Weekly Health Care Policy Update – October 31, 2022

In this update: 

• Legislative Update
  • Senate Finance Committee Works on Draft Legislation on Integrated Behavioral and Primary Care
  • House Committee Releases Staff Report on Private Insurance Coverage of Contraception
• Federal Agencies
  • CMS Issues “Make Your Voice Heard” RFI, Due November 4^th
  • CMS Finalizes Changes to Medicare Eligibility and Enrollment Rules
  • CMS Again Extends Timeline for Revision of MA Risk Adjustment Regulations
  • CMS Administrator Says Equity in Accessing MA Supplemental Benefits Is a Priority
  • CMS Releases FAQ on PHE Unwinding
  • CMS to Hold Quarterly National Stakeholder Call on November 1^st
  • CMMI to Host Second Safety Net Provider Roundtable on November 3^rd
  • HHS Announces Listening Session on Patient and Health Care Worker Safety
  • HealthCare.gov Opens for 2023 “Window Shopping”
  • HHS Announces Over $100 Million for Mental Health Services
  • CMS Revises Guidelines for SNF Staff Vaccination Requirement
  • GAO Issues Report on National Strategic Stockpile Inventory Risks
  • AHRQ Selects Diagnostic Centers of Excellence
• Other Updates
  • AHA and FAH Write to Congress on Policy Priorities, Including Proposal for “Metropolitan Anchor Hospitals”
  • National Academy of Medicine Announces New Members, Including CMS Staff
  • Plaintiffs in ACA Case Seek to Invalidate All Preventive Coverage Mandates
  • National Academy Publishes National Plan for Health Workforce Well-Being
• New York State Updates
  • Governor Hochul Extends Staffing Emergency; Updated SPG Covid-19 Regulatory Waiver Tracker Available (Including Vaccine/Mask Rules)
  • DOH Releases Proposed Regulations for Medical Respite Programs
  • DOH Proposes to Pay for Services Provided by Formerly License-Exempt Staff at Article 29-I Health Facilities
  • DOH Proposes 5% Rate Adjustment for OASAS Services
  • NYSOFA Proposes Modifications Allowing Flexibility for EISEP Assessment Requirements
  • CMS Approves New York’s NHTD and TBI Appendix K Waiver Amendment
  • NYSNA Signs Affiliation Agreement with National Nurses United
  • Governor Hochul Signs Health Care-Related Legislation
• Funding Opportunities
  • DOH Releases RFA for Portion of Statewide Health Care Facility Transformation Program Round 4 Funding
  • OMH Opens Attestation for Supportive Housing Stipend Increase, Due November 30^th
  • OMH and OASAS Will Reissue Intensive Crisis Stabilization Center RFP for NYC and Capital District
  • NYC ACS Releases RFP for $9 Million for Alternative to Detention Services
  • HRSA Releases NOFO for $23.5 Million for the 2023 Teaching Health Center Planning and Development Program
  • HRSA Issues NOFO for $4.2 Million for the Developmental-Behavioral Pediatrics Training Program
  • SAMHSA Releases NOFO for States Seeking Planning Grants to Join CCBHC Demonstration

Legislative Update

Senate Finance Committee Works on Draft Legislation on Integrated Behavioral and Primary Care
The Senate Finance Committee continues bipartisan work on a package of mental health legislation. The Committee publicly released a draft bill on the mental health workforce in September (covered in SPG’s September 26^th update here), and is now working on a bill covering provisions to promote the integration of mental and physical care in Medicare and Medicaid. Notable proposed provisions of the draft bill include:
 
Medicare

• Providing three-year temporary increase in Medicare reimbursement for behavioral health integration services (HCPCS codes 99484, 99492, 99493, 99494, and G2214). Reimbursement would be increased by 75% in 2025, 50% in 2026, and 25% in 2027.
• Covering mobile crisis response intervention services under the Medicare physician fee schedule.
• Covering crisis stabilization services under the Hospital Outpatient Prospective Payment System (OPPS).
• Enabling peer support workers to participate in providing behavioral health integration services.
• Requiring the Department of Health and Human Services (HHS) to issue guidance on integration of behavioral health into primary care within 18 months.

Medicaid

• Requiring HHS to issue guidance to states on ways to support: 
  • Integration of behavioral and primary care;
  • Access to community social supports and non-medical services; and
  • Access to a continuum of crisis response services. HHS would also be able to offer planning grants and technical assistance to Medicaid programs to support the development of such a continuum of services.
• Making permanent the option for states to operate community-based mobile crisis intervention services.

House Committee Releases Staff Report on Private Insurance Coverage of Contraception
On October 25^th, the House Oversight and Reform Committee released a staff report presenting the findings of an investigation into contraception coverage for individuals enrolled in private health insurance. The Chair, Rep. Carolyn Maloney (D-NY), opened the investigation earlier this year in response to reports of patients facing barriers to accessing birth control without cost-sharing as required by the ACA.
 
The Committee reviewed cost-sharing requirements and coverage exclusions for 120 contraceptive products across approximately 68 health plan and pharmacy benefit manager (PBM) formularies. It found the following: 

• Plans and PBMs imposed coverage exclusions or cost-sharing requirements for 34 different contraceptive products, 12 of which have no equivalent product on the market.
• Plans and PBMs are more likely to impose cost-sharing or coverage exclusions for newer contraceptive products and the products used by patients with distinct health care needs or disproportionately used by lower-income patients.
• Plans and PBMs studied denied at least 40% of the exceptions requested by enrollees and that the exceptions processes themselves are inadequate.

The Committee recommends that the Departments of HHS, Labor, and Treasury clarify requirements for appropriate medical management for coverage of contraceptives to require coverage of all contraceptive products approved by the Food and Drug Administration (FDA) that do not have a therapeutic equivalent without cost-sharing. Further, the Committee recommends that the Departments update guidance encouraging exceptions processes that are automatic at the point of prescribing, so that the prescriber does not have to “take any additional steps” to ensure patient access to the contraceptive product appropriate for them.   
 
The Committee staff report is available here.

Federal Agencies

CMS Issues “Make Your Voice Heard” RFI, Due November 4^th
On October 26^th, the Centers for Medicare and Medicaid Services (CMS) issued a Request for Information (RFI) seeking general stakeholder input on achieving efficiency and equity in CMS programs. The RFI will gather public input on “accessing health care and related challenges, understanding provider experiences, advancing health equity, and assessing the impact of waivers and flexibilities provided in response to the COVID-19 Public Health Emergency” (PHE). This includes strategies that address social determinants of health (SDH).
 
CMS is specifically seeking the following: 

• Accessing Healthcare and Related Challenges: Personal perspectives and experiences describing challenges individuals currently face in interacting with the health care ecosystem, including narrative anecdotes.
• Understanding Provider Experiences: Descriptions of factors affecting provider well-being and understanding the supply and distribution of the workforce. In particular, CMS seeks to understand the greatest challenges facing health care workers in meeting patient needs, and the effect of CMS policies (including documentation and reporting requirements) on provider experiences.
• Advancing Health Equity: Information to help CMS better understand individual and community-level burdens, health-related social needs, and strategies to reduce inequities.
• Impact of the PHE: Feedback on areas for improvement related to the Covid-19 PHE flexibilities, including “opportunities to further decrease burden.”

All interested stakeholders, including patients and their families, providers, clinicians, consumer advocates, and health care professional association, are encouraged to respond.
 
The RFI is available here and will be open for comment through November 4^th.
 
CMS Finalizes Changes to Medicare Eligibility and Enrollment Rules
On October 28^th, CMS finalized a rule implementing portions of the Consolidated Appropriations Act of 2021 to make changes to Medicare enrollment rules, to extend coverage of immunosuppressive drugs for former end-stage renal disease (ESRD) beneficiaries, and to update rules on state subsidies for the Medicare buy-in.
 
The rule’s changes enrollment policies include:  

• Coverage begins the month after enrollment: Medicare coverage will now become effective the month after enrollment for almost all individuals, including those who enroll in the last three months of their initial enrollment period or during the General Enrollment Period (January 1^st through March 31^st). Currently, these enrollments may take between two and six months to take effect.
• New special enrollment periods (SEPs) related to exceptional conditions: CMS is establishing new SEPs which would allow the following groups of individuals to enroll in Medicare without being subject to a late penalty:  
  1. Individuals impacted by an emergency or disaster. 
     • In the final rule, this SEP has been extended to last for six months after the end of the declaration, up from two months in the proposed rule.
  2. Individuals affected by a health plan or employer error.
  3. Individuals who have been released from a correctional facility. 
     • This SEP has been modified. It is extended to last from the day of an individual’s release until the last day of the 12^th month after release. Also, individuals may choose between prospective enrollment (effective the first day of the month after the enrollment month) or, if their release is after January 1, 2023, retroactive enrollment (retroactive by six months, up to the date of their release from incarceration).
  4. Coordination with individuals whose Medicaid coverage is terminated. 
     • This SEP is modified to allow retroactive entitlement to the date of termination of Medicaid coverage, but no earlier than January 1, 2023.
  5. Other exceptional conditions, which may be evaluated on a case-by-case basis. 
     • This SEP is modified to clarify that any relevant SEP will last no less than six months.

CMS is also implementing Section 402 of the CAA to extend coverage of immunosuppressive drugs for kidney transplant patients. Most individuals with ESRD are eligible for Medicare regardless of age. When these beneficiaries receive a transplant, their Medicare eligibility is terminated after 36 months. Under the CAA and this rule, individuals who do not have another form of insurance coverage will be eligible to enroll in Part B for the limited purpose of coverage of immunosuppressive drugs. Enrollment in the new benefit may begin October 2022 and coverage will begin in January 2023.
 
Finally, the rule updates rules governing state payment of the Medicare Part A and Part B premium on behalf of low-income individuals (the “Medicare buy-in”), as follows: 

• The rule codifies the current practice of states and CMS using the Medicaid State Plan and State Plan Amendments to document the buy-in policy in each state (rather than the free-standing buy-in agreements each state enacted in 1992, which have not been updated).
• The rule limits states’ retroactive liability for Medicare Part B premiums to 36 months. In some cases, the Social Security Administration may retroactively establish Medicare Part A entitlement for a beneficiary, which can make states liable for Part B premiums going back several years. The final rule delays implementation of this provision to January 1, 2024.

The final rule is available in the Federal Register here.
 
CMS Again Extends Timeline for Revision of MA Risk Adjustment Regulations
On October 28^th, CMS issued a notice that it will be extending the timeline for publication of a final rule to revise the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) regulations. The proposed rule, originally published in November 2018, would enable CMS to recover overpayments based on extrapolated audit findings through the use of statistically valid random sampling techniques, starting with payment year 2011 contract-level audits. It also proposed not to use a fee-for-service (FFS) adjuster to RADV overpayment determinations, which had been considered as a way to correct for errors in FFS claims data.
 
By statute, CMS must finalize rules within three years of publication, meaning this rule should have been published by November 1, 2021. However, CMS extended its publication due to the effects of Covid-19 last year (covered in SPG’s October 22, 2021 update here). CMS is now extending the publication deadline by a further three months, until February 1, 2023, as “additional time continues to be needed to address the complex policy and operational issues” raised by the rule.
 
The notice is available in the Federal Register here.
 
CMS Administrator Says Equity in Accessing MA Supplemental Benefits Is a Priority
On October 18^th, CMS Administrator Chiquita Brooks-LaSure spoke at the Better Medicare Alliance annual conference, discussing priorities for the MA program in 2023. Brooks-LaSure said that a major focus for CMS will be whether supplemental benefits, such as dental coverage, are available to enrollees on an equitable basis. In particular, she highlighted the requirement in the 2023 MA final rule to provide detailed reporting on supplemental benefits in medical loss ratio (MLR) reporting, which “will help us to evaluate and begin to address disparities in access.”
 
A video of Brooks-LaSure’s comments is available here.
 
CMS Releases FAQ on PHE Unwinding
On October 17^th, CMS released an updated Frequently Asked Questions (FAQ) document designed to help states prepare for the eventual end of the Covid-19 public health emergency (PHE). The 17-page document answers 38 questions regarding the end of the PHE, mostly restating and compiling previously issued guidance. Notable items include: 

• Unwinding period and timeline: The guidance reiterates that states may begin the unwinding period in the month the PHE ends, or the month before or after, and states, “For example, if the PHE ends in January 2023, states may begin their unwinding period anytime in December 2022, January 2023, or February 2023.”
• Medicaid beneficiary renewals, including changes in circumstances: States must conduct a full renewal for all currently enrolled individuals before terminating their coverage. States may only redetermine based on a change in circumstances if they have already previously conducted an initial or renewed eligibility determination.
• Section 1902(e)(14)A waivers: These waivers may provide states with flexibilities related to Medicaid enrollment. CMS will consider state requests for waivers that would allow conducting renewals based on SNAP eligibility, conducting ex parte renewals without some otherwise-required data, and other policies.

Other topics covered include policies regarding: 

• Income verification;
• Countable resources;
• The Reasonable Opportunity Period to verify individuals’ claimed citizenship or satisfactory immigration status;
• Premiums;
• Fraud and abuse/recoupment;
• Single state agency requirements vs. use of private contractors;
• Eligibility and enrollment data reporting; and
• Outreach.

The full FAQ is available here.
 
CMS to Hold Quarterly National Stakeholder Call on November 1^st
On November 1^st from 3pm to 4pm ET, CMS will host another in its series of quarterly National Stakeholder Calls. On these calls, which started in September 2021, CMS Administrator Chiquita Brooks-LaSure and her leadership team will provide an update on key initiatives, recent accomplishments, and advancing the CMS Strategic Plan.
 
Registration is available here.

CMMI to Host Second Safety Net Provider Roundtable on November 3^rd
On November 3^rd, from 12:30pm to 2pm ET, the CMS Innovation Center (CMMI) will host a Safety Net Provider Roundtable discussion on “increasing safety net participation in CMMI models.” The roundtable is a follow-up to the March 2022 Equity Roundtable and will cover the following topics: 

• Updating stakeholders on CMMI’s approach to increase safety net participation in CMMI models;
• Sharing findings and discussing recommendations from model application analysis and stakeholder interviews; and
• Soliciting input from stakeholders to enhance CMMI’s proposed definition for safety net providers.

Registration is available here. Attendees may submit written comments or questions before the webinar via the registration page.

HHS Announces Listening Session on Patient and Health Care Worker Safety
On November 14^th, from 1pm to 2:40pm ET, HHS Secretary Xavier Becerra will convene a livestreamed listening session to “recommit to the advancement of patient and health care worker safety.” Secretary Becerra will be joined by leaders of the country’s largest health care systems, board members, organizational patient safety leaders, and patient and family safety advocates to discuss the creation of a National Healthcare System Action Alliance to Advance Patient Safety.
 
The Action Alliance will be built on the following principles: 

• Culture, Leadership, and Governance: to demonstrate and foster commitments to safety as a core value and promote the development of safety cultures;
• Patient and Family Engagement: to instill the practice of co-designing and co-producing care with patients, families, and care partners to ensure their meaningful partnership in all aspects of care design, delivery, and operations;
• Health Care Workforce Safety: to ensure the safety and resiliency of health care organizations and workforces as a precondition to advancing patient safety with a unified, total systems-based approach to eliminate harm to both patients and the healthcare workforce; and
• Learning System: to foster networked and continuous learning within and across healthcare organizations at all levels to encourage widespread sharing, learning, and improvement.

Registration is available here. More information on the Action Alliance is available here.

HealthCare.gov Opens for 2023 “Window Shopping”
On October 26^th, the Biden Administration announced the launch of “window shopping” on Healthcare.gov, a period for consumers to view 2023 health insurance plans and prices offered in their area in advance of the 2023 marketplace open enrollment period beginning on November 1^st. The Administration also published a report showing that 92% of enrollees will have access to options from three or more insurance companies for 2023. This open enrollment period will also introduce new standardized plan options which offer the same deductibles and cost sharing for certain benefits, and the same out of pocket limits as other standardized plan options within the same health plan category. The open enrollment period will remain open through January 15^th, although consumers must enroll by December 15^th to have full-year coverage beginning on January 1^st.
 
A fact sheet is available here. Consumers may view plan options here.
 
HHS Announces Over $100 Million for Mental Health Services
On October 21^st, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced that it had awarded over $100 million in funding from the Bipartisan Safer Communities Act (BSCA) to states and territories for mental health emergency preparedness, crisis response, and the expansion of 988 Suicide & Crisis Lifeline services.  SAMSHA awarded $59.4 million to states and territories through the Community Mental Health Services Block Grant program, recommending that the money be used to address mental health needs in communities in the aftermath of traumatic events such as mass shootings. The New York State Office of Mental Health received over $4 million under this program.
 
In addition, HHS announced the availability of $50 million in supplemental grant funding to help states and territories expand and enhance 988 Suicide and Crisis Lifeline services. The funding, which will range between $458,000 and $2 million, is available to states and territories that received American Rescue Plan funding earlier this year. It will be distributed before December 31^st.
 
More information is available here.
 
CMS Revises Guidelines for SNF Staff Vaccination Requirement
On October 26^th, CMS issued revised guidance for Covid-19 vaccination of long-term care and skilled nursing facility staff. In the memo to state survey agency directors, CMS redefined noncompliance as “facility staff vaccination rates under 100% of unexcepted staff,” aligning the definition with that for other facility types. Further, CMS notes that noncompliance does not necessarily lead to termination and facilities will have opportunities to return to compliance. Noncompliant facilities that implement a plan to achieve compliance will not be subject to an enforcement action.
 
CMS’ memo to state survey agency directors is available here.
 
GAO Issues Report on National Strategic Stockpile Inventory Risks
On October 17^th, the Government Accountability Office (GAO) published a report entitled “Public Health Preparedness: HHS Should Address Strategic National Stockpile Requirements and Inventory Risks.” In the report, GAO says that HHS has failed to meet most legal requirements for inventory planning reports for the Strategic National Stockpile (SNS), a multibillion-dollar inventory of medical countermeasures to be used in emergencies. The report also says HHS has failed to communicate risks associated with not meeting recommended inventory levels for the SNS. GAO attributes these failures to the fact that HHS suspended the process of annual SNS reviews with inventory recommendations after the expert group that produced them underwent a reorganization in 2019. After this point, purchases were made based on past reviews and HHS discretion. Inventory decisions for fiscal years 2023 and 2024 have been informed by new reviews, but the reviews do not meet most statutory requirements.
 
GAO recommends that HHS should: 

• Update procedures for how SNS reviews will be conducted in accordance with statutory requirements;
• Develop an approach to ensure that medical countermeasures under consideration for SNS procurement receive the same consideration regardless of whether they received development funding from BARDA, in accordance with statutory requirements; and
• Develop an approach for regularly managing the risks associated with the gaps between current inventory levels and the recommended levels.

The full report is available here.
 
AHRQ Selects Diagnostic Centers of Excellence
On October 18^th, the Agency for Healthcare Research and Quality (AHRQ) announced that it has selected 10 research institutions as Diagnostic Safety Centers of Excellence. Each grantee will receive approximately $1 million per year for up to four years to develop systems and new technology solutions to improve diagnostic safety and quality. The 10 Diagnostic Safety Centers of Excellence will be established at the following institutions: Oregon Health and Science University, Johns Hopkins University, Brigham and Women’s Hospital (two Centers), MedStar Health Research Institute, University Hospitals of Cleveland, University of Texas Health Science Center in Houston, University of California in San Francisco, Boston Children’s Hospital, and Baylor College of Medicine.
 
More information on each project is available here.

Other Updates

AHA and FAH Write to Congress on Policy Priorities, Including Proposal for “Metropolitan Anchor Hospitals”
On October 24^th, the American Hospital Association (AHA) and the Federation of American Hospitals (FAH) each sent letters to congressional leadership outlining their policy priorities for the lame duck session. Notably, the AHA requested that Congress consider creating a new “metropolitan anchor hospital” (MAH) designation, modeled on the Rural Emergency Hospital (REH) designation launched earlier this year. The MAH designation would be a statutory status for hospitals serving high-need vulnerable urban communities. AHA has proposed that hospitals should receive the designation if they: 

• Are located in a core-based statistical area;
• Have a Medicaid utilization rate higher than their state average; and
• Have one of the following: 
  • A disproportionate patient percentage (i.e., combined Medicare/SSI and Medicaid inpatient days) of 70% or above;
  • A disproportionate patient percentage of 35% or above and uncompensated care costs of at least $35,000 per bed over the last three years; or
  • A state designation as a “necessary provider.”

The FAH letter highlighted the following priorities: 

• Waiving PAYGO: The letter encourages Congress to avoid a four percentage point cut to Medicare payments under pending statutory pay-as-you-go (PAYGO) requirements;
• Reauthorizing rural hospital payment programs: The letter encourages Congress to reauthorize the Medicare-dependent Hospital (MDH) and Low-Volume Hospital programs.
• Updating the Medicare Physician Fee Schedule for inflation: The FAH seeks for CMS to update the Medicare physician payment system to include annual increases that account for inflation.
• MA prior authorization legislation: The FAH encourages the Senate to pass Improving Seniors’ Timely Access to Care Act, passed by the House of Representatives last month, which creates new requirements for MA plans around prior authorization.

The FAH letter also encourages Congress to “take up unfinished business” in several policy areas including telehealth, behavioral health, and pandemic preparedness.
 
Except for the Medicare fee schedule proposal, the AHA letter highlighted the same issues noted in the FAH letter, with the addition of the MAH proposal as well as the following: 

• Address Patient Discharge Backlog: The AHA asks Congress to establish a temporary per diem payment to hospitals to address this issue.
• Make certain waivers permanent: The AHA says that Covid-19 PHE waivers for telehealth and hospital-at-home programs, among other flexibilities, should be made permanent or extended.
• Increase GME slots: The letter asks Congress to pass legislation to further increase the number of Medicare-supported GME positions.

The FAH letter is available here. The AHA letter is available here.
 
National Academy of Medicine Announces New Members, Including CMS Staff
On October 17^th, the National Academy of Medicine (NAM) announced the election of 100 new members, including CMS Deputy Administrator and Centers for Medicare and Medicaid Innovation Center (CMMI) Director Liz Fowler and Assistant Secretary for Health Rachel Levine. Fowler was recognized for her efforts leading CMS efforts on payment and delivery system reform, as well as for her role as chief architect of the Affordable Care Act. Levine was recognized for her expertise in pediatrics and adolescent medicine, and for being the first openly transgender official ever to be confirmed by the U.S. Senate. The National Academy of Medicine now has a total membership of 2,200 individuals, including 190 international members. NAM was originally established as the Institute of Medicine in 1970 and works to address “critical issues in health, science, medicine, and related policy and inspires positive actions across sectors.”
 
Other new members from New York include: 

• Yvette Calderon (Chair of Emergency Medicine at Mount Sinai Beth Israel and Professor of Emergency Medicine, Icahn School of Medicine at Mount Sinai)
• Sankar Ghosh (Professor and Chair, Department of Microbiology and Immunology, Vagelos College of Physicians and Surgeons, Columbia University)
• Jose Pagan (Professor and Chair, Department of Public Health Policy and Management, School of Global Public Health, New York University)
• Sohail Tavazoie (Professor, Rockefeller University)
• Sally Temple (Scientific Director, Neural Stem Cell Institute, Regenerative Research Foundation)
• David Tuveson (Professor and Director, Cold Spring Harbor Laboratory Cancer Center)

A complete list of new members is available here.
 
Plaintiffs in ACA CaseSeek to Invalidate All Preventive Coverage Mandates
On October 24^th, plaintiffs in a lawsuit challenging the Affordable Care Act’s preventive care coverage requirement filed a motion arguing for a “universal remedy” that would invalidate the requirement for all parties subject to it. The motion is in response to a September 7^th ruling from Judge Reed O’Connor of the United States District Court for the Northern District of Texas on the constitutionality of the Affordable Care Act’s (ACA) preventive care coverage requirements (Braidwood Management v. Becerra). O’Connor ruled that requiring mandatory coverage of preexposure prophylaxis (PrEP) violates religious freedom and that requiring insurers to cover USPSTF-recommended items and services without cost-sharing is unconstitutional because Task Force members are neither appointed by the President nor confirmed by the Senate. O’Connor asked all parties to file motions regarding whether the ruling should apply to just the plaintiffs (two Texas businesses and several Texas residents) or a broader group.
 
This week, plaintiffs in the case filed a motion arguing for a “universal remedy,” that is, a ruling that applies to all entities subject to the ACA requirement to cover items and services recommended by the USPSTF without cost-sharing. The plaintiffs argue for application of the ruling to all actions the federal government has taken to enforce the requirement since March 23, 2010 (when the ACA became law) and prevent the government from taking any future action to enforce such a requirement. The federal government has 30 days to respond to the plaintiff’s motion.
 
The original ruling in the case is available here and the plaintiff’s motion may be found here.
 
National Academy Publishes National Plan for Health Workforce Well-Being
On October 19^th, the NAM published a “National Plan for Health Workforce Well-Being” to “drive collective action to strengthen health workforce well-being and restore the health of the nation.” The plan calls on health care leaders, public health leaders, government, payers, industry, and educators to help drive policy and systems change, and is intended as an evidence-based tool in that work. The plan has been endorsed by 30 organizations including the ACGME, AHA, AMA, AAMC, IHI, and the Joint Commission.
 
Priority areas in the report include: 

• Creating and sustaining positive work and learning environments and culture;
• Investing in measurement, assessment, strategies, and research;
• Supporting mental health and reducing stigma;
• Addressing compliance, regulatory, and policy barriers for daily work;
• Engaging effective technology tools;
• Institutionalizing well-being as a long-term value; and
• Recruiting and retaining a diverse and inclusive health workforce.

The full report is available here.

New York State Updates

Governor Hochul Extends Staffing Emergency; Updated SPG Covid-19 Regulatory Waiver Tracker Available (Including Vaccine/Mask Rules)
On October 27^th, Governor Hochul issued Executive Order 4.14, which extends through November 26^th the provisions in Executive Order 4 and its successors that reinstate many workforce and scope of practice flexibilities that applied during the original New York State Covid-19 public health emergency.
 
SPG has updated our Covid-19 regulatory waiver tracker document to reflect this and other recent updates. The document also now lists the current status of vaccination and mask mandates in New York.
 
The tracker is attached and available here. Executive Order 4.14 is available here.
 
DOH Releases Proposed Regulations for Medical Respite Programs
On October 19^th, the New York State (NYS) Department of Health (DOH) issued a proposed rule in the State Register establishing regulations and an application approval process for not-for-profit entities seeking certification as Medical Respite Program (MRP) operators. The State’s second Medicaid Redesign Team (MRT II) recommended, and the 2021-2022 Enacted NYS Budget authorized, the establishment of standards for medical respite programs as a lower-intensity care setting for patients who are homeless or at risk for homelessness and who would otherwise require a hospital stay. Programs provide temporary room and board, allowing individuals to rest in a safe environment while accessing on-site medical care, care coordination, and other supportive services.
 
The rule would require that medical respite programs meet the minimum operating standards, offer the required services, provide sufficient qualified staff, implement a quality improvement program that is reviewed at least annually, meet the required physical standards of the facility, and maintain accurate and current records for each recipient.
 
The proposed rule is available here. Public comment may be submitted to regsqna@health.ny.gov through December 18^th. 
 
DOH Proposes to Pay for Services Provided by Formerly License-Exempt Staff at Article 29-I Health Facilities
On October 26^th, DOH issued a notice in the State Register proposing to amend the Medicaid State Plan at the end of the federal Covid-19 PHE to authorize payment for services provided in an Article 29-I Health Facility by formerly license-exempt staff members who were employed by an authorized setting on June 24, 2022. In order to address the workforce shortage and staff hiring challenges, formerly exempt practitioners that meet licensure exemption requirements would be permitted to work under the supervision of a professionally licensed practitioner pursuant to State Education Law Article 153 (psychologists), 154 (social workers) or 163 (mental health practitioners).
 
The notice is available here. Comments may be submitted to spa_inquiries@health.ny.gov.

DOH Proposes 5% Rate Adjustment for OASAS Services
On October 26^th, DOH issued a notice in the State Register proposing to implement a 5% statewide rate adjustment for the following Office of Addiction Services and Supports (OASAS) services: 

• Outpatient addiction services (hospital and non-hospital);
• Freestanding (non-hospital) inpatient rehabilitation services;
• Freestanding inpatient detox services;
• Part 820 residential services; and
• Residential Rehabilitation Services for Youth (RRSY).

OASAS will also further enhance freestanding outpatient addiction services in-community rates by 40%. The rate adjustments would be effective on or after November 1^st.
 
The notice is available here. Comments may be submitted to spa_inquiries@health.ny.gov.
 
NYSOFA Proposes Modifications Allowing Flexibility for EISEP Assessment Requirements
On October 26^th, the New York State Office for the Aging (NYSOFA) issued a proposed rule in the State Register that would provide flexibility for service provision under the Expanded In-Home Services for the Elderly Program (EISEP) and Home-Delivered Meals. The proposed rule does not eliminate any current EISEP program requirements, but allows for the extension of the timelines related to required client assessments (generally needed within 10 days of initiating services) if strict compliance is impracticable.
 
The proposed rule is available here. Comments will be accepted through December 25^th.
 
CMS Approves New York’s NHTD and TBI Appendix K Waiver Amendment
On October 24^th, CMS approved New York State’s request for an Appendix K waiver amendment to the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) waivers. The Amendment includes Home Care Worker Minimum Wage increases for Home and Community Support Services (HCSS) for both NHTD and TBI. Effective October 1, 2022, the current rate for NHTD and TBI HCSS will increase by $2.56 per hour. The State will make amendments to the NHTD and TBI waiver applications prior to the expiration of the Appendix K, to ensure the rate adjustment remains in place as future rates are developed.
 
The CMS approval letter is available here. The Amendment is available here.
 
NYSNA Signs Affiliation Agreement with National Nurses United
On October 20^th, the New York State Nurses Association (NYSNA) announced that it has voted to affiliate with National Nurses United (NNU), the largest national union of registered nurses in the United States. With the addition of the roughly 42,000 members of NYSNA, the total NNU membership will now be “close to 225,000” nurses. NYSNA will now also be a member of the American Federation of Labor (AFL-CIO).
 
A press release is available here.
 
Governor Hochul Signs Health Care-Related Legislation
Governor Hochul recently signed the following health care-related bills: 

• S7881/A8537 requires insurance coverage of chest wall reconstruction surgery, in addition to breast reconstruction surgery, after a mastectomy or partial mastectomy.
• S7263A/A2519 requires insurance plans to provide victims of domestic violence with the option of providing alternative contact information.

Funding Opportunities

DOH Releases RFA for Portion of Statewide Health Care Facility Transformation Program Round 4 Funding
On October 20^th, DOH released a Request for Applications (RFA) for a portion of the Statewide Health Care Facility Transformation Program Round 4 (SHCFTP IV) funding. As authorized in the 2022-2023 NYS Enacted Budget, the RFA will provide $200 million for emergency department modernizations of regional significance. Awards may be used for capital projects, including but not limited to: 

• The planning or design of the acquisition, construction, demolition, replacement, major repair or renovation of a fixed asset or assets, including the preparation and review of plans and specifications including engineering and other services;
• Construction costs;
• Renovation costs;
• Asset acquisitions;
• Equipment costs; and
• Consultant fees and other expenditures associated with the preparation of Certificate of Need (CON) applications required for the proposed establishment action, construction activity or service expansion (so long as the costs incurred are in connection with original construction and not an ownership transfer).

Note that applications will be evaluated based on the extent to which the construction project is at an advanced enough stage of development for building to begin soon, including as evidenced by a CON submission for the project. However, CON approval of the project is not required at the time of application submission.
 
Eligible applicants are Article 28 general hospitals that operate an emergency department which: 

• Serves as a Level 1 trauma center with the highest volume in its region;
• Includes the capacity to segregate patients with communicable diseases, trauma, or severe behavioral health issues from other patients in the emergency department;
• Provides training in emergency care and trauma care to residents for multiple hospitals in the region; and
• Serves a high proportion of Medicaid patients.

Applicants may choose to submit a single application or multiple applications. Contracts will last for five years, starting on May 1, 2023. As with previous rounds, this RFA is non-competitive. As such, determinations by DOH are final and there is no right of appeal for either application denials or the amount of funding awarded.

The RFA is available here. Applications are due on December 29^th. Questions may be submitted to Paul Francis at Statewide4@health.ny.govthrough November 9^th.
 
OMH Opens Attestation for Supportive Housing Stipend Increase, Due November 30^th
Effective January 1, 2023, OMH supportive housing providers participating in the implementation of the Rehabilitation Housing Tenancy State Plan Amendment (SPA) are eligible for a Supportive Housing stipend increase of $600 per bed (upstate) or $1,200 per bed (NYC, Long Island, Putnam, Rockland, and Westchester). This SPA adds housing support services under the rehabilitative services benefit, allowing for Medicaid reimbursement of psychological rehabilitation, counseling, and other services that help beneficiaries maintain housing in the community.
 
Participation in the program is voluntary. All Supportive Housing, Supportive Single Room Occupancy (SP-SRO) units, and Community Residence Single Room Occupancy (CR-SRO) units under contract with OMH or local government (with the exception of Empire State Supportive Housing Initiative units) are eligible to participate. To participate, Medicaid-enrolled providers must attest that they meet eligibility requirements by emailing a signed copy of the attestation (available here) to OMH.SH@omh.ny.gov with the subject line “SH SPA Attestation on Participation” by November 30^th to receive the stipend increase on January 1, 2023. Attestations submitted after this date will be accepted; however, stipend increases will be delayed.
 
Additional details, including guidelines and FAQs, are available here.
 
OMH and OASAS Will Reissue Intensive Crisis Stabilization Center RFP for NYC and Capital District
On October 14^th, OMH and the Office of Addiction Services and Supports (OASAS) announced a forthcoming reissuance of the Intensive Crisis Stabilization Center Request for Proposals (RFP) for two centers in New York City (NYC) and one center in the Capital Region. The original RFP, released in January 2022, included awards for three centers in NYC and one center in each of the remaining nine Economic Development Regions. There were nine awardees announced in July 2022, a list of which is available here.
 
In preparation for the reissuance, the Offices will host a forum to discuss potential barriers, address questions, and hear feedback from providers who may be interested in applying for the remaining centers in NYC or the Capital Region. The forum will take place on November 1^st from 9am-10am. Registration is available here. 
 
Additional details, including a link to the original RFP, are available here. SPG’s summary of the opportunity is available here.
 
NYC ACS Releases RFP for $9 Million for Alternative to Detention Services
On October 14^th, the NYC Administration for Children’s Services (ACS) released an RFP for the provision of pre-dispositional supervision and services to court-involved youth as an alternative to detention (ATD). Through this opportunity, ACS will award $9 million in total funding across five awardees. There will be one program awarded in each New York City borough. The payment structure will be line-item reimbursement for permissible expenses.
 
Contracts will last for three years starting on July 1, 2023, with the option to renew for two additional three-year terms. Eligible applicants should have experience providing alternative and/or diversion program services and/or providing substantial services to children in child welfare or juvenile justice.
 
Additional details are available in the PASSPort system here by searching “alternative to detention.” Applications are due on November 21^st.
 
HRSA Releases NOFO for $23.5 Million for the 2023 Teaching Health Center Planning and Development Program
On October 13^th, the Health Resources and Services Administration (HRSA) released a Notice of Funding Opportunity (NOFO) for the Fiscal Year 2023 Teaching Health Center Planning and Development (THCPD) program. This program supports the establishment of new accredited community-based primary care residency programs, with the goal of addressing primary care physician and dental workforce shortages in rural and underserved communities. The new community-based residency programs will: 

• Achieve accreditation through the Accreditation Council for Graduate Medical Education (ACGME) or the American Dental Association’s Commission on Dental Accreditation (CODA);
• Develop a sustainability through public or private funding beyond the grant period; and
• Track residents’ career outcomes post-graduation, including but not limited to retention in rural and/or underserved communities.

HRSA will provide $23.5 million in total funding across 47 awardees (up to $500,000 per awardee) to support planning and development costs. Contracts will last for two years, starting on April 1, 2023. Eligible applicants include community-based ambulatory patient care centers, including Federally Qualified Health Centers (FQHCs), community mental health centers, and rural health clinics. Non-community-based ambulatory patient care settings such as teaching hospitals, health care systems and/or networks, and academic institutions are not eligible to receive THCPD funding. However, applicants may collaborate with such entities to form a community-based Graduate Medical Education (GME) consortium that will operate an accredited primary care residency program.
Applications are due on December 12^th. Additional details are available here.
 
HRSA Issues NOFO for $4.2 Million for the Developmental-Behavioral Pediatrics Training Program
On October 21^st, HRSA issued a NOFO for the Fiscal Year 2023 Developmental-Behavioral Pediatrics (DBP) Training Program. This program aims to expand the DBP workforce and increase access to evaluation and services for children with a wide range of developmental and behavioral concerns, including autism. Awarded programs will: 

• Prepare DBP fellows and other long-term trainees for leadership roles as teachers, investigators, and clinicians;
• Build workforce capacity to evaluate for, diagnose, or rule out developmental disabilities and other behavioral health concerns;
• Prepare trainees to participate in clinical care and research;
• Provide pediatric practitioners, residents, and medical students with essential psychosocial knowledge and clinical expertise; and
• Provide technical assistance to strengthen systems of care for children who may have developmental disabilities and their families.

HRSA will award over $4.2 million in annual funding across 15 awardees. Applicants may apply for up to $283,000 in annual funding, inclusive of direct and indirect costs. Contracts will last for five years starting on July 1, 2023. Eligible applicants are public or not-for-profit agencies, including institutions of higher education.
 
Additional details are available here. Applications are due on January 19, 2023.
 
SAMHSA Releases NOFO for States Seeking Planning Grants to Join CCBHC Demonstration
On October 18^th, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a NOFO for Certified Behavioral Health Clinic (CCBHC) Planning Grants. These grants will support states in developing and implementing certification systems for CCBHCs, establishing Prospective Payment Systems (PPS) for Medicaid-reimbursable services, and preparing an application to participate in a four-year CCBHC Demonstration Program. SAMHSA will award up to $15 million in total funding across 15 states ($1 million per award). Contracts will last for one year.
 
Eligible applicants are State Mental Health Authorities, Single State Agencies, or State Medicaid Agencies. New York State is not eligible for funding as it received a CCBHC Planning Grant from SAMHSA in 2015 and was selected for the first CCBHC Demonstration in 2016. 
 
Applications are due on December 19^th. Additional details are available here.