Weekly Health Care Policy Update – May 1, 2023

May 9, 2023

In this update:

  • Federal Agencies
    • CMS Proposes Two Rules to Improve Access and Quality in Medicaid and CHIP
    • CMS Tightens Hospital Transparency Enforcement Processes
    • HHS Releases Proposed Rule to Expand Coverage for DACA Recipients
    • CMS Approves Illinois SPA Expanding Medicaid Reimbursement for School-Based Services
  • Other Updates
    • GAO Releases Report on Electronic Health Information Exchange
    • Kaiser to Acquire Geisinger Health and Launch Risant Health
  • New York State Updates
    • Governor Hochul Announces Conceptual Agreement on NYS FY 2024 Budget
    • Mayor Adams Releases NYC Executive Budget for FY 2024
    • New York City Council Releases Mental Health Roadmap
    • OMH Releases Part 599 MHOTRS Medicaid Billing and Fiscal Guidance
    • DOH and OMH Host Webinar on Medicaid Recertifications 
    • OASAS and DOH Launch Buprenorphine Assistance Pilot Program
  • Funding Opportunities
    • DOH and HRI Announce RFA for Large Wellness Program
    • ACS Releases RFP for Parent Advocate Services for Justice-Involved Youth
    • HDP Releases Concept Paper for Queens Family Center Services

Federal Agencies

CMS Proposes Two Rules to Improve Access and Quality in Medicaid and CHIP
On April 27th, the Centers for Medicare & Medicaid Services (CMS) released two proposed rules designed to improve access to and quality of care in Medicaid and the Children’s Health Insurance Program (CHIP). Together, the rules would establish access standards through Medicaid or CHIP managed care plans and require transparency of Medicaid payment rates to providers, including hourly rates and compensation for certain direct care workers. For Medicaid managed care, the proposals include new standards related to appointment wait times and new requirements related to medical loss ratio (MLR) calculation and state directed payments.
 
Other highlights of the two proposed rules include:

  • Establishing national maximum standards for certain appointment wait times for Medicaid or CHIP managed care enrollees;
  • Requiring states to conduct independent secret shopper surveys;
  • Creating new payment transparency requirements for states;
  • Establishing additional transparency and interested party engagement requirements for setting Medicaid payment rates for home and community-based services;
  • Creating timeliness-of-access measures for HCBS;
  • Strengthening how states use state Medical Care Advisory Committees,;
  • Requiring states to conduct enrollee experience surveys in Medicaid managed care annually for each managed care plan; and
  • Establishing a framework for states to implement a Medicaid or CHIP quality rating system, a “one-stop-shop” for enrollees to compare Medicaid or CHIP managed care plans.

Comments on both proposed rules will be accepted until July 3rd. The proposed rule on ensuring access to Medicaid services is available here. The proposed rule on Medicaid and CHIP access, finance, and quality is available here.
 
CMS Tightens Hospital Transparency Enforcement Processes
On April 26th, CMS issued a fact sheet outlining “process updates” that CMS is making to increase compliance with hospital transparency requirements. Under the transparency regulations, hospitals are required to make standard charges public in two ways: 1) a single machine-readable file and 2) a consumer-friendly display of standard charges for at least 300 shoppable services. CMS monitors compliance via public complaints, review of individuals’ or entities’ analysis of noncompliance; and internal audits of hospitals’ websites. To date, CMS has issued over 730 warning notices and 269 requests for a corrective action plan (CAP).
 
CMS is now updating its enforcement process to include:

  • Requiring CAP completion deadlines: In addition to requiring hospitals that are out of compliance with the hospital price transparency regulation to submit a CAP within 45 days, CMS will also now require hospitals to be in full compliance with the hospital price transparency regulation within 90 days from when CMS issues the CAP request, rather than allowing hospitals to propose a completion date for CMS approval which can vary. 
  • Imposing Civil Monetary Penalties (CMPs) earlier and automatically:  CMS does not currently impose automatic CMPs for failure to submit a requested CAP or failure to come into compliance. CMS will now automatically impose a CMP on hospitals that fail to submit a CAP at the end of the 45-day CAP submission deadline. Before imposing the CMP, CMS will re-review the hospital’s files to determine whether any of the violations cited in the CAP request continue to exist and, if violations are found, impose a CMP.
  • Streamlining the compliance process: For hospitals that have not made any attempt to satisfy the requirements, CMS will no longer issue a warning notice to the hospital and will instead immediately request that the hospital submit a CAP.

More information is available here.
 
HHS Releases Proposed Rule to Expand Coverage for DACA Recipients
On April 24th, the Department of Health and Human Services (HHS) released a proposed rule to expand health coverage for Deferred Action for Childhood Arrivals (DACA) program recipients. The proposed rule follows an announcement of the policy in early April. The proposed rule would amend the definition of “lawful presence” to include DACA recipients for purposes of Medicaid and Affordable Care Act coverage. The change would make DACA recipients eligible to apply for coverage through state Medicaid programs or through Health Insurance Marketplaces, where they would be able to qualify for financial assistance based on income. If finalized, DACA recipients would qualify for a special enrollment period to select a qualified health plan through the Marketplace during the 60 days following the effective date of the final rule. HHS estimates this change could provide coverage for up to 129,000 previously uninsured individuals.
 
The announcement is available here.
 
CMS Approves Illinois SPA Expanding Medicaid Reimbursement for School-Based Services
On April 18th, CMS approved a request by Illinois for a State Plan Amendment (SPA) to allow schools to receive Medicaid reimbursement for covered school-based services provided to all children with Medicaid. Originally, Medicaid allowed reimbursement for school-based services only to those children with an Individualized Education Program (IEP) or through the Maternal and Child Health Block Grant, but in 2014, CMS issued guidance allowing states to modify their state plans to seek reimbursement for all students.
 
The Biden Administration is highlighting Illinois’s SPA to highlight its focus on promoting school-based care. Illinois now joins 11 other states that have previously expanded Medicaid payment for school-based health services under their state plans, although New York is not one of them. In New York, school-based services have been traditionally considered certified public expenditures (CPEs), and although they are scheduled to be transitioned into managed care, they currently remain carved out through April 2024.
 
More information is available here.

Other Updates

GAO Releases Report on Electronic Health Information Exchange
On April 21st, the Government Accountability Office (GAO) released a report, “Electronic Health Information Exchange: Use Has Increased, but is Lower for Small and Rural Providers.” The report found that while the use of electronic exchange among hospitals and physicians has increased in recent years, partly spurred on by enhanced Medicaid matching funds to states through the Health Information Technology for Economic and Clinical Health (HITECH) act, use among small and rural hospitals was lower than other hospitals. For example, roughly half of small hospitals send or receive information via mail/fax, while roughly one-third of medium/large hospitals do the same. Similarly, while roughly half of medium/large hospitals send and receive information via a regional/state/local health information exchange organization or an electronic health record vendor-based network, fewer than one-third of small hospitals do the same.

GAO proposes that such providers might be less likely to have the “financial and technical resources to participate in electronic exchange” such as staff and broadband internet, and suggests that federal efforts may address some impediments. The Trusted Exchange Framework and Common Agreement (TEFCA), for example, may mitigate costs by providing a simpler approach to connecting with other providers, but does not sufficiently address issues faced by small and rural providers like staffing shortages and gaps in broadband access.

The full report is available here.

Kaiser to Acquire Geisinger Health and Launch Risant Health
On April 26th, Kaiser Foundation Hospitals announced the acquisition of Geisinger Health and the formation of a new nonprofit organization, Risant Health. Geisinger will become the first member of Risant Health, whose aim is “to expand and accelerate the adoption of value-based care in diverse, multi-payer, multi-provider, community-based health system environments.” Kaiser intends to invest approximately $5 billion in Risant to continue “acquiring and connecting a portfolio of like-minded, nonprofit, value-oriented community-based health systems anchored in their respective communities.” Risant Health systems will continue to operate as regional or community-based health systems with support from Risant’s value-based platform.

More information is available here.

New York State Updates

Governor Hochul Announces Conceptual Agreement on NYS FY 2024 Budget
On April 27th, Governor Hochul announced a “conceptual agreement” with the New York State (NYS) Legislature on an estimated $229 billion budget for Fiscal Year (FY) 2024. News reports indicate that some items remain to be worked out, but lawmakers are expected to pass legislation to enact the budget in the next day or two. The Governor highlighted several health care elements of the budget agreement, including:

  • $1 billion in new capital funding;
  • A $1 billion investment in mental health services;
  • $100 million for reproductive health care services as well as policy changes to improve access to reproductive health care;
  • Increased funding for the Master Plan on Aging; and
  • Expansion of the Medicaid Buy-In program

The Governor’s press release is available here. SPG will publish a full summary of the FY 2024 NYS Budget following the release of the Budget documents and legislation.
 
Mayor Adams Releases NYC Executive Budget for FY 2024
On April 26th, New York City (NYC) Mayor Eric Adams released NYC’s Executive Budget for FY 2024. The budget proposes total spending of $106.7 billion, which is $4.2 billion more than the preliminary budget (available here) due to positive revisions in projected tax revenues. It had been expected that the administration would require city agencies to reduce spending by 4% in the Executive Budget; however, it was determined that some agencies would only be able to meet such targets by reducing critical services needed for public safety and health. As a result, spending reduction targets have been revised for these agencies, including the Human Resources Administration (HRA) and the Department of Homeless Services (DHS).
 
The budget includes the following health-related investments, including a number of proposals to strengthen the city’s mental health resources:  

  • $5.3 million to increase outreach to New Yorkers about benefits such as Medicaid, SNAP, etc.
  • $27 million to continue the expansion of the Behavioral Health Emergency Assistance Response Division (B-HEARD) program in the Bronx and other high-need neighborhoods;
  • $1 million for children’s mental telehealth services in family shelters;
  • $9 million to launch the School Tele-Mental Health program that gives high school students access to telehealth services;
  • $1 million to develop digital access to mental health supports and to consolidate and streamline how New Yorkers with serious mental illness access services; and
  • $2 million to increase the capacity of clubhouse community centers that provide peer-led support.

The Executive Budget documents are available here.
 
New York City Council Releases Mental Health Roadmap
On April 24th, the New York City Council released a Mental Health Roadmap that includes legislative and budget proposals that seek to increase access to mental healthcare services and expand the city’s existing mental health infrastructure, with a focus on four main areas:

  • Increased prevention and support services, particularly at the community level;
  • Investments to address the mental health workforce shortage;
  • Intersection with the criminal justice system; and
  • Public awareness and interagency communication/coordination.

Examples of specific proposals include:

  • Legislation (No. 1021) to expand the number of crisis respite centers to at least two per borough;
  • Legislation (No. 1022) for a pilot program that expands clubhouse-style community centers for individuals with serious mental illness (SMI) in high-need areas;
  • Legislation (No. 1018) that requires the Mayor’s Office of Community Mental Health (OCMH) to report on the implementation of the Mayor’s Involuntary Transport directive authorizing community removals of individuals with serious mental illness (available here);
  • Legislation (No. 1019) that requires the creation of a comprehensive database and interactive map of outpatient mental health service providers in NYC;
  • Legislation (No. 1006) for the establishment and implementation of an outreach and education campaign regarding mental health services;
  • Establish Social Work Fellows Programs at CUNY schools to subsidize the cost of mental health education, degrees, and licensing;
  • Advocate for adequate funding and in contracts to achieve pay parity for workers across the mental health workforce;
  • Invest an additional $28 million to strengthen existing school-based mental health clinics and establish additional sites;
  • Advocate for a reevaluation of the 15/15 Supportive Housing Plan and allocate an additional $45 million to fund the plan’s remaining supportive housing units; and
  • Allocate $12.8 million to meet funding needs of 380 units of supportive housing for Justice-involved individuals.

The Roadmap is available here. The City Council’s proposed legislation will be discussed at a May 4th hearing by the Committee on Mental Health, Disabilities, and Addiction. Details on the hearing are available here. Over the next two months, the City Council and Mayor will negotiate adjustments to the recently released Executive Budget and must reach agreement and adopt a final budget before July 1st.
 
OMH Releases Part 599 MHOTRS Medicaid Billing and Fiscal Guidance
On April 24th, the NYS Office of Mental Health (OMH) released billing and fiscal guidance for Part 599 Mental Health Outpatient Treatment and Rehabilitative Services (MHOTRS), which had been updated and reclassified from Clinic Treatment Services after moving to the Medicaid State Plan Rehabilitative Services benefit in November 2022. A non-exhaustive list of fiscal changes resulting from the Part 599 regulations amendments include:

  • Expands allowable off-site services and removes daily off-site service limits;
  • Includes new rate codes for Integrated Outpatient Services (IOS) off-site services;
  • Adds additional service types that are exempt from the Medicaid Utilization Threshold count;
  • Allows non-physician practitioners (NPPs) as clinicians who may sign treatment plans;
  • Adds Peer Support Services as an allowable service;
  • Updates allowable time durations for services; and
  • Updates Safety Net payment calculations and details for both FQHC and non-FQHC providers.

A summary of fiscal changes made in the guidance document is available here. The guidance document, available here, focuses on Medicaid fee-for-service and Medicaid managed care billing and fiscal guidance only. OMH expects to release a second guidance document that focuses on program licensure, operations, and service provision.
 
DOH and OMH Host Webinar on Medicaid Recertifications 
On April 25th, the NYS Department of Health (DOH) and OMH held a webinar to provide an overview of the unwind of Medicaid continuous enrollment provisions. The webinar reviewed the State’s process and timeline to resume Medicaid eligibility renewals and provided guidance to providers and managed care organizations on their roles in identifying and notifying beneficiaries who need to be recertified. The webinar also provided an update on the unwind process for dually eligible individuals.
 
The presentation is available here. A recording of the presentation is available here.
 
OASAS and DOH Launch Buprenorphine Assistance Pilot Program
On April 24th, DOH and the NYS Office of Addiction Services and Supports (OASAS) announced the launch of the Buprenorphine Assistance Pilot Program (Bupe-AP) to help eligible uninsured and under-insured individuals with opioid use disorder (OUD) access buprenorphine treatment with no out-of-pocket costs. The program will cover the costs of medication for program participants, as well as staff time to process claims.
 
The program will utilize the DOH AIDS Institute’s Office of Uninsured Care Programs’s existing pharmacy benefit management system, allowing participants to access over 4,300 pharmacies. Select OASAS and DOH programs will roll-out the benefit, make modifications as necessary, and expand to additional agencies in the future.
 
The press release is available here.

Funding Opportunities

DOH and HRI Announce RFA for Large Wellness Program
On April 21st, DOH and the Health Research Inc. (HRI) issued a Request for Applications (RFA) for community-based organizations based outside of NYC to create or expand a self-management program that engages participants in wellness activities and to promote COVID-19 health literacy information. DOH will award up to 27 one-time grants of up to $250,000 per organization.
 
Organizations must choose one of the following focus areas:

  • Chronic Disease Management; or
  • Social Determinants of Health.

The proposed project cannot include the provision of any clinical services. Organizations must also identify focus populations for program participation, which may include, but are not limited to: racial/ethnic/religious minority populations; individuals experiencing poverty and/or homelessness; incarcerated individuals; individuals with disabilities; seniors; individuals experiencing mental illness and/or substance use disorders, etc. 
 
Eligible organizations include:

  • Non-profit organizations (except for hospitals);
  • Community-based organizations;
  • Rural Health Networks;
  • Community health centers; and
  • Faith-based organizations.

Hospitals and county health departments are excluded from applying. Applicants may apply for more than one award in different focus areas or regions; however, only one award can be made per organization. Applicant organizations must propose to partner with a grassroots organization in their community catchment area whose work aligns with the applicant’s proposed project and who can assist in reaching individuals in the focus population. At least $75,000 of the $250,000 must be allocated to the partner grassroot organization.
 
The RFA is available here. Questions must be submitted to Samantha Cassidy at covidhdp@health.ny.gov through May 12th. Applications are due June 16th. Awarded funding must be used by March 31, 2024.
 
ACS Releases RFP for Parent Advocate Services for Justice-Involved Youth
On April 14th, the NYC Administration for Children’s Services (ACS) issued a Request for Proposals (RFP) for organizations that will hire parents with lived experience in child-serving systems (e.g juvenile justice, child welfare) to serve as parent advocates to provide support to the parents/families of youth detained or remanded to ACS juvenile justice congregate care settings (i.e. Detention facilities and Close to Home programs). There are two competition pools for the RFP, and ACS will award one contract for each pool. Applicants wishing to apply for both competitions must submit separate proposals for each pool:  

  • Competition pool 1: Secure detention (two sites) and non-secure detention (seven sites), which has a projected need of at least 12-15 weekly hours at each secure facility and 12-15 weekly hours across all non-secure detention sites.
  • Competition pool 2: Close to Home (Non-Secure Placement/Limited Secure Placement/ Aftercare), which has a projected need of approximately 800 conferences annually.

Applicants should have current or previous experience providing contracted Parent Advocate services for ACS or other jurisdictions and/or previous subcontracts or other business relationships to provide substantial services to children in child welfare or juvenile justice in New York City or other jurisdictions. Furthermore, applicants should have experience providing culturally and linguistically competent services through staff representative of the community being served.

The anticipated funding for each of the two contracts is $365,000 per year, for a contract period of three years. Contracts will begin October 1st, with the option to renew for another three-year term. Contractors will be reimbursed using a line-item payment structure, with payments made for expenses incurred against an approved budget.
 
The RFP documents are available in the PASSPort system here by searching “parent advocate”. Applications are due May 19th. Questions can be directed to ParentAdvocateJJ-RFP@acs.nyc.gov.
 
HDP Releases Concept Paper for Queens Family Center Services
On April 20th, the NYC Department of Housing Preservation (HPD) released a Concept Paper outlining a forthcoming RFP seeking a Family Center provider who will operate, manage, and maintain emergency housing/shelter and relocation assistance services to HPD-registered relocatees. The Family Center provider would be expected to have the capacity to temporarily house a minimum of 185 people in family units. Only adults with at least one accompanying minor under the age of 18 years will be housed in the Family Center. The Family Center must include cooking facilities and private bathroom accommodations. While the Family Center will be located in Queens, the contract will be for citywide services and families from other boroughs may be assigned to the Family Center.
 
At the time of proposal submission, the contractor would either own, lease, or otherwise control, or have identified appropriate building(s) for acquisition and demonstrate the capability to manage and operate facility(s) to be used as a Family Center. The contractor must maintain administrative offices and administrative personnel at the Family Center and provide the following services through competent on-site staff: facility maintenance and security, client case management services, and housing relocation services.
 
HPD anticipates that the total maximum funding for the contract will be approximately $29 million. The anticipated term of the contract award will be three years, beginning July 1, 2024, with the option to renew for two additional two-year terms.
 
The Concept Paper is available in the PASSPort system here by searching “Queens Family Living Center”. Comments and feedback may be submitted by June 4th to John Alter at Alterj@hpd.nyc.gov and Jasmine Chapman at Chapmanj@hpd.nyc.gov with “Queens Family Center Services Concept Paper” in the subject line of the email.