Weekly Health Care Policy Update – September 26, 2022

October 3, 2022

In this update: 

  • Administration Updates
    • PHE Expected to be Renewed Next Month
  • Legislative Update
    • Senate Finance Committee Releases Draft Mental Health Workforce Bill
  • Federal Agencies
    • HHS OIG Issues Report on Early Pandemic FDA EUA Process
    • HHS OIG Releases Report on Medicaid MLR Oversight Opportunities
    • Task Force Recommends Screening all Adults for Anxiety
    • SAMHSA Issues $1.5 Billion to States for SUD Treatment
    • HHS Releases Roadmap on Behavioral Health Integration
  • Other Updates
    • CDC Data Shows 80% of Pregnancy Deaths are Preventable
    • MACPAC Holds September Meeting
    • AHA/AMA Drop Surprise Billing Lawsuit
    • Texas Medical Association Files Another Surprise Billing Lawsuit
  • New York State Updates
    • NYS State Plan Amendment Submission and Approval Updates
    • OIG Releases Audit Report Investigating NYS Eligibility Determinations for BHP
    • OMH Announces Partnership with NYAPRS on Psychiatric Rehabilitation Training Academy
  • Funding Opportunities
    • OASAS Releases Funding Opportunity for Transitional Housing Unit Initiative
    • NYS HCR Releases RFP for Plus One Accessory Dwelling Units Program

Administration Update

PHE Expected to be Renewed Next Month
On September 19th, Department of Health and Human Services (HHS) Assistant Secretary for Public Affairs Sarah Lovenheim tweeted that the Department remains committed to providing 60 days’ notice before expiration of the Covid-19 Public Health Emergency (PHE). The tweet likely came in response to President Biden’s comment in a September 18th interview that “the pandemic is over.” The current declaration expires October 13, 2022, and a 90-day renewal is still expected.

Legislative Update

Senate Finance Committee Releases Draft Mental Health Workforce Bill
On September 22nd, the Senate Finance Committee released a bipartisan discussion draft of legislation to enhance the mental health care workforce. Major provisions of the draft bill include: 

  • Expanding Medicare coverage to the full scope of services of licensed clinical social workers (LCSW) by adding health and behavior assessment and intervention (HBAI) services;
  • Enabling licensed marriage and family therapists (LMFT) and licensed mental health counselors (LMHC) with two years’ experience to be Medicare providers who may provide their full scope of services (mental health and HBAI), to be paid, like LCSWs, at 75% of the psychologist rate;
  • Enabling psychologist trainee services to be billed under general supervision rather than direct supervision;
  • Clarifying Medicare coverage of occupational therapist services for beneficiaries with mental health or substance use disorder diagnoses;
  • Creating and funding an additional 400 residency slots, beginning in fiscal year 2025, for psychiatry residencies. The Committee is seeking comment from stakeholders on considerations for appropriate allocation of these slots;
  • Providing a 15% bonus, beginning in 2024, to Medicare reimbursement of mental health services provided by any appropriate practitioner in a mental health Health Professional Shortage Area (HPSA) (currently, only psychiatrists are eligible for a bonus and the bonus level is 10%);
  • Adding a Stark law exception that permits hospitals or other entities to provide and pay for programs providing evidence-based mental health programs for physicians (addressing issues like burnout, resiliency, and suicide prevention).
  • Creating a six-year Medicaid and CHIP demonstration project to improve provider capacity for mental health and SUD services. Funding and benefits are yet to be determined; and
  • Requiring HHS to issue guidance on how states may use 1115 waivers and other strategies to improve mental health and SUD provider education, training, recruitment, and retention.

The draft released today is part of the Committee’s broader effort to improve mental health care for Medicare, Medicaid, and CHIP beneficiaries.
 
The discussion draft legislative text is available here, a summary is available here, and a press release is also available here.

Federal Agencies

HHS OIG Issues Report on Early Pandemic FDA EUA Process
On September 21st, the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) published a study reviewing how the Food and Drug Administration (FDA) conducted emergency use authorization (EUA) activities and decision-making from January 1, 2020 through May 31, 2020. OIG’s investigation revealed “vulnerabilities in the federal approach to testing early in the Covid-19 pandemic,” including that FDA was “slow to realize that testing by public health labs was far more limited than initially expected” which then led to FDA authorizing tests with lower levels of evidence to increase testing availability. This resulted in problematic tests on the market, requiring further FDA action. In the report, OIG is also critical of FDA’s decision to accept all EUA requests, many of which were low-quality, submitted by developers without appropriate experience.
 
In order to better prepare for future infectious disease emergencies, OIG recommends the following: 

  • Assess and, as appropriate, revise guidance for test EUA submissions;
  • Develop a suite of EUA templates for future emergencies involving novel pathogens;
  • Expand the FDA Center for Devices and Radiological Health’s existing device-tracking platform to facilitate EUA submission and monitoring;
  • Expand and improve resources for test developers on the EUA process;
  • Establish formal communication channels between FDA and the lab community, to be used in emergencies that require testing; and
  • Work with Federal partners to implement lessons learned about a national testing strategy that go beyond the EUA process.

The full report is available here.
 
HHS OIG Releases Report on Medicaid MLR Oversight Opportunities
On September 22nd, the HHS OIG released a report on State oversight of Medicaid managed care reporting of medical loss ratios (MLRs). The Centers for Medicare and Medicaid Services (CMS) requires that States oversee Medicaid managed care plan reporting of MLR to ensure plans spend most of their revenue on health services for enrollees. OIG found that while most plans submit MLR reports as required, nearly half of the reports OIG reviewed in its sample were incomplete, missing at least one of the seven numeric data points required to calculate the MLR. Two-thirds of the incomplete reports did not even include fields for plans to enter amounts for at least one necessary data element.
 
OIG recommended several steps CMS should take to strengthen State oversight of Medicaid managed care plan MLR reporting, including: 

  1. Designing a template for States to provide plans;
  2. Clarifying that States should verify completeness of plans’ MLR reports;
  3. Clarifying that States should review MLR reports for accuracy; and
  4. Providing States with additional guidance on plan reporting of non-claims costs in the MLR.

The OIG report is available here.
 
Task Force Recommends Screening all Adults for Anxiety
On September 20th, the United States Preventive Services Task Force (USPSTF) recommended (with a grade of B) screening all adults under age 65 for anxiety for the first time. The Task Force noted a substantial increase in the share of adults exhibiting symptoms of an anxiety or depressive disorder during the pandemic. The Affordable Care Act (ACA) requires most health insurers to cover preventive items and services with an A or B grade recommendation from the USPSTF without cost-sharing. However, this provision of the ACA is subject to ongoing litigation, with a Texas District Court judge ruling the requirement unconstitutional earlier this month.
 
The Task Force will accept comments on this draft recommendation through October 17thand will review public comments before issuing a final recommendation. The Task Force recommendation is available here.
 
SAMHSA Issues $1.5 Billion to States for SUD Treatment
On September 23rd, the Biden Administration announced it has awarded $1.5 billion across all states and territories to support substance use disorder (SUD) treatment. The funding, awarded through HHS’ Substance Abuse and Mental Health Services Administration (SAMHSA), will support efforts to address the opioid crisis and support individuals in recovery. States may use the funding to increase access to SUD treatment, remove barriers to naloxone, and expand access to opioid treatment programs. New York State’s Office of Addiction Services and Supports (OASAS) received $56.9 million as part of this funding, and the Saint Regis Mohawk Tribe and Blossom Sustainable Development each received $250,000.
 
A press release announcing the funding is available here.
 
HHS Releases Roadmap on Behavioral Health Integration
On September 16th, the Department of Health and Human Services (HHS) released an “HHS Roadmap for Behavioral Health Integration,” which details the Biden Administration’s policy solutions to better integrate mental health and substance use care into the larger health care system. The Roadmap’s contents are based on feedback HHS Secretary Xavier Becerra received on his national tour to strengthen mental health. The document provides a general overview of HHS’s approach and highlights selected programs and policy actions to achieve its goals. The work will be built around President Biden’s three pillars to address the nation’s mental health crisis: 

  • Strengthening system capacity: expanding the supply and diversity of the behavioral health workforce and ensuring the full continuum of behavioral health care is available;
  • Connecting Americans to care: bridging the gap between services the system offers and people’s ability to get the care they need; and
  • Supporting Americans by creating healthy environments: making “a whole-of-society effort,” recognizing the importance of “culture and environment” in promotion, prevention, and recovery.

The full roadmap is available here.

Other Updates

CDC Data Shows 80% of Pregnancy Deaths are Preventable
On September 19th, the Centers for Disease Control and Prevention (CDC) released data showing that more than 80% of pregnancy-related deaths, over a 2017 to 2019 study period, were preventable. Overall, 22% of the pregnancy-related deaths occurred during pregnancy, 25% occurred on the day of delivery or within seven days after, and 53% occurred between seven days after and one year after pregnancy. The leading causes of death were: mental health conditions including suicide and overdose (23%), hemorrhage (14%), cardiac and coronary conditions (13%), infection (9%), thrombotic embolism (9%), cardiomyopathy (9%), and hypertension (7%). The leading cause of death varied by race and ethnicity, with cardiac and coronary conditions causing the most deaths among non-Hispanic black people, mental health conditions causing the most deaths for Hispanic and non-Hispanic white people, and hemorrhage causing the most deaths for non-Hispanic Asian people. American Indian or Alaska Native people were disproportionately impacted by pregnancy-related deaths over the study period. In this group, mental health conditions and hemorrhage were the most common underlying causes of death, accounting for 50% of deaths. In this group, 93% of deaths were determined to be preventable.
 
The CDC press release, with links to the data, is available here.

MACPAC Holds September Meeting
On September 15th and 16th, the Medicaid and CHIP Payment and Access Commission met for its monthly public meeting. Commissioners discussed the following issues: 

  • Medicaid race and ethnicity data collection and reporting: Commissioners discussed current data gaps and seek more information on beneficiary reluctance to share such data.
  • Unwinding the PHE continuous coverage requirement: Commissioners seek more information on the data sources states plan to use for redeterminations and whether staffing is adequate to handle all redetermination work.
  • Improving rate setting and risk mitigation in Medicaid managed care: Commissioners were supportive of greater transparency in the rate setting process and seek more information on risk adjustment.
  • Principles for assessing Medicaid nursing facility payments relative to costs: Commissioners explored options for assessing Medicaid nursing facility payments relative to facility costs, highlighting support for value-based policies, and seek more information on staffing payment and administrative costs.
  • Countercyclical disproportionate share hospital policies: MACPAC staff will further explore a policy recommendation that would provide enhanced FMAP for DSH payments and increase the federal DSH allotment so that total funding would be equivalent to payment without the countercyclical policy.
  • Medicaid coverage of monoclonal antibodies directed against amyloid for the treatment of Alzheimer’s disease: Commissioners debated a recommendation to Congress to allow states to implement Medicaid coverage criteria based on Medicare National Coverage Determinations.

The slides from the meeting are available here.
 
AHA/AMA Drop Surprise Billing Lawsuit
On September 20th, the American Hospital Association (AHA) and the American Medical Association (AMA) moved to dismiss their challenge to the federal government’s September 2021 interim final rule governing the No Surprises Act’s independent dispute resolution process. The AHA and the AMA previously challenged the rule last December, on the grounds that the interim final rule departed from congressional intent. In requiring arbiters to choose the offer closest to the insurer’s median contracted in-network rate, the interim final rule would harm providers by leading to underpayment of out-of-network services. The AHA and AMA won this challenge in February, and the August 26th final rule requires arbiters to consider an insurer’s median contracted in-network rate along with additional information when determining payment for a surprise bill. This inclusion rendered the lawsuit moot, though the AHA and AMA remain concerned with the process and plan to continue their advocacy on the issue.
 
The AHA press release is available here.
 
Texas Medical Association Files Another Surprise Billing Lawsuit
 On September 22nd, the Texas Medical Association (TMA) filed a second lawsuit challenging the federal government’s surprise billing arbitration process, arguing that the August 26th final rule still unlawfully favors insurers over providers. The TMA argues that the methodology for calculating insurers’ median in-network rates is “deflated” compared to actual contracted rates and therefore the regulation does not adequately protect providers. AHA and AMA, despite dropping their own lawsuit earlier in the week, announced they will file amici briefs outlining how the latest federal regulation departs from Congressional intent.
 
The TMA’s complaint is available here and a press release from the organization is available here.

New York State Updates

NYS State Plan Amendment Submission and Approval Updates
New York State (NYS) has recently submitted the following State Plan Amendments (SPA) to CMS for approval: 

  • SPA 22-0072 proposes to adjust rates statewide to reflect a 5.4% Cost of Living Adjustment (COLA) for Health Home Plus and to implement an across-the-board rate increase of 1% for Health Homes serving adults and children. Rates subject to the 5.4% COLA will not be eligible for the 1% increase.
  • SPA 22-0073 proposes to adjust rates statewide to reflect a 5.4% COLA for Care Coordination Organizations/Health Homes (CCOs/HHs) for individuals with intellectual and developmental disabilities.

NYS has recently received approval from CMS for the following SPAs: 

  • SPA 22-0036 allows the State to enter into outcomes-based contract arrangements with drug manufacturers through supplemental rebate agreements (approved9/14/2022).
  • SPA 22-0059 ends the 1.5% across-the-board payment reduction on hospital inpatient services effective March 31, 2022 (approved 9/20/2022).
  • SPA 22-0067 increases the operating cost component of Federally Qualified Health Center (FQHC) and Rural Health Center (RHC) rates by 1% (approved 9/20/2022).
  • SPA 22-0064 adds a 5.4% COLA for OASAS Residential Rehabilitation Services for Youth (RRSY) (approved 9/20/2022).
  • SPA 22-0083 increases the pharmacy professional dispensing fee by 1% (approved9/14/2022).

OIG Releases Audit Report Investigating NYS Eligibility Determinations for BHP
On September 20th, the HHS OIG released an audit report which found that New York generally determined eligibility for Basic Health Program (BHP) enrollees in accordance with applicable federal and state eligibility requirements. BHP is a health benefits overage program implemented by the Affordable Care Act for low-income residents who would otherwise be eligible to purchase coverage through the health insurance marketplace. NYS is one of only two states that have established BHPs, which are jointly funded by federal and state funds.
 
Specifically, the report found that NYS correctly determined eligibility for all but five individuals sampled, who were ineligible or potentially ineligible and for whom NYS received improper monthly payments totaling $8,615. OIG further estimated that the financial impact of the incorrect or potentially incorrect eligibility determinations during the audit period totaled $69.9 million. OIG therefore recommends that NYS reimburse its BHP Trust Fund for these amounts and provides additional recommendations for system improvements.
 
The report is available here.
 
OMH Announces Partnership with NYAPRS on Psychiatric Rehabilitation Training Academy
On September 20th, the NYS Office of Mental Health (OMH) announced a collaboration with the New York Association of Psychiatric Rehabilitation Services (NYAPRS) to create a Psychiatric Rehabilitation Training Academy. Using $6.5 million in funding from OMH, NYAPRS will develop and provide evidence-based psychiatric rehabilitation training for direct practitioners statewide. This funding was made available through the enhanced Federal Medial Assistance Percentage (FMAP) implemented in the American Rescue Plan Act (ARPA).
 
Trainings will target community-based adult outpatient rehabilitation providers and will be delivered through a variety of in-person, virtual, and web-based sessions. Practitioners who complete the entire training series will be eligible to sit for the Certified Psychiatric Rehabilitation Practitioners (CPRP) exam. Funding includes scholarships for staff to cover the costs of test readiness and the exam.
 
The OMH press release is available here. Practitioners can learn more about and enroll in the Academy here.

Funding Opportunities

OASAS Releases Funding Opportunity for Transitional Housing Unit Initiative
On September 21st, OASAS released a funding opportunity for OASAS permanent supportive housing providers to offer short-term housing for individuals with substance use disorders (SUD) who are experiencing homelessness and who are awaiting a permanent housing unit. Specifically, transitional housing units should be offered to such individuals who are exiting a residential treatment program or the criminal justice system.
 
Allowable use of funds include: 

  • Rental subsidies;
  • Security deposits;
  • Furnishings and turnover expenses; and
  • Supportive services (e.g., one full-time case manager).

It is expected that standard supportive housing services, including case management, be provided to the tenants. The units are designed to provide supportive housing for no more than one year, with the ideal target of six to nine months as the individual pursues permanent housing.
 
Additional details are available here. To receive funding for this program, providers must submit a Letter of Inquiry and a completed budget form. Questions may be submitted to housing@oasas.ny.gov.
 
NYS HCR Releases RFP for Plus One Accessory Dwelling Units Program
On September 14th, the NYS Homes and Community Renewal (HCR) released a Request for Proposals (RFP) for eligible applicants to apply to administer the Plus One Accessory Dwelling Units (ADU) Program. Through this RFP, HCR will award a total of $20 million across 10 awardees during the two-year program period, $10 million of which will be awarded to applicants within New York City and Long Island. Individual awards will not exceed $2 million.
 
The program will provide full-service support for low- and middle-income single-family homeowners who seek to build a new ADU on their property or improve an existing ADU. Applications must include partnerships between a not-for-profit housing organization and a municipal or county government. Either the governmental or not-for-profit entity may serve as the lead applicant.
 
The RFP is available here. Applications are due on October 28th. Questions should be submitted to NOFA_Applications@hcr.ny.gov.