In this update:
- Administration Updates
- White Houses Announces Regional Tech Hubs
- Legislative Updates
- House Members Send Bipartisan Letter to HHS on Nursing Home Staffing Rule
- Senate HELP Committee Advances Bertagnolli Nomination
- House Members Send Bipartisan Letter to CMMI on Improving Mental Health Care
- Federal Agencies
- CMMI Releases Making Care Primary Resources
- CMS Releases ACO REACH/GPDC Performance Report, Showing Large Savings
- CDC Report on Poor Mental Health and Working Conditions Among Providers
- HRSA Publishes 340B Registration Requirements for Off-site Outpatient Hospital Facilities
- Other Updates
- National Advocacy Group for Independent Physicians Launches
- Commonwealth Fund Issues Report on Health Care Affordability
- New York State Updates
- NYS Issues Guidance on Medicaid Coverage of CHW Services for Pregnant and Postpartum People
- DOH Issues Guidance Regarding Enhanced EBP Rates for CFTSS Providers
- NYS Issues Coverage Updates for Infant RSV Antibody and OTC Naloxone
- OMH and DOH Release Evaluation and Discharge Guidance for Inpatient Programs, EDs, and CPEPs
- DOH Adopts Rule to Maintain MCO Contingent Reserve Requirement at 7.25%
- DOH Notifies Hospitals Regarding Revised 2023 Clinical Staffing Plan Submissions
Administration Update
White Houses Announces Regional Tech Hubs
On October 23rd, the Biden Administration announced the designation of 31 communities across the country as Regional Tech Hubs. The Hubs are being designated as centers of innovation across a number of industries, including biotechnology and precision medicine. Hubs can apply directly for implementation funding, will be given preference for other economic development programs, and be eligible for technical assistance. The Tech Hubs program is operated through the Department of Commerce and was authorized by the CHIPS and Science Act.
Hubs in New York include the New Energy New York (NENY) Battery Tech Hub and the NY SMART I-Corridor Tech Hub. The announcement is available here.
Legislative Updates
House Members Send Bipartisan Letter to HHS on Nursing Home Staffing Rule
On October 20th, over 90 Representatives from both parties sent a letter to HHS Secretary Xavier Becerra expressing concerns over the recent proposed rule on staffing requirements. The rule, issued on September 1st, would establish minimum staffing requirements and new standards for nursing homes. The Representatives posit that this new regulation will limit access to care for seniors, create more Medicaid spending, and lead to the closure of nursing homes not in compliance.
The letter is available here.
Senate HELP Committee Advances Bertagnolli Nomination
On October 25th, the Senate Health, Education, Labor and Pensions Committee (HELP) advanced President Biden’s nominee to head the National Institutes of Health (NIH), Dr. Monica Bertagnolli, by a vote of 16-5. After prior refusal to schedule her confirmation hearing, Chair Sanders (I-VT) voted with a handful of Republican Senators against her nomination on the grounds of drug pricing. Other controversies surrounded this nomination, though, including concerns over the NIH’s funding of gender affirming care research and the origins of Covid-19.
House Members Send Bipartisan Letter to CMMI on Improving Mental Health Care
On October 24th, a bipartisan group of 10 Representatives sent a letter to CMMI Administrator Liz Fowler urging her to implement a model to provide incentive payments for behavioral health providers to adopt electronic health records (EHRs). The Representatives write that the push to integrate EHRs over the past decade has largely ignored behavioral health providers.
The letter is available here.
Federal Agencies
CMMI Releases Making Care Primary Resources
On October 27th, the Center for Medicare and Medicaid Innovation (CMMI) released a step-by-step application user manual for the Making Care Primary (MCP) Model. The document is intended to support, new user registration, portal, navigation, and application submission.
The MCP model aims to strengthen coordination between primary care clinicians, specialists, social service providers, and behavioral health clinicians. MCP will launch on July 1, 2024 across eight states, including New York, and will run through December 31, 2034.
The user manual is available here. A more detailed summary of the MCP model is available here. Applications are due on November 30th.
CMS Releases ACO REACH/GPDC Performance Report, Showing Large Savings
Last month, the Centers for Medicare and Medicaid Services (CMS) released a summary of quality and financial performance for the ACO REACH Model, formerly known as the Global and Professional Direct Contracting Model. In the first two quarters of 2023, model participants combined for a roughly 7.7% reduction in spending compared to their benchmarks. Model participants also scored well on measures for unplanned admissions for patients with multiple chronic conditions.
The data examined includes performance years (PY) 2022 and 2023. While most entities began as Direct Contracting Entities (DCEs) under the GPDC model and later transitioned to become REACH Accountable Care Organizations (ACOs), some began their participation in 2023 as REACH ACOs.
The report is available here.
CDC Report on Poor Mental Health and Working Conditions Among Providers
On October 24th, the Centers for Disease Control and Prevention (CDC) released a report on poor mental health and working conditions among health care providers. Between 2018 and 2022, respondents reported more days of poor mental health and were more likely to report burnout. Respondents also reported an increase in anxiety as a result of workplace harassment. Conversely, positive conditions like supportive management were associated with lower odds of poor mental health and burnout.
The report is available here.
HRSA Publishes 340B Registration Requirements for Off-site Outpatient Hospital Facilities
On October 26th, the Health Resources and Services Administration (HRSA) released a notice for stakeholders regarding registration requirements for off-site, outpatient hospital facilities participating in the 340B program. These requirements were waived during the public health emergency (PHE). Now that the PHE has lapsed, in order to continue purchasing 340B drugs, covered entities’ off-site, outpatient hospital facilities must register with HRSA. This change is part of HRSA’s ongoing work to maintain program integrity in the midst of allegations of inappropriate use.
The notice is available here.
Other Updates
National Advocacy Group for Independent Physicians Launches
On October 19th, nearly 5,000 physicians joined together to launch the American Independent Medical Practice Association (AIMPA), an advocacy organization for independent physicians. AIMPA says it is the first “national, multi-specialty advocacy organization” focused promoting independent medical practices, particularly in the face of “rapidly consolidating hospitals and health systems.” Collectively, these physicians care for 10 million patients across 39 states and the District of Columbia.
The announcement is available here.
Commonwealth Fund Issues Report on Health Care Affordability
On October 26th, the Commonwealth Fund released findings from its 2023 Health Care Affordability Survey. The report found that large shares of insured adults aged 19-64, across all payers—employer-based, marketplace, Medicaid, and Medicare—still found it “somewhat or very” difficult to afford health care. Insurance coverage also did not prevent people from incurring medical debt. A large share of these adults are still currently paying off medical debt, ranging from 21% of adults with Medicaid to 33% of adults with Medicare (under 65) coverage.
The report is available here.
New York State Updates
NYS Issues Guidance on Medicaid Coverage of CHW Services for Pregnant and Postpartum People
Effective October 1, 2023, NYS Medicaid fee-for-service and managed care are reimbursing for Community Health Worker (CHW) services provided to pregnant and postpartum individuals (up to 12 months after the end of pregnancy, regardless of how the pregnancy ends). Next year, in accordance with a provision included in this year’s Enacted Budget, Medicaid will further expand access to CHW services to almost all Medicaid beneficiaries, including children under 21 and adults with health-related social needs.
A CHW is a public health worker (not otherwise recognized as a licensed or certified NYS Medicaid provider type) that reflects the community served through lived experience. CHW services include health advocacy, health education, and health navigation supports. The service must be recommended by a physician or other health care practitioner.
CHWs will not enroll in or bill NYS Medicaid directly. Services will be billed by one of the following Medicaid-enrolled entities that will be responsible for supervision:
- Clinic
- Hospital Outpatient Departments
- Physician
- Midwife
- Nurse Practitioner
- Psychologist
- Licensed Clinical Social Worker
- Licensed Mental Health Counselor
- Licensed Marriage Family Therapist
Additional details, including billing specifications, are available in the September Medicaid Update here and in the CHW services policy manual here. Questions may be submitted to MaternalandChild.HealthPolicy@health.ny.gov.
DOH Issues Guidance Regarding Enhanced EBP Rates for CFTSS Providers
On October 24th, DOH issued a notification to Medicaid Managed Care Plans (MMCPs) and Children and Family Treatment and Support Services (CFTSS) providers regarding implementation of Evidence-Based Practices (EBPs) within CFTSS programs. Effective November 1st (pending State Plan Amendment approval from CMS), the State will authorize a selected number of qualified CFTSS providers to receive EBP training and bill for new EBP rates. Authorization will only be granted to agencies designated to provide Other Licensed Practitioner (OLP) and Community Psychiatric Supports and Treatment (CPST) services.
Currently, DOH has identified Family Functional Therapy (FFT) and Parent-Child Interaction Therapy (PCIT) as allowable EBPs. DOH intends to further expand the list of allowable EBPs in the future. The new EBP service rate codes will supplant existing rate codes for OLP and CPST.
The guidance, which includes rate codes and draft reimbursement amounts, is available here. Questions may be submitted to BH.Transition@health.ny.gov.
NYS Issues Coverage Updates for Infant RSV Antibody and OTC Naloxone
In the most recent NYS Medicaid Update, the State announced that NYS Medicaid fee-for-service and managed care will now cover the following:
- Monoclonal antibody preparation for the prevention of Respiratory Syncytial Virus (RSV) for infants, to be reimbursed at $25.10 for administration; and
- Over-the-counter (OTC) naloxone when prescribed by the practitioner of a NYS Medicaid member or dispensed to a NYS Medicaid member in compliance with the State-issued naloxone standing order.
Additional details, including billing specifications, are available in the September Medicaid Update here.
OMH and DOH Release Evaluation and Discharge Guidance for Inpatient Programs, EDs, and CPEPs
On October 20th, the NYS Office of Mental Health (OMH) and DOH released joint guidance regarding evaluation and discharge practices for individuals who present with behavioral health conditions within psychiatric inpatient programs, emergency departments, and Comprehensive Psychiatric Emergency Programs (CPEPs). The guidance includes:
- Screening and assessments that should be completed at each patient encounter, including evaluations for suicide risk, substance use, violence risk, complex needs/social determinants, level of care determination, and appropriateness for Assisted Outpatient Treatment (AOT);
- Communication and collaboration standards with non-hospital providers;
- The process for coordinated discharge planning, including connections to care management agencies and psychiatric aftercare; and
- Pre-discharge interventions to improve discharge outcomes.
The guidance is available here.
DOH Adopts Rule to Maintain MCO Contingent Reserve Requirement at 7.25%
On October 25th, DOH adopted regulations maintaining the contingent reserve requirement at 7.25% through 2023 for Medicaid managed care organizations (MCOs), including mainstream plans, HIV Special Needs Plans (HIV SNPs), and Health and Recovery Plans (HARPs). Although the contingent reserve has been scheduled to eventually increase to 12.5%, DOH has annually continued the 7.25% level for several years now. The lower reserve requirement allows DOH to maintain the current 2% reduction in the premium rates while maintaining actuarial soundness.
The Notice of Adoption is available in the State Register here.
DOH Notifies Hospitals Regarding Revised 2023 Clinical Staffing Plan Submissions
On October 25th, DOH issued a notification to hospitals regarding revised practices for submission of clinical staffing plans. For 2023, hospitals were required to submit their clinical staffing plans in the General Clinical Staffing Plan Supplement HERDS survey, including the specific staffing for each patient care unit and work shift, an indication of how many patients are assigned to each registered nurse, and the number of nurses and ancillary staff to be present on each unit and shift.
DOH has decided to also collect in PDF format the actual clinical staffing plan documents that were adopted by the hospital clinical staffing committees, as was required during the first submission in 2022. Hospitals should submit the PDF plans to hospitalstaffingplans@health.ny.gov using the following format “[PFI number][HospitalName].pdf” by November 8th at 5pm. Plans must include both inpatient and outpatient units. However, extension clinics operating at a different location from the hospital and patient care units not staffed with nurses are not required to be submitted.
The notification is available here. Questions may be submitted to the email address above.