Weekly Health Care Policy Update – March 6, 2023

March 13, 2023

In this update: 

  • Legislative Update
    • HELP Committee Issues Bipartisan Health Workforce RFI
    • Democrats Urge HHS to Address Short-Term Insurance Plans
  • Federal Agencies
    • CMS Releases Overview Fact Sheet on PHE Unwinding
    • CMS Posts State Timelines for Ending Continuous Medicaid Enrollment
    • HHS Reorganizes OCR to Better Address Data Breaches and Cybersecurity
  • Other Updates
    • CDC Finds Black Americans Have Highest Rate of Mental Health ED Visits
    • Twelve Blue States Sue FDA Over Mifepristone Risk Mitigation Program
    • UCP and ANCOR Publish Report on I/DD Direct Service Workforce Crisis
    • RAND Publishes Study Showing Worse Care Experiences at For-Profit Hospices
  • New York State Updates
    • Governor Hochul Appoints Robert Megna as New York State Budget Director
    • DOH Revises Proposed Hospital Clinical Staffing Rule to Add 1:2 Staffing Requirement in ICUs and Critical Care Units
    • SED Proposes Streamlined Requirements for ABA Providers
    • NYS Comptroller Releases Audit Report on Early Intervention Program
  • Funding Opportunities
    • SAMHSA Releases NOFO for Employment Programs for Adults with Mental Illness
    • SAMHSA Releases NOFO to Develop School-Based Mental Health Programs and Services
    • SAMHSA Releases NOFO for Mental Health Awareness Training
    • OMH Releases RFP for Statewide Infrastructure and Network for Family Peer Support Services
    • OMH Releases RFP for Statewide Infrastructure and Network for Youth Peer Support Services
    • OMH Releases RFP to Support the NYS Parenting Education Partnership
    • AHRQ to Host Webinar on Equity-Focused Evidence-Based Interventions Funding Opportunity

Legislative Update

HELP Committee Issues Bipartisan Health Workforce RFI
On March 2nd, the chairs of the Senate Health, Education, Labor, and Pensions (HELP) Committee, Senators Bernie Sanders (I-VT) and Bill Cassidy (R-LA), issued a brief Request for Information (RFI) on the health care workforce. The RFI does not contain specific questions, but rather asks for the input of “all stakeholders” to explain the drivers of health care workforce shortages and to propose potential solutions. The RFI notes that the HELP Committee plans to develop bipartisan legislation on these issues this year.

A press release is available here. Responses should be submitted to HealthWorkforceComments@help.senate.gov by March 20th.

Democrats Urge HHS to Address Short-Term Insurance Plans
On February 22nd, a group of Senate Democrats wrote a letter to Secretary of Health and Human Services (HHS) Xavier Becerra, requesting that HHS promptly act to curtail the marketing and sale of short-term, limited duration insurance (STLDI) plans as the Medicaid unwinding process begins. STLDI plans are exempt from many of the insurance requirements established by the Affordable Care Act. The letter expresses Democrats’ concern that that many consumers will sign up for “sub-par” STLDI plans to quickly obtain coverage when they are disenrolled from Medicaid.

This letter follows a related letter from Democrats on the House Energy and Commerce Committee. Both letters request that HHS complete the issuance of a rule that would repeal a Trump-era regulation that extended the maximum duration of STLDI coverage from three months to 364 days and allowed renewals for up to 36 months. The Biden administration is expected to release its proposed rule in April, but Democrats are concerned that this will be too late to address the issue.

The letter from Senate Democrats is available here. The Energy and Commerce letter is available here.

Federal Agencies

CMS Releases Overview Fact Sheet on PHE Unwinding
On February 27th, the Centers for Medicare & Medicaid Services (CMS) issued an overview fact sheet on the unwinding of the Covid-19 public health emergency (PHE) and its effects on consumers, including Medicare, Medicaid and Children’s Health Insurance Program (CHIP), and private health insurance enrollees. The fact sheet addresses three major topics: 

  • Post-PHE coverage of Covid-19 testing, vaccination, and treatment across the three different payer types;
  • Post-PHE telehealth coverage; and
  • Continuing waivers and administrative flexibilities for health care professionals. These include: 
    • Blanket waivers to expand health care capacity. 
      • These will expire May 11th.
    • The Hospital at Home program. 
      • This will continue through December 2024, and hospitals may continue to apply to participate in the meantime.
    • Waivers of the requirement that nurse aides in nursing homes must complete an appropriate Competency Evaluation Program after four months. 
      • CMS ended this blanket waiver in 2022 but continued offering it on a case-by-case basis. All such waivers will end May 11th, and facilities will have four months from that date to ensure all nurse aides complete this requirement.
    • Modification of the definition of “direct supervision” to include virtual supervision. 
      • This will expire December 31st.
    • Waiver of the requirement that Certified Registered Nurse Anesthetists (CRNAs) must be supervised by a physician. 
      • This will expire May 11th, but states may apply to continue the waiver.

The full fact sheet is available here.
 
CMS Posts State Timelines for Ending Continuous Medicaid Enrollment
On March 2nd, CMS posted the current timelines for reinstating Medicaid eligibility determinations, as submitted by state Medicaid programs. Most states (29 of them) have elected to begin the redetermination process in April, the latest possible month. As covered in New York-specific documents, New York’s process technically begins in March (for certain enrollees), but coverage terminations will not commence until July 2023. Since March 2020, Medicaid enrollment nationally has increased from about 71 million to nearly 92 million, largely as a result of the continuous coverage requirement.
 
The timelines by state are posted here.
 
HHS Reorganizes OCR to Better Address Data Breaches and Cybersecurity
On February 27th, HHS announced that it is forming new divisions within its Office for Civil Rights (OCR) to address health information privacy and cybersecurity breaches. The three new divisions—Enforcement, Policy, and Strategic Planning—are intended “to provide a more integrated operational structure” for the issues addressed by OCR, which include civil rights, conscience protections and privacy protections and cybersecurity protections. The reorganization is in response to a 69% increase in OCR’s caseload since 2017. Violations of health information privacy and security laws make up 66% of this increase.
 
More information is available here.

Other Updates

CDC Finds Black Americans Have Highest Rate of Mental Health ED Visits
On March 1st, the Centers for Disease Control and Prevention (CDC) published a National Health Statistics Report that found that rates of mental health-related ED visits were much higher among non-Hispanic Black adults (96.8 visits per 1,000 adults). This rate was close to twice the second-highest rate, which was for non-Hispanic White adults (53.4 per 1,000) and Hispanic adults (36.0 per 1,000). The report, entitled “Emergency Department Visits Related to Mental Health Disorders Among Adults, by Race and Hispanic Ethnicity: United States, 2018–2020,” is based on data collected through an annual survey.
 
Non-Hispanic Black adults also had the highest rates of ED visits for specific mental health disorders, including substance use disorders, anxiety disorders, and mood disorders. In addition, a higher percentage of visits by Hispanic (57.7%) and non-Hispanic Black (49.5%) adults had Medicaid as the expected primary source of payment, compared to visits by non-Hispanic White adults (36.1%).

The full report is available here.
 
Twelve Blue States Sue FDA Over Mifepristone Risk Mitigation Program
On February 24th, a group of 12 Democratic attorneys general filed a lawsuit against the Food and Drug Administration (FDA) mifepristone prescribing requirements. Currently, the FDA requires that mifepristone be dispensed under a risk mitigation program. The program requires that: 

  • Prescribers must be certified by the manufacturer;
  • Patients and providers must attest that the patient is taking mifepristone and misoprostol; and
  • Pharmacies must have a special certification to dispense.

The Attorneys General filing suit argue that the drug is associated with fewer serious side effects and deaths than many common drugs without such risk mitigation programs, and that the certifications and agreements could expose individuals to violence, harassment, abuse, or even legal liability in states with anti-abortion laws. The Attorneys General also filed a preliminary injunction to stop FDA enforcement of the mifepristone risk mitigation program while the case proceeds.
 
UCP and ANCOR Publish Report on I/DD Direct Service Workforce Crisis
On March 1st, United Cerebral Palsy and ANCOR published a report, entitled “The Case for Inclusion 2023,” which highlights the direct service workforce crisis and its impact on community inclusion of people with intellectual and/or developmental disabilities (I/DD). Part 1 of the report focuses on presenting data on the current state of services for people with I/DD:

  • 481,601 individuals with I/DD were on state waiting lists for home and community-based services (HCBS) over the past year.
  • 36 states participated in the Money Follows the Person program, a slight increase after five years of a downward trend.
  • State funding for families of people with I/DD increased by approximately $978 million between FY 2017 and FY 2019.
  • 22% of people with I/DD who received employment or day services were participating in integrated employment (of which 19% worked for pay). This was the highest level since 2001, but the rate has essentially stagnated from between 19% and 22% since 2013.

Part 2 of the report offers recommended solutions for federal and state legislatures, as well as providers and advocates, to address the direct support workforce crisis. These recommendations include: 

  • Issuing guidance to address workforce-related regulatory flexibilities relative to the ending of the Public Health Emergency;
  • Requiring states to regularly review Medicaid reimbursement rates to ensure adequate payments for quality HCBS;
  • Requiring state and federal agencies to collect and publicly report on measures related to workforce volume, stability and compensation, as well as systemic barriers to equity and the delivery of culturally competent services within the direct support workforce;
  • Expediting existing visa processes to ensure opportunities for non-citizens interested in joining the direct support workforce;
  • Enacting legislation to significantly increase the federal share of Medicaid funding for HCBS to stabilize the direct support workforce;
  • Establish a Standard Occupational Classification for direct support professionals, the primary caregivers for people with I/DD; and
  • Enact legislation that would fund federal grant programs to support the training, recruitment, retention and advancement of the direct support workforce.

The full report is available here.
 
RAND Publishes Study Showing Worse Care Experiences at For-Profit Hospices
On February 27th, the RAND Corporation published the results of a study showing that patients receiving care from for-profit hospices have “substantially worse care experiences than patients who receive care from not-for-profit hospices.” The study analyzed 650,000 surveys of family caregivers of patients treated by over 3,100 hospices across the country. Surveys showed that patients treated by for-profit hospitals were nearly 6 percentage points less likely than those in not-for-profit hospices to “definitely recommend” their hospices to others. The survey sought feedback across multiple domains, including “help for pain and other symptoms,” “getting timely care,” and other elements.
 
In the last two decades, the proportion of for-profit hospices has increased from 30% in 2000 to 73% in 2020. At the same time, the percentage of Medicare beneficiaries using hospice services in the year in which they die increased from under 25% in 2000 to roughly 50% in 2020. The surveys were completed between 2017 and 2019, and included home-based, inpatient, and nursing home hospice care.
 
The full report is available here.

New York State Updates

Governor Hochul Appoints Robert Megna as New York State Budget Director
On February 28th, Governor Hochul announced that she was appointing Robert Megna as New York State Budget Director, effective immediately. Prior to his appointment, Megna was the President of the Rockefeller Institute of Government and Senior Advisor to the Chancellor at the State University of New York (SUNY). He previously served as Budget Director from 2009 to 2015. Megna has indicated he plans to serve through the legislative session and assist with the search for a long-term Budget Director before returning to SUNY.
 
The Governor’s press release is available here.
 
DOH Revises Proposed Hospital Clinical Staffing Rule to Add 1:2 Staffing Requirement in ICUs and Critical Care Units
On March 1st, the New York State (NYS) Department of Health (DOH) issued a revised proposed rule on the requirements for general hospitals to have clinical staffing committees and create clinical staffing plans. DOH first issued this proposed rule in February 2022 (see SPG’s summary here), which requires general hospitals to create a clinical staffing committee responsible for developing and overseeing the implementation of a clinical staffing plan. DOH has indicated that the initial rule did not establish staffing ratios for ICU and critical care units of general hospitals. The revised proposed regulation now includes a requirement of one registered professional nurse for every two intensive care or critical care patients.
 
The proposed rule is available here. Comments may be submitted to regsqna@health.ny.gov through April 30th.
 
SED Proposes Streamlined Requirements for ABA Providers
On March 1st, the NYS Education Department (SED) issued a proposed amendment to regulations on the licensure of Licensed Behavior Analysists (LBAs) and the certification of Certified Behavior Analyst Assistants (CBAAs) that provide Applied Behavior Analysis (ABA) services. The proposed amendment aligns education standards with evolving national certification requirements and outlines education, experience, and examination requirements for LBAs and CBAAs.
 
The amendment would create an exemption for supervised work in order to help graduates meet experience requirements for national certification and entry to the examination. The amendment would further allow individuals who meet the requirements for licensure as an LBA or certification as a CBAA except for examination, experience, and education requirements but who are certified by a national certifying body, to be licensed or certified without meeting the additional requirements following the submission of an application.
 
The proposed rule is available here. Comments may be submitted to regcomments@nysed.gov through April 30th.
 
NYS Comptroller Releases Audit Report on Early Intervention Program
On February 28th, the Office of the NYS Comptroller released an audit report on oversight and administration of the Early Intervention Program (EIP). This program identifies and evaluates infants and toddlers whose health development is compromised and provides appropriate intervention to improve child and family developments. The audit investigated whether DOH is effectively administering the EIP in compliance with all applicable laws and regulations and ensuring equitable and timely access to services for children statewide.
 
The audit concluded that many children who would benefit from EIP services are not receiving services, and those who are receiving services are not receiving them in a timely manner. The audit attributes these issues to a lack of parental consent and insufficient provider capacity. The report also found: 

  • Statewide disparities in the referral and inclusion of children into EIP and in the availability of providers and access to services;
  • Health equity issues, with white children being referred at a younger age and Black children being less likely to receive services within the prescribed timeframe; and
  • The web-based management platform (NYEIS) for the program does not have the functionality or accuracy required to administer the program efficiently and effectively at a local level.

The Office recommends that DOH take steps to identify and address barriers to accessing services and to develop an action plan to improve equitable access to services. Additionally, the Office recommends that DOH expedite the implementation process for the new web-based system for program management.
 
The audit report is available here.

Funding Opportunities

SAMHSA Releases NOFO for Employment Programs for Adults with Mental Illness
On February 28th, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a Notice of Funding Opportunity (NOFO) for the implementation of supported employment programs for adults with Serious Mental Illness (SMI) or co-occurring mental and substance use disorders (COD). Funding will support direct services, including but not limited to: 

  • The identification and implementation of an evidence-based supported employment model;
  • The provision of specialized and individualized support to individuals with SMI and COD to choose, acquire, and maintain competitive employment;
  • The provision of comprehensive treatment and recovery supports (e.g., psychiatric services, physical health care, social services supports); and
  • Program outreach and accessibility services for under-resourced populations.

Through this opportunity, SAMHSA will award over $4.8 million in total annual funding to six applicants (up to $800,000 annually per awardee) over a five-year program period. Eligible applicants include health facilities and other private non-profit entities.
 
The NOFO is available here. Applications are due on May 1st. Questions may be submitted to Mogens Baerentzen at mogens.baerentzen@samhsa.hhs.gov.  
 
SAMHSA Releases NOFO to Develop School-Based Mental Health Programs and Services
On February 27th, SAMHSA released a NOFO for the development of a sustainable infrastructure for school-based mental health programs and services. Award recipients will be expected to develop partnerships with state agencies, community-based providers, and school personnel and leverage these partnerships to implement mental health-related promotion, awareness, prevention, intervention, and resilience activities for school-aged youth.
 
Through this opportunity, SAMHSA will award over $38 million in total annual funding to 21 applicants (up to $1,800,000 annually per awardee) over a five-year program period. Eligible applicants include health facilities and other private non-profit entities.
 
The NOFO is available here. Applications are due on April 28th. Questions may be submitted to Jennifer Treger at sea_aware@samhsa.hhs.gov.
 
SAMHSA Releases NOFO for Mental Health Awareness Training
On March 1st, SAMHSA released a NOFO for the 2023 Mental Health Awareness Training (MHAT) program. This program: 

  • Trains individuals (e.g., school personnel and EMS personnel) to recognize the signs and symptoms of mental disorders and how to safely de-escalate crisis situations; and
  • Provides education on resources available in the community for individuals with a mental illness, including how to establish linkages with school and/or community-based mental health agencies.

Through this opportunity, SAMHSA will award over $4.4 million in total annual funding to 22 applicants (up to $200,000 annually per awardee) over a three-year program period. Eligible applicants include private non-profit entities. Recipients who received funding under the 2021 or 2022 MHAT program opportunities are not eligible.
 
The NOFO is available here. Applications are due on May 1st. Questions may be submitted to Shane Grant at mhat_nofo@samhsa.hhs.gov.
 
OMH Releases RFP for Statewide Infrastructure and Network for Family Peer Support Services
On March 1st, the NYS Office of Mental Health (OMH) released a Request for Proposals (RFP) for the development of a statewide infrastructure that supports the provision of family peer support services. OMH is seeking one applicant that will collaborate with OMH to advance the goals and objectives of the Statewide Structure and Network for Family Support and Advocacy, including but not limited to: 

  • Supporting family education and empowerment, including providing training and technical assistance;
  • Working closely with local government and OMH to provide family voice to program and policy development;
  • Providing organizational support to family peer-run organizations; and
  • Supporting advancement and mentoring for family peer advocates.

Through this opportunity, OMH will award $5 million in total funding to one applicant during the five-year program period. Eligible applicants are not-for-profit, family-run entities (as defined in the RFP) with experience working with OMH and other child-serving systems in NYS, working with OMH licensed and non-licensed providers, and conducting activities on a statewide basis.
 
The RFP is available here. Applications are due on April 26th. Questions may be submitted to Amanda Szczepkowski at Amanda.szczepkowski@omh.ny.gov through March 22nd.
 
OMH Releases RFP for Statewide Infrastructure and Network for Youth Peer Support Services
On March 1st, OMH released an RFP for the development of a statewide infrastructure that supports the provision of youth peer support and advocacy services. OMH is seeking one applicant that will collaborate with OMH to advance the goals and objectives of the Statewide Structure and Network for Youth Support and Advocacy, including but not limited to: 

  • Promoting and providing peer-to-peer mentoring for young people with social and emotional challenges;
  • Working closely with OMH to provide feedback regarding agency policy and program development; and
  • Providing technical assistance and support to providers and local counties/regions.

Through this opportunity, OMH will award $5 million in total funding to one applicant during the five-year program period. Eligible applicants are not-for-profit organizations in which all youth/peer-oriented services are directed, managed, and provided by youth peers. Eligible applicants must also have at least two youth/youth peer representatives on the Board and must have experience working with OMH and other child-serving systems in NYS, working with OMH licensed and non-licensed providers, and conducting activities on a statewide basis.
 
The RFP is available here. Applications are due on April 26th. Questions may be submitted to Carol Swiderski at carol.swiderski@omh.ny.gov through March 22nd.
 
OMH Releases RFP to Support the NYS Parenting Education Partnership
On March 1st, OMH released an RFP to support the activities of the NYS Parenting Education Partnership (NYSPEP), a statewide professional organization for individuals engaged in or interested in parenting education. OMH seeks one applicant to serve as the fiscal agent for NYSPEP, provide administrative staffing, and ensure the completion of projects and deliverables to strengthen the delivery of quality parenting education.
 
OMH will award $2 million in total funding to one applicant over a five-year program period. Eligible applicants are for-profit or not-for-profit agencies that have experience delivering quality parental education.
 
The RFP is available here. Applications are due on April 19th and mandatory Letters of Intent must be submitted by April 12th. Questions may be submitted to Amanda Szczepkowski at Amanda.szczepkowski@omh.ny.gov through March 15th.
 
AHRQ to Host Webinar on Equity-Focused Evidence-Based Interventions Funding Opportunity
On March 9th at 2pm ET, the Agency for Healthcare Research and Quality (AHRQ) will host a webinar to discuss a funding opportunity entitled “Dissemination and Implementation of Equity-Focused Evidence-Based Interventions in Healthcare Delivery Systems.” The program will invest up to $15 million over five years in innovative research studies to test, refine, and implement equity-focused evidence-based interventions within health care delivery systems including the integration of implementation and outcome/impact evaluations. Applications are due April 21st.  
 
Webinar registration is available here. More information on the grant application is available here.