In this update:
- Legislative Updates
- Democratic Senators Send Letter to HHS on Mental Health Parity
- Wyden Sends Letter to HHS on Cybersecurity
- Federal Agencies
- CMMI Publishes Health Affairs Blog on Health Equity
- CMS Extends Reporting of State Medicaid Renewal Data
- CMS Publishes FAQ on Peer Supports in Medicaid
- HHS Allows for Notification Delegation in Updated Change Cybersecurity Incident FAQs
- HHS Releases Strategic Framework on Aging
- CMS Announces 10 More States Added to CCBHC Medicaid Demonstration
- Other Updates
- SCAN Health Plan Wins Suit Against CMS on MA Star Ratings
- Commonwealth Fund Data Shows U.S. Lagging in Maternal Mortality
- New York State Updates
- DOH to Host 2024-25 Enacted Budget Medicaid Briefing Webinar on June 11th
- DOH Adopts Regulations on EMS Provider Certification Requirements
- OSC Releases Audit Report Finding Improper Medicaid Payments to Unenrolled Providers
Legislative Updates
Democratic Senators Send Letter to HHS on Mental Health Parity
On June 6th, Senator Chris Murphy (D-CT) led a group of seven Democratic senators in writing to the Department of Health and Human Services (HHS), the Department of Labor (DoL), and the Internal Revenue Service (IRS) urging them to finalize proposed rules for the Mental Health Parity and Addiction Equity Act of 2008, first proposed last summer. The letter notes that “more than 15 years after the Parity Act was enacted with bipartisan support, insurance companies are still preventing patients from getting access to mental health and substance use disorder care.”
The letter cites an April 2024 study by the Research Triangle Institute, which found that in 2021, individuals seeking care from a psychiatrist had to go out of network 8.9 times more often than for medical/surgical specialists. It also found that physical health providers are reimbursed 21.7% higher on average than mental health/substance use disorder providers, relative to Medicare rates.
The ERISA Industry Committee, the Chamber of Commerce, and others are opposed to the rules as proposed.
The letter is available here.
Wyden Sends Letter to HHS on Cybersecurity
On June 5th, Senate Finance Committee Chair Ron Wyden (D-OR) sent a letter to HHS urging the Secretary to mandate “systemically important health care companies to improve their cybersecurity practices and to protect against cyberattacks that can shut down medical centers for weeks and leave patients’ personal medical information exposed to criminals and foreign spies.” HHS currently does not mandate specific cybersecurity practices such as the use of multi-factor authentication (MFA), resiliency standards, or periodic audits, although it and other state and federal agencies have released a variety of frameworks and guidance. The letter also says that HHS does not provide sufficient technical assistance or additional support to institutions with limited resources.
The letter is available here.
Federal Agencies
CMMI Publishes Health Affairs Blog on Health Equity
On June 4th, staff from the Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMI) published a blog in Health Affairs Forefront, titled “Advancing Health Equity Through Value-Based Care: CMS Innovation Center Update.” In it, CMMI provides updates across three key domains:
- Safety net provider participation in alternative payment models (APMs);
- Data collection for whole-person care; and
- Payment innovations to narrow disparities.
CMMI states that its initiatives to increase safety net provider participation in APMs have contributed to the number of such participants doubling in 2023 and increasing by a further 25 percent in 2024. However, it also acknowledges that both statutory and practical barriers continue to keep some safety net providers, like federally qualified health centers, from meaningfully participating in APMs. CMMI also notes that, besides requiring health equity plans as part of participation, “moving forward, there is also an opportunity for more standardized information” regarding health disparities.
The full blog post is available here.
CMS Extends Reporting of State Medicaid Renewal Data
On May 30th, CMS sent a letter to state Medicaid agencies extending the reporting requirements for certain metrics pertaining to the ongoing Medicaid unwinding. Under this directive, states will be required to continue reporting monthly about their renewal actions—including application processing, renewals initiated, and renewal outcomes—until “the date when the state completes all unwinding-related renewals.”
The original guidance expected the unwinding to complete by the end of June, but CMS recently issued guidance permitting states to continue activities for up to an additional year. CMS commits to continuing to share this data publicly to ensure transparency. To date, at least 22.8 million people have been disenrolled in Medicaid coverage during the unwinding.
The letter is available here.
CMS Publishes FAQ on Peer Supports in Medicaid
On June 5th, CMS released a new Frequently Asked Questions (FAQ) document regarding Medicaid and CHIP coverage of peer support services. In the FAQ, CMS encourages states to offer peer support services as part of a comprehensive Medicaid behavioral health services benefit and to reimburse peers at a living wage.
The FAQ is in response to stakeholder concerns about CMS’s existing guidance on peer supports from 2007, which stated that “supervision must be provided by a competent mental health professional (as defined by the State).” In the new FAQ, CMS clarifies that this is not meant to establish specific requirements for all peer support staff. State Medicaid programs have the authority to define qualifications, and CMS guidance is meant to provide recommendations and guidelines. States may choose to allow licensed or unlicensed staff, or other more experienced peers, to provide supervision.
The FAQ is available here.
HHS Allows for Notification Delegation in Updated Change Cybersecurity Incident FAQs
On May 31st, HHS announced updates to its FAQ webpage for the Change Healthcare cybersecurity incident. The update clarifies that covered entities affected by the incident may delegate Health Insurance Portability and Accountability Act of 1996 (HIPAA) breach notifications to Change Healthcare, rather than conducting the notifications themselves. These notifications must be sent to HHS, affected individuals, and in some instances the media. Only one notification is required for each affected entity. This change is consistent with the American Hospital Association’s (AHA) requests in March and May. To date, HHS has not received the breach report from Change Healthcare and United Health Group. After that is received, a 60-day period begins in which notifications must be sent for each affected entity.
The announcement is available here, and the updated FAQs are available here.
HHS Releases Strategic Framework on Aging
On May 30th, the HHS Administration for Community Living (ACL) released a document entitled “Aging in the United States: A Strategic Framework for a National Plan on Aging.” The National Plan advances best practices for more inclusive healthy aging policies that draw on expertise across private and public sectors, including 16 federal agencies and departments. Access to long-term care services plays prominently in the National Plan with proposed strategies including new navigational hubs and bolstering ACL’s Eldercare Locator and No Wrong Door system.
The announcement is available here, and the plan is available here.
CMS Announces 10 More States Added to CCBHC Medicaid Demonstration
On June 4th, CMS announced the ten new states that will join the Certified Community Behavioral Health Clinic (CCBHC) Medicaid Demonstration Program: Alabama, Illinois, Indiana, Iowa, Kansas, Maine, New Hampshire, New Mexico, Rhode Island and Vermont. Under the CCBHC demonstration, states reimburse participating providers under a cost-based daily or monthly rate to provide a full range of behavioral health services and care coordination. CCBHCs must meet standards established by the Substance Abuse and Mental Health Services Administration (SAMHSA). The 10 new states are joining 10 other current demonstration participants, including New York and New Jersey.
This expansion was statutorily authorized in the Bipartisan Safer Communities Act of 2022. The Act also authorized CMS to continue issuing planning grants to 15 more states in Fiscal Year (FY) 2025 and add 10 more to the demonstration in FY 2026, and every two years after. As a result, every state that wishes could apply to participate by 2030. Each new state added will be eligible to participate for a four-year period. New York, as one of the original state demonstration, is currently scheduled to end its participation in September 2025 unless further extended.
The announcement is available here.
Other Updates
SCAN Health Plan Wins Suit Against CMS on MA Star Ratings
On June 3rd, a District of Columbia federal court judge ruled in favor of SCAN Health Plan in its star ratings dispute with the CMS. SCAN filed its suit in December 2023, arguing that CMS’s updated methodology to determine Medicare Advantage (MA) Star Ratings for the 2024 plan year was flawed and violated the Administrative Procedure Act (APA). With the new methodology, SCAN’s Star Ratings dropped from 4.5 to 3.5 in 2024, costing the insurer $250 million in bonus payments. With this decision, this sum will be transferred back to SCAN.
CMS has not commented on the case, but most do not expect the government to challenge the ruling. Elevance Health also recently successfully challenged changes to its ratings for 2024. While this ruling was technical in nature, it points to larger questions over how CMS will defend its methodology and the possibility that CMS may have to refund millions in foregone bonuses. Additionally, unless CMS appeals, it will likely have to issue new regulations.
Commonwealth Fund Data Shows U.S. Lagging in Maternal Mortality
On June 4th, the Commonwealth Fund published an issue brief on comparative maternal mortality, finding that the maternal mortality rate in the United States far exceeds that of other high-income countries. The U.S. has experienced a decline in maternal deaths since the Covid-19 pandemic, but still lags behind comparable nations in terms of maternal health outcomes, particularly among Black women. With most deaths occurring in the postpartum period, researchers found that 80% of deaths are considered preventable with more supportive services and guaranteed paid leave as potential mitigating factors. Of all countries surveyed, the U.S. and Canada have the smallest supply of midwives and OB-GYNs.
The issue brief is available here.
New York State Updates
DOH to Host 2024-25 Enacted Budget Medicaid Briefing Webinar on June 11th
On June 11th at 12:30pm, the New York State (NYS) Department of Health (DOH) will host an informational webinar on Medicaid provisions included in the 2024-25 NYS Enacted Budget. There will be an opportunity at the end of the webinar for questions, which may be submitted via the “Chat” feature or in advance via email to mrtupdates@health.ny.gov.
Registration for the webinar is available here. The recently published 2024-25 Enacted Budget Medicaid Scorecard is available here.
DOH Adopts Regulations on EMS Provider Certification Requirements
On June 5th, DOH adopted regulations that amend educational requirements for Certified Emergency Medical Services Provider, in order to “improve the overall educational and certification experience that will ease barriers to recruitment of individuals.” The regulations amend Part 800 of Title 10 of the New York Codes, Rules, and Regulations (NYCRR) to:
- Allow individuals who are 17 years of age prior to the last day of the month to qualify for initial certification;
- Clarify the process for obtaining a certification through reciprocity;
- Remove reference to Emergency Critical Care technicians, which are being phased out as a certification option;
- Allow for the completion of all requirements, including a passing grade on both the practical skills evaluation and a written examination, within two years of the end of course date;
- Increase the number of attempts to pass the written examination to three;
- Modify the requirements for recertification to allow a broader definition of continuous practice;
- Change the term “examination” to “evaluation” for determining skills competencies; and
- Clarify that remediation is required when the candidate is unsuccessful with the skills evaluation and/or written examination.
The notification of adoption, as well as public comments received on the proposed rule and corresponding DOH responses, are available in the State Register here.
OSC Releases Audit Report Finding Improper Medicaid Payments to Unenrolled Providers
On June 4th, the Office of the NYS Comptroller (OSC) released an audit report that found over $1.5 billion in improper Medicaid managed care payments to providers that were not enrolled in the State’s Medicaid program. The audit, which covered a sample of payments from January 2018 through June 2022 across five managed care organizations (MCOs), found:
- $916 million paid to providers whose identification numbers did not correspond to an identification number of a Medicaid-enrolled provider.
- $832.5 million paid to providers who had a Medicaid enrollment application that was either denied or withdrawn.
- $9.6 million paid to providers who were excluded or otherwise ineligible for the Medicaid program.
OSC recommends that DOH take appropriate corrective steps and recover payments where appropriate. OSC also recommends that DOH enhance monitoring of, and support MCO compliance with the 21st Century Cures Act requirement for in-network providers to enroll in the Medicaid program by January 1, 2018. This may include developing a process to notify MCOs of providers who have been denied or withdrawn from enrollment in the Medicaid program and reviewing encounter claims to identify payments to unenrolled providers.
The audit report is available here.