Weekly Health Care Policy Update - March 26, 2021

In this update:

President Biden Announces Updates on Combatting COVID-19
Senate Confirms Surgeon General, HHS Assistant Secretary
HHS Announces Further Administration Staff Appointments
Senate Passes the PPP Extension Act of 2021
Senate Passes Bill to Extend Medicare Sequestration Moratorium
CMS Extends Special Enrollment Period for Marketplace Coverage
CMS Submits Modifications to Comprehensive Joint Replacement Model and Notice of Benefit and Payment Parameters
OIG Publishes Report on the Impact of COVID-19 on Hospitals
Governor Cuomo Provides Updates on NYS Budget
CMS Approves Temporary Extension of NYS MRT 1115 Waiver
CMS Approves NYS DOH Extension Request for Children’s Waiver COVID-19 Appendix K Amendment
Updated Guidance Documents

Administration Updates

President Biden Announces Updates on Combatting COVID-19
On March 25^th, the Biden Administration announced new steps to combat the COVID-19 pandemic:

The Administration will raise its goal to distribute 200 million doses of the COVID-19 vaccine in its first 100 days, an increase from its initial 100 million dose pledge. At the current rate of roughly 2.5 million doses per day, the United States is on track to meet this goal by the 100^th day (April 30^th).
The Administration will implement a $10 billion investment to expand access to vaccines for vulnerable populations and increase vaccine confidence (announced here). Most of these funds were allocated in the American Rescue Plan (ARP). The investment includes:
- $6 billion for federally qualified health centers (FQHCs) to expand vaccinations, testing, and healthcare services for high-risk individuals;
- $3 billion, through the Centers for Disease Control and Prevention (CDC), to states and vaccine-administering localities (including New York City) to support local efforts to increase vaccine uptake and equity; and
- $330 million, through the CDC, to invest in community health workers (CHWs) to support COVID-19 prevention and control efforts.
The Administration is inviting FQHCs participating in the Health Center COVID-19 Vaccine program to expand COVID-19 vaccine eligibility to all frontline essential workers and adults (16 or over) with high-risk conditions.
The Administration is engaging in a new partnership with outpatient dialysis clinics to directly provide them with COVID-19 vaccines for their staff and patients.

Senate Confirms Surgeon General, HHS Assistant Secretary
This week, the Senate confirmed Vivek Murthy to serve as Surgeon General by a vote of 57 to 43. Dr. Murthy will be returning to the role that he served in under the Obama Administration from 2014 to 2017. The Senate confirmed Rachel Levine to be Assistant Secretary of Health at the Department of Health and Human Services (HHS) by a vote of 52 to 48. Dr. Levine previously was the Secretary of the Department of Health of Pennsylvania.

HHS Announces Further Administration Staff Appointments
On March 22^nd, HHS announced a further set of staff appointments within the Department. The list includes:

Rebecca Haffajee, Principal Deputy Assistant Secretary for Planning and Evaluation
Miranda Lynch, Deputy Assistant Secretary for Planning and Evaluation
Jonathan Warsh, Senior Policy Advisor (COVID Response)
Leni Hirsch, Special Assistant (COVID Response)
Cheryl Campbell, Principal Deputy Assistant Secretary for Administration
Trina Dutta, Senior Advisor, Substance Abuse and Mental Health Services Administration (SAMHSA)

The full announcement can be found here.

Legislative Updates

Senate Passes the PPP Extension Act of 2021
On March 25^th, the Senate passed the Paycheck Protection Program (PPP) Extension Act of 2021, which will extend the loan application period for the PPP program, which was originally set to expire on March 31^st, through May 31^st. Furthermore, the SBA would continue to process existing applications through June 30^th. The PPP Extension Act is expected to be signed by President Biden shortly.

SPG distributed a primer on the PPP yesterday, available here. The full text of the PPP Act of 2021 is available here.

Senate Passes Bill to Extend Medicare Sequestration Moratorium
On March 25^th, the Senate passed a bill which would delay the reinstatement of Medicare sequestration (across-the-board budget cuts of 2%) for an additional nine months (through December 31^st). The bill also makes certain additional technical corrections regarding rural health clinics and the California exemption for Medicaid disproportionate share hospital (DSH) payments.

Unlike the version that the House of Representatives passed, however, the Senate bill does not waive PAYGO rules and includes a future offset. As a result, the House will need to pass this amended version when it returns from recess in April, after the technical deadline for the sequester. However, the Centers for Medicare and Medicaid Services (CMS) is expected not to implement sequestration cuts immediately, in anticipation that they will be reversed.

The full text of the bill is available here.

Regulatory Updates

CMS Extends Special Enrollment Period for Marketplace Coverage
On March 23^rd, the Centers for Medicare & Medicaid Services (CMS) announced that it will extend the Special Enrollment Period (SEP) for marketplace coverage through the HealthCare.gov platform by three months. The SEP will now end on August 15^th. The enrollment extension applies to the 36 states that utilize the HealthCare.gov platform as its insurance marketplace, but State-based exchanges may set different dates.

The extension will provide more time for individuals to take advantage of the increased tax credits in the American Rescue Plan Act (ARP), either through new enrollments or changes to existing coverage. The additional assistance outlined in the ARP will be available for individuals who enroll in ACA coverage starting April 1^st.

The official announcement is available here.

CMS Submits Modifications to Comprehensive Joint Replacement Model and Notice of Benefit and Payment Parameters
This week, CMS submitted to the Office of Management and Budget (OMB) for review two notable final rules. The first rule is titled “Comprehensive Care for Joint Replacement Model Three-Year Extension and Modifications to Episode Definition and Pricing,” while the second is entitled “Notice of Benefit and Payment Parameters (NBPP) for 2022.” Because this rule is a final rule, it is not expected to change the provisions announced in the previous NBPP final rule issued by the Trump Administration in January.

OIG Publishes Report on the Impact of COVID-19 on Hospitals
On March 23^rd, the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) published a report highlighting the results of a survey of hospitals on how responding to the COVID-19 pandemic has affected their capacity to care for patients, staff, and communities. The OIG conducted the survey in late February 2021 with hospital administrators from 320 hospitals across the nation. The top issues hospitals reported facing were that:

Staffing shortages impacted patient care;
Trauma and exhaustion took a toll on the mental health of staff members;
Hospitals faced financial instability associated with increased expenses and lower revenue from other hospital services;
Administrators had concerns about vaccine hesitancy among staff and community members.

The full report is available here.

Congressional Hearings

The House and Senate are in recess. The House will be back in session on April 13^th and the Senate will return on April 12^th. Select Senate committees will proceed with confirmation hearings for President Biden’s nominees.

New York State Updates

Governor Cuomo Provides Updates on New York State Budget
This week, Governor Cuomo and State Budget Director Robert Mujica provided several updates regarding the New York State (NYS) Budget for Fiscal Year 2022, which is currently being negotiated to reconcile the Governor’s Executive Budget proposal and the Legislature’s One-House Budget proposals. Budget Director Mujica announced that the State has identified over $5 billion in resources that could be used to restore all of the reductions proposed in the Executive Budget. This includes an additional $2.5 billion in forecasted revenue and additional federal aid. As a result, the State plans to:

Restore reductions proposed in the Executive Budget;
Utilize funding from the federal government and other resources to fund one-time expenses related to COVID-19, such as rental and unemployment assistance; and
Identify additional priorities outside of the COVID-19 response to finance.

The Governor noted that the ARP’s unrestricted federal aid for the State government of roughly $12.5 billion was approximately $2.5 billion under the State’s initial request of $15 billion. This funding gap will be a priority for the Governor during budget negotiations, in addition to other items, including universal broadband access and affordability and nursing home reform proposals.

The Governor’s press release is available here.

CMS Approves Temporary Extension of NYS MRT 1115 Waiver
On March 18^th, CMS announced a temporary extension of the NYS Section 1115 Demonstration Medicaid Redesign Team (MRT) Waiver through March 31, 2022. CMS completed preliminary review of New York’s three-year extension request and will work with NYS on full approval of the proposal, which will include rebasing the demonstration. The current Special Terms and Conditions (STCs), waivers, and expenditure authorities will continue to apply during the temporary extension period. The extension application will be open for a comment period of 30 days through the Medicaid.gov website.

The CMS letter is available here. Public comments may be submitted on the waiver here.

CMS Approves DOH Extension Request for Children’s Waiver COVID-19 Appendix K Amendment
On March 25^th, the NYS Department of Health (DOH) announced that CMS approved the State’s request for an extension of the Children’s Waiver Appendix K effective dates due to the continued COVID-19 State of Emergency. The approved Appendix K has been effective since March 1, 2020, and the anticipated end date is no later than six months after the expiration of the federal Public Health Emergency (PHE). The Appendix K includes, among others, provisions that:

Allow services to be provided via electronic modalities (telehealth/telephonic);
Modify service limits and incident reporting protocols; and
Allow retainer payments for community and day habilitation providers.

The approved Appendix K is available here. Questions can be submitted to BH.Transition@health.ny.gov.

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

This Week’s SPG Updates

Please find below links to updated SPG resource documents and all other updates distributed by SPG this week.