Weekly Health Care Policy Update – June 26, 2023

July 3, 2023

In this update: 

  • Administration Updates
    • President Biden Issues Executive Order on Contraception
    • Biden Formally Nominates Mandy Cohen for CDC Director
  • Federal Agencies
    • CMS to Hold Webinar on Making Care Primary Model on June 27th
    • CMS Proposes New Transitional Coverage for Emerging Technologies Policy
    • CMS Launches School-Based Services Technical Assistance Center
  • Other Updates
    • USPSTF Recommends Screening Adults for Anxiety
    • Commonwealth Fund Publishes 2023 State Health Scorecard
    • Health Affairs Publishes Study on Health System Consolidation
    • KFF Releases Report on Fiscal Implications of Medicaid Unwinding
  • New York State Updates
    • New York State Assembly Reconvenes for Special Legislative Session
    • DOH Releases Health Equity Impact Assessment Documents for CON Applications
    • CMS Approves SPAs for Minimum Wage Increases for Long-Term Care Service Payment Rates
    • CMS Approves SPA for Supplemental Payments to Adult Day Health Care Services Providers
    • CMS Approves SPA to Maintain Nursing Home Quality Pool
  • Funding Opportunities
    • OMH Announces RFP for TAP Housing Units for Individuals with Serious Mental Illness

Administration Updates

President Biden Issues Executive Order on Contraception 
On June 23rd, President Biden issued an Executive Order (EO) on “Strengthening Access to Affordable, High-Quality Contraception and Family Planning Services.” The EO is specifically focused on protecting and expanding access to contraception. It directs the Departments of the Treasury, Labor, and Health and Human Services (HHS) to consider a variety of actions to support this goal, including: 

  • Issuing new guidance to ensure that private health insurance under the Affordable Care Act (ACA) covers all contraceptives approved by the Food and Drug Administration (FDA)  without cost sharing;
  • Improving access to affordable over-the-counter contraception, including emergency contraception;
  • Expanding access to affordable family planning services and supplies in Medicaid;
  • Strengthening coverage of contraception through Medicare Advantage and Medicare Part D plans;
  • Encouraging federally-supported health care and human services entities to expand the availability and quality of contraception access for those they serve;
  • Identifying and sharing best practices for employers and insurers in making affordable, high-quality contraception available to employees; and
  • Supporting research, data collection, and data analysis on contraception access and family planning services.

The full Executive Order is available here.

Biden Formally Nominates Mandy Cohen for CDC Director
On June 16th, President Biden formally nominated Mandy Cohen to lead the Centers for Disease Control and Prevention (CDC), as reported in SPG’s June 5th newsletter here. Dr. Cohen, who is trained in internal medicine, currently serves as EVP of Aledade and CEO of Aledade Care Solutions. She previously served as the Secretary of North Carolina’s Department of Health and Human Services and as Chief Operating Officer and Chief of Staff at the Centers for Medicare and Medicaid Services (CMS) during the Obama Administration. Senate confirmation is not required for the position.

Federal Agencies

CMS to Hold Webinar on Making Care Primary Model on June 27th 
On June 27th, from 2pm to 3:30pm ET, CMS will host a webinar providing an overview of the Making Care Primary (MCP) Model, a new primary care model aiming to offer a gradual pathway to population-based payments for practices in eight states. The webinar will cover the goals of the model, eligibility, participant types, care delivery requirements, performance assessment, and payment structure, as well as the application process, timeline, and resources available to applicants.

Registration, including an opportunity to submit questions in advance, is available here.

CMS Proposes New Transitional Coverage for Emerging Technologies Policy
On June 22nd, CMS issued a proposed procedural notice for a new policy on transitional coverage for emerging technologies (TCET) in Medicare. CMS repealed the Trump Administration’s more expansive policy on breakthrough technologies, which would have offered Medicare coverage of any commercially-available FDA-designated “breakthrough technology” unless evidence indicated it should not be included, in November 2021 (as covered by SPG here).

This proposed policy would offer a narrower path using the current Medicare national coverage determination (NCD) and coverage with evidence development (CED) processes. For entities who voluntarily participate in the TCET pathway, CMS would conduct a pre-market review along with the FDA to approve the technology with an Evidence Development Plan (EDP), which will be developed by the Agency for Healthcare Research and Quality (AHRQ). CMS would then aim to issue an NCD within six months to cover the device for “as long as needed to facilitate the timely generation of evidence.” CMS expects that in general, the period “would last three to five years.” Following the evidence review, CMS would issue a revised NCD.

A fact sheet on the proposed pathway is available here. Comments will be accepted through August 26th.

CMS Launches School-Based Services Technical Assistance Center
On June 23rd, CMS announced the launch of the School-Based Services (SBS) Technical Assistance Center, which aims to support Medicaid programs and school-based providers in expanding capacity to provide Medicaid SBS. CMS and the Department of Education will maintain the Center jointly. It will offer guidance and support for: 

  • Billing and payment for SBS;
  • Other funding sources; and
  • Reduction of administrative burden, such as through providing sample templates and forms.

More information is available here.

Other Updates

USPSTF Recommends Screening Adults for Anxiety
On June 20th, the United States Preventive Services Task Force (USPSTF) recommended that adults aged 19 to 64, including those without symptoms, be screened for anxiety. Individuals who screen positive should be further evaluated for diagnosis and, if appropriate, provided or referred to evidence-based care. This is the first time the Task Force has recommended anxiety screening for adults, and the ‘B’ rating means anxiety screening must be covered without cost-sharing by most health insurance plans. The Task Force notes there is no evidence on optimal screening frequency and suggests a “pragmatic approach” might include screening adults who have not been previously screened and then using clinical judgment, considering risk factors, comorbid conditions, and life events, regarding additional screening.

More information is available here.

Commonwealth Fund Publishes 2023 State Health Scorecard
On June 22nd, the Commonwealth Fund published its 2023 Scorecard on State Health System Performance. The scorecard uses 58 measures of health care access, quality, use of services, costs, health disparities, reproductive care and women’s health, and health outcomes to rank states. Massachusetts achieved the best overall score, followed by Hawaii, New Hampshire, Rhode Island, and Vermont. New York ranked ninth.

Overall, the report highlights several troubling nationwide trends including: 

  • Historically high rates of premature death from Covid-19 and other preventable causes (drug overdoses, firearms, and certain treatable chronic conditions);
  • Poor performance on the health of women, mothers, and infants (including maternal mortality and deaths related to substance abuse among women of reproductive age); and
  • Expiring pandemic-era insurance policies paired with high health care costs.

New York performed best on measures of suicide death, women with an up-to-date breast and cervical screening, and women ages 18-44 without a routine check-up. New York performed most poorly on measures of severe maternal morbidity, hospitals with better-than-average patient experience ratings, and home health patients with a hospital admission. New York improved the most on measures of hospital 30-day mortality, preventable hospitalizations age 65 and older, and potentially avoidable emergency department visits age 65 and older.

The full report is available here.

Health Affairs Publishes Study on Health System Consolidation
On June 20th, Health Affairs published a study entitled “Consolidation and Mergers Among Health Systems in 2021,” based on new data from the AHRQ Compendium of U.S. Health Systems. The study authors describe “how the landscape of health systems changed from 2018 to 2021, highlighting key trends in system formation and their implications.” The authors defined “health systems” as including one non-federal general acute care hospital and 50 or more physicians, including ten or more primary care physicians.

Overall, the authors concluded that, between 2018 and 2021, the increase in consolidation for both hospitals and physicians was modest, and slower than the growth between 2016 and 2018. Some key findings include: 

  • Slightly more hospitals (76%) and physicians (52%) were affiliated with vertically-integrated health systems in 2021, compared to 2018 (72% of hospitals and 51% of physicians).
  • Since 2018, 65 health systems lost their “system” designation. In 49 of these cases, the loss was due to a merger or acquisition.
  • The largest health systems were larger in 2021 than they were in 2018 (3,274 vs. 3,189 beds on average), and the smallest health systems were smaller in 2021 than in 2018 (61 vs. 80 beds).

The full paper is available here.

KFF Releases Report on Fiscal Implications of Medicaid Unwinding
On June 16th, the Kaiser Family Foundation (KFF) released a brief examining how Medicaid spending changed during the three-year period in which states provided continuous enrollment in Medicaid in exchange for a 6.2 percentage point increase in their Federal Medical Assistance Percentage (FMAP). The increased FMAP was retroactive to January 1, 2020, and is currently winding down (between April and December of 2023). Over this three-year period, over 23 million people gained Medicaid coverage, and states received over $117 billion from the increased FMAP. Of this sum, New York received about $12.4 billion.

The report finds that, as a result of the increased FMAP, state spending dropped below pre-pandemic levels even though total Medicaid spending and enrollment increased. As the unwinding continues and the enhancement expires, state spending will likely have to increase. The brief notes that how much state Medicaid spending increases as the enhanced FMAP expires will depend on: 

  • How many people are disenrolled;
  • How quickly they are disenrolled;
  • How many individuals newly join the Medicaid program; and
  • How spending per person in the Medicaid program changes.

The full brief is available here.

New York State Updates

New York State Assembly Reconvenes for Special Legislative Session
On June 20th and June 21st, the New York State Assembly reconvened for a two-day legislative session to vote on outstanding bills that had already been passed by the Senate earlier during the scheduled 2023 Legislative Session. During the session, the Assembly passed various bills to be delivered to Governor Hochul for her consideration, including the following: 

  • A.01709/S.1066: Provides legal protections to health service providers who perform legally protected reproductive health care services, including those delivered by means of telehealth, and restricts the use of evidence relating to the involvement of providers in providing legally protected health activities to individuals located out-of-state.
  • A.06275/S.04907: Prohibits medical service providers (including hospitals and ambulance services) from reporting medical debt directly or indirectly to consumer reporting agencies.
  • A.07724/S.07527: Updates the scope of restricted clinical laboratory licenses to include the practice of molecular testing.
  • A.03484/S.00995: Requires the disclosure of the identities of beneficial owners of limited liability companies (LLCs) and foreign LLCs and requires the State to maintain a publicly available database on its website for each business entity organized in New York.

Notably, the Assembly did not pass A.3020, which proposed to extend coverage for certain undocumented immigrants under the State’s application for a Section 1332 waiver program that would expand and replace the Essential Plan.

These bills will now join a number of other health care-related bills passed earlier in the 2023 Legislative Session to be considered by Governor Hochul, who may sign or veto them. SPG summarized some of these other bills here.  

DOH Releases Health Equity Impact Assessment Documents for CON Applications 
Beginning June 22nd, Article 28 facilities submitting Certificate of Need (CON) applications are required to include a Health Equity Impact Assessment (HEIA) in addition to previously required CON schedules. In accordance with statute (available here), facilities must contract with an Independent Entity, which must not have any conflicts of interest regarding the facility’s CON approval, to prepare the HEIA.

The New York State Department of Health (DOH) has released the following HEIA documents: 

Applicant facilities meeting regulatory criteria as indicated on the HEIA Requirement Criteria form must include the above documents as part of their CON application package. Additionally, such applicants will need to provide a copy of their HEIA contract with the Independent Entity, as well as a full version of their CON application with redactions to be shared publicly.

All HEIA documents are available here. DOH has released proposed regulations on the inclusion of the HEIA as part of the CON process, to be voted on by the Public Health and Health Planning Council (PHHPC) on June 29th. SPG’s summary of the proposed regulations is available here.

CMS Approves SPAs for Minimum Wage Increases for Long-Term Care Service Payment Rates 
On June 21st, CMS approved New York’s proposed State Plan Amendments (SPAs) to update the minimum wage add-on reimbursement to the Medicaid payment rates for long-term care services provided by the following provider types: 

  • Certified Home Health Agency (CHHA) providers (CMS approval letter is available here)
  • Non-residence Hospice providers (CMS approval letter is available here, rates available here)
  • Assisted Living Program (ALP) providers (CMS approval letter is available here, rates available here)
  • Personal Care providers (CMS approval letter is available here, rates available here)  

Effective January 1, 2023, the statutory minimum wage value for employers outside of NYC, Long Island, and Westchester County is $14.20.

CMS Approves SPA for Supplemental Payments to Adult Day Health Care Services Providers 
On June 23rd, CMS approved New York’s proposed SPA to provide a one-time supplemental payment to support eligible Adult Day Health Care and AIDS Adult Day Health Care program sites impacted by the Covid-19 pandemic. By September 30th, the State will proportionately distribute $6 million in total funding to eligible sites based on their site spot capacity (i.e., the number of participants the site is able to serve on and after August 1st). To be eligible, a site must hold a valid operating certificate and be in, or actively working toward, compliance with the HCBS Settings Rule and programmatic regulations in the HCBS Final Rule Statewide Transition Plan.

Funds may not be used for capital projects. They may be used for operational costs, including: 

  • Workforce;
  • Transportation;
  • Person-centered care management services;
  • Community integration; and
  • Emergency preparedness.

CMS’s approval letter is available here.

CMS Approves SPA to Maintain Nursing Home Quality Pool
On June 15th, CMS approved a proposed SPA to maintain the New York State Nursing Home Quality Pool (NHQP) into the 2022 rate year and continue to recognize improvement in quality performance as part of the program. The NHQP is an annual budget-neutral pool of $50 million that evaluates and incentivizes Medicaid-certified nursing facilities based on quality performance metrics. Several quality measures that were removed to offset the impact of Covid-19 have returned for the 2022 rate year.

The SPA is effective as of January 1, 2023. The CMS approval letter is available here.

Funding Opportunities

OMH Announces RFP for TAP Housing Units for Individuals with Serious Mental Illness
On June 23rd, the New York State Office of Mental Health (OMH) released a Request for Proposals (RFP) seeking interested organizations to develop and operate up to 450 Treatment Apartment Program (TAP) transitional housing units statewide to serve individuals with serious mental illness or co-occurring substance use disorder and who also meet one of the following criteria: 

  • Discharged from State-operated Psychiatric Centers (PCs) or State-operated residential programs;
  • Discharged from an Article 28 hospital or Article 31 hospital and in need of TAP housing or for whom housing would assist in a diversion from a State PC;
  • High user of Medicaid services and referred by Health Homes;
  • Experiencing street homelessness and in temporary shelter settings,
  • Is a current resident of an OMH-licensed Community Residence or CR-SRO, prioritizing individuals who have a Length of Stay greater than two years; or
  • Is at least 18 years old and being discharged from a Residential Treatment Facility (RTF).

Awarded agencies will receive resident referrals through the Housing Single Point of Access (SPOA/SPA). Agencies must provide residents with on-site person-centered restorative and rehabilitative services, linkages to services in the community, assistance with educational and employment opportunities, and help with discharge planning to more independent housing opportunities.

Eligible applicants are 501(c)(3) not-for-profit agencies that have demonstrable experience in operating housing or mental health programs. Awards will be made in each of the OMH regions: Western New York, Central New York, Hudson River, Long Island, and NYC. Agencies are limited to submitting one application per region, but may submit applications for multiple regions. Applications proposing to serve NYC may apply for up to 30 units. Applications for regions outside of NYC may apply for up to 20 units. TAP units must be developed as scattered site rental units that are studios, one or two-bedroom apartments, with each resident having their own bedroom.

Program Development Grant (PDG) funds are available as part of the contract to assist with establishing TAP units, and are currently set at $9,410 per bed. Funding to support the ongoing operation of TAP units will be provided by a combination of SSI and Medicaid funding. Each agency’s current programmatic structure will determine specific funding amounts. Site specific property costs for the units will also be incorporated into the resident’s Gross, Income, and Net (GIN) fiscal model and paid for with SSI revenue and state-aid in the event the GIN model’s anticipated SSI revenue is not adequate to cover 100% of the expense.

The RFP is available here. Applications are due by August 9th. Questions may be submitted by July 12th to Amanda Szczepkowski at OMHLocalProcurement@omh.ny.gov with “Apartment Treatment Housing” in the subject line.