Weekly Health Care Policy Update – October 2, 2023

October 9, 2023

In this update: 

  • Legislative Updates
    • Biden Signs Clean CR to Keep Government Open
    • Cassidy Issues RFI on CDC Reform
  • Federal Agencies
    • CMS Seeks Public Input on Mental Health Parity in Medicaid
    • CMS Seeks Public Input on OTC Preventive Services
    • MA Premiums to Remain Stable for 2024
    • ARPA-H Decides on Three Headquarters
    • NIH Designates People with Disabilities as a Population with Health Disparities
    • HRSA Announces $90 Million in Awards for Maternal Mental Health
    • HRSA Issues School-Based Service Expansion Awards for Health Centers
  • Other Updates
    • CBO Estimates CMMI Initiatives Will Slightly Increase Net Federal Spending
    • CBO Publishes New Estimates of Baseline Federal Health Spending for 2024-2033
    • MACPAC Holds September Meeting
  • New York State Updates
    • NYS DOB Approves Rate Increase for NYS OASAS Certified Treatment Providers
    • DOH Issues Guidance to Hospitals Regarding PPE Stockpile Requirements
    • DOH Publishes Semi-Annual Report on Enhanced HCBS Spending Plan
    • SED Issues Revised Amendment on Proposed Regulations for ABA Providers
    • DOH Issues Public Notices Announcing Implementation of Budget Initiatives
    • CMS Approves New York SPA Extending PDN Services for Young Adults and Medicaid Reimbursement for Covid-19 Tests
  • Funding Opportunities
    • OMH Releases RFP for the Development and Operation of Young Adult Enhanced Housing Programs
    • NYS Issues RFP for Purchase and Redevelopment of Former Bayview Correctional Facility into Affordable Housing

Legislative Updates

Biden Signs Clean CR to Keep Government Open 
On September 30th, in a surprise move, House Speaker Kevin McCarthy brought a clean 45-day continuing resolution (CR) to forestall a government shutdown to the House floor. The measure, which does not include the significant spending cuts previously proposed by Republicans, passed 334-92 with strong bipartisan support. On the same day, the Senate passed the bill by a vote of 88-9 and President Biden signed it. As such, the federal government will now be funded at least through November 17th.
 
The CR extends a number of authorizations for health programs, including community health centers, the National Health Service Corps, teaching health centers, and graduate medical education, and delays the scheduled Medicaid Disproportionate Share Hospital (DSH) cuts. However, it did not extend the SUPPORT Act or the Pandemic and All-Hazards Preparedness Act. Otherwise, the bill’s only additional feature is disaster aid, as requested by the White House.
 
Cassidy Issues RFI on CDC Reform
On September 26th, Senator Bill Cassidy (R-LA), the Ranking Member of the Committee on Health, Education, Labor, and Pensions, issued a Request for Information (RFI) regarding potential reforms to the Centers for Disease Control and Prevention (CDC). The letter solicits stakeholder input on a slew of questions regarding shortcomings of the agency as well as opportunities to modernize. This RFI is part of a broader conversation on Capitol Hill surrounding the CDC following conflicting and incomplete information during the Covid-19 pandemic.
 
The RFI is available here.

Federal Agencies

CMS Seeks Public Input on Mental Health Parity in Medicaid
On September 29th, the Centers for Medicare and Medicaid Services (CMS) issued an RFI seeking public feedback on how to improve implementation of mental health parity in Medicaid, under the Mental Health Parity and Addiction Equity Act (MHPAEA). The RFI describes current requirements under MHPAEA and processes for ensuring compliance. It seeks responses on a number of questions, including: 

  • How can CMS improve the process of reviewing documentation for parity compliance in Medicaid (e.g., templates, forms, etc.)?
  • What processes are states and Medicaid plans using to determine whether behavioral health coverage and medical coverage are “comparable”?
  • What non-quantitative treatment limits (NQTLs) or benefit classifications should be prioritized for parity review? What should be the criteria for identifying high-priority NQTLs?
  • What measures or data could help identify potential parity violations in Medicaid (e.g., rates of denial of coverage, wait times, etc.)? How should such data be collected?
  • Do any particular mental health issues disproportionately affect Medicaid recipients, or that are at particular risk of not being covered in compliance with parity requirements?

The full RFI is available here. Responses are due to MedicaidandCHIP-Parity@cms.hhs.govby December 4th.

CMS Seeks Public Input on OTC Preventive Services
On September 29th, CMS issued an RFI seeking public feedback on over-the-counter (OTC) preventive services. The RFI specifically concerns “how to best ensure coverage and access to over-the-counter (OTC) preventive services, including the benefits of requiring most health insurance plans to cover these services at no cost and without a prescription by a health care provider.”

CMS seeks feedback on a range of OTC items such as contraceptives, tobacco smoking cessation products, and breastfeeding supplies. While plans must cover certain recommended preventive items and services at no cost under the Affordable Care Act, some such products are available without a prescription. CMS seeks to understand the challenges and benefits of providing coverage at no cost for recommended OTC preventive products.

The full RFI is available here. Responses are due 60 days after publication in the Federal Register. A press release is available here.

MA Premiums to Remain Stable for 2024
On September 26th, CMS announced that average premiums, benefits, and plan choices for Medicare Advantage and Medicare Part D prescription drug programs will remain stable in 2024. The average plan premium for all Medicare Advantage (MA) plans is projected to increase less than a dollar to $18.50 per month. More than 70% of beneficiaries will not experience a premium increase on MA plans.

The announcement is available here.

ARPA-H Decides on Three Headquarters 
On September 26th, the Advanced Research Projects Agency for Health (ARPA-H) announced the advent of ARPANET-H, a nationwide health innovation network anchored by three ARPA-H regional hubs in the greater D.C. area, Boston, MA, and Dallas, TX. These three hubs are supported by 10 initial spokes spanning from Alaska to Florida. No spokes have been announced in the tri-state area. 

The announcement is available here.

NIH Designates People with Disabilities as a Population with Health Disparities
On September 26th, the Director of the National Institute on Minority Health and Health Disparities (NIMHD), Dr. Eliseo J. Pérez-Stable, designated people with disabilities as a population with health disparities for the purposes of research supported by the National Institutes of Health (NIH). In order to further health equity, NIMHD and other NIH institutes launched a new research program to address disparities in this population.

The announcement is available here.

HRSA Announces $90 Million in Awards for Maternal Mental Health 
On September 27th, the Health Resources and Services Administration (HRSA) announced nearly $90 million in new awards to support the White House Blueprint for Addressing the Maternal Health Crisis. These investments are divided between the Maternal and Child Health Bureau, the Federal Office of Rural Health Policy, and the Bureau of Health Workforce. Health Research, Inc., in the Albany area, received a number of awards.

The announcement is available here.

HRSA Issues School-Based Service Expansion Awards for Health Centers 
On September 25th, HRSA announced $55 million in awards to expand access to mental health care for young people. These investments are divided between the Bureau of Primary Health Care ($25 million across 77 recipients), the Maternal and Child Health Bureau ($19 million across 25 recipients), and the Bureau of Health Workforce ($11 million across 23 recipients). Awards for the Bureau of Primary Care went to health centers to create new or expand existing school-based health centers. The William F. Ryan Community Health Center in New York City received $250,000.

The announcement can be found here.

Other Updates

CBO Estimates CMMI Initiatives Will Slightly Increase Net Federal Spending
On September 28th, the Congressional Budget Office published an updated estimate of the effect of the Centers for Medicare and Medicaid Innovation (CMMI) initiatives on federal spending. CBO found that CMMI operations increased federal spending by $5.4 billion from 2011 to 2020, or 0.1 percent of Medicare spending. This represented the combination of $2.6 billion in savings on reduced spending but $7.9 billion in spending on CMMI administration, model infrastructure, and evaluations. In CBO’s 2010 forecast from before CMMI’s establishment, CMMI had been projected to produce a net savings of $1.3 billion over this period.

CBO’s updated projection for the future estimates that from 2021 to 2030, CMMI activities will increase federal spending by $1.3 billion, with savings of $7 billion from models offset by spending of $8.3 billion. In the 2010 forecast, CBO had originally projected much more substantial net savings of $77.5 billion. However, CBO notes that all of these projections “are subject to considerable uncertainty.”

The full report is available here.

CBO Publishes New Estimates of Baseline Federal Health Spending for 2024-2033
On September 28th, CBO published an updated estimate of federal spending on health care insurance for the period from 2024 to 2033. This is the first such estimate that covers the whole population, rather than only adults over 65. These estimates underlie CBO’s May 2023 baseline projections for federal spending.

CBO’s estimate considers federal spending in the following areas: 

  • Tax benefits for employer-sponsored coverage;
  • Federal funding for Medicaid;
  • The Medicare program; and
  • Subsidies available for individual coverage on Marketplaces and the Basic Health Program.

Notable estimates include: 

  • CBO projects Medicare spending will increase from $759 billion in 2022 to $1.572 trillion in 2033, or from about $12,800 per capita to about $21,700 per capita (70%).
  • CBO projects federal subsidies for employment-based coverage will increase from about $2,160 per capita to $4,130 per capita over the same period (91%).

The full estimates are available here.

MACPAC Holds September Meeting 
On September 21st and 22nd, the Medicaid and CHIP Payment and Access Commission (MACPAC) convened its monthly public meeting. The Commissioners expressed support for policy options to improve oversight of denials and subsequent appeals processes among Medicaid Managed Care Organizations (MCOs). Potential solutions include data reporting and publication requirements, denial audits for clinical appropriateness, and the inclusion of denial data on the quality rating system website. The Commission also intends to comment publicly on the recently proposed minimum staffing standard for long-term care facilities.

The slides from the presentation are available here.

New York State Updates

NYS DOB Approves Rate Increase for NYS OASAS Certified Treatment Providers
On September 15th, the New York State (NYS) Office of Addiction Services and Supports (OASAS) issued a notice to Mainstream Medicaid Managed Care Plans (MMCPs), HIV Special Needs Plans (HIV SNPs), Health and Recovery Plans (HARPs), and Medicaid Advantage Plus (MAP) Plans regarding a rate increase for OASAS services. Effective January 1, 2023, the NYS Division of the Budget (DOB) approved new levels of reimbursement for the following OASAS programs:   

  • Part 822 Outpatient Addiction Services (both freestanding and hospital) – including clinic, outpatient rehabilitation, and Opioid Treatment Programs (OTPs);
  • Part 820 Residential Services (stabilization, rehabilitation, and reintegration);
  • Part 818 Freestanding Inpatient Rehabilitation;
  • Part 816 Freestanding Inpatient Withdrawal and Stabilization; and
  • Part 817 Residential Rehabilitation Services for Youth (RRSY).

Plans have 90 days from receipt of the notification to update their systems with the rate changes.

The notice, which includes rate increase details for each program, is available here. Questions may be submitted to PICM@oasas.ny.gov.

DOH Issues Guidance to Hospitals Regarding PPE Stockpile Requirements
On September 25th, the NYS Department of Health (DOH) sent a letter to hospital administrators and staff regarding personal protective equipment (PPE) stockpile requirements. DOH notes that emergency regulations outlining current requirements, which were implemented as a result of the Covid-19 pandemic, were scheduled to expire on September 26, 2023. However, DOH intends to permanently adopt the emergency regulations and therefore advises hospitals to continue to rely on the required minimum two-month supply of PPE. The emergency regulations outline the following calculations: 

  • For single gloves, 15 percent, multiplied by the number of the hospital’s staffed beds, multiplied by 550;
  • For gowns, 15 percent, multiplied by the number of the hospital’s staffed beds, multiplied by 41;
  • For surgical masks, 15 percent, multiplied by the number of the hospital’s staffed beds, multiplied by 21; and
  • For N95 respirator masks, 15 percent, multiplied by the number of the hospital’s staffed beds, multiplied by 9.6.

The letter is available here. Questions may be submitted to hospinfo@health.ny.gov.

DOH Publishes Semi-Annual Report on Enhanced HCBS Spending Plan
This week, DOH published its Federal Fiscal Year (FFY) 2024 Quarter 1 update for spending proposals to enhance Home and Community Based Services (HCBS) using enhanced Federal Medical Assistance Percentage (eFMAP) funds available under Section 9817 of the American Rescue Plan Act. On April 6, 2023, the State received approval from CMS for all proposals submitted in the original spending plan and previous quarterly reports. The report includes updates on current implementation efforts for each proposal and includes details on the following two new proposals: 

  • Enhance Community Access to Existing Personalized Recovery Oriented Services (PROS)
  • Invest in Certified Community Behavioral Health Clinics (CCBHCs)

To date, the State has begun spending on 24 of the 41 proposals (59 percent). Funds must be expended before March 31, 2025. The State projects that it will be eligible for over $2.6 billion in state funds equivalent (SFE) during the first quarter of FFY 2024.

The narrative report is available here. The spending plan is available here.

SED Issues Revised Amendment on Proposed Regulations for ABA Providers
On September 27th, the NYS Education Department (SED) issued a continuation of an emergency rule and a revised amendment to proposed regulations regarding licensure and certification requirements for behavioral analysts. As noted in previous SPG updates (hereand here), the State has issued emergency/proposed regulations to more closely align NYS education standards with evolving national certification requirements for Licensed Behavior Analysts (LBAs) and Certified Behavior Analyst Assistants (CBAAs). In response to public comment on the proposed regulations, the State made several modifications to better align with national standards, including changes to supervision requirements and the elimination of the internship requirement.

The notice of emergency rule and revised rulemaking is available in the State Register here. It is anticipated that the proposed rule will be presented to the Board of Regents for adoption as a permanent rule at the December 2023 meeting.

DOH Issues Public Notices Announcing Implementation of Budget Initiatives 
On September 27th, DOH published several public notices announcing the implementation of the following initiatives, effective on or after October 1, 2023: 

  • DOH will amend the State Plan for rehabilitation services provided by Assertive Community Treatment (ACT) teams to include rates for larger ACT teams and to implement youth ACT team rate increases.
  • The NYS Medicaid program will begin covering the Chronic Disease Self-Management Program (CDSMP) for arthritis.
  • No greater than zero trend factors will be applied to rates of payment for inpatient and adult day health care outpatient services provided by Article 28 residential health care facilities (except for residential health care or children’s units).
  • DOH will make necessary updates to the Intermediate Care Facility (ICF/IDD) rate methodology, including but not limited to amending the language pertaining to rebasing, budget neutrality, trends, and other changes to align to recent updates within the OPWDD Comprehensive Waiver Amendment.
  • DOH will adjust Medicaid rates by 1.86 percent statewide for Mental Health Outpatient Treatment and Rehabilitative Services (MHOTRS) providers who participate in the OMH Quality Improvement Initiative.
  • DOH will adjust rates statewide to reflect the impact of NYS minimum wage increases for MHOTRS, Day Treatment for Children, Continuing Day Treatment, PROS, and Comprehensive Psychiatric Emergency Program (CPEP) services.
  • DOH will make updates to the OPWDD Specialty Hospital rate methodology to facilitate expansion of the voluntary service provide network and to more accurately reflect provider costs.
  • DOH will amend the State Plan to amend PROS provider qualifications and service definitions and add new services, and will also amend the reimbursement methodology.
  • DOH will update rates paid to Article 28 clinics and private practitioners that have been designated by OMH to provide collaborative care services.

DOH also issued a notice indicating that the $1.00 increase in minimum wage for a home care aide will be delayed from October 1, 2023 to January 1, 2024.

The public notices are available in the State Register here. Comments may be submitted to spa_inquiries@health.ny.gov.

CMS Approves New York SPA Extending PDN Services for Young Adults and Medicaid Reimbursement for Covid-19 Tests
On September 27th, CMS approved New York’s State Plan Amendment (SPA) that temporarily extends Private Duty Nursing (PDN) provided to fee-for-service individuals who have aged out of the medically fragile children’s reimbursement program. The amendment also temporarily extends Medicaid reimbursement for Covid-19 tests; however, reimbursement will be reduced from 100 percent to 60 percent of the Medicare fee. The changes are effective retroactive to May 12, 2023.

The CMS approval letter is available here. The SPA is available here.

Funding Opportunities

OMH Releases RFP for the Development and Operation of Young Adult Enhanced Housing Programs
On September 26th, the NYS Office of Mental Health (OMH) released a Request for Proposals (RFP) for the development and operation of seven Enhanced Young Adult Housing programs located throughout New York State for young adults with a serious mental illness (SMI). Each opportunity consists of apartment treatment units (5-10 units, depending on county) and 20 scattered-site supportive housing units. The target population is young adults between the ages of 18 and 25 with SMI who are homeless, coming from an institutional setting or community residence, or leaving foster care. Awarded agencies will be expected to provide enhanced case management, skill-building, vocational/educational support, and peer services. There will be one award in each of the following counties: 

  • Bronx
  • Nassau/Suffolk
  • Albany/Rensselaer/Schenectady
  • Sullivan/Orange
  • Onondaga
  • Erie
  • Monroe

Eligible applicants are not-for-profit 501(c)(3) agencies with experience operating housing and/or services for the young adult population. Agencies may submit multiple applications; however, a separate application is required for each program to which the agency is applying. Contracts will last for five years beginning on March 1, 2024. Ongoing funding to support the operation of the apartment treatment units will be provided by a combination of SSI and Medicaid funding. Program Development Grant (PDG) funds of $9,140 per bed are also available to assist with establishing the apartment treatment units. Funding for scattered-site supportive housing is a combination of client rent payments (30 percent of net income) and OMH funds ($20,000-$33,500 per unit).

The RFP is available here. Applications are due on November 16th. Questions may be submitted to OMHLocalProcurement@omh.ny.gov with “Enhanced SSSH for Young Adults” in the subject line through October 17th.

NYS Issues RFP for Purchase and Redevelopment of Former Bayview Correctional Facility into Affordable Housing
On September 26th, New York State Empire State Development (ESD) released an RFP for the purchase and redevelopment of the former Bayview Correctional Facility (550 West 20thStreet, NY, NY) into affordable and supportive housing. The redevelopment must include at least 60 supportive housing units, 5,000-6,000 square feet of white box space for 15 units of short-term transitional residence, and preservation and adaptive reuse (to the extent feasible) of the historic building and features. The site must have at least 51 percent not-for-profit ownership. ESD, NYS Homes and Community Renewal (HCR), and OMH will collaborate to provide capital and operating funding for the housing programs.

The RFP is available here. The Governor’s press release is available here. Applications are due December 13th. Questions may be submitted to 2023Bayview@esd.ny.gov through October 20th. There will be an optional site visit on October 18th. Applicants who wish to attend must RSVP to the email address above on or before October 10th.