Weekly Health Care Policy Update – July 31, 2023

August 7, 2023

In this update:

  • Legislative Update
    • Congress Passes Organ Donation Overhaul Bill
  • Federal Agencies
    • CMMI Announces GUIDE Dementia Care Model
    • DoL, HHS, and Treasury Propose Rules to Strengthen Mental Health Parity
    • CMS Issues FY 2024 Medicare Hospice Payment Rule
    • CMS Issues FY 2024 Medicare IPF PPS and Quality Reporting Rule
    • CMS Issues FY 2024 Medicare IRF PPS and Quality Reporting Final Rule
    • FTC Follows DOJ in Withdrawing Health Care Antitrust Guidance, Releases Draft Update of Merger Guidelines
    • FCC Announces New Cybersecurity Labeling Program
    • HRSA Announces National Telehealth Conference Dates
    • CMS Updates Overall Hospital Quality Star Ratings, Including VA Hospitals
    • HHS Awards $47.8 Million in Grants to Combat Substance Misuse and Overdose
    • CMS Announces Three CMPs for Price Transparency Rule Violations
    • HRSA Releases 2022 Health Center Patient Survey Data
  • Other Updates
    • JAMA Study Concludes Covid Relief Funds Were Excessive for Some Hospitals
    • AHIP, AMA, and NAACOS Release Recommendations on Value-Based Care
    • Cigna Sued for Allegedly Using Algorithms to Deny Claims
    • Joint Commission Reduces Accreditation Standards
  • New York State Updates
    • DOH Releases Public Health Emergency Unwind Dashboard
    • OMH Updates Guidance for MHOTRS
    • Legislators Introduce New Version of the New York Health Act
  • Funding Opportunities
    • OMH Releases RFP for Young Adult ACT Expansion in NYC and Rest of State
    • OMH Releases RFP for Adult Forensic ACT Teams
    • OMH Releases RFP for Upstate SOS CTI Teams

Legislative Update

Congress Passes Organ Donation Overhaul Bill
On July 27th, the Senate unanimously passed H.R. 2544, the Securing the U.S. Organ Procurement and Transplant Network Act. The Network is a public-private partnership that links organizations and professionals involved in the organ donation and transplant system. Since 1986, the United Network for Organ Sharing (UNOS) has been the sole recipient of a contract to manage the Network. The bill would expressly authorize the Health Resources and Services Administration to award multiple grants, contracts, or cooperative agreements to support operation of the network, and would eliminate the existing cap on the amount of funding available to support the Network. The House previously approved the bill via voice vote on July 25th and President Biden is expected to sign the bill into law.
 
Information on the legislation is available here.

Federal Agencies

CMMI Announces GUIDE Dementia Care Model
Today (July 31st), the Center for Medicare and Medicaid Innovation (CMMI) announced the new Guiding an Improved Dementia Experience (GUIDE) demonstration. The GUIDE model seeks to implement a new care management approach to support unpaid caregivers of people with dementia who are living in the community, reducing and delaying the need for nursing home care.

The GUIDE approach will be standardized nationally and incorporate various supports for caregivers—including a 24/7 support line and billable respite services—as well as care coordination activities that will help link dementia patients to community resources. Participants in GUIDE will be Medicare Part B providers. They will establish dementia care programs (DCPs) that use an interdisciplinary team (IDT) approach—involving at least a clinician and a care navigator trained specifically in dementia care—to provide ongoing, longitudinal care. In addition to payments under the Physician Fee Schedule and new payments for respite services, GUIDE participants will receive a monthly per-beneficiary payment. They may also be eligible for an upfront infrastructure payment.

CMMI will hold a webinar on August 10th to provide more information on GUIDE. More information, including registration for the webinar, is available on CMMI’s website here. Interested clients should please contact SPG to discuss further details on this model.

DoL, HHS, and Treasury Propose Rules to Strengthen Mental Health Parity 
On July 25th, the Departments of Labor (DoL), Health and Human Services (HHS), and the Treasury announced proposed rules to strengthen the Mental Health Parity and Addiction Equity Act (MHPAEA). The law, originally enacted in 2008, was intended to ensure that patients seeking care for mental health and substance use disorders do not face barriers to treatment—such as copayments, prior authorization, or any other requirements—that do not exist for patients seeking treatment for medical or surgical conditions. However, the agencies find that patients seeking coverage for mental health and substance use disorders continue to face greater barriers. The proposed rule therefore seeks to strengthen parity by enacting changes in network composition requirements and medical management techniques. Specifically, the rule would enact: 

  • Requiring health plans to collect data on outcomes of coverage rules: The rule proposes that health plans evaluate the outcomes of their coverage rules to make sure people have equivalent access between their mental health and medical benefits. This includes: 
    • Evaluating the health plan’s actual provider network;
    • Rates paid to out-of-network providers;
    • How often prior authorization is required; and
    • The rate at which prior authorization requests are denied.
  • Clarify prohibited practices: The rule provides specific examples of some practices that are forbidden under MHPAEA because they impose restrictive prior authorization, other medical management techniques, or narrower networks that violate parity.  
  • Expand applicability: The rule proposes to codify congressional changes made to MHPAEA by requiring non-federal government health plans to comply with MHPAEA, providing protections to an additional 90,000 consumers.

In addition to the proposed rule, DoL issued a technical release, requesting feedback on the proposed new data collection requirements for the composition of a health plan’s or insurer’s network. The technical release seeks public comment related to nonquantitative treatment limitations and safe harbors for plans and issuers that submit data indicating that their mental health networks are comparable to their medical/surgical networks.

The Departments also released their second Mental Health Parity and Addiction Equity Act’s Comparative Analysis Report to Congress, and a fact sheet on MHPAEA enforcement, which includes results for cases closed in fiscal year 2022.

A summary of the rules, technical release, the comparative analysis report, and the fact sheet on enforcement, is available here. A link to the proposed rules is available here. A link to the comparative analysis is available here. A link to the fact sheet on enforcement is available here. The proposed rules will be open for comment for 60 days.

CMS Issues FY 2024 Medicare Hospice Payment Rule 
On July 28th, the Centers for Medicare and Medicaid Services (CMS) issued the Fiscal Year (FY) 2024 Hospice Payment Rate Final Rule. Overall, total estimated payments to hospices will increase by 3.1%, or a total of $780 million. This increase reflects a market basket update of 3.3% and a 0.2 percentage point productivity adjustment. In addition, the payment reduction for failing to meet hospice quality reporting requirements will increase from 2 to 4 percentage points. As a result, hospices that do not submit the required quality data would be updated by -0.9%. The hospice cap amount for FY 2024 will be $33,494.01 (the FY 2023 cap amount updated by the FY 2024 hospice payment update percentage of 3.1%).

The final rule also makes changes to hospice certifying physician enrollment, reflecting CMS’ concerns about fraud, waste, and abuse in the hospice industry. The rule requires that physicians who certify patient eligibility for hospice services must be enrolled in Medicare or validly opted out as a prerequisite for payment for the hospice period of care in question.

The final rule is available here. A fact sheet is available here.

CMS Issues FY 2024 Medicare IPF PPS and Quality Reporting Rule 
On July 27th, CMS issued the FY 2024 Medicare Inpatient Psychiatric Facility (IPF) Prospective Payment System and Quality Reporting Final Rule. Overall, total estimated payments to IPFs will increase by 2.3%, or a total of $70 million. This increase reflects a market basket update of 3.5%, a 0.2 percentage point productivity adjustment reduction, and an update to the outlier threshold that will result in a 0.9% decrease to aggregate payments.

CMS is also finalizing new flexibility for hospitals to open and bill Medicare for new excluded inpatient psychiatric distinct part units, allowing hospitals to open a new excluded IPF unit at any time during the cost-reporting period rather than only at the start of a hospital’s cost-reporting period. In addition, CMS made changes to its IPF Quality Reporting (IPFQR) Program, adopting four new measures, modifying one existing measure, removing two existing measures, and adopting and implementing a data validation pilot. Three of the measures being adopted will help integrate information about facility commitment to health equity and social drivers of health data into IPF quality performance measurement, and the fourth is a patient experience survey measure.

The final rule is available here and a fact sheet is available here.

CMS Issues FY 2024 Medicare IRF PPS and Quality Reporting Final Rule
On July 27th, CMS published the FY 2024 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) and Quality Reporting Program Final Rule. Overall, IRF PPS payment rates will increase by 3.4%, reflecting a marketing basket update of 3.6% reduced by a 0.2 percentage point productivity adjustment. The final rule also adjusts the outlier threshold to maintain outlier payments at 3.0% of total payments, which CMS estimates will increase outlier payments by 0.6 percentage point. These adjustments combine for an overall IRF payment increase of 4.0% or $355 million relative to FY 2023 payments.

CMS is also finalizing policies to allow hospitals to open a new IRF unit and begin being paid under the IRF PPS at any time during the cost reporting period and to rebase and revise the IRF market basket using 2021 data and changing the market basket cost weights, price proxies, and labor-related share. Changes to the QRP include the finalization of two new measures, modification of another measure, and removal of three measures.

The final rule is available here and a fact sheet is available here.

FTC Follows DOJ in Withdrawing Health Care Antitrust Guidance, Releases Draft Update of Merger Guidelines 
On July 14th, the Federal Trade Commission (FTC) announced the withdrawal of two antitrust policy statements that relate to antitrust enforcement in health care markets. These two documents are: 

  • Statements of Antitrust Enforcement Policy in Health Care (published in August 1996); and
  • Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program (published in October 2011).

They were previously rescinded by the Department of Justice (DOJ) in February (as announced here). The FTC voted 3-0 to follow suit, noting, like DOJ, that they are “outdated and no longer reflect market realities” and “no longer serve their intended purpose of providing accurate guidance to market participants.”

On July 19th, FTC and DOJ jointly released a draft update of their general Merger Guidelines, which the agencies first announced in January 2022.  The document describes how both agencies will review mergers and acquisitions to determine compliance with federal antitrust laws across all industries. The agencies are updating the draft guidelines to better reflect how they will determine the effect of a merger on competition in a modern economy, and to provide transparency and awareness of how the agencies evaluate mergers and acquisitions.

The updated guidelines focus on 13 specific points that the agencies will use to evaluate a merger. These include: 

  • A lower threshold for post-merger concentration levels (from 2500 to 1800) that will trigger a presumptive unlawful merger;
  • Mergers that “entrench” or “extend” a firm’s “dominant position” (30% market share or greater) may be considered unlawful;
  • A focus on whether a merger reduces competition for workers that could lead to lower wages or slower wage growth; and
  • A focus on “vertical theories of harm.”

Comments on the updated draft guidelines are due September 18th. The updated draft Merger Guidelines are available here. A fact sheet is available here and a press release is available here.

FCC Announces New Cybersecurity Labeling Program
On July 18th, the Federal Communications Commission (FCC) announced a new cybersecurity certification and labeling program to help consumers choose smart devices that are less vulnerable to cyberattacks.

The “U.S. Cyber Trust Mark” would be a voluntary labeling program to indicate that marked smart devices meet widely accepted industry standards for cybersecurity. FCC plans to issue a proposed rule to further outline the parameters of the program, including requests for comment issues such as: 

  • The scope of devices that should be eligible for inclusion;
  • Which entity should oversee and manage the program; and
  • How to develop security standards applicable to different types of devices and demonstrate compliance with such standards.

The FCC will vote on releasing this rule at its next meeting, after which it will be published in the Federal Register. The FCC’s press release is available here. Images of the proposed certification mark for the cybersecurity program may be found here.

HRSA Announces National Telehealth Conference Dates
On September 12th, the Health Resources and Services Administration (HRSA) will host the National Telehealth Conference. The conference will be held virtually, and will discuss telehealth best practices and the importance of integrating telehealth into standard care. Specific topics will include: 

  • The adoption of telehealth and expansion of broadband connectivity to improve health equity;
  • Using tele-behavioral health as a successful model for integrating telehealth into the standard of care;
  • Telehealth’s role in supporting the health care workforce and expanding services for patients; and
  • Implications of health policy to inform telehealth’s future in an evolving health care environment.

Registration is available here.
CMS Updates Overall Hospital Quality Star Ratings, Including VA Hospitals 
On July 26th, CMS updated the Overall Hospital Quality Star Ratings on its Care Compare website. With this update, all Veterans Health Administration (VA) hospitals are included in Care Compare for the first time. The Overall Star Rating summarizes data from more than 100 quality measures for each hospital.

Eleven hospitals in New York have a 5-star overall rating on Care Compare: Hospital for Special Surgery, Mather Memorial, New York-Presbyterian Hospital, New York-Presbyterian Queens, North Shore University Hospital, NS/LIJ Huntington Hospital, NYU Langone Hospital, St. Anthony Community Hospital, St. Francis Hospital Heart Center, Western NY VA Healthcare System, and White Plains Hospital Center. Only the Hospital for Special Surgery also has five stars on its Patient Survey Rating.

The Care Compare website is available here. Information about the Overall Hospital Quality Star Ratings data release can be found here.

HHS Awards $47.8 Million in Grants to Combat Substance Misuse and Overdose 
On July 19th, HHS announced the award of $47.8 million in grant funding to combat substance misuse and overdose. The grants are distributed over five programs, including: 

  • Medication-Assisted Treatment-Prescription Drug and Opioid Addiction Program: 21 awards totaling up to $18.4 million to expand or enhance access to Medications for Opioid Use Disorder;
  • Emergency Department Alternatives to Opioids Demonstration Program: 15 awards up to $7.4 million to develop and implement alternatives to opioids for pain management in hospitals and emergency department settings;
  • Sober Truth on Preventing Underage Drinking Act Program: 50 awards and up to $3 million to prevent and reduce alcohol use among youth and young adults ages 12-20;
  • Adult Reentry Program: 34 awards totaling up to $13.6 million to expand substance use disorder (SUD) treatment and related recovery and reentry services to sentenced adults in the criminal justice system who have SUDs and/or co-occurring substance use and mental disorders; and
  • State Pilot Grant Program for Treatment for Pregnant and Postpartum Women Program: Six awards that total up to $5.4 million to support family-based services for pregnant and postpartum women with a primary diagnosis of an SUD, including OUDs.

More information, including links to lists of awardees, is available here.

CMS Announces Three CMPs for Price Transparency Rule Violations
On July 25th, CMS announced that it had imposed civil monetary penalties (CMPs) on three hospitals due to lack of compliance with the hospital price transparency final rule. The hospitals are Falls Community Hospital & Clinic in Marlin, TX (CMP of $70,560), Fulton County Hospital in Salem, AR (CMP of $64,900), and Community First Medical Center in Chicago, IL (CMP of $847,740). To date, CMS has imposed a total of CMPs on seven hospitals in connection with price transparency rule violations which came to its attention, either through sample audits or complaints submitted to the agency.

More information on hospital price transparency requirements is available from CMS hereand a list of hospitals that have been assessed CMPs is available here.

HRSA Releases 2022 Health Center Patient Survey Data
On July 18th, the Health Resources and Services Administration (HRSA) announced the release of findings from the 2022 Health Center Patient Survey. The survey, conducted approximately every five years, queries patients about their experiences with comprehensive care received at HRSA-funded health centers. The 2022 survey includes data collected in one-on-one interviews from more than 4,400 patients who received care at one of 318 HRSA-funded health center sites. Highlights reported by HRSA include: 

  • 97% of respondents would recommend their health center to family and friends;
  • 94% of respondents were satisfied with how health center staff explained their medications to them, including instructions for use and potential side effects; and
  • 92% of respondents who accessed dental services said those services were “very good” or “excellent.”

More information about the survey is available here and a dashboard containing the 2022 results is available here.

Other Updates

JAMA Study Concludes Covid Relief Funds Were Excessive for Some Hospitals 
On July 14th, JAMA Health Forum published a study, “Changes in U.S. Hospital Financial Performance During the Covid-19 Public Health Emergency” (PHE) which examined the financial experience of 4,423 short-term acute care and critical access hospitals from 2017 to 2021. The authors found that 75% of hospitals had a positive net operating income during 2020 and 2021, while 16% experienced new financial distress. The authors also found that median operating margins in 2020 and 2021 were at an all-time high of 6.5%, compared with 2.8% before the PHE.

The authors also found that 46.3% of hospitals would have been in financial distress if not for the Covid-19 relief funding. Hospital location in areas with higher proportions of Hispanic residents was the only independent variable associated with financial distress after receiving relief money. The authors conclude that “the size of Covid-19 relief funds may have been larger than was necessary for many hospitals.”

The full article is available here.

AHIP, AMA, and NAACOS Release Recommendations on Value-Based Care 
On July 25th, America’s Health Insurance Plans (AHIP), the American Medical Association (AMA) and the National Association of ACOs (NAACOS) announced the release of data sharing best practices to support “a sustainable future for value-based care.” The document, entitled “The Future of Sustainable Value-Based Care and Payment: Voluntary Best Practices to Advance Data Sharing,” is intended to provide value-based care entities with “best practices informed by real-world experiences to help guide, in a voluntary manner, considerations for the design, implementation, and evaluation of potential future arrangements that accommodate participants with a range of experience.”

The document focuses on five key areas of opportunity. These include: 

  • Create an Interoperable Data Ecosystem: Adopt consistent content and exchange standards to simplify and expand data sharing.
  • Share More Complete, Comprehensive Data: Empower value-based care participants with complete, accurate, and consistent data that paints a more comprehensive picture of a patient or population.
  • Improve Data Collection and Use to Advance Health Equity: Collect and share data to identify and address health disparities as well as barriers to care beyond the clinical setting, while ensuring transparency, appropriate use, and confidentiality.
  • Share Timely, Relevant, and Actionable Data: Prioritize sharing focused insights and data early, often, and in accessible ways to improve care.
  • Make Data Methodologies, Calculations, and Context Readily and Easily Available: Share detailed information on how and what data were derived from to foster trust among value-based care participants in the data they receive, use, and by which performance is measured.

The full document is available here.

Cigna Sued for Allegedly Using Algorithms to Deny Claims 
On July 24th, Cigna members filed a lawsuit in the U.S District Court in the Eastern District of California accusing Cigna of using an algorithm known as PXDX to allow doctors to automatically deny claims that do not meet pre-set criteria. The system flags discrepancies between a diagnosis and what the insurer considers acceptable tests and procedures for the condition. Physicians approve the denials, but can do so without opening patient records. Cigna is accused of making such denials in batches as large as hundreds or thousands at a time.

Plaintiffs argue that the practice violates California competition law for unfair and fraudulent business acts, as well as the state’s “reasonable standard” for processing claims, and are seeking financial relief and an injunction against the use of the practice. The suit is the first of its kind, and raises larger questions about whether legal standards may limit the extent to which insurers may use automated processes and artificial intelligence.

The complaint is available here.

Joint Commission Reduces Accreditation Standards
On July 20th, the Joint Commission announced that, effective August 27th, it will retire 200 accreditation standards for ambulatory and behavioral care centers, critical-access hospitals, laboratories and nursing homes as part of an ongoing review of its requirements. The Commission aims to refocus accreditation requirements on quality and safety while also aiming to reduce the administrative burden on health systems.

The announcement follows a December 2022 reduction of quality standards by 14%. In this latest round of reductions, standards will be reduced by 28% for laboratories, 26% for nursing facilities, 25% for behavioral care centers, and 15% for critical access hospitals, home health providers, and ambulatory care centers.

More information on retired and revised accreditation standards is available here.

New York State Updates

DOH Releases Public Health Emergency Unwind Dashboard 
On July 18th, the New York State Department of Health (DOH) released the first issue of its PHE Unwind Dashboard, a monthly report on the eligibility renewal process for New York’s Medicaid, Child Health Plus, and Essential Plan (EP) populations. All individuals in these programs will need to renew their eligibility over the course of the next year, through May 31, 2024.

Every month, the Unwind Dashboard will be updated and issued, based on data collected from the most recent cohort. This first issue of the Dashboard documents the renewal status, demographics, and program transitions of enrollees in the first cohort of eligibility redeterminations, who have June 30th coverage end dates. The report does not include information on former enrollees who found coverage through non-public sources, such as employer-based insurance.

The report shows that approximately 72% of more than 558,000 enrollees had renewed their coverage by the June 30th deadline, which is significantly higher than the 59% national renewal rate for states reporting data. Since New York has a 30-day grace period for individuals to re-establish coverage, the number of individuals renewing their coverage is expected to increase.

CMS has required a mitigation plan from most states to address potential issues with the unwinding as they arise. As a result, some enrollees’ renewals have been paused. In New York, about 11,000 enrollees’ renewals in this cohort have not yet been completed due to this pause, which is related specifically to the state’s non-MAGI-eligible population.

The DOH press release is available here. The dashboard is available on the DOH Medicaid website here.

OMH Updates Guidance for MHOTRS
On July 19th, the New York State Office of Mental Health (OMH) released two updated documents that provide guidance on Mental Health Outpatient Treatment and Rehabilitative Services (MHOTRS).

MHOTRS Service Guidance
The updated document, available here, provides an overview of MHOTRS required and optional services, operational and documentation requirements, and other program components. The below updates are included: 

  • Changes to utilization review requirements to reduce provider burden;
  • Allowance of nurse practitioners of psychiatry (NPP) signatures for Initial Treatment Plans;
  • Addition of off-site service allowances for all services and age ranges;
  • Addition of co-enrollment allowances;
  • Addition of guidance for peer support services;
  • Addition of Neurobehavioral Status Examination guidance;
  • Addition of guidance for Intensive Outpatient Program (IOP) and use of Administrative Action (AA) for approval;
  • Updated staffing requirements, including removal of the requirement that Psychiatrists be Board-certified;
  • Defines Physician Assistant (PA) credentials to provide psychiatric assessments and medication services;
  • Assessment now includes Health Screening;
  • Health Monitoring now includes Tobacco Use Disorder and Health Physical;
  • Removes telepsychiatry guidance due to release of separate telehealth guidance (available here); and
  • Inclusion of Assisted Outpatient Treatment (AOT) recipients and individuals transitioning from Assertive Community Treatment (ACT) in the populations prioritized for admission/services in MHOTRS programs.

Standards of Care Anchor Element Document
This document, available here, includes the addition of NPP signatures for Initial Treatment Plans; flexibilities for the provision of optional and off-site services; and the inclusion of peer support services as part of exemplary standards.

OMH expects providers to rapidly come into compliance with the above guidance, which will be incorporated into OMH’s certification reviews effective August 1st. Correspondingly, OMIG will be informed of this date to use for future audits.

Questions regarding the MHOTRS program service guidance can be directed to omh.sm.Adult-Clinic@omh.ny.gov for adult services, and omhchildclinics@omh.ny.gov for child/adolescent services. Questions regarding the Standards of Care can be directed to certification@omh.ny.gov. Billing guidance for the MHOTRS program was released in April and is available here.

Legislators Introduce New Version of the New York Health Act 
This month, New York Senate Health Committee Chair Gustavo Rivera and Assembly Health Committee Chair Amy Paulin introduced a new version of the New York Health Act (S.7590/A.7897), which aims to create a universal single payer health plan to provide comprehensive health coverage for all New Yorkers. Many versions of this proposal have been introduced in past years. This version of the Act: 

  • Provides for an administrative structure of the plan;
  • Establishes a Board of Trustees to make recommendations for the effectuation of the plan;
  • Describes the scope of benefits;
  • Describes provider standards for participation and payment methodologies;
  • Describes care coordination requirements;
  • Enacts provisions relating to financing the plan, including a payroll assessment, similar to the Medicare tax;
  • Provides for collective negotiations by health care providers; and
  • Establishes a temporary commission on implementation of the plan.

Funding Opportunities

OMH Releases RFP for Young Adult ACT Expansion in NYC and Rest of State
On July 27th, the NYS Office of Mental Health (OMH) released a Request for Proposals (RFP) for the development of three Young Adult Assertive Community Treatment (ACT) teams to serve individuals ages 18-25 with serious mental illness (SMI), as follows: 

  • One team in Brooklyn and Staten Island, serving 68 individuals (downstate model);
  • One team in Manhattan, serving 48 individuals (downstate model);
  • One team in one of the following regions, serving 48 individuals: 
    • Albany/Rensselaer/Schenectady Counties (upstate model);
    • Monroe County (upstate model);
    • Nassau County/Western Suffolk County, within the Towns of Babylon, Huntington, Islip, Smithtown (downstate model);
    • Onondaga County (upstate model); and
    • Westchester County (downstate model)

Eligible applicants are 501(c)(3) not-for-profit agencies with experience providing mental health services to individuals with SMI through programs that are licensed by OMH. Awarded providers will follow the basic ACT model, which uses a multi-disciplinary team of professionals who are available 24/7 to provide comprehensive behavioral treatment, support, and rehabilitation services for individuals with continuous high service needs.

Each team will receive $100,000 in start-up funding and $350,000 in transition/ramp-up costs, for a total of $450,000. The teams will be funded though Medicaid and ongoing net deficit funding, per the approved ACT Model depending upon catchment area, for a five-year contract beginning January 1, 2024: 

  • For the Downstate 68 Slot Model, the annual expected Medicaid revenue per team is $1,117,232, with annual net deficit funding of $119,544, and service dollars amounting to $37,154;
  • For the Downstate 48 Slot Model, the annual expected Medicaid revenue per team is $828,359, with annual net deficit funding of $88,637, and service dollars amounting to $24,771;
  • For the Upstate 48 Slot Model, the annual expected Medicaid revenue per team is $803,483, with annual net deficit funding of $54,514, and service dollars amounting to $24,771.

The full RFP is available here. Proposals are due by September 28th. Letters of intent are optional but strongly encouraged, and should be submitted to Carol Swiderski at OMHLocalProcurement@omh.ny.gov by September 21st. Questions may be submitted to OMHLocalProcurement@omh.ny.gov with “Youth ACT 2023” in the subject line by August 22nd.

OMH Releases RFP for Adult Forensic ACT Teams 
On July 25th, OMH released an RFP to fund the development of four new Forensic ACT teams to serve justice-involved individuals with SMI who have not been successfully engaged by the traditional mental health treatment and rehabilitation system, in the following regions: 

  • One team in Brooklyn, serving 68 individuals (downstate model);
  • One team in Monroe County, serving 48 or 68 individuals (upstate model);
  • One team in Erie County, serving 48 or 68 individuals (upstate model); and
  • One team in Suffolk County, serving 68 individuals (downstate model).

Two awarded teams will have the capacity to serve 68 individuals. ACT Providers will follow the ACT model to provide fully integrated behavioral health services.
Eligible applicants are 501(c)(3) not-for-profit agencies with experience providing mental health services to individuals with SMI.

Each team will receive one-time start-up funding of $100,000 and transition/ramp-up funding of $350,000. During the ramp-up period, ACT providers are expected to enroll individuals at a rate of 4-6 individuals a month up to the capacity of 48 or 68 individuals. The teams will be funded though Medicaid and ongoing net deficit funding, per the approved ACT Model depending upon catchment area, for a five-year contract beginning January 1, 2024. These funding amounts are detailed in the full RFP.

The full RFP is available here. Proposals are due by August 31st. Questions may be emailed to Amanda Szczepkowski at OMHLocalProcurement@omh.ny.gov with “Forensic ACT” in the subject line by August 11th. An optional bidder’s conference will be held on August 8th at 12pm (registration is available here).

OMH Releases RFP for Upstate SOS CTI Teams  
On July 27th, OMH released an RFP for funding to support Safe Options Support (SOS) Critical Time Intervention (CTI) teams to operate in the following geographic regions: Hudson Valley, Central NY, Southern Tier, and Central NY/Southern Tier. Four teams will receive funding, with one team awarded from each region. SOS CTI teams are expected to use an evidence-based approach to provide intensive outreach, engagement, and care coordination services to street homeless individuals who are referred to the team through the SOS Referral Hub and who are transitioning into stable housing. Teams will be comprised of licensed clinicians, care managers, peer specialists, and registered nurses who provide services for up to 12 months, pre- and post-housing placement.

Eligible applicants are not-for-profit 501(c)(3) agencies with experience providing outreach, case management, and/or behavioral health services to populations with a history of housing instability and/or street homelessness.

Each team will be granted $991,848 annually, for a five-year contract period starting on January 1, 2024. This funding includes $60,000 in wrap-around dollars. Teams may explore opportunities to provide billable services under the Health Home Plus program.

The full RFP is available here. Applications are due by September 11th. Questions may be emailed to Jeremy Rossello at OMHLocalProcurement@omh.ny.gov by August 17th with “SOS CTI Inquiry” in the subject line. An optional bidder’s conference will be held on August 8th at 2pm and can be accessed here.