Weekly Health Care Policy Update – December 19, 2022

December 27, 2022

Note: This is SPG’s last weekly update for 2022. Our next update will be distributed on January 3, 2023. As always, we will continue to distribute notable information that arises to clients individually, and please feel free to contact us at any time to discuss any policy issues on your mind. We’d also appreciate any feedback on how we can make our updates more useful. Happy Holidays!

In this update: 

  • Legislative Update
    • Congressional Leaders Announce Funding Agreement; Legislative Text to Come
  • Federal Agencies
    • CMS Proposes CY 2024 Medicare Advantage and Part D Policies
    • CMS Releases 2024 Proposed Notice of Benefit and Payment Parameters
    • CMS Releases 2021 National Health Expenditure Report
    • IRS Finalizes Rule Extending ACA Reporting Deadline for Coverage Providers
    • CMS Issues Guidance on Maintaining Coverage for Children after Covid-19 PHE
    • SAMHSA Issues Proposed Rule to Update Access to Opioid Treatment
    • Administration Announces Launch of Ground Ambulance Billing Advisory Committee
    • CMS InnovationCenter Delivers 2022 Report to Congress
    • HRSA Awards $350 Million to Increase Covid-19 Vaccinations
  • Other Updates
    • MACPAC Holds December Meeting
    • MedPAC Holds December Meeting
    • HHS Approves Washington State Innovation Waiver to Cover Residents Regardless of Immigration Status
    • Federal Panel Rules Catholic Hospitals Do Not Have to Offer Transgender Care
    • Federal Judge Strikes Down Vaccine Choice Law in Health Care Settings
  • New York State Updates
    • Governor Hochul Ends Statewide Poliovirus Disaster Emergency
    • CMS Approves NHTD and TBI Appendix K Waiver Amendment
    • Governor Hochul Signs HEAL Act and Legislation Permitting ALP Residents to Receive Hospice
    • DOH to Hold Webinar on Medicaid Pharmacy Carveout on December 20th
  • Funding Opportunities
    • OPWDD Extends Public Comment Period for New Housing Subsidy Funding Opportunity
    • OPWDD Seeks Independent Consultant to Conduct Evaluation of Care Coordination Program
    • OASAS Releases Funding Opportunity for Evidence-Based Practices within SUNY or CUNY Campuses
    • OMH Releases Funding Opportunity for Scattered Site Supportive Housing for Homeless Adults in NYC
    • OMH Releases Funding Opportunity for a Short-Term Transitional Residence for Homeless Adults in NYC
    • OPWDD Releases Second Round of 2022 Integrated Supportive Housing Program
    • OPWDD Releases RFI Seeking Vendors Capable of Providing Health Assessment and Coordination Services
    • DOH Releases Funding Opportunity for Consultative Examinations for Medicaid Eligibility

Legislative Update

Congressional Leaders Announce Funding Agreement; Legislative Text to Come
On December 14th, three of the four chairs of the House and Senate Appropriations Committees announced they had reached an agreement on a “bipartisan, bicameral framework” for an omnibus spending bill to fund the federal government for the remainder of the fiscal year. The chairs—Senator Pat Leahy (D-VT), Senator Richard Shelby (R-AL), and Representative Rosa DeLauro (D-CT)—said that the agreement should allow a final deal to be passed by December 23rd. As a result, on December 15th, Congress passed a one-week continuing resolution, keeping the government funded at current levels until December 23rd while the omnibus bill is being drafted.
 
An initial text of the omnibus spending bill is expected to be available later today (December 19th) but has not yet been released as of this writing. Some of the notable health care provisions expected to be part of the bill include: 

  • Temporary increases to Medicare Physician Fee Schedule (PFS) reimbursement for the next two years, which effectively phase down the current 3% temporary increase;
  • An extension of the bonus for participating in advanced alternative payment models (APMs), potentially at a reduced rate;
  • An extension of the removal of geographic restrictions on Medicare telehealth services for up to two years (through 2024); and
  • A process for resuming the performance of Medicaid eligibility redeterminations starting in April 2023.

SPG will provide a more detailed summary when the full text is available. Notably, House Republicans opposed both the one-week continuing resolution and the broader funding agreement, so House Appropriations Committee Ranking Member Kay Granger (R-TX) was not party to the agreement. Only nine House Republicans voted to pass the one-week measure.

Federal Agencies

CMS Proposes CY 2024 Medicare Advantage and Part D Policies
On December 14th, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule revising regulations for Medicare Advantage (MA), Part D, and Programs of All-Inclusive Care for the Elderly (PACE). Key provisions include: 

  • Utilization Management Requirements: In situations when no applicable Medicare statute, regulation, National Coverage Determinations (NCD), or Local Coverage Determinations (LCD) establishes when an item or service must be covered, MA organizations may establish their own coverage criteria. However, such criteria must be “based on current evidence in widely used treatment guidelines or clinical literature that is made publicly available” to CMS, enrollees, and providers. CMS also proposes to require that when an enrollee is granted prior authorization approval, it will remain valid for the full course of treatment.
  • Marketing Requirements: CMS proposes prohibiting ads that do not mention a specific plan name as well as ads that use the Medicare name, logo, or products like the Medicare card “in a misleading manner.” CMS also proposes a ban on sales presentations that immediately follow an educational event, a ban on agent distribution and collection of Scope of Appointment and Business Reply Cards at educational events, and a ban on sales and/or enrollment meetings with a beneficiary within 48 hours after a beneficiary’s consent. CMS also proposes to require agents to: 
    • Disclose to beneficiaries all the plans the agent sells;
    • Inform beneficiaries that they can obtain complete Medicare options/information from 1-800-MEDICARE, SHIPs, or Medicare.gov; and
    • Ask a standardized list of questions that address a beneficiary’s health care needs, current providers, and prescriptions, prior to enrolling a beneficiary into a plan.
  • Star Ratings Program: CMS proposes to implement a new health equity index (HEI) reward to replace the current high-performance reward factor, beginning with the 2027 Star Ratings. The HEI would be based on plans’ performance on Star Ratings measures for specific subsets of enrollees with social risk factors (SRFs). The initial set of SRFs would include dual eligibles, beneficiaries receiving the Low Income Subsidy, and disabled beneficiaries. CMS also proposes to: 
    • Reduce the weight of patient experience/complaints and access measures by half;
    • Remove guardrails when determining measure-specific-thresholds for non-Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures;
    • Modify the Improvement Measure hold harmless policy to include an additional rule for the removal of Star Ratings measures; and
    • Adjust the extreme and uncontrollable circumstances policy by ending the 60 percent rule, which excludes contracts with more than 60 percent of enrollees in Federal Emergency Management Agency (FEMA) designated areas from the calculations.
  • Advancing Health Equity: CMS proposes to significantly expand the list of populations that MA organizations must provide services to in a culturally competent manner. CMS also proposes requiring MA organizations to develop and maintain procedures to offer digital health education to enrollees to improve access to medically necessary covered telehealth benefits, and to require MA organizations to include providers’ cultural and linguistic capabilities in provider directories.
  • Improving Access to Behavioral Health: CMS proposes to add network adequacy requirements for Clinical Psychologists, Licensed Clinical Social Workers, and Prescribers of Medication for Opioid Use Disorder. CMS also proposes to include behavioral health services to general access to services standards and codify standards for appointment wait times for both primary care and behavioral health.
  • Part D: CMS proposes to permit Part D sponsors to immediately substitute:(1) a new interchangeable biological product for its corresponding reference product; (2) a new unbranded biological product for its corresponding brand name biological product; and (3) a new authorized generic for its corresponding brand name equivalent. CMS also proposes changes to Medication Therapy Management (MTM) Programs including adding HIV/AIDS to the list of core chronic diseases and lowering the maximum number of Part D drugs a sponsor may require from eight to five.
  • LI NET: CMS proposes to make the Limited Income Newly Eligible Transition (LI NET) Program a permanent part of the Medicare Part D program.
  • LIS: CMS proposes, as directed by the Inflation Reduction Act, to expand eligibility under the LIS program such that all individuals with incomes up to 150 percent of the federal poverty level (FPL) and who meet statutory resource requirements will qualify for the full LIS, beginning January 1, 2024.

The proposed rule is available here. A fact sheet is available here. The rule will remain open for comment through February 13, 2023.
 
CMS Releases 2024 Proposed Notice of Benefit and Payment Parameters
On December 12th, CMS released the proposed 2024 Notice of Benefit and Payment Parameters (NBPP), which contains policies for qualified health plans (QHPs) in the individual and small group markets. Key policies include: 

  • Risk Adjustment: The permanent risk adjustment program for FY 2024 is subject to FY 2023 sequestration. Funds collected during FY 2023 will be sequestered at a rate of 5.7% and will become available for payment to issuers in FY 2024. CMS also proposes changes related to EDGE data used for the risk adjustment models, the flexibility for States to request reductions of federally-calculated risk adjustment State transfers, extraction of new data elements from issuers’ EDGE Server Enrollment Submission files, and to the risk adjustment data validation program.
  • Exchange Standards: CMS proposes to amend standards for Navigators, Non-Navigator Assistance Personnel, and Certified Application Counselors, requirements for agents, brokers, and web-brokers, requirements related to Exchange determinations of taxpayer eligibility for advance premium tax credits, and special enrollment periods for individuals with lapsing Medicaid or CHIP coverage.
  • Stand-Alone Dental Plans: CMS proposes to require issuers of stand-alone dental plans on all Exchanges to use an enrollee’s age at the time of policy issuance or renewal as the sole method to calculate an enrollee’s age for rating and eligibility purposes. CMS proposes to apply this requirement to products sold both on- and off-Exchange. Further, CMS proposes to require issuers of stand-alone dental plans on all Exchanges to submit guaranteed rates beginning with plan year 2024.
  • Network Adequacy and Essential Community Providers (ECPs): CMS proposes to revise network adequacy and ECP standards across all Exchanges to state that QHPs must use a network of providers that complies with existing standards and remove the exception for plans that do not use a provider network. CMS also proposes to establish two additional stand-alone ECP categories: Mental Health Facilities and Substance Use Disorder (SUD) Treatment Centers.
  • Re-enrollment Hierarchy: Beginning with the open enrollment period for plan year 2024 coverage, CMS proposes to allow Marketplaces to modify their automatic re-enrollment processes to allow enrollees who are eligible for cost-sharing reductions (CSRs) and who would otherwise be automatically re-enrolled in a bronze-level QHP without CSRs, to instead be automatically re-enrolled in a silver-level QHP (with CSRs) in the same product with a lower or equivalent premium, provided that certain conditions are met.
  • Special Enrollment Periods: CMS proposes that beginning January 1, 2024, Marketplaces have the option to give consumers 60 days before, or 90 days after, loss of Medicaid or CHIP coverage to select a plan for Marketplace coverage via a special enrollment period (SEP). CMS also proposes to give Marketplaces the option to offer earlier coverage effective start dates for consumers attesting to a future loss of minimum essential coverage (MEC) and who would otherwise experience gaps in coverage. CMS also proposes to grant SEPs to consumers who are affected by a material plan display error with current plan display.
  • User Fees: For the 2024 benefit year, CMS proposes to lower the user fee rate from 2.75% to 2.5% of premium for QHPs sold on the FFM, and to lower the user fee rate from 2.25% to 2.0% of premium for QHPs sold on the SBM-FP.
  • Non-Standardized Plan Options: CMS is continuing its rulemaking on standardized plan options, proposing to limit issuers to two non-standardized plan options per product network type and metal level.

Comments on the proposed rule will be due February 14, 2023.  The rule is available here, a fact sheet is available here, and the press release is available here.
 
CMS Releases 2021 National Health Expenditure Report
On December 14th, the CMS Office of the Actuary released the 2021 National Health Expenditure (NHE) Report. The NHE measures total annual U.S. spending for the delivery of health care goods and services. Overall, the report found that U.S. health care spending grew at 2.7% in 2021, slower than the increase of 10.3% in 2020. The decline was driven by a 3.5% decline in federal government expenditures for health care, attributable to reduced Covid-19 supplemental funding and a decline in federal public health activity. Health care expenditures also declined as a share of national Gross Domestic Product (GDP), from 19.7% in 2020 to 18.3% in 2021. Health spending by major funding sources included private health insurance (28%), Medicare (21%), Medicaid (17%), and out-of-pocket (10%). Health care spending on the largest services included: hospital care (31%), physician and clinical services (20%), and retail prescription drugs (9%).
 
The 2021 NHE data is available here.
 
IRS Finalizes Rule Extending ACA Reporting Deadline for Coverage Providers
On December 13th, the Internal Revenue Service (IRS) issued a final rule providing an automatic extension for providers of minimum essential coverage to provide statements to covered individuals. The final rule gives providers of minimum essential coverage, including health insurance issuers, self-insured employers, and government agencies, an additional 30 days to provide the required information to the IRS and to covered individuals. This extension also applies to applicable large employers and statements they must furnish to full-time employees. The IRS had allowed affected entities to rely on the proposed rule until it was finalized.
 
The rule is available here.
 
CMS Issues Guidance on Maintaining Coverage for Children after Covid-19 PHE
On December 12th, CMS issued guidance on best practices and strategies for states to maintain coverage of children after the end of the Covid-19 public health emergency (PHE). The guidance is intended to help states plan for unwinding the Medicaid continuous eligibility and resumption of eligibility redeterminations that will occur at the end of the PHE. It reviews federal requirements for the transition and recommends that states takes steps to proactively transfer children from Medicaid to the Children’s Health Insurance Program (CHIP), or vice versa, when data indicates that they may be eligible, even if families do not respond to requests.
 
The guidance is available in a slide deck which is available here.
 
SAMHSA Issues Proposed Rule to Update Access to Opioid Treatment
On December 13th, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a proposed rule to improve access to and experiences with opioid use disorder (OUD) treatment. The most significant changes would allow Americans to take home doses of methadone and use telehealth in initiating buprenorphine at opioid treatment programs (OTPs). Such flexibilities were granted during March and April of 2020, and a recent study showed that patients who received take-home doses during this period saw positive impacts on their recovery.
 
Additional changes in the proposed rule include: 

  • Expanding the definition of an OTP treatment practitioner to include any provider who is appropriately licensed to dispense and/or prescribe approved medications;
  • Adding new models of care such as split dosing, telehealth and harm reduction activities;
  • Removing the term “detoxification”;
  • Promoting shared and evidence-based decision-making; and
  • Reviewing OTP accreditation standards.

The press release is available here. The proposed rule is available here.
 
Administration Announces Launch of Ground Ambulance Billing Advisory Committee
On December 14th, the Biden Administration announced the members of the Ground Ambulance and Patient Billing Advisory Committee. Established by Congress as part of the No Surprises Act, the Committee is tasked with recommending ways to protect consumers from balance billing related to unintentional use of out-of-network ground ambulance services, which are not directly regulated by the No Surprises Act. The Committee includes representatives from the federal government, state and local governments, the American Ambulance Association, public interest groups, and other stakeholders. The Committee’s first meeting will be January 17-18, 2023, and a report will be due 180 days later, discussing how to protect patients from
 
More information about the Committee is available here. The announcement is available here. The notice and agenda for the Committee’s first meeting is available here.
 
CMS Innovation Center Delivers 2022 Report to Congress
On December 12th, the CMS Innovation Center (CMMI) submitted its 2022 Report to Congress. The report, which is required every other year, covers the period from October 2020 through September 2022. The report covers 32 payment and service delivery models and initiatives, as well as six congressionally mandated (or authorized) demonstration projects. Key findings include: 

  • Over 41.5 million Medicare and Medicaid beneficiaries (and individuals with private insurance in multi- payer model tests) were included in, received care from, or will soon receive care from providers participating in Innovation Center programs.
  • Over 314,000 health care providers and/or plans participated in Innovation Center payment and service delivery models and initiatives.
  • The Medicare Prior Authorization Model: Repetitive Scheduled Non-Emergent Ambulance Transport (RSNAT) Model generated $1 billion in total Medicare savings among Medicare beneficiaries with end stage renal disease and/or pressure ulcers over its first 20 quarters (beginning December 2014) relative to the comparison group, averaging a savings of $381 per-beneficiary-per-quarter.
  • The Home Health Value Based Purchasing (HHVBP) Model showed cumulative net savings of $949 million in the first five years of the model and led to higher quality care in home health agencies within model states compared to home health agencies in non-model states, and to a reduction in unplanned hospitalizations and use of skilled nursing facilities in model states compared to non-model states.
  • The Medicare Care Choices Model (MCCM) generated $41.5 million in gross Medicare spending reductions and $33.2 million in net savings after accounting for provider payments. Beneficiaries in MCCM were 26 percent less likely to receive an aggressive life-prolonging treatment in the last 30 days of life and spent six more days at home in the period between MCCM enrollment and death.

The full CMMI Report is available here.
 
HRSA Awards $350 Million to Increase Covid-19 Vaccinations
On December 9th, the Health Resources and Services Administration (HRSA) awarded roughly $350 million to 1,471 health centers to increase Covid-19 vaccinations among underserved populations. Health centers may use the funding to expand outreach and education, community engagement, and coordinated events to increase vaccination through mobile, drive-up, walk-up, or community- based events. Awardees will have until January 8, 2023 to submit information about planned activities and costs to be supported by the funding. The funding is part of a broader effort by the Biden Administration to encourage Americans to get their updated Covid-19 vaccine by the end of the year.
 
Through the grant, 63 HRSA-funded health centers in New York received over $23 million in funding. A full list of New York health centers receiving funding is available here. The press release is available here.

Other Updates

MACPAC Holds December Meeting
On December 8th and 9th, the Medicaid Access and Payment Advisory Commission (MACPAC) met for its monthly meeting. Highlights of the discussion include: 

  • Race and Ethnicity Data: Commissioners supported updating the Medicaid model application to include race and ethnicity data.
  • Nursing Facility Payment: Staff recommended that CMS collect and report facility-level data on all types of Medicaid payments for all nursing facilities that receive them in.
  • Disproportionate Share Hospital (DSH) Allotments: Commissioners will revisit discussions to develop recommendations on countercyclical adjustments to the allotments.
  • In-Lieu-Of Services and Value-Added Benefits: Commissioners supported recommendations that CMS provide more clarity around processes and definitions of “in-lieu-of services” and “value-added benefits.” These options allow Medicaid plans to deliver substitute services or additional services to address enrollees’ non-medical needs, including needs related to social determinants of health (SDH).
  • Medicaid Use of Medicare National Coverage Determinations: Commissioners supported a recommendation to permit states to use the Medicare National Coverage Determinations.
  • Congressional Request for Information: Commissioners discussed a request for information on dual eligible beneficiaries recently released by Sens. Bill Cassidy (R-LA), Tim Scott (R-SC), John Cornyn (R-TX), Mark Warner (D-VA), Tom Carper (D-DE), and Bob Menendez (D-NJ), stressing the need to reduce complexity for states around plans for duals.

MedPAC Holds December Meeting
On December 8th and 9th, the Medicare Payment Advisory Commission (MedPAC) met for its monthly meeting. Highlights of the discussion include: 

  • Hospital Services: Commissioners reviewed payment adequacy indicators and discussed appropriate updates to Medicare payment rates for 2024. They expressed some concern that data inputs for Medicare base payment rates for inpatient and outpatient services are outdated data.
  • Physician and Other Health Professional Services: Commissioners supported recommendations to address increases in clinicians’ input costs due to inflation and supply chain issues, and expressed concerns about workforce burnout.
  • Outpatient Dialysis Services: Commissioners supported the proposed update to the CY 2023 Medicare end-stage renal disease prospective payment system base rate.
  • Skilled Nursing Services: Commissioners generally supported the draft recommendation to reduce payments by three percent for CY 2024, but also expressed concern about the “three-day rule.”

HHS Approves Washington State Innovation Waiver to Cover Residents Regardless of Immigration Status
On December 9th, the Departments of Health and Human Services (HHS) and the Treasury approved Washington State’s application for a State Innovation Waiver to expand access to Exchange-based plans and to provide a state affordability program to Washington residents regardless of immigration status. The approval allows the State to waive section 1312(f)(3) of the Affordable Care Act, which prohibits undocumented immigrants from enrolling in QHPs and stand-alone dental plans. The State projects that, under the waiver, average statewide premiums for individual health insurance coverage will be about 0.2% lower in PY 2024 than they would be without the waiver. The state also predicts that enrollment in individual health insurance coverage will be about 1% higher in PY 2024 than it would have been without the waiver. The waiver will go into effect in 2024 and last through 2028.
 
More information is available here. 
 
Federal Panel Rules Catholic Hospitals Do Not Have to Offer Transgender Care
On December 9th, a three-judge panel from the U.S. Court of Appeals for the Eighth Circuit ruled that Catholic health care organizations that receive federal dollars cannot be required to provide or pay for gender-transition procedures if they have religious objections to them. Sex discrimination was originally protected under the Affordable Care Act’s nondiscrimination regulations, but the Trump Administration reversed these regulations. In July 2022, the Biden administration reinstated the rule, specifically including protections for gender identity and sexual orientation.
 
The Eighth Circuit panel unanimously disagreed with the Biden Administration, arguing that the regulation violates the Religious Freedom Restoration Act, making it unconstitutional. The panel noted that less restrictive alternatives exist including government-sponsored health care for gender transitions or redirecting patients to community health centers. The decision is consistent with an August ruling from the Fifth Circuit, which held that Christian providers are not required to perform abortions or gender-transition surgeries in violation of their religious beliefs.
 
Federal Judge Strikes Down Vaccine Choice Law in Health Care Settings
On December 9th, U.S. District Judge Donald Molloy blocked a section of Montana State law passed in 2021 that made it illegal for a person to be denied services, goods, or employment based on their vaccine status, including employment in many health care facilities. The Montana Medical Association filed a lawsuit against the state in September 2021 arguing that the law violates the Americans with Disabilities Act, which requires public facilities to make reasonable accommodations for people with disabilities (including those who are immunosuppressed and being treated at a health care facility) and the Occupational Health and Safety Act by failing to keep the workplace free from recognized hazards. Molloy concluded that “the public interest in protecting the general populace against vaccine-preventable diseases in health care settings using safe, effective vaccines is not outweighed by the hardships experienced to accomplish that interest.”

New York State Updates

Governor Hochul Ends StatewidePoliovirus DisasterEmergency
On December 8th, the New York State disaster emergency due to the spread of poliovirus expired. Governor Hochul first declared the disaster emergency in Executive Order 21 (here) on September 9th as a result of poliovirus detection in wastewater samples, and was renewed on October 9th and November 8th.
 
The Executive Orders created flexibility to allow additional practitioners to administer poliovirus vaccinations and reduce barriers to the provision of vaccinations and also required all poliovirus vaccinations to be reported to the New York State Immunization Information System (NYSIIS) or the Citywide Immunization Registry (CIR) within 72 hours of administration.

CMS Approves NHTD and TBI Appendix K Waiver Amendment
On December 7th, CMS approved an Appendix K Emergency Waiver Amendment to the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) programs. The Amendment includes planned minimum wage-related rate increases that effect all counties except New York City, Westchester, Nassau, and Suffolk. The minimum wage increases were implemented as part of New York State regulations promulgated in 2017 and phased-in over five years.
 
The State will make amendments to the NHTD and TBI waiver applications prior to the expiration of the Appendix K, which will occur six months after the end of the federal Covid-19 PHE.
 
The Amendment is available here.
 
Governor Hochul Signs HEAL Act and Legislation Permitting ALP Residents to Receive Hospice
On December 9th, Governor Hochul signed the Hospital Equity and Affordability Legislation (HEAL) Act (S7199/A8169). The HEAL Act amends the Insurance Law to prohibit contracts between covered Article 32 accident and health insurers and health care providers, other than Article 28 nursing homes, that: 

  • Include “most-favored-nation” provisions (without explicitly defining this term); and
  • Restrict the disclosure of: 
    • Actual claims cost, or
    • Price or quality information required to be disclosed under federal law, including the allowed amount, negotiated rates/discount, or any other claim-related financial obligations (including patient cost-sharing).

These restrictions go into effect January 1, 2023. Notably, the final version of the HEAL Act is significantly narrower than the originally introduced version, which would have also: 

  • Prohibited contracts that required all of an insurer’s covered groups (including groups for which the insurer served as a third-party administrator) to be included in the contract scope;
  • Prohibited “all-or-nothing” requirements that all components of a provider system must be equally included in an insurer’s network;
  • Prohibited restrictions on insurers’ ability to offer tiered network plans or preferred networks;
  • Prohibited restrictions on using benefit designs to encourage members to seek value-based care; and
  • Applied all of these restrictions to Article 44 insurers as well.

Governor Hochul also signed legislation (S7626/A8006) that authorizes residents of assisted living programs to receive hospice services and directs the Commissioner of Health to convene a workgroup of stakeholders to make recommendations on coordination of services, responsibilities, and reimbursement of assisted living programs and hospice programs.
 
DOH to Hold Webinar on MedicaidPharmacyCarveout on December 20th
On December 20th at 1pm, the New York State Department of Health (DOH) will host an informational webinar about the transition of the pharmacy benefit from Medicaid Managed Care to NYRx, the Medicaid fee-for-service pharmacy program. The webinar is part of a recurring monthly series for stakeholders on the carveout, which is set to take place beginning April 1, 2023.
 
There will be a designated question and answer period at the end of the webinar. Required registration for the webinar is available here. Following the webinar, the presentation will be posted to the DOH website here. Previous presentations are also available on this website.

Funding Opportunities

OPWDD Extends Public Comment Period for New Housing Subsidy Funding Opportunity
The New York State Office for People with Developmental Disabilities (OPWDD) is extending the deadline for submission of public comments on the draft new Funding Opportunity for Independent Living Letters of Support (FOFILLS) through January 31, 2023. As reported in SPG’s update last week, the new FOFILLS funding opportunity will be used to request groups of housing subsidies for individuals with intellectual and/or developmental disabilities (I/DD) whose living arrangement would include four or more individuals. Proposed projects may include the development of an apartment complex, apartment style living, large single-family home, or a group of co-located houses by an OPWDD provider or a family or group of families/people with I/DD that are affiliated with an OPWDD provider.
 
The draft funding opportunity is available here. Public comment may be submitted to housing.initiatives@opwdd.ny.gov. It is expected that the final application for this funding will be released in late spring 2023.
 
OPWDD Seeks Independent Consultant to Conduct Evaluation of Care Coordination Program
On December 15th, OPWDD released a Request for Proposals (RFP) for a comprehensive evaluation of the Care Coordination Program. The RFP seeks a qualified consultant to evaluate the effectiveness of care management services delivered through OPWDD’s seven Care Coordination Organizations (CCOs). The evaluation will examine: 

  • The program’s impact on overall health and wellness of the people being served;
  • How well the program is meeting the needs of people from diverse and/or complex backgrounds;
  • How the program interacts with the service systems beyond the developmental disabilities system;
  • The effectiveness of its health information technology; and
  • Any systemic challenges that are impacting the program’s effectiveness.

The results of the program evaluation are intended help OPWDD understand how it can improve the quality and effectiveness of care coordination and the outcomes for people who receive care management services. The contract will last for 15 months, with the opportunity for a 12-month no-cost extension.
 
The RFP is available here. Applications are due on February 17, 2023. Questions may be submitted to Connie Blais at fmapcontracts@opwdd.ny.gov through January 6, 2023.

OASAS Releases Funding Opportunity for Evidence-Based Practices within SUNY or CUNY Campuses
On December 12th, the New York State Office of Addiction Services and Supports (OASAS) released a Request for Applications (RFA) for the implementation of evidence-based practices (EBPs) on State University of New York (SUNY) or City University of New York (CUNY) college campuses to prevent or reduce substance misuse. Through this opportunity, OASAS will award up to 10 organizations with up to $100,000 in one-year funding to: 

  • Implement a three-pronged Environmental Change Strategies (ECS) approach; or
  • Implement one or more EBPs listed in Appendix A.

Contracts may be extended beyond the initial one year. Eligible applicants are OASAS State Aid funded providers of primary prevention services under program code 5520.
 
The RFA is available here. Applications are due on January 27, 2023. Questions may be submitted to COVIDFunds@oasas.ny.gov with the subject line “Requests for Applications – OASAS Project No. SUPP1014” through January 6, 2023.
 
OMH Releases Funding Opportunity for Scattered Site Supportive Housing for Homeless Adults in NYC
On December 12th, the New York State Office of Mental Health (OMH) released an RFP for the development and operation of up to 500 supportive housing units in New York City for individuals currently experiencing street homelessness or subway dwelling. Individuals may have a mental illness diagnosis, a substance use disorder, physical health care needs, or a combination of all three. Individuals with an Assisted Outpatient Treatment (AOT) must receive priority access.
 
The units may be sited in either New York, Bronx, Kings, or Queens counties. Eligible applicants are not-for-profit 501(c)(3) agencies with experience providing housing and social services to individuals who are experiencing street homelessness, subway dwelling, chronic homelessness, or residing in a safe haven or shelter. Applicants may propose to develop a minimum of 15 units and up to a maximum of 60 units. Applicants may also submit a proposal to site a program in more than one county in the same application.
 
OMH will provide $16 million in annual state funding to support these units. Funding will be a combination of client rent payments and OMH operating funding. There is no capital funding associated with this RFP. Contracts will last for five years, starting on April 1, 2023.
 
The RFP is available here. The Governor’s press release is available here. Applications are due on January 30, 2023. Questions may be submitted to Carol.Swiderski@omh.ny.govthrough December 30th.
 
OMH Releases Funding Opportunity for a Short-Term Transitional Residence for Homeless Adults in NYC
On December 15th, OMH released an RFP seeking organizations with experience operating a licensed mental health housing program to develop and operate a 15-unit Short-Term Transitional Housing Residence for individuals being discharged from Extended Treatment Units that need time to strengthen their skills before moving to independent housing. OMH intends to award four 15-unit residences in New York, Kings, Queens, and Bronx counties. Both capital funding and operating funding will be available to selected applicants.
 
Eligible applicants are not-for-profit 501(c)(3) agencies with experience providing housing and social services to individuals who are experiencing street homelessness, subway dwelling, chronic homelessness, or residing in a safe have or shelter. Contracts will last for five years.
 
The RFP is available here. Applications are due on February 2, 2023. Questions must be submitted to Amanda.Szczepkowski@omh.ny.gov by January 5, 2023. There will be a bidder’s conference on January 3, 2023 from 11am-12pm and registration for the conference is available here.
 
OPWDD Releases Second Round of 2022 Integrated Supportive Housing Program
On December 12th, OPWDD released an RFA for a second round of the 2022 Integrated Supportive Housing (ISH) program. The ISH program encourages and supports the development of new housing opportunities for people I/DD who can benefit from an independent, non-certified community-integrated residential setting.
 
Unlike the first round, this second application round will not include a capital funding option and will only offer Letters of Support for Housing Subsidy Commitments. Letters of Support will be intended for projects seeking capital funding from the New York City Homes and Community Renewal (HCR) or other funders and that intend to set aside units for individuals with I/DD. Programs must be linked to a housing development project that will create new housing units through new construction, the adaptive reuse of non-residential space, or the repurposing of vacant residential units.
 
The RFA is available here and SPG’s summary of the opportunity is available here. Applications are due on January 20, 2023.
 
OPWDD Releases RFI Seeking Vendors Capable of Providing Health Assessment and Coordination Services
On December 16th, OPWDD released a Request for Information (RFI) seeking information on the interest and capabilities of vendors that are qualified to provide Health Assessment and Coordination (HAC) services for individuals with I/DD that receive Home and Community Based Services (HCBS). HAC services are consultative telemedicine services that provide: 

  • Advice on when to seek additional or in-person treatment;
  • Advice on when to coordinate care with local emergency departments, urgent care centers, and primary care physicians to enable real time support, consultation, and coordination on health issues; and
  • Assistance to individuals, families, and support providers to understand presenting health symptoms and to identify the most appropriate next steps, twenty-four hours a day, seven days a week.

OPWDD seeks information on how the respondent meets the expectations and experience outlined in the RFI, as well as a description of services and estimated pricing models.

The RFI is available here. Responses should be submitted to Contracts@opwdd.ny.gov with “HACS RFI 2022-10” in the subject line by February 3, 2023. Questions may be submitted through January 9, 2023.
 
DOH Releases Funding Opportunity for Consultative Examinations for Medicaid Eligibility
On December 14th, DOH released an RFP seeking organizations to conduct consultative examinations to determine the disability status of Medicaid applicants and recipients. The information provided from these examinations and any ancillary testing (including psychological examinations and/or intellectual evaluations) will be used by DOH and other State agency staff in deciding of an individual’s disability status for Medicaid eligibility purposes.
 
Applicant organizations must have a minimum of three years of experience providing disability determination examinations, examinations for Medicaid disability determination purposes, independent medical examinations, or direct patient care. Services will be reimbursed by DOH once per month based on the State Disability Review Unit (SDRU) Statewide Consultative Examination (CE) Fee Schedule. Contracts will last for five years, starting on November 1, 2023.
 
The RFP is available here. Applications are due on February 10, 2023. Questions may be submitted to OHIPcontracts@health.ny.gov through December 30th.