Weekly Health Care Policy Update – October 10, 2023

October 17, 2023

In this update: 

  • Federal Agencies
    • CMS to Hold National Stakeholder Call on October 17th
    • CMS to Hold Making Care Primary Office Hours on October 24th
    • HHS Announces All Targeted Drug Companies Will Participate in Medicare Prescription Drug Negotiations
    • DEA to Allow Continued Telehealth Prescribing Through 2024
    • HHS Announces $330 Million for Biomedical Breakthroughs
    • HRSA Releases National Children’s Health Survey Data on Material Hardship
    • CDC Proposes Guidelines to Reduce STIs in High-Risk Populations
    • FDA Issues Guidance on Treatments for Stimulant Use Disorder
  • Other Updates
    • MedPAC Holds October Meeting
    • Cigna to Pay $172 Million to Settle MA Risk Adjustment Misconduct Allegations
    • URAC to Offer Health Equity Accreditation
    • Aetna Cuts Commercial Coverage for Virtual Care
  • New York State Updates
    • CMS Approves Amendment to OPWDD 1915(c) HCBS Waiver
    • NY Independent Asssessor to Begin Conducting Personal Assistance Reassessments in January 2024
    • OASAS Establishes CASAC-Provisional Credential to Address Workforce Crisis
    • DOH Adopts Rule Updating Investigation Procedures for Communicable Disease
    • DOH Repeals Covid-19 Vaccination Requirements for Healthcare Workers at Covered Entities
    • OMH and MCTAC to Host CFTSS Provider Forum on November 15th
    • OASAS and MCTAC to Host Webinar on New OASAS Rates on October 19th
  • Funding Opportunities
    • DASNY Releases 2023 Nonprofit Infrastructure Capital Investment Program
    • DOH Releases SOI for Round 6 of the Primary Care Service Corps
    • NYC DOHMH Releases RFP to Re-Procure Adult Clubhouse Contracts
    • NYC Department for the Aging Releases Concept Paper on Home Delivered Meals Program
    • HCR Releases 2023 Multifamily Programs RFP

Federal Agencies

CMS to Hold National Stakeholder Call on October 17th 
On October 17th, the Centers for Medicare and Medicaid Services (CMS) will conduct a national stakeholder call to provide an update on CMS’ recent accomplishments. The call will focus on how cross-cutting initiatives are working to advance their Strategic Plan. This is the fourth such call this year and will include remarks from Administrator Brooks-LaSure and Chief Operating Officer Blum, with supporting leadership staff.
 
The RSVP is available here.
 
CMS to Hold Making Care Primary Office Hours on October 24th
On October 24th at 2pm, the CMS Innovation Center will hold a webinar that offers “office hours” for applicants interested in the Making Care Primary (MCP) model. A registration link will be forthcoming shortly.
 
HHS Announces All Targeted Drug Companies Will Participate in Medicare Prescription Drug Negotiations 
On October 3rd, the Department of Health and Human Services (HHS) announced that all 10 drug companies with drugs selected for Medicare price negotiation agreed to participate in the negotiations. Negotiations will take place during the remainder of 2023 and 2024, and any negotiated prices will become effective at the beginning of 2026. The negotiation process is slated to consider the drug’s clinical benefit, whether it fulfills an unmet medical need, its impact on those who rely on coverage, and costs associated with drug research and development.
 
The announcement is available here.
 
DEA to Allow Continued Telehealth Prescribing Through 2024
On October 6th, the Drug Enforcement Administration (DEA), in collaboration with HHS, announced a second, temporary extension of Covid-19 telemedicine flexibilities for the prescription of controlled medications. These flexibilities and exemptions to current DEA regulations for new practitioner-patient relationships will be extended through December 31, 2024. 
 
The announcement is available here.
 
HHS Announces $330 Million for Biomedical Breakthroughs
On September 29th, HHS announced over $330 million through the Advanced Research Projects Agency for Health (ARPA-H) to support biomedical health breakthroughs aimed at improving health treatments and solutions for the American public. These investments will go towards a host of initiatives within ARPA-H including digital security, 3D printing of human organs, antimicrobial resistance, and Cancer Moonshot.
 
The announcement is available here.
 
HRSA Releases National Children’s Health Survey Data on Material Hardship
On October 2nd, the Health Resources and Services Administration (HRSA) released the 2022 National Survey of Children’s Health (NSCH) Material Hardship Among Children data brief. The NSCH is conducted by the U.S. Census Bureau and is the largest national- and state-level survey on the health and health care needs of children ages 0-17. Overall, 44.7% of children surveyed experienced material hardship—defined as the inability to afford basic needs like food, housing, and medical care—at some point in their lifetime. Among racial groups, Asian children were least likely to experience material hardship, while American Indian/Alaska Native children were most likely.
 
The data brief is available here.
 
CDC Proposes Guidelines to Reduce STIs in High-Risk Populations 
On October 2nd, the Centers for Disease Control and Prevention (CDC) proposed guidelines for the use of doxycycline post-exposure prophylaxis (PEP) for the prevention of bacterial sexually transmitted infections. Doxycycline PEP has demonstrated benefit in reducing chlamydia, gonorrhea, and syphilis infections. This intervention represents a new approach to STI prevention in populations at increased risk for these infections.
 
The guidance is available here.
 
FDA Issues Guidance on Treatments for Stimulant Use Disorder 
On October 4th, the Food and Drug Administration (FDA) released new draft guidance for sponsors in developing treatments for stimulant use disorders.  There is currently no FDA-approved medication for stimulant use disorder, a general term for the treatment of moderate to severe cocaine, methamphetamine, and prescription stimulant use disorders. The draft guidance sets out FDA’s current thinking on clinical trial and overall development program design for this new class of treatments.
 
The guidance is available here.

Other Updates

MedPAC Holds October Meeting 
On October 5th, the Medicare Payment Advisory Commission (MedPAC) convened for its October public meeting. The meeting covered three central topics: 

  • Current updates to payment rates for clinician services: Commissioners voiced widespread support for changing the default payment update mechanism to incorporate some type of inflationary factor. Further, many commissioners expressed an interest in tailoring the application of any such change to account for differences in primary care and specialty care and encourage site neutral payment. Commissioners were also interested in better understanding the increase in service volume and intensity identified by staff. Finally, while there was broad agreement that physicians should be moving towards Advanced Alternative Payment Models (A-APMs), there was less consensus around how to best incentivize that movement.
  • Examining staffing ratios and turnover in nursing facilities: Commissioners raised concerns regarding the potential effects of CMS’s proposed rule to establish ratios in long-term care facilities, including weekend staffing variations, the impact of wage pass-through, and the potential for closure and consolidation of facilities. MedPAC Chair Michael Chernew noted that Medicare might not be the most suitable means to address nursing payment policy due to the fragmentation of payment across Medicare, Medicaid, and other sources.
  • The evaluation of a work plan for the prices of generic drugs under Part D: Commissioners generally signaled support for the workplan as developed, although some indicated that the Inflation Reduction Act might mean that this work would be premature.

The next MedPAC meeting will take place virtually on November 2nd.

Cigna to Pay $172 Million to Settle MA Risk Adjustment Misconduct Allegations
On September 30th, the Department of Justice (DOJ) announced that Cigna agreed to pay over $172 million to resolve allegations that it violated the False Claims Act. The DOJ alleged that Cigna submitted inaccurate and untruthful patient diagnosis data to CMS in the operation of their Medicare Advantage (MA) plans’ risk assessments. Moreover, the DOJ claimed that Cigna failed to withdraw the inaccurate information, repay CMS, and falsely certified that the data was accurate. This settlement resolves the allegations.

The announcement is available here.

URAC to Offer Health Equity Accreditation 
On October 4th, the URAC, the nation’s largest health care accreditation entity, announced a new health equity program. The goal of this accreditation, in consultation with the National Minority Quality Forum, is to showcase organizations’ commitment to addressing health disparities in the communities they serve. Accredited organizations can use performance data to demonstrate efforts to access identified populations. The accreditation’s three focus areas include organizational commitment, program plan, and equitable services and support.

The announcement is available here.

Aetna Cuts Commercial Coverage for Virtual Care 
On October 5th, Aetna announced that it will cease commercial coverage for a variety of virtual care services, starting on December 1st. Aetna said that the affected services would generally include audio-only and asynchronous text-based visits, which were permitted under the terms of the Covid-19 public health emergency. Aetna emphasized that it plans to continue to provide coverage for telemedicine on a basis “more extensive than what was provided pre-pandemic.”

New York State Updates

CMS Approves Amendment to OPWDD 1915(c) HCBS Waiver
CMS has approved Amendment 13 to New York’s Office for People with Developmental Disabilities (OPWDD) Comprehensive Waiver, which was published in draft form in April 2023 (SPG’s summary available here).

This amendment updates OPWDD’s 1915(c) Home and Community Based Services (HCBS) waiver program, to make permanent several flexibilities that were temporarily permitted during the Covid-19 pandemic as part of OPWDD’s Appendix K emergency waiver. This amendment, which has an effective date of October 1, 2023, will ensure that these flexibilities do not lapse when the  Appendix K waiver expires on November 11th. The amendment includes the following changes, among others:

Programmatic Changes

  • Allowing Family Education and Training services to be delivered via remote technology;
  • Adding “home-enabling supports” to Assistive Technology-Adaptive Device services for individuals that live in the community; and
  • Returning to higher “hard limits” on Environmental Modifications, Assistive Technology, and Vehicle Modifications. However, these limits will not take effect until all remaining American Rescue Plan Act (ARPA) funds are exhausted or until they expire in March 2025.

Fiscal Changes

  • Making permanent the temporary Covid-19 rate enhancements for Intensive Behavioral Services;
  • Changing the timeframe for rebasing provider costs from four years to five years, starting July 1, 2024, so that OPWDD can evaluate the impact of Covid-19;
  • Delaying until July 1, 2024 the rebasing of transportation costs for day services;
  • Continuing the State’s ability to calculate occupancy adjustments for Residential Habilitation;
  • Removing the Self-Direction Fiscal Intermediary and Broker fees and the Personal Resource Account (PRA) table from the waiver to allow OPWDD to make updates on a more timely basis without submission of an amendment and subsequent federal approval;
  • Eliminating the second phase of the Consolidated Fiscal Report (CFR) penalty of 50% for late submissions, while retaining the first phase penalty of 2%;
  • Further delaying implementation of the 15% cap on administrative cost reimbursement until at least October 1, 2023; and
  • Clarifying that one-time bonuses and similar funding that are reported in the CFR may be excluded for rate-setting purposes.

Other

  • Changing the scope of Division of Quality Improvement (DQI) reviews.

The approved amendment does not include the proposal to allow individuals over 60 who reside in certified settings to receive Respite services which was included in the draft amendment. OPWDD “remains committed to evaluating and assessing options to move forward with a senior-focused service option to address retirement-related socialization needs.”

The amendment is available here. A “plain language” summary of the amendment is available here. OPWDD responses to public comment are available here. Additional guidance on these changes will be provided by OPWDD over the next few weeks.

NY Independent Asssessor to Begin Conducting Personal Assistance Reassessments in January 2024
On October 2nd, the New York State (NYS) Department of Health (DOH) issued a letter to Medicaid managed care plans announcing that the New York Independent Assessor (IA) will expand its range of activities related to personal assistance assessments.

Specifically, beginning January 2024, the IA will now conduct the following activities for adults (18+) seeking personal care services (PCS) or consumer-directed personal assistance services (CDPAS): 

  • Sending reminder notifications to individuals who need routine reassessments; and
  • Conducting non-routine reassessments (e.g., change in condition, consumer requested).

The IA will begin to provide these services on a phased-in basis by county, as outlined on the second page of the letter here. Until the implementation dates indicated in the chart for each county, Local Departments of Social Services (LDSS) and managed care plans will remain responsible for all reassessments. LDSS and managed care plans remain responsible for all assessments (initial and reassessment) of individuals under age 18 until further notice.

Further information, including guidance documents and webinars outlining implementation, will be forthcoming. Questions may be submitted to independent.assessor@health.ny.gov.

OASAS Establishes CASAC-Provisional Credential to Address Workforce Crisis
On October 4th, the NYS Office of Addiction Services and Supports (OASAS) issued an emergency/proposed rule to establish an additional credential for Credentialed Alcoholism and Substance Abuse Counselors (CASACs). The new credential will be called the CASAC-Provisional (“CASAC-P”) and will allow individuals with a bachelor’s or master’s degree in human services to be hired in OASAS-certified programs with minimum qualifications while they are working towards their credential as a full CASAC. OASAS will also streamline the credentialing process and expedite the process for obtaining a renewal for a credential. OASAS intends for these changes to address the ongoing workforce crisis, specifically the expiration of the “social work exemption” in 2022.

The emergency/proposed rules are available here and a summary of changes is available here. The changes are effective as of September 26, 2023. Public comments may be submitted to comments@cs.ny.gov through December 3rd.

DOH Adopts Rule Updating Investigation Procedures for Communicable Disease
On October 4th, DOH issued a Notice of Adoption in the State Register for regulations that update the State and local health departments’ authority to take specific actions to monitor the spread of disease, including actions related to investigation and response to a disease outbreak.

There were no significant changes made from the draft rule (summarized by SPG in its April 24th update here) following a review of public comment. Additional details, including public comments received and corresponding DOH responses, are available in the State Register here.

DOH Repeals Covid-19 Vaccination Requirements for Healthcare Workers at Covered Entities
On October 4th, DOH issued a Notice of Adoption in the State Register of regulations that officially repeal the Covid-19 vaccine mandate for health care personnel at covered entities across New York, including: 

  • Article 28 hospitals, nursing homes, and diagnostic and treatment centers;
  • Article 36 (Public Health Law) home care providers;
  • Article 40 (Public Health Law) hospices; and
  • Article 7 (Social Services Law) adult care facilities.

As per guidance issued to covered entities in May 2023 (available here), DOH has already ceased enforcement of the regulations and encourages organizations to individually consider how to implement their own internal policies regarding Covid-19 vaccination requirements.

The Notice of Adoption, which includes DOH responses to public comment, is available in the State Register here.

OMH and MCTAC to Host CFTSS Provider Forum on November 15th
On November 15th from 10am-11:30am, the NYS Office of Mental Health (OMH), in partnership with the Managed Care Technical Assistance Center (MCTAC), will host an interactive webinar with Children’s Mental Health Rehabilitation Services (CMHRS) and non-licensed OMH-designated Children and Family Treatment and Support Services (CFTSS) providers. Topics will include: 

  • A review of CFTSS co-enrollment allowances with Mental Health Outpatient Treatment and Rehabilitative Services (MHOTRS) clinics;
  • Service delivery in school settings;
  • Child Health Plus;
  • Site review citation trends, including documentation practices; and
  • A review of training and resources.

Registration for the event is available here.

OASAS and MCTAC to Host Webinar on New OASAS Rates on October 19th 
On October 19th from 12pm-1pm, OASAS, in partnership with MCTAC, will host a webinar for all OASAS providers to address the recently-approved rate increases for OASAS treatment providers (as described in plan guidance here). During the webinar, OASAS will discuss the rate increases and how providers should claim for the services. Providers will also have an opportunity to ask questions directly to OASAS.

Registration is available here.

Funding Opportunities

DASNY Releases 2023 Nonprofit Infrastructure Capital Investment Program
On October 2nd, the Dormitory Authority of the State of New York (DASNY) released a Request for Applications (RFA) for the 2023 round of the Nonprofit Infrastructure Capital Investment Program (NICIP). NICIP offers funding for capital construction projects that improve or maintain the “quality, efficiency, and accessibility” of New York-based not-for-profit human service providers, excluding Article 28 licensed health care providers.

The first round of NICIP projects, totaling approximately $120 million, were awarded to recipients in 2017 and 2018.The 2022-23 NYS Enacted Budget appropriated $50 million in total funding for this NICIP round, which will be combined with the withdrawals and forfeitures from previous NICIP awards to make a total of $60 million in funding. Awards will range between $50,000 and $500,000. Applicants must be nonprofit human services organizations that provide direct programs and services to individuals and families in NYS. Direct services include prevention, intervention, respite, and/or habilitative services. Hospitals, nursing homes, and Article 28 diagnostic and treatment centers are not deemed to be human services organizations and are therefore not eligible to apply.

The full RFA is available here and an FAQ document is available here. SPG’s summary of the opportunity is available here. The Governor’s press release is available here. Applications will be processed and scored (based primarily on project viability) on a first-come, first-serve rolling basis between December 1st and January 12, 2024.

DOH Releases SOI for Round 6 of the Primary Care Service Corps
On October 5th, DOH released a Solicitation of Interest (SOI) for the sixth round of the Primary Care Service Corps (PCSC) Loan Repayment Program. PCSC is a service-obligated loan repayment program for clinicians working part-time (20-39 hours per week) in primary care or behavioral health and is intended to increase the supply of such clinicians in underserved settings. Up to $1.5 million in funding is available to support new awards through this program. Awarded clinicians will receive up to $36,000 in loan repayment funding if they commit to practicing for three years at a National Health Service Corps Approved Site.  

Clinicians eligible to apply for loan repayment funding under the program must be licensed in New York State at the time of application and may include the following:  

  • Dentists (full-time dentists may receive up to $72,000)
  • Dental hygienists
  • Nurse practitioners
  • Physician assistants
  • Midwives
  • Clinical psychologists
  • Licensed clinical social workers
  • Licensed marriage and family therapists
  • Licensed mental health counselors

Applicants may not have previously received, or currently be receiving, an award from PCSC. The three-year employment commitment will begin on January 1, 2024.

The SOI is available here. Applications may be submitted through November 22nd and will be reviewed in the order in which they are received. Questions may be submitted to sch_loan@health.ny.gov with the subject line “PCSC Round 6 Question” through October 19th.

NYC DOHMH Releases RFP to Re-Procure Adult Clubhouse Contracts
On September 29th, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) released a Request for Proposals (RFP) re-procuring all current clubhouse contracts, with the goal of expanding and enhancing program reach and impact. Clubhouses are evidence-based, one-stop locations that offer an array of services to adults with serious mental illness, including but not limited to supported employment, education support, skill-building, case management, and recreation. DOHMH currently contracts with 16 clubhouses that serve approximately 5,000 members.

Through this RFP, DOHMH intends to provide $30 million in annual funding across 13 new contracts. The anticipated annual contract value range is based on the expected number of active members, as follows: 

  • 300 active members: $1.05-$1.35 million
  • 600 active members: $2.15-$2.7 million
  • 900 active members: $3.15-$4.05 million

The RFP is open to both current clubhouse contractors and new providers. Current contractors must submit a proposal if they are interested in continuing to provide clubhouse services. Applicants must have experience promoting racial justice and health equity, working with the target population, and providing relevant services. Applicants must be accredited by Clubhouse International or attest that they will work to obtain one-year provisional Clubhouse International accreditations within the first two years of the contract term, followed by the full three-year accreditation. Contracts will last for nine years, beginning on July 1, 2024.

The RFP is available in the PASSPort system here. Applications are due on November 22nd. There will be an optional pre-proposal conference on October 28th from 2:30pm-4pm. Interested parties may RSVP to RFP@health.nyc.gov with “81624P0001-PPC” in the subject line. Questions may be submitted to Richard Cheung at the email address above with “81624P0001-Question” in the subject line through October 25th.

NYC Department for the Aging Releases Concept Paper on Home Delivered Meals Program
On September 22nd, the NYC Department for the Aging released a Concept Paper that seeks feedback on the City’s Home Delivered Meals (HDM) program for eligible older adults. The Concept Paper, which will inform a forthcoming RFP, includes an overview and history of the existing HDM program as well as a summary of proposed modifications to the program. The proposed modifications aim to address changes to the target population, cultural competency, coordination with care management agencies, and economic considerations, such as inflation and staff turnover costs. The City is seeking stakeholder feedback on the proposed changes and ways to expand and enhance the services provided by the HDM program.

The Concept Paper is available here. Comments and questions may be submitted to Mary Tracy at rfp@aging.nyc.gov with “Home Delivered Meals Concept Paper” in the subject line through November 6th.

HCR Releases 2023 Multifamily Programs RFP
NYS Homes and Community Renewal (HCR) has released the 2023 Multifamily Programs RFP, which consolidates the availability of funding for the HCR Multifamily Programs. These programs support affordable rental housing for low-to-moderate income individuals and families as part of the State’s five-year plan to combat homelessness and advance the construction and preservation of affordable housing. Awards include 9% Low-Income Housing Tax Credits and subsidy financing to sponsors proposing affordable and supportive multifamily housing projects. Projects may include new construction, rehabilitation, and/or adaptive reuse of site-specific projects that provide multifamily rental housing. Funding is not available for projects proposing to use tax-exempt bond financing.

The full RFP is available here. Additional information, including maximum award amounts for each program, is available in each program’s term sheet (accessible here). Applications are due on November 7th.

All applicants are required to request and participate in a technical assistance (TA) session prior to application submission. The deadline to request a TA session is October 18th. Additional information on the TA process and the TA request form is available here. Questions may be submitted to 9%RFP@hcr.ny.gov.