johnson bill last week has derailed bipartisan efforts by the Senate Finance Committee to reauthorize the Children’s Health Insurance Program (CHIP). The bipartisan leadership of the Senate Health, Education, Labor, and Pensions Committee has also ended efforts to stabilize the health insurance market places by extending the programs that help make health insurance affordable for people and making other small changes to the Affordable Care Act. These two efforts are critical to maintaining affordable health insurance for children and people in the individual health insurance market and The Arc urges Congress to address these critical issues.
Over the weekend, the Graham-Cassidy-Heller-Johnson proposal was revised. The new version appears to make adjustments to the funding provisions designed to benefit certain states. It also allows more state flexibility to waive requirements in the law such the essential health benefits, prohibiting discrimination based on disability, age, and other factors, covering preventive services without cost-sharing, charging people with pre-existing conditions higher premiums, and other provisions. It is unlikely that the bill will be scored by the Congressional Budget Office in time for a vote this week. The new version does not appear to alter the Medicaid per capita cap provisions which cuts and caps the traditional Medicaid program. The Arc continues to oppose this proposal and is deeply concerned about the impact it will have on people with disabilities who rely on the Medicaid program for access to health care and long term supports and services.