Weekly Health Care Policy Update – April 9, 2021

April 16, 2021

In this update:

  • Biden Administration Announces Updates on Combatting COVID-19
  • Biden Releases Preliminary Discretionary Budget Request for FFY 2022
  • CMMI Announces Direct Contracting Participants, Will Not Accept Further Applications
  • CMS Proposes SNF, Hospice, IRF, and IPF Payment Rules
  • CMS Selects Value in Opioid Treatment Demonstration Participants
  • HHS Announces Increased Enrollment in Marketplace Coverage During SEP
  • HHS Issues Updated Provider Relief Fund FAQs
  • HHS and Other Agencies Release Behavioral Health Parity FAQs
  • DOL Announces Implementation of COBRA Premium Assistance
  • CBO Issues Report on Public Option Design Considerations
  • CDC Issues Guidance on Travel for Vaccinated Individuals
  • Congressional Hearings
  • Governor Cuomo Issues Executive Orders 202.100 and 202.101
  • Governor Cuomo Signs Legislation Repealing Liability Protections for Health Care Facilities and Providers
  • Updated Guidance Documents

Administration Updates

Biden Administration Announces Updates on Combatting COVID-19
This week, the Biden Administration made new announcements on the COVID-19 pandemic:

  • President Biden announced that as of April 5th, 150 million doses of COVID-19 vaccines have been delivered, and 76 percent of seniors and over 80 percent of teachers, school staff, and child care workers have received at least one shot. He also announced the acceleration of the timeline for all adults nationally to be eligible for a COVID-19 vaccine from May 1st to April 19th.
  • The Department of Health and Human Services (HHS) announced (available here) that the Federally Qualified Health Center (FQHC) COVID-19 Vaccine program is being expanded so that all 1,470 FQHCs nationwide are eligible to participate.
  • During the COVID Response Team’s weekly governor’s meeting, Vice President Harris announced further updates on distributing about $3 billion, largely from the American Rescue Plan (ARP), that “will enable states and cities to support community-based organizations in launching new programs to increase vaccine access, acceptance, and uptake.”
  • The State Department announced the appointment of Gayle Smith as the Coordinator for Global COVID Response and Health Security. Smith previously served as the administrator for the U.S. Agency for International Development (USAID) under the Obama Administration. In her new role, she will focus on coordinating international vaccine diplomacy efforts.

Biden Releases Preliminary Discretionary Budget Request for FFY 2022
Today (April 9th), the Office of Management and Budget (OMB) published President Biden’s preliminary discretionary budget request for federal fiscal year (FFY) 2022. The $1.5 trillion request, including $769 billion for non-defense programs, a 16 percent increase, kicks off the annual appropriations process. The full President’s Budget will be released later this spring. Items included in the President’s request include:

  • Launching the Advanced Research Projects Agency for Health (ARPA-H);
  • Increasing funding to combat the opioid epidemic to $10.7 billion;
  • Improving readiness for public health crises with an allocation of $8.7 billion for the Centers for Disease Control and Prevention (CDC); and
  • Promoting health equity by addressing racial disparities in health care, including:
    • Increasing the diversity of the health workforce;
    • Expanding access to culturally competent care; and
    • Providing $153 million for the CDC Social Determinants of Health (SDH) program to support states and territories in improving health equity and data collection. 

The budget request and an associated press release are available here.

Regulatory Updates

CMMI Announces Direct Contracting Participants, Will Not Accept Further Applications
On April 8th, the Center for Medicare and Medicaid Innovation (CMMI) announced that 53 Direct Contracting Entities (DCEs) are now participating in the first performance year (a shortened nine-month period through December 31st) of the Global and Professional Direct Contracting (GPDC) models. The list of participating DCEs, which is available here, has five entities whose service areas include New York:

  • Advanced Value Care II (New Entrant)
  • Clover Health Partners (Standard)
  • Oak Street Health Medicare Partners (Standard)
  • Perfect Health (New Entrant)
  • Vively Health (New Entrant)

CMMI also announced that it no longer intends to solicit any further applications for Direct Contracting at this time. This means there will be no Medicaid Managed Care Organization-based (MCO) DCE option and no second round of the GPDC model to begin January 1, 2022 as previously mooted. The only additional DCEs that may be added at this time are either:

  • Organizations that have already applied but deferred their start date to 2022, who will still be permitted to begin participating as DCEs if they so choose. CMMI may also provide an optional Implementation Period for such entities; or
  • Organizations that entered the Implementation Period but then terminated participation, who may also be able to return to participate in 2022 with the submission of a modified application.  

More information is available on the GPDC model site here. CMMI additionally updated the GPDC General FAQ and Financial FAQ documents.
 
CMS Proposes SNF, Hospice, IRF, and IPF Payment Rules
This week, the Centers for Medicare & Medicaid Services (CMS) issued four proposed rules that would update Medicare payments for FFY 2022 for various provider types:

CMS is also proposing changes to the quality reporting systems for each provider type. For SNFs, hospice providers, and IRFs, CMS is issuing two accompanying Requests for Information (RFIs) each. The first RFI seeks comment on closing the health equity gap in each provider type, including through expanded quality measure development and data collection. The second seeks comment on the use of the Fast Healthcare Interoperability Resources (FHIR) standard in support of digital quality measurement in quality reporting programs (QRPs).

The press releases for each rule are available below:

CMS Selects Value in Opioid Treatment Demonstration Participants
On April 8th, CMS announced the selected participants for the Value in Opioid Use Disorder Treatment Demonstration. Under this 4-year demonstration, participants will receive a care management fee and performance-based incentive for opioid use disorder (OUD) treatment for Medicare fee-for-service beneficiaries, including dual eligibles. A total of 61 providers were selected to participate (none in New York).
 
More information is available on the demonstration website here.
 
HHS Announces Increased Enrollment in Marketplace Coverage During SEP
On April 8th, HHS released a March enrollment report for the Healthcare.gov federal marketplace. As of March 31st, more than 500,000 individuals have enrolled in health insurance through HealthCare.gov during the current Special Enrollment Period (SEP). The SEP has currently been extended through August 15th due to the COVID-19 public health emergency. New enrollees are significantly more likely to be part of historically uninsured communities, including Black and lower-income populations.
 
The HHS press release is available here.
 
HHS Issues Updated Provider Relief Fund FAQs
HHS has issued further updates to its guidance on the CARES Act Provider Relief Fund (PRF), the $178 billion fund to help to hospitals and health providers impacted by the COVID-19 pandemic. Updates and clarifications include:

  • Providers do not need to prove, at the time of accepting a PRF payment, that prior and/or future lost revenues and expenses attributable to COVID-19 exceed their payment. If they have remaining funds on June 30th, those funds must be returned to HHS.
  • Organizations that sold a provider entity for whom they received a PRF payment may keep the funds and use them for eligible expenses or lost revenue. However, they must substantiate proper usage or be subject to audit and potential recoupment.
  • The PRF permits reimbursement of marginal increased expenses if not reimbursed from other sources. For example, if the cost of delivering a visit increases by $5, but the provider does not receive supplemental reimbursement, that $5 may be attributed to the PRF.
  • Providers are reminded that HHS reserves the right to audit PRF recipients and recoup funds that were overpaid or not used in a manner consistent with program requirements.

The FAQ document is available here.
 
HHS and Other Agencies Release Behavioral Health Parity FAQs
On April 2nd, HHS, the Department of Labor (DOL), and the Treasury released an FAQ document on modifications made by the 2020 year-end spending omnibus (the Consolidated Appropriations Act, 2021) to behavioral health parity requirements as established by the Mental Health Parity and Addiction Equity Act (MHPAEA). These amendments expressly required plans (including ERISA-covered plans) that impose non-quantitative treatment limits (NQTLs) on behavioral health limits to perform and document comparative analyses of the design and application of those NQTLs. These comparative analyses must be reported to the Departments upon request, and may also be requested by State authorities, individual enrollees, or providers acting on their behalf.
 
The FAQ is available here.
 
DOL Announces Implementation of COBRA Premium Assistance
On April 7th, the DOL Employee Benefits Security Administration (EBSA) announced the implementation of the enhanced COBRA premium assistance made available in the ARP. Under the ARP, the federal government will subsidize 100 percent of COBRA premiums for up to six months for individuals who lost employment or had reduced hours. The premium assistance applies to periods of health coverage on or after April 1st through September 30th of this year. An employer or plan to whom COBRA premiums are payable is entitled to a tax credit for the amount of the premium assistance.
 
The EBSA has created a dedicated COBRA Premium Subsidy webpage with FAQs and Model Notices, which is available here.

Other Updates

CBO Issues Report on Public Option Design Considerations
On April 7th, the Congressional Budget Office (CBO) issued a report on design considerations for a potential federally administered public option for individual health insurance coverage. The report considers issues such as:

  • How a public option might affect federal spending and revenues;
  • Changes in premiums, both for the public option and for competing private plans; and
  • The potential change in health insurance coverage and the uninsured population. 

The CBO report is available here.
 
CDC Issues Guidance on Travel for Vaccinated Individuals
On April 2nd, the Centers for Disease Control and Prevention (CDC) announced that fully vaccinated Americans can resume domestic and international travel under the condition that masks are worn in public. The CDC considers people fully vaccinated 2 weeks after their second dose in a 2-dose series or 2 weeks after a single-dose vaccine.
 
For vaccinated domestic travelers:

  • Fully vaccinated travelers do not need to get tested before or after travel unless their destination requires it.
  • Fully vaccinated travelers do not need to self-quarantine.
  • Travelers should continue to wear a mask, social distance, and frequently wash their hands.

For fully vaccinated individuals traveling internationally:

  • Individuals should follow the CDC’s recommendations for traveling safely and get tested 3-5 days after travel.
  • Individuals do not need to get tested prior to leaving the United States unless the final destination requires it.
  • Individuals do not need to self-quarantine after arriving in the United States. 

Additional travel guidance for vaccinated and unvaccinated individuals can be found here.

Congressional Hearings

Wednesday, April 14th:

  • At 10am, the Senate Homeland Security and Governmental Affairs Committee will hold a hearing to examine preparedness for COVID-19, focusing on the initial pandemic response and lessons learned. More information is available here.
  • At 2pm, the House Veterans Affairs Subcommittee on Technology Modernization will hold a hearing to evaluate concerns about the ongoing implementation of the electronic health record (EHR) modernization program. More information is available here.

Thursday, April 15th:

  • At 9:30am, the Senate Finance Committee will hold hearings on the nominations of Andrea Palm to be Deputy Secretary of HHS and of Chiquita Brooks-LaSure to be Administrator of CMS. More information is available here.
  • At 10am, the House Appropriations Subcommittee on Departments of Labor, Health and Human Services, Education, and Related Agencies, will hold a hearing on the FY 2022 Budget Request for the HHS Department. More information is available here.
  • At 10:15am, the House Education and Labor Subcommittee on Health, Employment, Labor, and Pensions (HELP) will hold a hearing entitled “Meeting the Moment: Improving Access to Behavioral and Mental Health Care.” More information is available here.
  • At 10:30am, the House Select Committee on the Coronavirus Crisis will hold a hearing entitled “Reaching the Light at the End of the Tunnel: A Science-Driven Approach to Swiftly and Safely Ending the Pandemic.” More information is available here.

New York State Updates

Governor Cuomo Issues Executive Orders 202.100 and 202.101
On March 31st, Governor Cuomo signed Executive Order 202.100 (available here), which modifies the provisions contained in Executive Order 202.30 regarding hospital discharges to nursing homes. The modification prohibits any Article 28 general hospital from discharging a patient to a nursing home without first offering a COVID-19 vaccine to medically eligible patients and, if the patient consents, providing the vaccine.
 
On April 6th, Governor Cuomo signed Executive order 202.101 (available here), which extends all disaster emergency provisions outlined in Executive Order 202 and its successors that have not been otherwise superseded, modified, or expired through May 6th. Additionally, the Order expands the scope of the amendment contained in Executive Order 202.100 above to require Article 28 general hospitals to offer and provide a COVID-19 vaccine to medically eligible patients who consent to receive the vaccine prior to discharge to an adult care facility or long-term care facility (in addition to nursing homes).

Governor Cuomo Signs Legislation Repealing Liability Protections for Health Care Facilities and Providers
On April 6th, Governor Cuomo signed legislation (S5177/A3397) that repeals liability protections for health care facilities and providers, including hospitals and nursing homes, that were granted at the beginning of the COVID-19 pandemic. Specifically, the legislation repeals the Emergency or Disaster Treatment Protection Act (EDTPA), which was passed as part of last year’s State budget and which granted health care facilities, professionals, and volunteer organizations immunity from civil or criminal liability for actions occurring in the course of providing health care services during the COVID-19 emergency, unless due to intentional misconduct or gross negligence.
 
The repeal was effective immediately but is expected not to be considered retroactive for actions between the EDTPA’s passage date on April 3, 2020 and the repeal date of April 6, 2021, at minimum. The bill’s sponsors, Assemblyman Ron Kim and Senator Alessandra Biaggi, have stated that they expect potential litigation regarding retroactivity for incidents that occurred between the initial PHE declaration on March 7, 2020 and the EDTPA’s passage.
 
Updated Guidance Documents
Recently released New York State and City COVID-19 guidance documents are listed below.

This Week’s SPG Updates

Please find below links to updated SPG resource documents.