Weekly Health Care Policy Update – June 4, 2021

June 11, 2021

In this update: 

  • Biden Administration Announces Updates on COVID-19 Response
    • Global Vaccine Sharing
    • CDC Summer Camp Guidance
    • Employer Vaccination Requirements and Incentives
    • National Month of Action
  • President Biden Releases FY 2022 Budget Request
  • Senate Confirms Eric Lander to Lead Office of Science and Technology Policy
  • New Heads of CMS, CMMI Discuss Administration’s Policy Agenda
  • BARDA Launches New Program to Fight Future Pandemics
  • Treasury Updates FAQs on Coronavirus State and Local Fiscal Recovery Funds
  • WHO Announces New Nomenclature for COVID-19 Variants
  • Study Finds Widening Socioeconomic Disparities in Respiratory Health
  • Congressional Hearings
  • DOH Amends Case Mix Acuity Process for Nursing Homes
  • DOH Proposes Rule Maintaining Current Contingent Reserve Requirement for MCOs
  • Note on COVID-19 Resources

Administration Updates

Biden Administration Announces Updates on COVID-19 Response
This week, the Biden Administration announced new updates on the COVID-19 response: 

  • Global Vaccine Sharing: On June 3rd, the Administration committed to distribute a total of 80 million doses of COVID-19 vaccines in its global vaccine sharing initiative by the end of June, along with a specific plan for the allocation of the first 25 million doses. The Administration will share 75% of the vaccines through the global COVAX initiative, while 25% will be dedicated to immediate needs and surges around the world. A fact sheet is available here.
  • CDC Summer Camp Guidance: On May 28th, the Centers for Disease Control and Prevention (CDC) updated its guidance for summer camps. Camps where everyone has been fully vaccinated prior to the start of camp may return to full capacity without masking or social distancing. Campers who have not been vaccinated may also take off masks in most situations outdoors, but are strongly encouraged to wear masks indoors, outdoors in crowds, or outdoors when in close contact with others for a prolonged period. However, given uncertainty around vaccination status, the CDC says camps may still apply the agency’s previous guidance, which encourages masks for all.
  • Employer Vaccination Requirements and Incentives: On May 28th, the Equal Employment Opportunity Commission (EEOC) issued an updated technical assistance document on equal employment issues related to COVID-19. The EEOC continues to advise that employers may require employees to receive a COVID-19 vaccination, subject to reasonable accommodations for employees with disabilities and sincerely held religious beliefs. Accommodations could include masks, social distancing, modified shifts, COVID-19 testing, working remotely, or reassignment. Employers may also offer vaccination incentives so long as they are “not so substantial as to be coercive,” including incentives to provide documentation confirming vaccination of employees or their family members. However, employers may not offer incentives for employees’ family members to be vaccinated by the employer or its agent due to genetic information regulations.
  • National Month of Action: On June 2nd, President Biden announced a National Month of Action to support his goal of having 70% of Americans receive at least one dose of COVID-19 vaccine by July 4th. Biden announced a number of initiatives and incentives to make it easier for Americans to get vaccinated, including free child care for vaccination appointments and recovery, extended vaccine appointment hours at several pharmacy chains, targeted outreach to areas with low vaccination rates, a “Mayors Challenge” competition to increase vaccination rates in various cities, an initiative to engage black-owned barbershops and beauty salons, a number of incentives offered by private businesses, and more. A fact sheet is available here.

President Biden Releases FY 2022 Budget Request
On May 28th, the Biden Administration released its full fiscal year (FY) 2022 budget request. Overall, the $6 trillion budget proposal includes $769 billion in spending for nondefense programs, a 16% increase from FY 2021. The budget calls for a 23.5% funding increase for the Department of Health and Human Services (HHS), and expresses support for several major health policy initiatives, including a public option through Affordable Care Act (ACA) exchanges, allowing individuals 60 and older to enroll in Medicare with the same premiums and benefits as current beneficiaries, and permanent expansion of the ACA subsidies created in the American Rescue Plan (ARP). In addition, the budget calls for increased investments in Home and Community-Based Services, the Community Mental Health Services Block Grant, Substance Use Disorder services, and Certified Community Behavioral Health Clinics. While the President’s budget serves as a blueprint for policy priorities, it has no force of law unless corresponding legislation is passed.
 
A fact sheet is available here.
 
Senate Confirms Eric Lander to Lead Office of Science and Technology Policy
On May 28th, the Senate confirmed Eric Lander to lead the White House Office of Science and Technology Policy (OSTP). Lander is a geneticist who previously served as co-chair of the Presidential Council of Advisors on Science and Technology during the Obama administration. President Biden elevated the OSTP director to a Cabinet-level position for the first time in history. Lander is the last of Biden’s Cabinet-level nominees to be confirmed, although a new permanent nominee for the Office of Management and Budget (OMB) has yet to be announced.

Agency Updates

New Heads of CMS, CMMI Discuss Administration’s Policy Agenda
On June 3rd, Kaiser Health News published excerpts from an interview with Chiquita Brooks-LaSure, the newly-confirmed Administrator of the Centers for Medicare & Medicaid Services (CMS). Brooks-LaSure said that CMS’s focus would be on using regulation to enhance health equity and to improve coverage, including on the ACA exchanges and for people in the “Medicaid gap” (i.e., people who would be covered if all states expanded Medicaid). This could be achieved through Medicaid expansion or other approaches, although all would likely require legislation and/or state cooperation. The KHN article is available here.
 
Also on June 3rd, CMS Innovation Center (CMMI) Director Liz Fowler spoke at a Health Affairsevent on the Administration’s priorities for CMMI. Fowler emphasized that, going forward, CMMI would pursue more a focused approach towards the goal of ensuring that every beneficiary has a care relationship with a provider who is accountable for the quality and outcomes of their care. This will likely include more models with mandatory participation, with the goal of increasing incentives to transition to value-based care, although CMMI may face statutory limits that would require legislative action. In keeping with the Administration’s focus on health equity, future requests for proposals (RFPs) will include sections on equity, with the requirement to examine models and evaluations through this lens. More information on the event is available here.
 
BARDA Launches New Program to Fight Future Pandemics
On June 2nd, the HHS Biomedical Advanced Research and Development Authority (BARDA) announced a new program to spur development of transformative technologies to enhance national health security. The initiative, a partnership between the nonprofit Global Health Investment Corporation (GHIC) and BARDA’s Division of Research, Innovation, and Ventures (DRIVe), will be funded with $50 million over five years, matched with additional capital from private or corporate investors. Public and private funds will be invested together in designated projects, with proceeds returned to GHIC for reinvestment and sustainment of BARDA Ventures. The public-private partnership hopes to improve U.S. preparation for the next public health emergency.
 
The HHS announcement is available here.
 
Treasury Updates FAQs on Coronavirus State and Local Fiscal Recovery Funds
On May 27th, the Treasury Department published an updated list of Frequently Asked Questions on the Coronavirus State and Local Fiscal Recovery Funds. The $350 billion pool of funding, established through the ARP, may be used to cover costs related to public health, negative economic pandemic impacts, lost public sector revenue, premium pay for essential workers, and investments in water, sewer, and broadband infrastructure.
 
The updated FAQs clarify that funds may be used to provide assistance to unemployed workers that includes “back to work incentives” for newly-employed workers after a period of time on the job. States may use funds for the payroll and covered benefits of public health and safety employees, to the extent that the employee’s time is dedicated to responding to the pandemic. If more than half of an employee’s time is dedicated to responding to the pandemic, the employee’s pay may be fully covered. The FAQs also include clarifications on the definitions of “public health and safety employees,” as well as a definition of “general revenue.” The first tranche of Coronavirus State and Local Fiscal Recovery Funds has already been distributed; total allocations can be found here. 

Other Updates

WHO Announces New Nomenclature for COVID-19 Variants
On May 31st, the World Health Organization (WHO) announced a new naming system for COVID-19 “variants of interest” and “variants of concern.” In order to simplify and destigmatize the naming structure, new and existing variants will be assigned a name from the Green alphabet in order of emergence. As such, B.1.1.7, the first variant identified in the United Kingdom, will be “Alpha,” B.1.351, the variant first identified in South Africa, will be “Beta,” P.1, the variant first identified in Brazil, will be “Gamma,” and B.1.671.2, the variant first identified in India, will be “Delta.” The list of variants will be maintained on a WHO website.
 
Study Finds Widening Socioeconomic Disparities in Respiratory Health
On May 28th, JAMA Internal Medicine published a study on socioeconomic disparities in respiratory health in the U.S. over the last six decades. During this period, air quality improved and smoking prevalence decreased. However, the study found that gains were not spread equally across groups, resulting in income- and education-related disparities in respiratory symptoms, lung disease prevalence, and pulmonary function that mostly persisted from 1959 to 2018 and, in some instances, appeared to worsen. Income-based disparities in chronic obstructive pulmonary disease (COPD) also increased, as did asthma prevalence for children after 1980.
 
The abstract of the article is available here. 

Congressional Hearings

Tuesday, June 8th:  

  • At 10am, the Senate Committee on Health, Education, Labor, and Pensions (HELP) will hold a committee hearing to examine the nominations of Miriam Delphin-Rittmon as HHS Assistant Secretary for Mental Health and Substance Use and Dawn O’Connell as HHS Assistant Secretary for Preparedness and Response (ASPR). More information is available here.  
  • At 11am, the Senate Committee on the Budget will hold a hearing to consider the President’s FY 2022 Budget Proposal. More information is available here.  
  • At 12pm, the House Committee on Oversight and Reform will hold a hearing entitled “The SACKLER Act and Other Policies to Promote Accountability for the Sackler Family’s Role in the Opioid Epidemic.” More information is available here.  

Wednesday, June 9th: 

  • At 10am, the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies will hold a hearing on the President’s FY 2022 Budget Request for HHS. More information is available here.  
  • At 11am, the House Committee on the Budget will hold a hearing on the President’s FY 2022 Budget Proposal. More information is available here. The Committee’s Budget summary is available here.   

Thursday, June 10th: 

  • At 10am, the Senate Finance Committee will hold a hearing to review the President’s FY 2022 Budget Request for HHS. More information is available here.
  • At 10am, the Senate Appropriations Subcommittee on Agriculture, Rural Development, Food and Drug Administration (FDA), and Related Agencies will hold a hearing to review the FY 2022 Budget Request for the FDA. More information is available here.

New York State Updates

DOH Amends Case Mix Acuity Process for Nursing Homes
On June 2nd, the New York State Department of Health (DOH) published a Notice of Adoption in the State Register (available here) of an amendment to section 86-2.40(m) of NYCRR Title 10 regarding nursing home case mix rationalization. The amendment includes the following changes: 

  • Beginning July 1, 2021, DOH intends to calculate the case mix adjustment by viewing acuity data for all relevant dates, rather than a single date, to reduce statistical distortions.
  • Facilities will no longer be required to upload census data separately from the Minimum Data Set (MDS) data. DOH anticipates that the streamlining of the MDS process will reduce administrative burdens on the provider and increase accuracy in Medicaid rates of payment.
  • Current regulations give DOH discretion to cap changes in a facility’s case mix index at 5 percent. DOH does not intend to exercise this discretion and, therefore, is repealing this provision.

For case mix periods beginning on and after July 1st, the case mix adjustment to the direct component of the price will be made every six months (in January and July), and will use all Medicaid-only case mix data from the previous relevant six-month period (e.g., April-September for the January case mix adjustment; October-March for the July case mix adjustment). Furthermore, nursing home operators will be required to submit a written certification of completeness and accuracy of MDS data submissions. The amendment also allows other agents authorized by DOH, in addition to the Office of the Medicaid Inspector General, to conduct audit reviews related to case mix adjustments.
 
DOH Proposes Rule Maintaining Current Contingent Reserve Requirement for MCOs
On June 2nd, DOH published a proposed amendment to section 98-1.11(e) of Title 10 NYCRR in the State Register (available here). The amendment proposes to maintain the contingent reserve requirement applied to Medicaid Managed Care Organizations (MCOs), including HIV Special Needs Plans (SNPs) and Health and Recovery Plans (HARPs), at the current level of 7.25 percent through 2022.
 
To implement Medicaid Redesign Team (MRT) initiatives that introduced new benefits and populations into managed care and reduced premiums, DOH reduced the MCO contingent reserve requirement. DOH is proposing to continue this adjustment for an additional two years, since premium rates have not been adequate to allow for the planned increase. The increase would now be scheduled to begin in 2023. The schedule of increases would be to increase the reserve requirement to 8.25 percent in 2023 and by one percentage point annually thereafter, until 2027, at which point the reserve requirement will be maintained at 12.5 percent.
 
DOH will accept public comment on this proposed amendment through August 1st.

Note on COVID-19 Resources

As the pace of emergency policy changes related to COVID-19 continues to decrease, SPG plans to discontinue updates to several of our COVID-19 Resources, including the Directory of COVID-19 Guidance Documents and NYS Waiver Timeline Tracker. Archived versions will continue to be available on our website (currently here). Clients with questions regarding these topics or seeking an updated version should feel free to contact us.