Weekly Health Care Policy Update – June 5, 2023

June 12, 2023

In this update: 

  • Administration Updates
    • President Biden to Appoint Dr. Mandy Cohen to Lead CDC
  • Legislative Updates
    • Biden Signs Debt Ceiling Legislation
  • Federal Agencies
    • CMS Finalizes Withdrawal of Covid-19 Vaccination Requirements for Health Care Staff
    • CMS Announces Plan for Medicare Coverage of Alzheimer’s Drugs
  • Other Updates
    • KFF Releases Report on Medicaid Redeterminations
  • New York State Updates
    • DOH Updates Standards for Regional Perinatal Centers, Birthing Centers, and Perinatal Services
    • SED Eases Dental Residency Program Requirements
    • DOH and SOFA to Launch Town Hall Meetings on Master Plan for Aging
  • Funding Opportunities
    • Children’s Bureau Issues NOFO on Trauma Interventions for Children and Youth in Foster Care
    • ACF Releases NOFO for Runaway and Homeless Youth Demonstration Program

Administration Update

President Biden to Appoint Dr. Mandy Cohen to Lead CDC
On June 1st, the Washington Post reported that President Biden will nominate Dr. Mandy Cohen to lead the Centers for Disease Control and Prevention (CDC). In May, Dr. Rochelle Walensky announced that she would leave her post on June 30th. Dr. Cohen, who is trained in internal medicine, currently serves as EVP of Aledade and CEO of Aledade Care Solutions. She previously served as Secretary of North Carolina’s Department of Health and Human Services, as well as Chief Operating Officer and Chief of Staff at the Centers for Medicare and Medicaid Services (CMS) during the Obama Administration. A formal announcement is expected later this month. Senate confirmation is not required for the position.
 
The Washington Post article is available here.

Legislative Update

Biden Signs Debt Ceiling Legislation
On June 3rd, President Biden signed H.R. 3746, the Fiscal Responsibility Act, a bill that suspends the federal debt limit through January 1, 2025. The House passed the Act on May 31st, by a vote of 314-117, and the Senate passed it on June 1st by a vote of 63-36.
 
In addition to raising the debt limit, the bill will rescind approximately $30 billion in unspent Covid-19 relief funds, although it retains $5 billion to develop the next generation of Covid vaccines. The bill did not include work requirements for Medicaid recipients, but it did tighten work requirements for Supplemental Nutrition Assistance Program (SNAP) recipients between ages 18-54 who do not have disabilities. The bill also establishes spending caps for non-defense discretionary spending, keeping spending flat in 2024 and increasing spending by 1% in 2025. If Congress fails to pass all 12 appropriations bills by the end of the fiscal year, the bill would trigger a 1% spending cut.
 
The bill text is available here. A section-by-section summary is available here.

Federal Agencies

CMS Finalizes Withdrawal of Covid-19 Vaccination Requirements for Health Care Staff
On May 31st, CMS announced a rule finalizing changes to Covid-19 health care staff vaccination requirements that would end mandatory vaccination, aligning its approach with requirements for influenza and other infectious diseases. The rule: 

  • Removes regulatory provisions on Covid-19 vaccination requirements for health care staff of specified Medicare- and Medicaid-certified providers and suppliers;
  • Removes staff and patient Covid-19 testing requirements for long-term care (LTC) facilities, which were originally published on September 2, 2020 and were applicable for the duration of the Public Health Emergency (PHE); and
  • Requires LTC facilities to provide education about Covid-19 vaccines, and to offer such vaccines to residents, clients, and staff.

CMS intends to encourage ongoing Covid-19 vaccination through quality reporting and value-based incentive programs “in the near future,” as indicated by the inclusion of Covid-19 vaccination measures in the Measures Under Consideration (MUC) List published on December 1, 2022.

The final rule, including MUCs for Covid-19 vaccination, is available here. 

CMS Announces Plan for Medicare Coverage of Alzheimer’s Drugs 
On June 1st, CMS announced a plan for Medicare beneficiary access to new Alzheimer’s drugs. Medicare will cover new Alzheimer’s drugs if they have traditional Food and Drug Administration (FDA) approval and if a physician and clinical team participate in the collection of evidence through a CMS-facilitated registry. Such a registry will gather information on patient outcomes and will become available as soon as a drug receives traditional approval.

Today, while two new Alzheimer’s drugs have received accelerated approval, no drugs have received traditional approval. The FDA’s Peripheral and Central Nervous System Drugs Advisory Committee will meet on June 9th to decide whether the new drug Leqembi should be granted traditional approval. If approved, Medicare Part B beneficiaries will be eligible for coverage if: 

  • They have been diagnosed with mild cognitive impairment or early dementia caused by Alzheimer’s disease; and
  • Have a qualified physician participating in a registry.

More information is available here.

Other Updates

KFF Releases Report on Medicaid Redeterminations 
On May 31st, the Kaiser Family Foundation (KFF) released a report on the ongoing Medicaid unwinding process, entitled “What Do the Early Medicaid Unwinding Data Tell Us?” The report is based on data from only 11 states, but shows that over 500,000 Medicaid beneficiaries have already been disenrolled from the program. Close to 250,000 individuals have been disenrolled in Florida alone, a disenrollment rate of 54% of those renewing. The median disenrollment rate for these 11 states is 24%, but is as low as 10% in Pennsylvania and Virginia.
 
Among states that reported reasons for disenrollment, the majority of disenrollments were “procedural,” meaning individuals did not complete the enrollment process, regardless of whether or not they remained eligible for the program. Data show, however, that nearly two-thirds of current Medicaid enrollees do not report a change in income or circumstances in the past year, meaning they have likely remained eligible. In Indiana, West Virginia, Arkansas, and Florida, over 80% of disenrolled beneficiaries have been terminated for procedural reasons, as opposed to being determined ineligible. However, several of these states have prioritized performing renewals for those considered unlikely to re-enroll, which may affect these rates. KFF notes that such data “raise concerns and signal that outreach to Medicaid enrollees throughout the renewal process could help reduce the rate of procedural disenrollments.”
 
The full report is available here.

New York State Updates

DOH Updates Standards for Regional Perinatal Centers, Birthing Centers, and Perinatal Services 
On May 31st, the New York State Department of Health (DOH) issued proposed regulations to make updates to standards for New York’s regionalized perinatal system, which is comprised of Regional Perinatal Centers (RPCs); freestanding and midwifery-led birth centers; and Level I, II, and III hospitals, to align with standards of clinical care and recommendations from DOH’s perinatal regionalization expert panel. The rule proposes to: 

  • Add accreditation and operational requirements for accredited midwifery birth centers, including physical plant standards, transfer agreements, and data and quality improvement measures;
  • Require RPCs to establish affiliation agreements and provide supportive and consultation services with any freestanding and midwifery birth centers;
  • Require RPCs to coordinate patient transfers among affiliates and maternal transports between affiliates and RPCs to ensure appropriate levels of care;
  • Strengthen the role of RPCs to support affiliates through quality improvement activities and staff education;
  • Require facilities to notify DOH within two days when their Neonatal Intensive Care Unit (NICU) and/or maternity census exceeds the number of licensed beds to help reduce overcrowding;
  • Removes Advanced Cardiac Life Support (ACLS) requirements for freestanding and midwifery birth centers; and
  • Update certain standards of practice for neonate care.

The full text of the proposed rules is available here. Comments may be submitted to Katherine Ceroalo at regsqna@health.ny.gov until July 30th. 

SED Eases Dental Residency Program Requirements
On May 31st, pursuant to legislation passed last year (available here), the New York State Education Department (SED) posted a notice of emergency adoption of a proposed rule that amends postdoctoral dental residency program requirements (for both general practice and specialties) needed to obtain dental licensure. The rule aims to increase the number of licensed dentists and improve access to dental services. Specifically, the rule implements the following provisions: 

  • Removes the requirement that a licensure applicant’s dental residency program be completed in an accredited “dental facility” and instead allows the program to be competed in an accredited community health center or facility;
  • Removes the requirement that the accredited dental residency program have at least 50 percent of the program consist of clinical training in certain areas;
  • Adds residency programs in specialties of dental public health, orofacial pain, and oral medicine to the list of residency program types that can be used to meet experience requirements for licensure; and
  • Simplifies requirements for dental residency programs to attest to a licensure applicant’s competency to practice dentistry. 

The text of the emergency rule is available here. The emergency rule will expire July 14th and is anticipated to be extended until presented for permanent adoption at the next Board of Regents meeting in September. Comments may be submitted to Sarah Benson at REGCOMMENTS@nysed.gov until July 15th.

DOH and SOFA to Launch Town Hall Meetings on Master Plan for Aging
On May 26th, DOH and the State Office for the Aging (SOFA) issued a press release announcing a series of town hall meetings to be held across the state to provide information to local communities and solicit input on the development of the State Master Plan for Aging (MPA).

The kick-off meeting will be held at Hunter College on June 7th from 10am to 12pm. Registration to attend in person is available here and to attend online is available here.

The press release is available here. More information on the MPA is available here.

Funding Opportunities

Children’s Bureau Issues NOFO on Trauma Interventions for Children and Youth in Foster Care 
On May 26th, the United States Children’s Bureau released a notice of funding opportunity (NOFO) for demonstration projects that implement and evaluate innovative trauma-informed programming for children and youth with complex needs placed in foster care. Projects may include any or all of the following eligible services: 

  • Evidence-based clinical services;
  • Foster parent training and curricula;
  • Volunteer support services for foster parents;
  • Positive biological and birth family engagement;
  • Enrichment activities for children; and
  • Trauma-informed systems work.

Eligible applicants are non-profit organizations, including faith-based organizations, with demonstrated experience working with children in foster care who have experienced severe trauma. Applicants must provide a letter of support from their jurisdiction’s child welfare agency. At least 15% of total project costs must be budgeted for project evaluation.

The Children’s Bureau expects to make two awards, each ranging between $750,000 to $1 million in total funding over a three-year project period.

The NOFO is available here. Questions can be submitted to CB@grantreview.org. Optional letters of intent may be submitted to CB@grantreview.org by June 30th. Applications can be submitted electronically via Grants.gov through July 31st.

ACF Releases NOFO for Runaway and Homeless Youth Demonstration Program
On May 30th, the Administration for Children and Families (ACF) released a NOFO for the Runaway and Homeless Youth Prevention Demonstration Program (RHY-PDP), which aims to support the design and delivery of community-based demonstration initiatives to prevent youth and young adults under the age of 22 from experiencing homelessness.

Grant recipients are expected to: 

  • Develop a prevention plan that is co-designed alongside youth with lived experience of homelessness or who are risk of homelessness/housing instability;
  • Implement prevention interventions and services that must include flexible cash assistance and individualized supportive services and case management;
  • Implement a referral strategy to connect youth to emergency shelter, housing, and counseling services when prevention efforts are unsuccessful; and
  • Provide a plan to provide safe and inclusive spaces for all youth.

Eligible applicants include public and nonprofit entities that are not part of the juvenile justice system. Applicants must have existing partnerships with at least three youth and family partners, such as schools, mental health services and child welfare providers, etc. 

Through this funding opportunity, ACF intends to award up to five prevention demonstration projects, for up to $350,000 annually for each project, for a 3-year project period. Cost-sharing is required, and recipients must provide at least 10% of the total approved project costs.

The NOFO is available here. Questions may be submitted to Christopher Holloway at Christopher.Holloway@acf.hhs.gov and Katrina Morgan at katrina.Morgan@acf.hhs.gov. Applications must be submitted via grants.gov through July 31st.