December 2018
The Federation is involved at the national level in monitoring legislation, funding opportunities, advocacy opportunities and resources that could aid your work as the voice for families.
We will continue to provide these overviews and we need your help. Alerting us to what is happening on the state level will aid not only those in your state but others nationally as ideas spread. As you become aware of state or national legislative alerts, funding and advocacy opportunities or resources that could be used to build funding requests, please let us know by emailing mcovington@ffcmh.org .
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Starting in January the Legislation and Advocacy Update will only be posted on
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CMS Demonstration Funding Opportunity
November 13th, the Department of Health and Human Services Centers for Medicare and Medicaid Services announced in a letter to State Medicaid Directors a new opportunity for states. The new opportunity for state funding, outlines that states that participate in the demonstration opportunity will be expected to commit to taking a number of actions to improve community-based mental health care. The importance of the inclusion of person-centered care to assist in the delivery of services and supports to address cultural needs and values and to help those at high risk access services across a continuum of care is emphasized. The benefit of the inclusion of peer support is specifically mentioned on page 9 of the announcement and specifically mentioned Peer Support services to the parents/legal guardians of Medicaid eligible children.

Attached you will find the letter that went out to your State Medicaid Directors. Information that you might find helpful in discussing the partnership between your Family-Run Organization and your state should the decide to pursue this funding opportunity through CMS are highlighted. Given the announcement’s specific mention of peer support, this could be a great time to engage with your State Medicaid Director around the Parent Peer Support Services you provide.
Federal Health Insurance Exchange
Federal Health Insurance Exchange 2019 Open Enrollment Has Begun  The Federal Health Insurance Exchange (also known as the Marketplace) Open Enrollment Period runs from November 1, 2018 to December 15, 2018, for coverage starting on January 1, 2019. Similar to last year, the Centers for Medicare & Medicaid Services (CMS) is taking a strategic and costeffective approach to inform individuals about Open Enrollment, deliver a smooth enrollment experience, and use consumer feedback to drive ongoing improvements across the Exchange platform.
CMS 1332 Flexibility Waiver Future
On November 29, 2018, the Centers for Medicare and Medicaid Services (CMS) released four new waiver concepts designed to help states understand some options for pursuing a Section 1332 waiver under the Affordable Care Act (ACA).  CMS said the guidance reflected its commitment “to empowering states to innovate in ways that will strengthen their health insurance markets, expand choices of coverage, target public resources to those most in need, and meet the unique circumstances of each state.” In releasing the waiver concepts, CMS makes clear that states are not limited to these options and could propose these concepts alone, in combination, or not at all. Rather than dictating state options, the goal of releasing the waiver concepts is to spur state innovation and illustrate some of the ways that states might take advantage of the flexibility offered in the new guidance on Section 1332.
National Academy for State Health Policy will be hosting a webinar
Stabilizing markets with 1332: Lessons and a new tool for states considering reinsurance  Webinar: How States Use 1332 Waivers to Develop Reinsurance Programs to Stabilize Markets  
Tuesday, Dec. 11, 2018
4 to 5 p.m. (EST)
Integrated Care for Kids (InCK) Model 
The Center for Medicare and Medicaid Innovation (Innovation Center) is announcing a new model as part of a multi-pronged strategy to combat the nation’s opioid crisis. The Integrated Care for Kids (InCK) Model is a child-centered local service delivery and state payment model that aims to reduce expenditures and improve the quality of care for children under 21 years of age covered by Medicaid and the Children’s Health Insurance Program (CHIP) through prevention, early identification, and treatment of behavioral and physical health needs.

Who will be served?
InCK Model participants will serve all children covered by Medicaid and CHIP, if applicable, from the prenatal period up to 21 years of age residing within an awardee-specified (and CMS-approved), sub-state geographic service area.

What are the model’s goals?
The InCK Model will award states and local communities cooperative agreements to build on existing delivery system innovations with the goals of:
How will the model achieve these goals?
The CMS Innovation Center anticipates releasing a detailed Notice of Funding Opportunity in Fall 2018 with additional details on how state Medicaid agencies and local health and community-based organizations can apply to participate in the model. CMS intends to award funding for up to 8 cooperative agreements at a maximum of $16 million each as early as Spring of 2019 to implement the seven-year model.

InCK presents an opportunity to implement, expand and sustain initiatives that advance best practices in behavioral health for children, youth, and young adults: screening, behavioral health consultation programs, mobile response and stabilization, in-home services, peer support, respite, team-based care coordination, including physical and behavioral health integration and intensive care coordination with fidelity Wraparound, respite, SUD and culturally relevant services, and effective family and youth engagement strategies 

The Integrated Care for Kids (InCK) Model will be hosting a Q&A session for the public on
Thursday, December 13, 2018 from 3-4pm EST
to respond to inquiries about the Model and the upcoming Notice of Funding .
Maternal Opioid Misuse (MOM) Model
CMS announced a new State-based transformation model to better coordinate care for pregnant and postpartum Medicaid beneficiaries and children with opioid use disorder. The CMS Center for Medicare and Medicaid Innovation (Innovation Center) will execute up to 12 cooperative agreements with states, whose Medicaid agencies will implement the model with one or more “care-delivery partners” in their communities.

The Maternal Opioid Misuse (MOM) model is the next step in the Center for Medicare and Medicaid Innovation’s (Innovation Center) multi-pronged strategy to combat the nation’s opioid crisis. The model addresses fragmentation in the care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder (OUD) through state-driven transformation of the delivery system surrounding this vulnerable population. By supporting the coordination of clinical care and the integration of other services critical for health, wellbeing, and recovery, the MOM model has the potential to improve quality of care and reduce costs for mothers and infants.

CMS anticipates releasing a Notice of Funding Opportunity in early 2019 to solicit cooperative agreement applications to implement the MOM model. A maximum of $64.6 million will be available across the maximum of 12 state awardees, over the course of the five-year model.
Medicaid 1115 Waivers
A waiver is a state request that the Secretary of Health and Human Services waive certain federal health care program requirements, usually in Medicaid (Section 1115 waivers) or the marketplaces (Section 1332).
On October 19, 2018, the federal Centers for Medicare & Medicaid Services (CMS) approved North Carolina’s 1115 Medicaid waiver demonstration to implement integrated managed care ending the state’s behavioral health carve-out, phase in tailored vertical health plans for certain populations, expand addiction treatment benefits, and address the social determinants of health.
T he Centers for Medicare and Medicaid Services (CMS) re-approved Kentucky’s request to add work requirements to the state’s Medicaid program last week. These changes would require the population covered by Kentucky’s Medicaid expansion to report 80 hours of work or “work-related activities” each month, or face losing their coverage for a six-month lockout period. The approved 1115 waiver, which takes effect April 1, 2019, is almost identical to the state’s previously overturned application, and has been projected to result in at least 95,000 Kentuckians losing Medicaid coverage over the next five years.
The Centers for Medicare and Medicaid Services (CMS) has approved Wisconsin’s Medicaid waiver proposal, which will significantly restrict Medicaid coverage for low-income adults in a number of significant ways. For starters, Wisconsin is the first state allowed to take coverage away from people with incomes below the poverty line if they don’t pay $8 monthly premiums. Those with incomes as low as 50 percent of the poverty line — or about $500 per month for an adult without dependents — who don’t pay premiums will lose Medicaid for up to six months. Wisconsin also became the fifth state allowed to take Medicaid coverage away from people who aren’t working or engaged in work-related activities, which could cause many people to lose coverage. In addition, low-income adults will be required to complete a health risk assessment (HRA) in order to get or maintain their coverage. Learn More
Families USA's Waiver Strategy Center tracks the changes states make to health care programs using 1115 and 1332 waivers. These changes can be good or bad for consumers. Click on the map to explore waivers on a state-by-state basis, download the At-a-Glance Grid: Medicaid 1115 Coverage Restrictions: Status in the States .
SAMHSA Announces Strategic Plan
for FY2019 - FY2023
The Substance Abuse and Mental Health Services Administration (SAMHSA) had published its strategic plan for fiscal years (FY) 2019 to 2023. The plan establishes five priority areas to meet the behavioral health care needs of individuals, communities, and service providers. The five priority areas are: combating the opioid crisis, addressing serious mental Illness and serious emotional disturbance, advancing prevention, treatment and recovery services for substance use, improving data collection, analysis and evaluation, and strengthening health practitioner education.

In order to achieve its mission, SAMHSA has identified five priority areas to better meet the behavioral health care needs of individuals, communities, and service providers. The five priority areas are:
  1. Combating the Opioid Crisis through the Expansion of Prevention, Treatment, and Recovery Support Services.
  2. Addressing Serious Mental Illness and Serious Emotional Disturbances.
  3. Advancing Prevention, Treatment, and Recovery Support Services for Substance Use.
  4. Improving Data Collection, Analysis, Dissemination, and Program and Policy Evaluation.
  5. Strengthening Health Practitioner Training and Education.

SAMHSA’s work is guided by five core principles that are being infused throughout the Agency’s activities. The five core principles are:
  1. Supporting the adoption of evidence-based practices.
  2. Increasing access to the full continuum of services for mental and substance use disorders.
  3. Engaging in outreach to clinicians, grantees, patients, and the American public.
  4. Collecting, analyzing, and disseminating data to inform policies, programs, and practices.
  5. Recognizing that the availability of mental health and substance use disorder services are integral to everyone’s health.
ISMICC Meeting - December 11th
The Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) has posted the attached notice of an all-day meeting scheduled for December 11. As was previously the case, the public may attend only by webcast or telephone; non-ISMICC members will not be able to attend in person. There will be an opportunity for public comment (limited to two minutes) by telephone at 1 p.m. Individuals interested in submitting a comment must notify Pamela Foote, on or before November 26, 2018 via email to Pamela.Foote@samhsa.hhs.gov . Written comments received in advance of the meeting will be included in the official record of the meeting.

Children's Health Insurance Program
CMS Proposes Changes to Streamline and Strengthen Medicaid and CHIP Managed Care Regulations - Proposed Rule Continues Commitment to Promote Flexibility, Strengthen Accountability, and Maintain and Enhance Program Integrity
in Medicaid and CHIP

On November 8th, the Centers for Medicare & Medicaid Services (CMS) proposed significant regulatory revisions to streamline the 2016 managed care regulatory framework. As part of CMS’ broader efforts to reduce administrative burden, CMS formed a working group with the National Association of Medicaid Directors (NAMD) and state Medicaid Directors to create a framework to review and prioritize areas of concern within the managed care regulations. Together the working group reviewed and analyzed the regulation to identify opportunities to achieve a better balance between appropriate federal oversight and state flexibility, while also maintaining critical beneficiary protections, ensuring fiscal integrity, and promoting accountability for providing quality of care for Medicaid beneficiaries.

Legislative and Advocacy Presentation Updated From NFFCMH Conference
Bill Tracker
Nonpartisan children’s policy experts rate the current bills in Congress. Do they help kids or harm kids? See also key votes in the 115th Congress that would impact the well-being of our nation’s children.
Free Grants Management Training
This free training from the White House Office of Management and Budget's Chief Financial Officers Council includes five modules that provide general information on grants and cooperative agreements. Grant recipients and their staff, pass-through entities, and potential grant recipients can use this training to develop an understanding of grants management.