Weekly Health Care Policy Update – August 29, 2022

September 6, 2022

In this update: 

  • Legislative Update
    • Wyden Seeks Information from 15 States on Deceptive MA Marketing Practices
  • Federal Agencies
    • HHS Issues Letter to Governors Encouraging Use of Medicaid to Provide Reproductive Services
    • CMS Issues Bulletin Encouraging Performance-Driven Payments for Nursing Homes
    • CMS Indefinitely Delays Radiation Oncology Model
    • CMS Provides $100 Million to Returning Marketplace Navigators
    • HRSA Awards $20 Million to Health Centers to Expand HIV Care
  • Other Updates
    • Epic CEO Judy Faulkner Outlines Product Updates
  • New York State Updates
    • DOH Releases New Healthcare Worker Bonus FAQs and Slides, Clarifying Employer Eligibility and Other Issues
    • DOH Announces Virtual Public Forum for New York’s Existing 1115 Waiver Programs
    • CMS Approves NHTD and TBI Appendix K Waiver Amendment
  • Funding Opportunities
    • Governor Hochul Announces $20 Million in Statewide Support for Substance Use Providers
    • NYC HPD Releases Concept Paper for Housing Management/Maintenance Training and Technical Assistance
    • NYS DOH Releases RFA to Improve Equity Through Clinical HIV Prevention in Community Health Settings

Legislative Update

Wyden Seeks Information from 15 States on Deceptive MA Marketing Practices
On August 23rd, Senate Finance Committee Chairman Ron Wyden (D-OR) announced an investigation into potentially deceptive marketing practices by Medicare Advantage (MA) plans. Wyden noted that the number of complaints about MA plans that were reported to the Centers for Medicare & Medicaid Services (CMS) more than doubled from 2020 to 2021. The Committee has also received reports of “aggressive sales practices” that may be false, misleading, or fraudulent. Wyden is requesting information from 15 state insurance commissioners (including New York) on examples of such practices and data on their prevalence. Specific practices might include: 

  • False marketing related to supplemental benefits;
  • Practices that would result in a greater number of prescriptions filled by a given pharmacy or chain;
  • False or misleading comparisons between MA and Medicare Supplemental plans; and
  • Enrollment practices such as cross-selling or enrollment without contact.

A press release on the investigation is available here.

Federal Agencies

HHS Issues Letter to Governors Encouraging Use of Medicaid to Provide Reproductive Services
On August 26th, Secretary of Health and Human Services (HHS) Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure issued a letter to governors which invites states to apply for Medicaid 1115 waivers to “provide increased access to care for women from states where reproductive rights are under attack and women may be denied medical care.” The letter specifically notes that HHS is willing to engage on using waivers to enable states to access federal Medicaid funding “within the scope of Medicaid’s legal authority” to provide abortion care for “women traveling from a state that has restricted or prohibited abortion services.”
 
In addition to the letter, HHS also issued a report entitled “Health Care Under Attack: An Action Plan to Protect and Strengthen Reproductive Care.” The report summarizes the various actions the Administration has taken in the last several months to respond to the overturning of Roe v. Wade, specifically in the following areas: 

  • Access to medication abortion and contraception, including the Food and Drug Administration’s (FDA) removal of the in-person dispensing requirement for mifepristone and the Administration’s position that states may not ban mifepristone “based on disagreement with FDA’s expert judgment about its safety and efficacy.”
  • Access to care under the law, including nondiscrimination enforcement through HHS’s Office of Civil Rights (OCR) to ensure pharmacies supply prescribed medications and ongoing lawsuits around the Emergency Medical Treatment and Labor Act (EMTALA) superseding state laws against abortion under emergency circumstances.
  • Protecting patient privacy, through enforcement of the HIPAA Privacy Rule to protect information around abortion care.
  • Improving awareness and education, through several outreach initiatives and the ReproductiveRights.gov website.
  • Improving data and research, to measure the effect of restrictive abortion policies on maternal mortality and morbidity, frequency of abortions, and use of contraception.

The report is available here. HHS issued a press release announcing the letter and report which is available here.
 
CMS Issues Bulletin Encouraging Performance-Driven Payments for Nursing Homes
On August 22nd, the Center for Medicaid and CHIP Services (CMCS) issued an informational bulletin encouraging state Medicaid programs to use more performance-driven payments for nursing to advance health equity and improve outcomes. The document details actions that states can take using existing Medicaid authorities to reduce their reliance on institutional services and expand access to high-quality home-and community-based services (HCBS). Specifically, CMS is encouraging states to:

  • Design payment structures to incentivize providers for implementing or performing highly on efforts to improve resident quality of care, such as by establishing higher rates for single-occupancy rooms;
  • Increase accountability for patient safety, such as by using CMS Quality Ratings to adjust payments; and
  • Leverage payment approaches to strengthen staffing, such as by including eligible training costs in rates.

The full bulletin is available here.
 
CMS Indefinitely Delays Radiation Oncology Model
On August 25th, CMS published a final rule indefinitely delaying the start of the CMS Innovation Center’s Radiation Oncology Model, which was originally scheduled to begin on January 1, 2021. The indefinite delay was proposed by CMS in April, following two delays mandated by Congress in the year-end 2020 and 2021 omnibus bills. Provider groups have expressed opposition to the model in its current form, including the “discount factor” for episode payments and the model’s geographic scope, arguing that CMS has prioritized savings over transformation. The final rule indicates that CMS will propose a new start date through future rulemaking, which will be at least six months in advance of the new start date.
 
More information on the Radiation Oncology model can be found here. The final rule can be found here.
 
CMS Provides $100 Million to Returning Marketplace Navigators
On August 26th, CMS announced an investment of nearly $100 million in grant funding to 59 returning Navigator organizations for the 2023 Open Enrollment Period. The funding is intended to enable Navigator organizations to retain the roughly 1,500 Navigators who were trained for the 2022 open enrollment period, and hire additional staff as well. Navigators are not-for-profit, independent entities that help consumers prepare applications, establish eligibility, and enroll in coverage through Marketplaces, with a particular focus on outreach to underserved communities. In 2022, Navigators contributed to the enrollment of 14.5 million Americans who signed up for coverage on a Marketplace.
 
A full list of awardees is available here.

HRSA Awards $20 Million to Health Centers to Expand HIV Care
On August 24th, the Health Services and Resources Administration (HRSA) announced the award of $20 million to 64 health centers as part of the Department of Health and Human Services’ Ending the HIV Epidemic in the U.S. (EHE) initiative, which aims to reduce the number of new HIV infections in the U.S. by 90% by 2030. The funding is specifically focused on expanding HIV prevention (including pre-exposure prophylaxis and related services), testing, and treatment services at health centers nationwide. The funding is also intended to help health centers strengthen partnerships with community organizations and health departments.
 
Award recipients in New York include BronxCare Health Integrated Services System, Bedford Stuyvesant Family Health Center, Healthcare Choices NY, and The Floating Hospital Inc. A full list of award recipients is available here.

Other Updates

Epic CEO Judy Faulkner Outlines Product Updates
On August 23rd, Epic CEO Judy Faulkner outlined upcoming changes to the company’s products during an annual User Group Meeting. Epic is planning to add additional capabilities to its Cosmos life sciences research platform—a database of deidentified electronic health records data—to allow patients to connect to clinical trials, bring doctors together treating patients with similar rare conditions, and allow providers to share data on trial participants with study sponsors. In addition, Epic will add genomics and patient-reported outcome data to the platform. Epic also announced the development of “MyChart Central,” which will provide patients with a single sign-on to portals from various providers, and allow patients to search for physicians on the Epic platform by specialty and insurance status.

New York State Updates

DOH Releases New Healthcare Worker Bonus FAQs and Slides, Clarifying Employer Eligibility and Other Issues
Today (August 29th), the New York State Department of Health (DOH) released new frequently asked questions (FAQs) and slides from a new town hall webinar on the Healthcare Worker Bonus (HWB) program. Notable clarifications and updates include:

  • Qualification through 20% Threshold: Qualifying employers do not need to be in the list of provider types in the statute if they meet the 20% Medicaid threshold. An employer may be eligible if it meets all of the following criteria: 
    • Is enrolled in Medicaid;
    • Bills for Medicaid services;
    • Employs at least one eligible employee; and
    • Is any of the following: 
      • On the list of provider types in the statute;
      • Subject to a Certificate of Need (CON) process; or
      • Serves at least 20% Medicaid enrollees.
  • Grace Period for Vesting Period 1: DOH will allow a grace period for submissions for Vesting Period 1 (October 2021 through March 2022), for which submissions are due September 2nd. Employers may submit Vesting Period 1 claims during the Vesting Period 2 submission period (October 1st through October 31st).
  • Contract Staff: Contrary to previous guidance, contract staff will be eligible for the HWB program. Employers who have staff who are otherwise eligible but who are employed through third-party staffing arrangements such as a professional employer organization (PEO) should submit claims for such staff. The qualified employer, not the contracted agency, must submit the claim.
  • Medical Residents: Medical Residents and Medical Fellows are eligible for the HWB bonuses, regardless of if they have transferred to alternate roles during the vesting period, except for if the transfer occurs during Vesting Period 4 and is to an unaffiliated hospital.
  • Guidance on Calculations: The guidance answers various questions around the calculation of base salary and average hours to determine eligibility, including that overtime hours do not count towards the average hours worked.

Rather than host live webinars, DOH intends to post pre-recorded Town Hall Webinars on HWB Program website on a weekly basis, although this week only the slides are available.
 
The HWB Program website is available here. The FAQ is available here and the slides are available here. Questions may be submitted to NYSWorkersBonus@health.ny.gov.
 
DOH Announces Virtual Public Forum for New York’s Existing 1115 Waiver Programs
On September 28th from 1pm-4pm, DOH will host a virtual public forum for New York’s existing 1115 Waiver programs, during which the public may provide oral comments. The forum is focused on New York’s current 1115 Medicaid Redesign Team (MRT) Waiver, which authorizes the State’s Medicaid managed care delivery system, among other provisions. The MRT Waiver was renewed for five years on April 1, 2022. Please note that this forum is not a public comment opportunity for the State’s recently proposed 1115 health equity-focused waiver amendment.
 
Public comment may be submitted to 1115waivers@health.ny.gov through October 10thwith the subject line “1115 Public Forum Comment.” Pre-registration is required for oral comments, which is available here. Questions may be submitted to the email address above.
 
Additional details are available in the State Register here.
 
CMS Approves NHTD and TBI Appendix K Waiver Amendment
On August 18th, CMS approved the Nursing Home Transition (NHTD) and Traumatic Brain Injury (TBI) Appendix K Waiver Amendment. The Amendment includes the following changes: 

  • A retroactive effective date of April 1, 2022 for the new hourly rate for Home and Community Support Services (HCSS) Nursing Visits; and
  • A 1 percent across the board rate increase for NHTD and TBI waiver services, consistent with the 2023 Enacted New York State Budget.

The Appendix K Waiver Amendment is available here.

Funding Opportunities

Governor Hochul Announces $20 Million in Statewide Support for Substance Use Providers
On August 22nd, Governor Hochul announced $20 million in funding to support addiction services providers that have been impacted by the ongoing effects of the Covid-19 pandemic. The funding is available through the supplemental federal Substance Abuse Prevention and Treatment Block Grant award and the Request for Applications (RFA) will be administered by the Office of Addiction Services and Supports (OASAS).
 
Funding may be used to support reasonable, necessary, and allowable program costs incurred after March 15, 2021 that were not previously and will not otherwise be reimbursed by other funding or grants. Examples of allowable use of funds include payroll expenses, staff recruitment costs (including signing bonuses), training, infection control, and supplies, among others.
 
Eligible applicants are voluntary agencies or local governmental units that provide direct substance use disorder treatment, prevention, and/or recovery services that: 

  • Are OASAS-certified and/or funded by OASAS State Aid; and
  • Were operational prior to January 31, 2020.

The Governor’s press release is available here. The RFA is available here. Applications will be accepted on a rolling basis through October 11th. Questions may be submitted to COVIDFunds@oasas.ny.gov through September 6th.
 
NYC HPD Releases Concept Paper for Housing Management/Maintenance Training and Technical Assistance
On August 23rd, the New York City (NYC) Department of Housing Preservation and Development (HPD) released a Concept Paper outlining a forthcoming Request for Proposals (RFP) that will seek applicants to provide training and technical assistance for housing management and maintenance. Training and technical assistance will be directed towards Board of Directors and will include areas such as capacity building, organizational skills, governance, financial and reporting compliance, and building management and maintenance.
 
NYC HPD intends to award one citywide contract with $6 million in total funding ($2 million annually). The contract will last for three years, with two three-year renewal options.
 
The Concept Paper is available here. Comments may be submitted to alterj@hpd.nyc.govor chapmanj@hpd.nyc.gov through October 6th with the subject line “Training and Technical Assistance for Housing Management and Maintenance Concept Paper.”
 
NYS DOH Releases RFA to Improve Equity Through Clinical HIV Prevention in Community Health Settings
On August 25th, DOH released an RFA seeking applicants for two opportunities that aim to improve screening, diagnosis, treatment, and prevention of human immunodeficiency virus (HIV), sexually transmitted infections (STIs), and hepatitis C (HCV) in community health settings: 

  • Component A: Pre-Exposure Prophylaxis (PrEP) Services in Primary Care Settings
  • Component B: Young Adult Community Access Programs (YACAP)

DOH will award over $8.4 million in annual funding during the five-year program. Annual awards for Component A will not exceed $225,000 and annual awards for Component B will not exceed $340,000 ($400,000 in NYC). The number of awards by region for each component is outlined in the RFA.
 
Eligible applicants are not-for-profit 501(c)(3) Article 28-licensed health care organizations. The applicant’s service site must be located within medically underserved areas (MUAs) with disproportionate instances of HIV and STIs. Applicants should propose a comprehensive, patient-centered health engagement model that uses a health equity lens, incorporates the Bureau of HIV Ambulatory Care Services Guidance Principles, and routinely collects and analyzes social determinants of health data.
 
The RFA is available here. Applications are due on October 11th.