Weekly Health Care Policy Update – October 11, 2022

October 18, 2022

In this update: 

  • Federal Agencies
    • CMS Issues RFI on National Provider Directory
    • IRS Finalizes Rule to Fix Family Glitch
    • CMS Releases 2023 Medicare Advantage Star Ratings
    • CMS Starts Designing Implementation of Medicare Drug Price Negotiation
    • Information Blocking Rule Expands to Include All EHI
    • HRSA Invests $266 Million in Community and Public Health Workforce
    • Biden’s AAPI Advisory Commission Releases Inaugural Report
    • HHS Awards $4.8 Million for Community-Driven Approaches to Tackling Structural Racism
    • HHS Awards $4 Million in Language Access Initiative
  • Other Updates
    • MedPAC Holds October Public Meeting
    • PatientRightsAdvocate.Org Report Says Hospitals Are Omitting Prices from Transparency Reports
    • AMA and AAP Write to AG on Violence Against Hospitals and Physicians
  • New York State Updates
    • DOH Issues NYHER 1115 Waiver Amendment Application FAQ
    • DOH Posts Waiver Request for IMD Short-Term Stays and In-Reach Services Reimbursement for Public Comment
    • Health Care Worker Bonus Program Portal Opens for Vesting Period 2
    • DOH Updates Plan Guidance on Non-Risk Minimum Payments for Children’s HCBS
    • OMH Extends Commissioner’s Regulatory Waiver
    • DOH Implements Electronic Noticing Guidelines for Medicaid Managed Care Plans
  • Funding Opportunities
    • DOH Releases RFA for Breast, Cervical, and Colorectal Cancer Services Screening Program
    • DOH Releases RFP for Person-Centered Planning Statewide Training Initiative
    • HRSA Announces Funding Opportunity for FY 2023 Residency Training in Mental and Behavioral Health
    • HRSA Announces Funding Opportunity for FY 2023 Family Engagement and Leadership in Systems of Care Program

Federal Agencies

CMS Issues RFI on National Provider Directory
On October 5th, the Centers for Medicare & Medicaid Services (CMS) issued a request for information (RFI) regarding a potential National Directory of Healthcare Providers & Services (NDH). CMS notes that currently, many types of payers are required to provide access to provider directories. However, information in these directories is often inaccurate, and seeking to maintain accurate information creates a significant administrative burden on payers and providers. The creation of an NDH would therefore potential opportunity for CMS to alleviate some of these burdens and improve directory accuracy.
 
CMS envisions the NDH as an Application Programming Interface (API)-enabled, “centralized data hub” containing accurate, up-to-date information that is validated by CMS against primary sources. CMS poses several questions in the RFI, some of which include: 

  • What types of providers and data elements should be included in a directory, including from existing CMS systems?
  • What types of health information exchange would it be important for the directory to support?
  • What state or local level systems should the NDH connect with?
  • How could CMS encourage participation in the directory by health plans not currently under CMS’s purview (i.e., group health plans)?
  • Are there use cases for the NDH to address social determinants of health?

The RFI is available here. Responses are due December 6th.
 
IRS Finalizes Rule to Fix Family Glitch
On October 11th, the Internal Revenue Service (IRS) finalized its proposed rule to change its policy to end the “family glitch” in eligibility for Affordable Care Act (ACA) premium tax credits. Under the ACA, individuals who are offered “affordable” employer-sponsored coverage are ineligible for premium tax credits to purchase Marketplace coverage. Currently, the affordability determination is based on the premium for an individual (self-only coverage) as a percentage of family income (9.5% indexed annually). Therefore, if self-only coverage is determined “affordable” for an employee, then the coverage is also considered affordable for a spouse and any dependents, regardless of the actual family coverage premium. An estimated 5.1 million Americans, most of whom are children, are ineligible for premium tax credits under the current regulations.
 
Under the final rule, the IRS reinterprets the statute to define employer-sponsored coverage as “affordable” for individuals related to the employee if the employee’s portion of the premium for family coverage does not exceed 9.5% (indexed annually) of household income. Family coverage includes all employer plans that cover any related individuals, including self plus-one plans. The IRS estimated that 200,000 uninsured individuals will gain coverage and 1 million will have more affordable coverage as a result of the final rule.
 
Notably, the rule does not make any changes to the employer mandate. As such, employers will continue to meet the ACA’s requirement to offer affordable coverage so long as the portion of the premium the employee must pay for self-only coverage does not exceed 9.5% (indexed annually) of household income, regardless of the cost of family coverage.
 
The final rule is largely the same as the proposed rule, except for one change related to the determination of whether employer coverage provides “minimum value” to related individuals. Under the final rule, a plan will be determined to provide minimum value to related individuals so long as the plan offers minimum value to the employee, and the scope of benefits and cost-sharing are the same for the employee and for their related individuals. This is to avoid the need to use a separate population, different from the standard population, for family members, to calculate minimum value.
 
The final rule can be found here. It is scheduled to be formally published in the Federal Register on October 13th and to go into effect on December 12th.
 
CMS Releases 2023 Medicare Advantage Star Ratings
On October 6th, CMS released the 2023 edition of the Medicare Advantage (MA) and Part D Star Ratings. This year, CMS rated 507 contracts in total (most national plans have multiple contracts operating in different regions). The average star rating decreased from 4.37 last year to 4.15. About 51% of combined MA-Part D plans (260 contracts) will have 4 stars or higher next year, down from nearly 70% in 2022. Plans receiving 4 stars or more are eligible for a 5% quality bonus
 
These decreases are in part because in 2022, nearly all contracts qualified for the regulatory adjustment due to extreme and uncontrollable circumstances related to Covid-19. By comparison, the 2023 Ratings are more similar to the 2020 Ratings (average rating of 4.16, with 52% of contracts receiving 4 stars or higher). However, this year more plans received 5 stars (11%, compared to 5% in 2020) and more plans also received 3 stars or lower (26%, compared to 15% in 2020).
 
A fact sheet on the Star Ratings is available here.
 
CMS Starts Designing Implementation of Medicare Drug Price Negotiation
CMS is beginning to establish a 95-employee group to operate its new authority to negotiate drug prices under the Inflation Reduction Act. The new group is called the Medicare Drug Rebate and Negotiations Group. The group will have six divisions: 

  • Rebate agreements and drug price negotiations;
  • Policy;
  • Data assessments and analytics;
  • Manufacturer data and inflation rebate operations;
  • Manufacturer compliance and oversight; and
  • Contract support.

Staff will include contract officers, economists, pharmacists, and data managers. Kristi Martin, a senior advisor at CMS, is currently leading the hiring process. A formal initial framework will be outlined in forthcoming regulatory guidance. The new group’s organization chart is available here.
 
Information Blocking Rule Expands to Include All EHI
As of October 6th, the 21st Century Cures Act’s regulations prohibiting information blocking are expanding to cover all electronic health information (EHI). Before October 6th, the Office of the National Coordinator (ONC) defined EHI for the purposes of information blocking requirements to include only data elements contained in the United State Core Data for Interoperability (USCDI), version 1. Starting October 6th, the EHI definition includes all electronic health information covered under the Designated Record Set, i.e., all electronic data protected under the HIPAA Privacy Rule. Enforcement is delegated to the Office of the Inspector General (OIG), which has not yet issued final regulations regarding civil monetary penalties.
 
The ONC published a blog post on September 30th reminding entities of this change and its implications, which is available here. ONC is also holding office hours for questions about information sharing on October 27th at 2pm. Registration is available here.
 
HRSA Invests $266 Million in Community and Public Health Workforce
On September 30th, the Health Resources and Services Administration (HRSA) awarded more than $266 million in American Rescue Plan funding to bolster both the community and public health workforces.  HRSA is awarding a total of $225.5 million to 83 grantees through the Community Health Worker Training Program, a new multi-year program to support training and apprenticeship of roughly 13,000 community health workers. HRSA is also awarding $40.7 million to 29 grantees through the Public Health Scholarship Program, which will encourage individuals to pursue training and careers in public health. Awardees in New York include: 

  • Research Foundation of the City University of New York;
  • Research Foundation of the State University of New York;
  • Sunset Park Health Council;
  • D’Youville College;
  • Cicatelli Associates; and
  • Staten Island Performing Provider System.

More information is available here.
 
Biden’s AAPI Advisory Commission Releases Inaugural Report
On September 30th, the President’s Advisory Commission on Asian Americans, Native Hawaiians, and Pacific Islanders released its inaugural report. The Commission is co-chaired by Department of Health and Human Services (HHS) Secretary Xavier Becerra and U.S. Trade Representative Ambassador Katherine Tai, and has six subcommittees, with one specifically focused on health equity. The Health Equity subcommittee approved one recommendation at the full commission meeting: that HHS, in coordination with the White House Office of Public Engagement and Commission, host a mental health summit focusing on Asian American, Native Hawaiian, and Pacific Islander mental health in October or November of 2022.
 
More information, including the full report, is available here.
 
HHS Awards $4.8 Million for Community-Driven Approaches to Tackling Structural Racism
On October 3rd, the Office of Minority Health (OMH) at HHS awarded a total of $4.8 million to ten organizations under its Community-Driven Approaches to Address Factors Contributing to Structural Racism in Public Health initiative. The three-year grants are intended to “identify new and innovative ways to address politics that create or perpetuate health disparities and may contribute to structural racism.” Specifically, recipients will assess the impact of existing policies or practices, and the implementation of new or modified policies and practices, to address factors contributing to health disparities and structural racism in health services.
 
Under the grant program, Flushing Hospital Medical Center received $499,923. The project period began on September 30th. More information on the grant awards is available here.
 
HHS Awards $4 Million in Language Access Initiative
On October 6th, the OMH at HHS announced grants to 11 organizations totaling over $4 million to cover “developing and testing methods of informing individuals with limited English proficiency (LEP) about the availability of language access services in health care-related settings.” The three-year initiative, “Promoting Equitable Access to Language Services in Health and Human Services,” aims to ensure appropriate communication with patients who have limited English proficiency, so that patients have meaningful access to programs, free of barriers or discrimination. Grant recipients are expected to implement and evaluate strategies to enhance language access services through policy development and implementation, technology utilization, education for individuals with LEP, and education for providers.
 
The NYU Grossman School of Medicine received $374,998 under this grant. More information is available here.

Other Updates

MedPAC Holds October Public Meeting
On September 29th and 30th , the Medicare Payment Advisory Commission (MedPAC) held its October public meeting. Commissioners held sessions to consider the following: 

  • Supporting safety-net clinicians: Staff presented a framework for identifying safety-net providers and determining whether new Medicare funding for such clinicians is warranted.
  • A prototype design for a post-acute care (PAC) prospective payment system (PPS): The Consolidated Appropriations Act of 2021 requires MedPAC to design a prototype PAC PPC and analyze its potential effects on Medicare payments and providers. Staff proposed the work plan for developing the prototype over the next year for Commissioner feedback.
  • Nursing facility staff: Staff reviewed federal and state nursing facility staffing requirements and Commissioners provided feedback on future work.
  • A study on the expansion of telehealth: The Consolidated Appropriations Act of 2022 required MedPAC to submit a report to Congress by June 2023 on the use of telehealth services during the public health emergency (PHE) and the impact of expanded access to telehealth services on care quality and access. Commissioners provided direction on this work.
  • A Congressionally requested report on Medicare and inpatient psychiatric facility care: In the first stage of work responding to the Congressional request, staff provided an overview of inpatient psychiatric facilities and Medicare payments.
  • An analysis of Part D data on drug rebates and discounts: Staff updated Commissioners about ongoing work evaluating direct and indirect remuneration (DIR) data to which MedPAC was recently granted access.

All slide presentations from the meeting are available here. MedPAC will hold its next monthly meeting November 3rd and 4th.
 
PatientRightsAdvocate.Org Report Says Hospitals Are Omitting Prices from Transparency Reports
On October 5th, PatientRightsAdvocate.org, a consumer advocacy organization, issued a report on hospital compliance with price transparency requirements. The report compared 20 price disclosures for the same services from hospitals and plans, since both types of entities are required to post price transparency information under the Hospital Price Transparency Rule (for hospitals) and the Transparency in Coverage Rule (for plans).
 
The report examined only a set of for-profit hospitals owned by Hospital Corporation of America and Ascension. It found that in several cases, the hospital disclosures omitted or contained “N/A” for prices that were disclosed under the plan transparency files. The report concludes that “some large hospitals are not posting their complete price lists as required,” and encourages HHS to engage in “robust and timely enforcement” of the Hospital Price Transparency Rule as a result.
 
The full report is available here.
 
AMA and AAP Write to AG on Violence Against Hospitals and Physicians
On October 3rd, the American Academy of Pediatrics, the American Medical Association, and the Children’s Hospital Association sent a letter to Attorney General Merrick Garland urging the Department of Justice to “investigate the organizations, individuals, and entities coordinating, provoking, and carrying out bomb threats and threats of personal violence against children’s hospitals and physicians across the U.S.” The letter notes that providers are being targeted and threatened for “providing evidence-based care,” particularly evidence-based gender-affirming health care, and it has made work not only “dangerous and difficult” but disruptive to families seeking all services. It urges the Department of Justice to take “swift action to investigate and prosecute all organizations, individuals, and entities responsible.”
 
A copy of the letter is available here.

New York State Updates

DOH Issues NYHER 1115 Waiver Amendment Application FAQ
On October 3rd, the New York State Department of Health (DOH) issued a Frequently Asked Questions (FAQ) document related to the New York Health Equity Reform (NYHER) 1115 Waiver Amendment Application. The FAQ summarizes and addresses questions that the State received as part of the public comment process, including the structure and responsibility of the HEROs and SDHNs, advanced Value Based Payment (VBP) arrangements, the populations and services included in the housing-related strategy, and the implementation of telehealth, among others.
 
The FAQ is available here.
 
DOH Posts Waiver Request for IMD Short-Term Stays and In-Reach Services Reimbursement for Public Comment
On October 5th, DOH released a draft 1115 waiver amendment request that seeks authorization for federal Medicaid matching funds to reimburse Institutions for Mental Diseases (IMD) for inpatient, residential, and other services provided to Medicaid beneficiaries with serious mental illness (SMI) and substance use disorder (SUD). As part of this amendment, the State is requesting: 

  • Federal reimbursement for visits at State-operated IMDs and from SUD residential treatment facilities within a 30-day statewide average length of stay, i.e., inpatients discharged from such facilities within 60 days if the average length of stay is less than 30 days. As part of this, the State will transform selected (pilot site) State-run psychiatric hospitals, facilities, and campuses from long-term care institutions to community-based enhanced service delivery systems, offering various services including: 
    • Crisis intervention services;
    • Step-down services to assist with the transition to community residential programs;
    • Recovery centers;
    • Mobile Integration Teams; and
    • The Pathway Home program.
  • Authorization for Medicaid coverage of a targeted set of in-reach services for people with SMI up to 30 days prior to discharge including care management, clinical consultations, peer services, and pharmaceutical management. These services would be available to individuals who do not fall into the 30-day average length of stay cohort, with the goal of increasing the proportion of patients who are effectively discharged from these facilities within 60 days.

The total cost of the amendment is estimated at $268 million over five years. Estimated enrollment is as follows: 

  • IMD Inpatient Services for People with SMI: 450 in year 1, increasing to 1,200 in year 5
  • Residential Services for People with SUD: 2,218 in year 1, increasing to 3,346 in year 5
  • In-Reach Services for People with SMI: 1,600 per year

The waiver amendment is available here. Public comment may be submitted to 1115waivers@health.ny.gov through November 4th. The State will also host two virtual public hearings, on October 26th at 3:30pm and on October 31st at 11am. Additional details, including how to register for the public hearings, are available here. 
 
Health Care Worker Bonus Program Portal Opens for Vesting Period 2
On October 5th, DOH announced that the Health Care Workforce Bonus (HWB) portal is now available for submission by eligible employers on behalf of their employees who qualify for bonus payments for Vesting Period 2. Vesting Period 2 is the timespan between April 1, 2022 and September 30, 2022. The portal will be open for submissions through October 31st.
 
The HWB portal is available here. Additional information is available on the HWB program webpage here.
 
DOH Updates Plan Guidance on Non-Risk Minimum Payments for Children’s HCBS
On September 19th, DOH sent a notification to Medicaid managed care plans (MMCPs) regarding non-risk minimum payments for children’s Home and Community-Based Services (HCBS). Children’s HCBS were carved-in to the managed care package on October 1, 2019, at which point the State required MMCPs to pay, at minimum, government fee-for-service rates for 24 months. Due to the Covid-19 Public Health Emergency, the State extended this requirement indefinitely. On August 26, 2022, the State extended the deadline through September 30, 2023.
 
This notice clarifies that children’s HCBS will continue to be non-risk for MMCPs while this requirement is in effect. MMCPs should continue to submit claims to eMedNY for children’s HCBS with dates of service on or before September 30, 2023. The State will be in communication with MMCPs to determine if an additional extension will be considered.
 
The notice is available here. Questions may be submitted to BH.Transition@health.ny.gov.
 
OMH Extends Commissioner’s Regulatory Waiver
On October 4th, the Commissioner of the New York State Office of Mental Health (OMH) extended the previously issued Commissioner’s Waiver for an additional 120 days through February 1, 2023. As noted in last week’s update, OMH has now adopted the new Part 596 telehealth regulations, which codify many of the flexibilities put in place under the Commissioner’s Waiver.
 
The waiver is available here.
 
DOH Implements Electronic Noticing Guidelines for Medicaid Managed Care Plans
Effective October 1, 2022, DOH has implemented the electronic transmittal of Managed Care Organization (MCO) notices when the enrollee has indicated their preference to receive these notices by electronic means. This includes all notifications required for MCO coverage determination, complaint, grievance, service authorization, adverse determination, or appeal processes. The MCO requirements within this guidance also apply to Management Contractors.
 
The guidance is available here. Questions may be submitted to MLTCinfo@health.ny.govfor all dual/long-term care plans (MLTCP, PACE, MAP), and to OMCmail@health.ny.govfor all other plans.

Funding Opportunities

DOH Releases RFA for Breast, Cervical, and Colorectal Cancer Services Screening Program
On October 6th, DOH released a Request for Applications (RFA) for the implementation of breast, cervical, and colorectal cancer screening programs. DOH will award over $41 million in total funding across 21 awardees during the 5-year program. One award will be made in each of the 21 service regions listed in Attachment 1 of the RFA. Awarded applicants will be responsible for establishing and maintaining a comprehensive provider network to provide the cancer screenings, conducting community outreach, and managing all other aspects of the program.
 
Eligible applicants are not-for-profit 501(c)(3) organizations and/or municipal agencies located within or providing services in the region for which they are applying. Such organizations may include health care facilities, primary care networks, academic institutions, community-based organizations, and professional associations. Eligible applicants may apply to serve more than one region; however, a separate application is required for each region.
 
The RFA is available here. Optional Letters of Interest are due on October 21st and applications are due on December 20th. Questions may be sent to canserv@health.ny.govthrough November 9th.
 
DOH Releases RFP for Person-Centered Planning Statewide Training Initiative
On October 6th, DOH released a Request for Proposals (RFP) seeking a qualified applicant to provide statewide trainings to support person-centered practice. Person-centered practice is the arrangement of services and supports that give individuals the ability to access all the benefits of community living while receiving services in a manner that can help them reach their goals. Person-centered practice may include a variety of different models of care.
 
Applicants must have relevant experience delivering a state- or federal-level training program to both professionals/professional organizations and to participants/consumers. Applicants should also have experience with person-centered practice and providing training, technical assistance, and policy development to disability service systems. Applicants’ cost proposal should include the cost of furnishing all required services, including but not limited to materials, reporting, equipment, travel, location rentals, profit, and labor. The contract will last for three years, with an option to renew for an additional two years.
 
The RFP is available here. Applications are due on November 30th. Questions must be submitted to OHIPContracts@health.ny.gov by October 20th.
 
HRSA Announces Funding Opportunity for FY 2023 Residency Training in Mental and Behavioral Health
On October 5th, the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) released a Notice of Funding Opportunity (NOFO) for the Fiscal Year (FY) 2023 Primary Care Training and Enhancement – Residency Training in Mental and Behavioral Health (PCTE-RTMB) program. This program trains primary care residents in the prevention, identification, diagnosis, treatment, and referral of services for mental and behavioral health conditions for at-risk populations, including children and young adults.
 
HRSA will award $11.5 million in annual funding to approximately 23 grantees during the 5-year project period. Each awardee will receive up to $500,000 in annual funding. Eligible applicants include accredited public or not-for-profit private hospitals, schools of allopathic or osteopathic medicine, or a public or private not-for-profit entity capable of carrying out a residency training program.
 
The NOFO is available here. Applications are due on November 15th.
 
HRSA Announces Funding Opportunity for FY 2023 Family Engagement and Leadership in Systems of Care Program
On September 22nd, HRSA released a NOFO for the FY 2023 Family Engagement and Leadership in Systems of Care (FELSC) program. This program aims to enhance engagement of families of children and youth with special health needs (CYSHCN). Through this program, HRSA will award one applicant with up to $600,000 in annual funding for the following two projects: 

  • Providing national leadership on family engagement to support maternal and child health programs that serve CYSHCN); and
  • Providing technical assistant to the HRSA-funded Family-to-Family Health Information Centers.

Eligible applicants are any domestic public or private entity, including community-based organizations. Contracts will last for five years, starting on June 1, 2023.
 
The NOFO is available here. Applications are due on January 3, 2023.