Weekly Health Care Policy Update – November 6, 2023

In this update: 

• Administration Updates
  • Biden Administration Issues Executive Order on Use of AI
• Legislative Updates
  • Senate Finance Committee to Hold Markup on Bipartisan Health Care Legislation on Wednesday
• Federal Agencies
  • CMS Finalizes CY 2024 Medicare Physician Fee Schedule Rule
  • CMS Finalizes CY 2024 Hospital OPPS and ASC Rule
  • HHS Issues New Proposed Rule on No Surprises Act IDR Process
  • HHS Publishes Proposed Rule on Information Blocking Penalties for Providers
  • AHRQ Requests Feedback on Preventive Services for People with Disabilities
  • CMS Announces Extension of Medicare Diabetes Prevention Program Enhancements
  • CMS Issues CY 2024 Home Health Final Rule
  • CMS Issues CY 2024 ESRD Final Rule
  • CMS Issues Notice on Payers Failing to Make Risk Adjustment Payments
  • CDC Launches Anti-Burnout Campaign
• Other Updates
  • AHA Sues HHS over Web Tracking Services Rule
• New York State Updates
  • Governor Hochul Launches NYS Commission on the Future of Health Care
  • DFS Adopts Regulations on Licensure Process for Pharmacy Benefit Managers
  • Governor Hochul Announces Initial Allocation of State Opioid Settlement Funds
  • DOH Issues Clarifying Guidance Regarding CDPAS Personal Assistants and Designated Representatives
  • DOH Releases Draft Amendments to TBI and NHTD Waivers
  • OMH Releases Additional Resources Regarding Billing Location Changes for Children’s Services
  • SED Issues Emergency/Proposed Rule on Requirements for Clinical Education and Simulation Experience in Nursing Education Programs
  • DOH Issues Emergency/Proposed Rule to Improve Access to Immunizations Against RSV

Administration Update

Biden Administration Issues Executive Order on Use of AI
On October 30^th, President Biden issued an Executive Order (EO) to establish new guardrails for the use and development of artificial intelligence (AI) technology, including in health care. The EO includes definitions of a wide range of AI-related terms and directs a range of federal agencies to develop implementation plans and regulations on the use of AI technology by public and private sector entities.

In health care, the EO directs the Department of Health and Human Services (HHS) to “advance responsible AI innovation” by: 

• Establishing an HHS AI Task Force to develop a strategic plan on the responsible use of AI in health care;
• Establish a program to manage reports of unsafe health care practices using AI;
• Collaborating with private-sector actors on developing certain types of AI-enabled tools; and
• Prioritizing certain awards to initiatives exploring ways to improve data quality to support responsible AI usage.

A fact sheet on the EO is available here.

Legislative Update

Senate Finance Committee to Hold Markup on Bipartisan Health Care Legislation on Wednesday
On November 8^th, the Senate Finance Committee will hold a markup hearing on a bipartisan health care package on behavioral health care and other Medicare and Medicaid policies. This package, which includes policies the Committee has working on since 2022, is likely to be part of the Senate’s negotiations around an end-of-year omnibus spending bill this year.

Notable provisions in the proposed legislation include: 

• Expansion of the range of behavioral health providers participating in Medicare, including the use of licensed clinical social workers (LCSWs);
• Funding primary care physicians to deliver integrated physical and behavioral health care;
• Requiring Medicare Advantage (MA) plans to have up-to-date provider directories;
• Improving behavioral health care in Medicaid, especially for youth;
• Reducing copays for Medicare beneficiaries for certain drugs; and
• Extending certain Medicare and Medicaid payment policies, including: 
  • Further delay of Medicaid disproportionate share hospital (DSH) cuts to fiscal year (FY) 2028; and
  • Extending a lower Medicare Advanced Alternative Payment Model (A-APM) bonus for the 2026 payment year. The A-APM bonus is currently set at 5% up to 2024 and 3.5% in 2025. The legislation would extend the bonus to 1.75% in 2026.

Please reach out to SPG for more details if desired.

Federal Agencies

CMS Finalizes CY 2024 Medicare Physician Fee Schedule Rule
On November 2^nd, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that announced finalized policy changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues for calendar year (CY) 2024. 

Key policies in the final rule include: 

• Rate Setting and Conversion Factor: CMS finalized the CY 2024 PFS conversion factor at $32.74, representing a decrease of $1.15 from the CY 2023 PFS conversion factor of $33.89. As directed by legislation, payment rates under the PFS will be reduced by 1.25% in CY 2024 compared to CY 2023. CMS’s overall changes to the PFS valuations will result in “significant increases in payment for primary care and other kinds of direct patient care.”
• Services Addressing Health-Related Social Needs (HRSNs): CMS is finalizing coding and payment changes to better account for resources involved in supporting patients’ HRSNs. Specifically, CMS is establishing: 
  • Payment for Community Health Integration, Social Determinants of Health (SDOH) Risk Assessment, and Principal Illness Navigation services; and
  • An additional set of Principal Illness Navigation Codes to support individuals with behavioral health conditions.
• Evaluation and Management (E/M) Visits: CMS is finalizing implementation of a separate add-on payment to better recognize the costs associated with evaluation and management visits for primary care and longitudinal care. CMS is also developing revisions to the definition of “substantive portion” of a split/shared visit.
• Telehealth Services: CMS is finalizing its proposal to add health and well-being coaching services to the Medicare Telehealth Services List on a temporary basis and SDOH Risk Assessments on a permanent basis for CY 2024. CMS is also finalizing flexibilities for teaching physicians’ usage of telehealth services. Finally, CMS is implementing several telehealth-related provisions of the 2022 year-end omnibus spending bill (the Consolidated Appropriations Act, 2023), including: 
  • Temporary expansion of the scope of telehealth originating sites for services furnished via telehealth to include any site in the United States where the patient is located, including a home (paid at the non-facility PFS rate);
  • Expanding scope of telehealth practitioners to include qualified occupational therapists, qualified physical therapists, qualified speech-language pathologists, and qualified audiologists;
  • Continued payment for telehealth services facilitated by Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs);
  • Maintaining flexibilities surrounding in-person visits for mental health telehealth services;
  • Continued coverage and payment of telehealth services included on the Medicare Telehealth Services List through CY 2024.
• Part B Payment for Preventive Vaccines: CMS is finalizing its proposal for an additional payment for in-home administration of the Covid-19, pneumococcal, influenza, and hepatitis B vaccines. All four vaccines will incur equal payment.
• Behavioral Health Services: CMS is implementing Medicare Part B coverage and payment for the services of marriage and family therapists and mental health counselors (MHCs). CMS is also finalizing a proposal to allow addiction counselors to enroll in Medicare as MHCs. and for Health Behavior Assessment and Intervention (HBAI) services to be billed by clinical social workers, MFTs, and MHCs. In addition, CMS is finalizing an increase in the valuation for timed behavioral health services under the PFS.
• Opioid Treatment Programs (OTPs): CMS is finalizing its proposal to extend current flexibilities for audio-only periodic assessments through CY 2024.

The announcement is available here.

CMS Finalizes CY 2024 Hospital OPPS and ASC Rule
On November 2^nd, CMS issued the 2024 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) Payment System Final Rules. Overall, CMS is updating OPPS and ASC payment rates for hospitals by 3.1%. This update reflects a projected hospital market basket percentage increase of 3.3%, reduced by 0.2 percentage point for the productivity adjustment.

Additional key policies in the final rule include: 

• Intensive Outpatient Program (IOP): In CY 2024, CMS will close a coverage gap for behavioral health between traditional inpatient and outpatient services by establishing payment for IOP services under Medicare. This final rule includes the scope of benefits, physician certification requirements, coding and billing, and payment rates under the IOP benefit. These services may take place in hospital outpatient departments, Community Mental Health Centers (CMHCs), Federally Qualified Health Centers (FQHCs), and Rural Health Clinics (RHCs).
• Partial Hospitalization Program: Per diem rates for an allotment of services and weekly hours were updated for CY 2024.
• Community Mental Health Centers: CMS is finalizing its proposal to modify CMHC Conditions of Participation (COPs) with more detailed personnel qualifications.
• OPPS Payment for Remote Mental Health Services: CMS is finalizing technical changes regarding how services are furnished, including a new untimed code for group psychotherapy.
• Dental Services: CMS is finalizing Medicare payment rates under the OPPS for over 240 dental codes to align with a recent rule by assigning them to clinical Ambulatory Payment Classifications (APCs). For dental services under anesthesia in the ASC setting, CMS is also adding 26 separately payable dental surgeries to the ASC Covered Procedures List.
• Hospital Price Transparency: CMS is finalizing modifications to the standard change display requirements and finalizing updates to enforcement provisions to streamline and improve the transparency of the enforcement process. The fact sheet is available here.
• 340B: CMS is finalizing a proposal without modification to continue to pay for 340B acquired drugs and biologicals at the statutory default rate, which is generally ASP plus 6%.
• Hospital Outpatient/ASC/REH Quality Reporting Programs: CMS is finalizing several changes, including: 
  • Modifications to three measures for both the OPPS and ASC quality programs (COVID-19 Vaccination Coverage Among HCP, a measure for cataract surgery efficacy, and a measure for colonoscopy follow-up timeliness);
  • A new measure for total knee or hip surgeries; and
  • For Rural Emergency Hospitals (REHs), the adoption of a standard quality reporting program with an initial four measures concerning abdominal CT scans, median time from emergency department arrival to departure, outpatient colonoscopy follow-ups, and hospital visits within seven days of outpatient surgery.

The announcement is available here.

HHS Issues New Proposed Rule on No Surprises Act IDR Process
On October 27^th, HHS released a proposed rule to improve the No Surprises Act (NSA) Federal Independent Dispute Resolution process (IDR). The Federal IDR is a mechanism through which providers, facilities, and health plans can resolve payment disputes over certain out-of-network charges. Providers have repeatedly sued HHS over the implementation of the IDR, resulting in several pauses and restarts. Currently, the IDR Portal is open for “certain new single and bundled disputes,” but remains on pause for batched disputes and air ambulance disputes.  

The proposed rule seeks to establish some new procedures to help address the greater-than-expected volume of initiated disputes. Specifically, the rule proposes to address specific communication issues that result from a “lack of clarity as to whether items and services are qualified” for the IDR and to encourage parties to engage during the open negotiation period and reach a settlement before opening a dispute. The rule does not address the dispute resolution criteria, which have proven particularly controversial.

Policies in this proposed rule include: 

• Communication between Payers and Providers: This rule proposes that payers be required to provide additional information at the time of initial payment with standardized codes to communicate whether an out-of-network item or service is subject to NSA provisions and the Federal IDR.
• Open Negotiation and IDR Initiation: Prior to an IDR, a party choosing to initiate an open negotiation must submit a notice through the Federal IDR portal. The proposed rule also outlines new content elements that would be required in an open negotiation notice such as plan type, location of service, and claim number. If an IDR is the preferred course of action, this rule would amend the requirements for the content of the IDR initiation notice.
• IDR Eligibility and Administrative Fee: This rule would establish a departmental eligibility review process in the instance of a high dispute volume. To initiate the IDR process, both parties must pay a non-refundable fee, which this rule includes more guidance for.
• Batching: This rule includes new batching provisions to allow qualified IDR items and services to be batched (included in a single dispute) to create flexibility for certain circumstances. In particular, disputes may batch together up to 25 items that are: 
  • Items and services furnished to a single patient in a single encounter, billed on the same claim form;
  • Items and services billed under the same service code or a comparable code under a different coding system; and
  • Anesthesiology, radiology, pathology, and laboratory items billed under codes belonging to the same Category I CPT code section.

The proposed rule is available here. Comments may be submitted through January 2, 2024.

HHS Publishes Proposed Rule on Information Blocking Penalties for Providers
On October 30^th, HHS issued a proposed rule to establish disincentives for health care providers found to have committed information blocking. Information blocking occurs when a provider knowingly and unreasonably interferes with the access, exchange, or use of electronic health information except as required by law or covered by a regulatory exception.

The proposed rule would create the following disincentives that may be applied to entities found to have committed information blocking: 

•  Medicare Promoting Interoperability Program: Eligible hospitals or critical access hospitals will be found not to qualify as a meaningful electronic health record (EHR) user for the relevant reporting period. The consequence is the loss of 75 percent of the annual market basket increase for hospitals (typically several percent of Medicare reimbursement) and reducing payment for CAHs to 100 percent of reasonable costs (from 101 percent).
• Merit-based Incentive Payment System (MIPS): MIPS clinicians or groups would not be found to be meaningful users of certified EHR, and would therefore receive a zero score for Promoting Interoperability. This category may typically represent up to 25% of the provider’s MIPS score overall in a year.
• Medicare Shared Savings Program (MSSP): A provider found to have engaged in information blocking will be deemed ineligible for participate in an MSSP Accountable Care Organization (ACO) for at least one year.

This rule complements the authority of the HHS Office of Inspector General (OIG), which recently finalized a rule on civil monetary penalties (CMPs) for other types of entities (health IT developers and information exchanges or networks) found to have committed impermissible information blocking.

The proposed rule is available here. HHS is accepting comments through January 2, 2024.

AHRQ Requests Feedback on Preventive Services for People with Disabilities
On November 1^st, the Agency for Health Research and Quality (AHRQ) published in the Federal Register a request for supplemental evidence and data submission related to its Healthcare Delivery of Clinical Preventive Services for People with Disabilities program. This program, part of the Evidence-based Practice Centers (EPC) initiative, seeks to review evidence and studies regarding the effectiveness of various interventions to improve the receipt of clinical preventive services for people with disabilities, and how this varies based on geography, race, disability, and other factors.

The full request is available here. Responses should be submitted by December 1^st.

CMS Announces Extension of Medicare Diabetes Prevention Program Enhancements
On November 1^st, CMS announced that it will extend the Medicare Diabetes Prevention Program’s (MDPP) Expanded Model’s Public Health Emergency (PHE) Flexibilities for four years. Without this flexibility, MDPP suppliers would be required to resume in-person delivery of services beginning in 2024. These PHE flexibilities include the virtual collection of weight measurements, distance learning G-code for MDPP services, and the ability to bill for each session attended.

The rule is available here.

CMS Issues CY 2024 Home Health Final Rule  
On November 1^st, CMS issued the CY 2024 Home Health Prospective Payment System (HH PPS) Rate Update final rule. Overall, the rule increases payments to home health agencies in CY 2024 by 0.8%, or a total of $140 million, compared to CY 2023. The 0.8% increase is the result of a 3% home health payment increase, a roughly 2.6% decrease due to the PPS behavioral assumption adjustment, and a 0.4% increase based on an adjustment to the fixed-dollar loss ratio used by CMS to identify outlier payments.

Additional policies in the final rule include: 

• Patient Driven Groupings Model (PDGM) and 30-Day Unit of Payment: CMS is finalizing a permanent prospective payment adjustment to the CY 2024 home health 30-day period payment rate to account for increases or decreases in aggregate expenditures derived from differences between assumed behavior changes and actual behavior changes.
• Rebasing and Revising the Home Health Market Basket: For CY 2024, CMS will adopt a 2021-based home health market basket, which includes proposed changes to the market basket weights and price proxies.
• Updating the Labor-Related Share (LRS): For CY 2024, the LRS is 74.9%.
• Disposable Negative Pressure Wound Therapy: For CY 2024, there will be a separate payment for a disposable device for patients under a home health plan of care.
• PDGM Case-Mix Weights: CMS is finalizing its proposal to recalibrate the case-mix weights and low utilization payment adjustment (LUPA) thresholds using CY 2022 data.

The final rule is available here.

CMS Issues CY 2024 ESRD Final Rule 
On October 27^th, CMS issued a final rule that updates payment rates and policies under the end-stage renal disease (ESRD) PPS for renal dialysis in CY 2024. Overall, CMS is increasing the base rate to $271.02, $5.45 over the previous base rate. The base rate reflects a productivity-adjusted market basket increase of 2.1% and application of the wage index budget-neutrality adjustment factor (1.000031).

CMS also made changes to the ESRD Quality Incentive Program (QIP). Key changes include: 

• CMS is finalizing its proposal to add the Facility Commitment to Health Equity reporting measure to the ESRD QIP measure set beginning in payment year (PY) 2026.
• CMS is finalizing its proposal to update the COVID-19 Vaccination Coverage Rate Among Healthcare Personnel reporting measure beginning in PY 2026 to align with CDC.
• CMS is finalizing its proposal to convert the Clinical Depression Screening and Follow-Up reporting measure to a clinical measure beginning in PY 2026.
• CMS is finalizing its proposal to remove the Ultrafiltration Rate reporting measure from the ESRD QIP measure set beginning in PY 2026.
• CMS is finalizing its proposal to remove the Standardized Fistula Rate clinical measure from the ESRD QIP measure set beginning in PY 2026.
• For PY 2027, CMS is finalizing its proposal to add the Screening for Social Drivers of Health reporting measure from the ESRD QIP measure set.
• For PY 2027, CMS is finalizing its proposal to add the Screen Positive Rate for Social Drivers of Health reporting measure from the ESRD QIP measure set.

Additional policies in the final rule include: 

• Increased Payment for Certain Drugs: This rule includes a payment adjustment that will increase payment for certain new renal dialysis drugs and biological products after the Transitional Drug Add-on Payment Adjustment (TDAPA) period ends.
• Reporting on ESRD PPS Claims: This rule includes new requirements for the reporting on ESRD PPS claims beginning in CY 2025, including on “time on machine” data and volumes of certain discarded renal dialysis drugs and biological products from single-use packaging.
• Pediatric ESRD: This rule finalizes a new transitional add-on pediatric ESRD dialysis payment adjustment for CYs 2024-2026.
• Disasters and Emergencies: This rule finalizes certain exceptions to the low-volume payment adjustment (LVPA) attestation process for ESRD facilities affected by disasters.
• Outlier Payments: CMS is updating the outlier services threshold values for adult and pediatric patients to better align outlier payments at 1% of total payments in CY 2024.
• Acute Kidney Injury (AKI): CMS updated AKI dialysis rate to equal the ESRD PPS base rate of $271.02.

The final rule is available here.

CMS Issues Notice on Payers Failing to Make Risk Adjustment Payments
On October 27^th, CMS announced that two payers, Bright Health Group and Friday Health Plans, were unable to pay their dues into the 2022 ACA risk adjustment pool. While Bright Health has entered into repayment agreements with CMS and is expected to continue making such payments, Friday Health Plans has entered liquidation and is unlikely to reimburse the full amount owed ($780 million, of which just 5% has been paid to CMS so far). Bright Health has exited the ACA exchanges and did not participate in the program in 2023.

The notice is available here.

CDC Launches Anti-Burnout Campaign 
On November 1^st, the Centers for Disease Control and Prevention’s (CDC) National Institute for Occupational Safety and Health (NIOSH) launched Impact Wellbeing, the first federal campaign for hospitals to address health care workforce burnout. This campaign aims to provide hospital administration with evidence-informed resources and actionable steps to improve workplace policies to reduce burnout and bolster workforce mental health.

The announcement is available here.

Other Updates

AHA Sues HHS over Web Tracking Services Rule
On November 2^nd, the American Hospital Association (AHA) sued HHS to bar the enforcement of a December 2022 rule on the application of privacy rules to their public-facing web sites. According to AHA, this rule restricts hospitals from using standard third-party web technologies, like Meta, Pixel, and Google Analytics, that capture IP addresses on portions of hospitals’ web sites that address health conditions or health care providers. Media and researcher investigations have found these technologies on nearly all hospital websites, making them a focus of class-action lawsuits.
 
The announcement is available here.

New York State Updates

Governor Hochul Launches NYS Commission on the Future of Health Care 
On November 2^nd, Governor Hochul announced the establishment and launch of the New York State Commission on the Future of Health Care. The Commission, which the Governor first committed to in her 2023 State of the State address, will “provide ongoing strategic recommendations to transform the health care system in New York State, with a goal of ensuring that the limited resources of the State and other health care payers are optimized to enable the delivery of accessible, equitable, high-quality care for all New Yorkers.”

The Commission is comprised of 13 health care experts and chaired by Sherry Glied, the Dean of the NYU Wagner Graduate School of Public Service and former HHS Assistant Secretary for Planning and Evaluation. It will provide annual recommendations to the Governor, the first of which will be due by the end of 2024 and will be released publicly. Recommendations will focus on policy, regulation, funding, and other strategies for long-term health system transformation. The Commission will meet every other month and summaries of the meetings will be publicly available. There will also be opportunities for public input from interested stakeholders.

The Governor’s press release is available here.

DFS Adopts Regulations on Licensure Process for Pharmacy Benefit Managers
On October 31^st, the NYS Department of Financial Services (DFS) announced the adoption of new regulations outlining the process for Pharmacy Benefit Managers (PBMs) to obtain a license to operate in New York. Specifically, the adopted rules outline: 

• Filings and application fees for PBMs to be issued a license;
• Requirements for licensed and registered PBMs to pay assessments to DFS for its operating expenses;
• Establishment of special assessments for specific investigations of individual PBMs;
• Penalties imposed on PBMs that fail to submit their reported number of claims by January 15^th annually;
• Requirements that PBMs comply with cybersecurity regulations; and
• Reporting and record-keeping requirements.

The DFS press release is available here. The adopted regulations are available here and will be effective on November 15^th.

Governor Hochul Announces Initial Allocation of State Opioid Settlement Funds 
On October 30^th, Governor Hochul announced that the first year of funding available through the opioid settlement agreements, approximately $192.8 million, has been allocated to support a variety of initiatives that address substance use. The State will be receiving over $2 billion through multiple settlement agreements with opioid manufacturers and pharmaceutical companies, a portion of which has been dedicated to support prevention, treatment, harm reduction, and recovery efforts to address the ongoing opioid epidemic.

The initial funding has been made available to support initiatives including scholarship programs for individuals in the addiction services workforce, funding for Recovery Centers and Transitional Safety Units, the establishment of Comprehensive Integrated Outpatient Treatment Programs, and funding to support outreach and engagement efforts, among others. The largest amount of funding (over $64 million) was provided as regional abatements for local governments, which may be spent by municipalities after they submit spending plans to the Office of Addiction Services and Supports (OASAS). Additional information on all initiatives funded, as well as the status of settlement funding, is available via the Opioid Settlement Fund Tracker here.

The Governor’s press release is available here.

DOH Issues Clarifying Guidance Regarding CDPAS Personal Assistants and Designated Representatives 
On October 30^th, the New York State (NYS) Department of Health (DOH) issued guidance to Medicaid Managed Long Term Care (MLTC) plans on: 

• The ability of a legal guardian to serve as a consumer directed personal assistant for Consumer Directed Personal Assistance Services (CDPAS); and
• Who may be assigned the role of the designated representative.

The guidance clarifies that: 

• The CDPAS personal assistant cannot also be the designated representative or someone who is legally responsible for the member’s care and support;
• A parent guardian or legal guardian of an adult (age 21+) may serve as the CDPAS personal assistant provided they are not also the member’s designated representative;
• When verifying if a legal guardian may provide CDPAS, the Local Department of Social Services (LDSS) must ensure that the legal guardian is not the member’s primary point of contact or otherwise oversees any decisions related to the member’s care under CDPAS, as these are the responsibilities of the designated representative;
• The designated representative may not be the CDPAS personal assistant or a fiscal intermediary employee, representative, or affiliated person; and
• When authorizing a designated representative, the managed care plan must approve a person who can make themselves available and present for any scheduled assessment or visit by the independent assessor, examining medical professional, or managed care plan staff and must ensure that the applicable CDPAS responsibilities are carried out without delay.

The guidance is available here. Questions may be submitted to consumerdirected@health.ny.gov.

DOH Releases Draft Amendments to TBI and NHTD Waivers
On October 30^th, DOH released draft amendments to the Traumatic Brain Injury (TBI) and Nursing Home Transition and Diversion (NHTD) waivers. The TBI waiver provides community-based alternatives to individuals with TBI who are eligible for nursing home level of care but who would like to either avoid or transition from nursing home placement. The NHTD waiver provides community-based long-term care services to seniors and individuals with physical disabilities as an alternative to institutional care.

The amendments include the following changes: 

• Provide updated rate methodology and rates for all services in the waiver;
• Increase rates for Home and Community Support Services (HCSS) pursuant to the home care worker minimum wage provisions included in the enacted New York State Budget;
• Allow for virtual or remote supervisory visits for services, including Service Coordination, Independent Living Skills Training (ILST), and Positive Behavioral Interventions and Supports (PBIS);
• Clarify that the process for conducting the approved Uniform Assessment System (UAS) Level of Care (LOC) assessment;
• Address issues related to Conflict of Interest (COI); and
• Provide further guidance regarding face-to-face visits for Service Coordination.

The draft TBI waiver amendment is available here and the draft NHTD waiver amendment is available here. The proposed effective date for both amendments is March 1, 2024. Public comment may be submitted to waviertransition@health.ny.gov through December 1^st.

OMH Releases Additional Resources Regarding Billing Location Changes for Children’s Services
Effective December 1^st, Children’s Home and Community-Based Services (HCBS), Article 29-I Other Limited Health-Related Services (OHLRS), and Children and Family Treatment and Support Services (CFTSS) claims will be paid based on the county in which services were provided, rather than a provider’s corporate headquarters or central office address. This change is necessary to align with CMS billing requirements, which dictate that services must be reimbursed based on the location of service delivery.

The State has assigned a Federal Information Processing Standards (FIPS) code and proxy locator code to each county in NYS. The applicable FIPS (if submitting electronically) or proxy locator (if submitting on paper) county code, indicating service location, must be included on all Children’s HCBS, CFTSS, and OHLRS claims for dates of service on or after December 1^st. The update does not apply to Article 29-I Medicaid Residual Per Diem (CORE) service claims.

The guidance is available here. An FAQ document is available here and a webinar is available here. Questions may be submitted to BH.Transition@health.ny.gov.  

SED Issues Emergency/Proposed Rule on Requirements for Clinical Education and Simulation Experience in Nursing Education Programs
On November 1^st, the NYS Education Department (SED) issued an emergency/proposed rule that requires nursing education programs to include clinical education/training, as defined in the regulations, in order to ensure that all graduates have common clinical learning experiences and meet comparable standards. The regulations also indicate that one-third of such clinical education may be completed through simulation experience. All new programs registered after November 11, 2023 must meet the requirements for clinical education as a condition of registration. Existing programs have until November 11, 2024 to conform their existing clinical education to these requirements.

The emergency/proposed rule is available in the State Register here. Public comments may be submitted to regcomments@nysed.gov through December 31^st. SED intends to permanently adopt the regulations following the public comment period.

DOH Issues Emergency/Proposed Rule to Improve Access to Immunizations Against RSV
On November 1^st, SED issued an emergency/proposed rule that adds Respiratory Syncytial Virus (RSV) vaccines to the list of immunizations that may be administered by a registered professional nurse pursuant to a non-patient specific order issued by a licensed physician or a certified nurse practitioner.

The emergency/proposed rule is available in the State Register here. Public comments may be submitted to regcomments@nysed.gov through December 31^st. SED intends to permanently adopt the regulations following the public comment period.