by Dena K. Hubbard MD, FAAP
The next KAAP Public Policy committee meeting will be at noon on Monday December 7th. All KAAP members are welcome to join this committee – contact Mel Hudelson if you are interested. We are currently working on strategic planning for the 2021 legislative session and will be updating our KAAP Blueprint with our priorities, expected to include promotion of immunizations, continued coverage of telemedicine, access to medical and mental/behavioral health pediatric care, optimizing child health and welfare including foster care, and delivering high-quality, physician-led care. Of course, the current COVID-19 pandemic has highlighted disparities and inequities of health care access, coverage, education (broadband access, special education services, supports for children with IEP), and outcomes across Kansas. KAAP will continue to advocate for our patients, families, and pediatricians. We need your voices in 2021!
Kansas State Affairs
We will know more about what to expect regarding health policy priorities after leadership elections (December 7) and committee assignments (end of December). KAAP has lost some loyal child health and welfare advocates on House Health Committee, but we will look forward to engaging and educating new committee members and continuing to develop relationships with standing members in both House and Senate Health Committees. See below for recent updates from committee work this fall.
Telemedicine will be front and center of the policy discussion. Current Medicaid policy, private insurance changes, state executive orders, and emergency declarations govern the use of telemedicine through the various deadlines, but generally those deadlines are January 26, 2021. The State and Medicaid managed care companies are examining telemedicine data and several groups are partnering proactively, including KAAP, along with KAAFP, KHA, KMS, and others to create a telemedicine bill.
Mental and Behavioral Health
The Joint Committee on Mental Health Modernization and Reform Mental final meeting of the year is scheduled for December 11. Expected recommendations will emphasize mental health in schools, jails, and expanded Certified Community Behavioral Health Clinics (model currently in place in MO) that provide integrated care, dependent on federal funding. Several gaps related to pediatric mental health needs that have been discussed include 1) availability of medical records for children in foster care or criminal justice system that have moved; 2) addressing children in need of out of home placements when state custody is not appropriate option; 3) inadequate access to services by schools for children with federal IEP who are required to receive services at home; 4) suicide awareness and prevention for youth and teens, exacerbated by the pandemic.
The focus on children in the child welfare system raised the following health issues: greater Medicaid ability for treatment and reimbursement for kids and/or parents for behavioral health needs (regardless of if in foster care system), continued coverage of appropriate telemedicine services by Medicaid, consideration of additional organizational and structural changes in the child welfare system (Office of the Child Advocate and Health Information Specialist Unit.) Congratulations to Mel Hudelson, KAAP Executive Director is now on the Family First Advisory Board!
American Academy of Pediatrics Federal Affairs
At the federal level, the Academy unveiled the most recent Blueprint for Children in October, and last week the Transition Plan: Advancing Child Health in the Biden-Harris Administration, which outlines specific policy recommendations to support our nation’s children and their futures. It covers 26 child health issue areas, breaking them down into more than 140 recommendations for the incoming administration. AAP shared the plan with President-Elect Joe Biden, Vice President-Elect Kamala Harris, and their transition team. Read the full plan atAAP.org/Transition. This press release has more.
The 117th Congress will officially take office in the new year. Senate majority leadership will come down to two Senate races in Georgia that are headed to a runoff election on January 5. Rep. Kim Schrier, MD, FAAP – who became the first pediatrician elected to Congress in 2018 – was re-elected. She won a second term representing Washington state’s 8th district. Pediatricians also won races in state houses in: Oregon, Lisa Reynolds, MD, FAAP; Colorado, Yadira Caraveo, MD, FAAP; and Ohio, Beth Liston, MD. The Biden transition team unveiled the members of its COVID-19 task force, which included two pediatricians: David Kessler, MD, FAAP, former Food and Drug Administration commissioner who will serve as a co-chair of the task force, and Julie Morita, MD, FAAP, executive vice president of the Robert Wood Johnson Foundation.
Many of you may have used tools from the nonpartisan voter registration effort Vot-ER. Even though Election Day 2020 has passed, you can continue using these tools as year-round voter registration tools.
Last week, the Supreme Court heard oral arguments in a third challenge to the Affordable Care Act (ACA), known as California v. Texas. The main issue in question is whether the law can stand without the individual mandate, which required most citizens and legal residents to have health insurance. Notably, Justices John Roberts and Brett Kavanaugh made statements suggesting that if the individual mandate were struck down, they were inclined to leave the rest of the law in place. While oral arguments are not always indicative of how the court will ultimately rule, many legal scholars agree that the ACA is likely to survive mostly intact.
The AAP has continued to defend the ACA while the case has made its way through the judicial process, including filing an amicus brief with the American Medical Association and other medical societies. A decision is expected as late as June 2021.
CMS Issues Final Rule Impacting Access to Medicaid and CHIP
The Centers for Medicare and Medicaid Services issued its 2020 Medicaid and Children’s Health Insurance Program (CHIP) Managed Care final rule. The final rule relaxes network adequacy standards and makes changes to how enrollees receive information that could leave children, particularly those with serious, chronic, or complex medical needs, with reduced access to the care they need.
More than 45 million children in the United States are enrolled in Medicaid or CHIP and the vast majority of them access medical homes at least partially financed through managed care arrangements. In 2019, the AAP submitted comments expressing concerns with some of the proposed changes. AAP is analyzing the impact of the finalized changes and will be developing resources for state chapters in the coming weeks.