Weekly Health Care Policy Update – April 12, 2024

In this update: 

• Federal Agencies
  • CMMI Proposes TEAM Mandatory Episode-Based Model for Post-Surgery Care
  • CMS Publishes Proposed FY 2025 IPPS and LTCH Rule
  • CMS Finalizes Rule on 2025 Medicare Advantage and Part D
  • CMS Finalizes MA and MA-PD CY 2025 Rate Announcement 
  • CMS Finalizes FY 2025 Benefit and Payment Parameters for Marketplace Plans
  • CMMI Publishes Update on Person-Centered Care Strategy
  • FDA Approves First Digital Treatment for Mental Health
  • CMMI Announces Person-Centered Listening Session
  • HRSA Increases Initial Repayments for NHSC Loan Repayment Program by 50%
  • ONC Releases Draft Strategic Plan
  • CMS Updates Guidelines for Informed Consent
• Other Updates
  • GAO and NACHC Release Reports on Health Center Finances
  • AHIP, AMA, NAACOS Release Playbook on Sustainable VBP
  • CDC Issues Health Alert Network Advisory for H5N1 Bird Flu
• New York State Updates
  • NYS Budget Deadline Continues to Be Pushed Back
  • NYSOH Launches Essential Plan Expansion
  • OMH Issues Proposed Updates to PAR Regulations
  • DOH Releases Eighth Monthly Edition of the State’s Public Health Emergency Unwind Dashboard
  • NYS Announces Prohibition on Waiting Periods in NYSOH Stand-Alone Dental Plans
  • Governor Hochul Announces Inaugural Mental Health Needs Assessment for First Responders

Federal Agencies

CMMI Proposes TEAM Mandatory Episode-Based Model for Post-Surgery Care 
On April 10^th, the Center for Medicare and Medicaid Innovation (CMMI) announced a proposed new mandatory episode-based payment model in Medicare. This model, called the Transforming Episode Accountability Model (TEAM), aims to test how episodic payments can improve post-acute care after certain high-cost surgeries.

Under the model, selected hospitals would become responsible for the cost and quality of care for the clinical episode extending from the qualifying surgery through the first 30 days after discharge. To promote coordinated post-acute care, the hospital would connect eligible patients to primary care services after they leave the hospital. Overlap for patients in an Accountable Care Organization (ACO) is allowed. More model specifics include: 

• Timeline & Selection: The model would run for five years, starting in January 2026. Hospitals would be selected based on geographic regions, capturing a mix of value-based care experiences.
• Risk Tracks: Although participation would be mandatory, hospitals would have the option to select a one-year phase-in, and certain hospitals would have the option to choose a lower risk model. These models are described as three tracks:
  • Track 1: Available for year 1 to all participants, offering no downside risk with low levels of reward.
  • Track 2: Available for years 2-5 to a limited set of participants (including safety net hospitals), offering lower levels of risk and reward.
  • Track 3: Available during all 5 years, offering higher levels of risk and reward.
• Episodes of Focus: TEAM would apply to episodes of care including the following surgeries:
  • Lower extremity joint replacement;
  • Surgical hip femur fracture treatment;
  • Spinal fusion;
  • Coronary artery bypass graft; and
  • Major bowel procedure.
• Billing: Hospitals would continue to bill Medicare fee-for-service (FFS). However, CMS will establish a target price for the episode, based on all non-excluded Medicare Parts A & B items and services. The hospital would receive a bonus or be required to make a repayment, depending on the eventual billed FFS cost. Hospitals would also be evaluated on quality measures.
• Equity: Safety net hospitals would have the opportunity to participate in TEAM with lower financial risks. Hospitals would submit health equity plans while reporting on sociodemographic data and screening for health-related social needs (HRSN).

The model is included within the proposed fiscal year (FY) 2025 Medicare hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) rule, available here. A fact sheet is available here. Comments on the TEAM model may be submitted as part of comments on this rule through June 10^th.

CMS Publishes Proposed FY 2025 IPPS and LTCH Rule
On April 10^th, the Centers for Medicare & Medicaid Services (CMS) published proposed updates to the Medicare hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment systems (LTCH PSS) for FY 2025. Overall, general acute care hospitals will receive a 2.6% increase in operating payment rates so long as they participate in the Hospital Inpatient Quality Reporting (IQR) program and are meaningful electronic health record (EHR) users. This increase is the result of a 3.0% market basket update, reduced by a 0.4 percentage point productivity adjustment. CMS notes that hospitals may be subject to additional payment adjustments within the Hospital Readmissions Reduction Program, the Hospital Acquired Condition Reduction Program, or the Hospital Value-Based Purchasing Program.

Disproportionate share hospital (DSH) payments and Medicare uncompensated care payments are projected to increase by $560 million. In addition, CMS estimates that additional payments for inpatient cases involving new medical technologies will increase by $94 million, due to the continuation of new technology add-on payments for several technologies. Additional policies include: 

• Maternity Care: CMS included a Request for Information (RFI) pertaining to maternity care services for Medicare patients as compared to non-Medicare patients. Specifically, CMS is interested in better understanding differences in hospital resources required to provide inpatient pregnancy and childbirth services across these two populations.
• Quality Reporting Programs: CMS also included an RFI pertaining to several quality reporting programs that account for unplanned patient visits. Specifically, CMS is interested in adopting new measures that better address the causes of unplanned patient visits following discharge from an inpatient stay.
• Social Determinants of Health (SDOH): The proposed rule includes new SDOH data elements in LTCH quality reporting, which would require LTCHs to report on housing, food stability, and access to transportation. Specifically, CMS is proposing a change to the severity designation of 7 ICD-10-CM diagnosis codes. Under this rule, if finalized, hospitals would receive an increase in payments when caring for patients experiencing homelessness.

The proposed rule is available here and a fact sheet is available here.

CMS Finalizes Rule on 2025 Medicare Advantage and Part D
On April 4^th, CMS finalized the Medicare Advantage (MA) and Part D final rule for calendar year (CY) 2025. The rule revises a number of policies around MA plans and other associated programs. The provisions of the final rule include:

Dual Eligibles

• Duals Alignment: CMS is finalizing proposals intended to increase the number of full-benefit dual eligibles (FBDEs) in MA plans that have an associated Medicaid plan. Modifications from the proposed rule include:
  • CMS proposed to disallow individuals in Medicaid MCOs from selecting a misaligned D-SNP. In the final rule, this has been limited to only FBDEs.
  • CMS proposed a monthly option for all duals to change enrollment to Medicare FFS with a standalone Part D plan, or to an integrated D-SNP, but not to a non-integrated plan. In the final rule, the monthly option to move to Medicare FFS remains, but moving to an integrated D-SNP is only available to FBDEs and only to a plan with aligned enrollment.
• One D-SNP per Service Area: Starting in 2027, an MA organization that offers a D-SNP and also a Medicaid managed care plan that enrolls FBDEs in the same area may only offer one D-SNP for FBDEs. New enrollment in the D-SNP must be limited to individuals in their aligned Medicaid MCO. If there are different eligibility or benefit groups in the plan’s Medicaid contract, the MA organization may offer one D-SNP for each such group.
• Out-of-Network Cost Sharing: Starting in 2026, CMS is limiting out-of-network cost sharing for Medicare Advantage Dual Eligible Special Needs Plans (D-SNP) preferred provider organizations (PPOs) for various services. This is intended to limit the cost-sharing which typically is paid by the State Medicaid program.
• D-SNP Lookalike Threshold: CMS is lowering the threshold for “D-SNP look-alikes” from 80 percent to 70 percent in 2025 and 60 percent in 2026 and afterwards. CMS will not renew contracts for non-D-SNP MA plans whose enrollment of dual eligibles is above that threshold.

Network Adequacy

• Behavioral Health: CMS is adding a new facility-specialty provider category, “Outpatient Behavioral Health,” to the network adequacy standards that MA plans must meet.
  • This category may include private practitioners such as marriage and family therapists (MFTs) and mental health counselors (MHCs) as well as outpatient clinics and facilities.
  • Nurse practitioners, physician assistants, and clinical nurse specialists may be included, but MA plans must verify that these practitioners have provided BH services to at least 20 patients in a recent 12-month period.

Supplemental Benefits

• SSBCI Program: CMS is implementing new requirements for MA plans offering Special Supplemental Benefits for the Chronically Ill (SSBCI) services:
  • In their bids, plans must demonstrate evidence that the proposed SSBCI benefit has a “reasonable expectation of improving the health or overall function of chronically ill enrollees.” CMS may deny the bid if such evidence is not submitted.
  • MA plans must follow written policies for SSBCI eligibility determinations, and must document both approvals and denials of SSBCI eligibility.
• Mid-Year Notification: MA plans are now required to notify enrollees mid-year of any available supplemental benefits that they have not used.

Part D Plans

• Medication Therapy Management Requirement: CMS is adding new requirements for the targeting criteria for Part D medication therapy management (MTM) programs, with the goal of expanding access to MTM. Part D plans are required to provide MTM services to targeted enrollees who need multiple drugs to treat multiple chronic conditions.
• Substitution of Biosimilars: Part D plans are currently permitted to immediately substitute generic equivalents to brand name drugs. The new rule allows them also to substitute interchangeable biological products or unbranded biological products for their reference products. They may also substitute biosimilars upon 30 days’ notice.

Outreach and Marketing

• Agents and Brokers: CMS is finalizing a new definition of “compensation” to set a fixed amount that agents and brokers will be paid, regardless of the plan the individual enrolls in.
• TPMOs: Third-party marketing organizations (TPMOs) are now prohibited from sharing beneficiary contact information with other TPMOs without express written consent.

Utilization Management

• Health Equity Assessment: CMS is requiring that utilization management (UM) committees have at least one member with expertise in health equity, conduct plan-level annual health equity analyses of prior authorization policies and procedures, and that the results of the analyses be made publicly available.
• Appeal Rights: CMS is requiring the Quality Improvement Organization (instead of the Medicare Advantage plan) to review fast-track appeals of decisions to terminate services in a skilled nursing facility, comprehensive outpatient rehabilitation facility or by a home health agency, and will no longer require forfeiture of an enrollee’s right to appeal a termination of services when they leave the facility.

More information is available here.

CMS Finalizes MA and MA-PD CY 2025 Rate Announcement  
On April 1^st, CMS finalized the CY 2025 Rate Announcement for the MA and Part D programs.  This announcement updates the capitation and risk adjustment methodologies used to calculate MA plan payments as well as other payment policies that affect the Part D program. Overall, payments to MA plans will increase by an average of 3.7% (totaling $16 billion) in 2025, which includes an effective growth rate of 2.33%. This is not a significant change from the Advance Notice.

Part C
CMS updating the Part C risk adjustment model to continue the ongoing phase-in of the 2024 HCC model. Specifically, in 2025, CMS will shift the blend of risk score models to use a weight of two-thirds for the 2024 model and one-third for the 2020 model. CMS is also restructuring certain condition categories and updating data. The resulting blended risk score trend for CY 2025 is 3.86%, which is 2.45% lower than it would have been under the CY 2024 policies.

Part D
CMS is updating the Part D program’s payment parameters in line with recent legislation: 

• Inflation Reduction Act: Annual out-of-pocket costs will be capped at $2,000 for Part D beneficiaries, a change reflected in CMS’s Final CY 2025 Part D Redesign Program Instructions, which was released concurrently. Additionally, CMS is sunsetting the Coverage Gap Discount Program and introducing the new Manufacturer Discount Program.
• Benefit Design: The Announcement introduces a new Part D benefit design, including three phases: annual deductible, initial coverage, and catastrophic coverage.

Star Ratings

• Patient Experience and Complaints and Access Measures: Beginning with the 2024 measurement year (for 2026 Star Ratings), the weight of patient experience and complaints and access measures will be reduced to two.
• Care for Older Adults – Pain Assessment (Part C): This measure will be removed for 2027 Star Ratings.
• Measures Under Consideration: CMS notes that it is considering the adoption of Initiation and Engagement of Substance Use Disorder Treatment (Part C) and Initial Opioid Prescribing for Long Duration (IOP-LD) (Part D) measures through future rulemaking.

The announcement is available here.

CMS Finalizes FY 2025 Benefit and Payment Parameters for Marketplace Plans 
On April 2^nd, CMS released the Notice of Benefit and Payment Parameters (NBPP) for Fiscal Year (FY) 2025, which provides policy and payment updates for insurance coverage sold through Affordable Care Act (ACA) Marketplaces. Key changes and updates in the rule include: 

• Network Adequacy: CMS finalized its proposal that State-Based Marketplaces (SBMs) and State-Based Marketplaces using the Federal Platform (SBM-FPs) align quantitative time and distance network adequacy standards for qualified health plans (QHPs) with those established for Federally-Facilitated Marketplaces (FFMs), starting in 2026. CMS also finalized a requirement that SMBs and SBM-FPs gather information from issuers about the provision of telehealth by network providers to inform potential future standards.
• Essential Health Benefits: CMS finalized its proposed changes to the definition of essential health benefits (EHBs) regarding prescription drug and routine adult dental benefits.
• EHB Benchmark Update: CMS finalized proposed changes to the process by which states update their EHB Benchmark plan to reduce the burden of the update process.
• Re-enrollment Hierarchy: CMS finalized its proposed amendment to the re-enrollment hierarchy for all Marketplaces such that enrollees with catastrophic coverage are re-enrolled into a new QHP for the coming plan year, beginning with open enrollment for the 2025 plan year.
• Enrollment Changes: CMS finalized several proposed changes designed to make enrolling in coverage easier, including to the special enrollment period (SEP) effective date, the failure to file and reconcile process, and the annual open enrollment date to ensure a minimum open enrollment length across Marketplaces.
• Standards for Web-Brokers and Direct Enrollment Entities: CMS finalized its proposal to apply the standards it uses for web-brokers and direct enrollment entities serving FFMs to SBMs and SBM-FPs.
• Risk Adjustment Program: For 2025, CMS finalized its proposal to recalibrate the risk adjustment models.

Notably, CMS did not finalize a proposal which would have allowed states greater flexibility in the use of income and resource disregards in determining financial eligibility for Medicaid for certain populations, including low-income individuals eligible for Supplemental Security Income (SSI), individuals older than 65 with income at or below 100% FPL, individuals in institutions, working disabled individuals, foster care children, and others (known as non-MAGI beneficiaries).

The announcement is available here.

CMMI Publishes Update on Person-Centered Care Strategy 
On April 2^nd, the CMMI leadership team published a blog post in Health Affairs offering an update on their strategy relative to person-centered, value-based specialty care. CMMI is now in the third year of its Strategic Refresh, which includes a goal of having 100% of Traditional Medicare beneficiaries in an accountable care relationship by 2030. The post notes that achievement of this goal will require integration of primary and specialty care, especially given that specialty care is a substantial portion of overall Medicare spending.

In the blog post, CMMI revisits the specialty care strategy it laid out in November 2022 (covered by SPG here) and examines progress towards its four goals: 

1. Enhancing specialty care data transparency: CMMI is making “shadow bundles” data available to ACO REACH participants to help them better understand specialist care patterns and costs. CMMI will also provide data on specialty care patterns to participants in the Making Care Primary (MCP) model.
2. Acute episode payment models and condition-based models: CMS references the new proposed TEAM model (covered above).
3. Financial incentives within primary care for specialist engagement: CMMI has sought to include specialty care integration in the MCP model and is exploring new options to encourage such integration in ACOs, as well as potential “mandatory and longitudinal” specialty-focused models to encourage specialist participation in value-based care.
4. Financial incentives for specialists: CMMI is considering “ways to create incentives for specialists to affiliate with ACOs,” including potentially implementing subpopulation targets for ACOs.

The blog post is available here.

FDA Approves First Digital Treatment for Mental Health
On March 30^th, the Food & Drug Administration (FDA) approved Otsuka Pharmaceutical’s digital treatment for major depressive disorder, Rejoyn. This product is the first digital treatment for a mental health disorder to be approved by the FDA. Rejoyn is intended to be used by prescription with an antidepressant pharmacotherapy over the course of the six-week program. It combines a new treatment approach called cognitive-emotional training and traditional cognitive behavioral therapy sessions. Some researchers and clinicians have expressed concern over the volume of research on cognitive-emotional training, given its recent development.

The approval is available here.

CMMI Announces Person-Centered Listening Session 
On April 24^th at 12pm ET, CMMI will hold a listening session entitled Person-Centered Listening Session: Leveraging Relationships with Community-Based Organizations to Meet Health-Related Social Needs. CMMI hopes to gain insights from experts and those in the field, focusing on how community-based organizations can be included in the life cycles of its models to better address the health-related social needs of beneficiaries.

Registration is available here. 

HRSA Increases Initial Repayments for NHSC Loan Repayment Program by 50%
On April 4^th, the Health Resources and Services Administration (HRSA) announced that its National Health Service Corps Loan Repayment Program has increased the initial loan repayment amount available to primary care providers who commit to practicing in high need and rural areas by 50%. Eligible providers include: 

• Primary care providers, OBGYNs, and pediatricians (MDs or DOs);
• Nurse practitioners;
• Certified nurse midwives; and
• Physician assistants.

The increase means that such providers could have as much as $75,000 forgiven in exchange for a two-year service commitment. Previously, the maximum initial loan repayment was $50,000, roughly the same amount as the program offered 30 years ago.

More information is available here.

ONC Releases Draft Strategic Plan 
On March 27^th, the Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology (ONC) released a draft strategic plan for health information technology over the next five years. The draft plan outlines the federal government’s plans to support electronic health information exchange in collaboration with the private sector. Artificial intelligence (AI) as an avenue for increased health equity features prominently in the plan. The American Hospital Association (AHA) responded with concerns over proposed cybersecurity requirements for hospitals alone.

The plan is available here and will be open for comment until May 28^th.

CMS Updates Guidelines for Informed Consent 
On April 1^st, CMS updated its Hospital Interpretive Guidelines for Informed Consent. In this update, CMS clarifies the obligation to receive informed consent from patients prior to any training- or education-related examinations outside of what is medically necessary. In a letter to teaching hospitals and medical schools, CMS reinforced the expectation that hospitals obtain and document informed consent before sensitive examinations. This is particularly important for patients that are anesthetized.

The announcement is available here.

Other Updates

GAO and NACHC Release Reports on Health Center Finances 
On April 8^th, the Government Accountability Office (GAO) released a report on the finances of Community Health Centers (CHCs), including federally qualified health centers (FQHCs) and others. This report was requested by senior Republican lawmakers as part of their consideration of the reauthorization of the Community Health Center program. The report found that from 2017 to 2022, CHC revenue rose over 60%, totaling $42.9 billion in 2022. The largest source of that revenue was Medicaid (over one-third).  During the pandemic, CHCs received a boost in Medicaid revenue, explaining part of the revenue increase. The federal funding bill passed last month included $4.27 billion to CHCs, backdated to the beginning of fiscal year (FY) 2024.
 
On April 3^rd, the National Association of Community Health Centers (NACHC) released a report on the impact of the Medicaid unwinding on CHCs and their patients. According to new survey data, 23% CHC patients with Medicaid have lost coverage through the unwinding, and 50% of these patients have discontinued or postponed treatment as a result. Among CHC patients, 18% of children and 27% of those with chronic illness have lost coverage. Staff at CHCs have reported additional administrative work as they assist those recently disenrolled with accessing care.
 
The GAO report is available here, and the NACHC report is available here.
 
AHIP, AMA, NAACOS Release Playbook on Sustainable VBP
On April 10^th, America’s Health Insurance Plans (AHIP), the American Medical Association (AMA), and the National Association of ACOs (NAACOS) released a playbook of voluntary best practices for adopting sustainable value-based payment (VBP) arrangements in the private sector. The playbook focuses on a number of payment domains as opportunities to advance VBP, including further patient attribution methods, establishing financial benchmarks, and better adjusting risk to appropriately reflect population health. It also focuses on more efficiently rewarding entities for quality performance while considering financial risk.
 
The playbook is available here.
 
CDC Issues Health Alert Network Advisory for H5N1 Bird Flu
On April 5^th, the Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Advisory for the highly pathogenic avian influenza (HPAI) A(H5NI) virus, commonly known as the bird flu. On March 27^th, a commercial dairy farmer in Texas tested positive for bird flu after exposure to presumably infected cattle, the first reported infection of this kind and the second human case of HPAI A(H5NI). The CDC updated its recommendations for infection prevention and control measures for clinicians, state health departments, agricultural workers, and the public. Antiviral treatment is available for those infected.
 
The announcement is available here.

New York State Updates

NYS Budget Deadline Continues to Be Pushed Back
Negotiations between the Executive, Assembly, and Senate over the New York State Fiscal Year (FY) 2024-25 Budget are continuing, requiring ongoing extensions of the statutory April 1^st deadline.

Today (April 12^th), the Assembly is expected to pass a further extension through April 15^th(S.9036) which was passed by the Senate last night. Further extenders are considered likely, as disputes over housing policy have deepened. Albany observers have noted that with only three more scheduled sitting days in April, a May timeline for the Enacted Budget is increasingly probable.

NYSOH Launches Essential Plan Expansion 
On April 1^st, the NYS Department of Health (DOH) and the New York State of Health (NYSOH), NYS’s health plan marketplace, announced the official launch of the expanded Essential Plan insurance program, under New York’s recently approved Section 1332 State Innovation Waiver. Eligibility for the Essential Plan will now include adults (ages 19-64) with incomes of up to 250% of the Federal Poverty Level (FPL), an increase from the previous maximum of 200%. All Essential Plan enrollees have no monthly premiums, no deductibles, and maximum out-of-pocket contributions of $2,000.

Effective immediately, first-time applicants who meet the Essential Plan expansion eligibility criteria will be able to enroll in the program. Individuals who completed a NYSOH application during the 2024 Open Enrollment period but did not enroll in coverage and now meet the expanded Essential Plan eligibility will receive outreach from their enrollment assistors to select and enroll in a health plan. The State projects that the expansion will allow for the enrollment of nearly 100,000 additional individuals.

DOH and NYSOH’s press release is available here. Details on the approved 1332 Waiver are available here.

OMH Issues Proposed Updates to PAR Regulations
On April 10^th, NYS OMH Issued a proposed rule that updates regulations for the Prior Approval Review (PAR) process, which ensures that new and existing licensed mental health service providers meet OMH’s quality, safety, and fiscal viability standards. The proposed changes incorporate provider and local government feedback over the past several years on the PAR process. Proposed changes include, but are not limited to: 

• Clarifying applicability to any existing or proposed limited liability company, corporation, or public or private agency proposing a project;
• Clarifying which projects are subject to comprehensive PAR reviews, E-Z PAR reviews, or administrative actions, including capital projects (E-Z PAR) and Mental Health Outpatient Treatment and Rehabilitation Services (MHOTRS) program changes that result in a staffing change less than 5.5 full-time equivalent staff and/or a change in physical space (administrative action);
• Allowing OMH to reclassify a project for review based on impact upon the local service system, complexity of the project, and expenditure of state/local resources;
• Clarifying the authority of OMH to charge a review fee to applicants for projects in accordance with a published fee schedule;
• Clarifying that the letter of support must come from the local government unit where the program will be located;
• Expanding the expectation that providers notify OMH of any changes to their Articles of Incorporation to include Articles of Organization (for-profit providers) and bylaws (when it impacts their corporate structure);
• Allowing OMH to request Memorandum of Understanding (MOU) when a project is physically hosted by another service provide (e.g., school-based satellites); and
• Allowing OMH to withdraw an application that has conditional approval if the project has not made progress in accordance with specified timeframes, unless an extension of the approval is requested and granted.

The proposed regulations are available here. Public comment may be submitted to regs@omh.ny.gov through June 10^th.

DOH Releases Eighth Monthly Edition of the State’s Public Health Emergency Unwind Dashboard
On April 1^st, DOH released the eighth issue of the State’s Public Health Emergency (PHE) Unwind Dashboard, a monthly enrollment report on the renewal process for New York’s Medicaid, Child Health Plus, and Essential Plan populations. All individuals in these programs will need to renew their eligibility through May 31^st.

The eighth issue includes the renewal status, demographics, and program transitions of enrollees who had a February 29^th coverage end date. The report shows that 79 percent of the 613,723 individuals in this cohort have renewed their coverage across the NYSOH marketplace and Local Departments of Social Services. The report does not include information on former enrollees who found coverage through non-public sources, such as employer-based insurance.

The eighth issue and previous issues may be accessed here. This process will continue each month until each enrollee cohort has had their eligibility redetermined.

NYS Announces Prohibition on Waiting Periods in NYSOH Stand-Alone Dental Plans
On April 4^th, DOH, NYSOH, and the NYS Department of Financial Services (DFS) announced that effective January 1, 2025, waiting periods will be eliminated for most adult dental services provided by Individual Stand-Alone Dental Plans offered through the NYSOH Marketplace. Waiting periods are still in effect for orthodontic services but are capped at 12 months. This policy does not apply to Qualified Health Plans (QHPs) that have a dental benefit, although DFS notes that most such plans do not have waiting periods.

This policy is the first step in a multi-phase initiative from DOH and DFS to establish more standards for dental coverage. The press release is available here.

Governor Hochul Announces Inaugural Mental Health Needs Assessment for First Responders
On April 4^th, Governor Hochul announced the launch of New York’s inaugural first responder mental health needs assessment, facilitated through a partnership between the State Division of Homeland Security and Emergency Services (DHSES) and SUNY New Paltz’s Institute for Disaster Mental Health (IDMH).

The needs assessment, which aims to better understand the mental health-related challenges facing public safety professionals, will gather input from law enforcement, the fire service, EMTs, 911 dispatchers and emergency managers via surveys and focus groups. The assessment results will be delivered at the annual IDMH Conference, to be held on May 14^th and 15^th. They will be used to inform how programs and services for first responders can be strengthened.

In addition to these initiatives, the NYS Office of Mental Health (OMH) is partnering with DHSES and IDMH to develop a statewide disaster mental health response strategy that trains and activates disaster mental health responders to support disaster response operations and provide immediate psychological first aid.

The Governor’s press release is available here.