Weekly Health Care Policy Update – September 18, 2023

September 25, 2023

In this update: 

  • Administration Updates
    • White House Announces Updates to Cancer Moonshot
    • White House Advisory Committee Publishes Report on Patient Safety
  • Legislative Update
    • Congress Begins Consideration of Government Funding, Health Care Bills
  • Federal Agencies
    • HHS Issues Proposed Rule Prohibiting Discrimination on the Basis of Disability
    • CMS Announces 34 Drugs for Which Part B Coinsurance May Be Lower
    • CMS Releases Preliminary Readmissions Penalty Data
    • HHS OIG Issues Report on Home Health Agencies Not Reporting Major Falls and Injuries
    • FDA Grants EUA to Covid Boosters
    • Census Bureau Issues New Report on Uninsured Rate
  • Other Updates
    • MedPAC Holds September Meetin
  • New York State Updates
    • DOL Issues Proposed Regulations for Pay Transparency in Job Requirements
    • DOH Updates Medicaid FFS Schedules for Physicians and NPs
    • OMIG Announces Updates to the Self-Disclosure Program
    • CMS Approves NYS-Directed Payments for Labor and Delivery Hospitals
    • DOH Issues Guidance for Medicaid FFS Coverage of eVisits
    • OMH to Hold Statewide Webinar on CTI and Coordination
  • Funding Opportunities
    • NYHealth Releases RFP for Healthy Food, Healthy Lives

Administration Updates

White House Announces Updates to Cancer Moonshot 
On September 13th, President Biden announced new actions by federal agencies to advance the mission of the White House Cancer Moonshot. The goal of the initiative is to cut the cancer death rate in half by 2047. These actions include: 

  • $240 million in additional funding to ARPA-H,
  • Initiatives to bring clinical trials to underserved communities;
  • New community health center awards for high quality screening;
  • Initiatives to curb tobacco use; and
  • New partnerships with non-governmental stakeholders, including CVS Health, Komodo Health, and various patient advocacy organizations.

The announcement is available here.

White House Advisory Committee Publishes Report on Patient Safety 
On September 7th, the President’s Council of Advisors on Science and Technology (PCAST) released a report with recommendations to transform patient safety. Approximately one in four Americans experience adverse outcomes during hospitalization, many of which are preventable. PCAST’s recommendations include bolstering federal leadership around patient safety, ensuring patients benefit from evidence-based practices that prevent harm, partnering with patients to reduce disparities in medical errors, and accelerating research and the deployment of exemplar systems of safe care.

The complete report is available here.

Legislative Update

Congress Begins Consideration of Government Funding, Health Care Bills 
This week, the House and Senate are both back in session. September 30th marks the end of the fiscal year, and therefore a possible government shutdown. It is also the date when many important legislative authorizations—including the Pandemic and All Hazards Preparedness Act, the SUPPORT Act, Community Health Center Fund, the National Health Service Corps, Food and Drug Administration (FDA) User Fee programs, the Farm Bill, and others—will expire without action. Additionally, on October 1st, large Medicaid Disproportionate Share Hospitals (DSH) cuts are scheduled to take place.
 
The Republican leadership in the House has proposed a draft continuing resolution (CR) that would substantially cut spending. It is not clear whether the full Republican caucus will support this proposal, and even if they do, it stands no chance of passing the Senate. The most likely consensus outcome is a clean CR, but there is a significant chance of a government shutdown beforehand.
 
Today (September 18th), the Lower Costs, More Transparency Act is scheduled to be brought to the floor under suspension. The bill largely includes previously marked up and advanced legislation from the Energy & Commerce, Ways and Means, and Education and Workforce Committees. While Energy & Commerce Committee Ranking Member Frank Pallone has endorsed the bill, the Ranking Members of the other two Committees have not. A summary of this bill is available here.

Federal Agencies

HHS Issues Proposed Rule Prohibiting Discrimination on the Basis of Disability 
On September 7th, the Department of Health and Human Services (HHS) issued a proposed rule to strengthen prohibitions against discrimination on the basis of disability. The rule, Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial Assistance, updates provisions to help persons with disabilities access health and human services under the Rehabilitation Act of 1973. HHS is proposing amendments to current regulations to improve consistency with the Americans with Disabilities Act. The proposed rule makes important clarifications to ensure accessibility in health settings, and prohibits the use of value assessment methods that place lower value on life-extension for individuals with disabilities.
 
The proposed rule is available here.
 
CMS Announces 34 Drugs for Which Part B Coinsurance May Be Lower 
On September 13th, the Centers for Medicare and Medicaid Services (CMS) announced a list of 34 prescription drugs for which Part B coinsurances may be lower in the fourth quarter of this year (from October through December). Under the Inflation Reduction Act, Medicare beneficiaries may have lower out-of-pocket costs for some Part B drugs and biologics if the drug’s price rises faster than the rate of inflation. For these drugs and biologics, the coinsurance is 20% of the inflation-adjusted payment amount. Humira, one of the highest cost products to the program, is among those included. In this quarter, beneficiary coinsurances may drop by as much as $618 per average dose.
 
The announcement is available here.
 
CMS Releases Preliminary Readmissions Penalty Data
On September 14th, CMS released preliminary data showing that a greater number of hospitals will face readmissions penalties in 2024. The performance period includes claims from July 2019 to December 2019, and July 2020 to June 2022; CMS excluded the first half of 2020 as well as hospitals with approved extraordinary circumstance exceptions. In 2024, 70.1% of hospitals will receive penalties of less than 1%, 7.5% of hospitals will receive penalties of 1% or more, and 22.4% of hospitals will not receive penalties. In 2023, 67.1% of hospitals faced penalties of less than 1%. The final data will be released in October.
 
HHS OIG Issues Report on Home Health Agencies Not Reporting Major Falls and Injuries 
On September 5th, the HHS Office of the Inspector General (OIG) released a report detailing home health agencies’ (HHA) failure to disclose patient falls. Among Medicare home health patients hospitalized for falls with major injury, the OIG report found that over half of the falls were not reported by HHAs on patient assessments as is required by CMS. This provider-reported information is used by CMS as a quality measure in their Care Compare website.
 
The complete report is available here.
 
FDA Grants EUA to Covid Boosters 
On September 11th, the FDA granted emergency use authorization (EUA) for updated Covid-19 boosters. The new mRNA vaccine boosters from Pfizer and Moderna are updated to target the XBB.1.5 omicron variant. On September 12th, the CDC’s Advisory Committee on Immunization Practices (ACIP) convened and recommended that people 6 months and older receive the booster to protect against serious outcomes from Covid-19 this fall and winter. Pharmacies are currently preparing for the first shipments of doses.
 
The FDA’s announcement is available here.
 
Census Bureau Issues New Report on Uninsured Rate
On September 12th, the U.S. Census Bureau released a report on health insurance rates. By the end of 2022, the uninsured rate hovered at 7.9%. There was a statistically significant increase in coverage across all demographics and geographic areas except for Asian Americans and Mid-Westerners. While there was a slight downturn in private plan enrollees, there was an increase in public plan enrollees. The report attributes the increase to factors such as a return to full-time work, provisions in the American Rescue Plan and other congressional packages, and recent program expansions continuing coverage through Medicaid.
 
The report is available here.

Other Updates

MedPAC Holds September Meeting 
On September 7th and 8th, the Medicare Payment Advisory Commission (MedPAC) convened for its September public meeting. Broadly, the Commissioners addressed spending trends in Medicare, including the financial status of the Medicare Trust Fund and the impact of the Inflation Reduction Act. Commissioners agreed that Medicare Advantage (MA) plans should be standardized, particularly in regard to dental, vision, and hearing benefits, while providing some policy recommendations to consider in this standardization. The Commissioners also recommend a more thorough examination of MedPAC’s cohort method and the demographic estimate of coding intensity (DECI) method to better align estimates and determine the impact of MA coding intensity. The next MedPAC meeting will take place on October 5th and 6th.
 
MedPAC’s slide presentation from the meeting is available here.

New York State Updates

DOL Issues Proposed Regulations for Pay Transparency in Job Requirements
On September 13th, the New York State Department of Labor (DOL) issued a proposed rule to establish standards for employers to disclose compensation information in job advertisements, pursuant to the State’s Pay Transparency Law. The proposed regulations describe: 

  • Which employers and advertisements are impacted;
  • The required information that advertisements must include;
  • How employers must formulate ranges of compensation; and
  • Enforcement actions for violations of the law.

The proposed regulations would apply to any employers with at least four employees and who are advertising for jobs, promotions, and transfer opportunities that are physically performed in New York State, or for opportunities performed outside of the state but that report to a supervisor, office, or worksite in the state (such as remote positions).

Under the proposed regulations, advertisements must contain the range of compensation for an opportunity, with the following requirements: 

  • The range must include the minimum and maximum base rate of pay (such as annual salary or hourly rate) that the employer believes in good faith to be what they are willing to pay the successful applicant/employee at the time of the advertisement’s posting, based upon factors such as experience/education levels. 
    • Employers may adjust the range of compensation after collecting additional information through the hiring process.
    • The range cannot be so broad that it prevents applicants from understanding the legitimate range of compensation that an employer is willing to pay.
  • The range cannot include other forms of compensation (such as overtime pay) or benefits.
  • The range must be for a single opportunity and for a single geographic location/region. If an advertisement for an opportunity covers multiple regions or includes multiple levels of seniority/supervisory authority, multiple ranges of compensation for each individual opportunity must be provided.

The proposed regulations do not apply for governmental agencies or for temporary help firms used by employers to support/supplement their workforce.

The regulations also outline allowable enforcement actions for violations. Applicants and employees may file a complaint, and the Commissioner of Labor may also initiate their own investigations based on tips and reports of violations from the public.

The proposed regulations are available here. Comments may be submitted to Jill Archambault at regulations@labor.ny.gov by November 12th.

DOH Updates Medicaid FFS Schedules for Physicians and NPs
Effective October 1st, New York State (NYS) Medicaid fee-for-service (FFS) reimbursement rates for most physician services will increase to 80 percent of Medicare non-facility rates. Additionally, rates for nurse practitioner services will increase to 95 percent of the new physician rates (i.e., 76 percent of Medicare). This increase was included in the most recent Enacted Budget. The following fee schedules have been updated: 

  • NYS Medicaid Physician Medicine Services Fee Schedule (available here)
  • NYS Medicaid Physician Drug and Drug Administration Services Fee Schedule (available here)
  • NYS Medicaid Physician Radiology Services Fee Schedule (available here)
  • NYS Medicaid Physician Surgery Services Fee Schedule (available here)
  • NYS Medicaid Nurse Practitioner Services Fee Schedule (available here)
  • NYS Medicaid Midwife Services Fee Schedule (available here)

The updated fee schedules are listed in the August 2023 Medicaid Update (available here) and are also available at the eMedNY website, available here, by selecting the provider manuals for the applicable provider types.

Questions should be directed to the Office of Health Insurance Programs (OHIP) Division of Program Development and Management (DPDM) at FFSMedicaidPolicy@health.ny.gov.

OMIG Announces Updates to the Self-Disclosure Program
In the August 2023 Medicaid Update (available here), DOH announced revisions to the Office of the Medicaid Inspector General’s (OMIG) Self-Disclosure program guidance. The Self-Disclosure program now includes two pathways for entities to report, return and explain overpaid NYS Medicaid funds: 

  • Abbreviated Self-Disclosure process: This is a new process that can be used by entities to report and explain identified overpayments resulting from routine and transactional errors with minimal monetary or program impact and that have already been voided or adjusted.
  • Full Self-Disclosure process: This is the existing process for entities.

Both processes require the submission of a statement that explains Medicaid overpayments within 60 days of identification.

As a best practice, entities using the abbreviated process may submit Self-Disclosure Abbreviated Statement forms monthly (by the 5th of each month) to report qualifying voids and adjustments from the previous month. OMIG anticipates the first full month of reports to be in September 2023 and the first monthly reporting to be October 5th.

Information about the new abbreviated process is available at OMIG’s website, available here. Feedback and questions may be directed to the NYS OMIG Self-Disclosure Unit by email at selfdisclosures@omig.ny.gov, and will be used to inform additional updates.

CMS Approves NYS-Directed Payments for Labor and Delivery Hospitals 
On September 11th, the New York State Department of Health (DOH) announced that New York’s Medicaid program has received approval from CMS for state-directed Quality Incentive Payments for eligible hospitals that reduce or maintain low-risk caesarean delivery rates.

Eligible hospitals are Labor and Delivery hospitals with over 500 Medicaid Managed Care (MMC) deliveries in SFY 2022. Hospitals will receive payments for meeting the following performance goals in SFY 2023 and 2024:   

  • For hospitals with a baseline low-risk Cesarean delivery rate above the statewide performance goal (14%): Reduction of at least 1% in their delivery rate.
  • For hospitals with a baseline rate at or below the statewide performance goal: Maintenance of delivery rate at or below 14%.  

A total of $38 million will be awarded to eligible hospitals that earn the payments over the two-year period. Payments will be distributed from MMC organizations to contracted hospitals that meet performance targets.

The announcement is in the August 2023 Medicaid Update, available here. Questions should be directed to MaternalAndChild.HealthPolicy@health.ny.gov.

DOH Issues Guidance for Medicaid FFS Coverage of eVisits 
Effective October 1st, the New York State Medicaid Fee-For-Service (FFS) program will reimburse for eVisits, which are virtual check-in services involving asynchronous, patient-initiated communications with a Medicaid provider through a digital platform, such as a patient portal. Coverage of eVisits allows for providers to be reimbursed for online evaluation/assessment and management services and medical decision-making conducted outside of the patient visit.

The August 2023 Medicaid Update provides guidance on the usage and coverage of eVisits, as well as requirements pertaining to patient rights and documentation. 

  • Coverage of eVisits is allowable only when the patient initiates communication and the problem requires a physician or other qualified practitioner’s professional’s evaluation, assessment, and management. Contact initiated by a provider, whether individualized or as part of an outreach program, are not covered under eVisits.
  • eVisits may be provided to established patients only (the presenting problem may be new).
  • Communication of test results, scheduling appointments, medication refills, and any other communications outside the scope of evaluation and management are not considered eVisits.
  • The patient’s verbal or written consent must be obtained annually and documented in their chart before eVisits can occur.

The Medicaid Update also provides guidance on billing for eVisits:  

  • Billing for eVisits is based on cumulative time spent with a single patient within a seven-day period after the provider reviews the initial patient communication (the review must take place within three business days of the patient initiating contact).
  • eVisits may not be billed if the patient inquiry is related to a visit within the previous seven days of the initial digital communication.
  • If the eVisit leads to an evaluation and management (E&M) visit, the eVisit should not be billed, but the time spent on the communication can be incorporated into the separately billed E&M visit.

The guidance is available here. Questions can be directed to OHIP at telehealth.policy@health.ny.gov.

OMH to Hold Statewide Webinar on CTI and Coordination
On September 21st at 11am, the New York State Office of Mental Health (OMH) will hold webinar for all provider organizations, hospitals, and county leadership across the state for a discussion on improving coordination across the mental health continuum of care, including through the use of critical time intervention concepts. Organizations are encouraged to invite their staff members involved in planning, quality improvement, clinical care, and/or care coordination to attend.

Registration is available here.

Funding Opportunities

NYHealth Releases RFP for Healthy Food, Healthy Lives
On September 12th, the New York State Health Foundation (NYHealth) released a Request for Proposals for their “Healthy Food, Healthy Lives” priority area, which seeks to advance racial health equity through two strategies: 

  • Promoting Food Is Medicine interventions (e.g., medically tailored meals, medically tailored groceries, and produce prescription programs); and
  • Supporting healthier, culturally responsive food purchasing.

Eligible applicants must be New York State-based and may include past NYHealth grantees as well as organizations that have not previously received NYHealth funding. Priority will be given to applicants’ proposals that are: 

  • Statewide or regional in scope;
  • Have system-wide implications; and
  • Build collaboration among organizations.

Awards of up to $50,000 each will be made to successful applicants. Funds requested must be commensurate with the work proposed, and the project period cannot exceed 24 months.

The full RFP is available here. An FAQ is available here. Informational webinars will be held on September 20th (registration is available here) and October 10th (registration is available here.) Interested applicants must submit online Letters of Inquiry (LOIs) by October 23rd. Applicants will be notified in December on their application status, and those who are invited to submit full proposals will have a deadline of January 17, 2024 to do so.