Legislative Update 6/7/2021: Family Advocacy Day, Congressional Hearings, Nebraska Medicaid

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This is the legislative update for June 7, 2021. View all updates here.



The June 7, 2021 legislative update includes highlights on patient advocacy and from federal, state, and local legislatures.

Family Advocacy

Next week, Children’s Hospital & Medical Center will have the honor of hosting virtual Hill visits with the Nebraska delegation and the Cooper family. This is usually done in DC, but will be held virtually this year as we continue to take extra precautions due to COVID-19.

Dathin and Bryelle Cooper are Children’s patients who were both born with medical complexities. Through the Speak Now for Kids Family Advocacy Week with the Children’s Hospital Association (CHA), the Cooper family will be discussing their health journey at Children’s, and why it is so critical for public and elected officials to invest in the future of patients like Dathin and Bryelle.

Learn more about the Cooper family and their journey.

Congress

This Week’s Hearings

There are dozens of hearings this week on Capitol Hill as House and Senate leaders begin to dissect and navigate President Joe Biden’s Fiscal Year (FY) 2022 budget proposal (which was released just before Memorial Day weekend).

Specifically, Children’s will be monitoring the following budget hearings:

  • Senate Committee on the Budget Hearing: The President’s FY 2022 Budget Proposal
  • House Committee on the Budget Hearing: The President’s FY 2022 Budget Proposal
  • Senate Appropriations Hearing: The President’s FY 2022 Budget Request for the United States Department of Health and Human Services
  • Senate Finance Committee Hearing: The President’s FY 2022 HHS Budget

There will also be a number of hearings featuring issues such as:

Update to Last Week’s Legislative Update (Week of June 1)

Last week’s update featured line-item appropriations available in President Biden’s budget proposal.
After extensive review, we found the budget does not call for any “new” policy initiatives related to Medicaid or the Children’s Health Insurance Program (CHIP). However, it does support the permanent implementation of several Medicaid and CHIP provisions that are in the American Rescue Plan (ARP), including:

  • Mandatory coverage of COVID-19 vaccines, administration and treatment under Medicaid and CHIP.
    • The ARP requires states to provide COVID-19 vaccines, administration, and treatment under Medicaid and CHIP with no cost to the beneficiary. This coverage is fully funded by the federal government.
  • Federal Medical Assistance Percentages (FMAP) increases.
    • The ARP temporarily increases the federal Medicaid share of home and community-based (HCBS) expenditures by an estimated $12.8 billion through a 10% FMAP increase for all states.
    • The act also includes a temporary 5% FMAP increase for any states that expand Medicaid and have not already done so.
    • Children’s has participated in a hearing with Nebraska Medicaid to understand what this one-time increase in funding could be used for. The comment period (Translation: The time where members of the public can submit input before the proposal is put into place) is open through the end of this month.
  • Coverage for pregnant women.
    • Currently, three states have approved section 1115 waiver demonstrations with extended coverage periods for pregnant women. The ARP provides a five-year time-limited state option for Medicaid coverage for pregnant women through 12-months postpartum. Under this state plan option, states would have to provide full Medicaid benefits during pregnancy and throughout the 12-month postpartum period.
  • Sunset of the limit on the maximum rebate amount for certain drugs.
    • The ARP removes the 100% average manufacturer price (AMP) cap on Medicaid manufacturer rebates beginning January 1, 2024.
    • The AMP is the average price paid to the manufacturer for the drug by wholesalers for drugs distributed to retail community pharmacies and by retail community pharmacies that purchase drugs directly from the manufacturer.
    • Eliminating the AMP cap on total drug rebates that manufacturers pay state Medicaid programs results in savings to the federal government and states.
  • State option for community-based mobile crisis intervention services.
    • The ARP provides states a temporary option to provide certain Medicaid services covered under the state plan or waiver as qualified community-based mobile crisis intervention services and provides an enhanced FMAP of 85% for those intervention services for the first three years of state coverage, as well as $15 million in planning grants.
    • These services are for Medicaid recipients in the community who are experiencing a mental health or substance use disorder crisis.

New Legislation

Last week, U.S. Senator Tina Smith (D, MN), reintroduced the Mental Health Services for Students Act (S. 1841). This legislation provides grants for schools to implement developmentally and culturally appropriate mental health programs that prepare school communities to recognize signs of behavioral health issues, trauma, and risk of suicide in students.

To facilitate students’ access to behavioral health services, grantees partner with community-based organizations, including mental health service providers.

The House version is H.R. 721 and is sponsored by Reps. Grace Napolitano (D-CA) and John Katko (D-NY).

State Updates

Nebraska Medicaid

As previously mentioned, Nebraska Medicaid Director Kevin Bagely and team held a hearing last week regarding the home and community-based services (HCBS) 10% FMAP increase available at the federal level.

The greatest takeaway was the emphasis the Department placed on sustainability. The 10% increase is limited to one year, retroactive to April 2021, but the funding can be used for up to 3 years.

The Department has asked for suggestions on how to build upon these community-based services with a one-time funding source, freeing them from soliciting funding requests in future years to maintain any measures.
Recommendations by the Department include:

  • 1. Build upon the workforce.
    • Retention bonuses: Honor the current workforce with a one-time retention bonus.
    • Hiring bonuses. Recruit and maintain new professionals to Nebraska — especially with universal license reciprocity under the Uniform Credentialing Act in Nebraska (excluding physicians). It is easy to onboard new professionals to the state.
  • 2. Training/ scholarships.
  • 3. Work on qualification/eligibility services for Developmental Disabilities (DD) waivers, simplifying the program.

The comment period remains open this month. We are working closely with Finance to track opportunities available in Nebraska with this funding.

(Sources: CHA, White House, Congress.gov, NHA, DHHS)

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