Weekly Health Care Policy Update – July 16, 2021

In this update: 

• Federal Administration
  • Biden Administration Announces Updates on COVID-19 Response 
    • FDA Adds Guillain-Barre Warning to J&J Vaccine
    • HHS Distributes $398 Million to Rural Hospitals
    • HHS Awards $144 Million to FQHC Look-Alikes
  • New HHS and White House Personnel Announcements
• Federal Agencies and Regulation
  • CMS Issues Proposed CY 2022 Medicare Physician Fee Schedule Rule
  • HHS Updates USCDI Standards to Incorporate SDH, Sexual Orientation, and Gender Identity
  • CDC Issues Updated Guidance for COVID-19 Prevention in K-12 Schools
  • FDA Interim Commissioner Requests Independent Investigation of Aduhelm Approval
  • CMS Announces Funds for States to Plan for Medicaid Coverage of Mobile Behavioral Health Crisis Interventions
  • CMS Issues Informational Bulletin on Medicaid Coverage of Medical Transportation
  • CMS Updates QPP Participation Status Tool with Recent APM Data
  • ONC Announces Timeline for Implementation of National Trusted Exchange Framework
  • ONC Publishes New EHR Reporting Program Certification Criteria for Comment
  • HRSA Issues Additional FY 2022 FQHC Service Area Competition
• Federal Legislature
  • Congressional Democrats Announce Parameters for Next Reconciliation Bill
  • House Appropriations Committee Passes 2022 HHS Appropriations Bill
• Other
  • Lown Institute Reports on Hospital Spending on Charity Care and Community Investment
  • FAIR Health Monthly Telehealth Regional Tracker Shows Decreased Telehealth Use
• Congressional Hearings
• New York State
  • OMH Submits ARP Community Mental Health Services Block Grant Funding Plan
  • OPWDD Adopts Amended Rate Methodologies for Day Habilitation and Residential Services
  • DFS Adopts Surprise Billing Rule to Incorporate Out-of-Network Emergency and Resulting Inpatient Services
  • OIG Releases Report on NYS Health Home Reimbursement Claims
  • 32BJ Health Fund Reports Low Compliance with Price Transparency Requirements Among NYC Hospitals
  • Updated Resources on NYS and Other Spending Plans for Enhanced HCBS ARP Funding

Administration Updates

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

• FDA Adds Guillain-Barre Warning to J&J Vaccine: On July 12^th, the Food and Drug Administration (FDA) has added a warning to the Johnson & Johnson COVID-19 vaccine of “an increased risk” of Guillain-Barre syndrome, a form of progressive paralysis that is generally reversible. The warning follows about 100 preliminary reports of such cases, mostly occurring in adult males, about two weeks after vaccination. Based on current data, the condition has occurred in about one per 128,000 people vaccinated. FDA emphasized that “the known and potential benefits clearly outweigh the known and potential risks.”
• HHS Distributes $398 Million to Rural Hospitals: On July 13^th, the Department of Health and Human Services (HHS) announced the provision of $398 million in funding from the American Rescue Plan (ARP) Act to rural hospitals for COVID-19 testing and mitigation. The funding is provided through the Health Resources and Services Administration’s (HRSA’s) Small Rural Hospital Improvement Program (SHIP). Nationwide, 1,540 hospitals will share in the funding. In New York, 22 small rural hospitals will receive a total of approximately $5.7 million. A press release is available here.
• HHS Awards $144 Million to FQHC Look-Alikes: On July 15^th, HHS announced that HRSA has awarded about $144 million in ARP funding to 102 designated federally qualified health center (FQHC) look-alikes. FQHC look-alikes operate under the same rules as FQHCs, including a sliding fee scale and being eligible for the FQHC per diem visit rate and wraparound, but do not receive Section 330 grants. In New York, six FQHC look-alikes were awarded $9.4 million. A press release is available here.

New HHS and White House Personnel Announcements
On July 9^th, HHS Secretary Xavier Becerra swore in Dawn O’Connell to serve as the Assistant Secretary for Preparedness and Response (ASPR). O’Connell previously served as Counselor to the Secretary, focusing on COVID-19 response. Secretary Becerra also swore in Cheryl Campbell as Assistant Secretary for Administration (ASA), a role she has filled in an acting capacity since March. Campbell previously founded and led the EagleForce Warrior Foundation and was an executive at CGI Group. A press release is available here.
 
On July 13^th, President Biden announced he will nominate Dr. Rahul Gupta to be Director of National Drug Control Policy. If confirmed by the Senate, Gupta would be the first physician to serve in the role. Gupta was most recently the chief medical officer at the March of Dimes and previously served as West Virginia’s Health Commissioner. A press release announcing this and other nominations is available here. 

Regulatory Updates

CMS Issues Proposed CY 2022 Medicare Physician Fee Schedule Rule
On July 13^th, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining changes to the Medicare Physician Fee Schedule (PFS) and other Medicare Part B payments for Calendar Year (CY) 2022. Highlights of the proposed policy changes include:

• Telehealth Extensions: CMS proposes various provisions that would maintain much of the Medicare telehealth expansion that occurred during the COVID-19 public health emergency (PHE) for two years, through December 31, 2023. This includes allowing all services defined by CPT code that have been temporarily added to the Medicare telehealth list (on a “Category 3” basis) to continue through that date, allowing CMS to gather more information to consider adding them permanently. CMS is also seeking comment on whether any services not added on a Category 3 basis, which will otherwise be removed from the list at the expiration of the PHE, should be reconsidered for inclusion in that list. These include, among others: 
  • Telephonic E/M codes (CPTs 99441-3);
  • Certain home services (CPTs 99341-5);
  • Certain speech, language, and audiology services;
  • Certain hospital inpatient and outpatient and nursing facility services; and
  • Certain behavioral health testing and interventions, such as cognitive function interventions and adaptive behavior treatment.
• Telehealth Expansion for Mental Health: CMS will also implement provisions in the 2020 year-end Consolidated Appropriations Act (CAA) that would permanently expand telehealth, with restrictions, for certain mental health services. Specifically, the rule would implement the CAA’s removal of Medicare geographic restrictions on telehealth for mental health providers who have an existing and ongoing in-person relationship with a patient. This requires an in-person, non-telehealth service to be conducted by the provider within six months prior to the initial telehealth service, and every six months thereafter.
  
  Additionally, CMS will revise its definition of “interactive telecommunications system” to include audio-only communication technology when used for the diagnosis, evaluation, or treatment of mental health disorders furnished to established patients in their homes. However, the rule proposes to limit the use of audio-only to providers who have the ability to provide two-way audio and video communications but use audio-only communications due to beneficiary choice.
• Evaluation and Management (E/M) Codes: CMS proposes several updates to coding and payment for E/M visits, including for a visit that is split or shared by both a physician and a non-physician nurse practitioner (NPP). CMS proposes to limit the definition of split/shared visit to include only E/M visits in institutional settings for which “incident to” payment is unavailable. CMS also proposes to modify its existing policy to allow for split/shared visits for both new and established patients and for critical care and certain skilled nursing facility/nursing facility visits.
• FQHCs and Rural Health Clinics (RHCs): CMS proposes two significant changes for FQHCs and RHCs, that would: 
  • Allow RHCs and FQHCs to furnish mental health visits through telehealth, including audio-only interactions in cases where beneficiaries are not capable of, or do not consent to, the use of two-way audiovisual technology; and
  • Implement statutory changes for independent RHCs and provider-based RHCs in a hospital with 50 or more beds to receive a per visit payment limit increase over an eight-year period, with a prescribed amount for each year from 2021 through 2028, followed by updates that reflect increases in the Medicare Economic Index (MEI).
• Opioid Use Disorders: CMS proposes adjustments for take-home supplies of opioid antagonist medications in which non-drug components would be geographically adjusted using the Global Assessment of Functioning (GAF) Scale and annually adjusted based on the MEI. CMS also proposes to allow opioid treatment programs to continue furnishing therapy using audio-only communication after the COVID-19 public health emergency in cases where audio/video is not available for the beneficiary.
• Quality Payment Program (QPP): CMS proposes to move forward with MIPS Value Pathways (MVPs). To provide clinicians and third-party intermediaries with sufficient time to prepare for a shift to this new participation framework, CMS is proposing to begin transitioning to MVPs in the 2023 Merit-Based Incentive Payment System (MIPS) performance year (2025 payment year), with a sunset of traditional MIPS beginning with the 2028 performance year (2030 payment year). More information is included in the Quality Payment Program fact sheet available here.
• Electronic Prescribing of Controlled Substances (EPCS): CMS proposes to use its authority under the SUPPORT Act to create exceptions to EPCS requirements, which mandate that Schedule II through V drugs covered through Medicare Part D must be prescribed electronically. The exceptions would apply if: 

• The prescriber and dispensing pharmacy are the same entity;
• The prescriber issues 100 or fewer controlled substance prescriptions for Part D drugs per calendar year; or
• The prescriber is in the geographic area of a natural disaster, or is granted a waiver based on extraordinary circumstances.

CMS also proposes to change the EPCS compliance date from January 1, 2022 to January 1, 2023, pending feedback. Similarly, CMS proposes to extend the compliance deadline for Part D controlled substance prescriptions written for beneficiaries in long-term care (LTC) facilities, excluding beneficiaries who are residents of nursing facilities and whose care is provided under Part A of the benefit, from January 1, 2022 to January 1, 2025.

• Average Sales Price (ASP) Reporting: CMS proposes changes to implement the CAA’s requirement that manufacturers of drugs or biologicals payable under Part B without a Medicaid Drug Rebate Agreement report ASP data. Beginning January 1, 2022, manufacturers will be required to report ASP for drugs and biologicals payable under Medicare Part B. CMS proposes to amend the definition of “drug” to include an item, service, supply or product that is payable under Medicare Part B as a drug or biological.
• Vaccine Administration Services: CMS seeks information regarding the different types of health care providers that administer vaccines and how those have changed since the beginning of the COVID-19 pandemic. CMS also seeks input on its recently adopted policy to pay an add-on of $35 for immunizers who vaccinate certain underserved patients in the patient’s home, including what qualifies as the “home.” CMS also seeks feedback on the treatment of COVID-19 monoclonal antibodies as vaccines, and whether those products should be treated similar to other monoclonal antibodies after the COVID-19 public health emergency.

The proposed rule is available here, and a press release is available here. A general fact sheet is available here, and a fact sheet on proposed changes to the Medicare Diabetes Prevention Program is available here.

HHS Updates USCDI Standards to Incorporate SDH, Sexual Orientation, and Gender Identity
On July 9^th, the HHS Office of the National Coordinator for Health Information Technology (ONC) released the second version of the United States Core Data for Interoperability (USCDI) standards, which will allow providers to start systematically capturing data on social determinants of health (SDH), sexual orientation, and gender identity.
 
Under UCSDI version 2, providers are encouraged (but not required) to capture such data in order to help identify, target, and address issues for lesbian, gay, bisexual, and transgender (LGBT) patients and to provide better insights into how SDH impacts the management of patients’ overall health. Overall, USCDI version 2 includes three new data classes and 22 new data elements. USCDI version 2 will be available for consideration as part of ONC’s Standards Version Advancement Process in the fall.
 
The announcement is available here.
 
CDC Issues Updated Guidance for COVID-19 Prevention in K-12 Schools
On July 9^th, the Centers for Disease Control and Prevention (CDC) issued updated guidance for COVID-19 prevention in K-12 schools this fall. The guidance emphasizes the importance of offering in-person learning “regardless of whether all of the prevention strategies can be implemented at the school.” Specifically, schools should not exclude students from in-person learning because they are unable to keep the minimum distance requirement of 3 feet, but instead implement physical distancing to the extent possible and engage in masking and other prevention strategies (testing, ventilation, etc.). The guidance also aligns with other CDC recommendations, including that vaccinated teachers and students not be required to wear masks indoors, and that in general, people do not need to wear masks when outdoors.
 
FDA Interim Commissioner Requests Independent Investigation of Aduhelm Approval
On July 9^th, Food and Drug Administration (FDA) Interim Commissioner Janet Woodcock sent a letter to the HHS Office of the Inspector General (OIG) requesting an independent investigation into the FDA’s decision to approve Aduhelm, Biogen’s controversial Alzheimer’s drug. The FDA approved Aduhelm last month with an indication that it could be used by all patients with Alzheimer’s, but narrowed the label on July 8^th to recommend its use only in cases of milder disease. The letter follows a report from Stat News suggesting that Biogen leadership had undue influence in the Aduhelm review, and an announcement from the House Committee on Oversight and Reform that it would conduct a separate investigation into the drug’s price. The letter states that the FDA will fully cooperate with the independent investigation.
 
Commissioner Woodcock posted the letter on Twitter here.
 
CMS Announces Funds for States to Plan for Medicaid Coverage of Mobile Behavioral Health Crisis Interventions
On July 13^th, CMS announced the availability of $15 million in funding from the ARP to support state Medicaid agencies expand mobile crisis intervention services. Grants will help states develop plans to create community-based, mobile intervention services for Medicaid enrollees experiencing a mental health or substance use-related crisis, based on the CAHOOTS model piloted in Oregon. Under the ARP, starting in April 2022, states will receive an 85 percent Federal Medical Assistance Percentage (FMAP) for such services for a five-year period.
 
Letters of intent are due from states by July 23^rd, final applications are due August 13^th, and the funding period begins September 30^th. A press release is available here.
 
CMS Issues Informational Bulletin on Medicaid Coverage of Medical Transportation
On July 12^th, the Center for Medicaid and CHIP Services (CMCS) at CMS issued an informational bulletin on Medicaid coverage of medical transportation. The 2020 year-end Consolidated Appropriations Act (CAA) created a statutory basis for a longstanding regulatory interpretation that generally requires State Medicaid programs to assure transportation for beneficiaries to and from covered services, including both emergency and non-emergency medical transportation (NEMT). The Appropriations Act also added new requirements for NEMT providers and drivers. States must submit a state plan amendment (SPA) to ensure state compliance with the provisions added by the CAA.
 
The Informational Bulletin is available here.
 
CMS Updates QPP Participation Status Tool with Recent APM Data
On July 8^th, CMS updated its Quality Payment Program (QPP) Participation Status Tool based on the first snapshot for calendar year 2021 of Alternative Payment Model (APM) data. The snapshot includes data from Medicare Part B claims from January 1^st through March 31^st. The tool includes 2021 Qualifying APM Participant status and Merit-based Incentive Payment System (MIPS) APM participation status.
 
To view QPP participation status by performance years in the updated tool, providers may enter their National Provider Identifier (NPI) here. To view 2021 eligibility at the APM entity level, providers can log in here.
 
ONC Announces Timeline for Implementation of National Trusted Exchange Framework
On July 13^th, ONC published a blog post announcing the timeline for the implementation of the Trusted Exchange Framework and Common Agreement (TEFCA). ONC is required by the 21^st Century Cures Act to develop a national network to encourage interoperability and health information exchange. Under TEFCA, ONC aims to establish a floor of universal interoperability across the country by having qualified health information networks (QHINs) signing a common agreement and implementing the functional and technical requirements for exchange as specified in the QHIN Technical Framework. ONC and the Recognized Coordinating Entity, the Sequoia Project, aim to have the network open for participation in the first quarter of 2022.
 
The ONC post is available here.
 
ONC Publishes New EHR Reporting Program Certification Criteria for Comment
On July 14^th, ONC and its contractor, the Urban Institute, released a draft for public comment of new criteria for the Electronic Health Record (EHR) Reporting Program. Under this program, EHR developers seeking to maintain certification under ONC’s Health IT Certification program are required to report a set of measures on how their IT products are being used. For example, developers must report the number of patients who accessed their health information through various methods (third-party apps, patient portals, etc.). In this first draft, ONC is focusing on interoperability, as defined across four categories:

• Patient access;
• Public health information exchange;
• Clinical care information exchange; and
• Standards adoption and conformance.

Comments will be accepted through September 14^th. The draft measures are available here, and questions may be sent to EHRfeedback@urban.org.  
 
HRSA Issues Additional FY 2022 FQHC Service Area Competition
On July 8^th, HRSA posted a new Service Area Competition (SAC) opportunity for fiscal year (FY) 2022. Through the SAC, organizations may apply to participate in the FQHC program by taking over a grant in an existing service area. FQHCs are typically approved for a three-year period and, if they seek to renew, must reapply to the SAC. For this opportunity, there is an additional SAC open in Brooklyn.
 
Applications are due September 7^th. More information is available here. 

Legislative Updates

Congressional Democrats Announce Parameters for Next Reconciliation Bill
On July 13^th, Congressional Democrats announced they had reached an agreement on the FY 2022 budget resolution. The budget resolution will include reconciliation instructions directing Congressional committees to spend up to $3.5 trillion on many of the policy initiatives included in President Biden’s American Jobs Plan and American Families Plan. The budget reconciliation process allows legislation to pass the Senate with just 51 votes, avoiding the 60-vote threshold typically required to end debate and move to a vote on final passage of a bill. Senate Majority Leader Chuck Schumer (D-NY) announced his intention to pass the budget resolution in the Senate during the next two weeks. Following passage, committees will begin assembling the reconciliation bill.
 
House Appropriations Committee Passes 2022 HHS Appropriations Bill
On July 12^th, the House Appropriations Subcommittee on Labor, HHS, Education, and Related Agencies passed a fiscal year (FY) 2022 appropriations bill without any amendments. The draft bill included $253.8 billion in funding, a $55.2 billion increase over FY 2021, including $120 billion for HHS. The bill contains significant increases for HHS agencies such as the National Institutes of Health (NIH) and the CDC, as well as $367 million of earmarks for health care facility construction and renovation, and increased funding for HRSA workforce and rural health programs.
 
The bill faced significant opposition from Republicans because it would repeal the Hyde Amendment, a legislative provision barring the use of federal funds to pay for abortion except to save the life of the mother, or in cases of rape or incest. On July 15^th, the bill was cleared by the full House Appropriations Committee. However, many provisions are likely to change during Senate consideration.

Other Updates

Lown Institute Reports on Hospital Spending on Charity Care and Community Investment
On July 11^th, the Lown Institute Hospitals Index released the first ranking of over 3,600 hospitals on spending on charity care and community investment. Using hospital tax filings, and 2018 CMS cost reports, hospitals were ranked based on charity care spending, spending on other community health initiatives, and the proportion of patient revenue from Medicaid. Five of the top ten hospitals for community benefit are in New York, all part of NYC Health + Hospitals.
 
Lown also calculated a measure of “fair share spending” for private nonprofit hospitals, which compares each hospital’s spending to the value of its tax exemption. The report shows that 72% of private nonprofit hospitals spent less than their tax savings, which Lown terms a “fair share deficit,” for an overall deficit of $17 billion. Hospitals in New York with the biggest fair share surplus include Mount Sinai Beth Israel (+$25 million) and Mount Sinai Hospital (+$8 million).
 
FAIR Health Monthly Telehealth Regional Tracker Shows Decreased Telehealth Use
On July 7^th, FAIR Health released its Monthly Telehealth Regional Tracker, reporting telehealth usage within the privately insured population for April 2021. Overall, the use of telehealth relative to other services continued to decline. Nationally, telehealth services decreased from 5.6% of all claims in March 2021 to 4.9% of all claims in April. The decrease is largely driven by the return of non-mental health services to in-person settings. Mental health conditions continue to be the leading telehealth diagnosis, with mental health conditions increasing from 57% of all claims in March 2021 to 58.6% in April. Acute respiratory diseases and infections also increased as a percentage of all claims, suggesting a return to non-COVID respiratory conditions.

Congressional Hearings

Tuesday, July 20^th:

• At 10am, the Senate Health, Education, Labor, and Pensions (HELP) Committee will hold a hearing entitled “The Path Forward: A Federal Perspective on the COVID-19 Response.” More information is available here.
• At 10:15am, two House Education and Labor subcommittees (the Subcommittee on Health, Employment, Labor, and Pensions and the Subcommittee on Higher Education and Workforce Investment) will hold a joint hearing entitled “Care for Our Communities: Investing in the Direct Care Workforce.” More information is available here. 

Wednesday, July 21^st: 

• At 10am, the Senate HELP Subcommittee on Primary Health and Retirement Security will hold a hearing to examine disparities in life expectancy. More information is available here. 
• At 10am, the House Education and Labor Subcommittee on Workforce Protections and Subcommittee on Civil Rights and Human Services will hold a joint hearing entitled “Phasing Out Subminimum Wages: Supporting the Transition to Competitive Integrated Employment for Workers with Disabilities.” More information is available here. 

New York State Updates

OMH Submits ARP Community Mental Health Services Block Grant Funding Plan
On July 9^th, the Office of Mental Health (OMH) submitted a funding plan and preliminary budget (available here) to the federal Substance Abuse and Mental Health Services Administration (SAMHSA) for use of the additional $80 million in supplemental Community Mental Health Services (CMHS) block grant funding made available by the American Rescue Plan (ARP).
 
The State is also receiving over $46 million in supplemental CMHS block grant funding included in the 2020 year-end Consolidated Appropriations Act (CAA), and OMH recently released a report (available here) outlining priorities for the CAA funding. With the $80 million from the ARP, OMH intends to build upon those priorities across the following five categories: 

• Crisis Service Development (over $17 million)
• Child and Family Service Development (over $16 million)
• Adult Ambulatory Service Development (over $14 million)
• Workforce and System Capacity Development (over $20.9 million)
• First Episode Psychosis Service Development (over $8 million)

The State intends to allocate approximately $4 million to support administrative activities.
 
OPWDD Adopts Amended Rate Methodologies for Day Habilitation and Residential Services
On July 14^th, the Office for People with Developmental Disabilities (OPWDD) posted a notice of adoption in the State Register (available here) of a rule modifying reimbursement rates for day and residential habilitation services. Specifically, the rule will reduce rates for Residential Habilitation delivered in Individualized Residential Alternatives (IRAs) and for non-state providers of Day Habilitation. In the calculation of the occupancy adjustment for IRAs, OPWDD will eliminate the factor based on a system-wide assessment of vacancy utilization and limit reimbursement for periods when individuals are not on-site, such as therapeutic leave or retainer days.
 
OPWDD noted stakeholder concerns that these cuts violate the provision of the ARP requiring that states seeking enhanced home and community-based services (HCBS) matching funds may not reduce reimbursement for HCBS services from the levels in effect as of April 1, 2021. OPWDD replied that because these regulations represent the final implementation of a waiver amendment with an effective date of October 1, 2020, they do not represent a cut to reimbursement rates that were in effect afterwards.
 
DFS Adopts Surprise Billing Rule to Incorporate Out-of-Network Emergency and Resulting Inpatient Services
On July 14^th, the New York State (NYS) Department of Financial Services (DFS) posted a notice of adoption in the State Register (available here) of a rule that expands NYS’s surprise billing regulations to conform with federal requirements recently passed in the No Surprises Act.
 
Specifically, NYS’s regulations now require plans to cover out-of-network emergency department (ED) services and inpatient services that follow such an ED visit. Under the original 2014 rule, the Independent Dispute Resolution (IDR) process was established to handle emergency services provided (1) at in-network hospitals by out-of-network providers or (2) when referred by an in-network provider. Under this amendment, consumers will also be protected from surprise bills if they receive emergency care at a hospital that does not participate in their insurance plan’s network.
 
The amended regulation also expands and clarifies the responsibilities of health care plans, hospitals, and IDR entities in relation to the IDR process, including notices, timeframes, and the determination of a reasonable fee. Specific requirements, in the case of disputes involving emergency care provided at a non-participating hospital, include:  

• Health plans are required to notify consumers if a bill is a covered surprise bill, and that if it is, they may submit an assignment of benefits (AOB) form and will then not be responsible for out-of-pocket costs greater than their in-network responsibility.
• Non-participating hospitals providing emergency care are required to provide their patients with claim forms and AOB forms, and, for patients who submit an AOB, to bill them only for their in-network cost-sharing.

There were no changes to the rule following a public comment period. The regulations will be effective on August 13^th.
 
OIG Releases Report on NYS Health Home Reimbursement Claims
On July 7^th, HHS OIG released a report of findings from a recent audit of the NYS Health Home program. The audit, which investigated Health Home services delivered to beneficiaries diagnosed with serious mental illness or substance use disorder, stated that most claims (141 of 150) were billed properly. However, based on the remaining claims with errors, OIG estimated that NYS improperly claimed at least $6 million in federal Medicaid reimbursement for payments made to Health Home providers.
 
The full report is available here and the OIG summary is available here.
 
32BJ Health Fund Reports Low Compliance with Price Transparency Requirements Among NYC Hospitals
This week, the 32BJ Health Fund, which provides benefits to building services union members and their eligible dependents, released a report that investigated whether hospitals in the downstate area (including New York City, Long Island, and the Hudson Valley) are in compliance with federal price transparency regulations. The federal regulations (available here) require hospitals to publish data on cost, including payer-negotiated rates, as well as consumer-friendly episode-based charge information for 300 “shoppable” services. Of the 81 hospitals analyzed, 32BJ found that 28 had made available negotiated price information, while less than a quarter (23.5 percent) had produced “high quality” data, containing at least 1,000 diagnosis-related groups (DRGs) for inpatient data and at least one payer-negotiated rate per code.
 
The report is available here.
 
Updated Resources on NYS and Other Spending Plans for Enhanced HCBS ARP Funding
On July 9^th, NYS published its initial spending plan for funds made available due to the ARP’s enhanced FMAP for Medicaid HCBS provided during the year from April 1, 2021 to March 31, 2022. In total, the State estimates that it will draw down approximately $5.4 billion in federal funding, including $2.15 billion of state funds equivalent to savings from the enhanced FMAP (SFE), and $3.25 billion of additional federal matching funds that will be generated through reinvestment of the SFE funds into matchable HCBS service spending.
 
The spending plan would fund proposals across the following three categories: 

• Supporting and strengthening the direct care workforce ($1.29 billion);
• Building HCBS capacity through innovations and systems transformation, including new pilots and expansion of existing services ($750 million); and
• Investing in digital infrastructure ($104 million).

Please note that amounts listed in the spending plan do not reflect the full federal matching funds that may be available. In most cases, NYS has indicated mechanisms—such as Section 438.6 directed payments, State plan amendments, or waiver amendments—through which it intends to obtain expenditure authority that would allow this spending to draw down matching funds. 
 
SPG has prepared a reference guide to the spending plan’s proposals, which is available here. SPG also earlier prepared a similar document detailing four other states’ plans for comparison, which is available here.
 
The full spending plan is available here. Transcripts and recordings of stakeholder public comment sessions are available here.