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  • November 20, 2020

Washington Update - November 20, 2020


MONDAY CALL — The next Public Policy Update Call will be held on Monday, Nov. 23, 12:30 p.m. ET. Please register in advance.

WASHINGTON UPDATE — There will be no Washington Update next week, Nov. 27, due to the Thanksgiving holiday.

CONGRESSIONAL SCHEDULE — Both the House and Senate will be out next week for the Thanksgiving holiday.


Reach out to Congress on children’s hospital priorities in “lame-duck” session – We submitted a letter to congressional leaders calling for action before the end of the year on important priorities for children’s health:

  • Passing additional COVID-19 relief funding, including clear intent for support for children’s hospitals and pediatricians, and an increase to state Medicaid funding in the form of enhanced FMAP 
  • Enacting MACPAC’s recommendation related to Medicaid shortfall and third-party payments, and eliminating Medicaid DSH cuts 
  • Including enhanced funding for Children’s Hospital Graduate Medical Education (CHGME) in year-end legislation, including the one-time $250 million increase included in the Senate HEALS Act
  • Enacting the Accelerating Kids’ Access to Care Act 

Children’s hospitals should share this letter with the House and Senate delegations and urge their elected officials to push their leadership on addressing these issues during the lame-duck session. We have prepared talking points with additional information to help with your advocacy. John Knapp


More than 1 million kids infected with COVID-19 – Since the start of the COVID-19 pandemic, more than 1 million infants, children and adolescents have been diagnosed with the illness, according to data released Monday by the American Academy of Pediatrics (AAP) and CHA. On a weekly basis, AAP and CHA track data reported by state health departments and release a summary report. Contact us with any questions. Gillian Ray

HHS updates FAQs on provider relief reporting requirements – Earlier this week, HHS updated their FAQs to clarify that expenses for capital equipment and inventory and capital facilities may be fully expensed if the purchase was directly related to COVID-19. HHS also provides examples of capital equipment and inventory and capital facilities. HHS updated an FAQ on lost revenues as well, stating that “when reporting net patient revenue, HHS instructs recipients to exclude payments received or payments made to third parties relating to care not provided in 2019 or 2020.” With this change, it appears that some Medicaid payments could be excluded from the revenue calculation for care provided in prior years. We expect these changes should help children’s hospitals keep more of their relief funding to cover financial damages. We continue to advocate for a full return to the June guidance. Aimee Ossman

Frequently updated COVID-19 resources for GRs: 

Resource for Interactive Child Health (RICH) Data – A new interactive dashboard is available for government relations staff that is specially designed to help educate policymakers about the status of children’s health in their states. The resource includes reliable data drawn from credible sources and is updated regularly. The resource can also be tailored to highlight state-specific stats and printed. We hope this will be a helpful resource for state and federal work. Alex Rothenburger 

Modern Medicaid Alliance advocates for Congress to support Medicaid with enhanced financing – This week, we signed onto a Modern Medicaid Alliance letter supporting additional federal Medicaid support for states. Specifically, the letter calls on Congress to enhance federal financing for Medicaid by increasing states’ Federal Medical Assistance Percentage (FMAP) to a total of at least 12 percentage points, consistent with the request made by the bipartisan National Governors Association. The letter also urges Congress to include dedicated funds for Medicaid home and community-based services. The Modern Medicaid Alliance includes national and regional organizations that represent patients, consumers, health care workers, children, older adults, people with disabilities, pregnant and postpartum women, and health insurance providers. We have been a member of this alliance for the last several years. Aimee Ossman

ACE Kids recommendations submitted to CMS – Since the enactment of the ACE Kids Act, we have been working on implementation of the law with a focus on policy and practice. This year, we have focused on informing the guidance that CMS will provide to states that consider opting in. Earlier this year, we convened a group of experts to recommend a consistent approach to identifying children with medical complexity eligible for ACE Kids to ensure national data on this population of children. This recommendation was shared with CMS in June. 

We then convened a similar group to develop a recommendation on a national quality measure set for ACE Kids. In early November, we shared this recommendation with CMS. The expert groups included clinicians, researchers, health plan representatives, former state officials and those with family experiences. All had extensive experience and knowledge of this unique group of children. Both of these recommendations and other resources on the law are on the ACE Kids page on our website. We will be working to build support for this recommendation with the ACE Kids Hill champions and stakeholders over the coming months. In addition, we will be conducting a readiness assessment targeting children’s hospitals we believe are interested in implementation. Aimee Ossman

MACPAC sends letter to HHS on need for additional research and guidance to states on telehealth utilization in Medicaid for pediatric behavioral health care – On Nov. 13, the Medicaid and CHIP Payment and Access Commission (MACPAC) sent a letter to HHS Secretary Azar and congressional leaders in response to a report to Congress released earlier this year on reducing barriers to using telehealth and remote patient monitoring to provide substance use disorder services to pediatric populations. In its response, MACPAC highlights that the rapid growth in telehealth use during the COVID-19 pandemic has led states to consider which emergency telehealth flexibilities to retain on a permanent basis. MACPAC outlines several areas for HHS to consider as the department explores approaches for using telehealth to provide behavioral health services to children under Medicaid.

  • Additional research and analysis – MACPAC agreed with report findings that additional research is needed on the effects of telehealth in Medicaid related to utilization, cost, outcomes, quality and patient and provider satisfaction. Existing evidence is primarily based on adult populations, and research focused on the unique needs of pediatric populations is needed. MACPAC urges CMS to continue to publish analyses using T-MSIS data, similar to the October 2020 Preliminary Medicaid & CHIP Data Snapshot.
  • Sharing information on state telehealth approaches – MACPAC urges CMS to provide additional technical assistance and structured opportunities to share information with other states on policy design and overcoming barriers to telehealth. CMS could build upon its existing infrastructure by adding to its Medicaid telehealth toolkit to equip states with information on existing flexibility they have to provide telehealth services under Medicaid.
  • Address technology barriers – MACPAC acknowledges that solutions to address technology barriers and broadband issues extend beyond the Medicaid program. State Medicaid programs could help inform providers and beneficiaries about resources to address technology challenges, including programs offered through the Federal Communications Commission.

Rachel Bonesteel

GAO releases report on Medicaid program integrity, highlights need for CMS to focus on timely completion of financial management reviews – Earlier this week, the U.S. Government Accountability Office (GAO) released a report at the request of several members of Congress, including Senate Finance Committee Chair, Sen. Charles Grassley, R-Iowa, titled “Medicaid Program Integrity: Action Needed to Ensure CMS Completes Financial Management Reviews in a Timely Manner.” The report highlights findings from an analysis GAO conducted on CMS’ use of Medicaid financial management reviews (FMRs) as a tool for Medicaid program oversight. FRMs are conducted to provide an in-depth look at state expenditures in areas where CMS believes federal dollars are at risk due to an improper use of federal funds. For example, CMS identified compliance issues from FMRs completed during FYs 2016-2020 with a financial impact of approximately $358 million in federal funds needing to be recovered from states. GAO found that CMS has cancelled several planned FMRs and delayed completion of others and expressed concern that these delays have postponed state actions to address program vulnerabilities. GAO recommends the CMS Administrator should develop and implement timeframes to ensure that the agency completes FMRs in a timely manner. In a response to the report, HHS concurred with GAO’s recommendation and stated it has already begun pursuing a strategy to develop and implement timeframes to ensure CMS completes FMRs. HHS reiterated its commitment to leveraging opportunities for efficiency, alignment and coordination of Medicaid program oversight. Rachel Bonesteel

House members and hospital groups urge HHS to protect the 340B program – Last week, we joined 217 House members and several hospital groups in asking Secretary Azar to take action and prevent companies like Kalderos from changing the 340B program from a discount program to a rebate model. Children’s hospitals have raised concerns around this sort of model. Moving from a savings model to a back-end rebate model will require hospitals to front the cost of expensive drugs in hopes that they would receive a rebate at a later point in time. Amanda Major

CMS to host webcast on negotiated price disclosure rule – CMS is hosting a webcast on the negotiated price disclosure rule compliance on Tuesday, Dec. 8, at 2:00 p.m. ET. CMS also has a website of resources to help hospitals prepare for compliance. CHA is challenging the legality of the negotiated price disclosure rule before the DC Circuit Court and a hearing was previously held on Oct. 15. The DC Circuit Court is aware of the Jan. 1, 2021, effective date, but while the court will generally try to issue a decision before the effective date, there is no timeline for when their ruling will be released. Steven Chen 


Gain key insights to help prepare for 2021 at the Dec. 1-3 Government Relations Professionals Meeting—Register now! – The all-virtual 2020 Government Relations Professionals Meeting will provide an invaluable opportunity for you to have robust discussions with your GR peers about key policy issues facing children’s hospitals and gain insights from state and federal officials and others. The agenda includes sessions on federal and state Medicaid/CHIP challenges during and post-COVID; an update from Hill staff; the intersection of research and advocacy; telehealth policy advocacy; working with your state mental health policymakers; strategies to respond to health care transparency requirements; and current workforce challenges. Meeting attendees will also hear from CHA leadership about our advocacy plans in the current and post-COVID environment. Register today! Will Dolive