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Appropriations Update: Congress Returns; CR Likely Through December
This week, Congress returns to Washington, DC, for a brief September session. Both chambers are attempting to complete work and adjourn by the end of next week, and not return until after the November elections. A core piece of business Congress will need to address is fiscal year (FY) 2015 spending, with the current fiscal year ending September 30, 2014. No FY 2015 appropriations bills have been passed to date, and congressional leaders appear to be uninterested in repeating last year’s government shutdown. There is some discussion of an omnibus spending bill for FY 2015 by the end of September, but most expect that Congress will pass a continuing resolution (CR) to fund the government through the elections and into December 2014.
Even as Congress works to complete work on FY 2015, the FY 2016 budget process is already underway. NFPRHA has submitted its Title X funding request letter to the Office of Budget and Management (OMB), the agency responsible for preparing the president’s budget proposal. NFPRHA has requested $327 million for FY 2016, a level that would restore money lost as a result of sequestration and recent budget cuts.
For more information on appropriations, please contact Burke Hays at bhays@npfrha.org or (202) 293-3114 ext. 224.
State of the States: Several Positive Decisions on State Abortion Restrictions this Summer
Over the past few years, state legislatures across the country have introduced and passed a record number of restrictions on access to safe, legal abortion services. Between 2011 and 2013, 30 states enacted 205 laws restricting abortion services and providers, compared to 190 in the preceding decade. However, several of those laws have been challenged in the courts, and several favorable decisions came down this summer. In July, a three-judge panel of the Fifth Circuit Court of Appeals ruled against Mississippi’s law requiring abortion providers to have admitting privileges at a nearby hospital. The decision did not rule the law unconstitutional, but instead determined that the law could not be used to close the sole remaining clinic in the state. A week later, a federal district court threw out a similar admitting privileges law in Alabama. In late August, a federal district court put in a temporary restraining order against the admitting privileges requirement in Louisiana, holding that providers who have already begun trying to get admitting privileges in that state may continue to provide abortions despite the state law going into effect. Most recently, a federal district court in Texas struck down parts of the controversial abortion law, known as House Bill 2, that would have required facilities that provide abortions meet the requirements of ambulatory surgical centers and have admitting privileges at nearby hospitals.
Despite these positive developments, there is still a great deal of work to do to protect access to safe, legal abortion services. NFPRHA continues to monitor developments in the states and on the federal level. If you have any questions about these court decisions or state-level abortion restrictions, please contact Mindy McGrath at mmcgrath@nfprha.org or (202) 293-3114 ext. 206.
DC Appeals Court to Review Halbig v. Burwell Decision
Last week, the full US Court of Appeals for the District of Columbia Circuit announced it will rehear Halbig v. Burwell, one of several cases challenging the availability of premium subsidies in insurance marketplaces not established and operated by the state. In July 2014, a three-judge panel of the DC Circuit ruled in a 2-1 decision that the subsidies can only be made available to individuals obtaining coverage in state-based marketplaces, and not to those obtaining coverage through Healthcare.gov, which is currently serving 36 states. On the same day and in a unanimous ruling, the Fourth Circuit Court of Appeals came to the opposite conclusion in King v. Burwell, finding that the subsidies should be available in any type of marketplace, not just those that are state-based.
The DC Circuit’s en banc (before the entire bench) review of Halbig is set for December 2014. Along with the DC and Fourth Circuit cases, there are two additional cases challenging the use of premium subsidies in the federally facilitated marketplaces—one in Oklahoma and another in Indiana; however, neither of those cases has yet reached the appellate level. Many believe the US Supreme Court will ultimately have to decide whether subsidies can be used outside of state-based marketplaces, particularly if the lower courts are split on the issue. The plaintiffs in King have already asked the Supreme Court to hear their appeal without waiting for further action by other courts. However, the DC Circuit’s decision to review Halbig likely lessens the chance that the Supreme Court will take up the issue in its next term, which runs from October 2014 through June 2015.
If you have questions about these cases or other ACA-related cases, please contact Robin Summers at rsummers@nfprha.org or (202) 286-6877.
PA Alternative Medicaid Expansion Waiver Approved; Other States May Follow
In late August, the Centers for Medicare & Medicaid Services (CMS) announced it has approved Pennsylvania’s alternative Medicaid expansion waiver. This would make Pennsylvania the 28th state, including DC, to implement some form of Medicaid expansion.
Pennsylvania’s waiver will allow an estimated 500,000 to 600,000 low-income Pennsylvanians to buy managed care plans through the marketplace. Although CMS did not approve some of the onerous provisions included in the state’s original proposal—including an attempt to undermine access to family planning services—the agency did approve some requests that may prove to be a barrier to care, such as a monthly premium of up to 2% of household income for individuals with incomes over 100% of the federal poverty level (FPL) starting in year two. Additionally, the benefit cuts originally proposed by the state—which included limits on coverage from specialist appointments to lab tests—have yet to be finalized and are reportedly still on the table. The state’s Medicaid expansion is set to begin January 1, and individuals will be able to enroll for coverage beginning with the next open enrollment period in November.
Pennsylvania is the fifth state—along with Arkansas, Iowa, Michigan, and New Hampshire—to receive approval from CMS to use federal funds to expand insurance coverage to low-income populations through an alternative expansion model. Indiana has a similar proposal under consideration at CMS, and other states—including Utah, Wyoming, and Tennessee—are reportedly seriously considering their own alternative expansions.
While these alternative expansions serve an important goal of expanding health coverage to low-income individuals, NFPRHA remains concerned that some states are using this option to get CMS to waive important Medicaid requirements and protections, which could undermine Medicaid coverage and serve as a barrier to care. If you have questions about Medicaid, please contact Robin Summers at rsummers@nfprha.org or (202) 286-6877.
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Countdown to Open Enrollment Tip
Visibility is key to a successful outreach and enrollment program because the more people hear about opportunities to enroll, the more likely they are to do it. This week’s countdown tip will help bring attention to your organization's outreach efforts:
Draft a communications plan that includes issuing a press release about your project to reporters, and prep a point person to respond to media inquiries.
A sample press release and more information on creating an earned and/or paid media plan are available in the Enrollment in a Box toolkit. Pre-order yours now to have it shipped on September 12.
Get Covered: Family Planning Webinar Reminders
Join NFRPHA on Monday, September 15, at 2:00 p.m. ET for a call to learn more about Enrollment in a Box and how to get started. NFPRHA will be hosting a series of webinars throughout the fall, which will focus on best practices for events, in-reach, and earned media outreach. Stay tuned for those dates! Please contact Nancy Clack at nclack@nfprha.org or Claire Manning at cmanning@nfprha.org with any questions.
Register for Health Reform Webinar
Interested in learning how a team-based approach can improve quality and drive financial performance? California Family Health Council (CFHC) Learning Exchange and NFPRHA have partnered to provide a series of webinars on best practices for family planning service delivery and operations. The next webinar in the series, “A Team-Based Approach for Enhancing Performance and Sustainability,” will take place on Tuesday, September 16, from 2:00 p.m. – 3:00 p.m. ET and cover the tools, skills and knowledge health care organizations need to enhance sustainability and ensure proper positioning with payers and other stakeholders.
Registration is free for NFPRHA members. NFPRHA members must log on to the Life After 40 website and navigate to the CFHC Trainings page to access a registration code. If you are unsure about who from your staff is your organization's contact for NFPRHA membership, please contact Melissa Kleder at mkleder@nfprha.org or (202) 293-3114 ext. 209. The registration deadline is Tuesday, September 16, at 12:00 p.m. ET.
Register for NFPRHA’s September 11 Service Delivery Webinar
With about a year to go before the switch to ICD-10, it's time to start thinking about what your health center needs to do to prepare. NFPRHA will soon host a webinar that will provide an overview of the ICD-10 transition, offer key steps to successful implementation, and outline important dates of a planning timeline.
Register today for “Prepare for ICD-10 to Protect Revenue,” which will take place on Thursday, September 11, at 3:00 p.m. ET. Participants are encouraged to come prepared with questions and/or share their own challenges and successes relating to the transition. If you have any questions about registering, please contact Catherine Fish at cfish@nfprha.org or (202) 293-3114 ext. 218.
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Webinar on New LARC Guidance
The American Congress of Obstetricians and Gynecologists (ACOG) is hosting a free webinar, “LARC Best Practices: The Latest Recommendations from ACOG and the CDC,” on Thursday, September 18, at 12:00 p.m. ET, that will cover the latest guidance from ACOG and the US Centers for Disease Control and Prevention (CDC) on contraceptive use and the important role it plays as a preventative public health intervention as well as strategies to integrate the guidance into your practice.
ACOG's OTC Contraceptives Policy
In light of recent attention on some candidates for electoral office who are embracing over-the-counter (OTC) contraceptives, ACOG wants to make clear that those efforts do not align with its policy. In a statement, issued earlier this summer, ACOG expressed support of OTC access to birth control and stressed that OTC status is not a replacement for full coverage of women's health services under the Affordable Care Act.
Apply Now for Health Policy Scholarship
AcademyHealth is offering 10 scholarships to give local health advocates the opportunity to expand their policy experience in Washington, DC. Participants will spend a week in DC and participate in a boot camp program as well as attend the 2015 National Health Policy Conference. The program gives scholars an opportunity to gain a real world perspective of how policy is created and how to work with decision makers. The application is available online, and the deadline to apply is October 31, 2014.
Coordination of Benefits Guide
CMS released important information for states on coordination of benefits (COB) for Medicaid beneficiaries who have additional coverage through a third party. Read the frequently asked questions page and corresponding guide for more information.
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