Skip to main content

Capitol to Capitol | Sept. 6, 2023

September 6, 2023

Questions? Please use the email icon at left to contact NCSL’s State-Federal Affairs Division.

NCSL Updates

NCSL Urges Congress to Replenish FEMA Disaster Relief Fund

The Federal Emergency Management Agency announced on Aug. 29 the implementation of “immediate needs funding” prioritization for disaster relief. The announcement comes after several weeks of warning from FEMA that its Disaster Relief Fund was reaching critically low levels. The Biden administration submitted a $12 billion supplemental funding request to Congress in early August and later increased the request to $16 billion to replenish the fund. NCSL, in coalition with state and local governments, first responders and emergency managers, sent a letter to congressional leadership urging Congress to replenish the disaster fund as quickly as possible. Read more.

Administration Updates

HHS Announces First 10 Drugs for Medicare Negotiation

In a move to lower the cost of prescription drugs for Medicare beneficiaries, the Inflation Reduction Act of 2022 authorized Medicare to negotiate the price of certain high-cost drugs under Medicare Part D (at-home medications) and Part B (medications received in a medical setting). The Department of Health and Human Services announced the first 10 drugs under Part D to be negotiated with manufacturers. The list includes well-known drugs such as Eliquis and Xarelto (blood thinners) and Jardiance (diabetes and heart disease) as well as seven other medications that prevent blood clots, treat cancer, arthritis and other diseases.

The HHS estimates that 9 million seniors used one or more of the drugs on the list in 2022 for a total out-of-pocket cost of $3.4 billion, and an average annual out-of-pocket cost of $6,497 per enrollee. The number of drugs eligible for negotiation will increase by up to 15 drugs in 2027 and 2028 and then up to 20 drugs annually thereafter.

More information about the first 10 drugs selected for negotiation can be found here. More information on the IRA’s requirements for eligible drugs can be found here. A state-by-state breakdown of the impact of the IRA and ACA on health care costs can be found here.

CMS Warns States to Review Medicaid Renewal Process as Millions of People Lose Coverage

In a letter to state Medicaid directors, the Centers for Medicare & Medicaid Services warned states to review their eligibility systems for errors that may be causing people to be erroneously disenrolled from Medicaid or the Children’s Health Insurance Program and to correct those errors immediately or risk additional federal oversight and sanctions.

More than 5 million people, including over 1 million children, have lost Medicaid coverage since the continuous coverage mandate ended in March. Overwhelmingly, these are “procedural disenrollments,” which occur when an enrollee remains eligible but is disenrolled for technical reasons such as incomplete paperwork, which can happen when a state does not have updated contact information for an enrollee or because the enrollee does not understand the paperwork and deadline for completion.

According to the CMS, procedural disenrollments are also occurring in states during the “automatic renewal” process. States are required to conduct automatic renewals, also known as “ex parte” renewals, to determine continued eligibility before sending forms and requesting additional information from enrollees. Ex parte renewals rely on other data available to states—state wage records, for example—to determine eligibility and are supposed to be done on an individual basis because different family members may be subject to different eligibility requirements, as is the case with children who may remain eligible for Medicaid or CHIP even if their parents no longer qualify. However, the CMS believes that some state eligibility systems are processing ex parte renewals on a household basis and subsequently disenrolling all household members if forms are not returned, even though some members should have remained eligible.

The CMS has directed states to immediately take the following steps:

1. Pause procedural disenrollments for those individuals impacted.

2. Reinstate coverage for all affected individuals.

3. Implement one or more CMS-approved mitigation strategies to prevent continued inappropriate disenrollments.

4. Fix state systems and processes to ensure renewals are conducted appropriately and in accordance with federal Medicaid requirements.

More information about the CMS announcement can be found here. A breakdown of disenrollments by state can be found here.

CMS Issues Proposed Staffing Standards for Long-Term Care Facilities

The Centers for Medicare & Medicaid Services issued a proposed rule that would establish minimum federal staffing levels for nurses in long-term care facilities. The rule would require every facility to have a registered nurse on-site 24/7 in addition to a minimum number of RNs and nurse aides on duty per day. The rule is intended as a minimal standard, and nursing homes would be required to conduct a “robust assessment” of the individual needs of their residents to determine if higher staffing levels are needed.

The rule would be phased in over three to five years, depending on the location of the facility. All facilities would have to complete the individual needs assessment within 60 days following publication of the final rule. However, urban and suburban facilities would have three years following publication to implement the 24/7 RN requirements and the RN and nurse assistant staffing requirements; rural facilities would have up to five years.

CMS would also permit a hardship exemption if a facility can document the unavailability of a local nursing workforce and good faith efforts to hire and retain staff as evidenced by job postings and vacancies, offers made, wage offerings and the total amount spent on direct care staff.

Additionally, CMS has announced a campaign to expand and retain the nursing home workforce by investing over $75 million in scholarships and tuition via the Civil Money Penalty Reinvestment Program.

The rule is open for public comment until Nov. 6. Click here for more information.

Biden Administration Updates Unmanned Aircraft System Language

The Biden administration released legislative language to update last year’s Domestic Counter-Unmanned Aircraft Systems National Action Plan, which addresses the threat of unmanned aircraft systems (UAS) to the U.S. The update seeks to bolster U.S. security while protecting individual privacy and safeguarding the airspace and communications spectrums. The plan proposes eight key action items, including expanding UAS detection authorities for state, local, territorial and tribal law enforcement agencies and critical infrastructure owners and operators. The plan also urges Congress to enact a “comprehensive criminal statute that sets clear standards for legal and illegal uses, closes loopholes in existing federal law, and establishes adequate penalties to deter the most serious UAS-related crimes.” The administration wants to expand its ability to protect against nefarious UAS activity, who is authorized to take action and how it can be accomplished lawfully. The administration’s proposal closely mirrors the bipartisan measure (S 1631) co-sponsored by Sens. Kyrsten Sinema (I-Ariz.), Gary Peters (D-Mich.), Joe Hoeven (R-N.D.) and Ron Johnson (R-Wisc.). The bill seeks to “enhance the authority granted to the Department of Homeland Security and Department of Justice with respect to unmanned aircraft systems and unmanned aircraft.” Read more.

  • Contact NCSL

  • For more information on this topic, use this form to reach NCSL staff.