Weekly Health Care Policy Update - February 12, 2021

Administration Updates

Biden Administration Announces New Strategies for Combatting COVID-19
This week, the Biden Administration announced new steps to combat the COVID-19 pandemic:

The overall weekly vaccine supply to states, Tribes, and territories will be increased to 13.5 million doses nationwide. The most recent weekly distribution was 11 million doses.
The Administration doubled the vaccine supply to its pharmacy program, amounting to 2 million doses going to local pharmacies this week.
The Administration will allocate $650 million to expand testing for K-8 schools and underserved congregate settings such as homeless shelters. The Department of Health and Human Services (HHS) will establish regional coordinating centers to organize distribution of testing supplies and partner with labs to collect specimens, perform tests, and report results.
The Administration will allocate $815 million to increase domestic manufacturing of testing supplies and raw materials.
The Centers for Disease Control (CDC) will invest nearly $200 million to identify, track, and mitigate emerging strains of SARS-CoV-2 through genome sequencing. This will increase the CDC’s sequencing from about 7,000 samples per week to approximately 25,000.

Chiquita Brooks-LaSure Likely to Lead CMS
On February 17^th, the Washington Post reported that Chiquita Brooks-LaSure is President Biden’s pick to become the next Administrator of the Centers for Medicare and Medicaid Services (CMS). Brooks-LaSure led the HHS Agency Review Team during the Biden-Harris transition and currently serves as a managing director at Manatt Health. She was a key staffer on the House Ways and Means Committee during the drafting of the Affordable Care Act (ACA), and later worked in CMS to implement the ACA at both the Center for Consumer Information and Insurance Oversight and the Office of Health Reform.

HHS Announces Administration Staff Appointments
On February 16^th, HHS formally announced a set of staff appointments to lead the Department. Though some names have been announced previously, the list includes:

Sean McCluskie, Chief of Staff, Office of the Secretary
David Kessler, Chief Science Officer, COVID Response, Office of the Secretary
Dr. Rochelle Walensky, Director, Centers for Disease Control and Prevention
Josh Peck, Deputy Assistant Secretary for Public Engagement
Kimberly Espinosa, Deputy Assistant Secretary for Legislation
Ben Sommers, Deputy Assistant Secretary for Planning and Evaluation
Micky Tripathi, National Health Information Technology Coordinator

The full list of announced appointments is available here.

Legislative Updates

House Committees Wrap Up Reconciliation Items
This week, House Committees completed their markups of reconciliation provisions and sent legislative language to the House Budget Committee. The Budget Committee will hold a virtual markup of the combined American Rescue Plan Act of 2021 on Monday, February 22^nd. The House is then scheduled to begin consideration of the bill late in the week of February 22^nd, with floor time potentially extending into the weekend. After the House passes the bill, the Senate will then begin considering it. Since changes may be required to meet the Senate’s stricter reconciliation rules, House members have been informed they may need to consider the legislation again during the week of March 8^th.

CBO Publishes Cost Estimates for Parts of COVID-19 Relief Proposal
On February 14^th, the Congressional Budget Office (CBO) published an estimate (available here) of the cost of the House Energy and Commerce Committee’s portion of the proposed American Rescue Plan. This portion would appropriate $105 billion for various COVID-19 response activities, allow increased (12-month) postpartum Medicaid eligibility, provide an additional funding incentive for states to expand Medicaid, and eliminate the cap on Medicaid drug rebates. CBO estimates that:

These provisions would cost a net $125 billion over the 2021-2030 period.
The bill will result in an additional 6 million vaccines delivered to Medicaid and Children’s Health Insurance Program (CHIP) enrollees over the next two years.
By 2024, 25 percent of women expected to receive Medicaid postpartum coverage would live in states that implement the 12-month coverage option.
States may implement the Medicaid expansion, on average, one year earlier than planned due to additional funding.

Also, on February 15^th, CBO published an estimate (available here) of the Ways and Means Committee’s portion of the relief package. This portion would extend unemployment benefits, establish a pandemic emergency fund, increase subsidies for health insurance, provide cash payments to eligible people, expand several tax credits, and modify rules for pensions, among other provisions. CBO estimates:

These provisions would cost a net $927 billion over the 2021-2030 period.
The four key coverage provisions would cost nearly $53 billion and cover 800,000 uninsured Americans this year (mostly through COBRA), 1.3 million in 2022 (mostly through Exchanges), and 400,000 in 2023 (again, mostly through Exchanges) before the policies phase out and coverage returns to current law levels in 2024.

Regulatory Updates

Biden Administration to Rescind Work Requirements in Medicaid Waivers
Last week, the Biden Administration began the process of reversing community engagement provision (work requirements) included in Medicaid waivers approved by the Trump Administration. On February 12^th, CMS sent letters to states with work requirement waivers informing them of a “preliminary” determination that the policy has been revoked. The letters state that due to COVID-19, CMS has decided that this is “not the time to experiment or test policies that risk a substantial loss of health coverage or benefits, especially for individuals and communities significantly impacted by COVID-19 and other health inequities.”

As required, CMS will give states 30 days to submit information contesting the decision. During the Trump administration, 13 states had work requirements approved, but none are currently in effect due to rulings by federal courts. The Supreme Court is scheduled to hear a final appeal on such policies on March 29^th.

CMS Rescinds January 4^th Letters Offering Nine-Month Withdrawal Period for Medicaid Waivers
On February 12^th, CMS Acting Administrator Elizabeth Richter notified states that CMS was rescinding letters sent on January 4^th, that laid out new procedures for withdrawal or suspension of a demonstration waiver, were being rescinded. Specifically, the January 4^th letters issued to State Medicaid Directors detailed that the effective date of a withdrawal or suspension of a waiver agreement would be at least nine months after CMS potentially transmits its withdrawal determination to a state.

In the new letter, CMS notes that “special terms and conditions governing each demonstration project […] already generally specify procedures that CMS would use, in the event it suspends or terminates a demonstration project” and that CMS “needs to remain able to exercise its authority […] to maintain continued oversight of demonstrations in order to ensure that they remain likely to achieve the story purposes.”

2021 Special Enrollment Period for Marketplace Coverage Begins
On February 15^th, HHS opened the federal marketplace’s Special Enrollment Period (SEP) for individuals in 36 states that use the HealthCare.gov platform. The SEP will continue through Saturday, May 15^th. At least 13 states running their own marketplaces have offered similar opportunities, including New York (see below under “New York State Updates”). The SEP was established by Executive Order on January 28^th, and is paired with a new, consumer-facing education campaign including broadcast, radio and digital advertising with a special focus on reaching Black and Latino communities.

Other Updates

NCQA Seeks Public Comment on HEDIS Measures
On February 12^th, the National Committee for Quality Assurance (NCQA) announced its annual public comment period on proposed changes to the Healthcare Effectiveness Data and Information Set (HEDIS). Items available for public comment include new measures (including Advanced Care Planning and Antibiotic Utilization for Acute Respiratory Conditions), changes to existing measures (including Acute Hospital Utilization and Use of Imaging for Low Back Pain), and proposed measure retirement (including Comprehensive Diabetes Care – HbA1c Testing and Antibiotic Utilization). The comment period will remain open until March 11^th.

More information on submitting comments is available here.

FAIR Health Reports 2,938% Increase in Telehealth Claim Lines
This month, the FAIR Health Monthly Telehealth Regional Tracker showed a 2,938% increase in telehealth claim lines between November 2019 and November 2020 for the privately insured population. FAIR Health, a national not-for-profit, produces this tracker to examine regional changes in the usage of telehealth based on billions of claims records. This increase represents a change from 0.2% of medical claim lines in November 2019 to 6.0% in November 2020. Mental health conditions remained the number one telehealth diagnosis nationally but fell as a percentage of all telehealth claim lines, perhaps as a result of an increase in COVID-19-related visits.

The latest edition of the Tracker is available here.

Congressional Hearings

Tuesday, February 23^rd:

At 10am, the Senate Health, Education, Labor, and Pensions (HELP) Committee will hold a courtesy hearing (non-confirmation) to consider the nomination of Xavier Becerra to serve as Secretary of HHS. More information, including the webcast, will be available here.

Wednesday, February 24^th:

At 2:30pm, the Senate Finance Committee will hold a confirmation hearing to consider the nomination of Xavier Becerra to serve as Secretary of HHS. More information, including the webcast, will be available here.

Thursday, February 25^th:

At 10am, the Senate HELP Committee will hold a confirmation hearing to consider the nominations of Vivek Murthy to serve as Surgeon General and Rachel Levine to serve as Assistant Secretary of HHS. More information, including the webcast, will be available here.

New York State Updates

OMH and OASAS Announce COVID-19 Vaccination Program
Last week, the New York State Office of Mental Health (OMH) and Office of Addiction Services and Supports (OASAS) announced the O-Agency Link-Outreach-Vaccinate (O-LOV) program to offer COVID-19 vaccinations to the staff and clients of OMH- and OASAS-operated, funded, or certified programs. Through this program, eligible individuals will be able to receive vaccinations at eight OMH psychiatric centers across the state.

The program will accommodate both individual and group vaccine scheduling. For groups, outreach teams will work with provider sites to identify dates, times, and locations for mass vaccinations of clients and/or staff. The outreach teams will arrange and confirm scheduling directly with psychiatric center vaccine clinic schedulers and review data from the NYS Multi-Agency Vaccination Data Collection System to determine prioritization. Mobile teams will be deployed into the community to vaccinate individuals as indicated.

The following individuals are eligible for participation in this program:

Staff with patient-facing responsibilities in OMH and OASAS residential programs;
Staff with patient-facing responsibilities in OMH and OASAS ambulatory treatment or support treatments;
Clients in OMH and OASAS residential programs;
Clients age 65 or older in OMH and OASAS ambulatory behavioral health treatment or support programs; and
Clients with comorbidities or underlying conditions in OMH and OASAS ambulatory behavioral health treatment or support programs.

Additional information and links for individual and provider group scheduling are available here. Provider agencies may contact Julie Duncan at Julie.Duncan@omh.ny.gov to inquire further.

OMH Updates COVID-19 Consolidated Telemental Health Guidance
On February 12^th, OMH updated its COVID-19 consolidated telemental health guidance, which was last updated on March 20, 2020. The updated guidance includes the following new sections:

Section 4, detailing the previously-announced new streamlined process for agencies seeking to permanently add telemental health as an optional/additional service; and
Section 7, regarding balancing in-person and telemental health services for OMH programs (licensed, designated, or otherwise funded).

In Section 7, OMH recommends that providers develop clear policies and procedures outlining processes for decision-making that will best meet the needs of each recipient. Determinations should consider individual and community risk for transmission of COVID-19, providers’ ability to deliver services with appropriate infection control precautions, clinical considerations, and recipient preference, among other considerations. The updated guidance also includes specific considerations for children’s day treatment programs, school-based mental health clinics, Assertive Community Treatment (ACT) programs, mobile crisis services, residential providers, and forensic transition programs.

The revised guidance is available here.

Governor Cuomo Issues Executive Orders 202.93 and 202.94
On February 12^th, Governor Cuomo signed Executive Order 202.93 (available here), which modifies the State’s cluster-based COVID-19 strategy to remove capacity restrictions on houses of worship located within the geographic areas designated by the State Department of Health (DOH) as “red,” “orange,” or “yellow” zones.

On February 14^th, Governor Cuomo signed Executive Order 202.94 (available here), which extends all previous directives not otherwise modified or expired through March 16^th.

New York State of Health Plan Open Enrollment Period Extended Through May 15^th
On February 17^th, Governor Cuomo announced that the open enrollment deadline for uninsured New Yorkers to enroll in a health plan has been extended to May 15^th. This extension aligns with the Biden Administration’s action to create a SEP through May 15^th for states using the federal marketplace to provide consumers with additional time to enroll for 2021. Individuals interested in enrolling may apply for coverage through the state marketplace, the New York State of Health (here), or directly through insurers.

Updated Guidance Documents
Recently released New York State COVID-19 guidance documents are listed below.