Weekly Health Care Policy Update – November 21, 2022

November 29, 2022

In this update:

  • Administration Updates
    • HHS Makes Climate Resilience Announcements at COP27
  • Federal Agencies
    • CMS Updates Medicare Care Compare with Clinician Facility Affiliation Information
    • CMS Releases Medicaid Coverage and Behavioral Health Data
    • CMMI to Hold VBID Hospice Webinar 
    • CMS Releases Estimated Improper Payment Rates for 2022
    • CMS Doctor/Clinician Preview Period Begins November 21st
  • Other Updates
    • CBO Presents on Medicaid Baseline Forecast
    • Leapfrog Group Releases Fall 2022 Hospital Safety Grade Report
    • HHS OIG Says About 80% of Long-Stay Nursing Home Residents Were Prescribed Psychotropic Drugs
  • New York State Updates
    • OMH Finalizes Updated Article 31 Clinic MHOTRS Regulations
    • CMS Approves New York SPA Permitting Licensed Psychologists to Provide OLP Services under CFTSS 
    • DOH Expands Healthcare Worker Bonus Program to Health Homes and Others
  • Funding Opportunities
    • DHS Releases RFP for Street Homelessness Outreach Services in NYC
    • NYC DSS Issues Congregate and Scattered-Site Supportive Housing Open-Ended RFPs

Administrative Updates

HHS Makes Climate Resilience Announcements at COP27
On November 10th, the Department of Health and Human Services (HHS) announced at the United Nations Climate Conference (COP27) that more than 100 health care organizations have signed onto the White House/HHS Health Sector Climate Pledge. The pledge, originally launched in April 2022, is a “voluntary commitment to climate resilience and emissions reduction” that asks organizations to:

  • Reduce their organization’s emissions (by 50% by 2030 and to net zero by 2050) and publicly report on their progress;
  • Complete an inventory of supply chain emissions;
  • Develop climate resilience plans for their facilities and communities; and
  • Designate an executive lead for this work.  

The pledge signatories represent 837 hospitals (15 percent of all U.S. hospitals) as well as health centers, suppliers, insurance companies, group purchasing organizations, and pharmaceutical companies. Health systems in New York signing the pledge include Montefiore, Mount Sinai Health System, NYC Health + Hospitals, NYU Langone Health, and Stony Brook University Hospital.

The HHS announcement can be found here.

Federal Agencies

CMS Updates Medicare Care Compare with Clinician Facility Affiliation Information
On November 14th, the Centers for Medicare and Medicaid Services (CMS) updated the Medicare Care Compare website to include information on clinicians’ affiliations with additional, non-hospital Medicare-enrolled facilities. With the most recent update, the site now includes doctor and clinician facility affiliation information for the following facility types: 

  • Long-term Care Hospitals (LTCHs);
  • Skilled Nursing Facilities (SNFs);
  • Inpatient Rehabilitation Facility (IRFs);
  • Home Health Agencies;
  • Hospices; and
  • Dialysis Facilities.

Previously, Medicare Care Compare included only information on doctor and clinician affiliations with groups, hospitals, and Advanced Payment Models (APMs). The Medicare Care Compare site includes almost all Medicare-billing doctors and clinicians, based on Medicare’s Provider Enrollment, Chain, and Ownership System (PECOS).
 
The Medicare Care Compare site is available here.
 
CMS Releases Medicaid Coverage and Behavioral Health Data
On November 15th, CMS released a new Medicaid “Coverage and Behavioral Health Data Spotlight” brief, which examines both overall enrollment and utilization of behavioral health services by enrollees in Medicaid and the Children’s Health Insurance Program (CHIP) nationally during the period from 2018 through 2021. Some notable observations include: 

  • In 2018, about 94% of full-benefit beneficiaries were continuously enrolled for at least 12 months. Of those who were disenrolled, about 17% re-enrolled within three months, and 36% re-enrolled within 12 months.
  • Mental health services per enrollee increased slightly from 2018 to the start of 2020, but declined to below the 2018 level over the period from 2020 to the end of 2021. The number of mental health services delivered dropped below 100 per 1,000 beneficiaries for the first time in December 2021. An increase in telehealth utilization was insufficient to offset the decline in the rate of outpatient mental health service utilization overall.

The brief also examines follow-up rates and patient-reported outcome measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS). The full brief is available here.
 
CMMI to Hold VBID Hospice Webinar 
On December 1st at 3pm ET, the Center for Medicare and Medicaid Innovation (CMMI)’s Value-Based Insurance Design (VBID) Model Team will host a Hospice Provider Webinar. The webinar will present information and policies for Calendar Year (CY) 2023 of the Hospice Benefit Component of the VBID Model, including the recently released 2023 VBID Hospice Minimum Number of Providers Public Data Book. The webinar will also include an overview of an October 2022 RAND report on the first two years of the program’s implementation.

Registration for the webinar is available here. Questions may be submitted in advance by email at VBID@cms.hhs.gov. The RAND report is available here.
 
CMS Releases Estimated Improper Payment Rates for 2022
On November 15th, CMS released estimates for the improper payment rates in Medicare, Medicaid, and CHIP in 2022 and for Federally-facilitated exchanges from benefit year 2020. CMS’s estimates for these rates by program are: 

  • 2022 Medicare fee-for-service (FFS): 7.5%, below the 10% statutory threshold but above the 6.3% rates achieved in both 2020 and 2021.
  • 2022 Medicare Part C: 5.4%. This estimate is “not directly comparable” with previous estimates because of policy and methodology refinements.
  • 2022 Medicare Part D: 1.5%, a “slight increase” from 1.3% in 2021.
  • 2022 Medicaid: 15.6%, a decrease from the 2021 reported rate of 21.7%. Most improper payments (86.8%) are estimated to be the result of insufficient documentation.
  • 2022 CHIP: 26.8%, a decrease from the 2021 reported rate of 31.8%. Most improper payments (76.1%) are estimated to be the result of insufficient documentation.
  • 2020 Federally-facilitated exchanges: 0.6%. This is the first year that CMS has reported on this program’s improper payment rate.

CMS’s press release on these estimates is available here.
 
CMS Doctor/Clinician Preview Period Begins November 21st
On November 21st, Medicare’s Doctors and Clinicians Preview Period officially opens, allowing providers to view 2021 Quality Payment Program (QPP) performance information before it appears on Medicare Care Compare and in the Provider Data Catalog. Accountable Care Organization (ACO) level data will not be available during this period. MIPS-eligible clinicians who participate in Medicare Shared Savings Program ACOs can preview their performance information in their 2021 MIPS Performance Feedback. Shared Savings Program ACOs can also review quality performance information in their previously provided 2021 Quality Performance Reports.
 
The preview can be accessed on the QPP website here. The preview period closes on December 20th.

Other Updates

CBO Presents on Medicaid Baseline Forecast
On November 15th, the Congressional Budget Office (CBO) released a presentation describing its process for issuing its Medicaid baseline spending forecast. The presentation lays out CBO’s considerations for the main drivers of growth in Medicaid costs, including enrollment, prices, and other elements. CBO noted that it has “no historical model of Medicaid price growth during periods of higher inflation,” creating additional uncertainty if inflation persists.
 
The current baseline forecast, from May 2022, is based on the expiration of the Covid-19 public health emergency in July 2023, which will cause a notable decrease in enrollments over the following year. CBO projects that the average monthly Medicaid enrollment will decrease from 87 million in 2023 to 75 million by 2025, thereafter remaining steady for several years. Meanwhile, per-enrollee spending is expected to increase at 4.8% per year during the CBO’s forecast window through 2032, from $6,100 to $10,200.
 
The presentation is available here, and CBO’s May 2022 baseline is available here.
 
Leapfrog Group Releases Fall 2022 Hospital Safety Grade Report
On November 16th, the Leapfrog Group released its fall 2022 Leapfrog Hospital Safety Grade report. In addition to basic hospital grading, the fall 2022 report also looked at hospital safety data over time, given that this is the 10th year of the release of Leapfrog grades. Overall, Leapfrog found improvements in safety over this period. Though many measures have changed over time, Leapfrog states that five measures consistently tracked over the last decade indicate that “improvements saved an estimated more than 16,000 lives over the 10-year period.” In particular, measures related to two “never” events—falls and trauma and objects left in a body—improved by 25% over the decade.  Pre-pandemic progress on healthcare-associated infections included: 

  • Methicillin-resistant Staphylococcus aureus (MRSA) decreased by 22%;
  • Central line-associated bloodstream infection (CLABSI) decreased by 43%; and
  • Clostridioides difficile infection (C. Diff) decreased by 8%.

Nationally, 30% of hospitals received a grade of A, 28% received a B, 36% received a C, 6% received a D, and 1% received an F. In New York, 19 of 151 hospitals (13%) received an A, while none received Fs.
 
The full Leapfrog report appears here.  
 
HHS OIG Says About 80% of Long-Stay Nursing Home Residents Were Prescribed Psychotropic Drugs
On November 14th, the HHS Office of the Inspector General (OIG) released a report entitled “Long-Term Trends of Psychotropic Drug Use in Nursing Homes.” OIG’s concern about the use of psychotropic medications in nursing homes began in 2011, at which time they encouraged the Centers for Medicare and Medicaid Services (CMS) to begin monitoring nursing home residents’ use of antipsychotics. In May 2021, OIG published a report showing that CMS’s methods for monitoring antipsychotic use by nursing home residents did not provide complete information.

In its latest report, OIG found that from 2011 through 2019, roughly 80% of Medicare’s long- stay nursing home residents were prescribed an antipsychotic drug. The report shows that while the use of antipsychotics dropped, the use of anticonvulsants, another category of psychotropic drugs, increased. Higher use of psychotropic drugs was associated with nursing homes with lower ratios of registered nurse staff to residents and higher percentages of residents with low- income subsidies. OIG also found that the number of unsupported schizophrenia diagnoses increased and was concentrated in a small number of facilities.

OIG makes three key recommendations in the report, encouraging CMS to: 

  • Evaluate the use of psychotropic drugs among nursing home residents to determine whether additional action is needed to ensure that use among residents is appropriate;
  • Use data to identify nursing homes or nursing home characteristics that are associated with a higher use of psychotropic drugs and focus oversight on nursing homes in which trends may signal inappropriate use; and
  • Expand the required data elements on Medicare Part D claims to include a diagnosis code.

CMS concurred with the first two recommendations; it did not concur with the third. The full report is available here.

New York State Updates

OMH Finalizes Updated Article 31 Clinic MHOTRS Regulations
Today (November 21st), the New York State Office of Mental Health (OMH) finalized changes to the Part 599 regulations for Article 31 outpatient mental health clinics. Article 31 clinics have been reclassified as rehabilitative services under the Medicaid state plan under the name “Mental Health Outpatient Treatment and Rehabilitation Services” (MHOTRS). The regulatory amendments add flexibility for billing and waiver processes, allow for the provision of peer/family support services, and allow offsite services for all populations served within MHOTRS.

The final regulations are available here. Changes since the proposed version, which SPG summarized in its June 27th update here, are largely technical in nature.

OMH also included supplemental guidance on the provision of the new peer services, which is available here. SPG will send a more detailed summary to behavioral health clients later this week.
 
CMS Approves New York SPA Permitting Licensed Psychologists to Provide OLP Services under CFTSS 
On November 15th, CMS approved New York’s State Plan Amendment (SPA) to allow Licensed Psychologists to provide Other Licensed Practitioner (OLP) services under the Child and Family Treatment and Support Services (CFTSS) program. This change is effective July 1, 2022.

As a result, the following non-physician licensed behavioral health practitioners (NP-LBHP) licensed in New York State may provide OLP services:  

  • Licensed Psychoanalyst
  • Licensed Clinical Social Worker (LCSW)
  • Licensed Marriage & Family Therapist
  • Licensed Mental Health Counselor 
  • Licensed Creative Arts Therapist
  • Licensed Psychologist
  • Licensed Master Social Worker (LMSW) under the supervision of a LCSW, Licensed Psychologist, or Psychiatrist

The SPA is available here. The CMS approval letter is available here.
 
DOH Expands Healthcare Worker Bonus Program to Health Homes and Others
On November 17th, the New York State Department of Health (DOH) announced that the Healthcare Worker Bonus (HWB) Program has been expanded to include both newly eligible employers and titles, as follows:  

  • New Qualified Employers
    • DOH-funded Health Homes
    • DOH-funded Permanent Supportive Housing Agencies
  • New Eligible Titles
    • Health Home Care Managers
    • Security Guards and Peace Officers (in residential and institutional settings only)
  • New Employers Who May Submit Qualifying “All Other Healthcare Support Workers”
    • OMH Psychiatric Centers
    • OASAS Addiction Treatment Centers
    • Residential programs operated or certified by OPWDD, OMH, and OASAS
    • Medicaid Assisted Living Programs
    • Hospice Residences

There will be a special submission period open only to employers and employees included in this expansion. The special submission period will begin in December (exact date TBD) and will remain open for 30 days. During this period, employers (including newly eligible employers) should submit claims on behalf of eligible workers for Vesting Period 1 (October 1, 2021 – March 31, 2022) and Vesting Period 2 (April 1, 2022 – September 30, 2022). After this period, employers should follow the same vesting period schedule as other employers for the remainder of the program. Providers should not submit claims for any expanded employers or titles until the new submission period opens.
 
Additional details are available on the HWB Program webpage here.

Funding Opportunities

DHS Releases RFP for Street Homelessness Outreach Services in NYC
On November 9th, the New York City Department of Homeless Services (DHS) released a Request for Proposals (RFP) for the provision of street outreach, case management, and housing placement services to homeless individuals in the five boroughs. There will be a single contractor awarded in each borough. DHS will award over $111 million in total funding across the five contracts during the three-year program period. Moving a client to permanent housing, a drop-in center, stabilization bed, safe haven, or shelter is a targeted outcome.
 
Applicants must have experience working with vulnerable populations, overseeing off-site staff, and meeting clients where they are with respect to substance use and treatment. Applicants should also have experience collaborating with ambulatory or inpatient detoxification services, residential treatment services, housing providers, behavioral health crisis treatment and care coordination services, and syringe service programs. Contracts will last for three years, starting on July 1, 2023, with the option to renew for an additional three-year term.
 
The RFP is available in the PASSPort system here by searching “Outreach.” Applications are due on December 14th. Questions may be submitted to ACCOContractPlanning@dss.nyc.gov through November 30th.  DHS will host a pre-proposal conference on November 30th at 10am which may be accessed here.
 
NYC DSS IssuesCongregate andScattered-Site Supportive Housing Open-Ended RFPs
On November 10th, the New York City Department of Social Services (DSS) released two RFPs for: 

  • 7,500 units of Congregate Supportive Housing; and
  • 6,578 units of Scatted-Site Supportive Housing.

The Congregate Supportive Housing RFP will fund supportive services; however, rental assistance and capital funding must be secured elsewhere. For the Scattered-Site Housing RFP, anticipated operating costs (inclusive of utilities) may not exceed the City’s designated annual operating rates, less $215 per head of household rent contribution at an expected collection rate of 75 percent annually. The anticipated payment structure is a line-item budget which may be converted to a unit rate. Contracts for both RFPs will last for five years, with the option to renew for up to four additional years.

The RFP documents are available in the PASSPort system here. The RFPs are open-ended and applications will be accepted on an ongoing basis. Questions may be submitted to Bukola Olode at olodeb@hra.nyc.gov.