Weekly Health Care Policy Update – March 14, 2023

March 21, 2023

In this update: 

  • Administration Updates
    • Biden Administration Releases FY 2024 Budget
  • Federal Agencies
    • CMS Releases FAQ on MA Advance Notice as AHIP, Others Submit Comments
    • ONC Issues 2022 Report to Congress
    • CMS to Hold Pre-Rulemaking Season Kick-Off Webinar
    • HHS Releases Cybersecurity Guide
  • Other Updates
    • MedPAC Holds March 2023 Meeting
    • MACPAC Holds March 2023 Meeting
  • New York State Updates
    • DOB Releases 30-Day Amendments to FY 2024 Executive Budget Legislation
    • Governor Hochul Signs Package of Health Care-Related Bills
  • Funding Opportunities
    • OASAS Releases RFA for Delivery of Street Outreach and Engagement Services
    • SAMHSA Releases NOFO for Implementation of Zero Suicide Intervention
    • SAMHSA Releases NOFO for Behavioral Health Services and Supports for Transition-Aged Youth
    • HRSA Announces $25 Million for School-Based Health Centers with Mental Health Services
    • HRSA Issues NOFO for Pathway to Registered Nurse Program

Administration Updates

Biden Administration Releases FY 2024 Budget
On March 9th, the Biden Administration released its fiscal year (FY) 2024 budget request. While the President’s budget has no force of law and most provisions are unlikely to be implemented, it marks the beginning of appropriations season and delineates many of the Administration’s priorities for the coming year. Key details from the budget regarding health care policy include:
 
Medicare

  • Solvency – The budget seeks to extend the solvency of the Medicare Trust Fund by at least 25 years by repealing the Trump tax cuts for the highest-income Americans (restoring the top tax rate of 39.6 percent for single filers making more than $400,000 a year and married couples making more than $450,000 per year), directing such revenue into the Medicare Hospital trust fund, and directing savings from proposed Medicare drug reforms into the Medicare Hospital trust fund.
  • Behavioral health in Medicare – The budget would: 
    • Remove Medicare cost-sharing for three mental or behavioral health care visits per year;
    • Establish a new parity requirement between behavioral health and medical benefits in Medicare;
    • Add Medicare coverage for new Medicare provider types, including peer support workers and certified addiction counselors, and services, including evidence-based digital applications for mental health; and
    • Abolish the 190-day lifetime limit on inpatient psychiatric stays.

Medicaid

  • Investments – The budget would: 
    • Provide $150 billion over 10 years to enhance Medicaid home and community-based services (HCBS);
    • Seek to double the size of the Federally Qualified Health Center (FQHC) program; and
    • Make the Certified Community Behavioral Health Center (CCBHC) demonstration program permanent.
  • Maternal health and health equity – The budget would require all state Medicaid programs to provide continuous coverage to pregnant women until 12 months postpartum. It also includes $471 million in funding for initiatives to: 
    • Reduce maternal mortality and morbidity rates;
    • Expand maternal health initiatives in rural communities;
    • Implement implicit bias training for health care providers;
    • Create pregnancy medical home demonstration projects; and
    • Address the highest rates of perinatal health disparities, including by supporting the perinatal health workforce.

General

  • Health care costs – The budget seeks to make permanent the average $800 per year premium cut to Marketplace plans through expanded premium tax credits.
  • Prescription drug costs – The budget seeks to extend new drug negotiation power to more drugs, to limit Medicare Part D cost-sharing for high-value generic drugs used for certain chronic conditions to no more than $2, to authorize the Department of Health and Human Services (HHS) to negotiate supplemental drug rebates on behalf of interested state Medicaid programs, to curb inflation in prescription drug prices, and to cap the price of insulin products at $35 per month in the commercial market.
  • Workforce – The budget would provide $966 million in 2024 to expand the National Health Service Corps and $350 million to expand programs that train and support the nursing workforce.
  • Cancer Moonshot – The budget includes $1.7 billion for dedicated Cancer Moonshot activities across HHS. The budget also invests $7.8 billion in the National Cancer Institute.
  • ARPA-H – The budget provides an increase of $1 billion for the Advanced Research Projects Agency for Health (ARPA-H), for a total of $2.5 billion.
  • Medical leave – The budget proposes to establish a national paid family and medical leave program, providing up to 12 weeks of leave to allow eligible workers to take time off for family or medical reasons.

The full summary of the President’s budget is available here.

Federal Agencies

CMS Releases FAQ on MA Advance Notice as AHIP, Others Submit Comments
On March 7th, the Centers for Medicare and Medicaid Services (CMS) published a Frequently Asked Questions (FAQ) document on the 2024 Medicare Advantage (MA) Advance Notice. The 2024 Notice has provoked controversy, with industry groups claiming that the Notice represents a significant cut to the MA program. Notably, America’s Health Insurance Plans (AHIP) submitted its comments on March 6th, focusing on what it calls a “flawed revision to the proposed risk model” which involves “numerous changes to the diagnoses and condition categories.” CMS projected that the impact of these changes would be -3.1% nationally.
 
AHIP highlighted the results of a study by Wakely that it commissioned on the effects of the changes, which are intended to “minimize HCCs susceptible to discretionary coding,” and which found that the decrease would be particularly significant for dual eligibles (-6.4% overall), while increasing the scores for new enrollees, “reflecting an overall diminishing of the contributions of HCCs to risk scores.” Wakely also noted that the “variation of impact” between plans and between geographies was “drastic,” with a variance of “140% between the minimum and maximum change in risk scores.” It found that plans in the Northeast would on average benefit (a 1.1% increase in scores), while plans in the South and West would be adversely impacted (a 4.9% and 4.2% decrease in scores).
 
The new CMS FAQ responds to some of these criticisms. It notes that MA payments, after all adjustments, will still increase by 1.03%, or $4 billion, which is “in line with past payment updates,” while recent updates have been higher than usual. CMS also states that the proposed updates to the risk model are “in line with the routine updates CMS has made in the past.” Finally, CMS reiterates that the removal of diagnoses codes from the risk adjustment model will not have an impact on beneficiary access to services.
 
The CMS FAQ is available here. AHIP’s comments on the Advance Notice are available here, and the Wakely analysis is available here.
 
ONC Issues 2022 Report to Congress
On March 6th, the Office of the National Coordinator for Health Information Technology (ONC) released the ONC’s 2022 Report to Congress. The report discusses progress in health IT adoption and usage since the passage of the HITECH Act in 2009: 

  • As of 2021, almost all hospitals (96 percent) and about 80 percent of physicians have adopted an electronic health record (EHR).
  • Hospitals have increasingly engaged in the four domains of electronic usage of health information (sending, receiving, finding, and integrating health information), with 62% of hospitals engaging in all four.
  • In 2020, 59% of patients were offered access to data through a patient portal, and about three in five of those (38% total) used this option.

ONC notes that further progress is needed in several areas, including “changing the culture of information sharing” to encourage providers to be more engaged with data exchange. To address this, ONC notes that Congress could statutorily authorize HHS to issue “binding advisory opinions” on whether a particular set of facts constitutes information blocking, which would allow HHS to expand and clarify guidance on these issues. ONC also notes that significant gaps remain among some providers, including long-term care providers, behavioral health providers, hospice, and HCBS providers.
 
The full report is available here.
 
CMS to Hold Pre-Rulemaking Season Kick-Off Webinar
On March 21st, at 12pm ET, CMS will hold a webinar to serve as a “2023 Pre-Rulemaking Season Kick-Off” session. The pre-rulemaking process, established by the Affordable Care Act (ACA), provides transparency into CMS’s regulatory process by requiring CMS to publish a list of Measures Under Consideration (MUC). This process allows stakeholders to have a voice in the selection of measures that produce publicly reported performance results. The webinar will address: 

  • Requirements for the Measures Under Consideration (MUC) List;
  • The process for pre-rulemaking; and
  • Resources available on the CMS pre-rulemaking website.

Registration is available here.
 
HHS Releases Cybersecurity Guide
On March 8th, the HHS Administration for Strategic Preparedness and Response (ASPR) published a document called the “Cybersecurity Framework Implementation Guide.” The guide, written in partnership with the Health Sector Coordinating Council (HSCC) Cybersecurity Working Group, the National Institute for Standards and Technology (NIST), and other federal agencies, is intended to provide “specific steps that health care organizations can take immediately to manage cyber risks to their information technology systems.” It also serves as a roadmap for organizations to implement the NIST Cybersecurity Framework, a risk management model that has become “the standard for government agencies and industry in managing cybersecurity risks.”
 
The document specifically includes information on:  

  • Guiding risk management principles and best practices;
  • Providing common language to address and manage cybersecurity risks;
  • Outlining a structure for organizations to understand and apply cybersecurity risk management; and
  • Identifying effective standards, guidelines, and practices to manage cybersecurity risk cost-effectively based on business needs.

The full guide is available here.

Other Updates

MedPAC Holds March 2023 Meeting
On March 2nd and 3rd, the Medicare Payment Advisory Commission (MedPAC) met for its March meeting. Highlights from the meeting include: 

  • Medicare Advantage payment policy: MedPAC staff noted that new analysis found that MA populations showed favorable selection bias, in which beneficiaries with lower-than-predicted costs (based on risk score) are more likely to enroll in MA, suggesting that the utility of the fee-for-service (FFS) Medicare population as a benchmark is decreasing. The commission discussed three possible proposals: 1) competitive bidding, or using plan bids to calculate benchmarks; 2) using data on spending from both FFS and MA to calculate benchmarks; and 3) using a fixed growth rate to increase spending. Commissioners were most supportive of the first and second options.
  • Aligning fee-for-services payment rates across ambulatory settings: Commissioners reviewed a recommendation for aligning payment rates for select services across three ambulatory settings—freestanding offices, ambulatory surgery centers, and hospital outpatient departments—such that the payment rate would more closely match the lowest cost setting.
  • Medicare Part B drug prices: Commissioners were supportive of draft recommendations to cap payments for accelerated approval drugs, and to use reference pricing for biosimilars and biologics with similar health effects.
  • Medicare wage index: Commissioners reviewed a proposed alternative wage index method that would use cross-industry, occupation-level wage data; reflect county-level differences in wages between and within metropolitan statistical areas and statewide rural areas; cap wage index differences across adjacent counties; and have no exceptions.

In addition, the meeting included a session on a mandated report on evaluation of a prototype design for a post-acute care prospective payment system.
 
All presentation slides from the meeting are available here. The next MedPAC meeting will be held on April 13th and 14th.  
 
MACPAC Holds March 2023 Meeting
On March 2nd, the Medicaid Access and Payment Advisory Commission (MACPAC) met for its March meeting. Highlights from the meeting include: 

  • Countercyclical Disproportionate Share Hospital (DSH) Allotments: Several commissioners supported adjusting federal DSH allotments so that total state and federal DSH funding is not affected by FMAP (Federal Medicaid Assistance Percentage) changes.
  • Unwinding the Continuous Coverage Requirements and Other Flexibilities: Commissioners discussed support for Section 1902(e)(14)(A) waivers, state call center capacity; handling returned mail from beneficiaries; and collecting information regarding dual-eligible beneficiaries.
  • Managed Care External Quality Review (EQR) Study Findings: Commissioners discussed the impact of EQRs on quality strategies; how states might increase their impact; and how states use EQRs.
  • CMS Proposed Rule on Disclosures of Nursing Facility Ownership: Commissioners will submit formal comments on the proposed rule.

In addition, the meeting included sessions on pre-release Medicaid services to adults leaving incarceration, focus group findings on the experiences of full-benefit dually eligible beneficiaries in integrated care models, and a panel on state flexibilities to coordinate care in the absence of full-risk capitation.
 
All presentation slides from the meeting are available here. The next MACPAC meeting will be held on April 13th and 14th.

New York State Updates

DOB Releases 30-Day Amendments to FY 2024 Executive Budget Legislation
On March 3rd, the New York State (NYS) Division of the Budget (DOB) published 30-day amendments to Governor Hochul’s Fiscal Year (FY) 2024 Executive Budget legislation. The Assembly and Senate’s one-house versions of the budget proposal are scheduled to be released today (March 14th). The three versions of the bills will then form the basis for negotiations in the closing weeks of March, with the aim to enact a final budget by April 1st.
 
Notable health care-related changes in the Executive’s 30-day amendments are:  

  • Removal of an “unnecessary” $1.5 million capital appropriation for the Hospital Capacity Direct Access program, which seek to automatically assess real-time hospital bed capacity.
  • Clarification of criteria for managed long-term care (MLTC) plans that would be eligible to meet performance standards. Specifically, eligible MLTC plans must either:  
    • Have continuous enrollment in the MLTC plan of at least 20,000 enrollees;
    • Operate a Medicare Dual Eligible Special Needs Plan (D-SNP) with continuous enrollment of at least 5,000 enrollees in the last year; or
    • Operate an integrated Medicaid product (i.e., Medicaid Advantage Plus) with continuous enrollment of at least 5,000 enrollees in the last year. 
  • Clarification that arthritis self-management services are considered a “chronic disease self-management program,” and that the ordering professional should have an affiliation with an organization nationally certified by the Self-Management Resource Center or a successor organization.

The 30-day amendments are available here.
 
Governor Hochul Signs Package of Health Care-Related Bills
Governor Hochul has recently signed into law the following health care-related legislation:  

  • S836/A2200 requires insurers or pharmacy benefit managers (PBMs) to provide cost, benefit, and coverage data upon request of a patient or their health care provider. Medicaid plans are exempted from this requirement.
  • S2228/A2201 directs the Commissioner of Health to develop a list of emergency drugs that are exempt from the 30-day supply requirement during a state emergency, which will include all Schedule II-III controlled substances.
  • S1355/A1975 removes the requirement for insurance plans to cover creative arts therapists under behavioral health parity provisions.  
  • S1330/A2205 delays the effective date of the Hospital Equity and Affordability Legislation (HEAL) Act from January 1, 2023 to July 1, 2023 and expands prohibitions to Article 44 corporations and group health plan contracts.
  • S853/A608 ensures that pharmacists are authorized to administer only FDA-approved medications.
  • S2230/A1706 outlines specific procedures for the closure and/or decertification of assisted living facilities.
  • S845/A627 aligns regulations with federal guidance for long-term care facilities regarding infectious disease control planning and procedures.
  • S1342/A997 limits availability and coverage for non-invasive prenatal testing for Medicaid patients based on age if such limits are recommended by the federal government.
  • S1348/A3770 requires the Department of Health (DOH) to post on its website and in the State Register certain changes to the model contract with managed care providers prior to federal submission.

Funding Opportunities

NYC HRA Releases Open-Ended Congregate Supportive Housing RFP
On March 8th, the New York City (NYC) Human Resources Administration (HRA) released a Request for Proposals (RFP) for the maintenance and operation of approximately 7,500 congregate (single-site) supportive housing units through the NYC 15/15 housing plan. Funding through this RFP will only provide support services and not rental assistance; providers may secure other sources of funding for rental assistance or capital. The anticipated payment structure is a line-item budget which may be converted to a unit rate.
 
Applicants must be not-for-profit 501(c)(3) organizations with at least five years of relevant experience. Contracts for 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 by searching “supportive housing.” The RFP is open-ended and applications will be accepted on an ongoing basis. Questions may be submitted to Bukola Olode at olodeb@hra.nyc.gov.
 
OASAS Releases RFA for Delivery of Street Outreach and Engagement Services
On March 8th, NYS Office of Addiction Services and Supports (OASAS) released a Request for Applications (RFA) for street-level Outreach and Engagement Services (OES) in communities with limited access to harm reduction, substance use disorder (SUD) treatment, and recovery support services. OASAS is seeking applicants to provide OES, which may include but is not limited to: 

  • Peer services;
  • Overdose prevention and intervention education;
  • Harm reduction strategies;
  • Linkage to SUD treatment, including medication for addiction treatment (MAT);
  • Naloxone dispensing and/or prescribing; and
  • Care management.

Through this opportunity, OASAS will award annual grants of up to $250,000 to twelve awardees during a two-year program period. There will be one award each in Kings and Queens counties, and the remaining 10 awards will be allocated across the rest of the state (outside of NYC). Rest of state applicants are also eligible for up to $75,000 for the cost of a vehicle purchase. Eligible applicants are non-profit entities that meet one of the following criteria and have an existing program located in the county where it intends to conduct outreach: 

  • Operators of OASAS-certified, funded, or otherwise authorized SUD treatment programs;
  • Operators of Office of Mental Health (OMH)-licensed, mental health services programs;
  • OMH Safe Options Supports (SOS) providers;
  • DOH-certified hospitals;
  • Syringe Service Programs;
  • DOH Drug User Health Hubs; and
  • Federally Qualified Health Centers (FQHCs).

OASAS-certified providers that received funding for OES (formerly known as Centers of Treatment Innovation) through State Targeted Response are not eligible applicants. Providers seeking to apply to serve more than one geographic area must submit separate applications for each geographic area; however, only one award will be made per provider through this procurement.
 
The RFA is available here. Applications are due on April 19th. Questions may be submitted to Grants@oasas.ny.gov with the subject line “RFA SETT-23006” through March 17th.
 
SAMHSA Releases NOFO for Implementation of Zero Suicide Intervention
On March 7th, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a Notice of Funding Opportunity (NOFO) for the implementation of the Zero Suicide intervention and prevention model. This model aims to reduce suicide ideation, suicide attempts, and deaths due to suicide. Applicants are expected to provide direct services as outlined in the Zero Suicide framework (available here), including convening a steering council to oversee the program, implementing training programs for the health care workforce, and using evidence-based treatments that address suicidal thoughts and behaviors.
 
Through this opportunity, SAMHSA will award over $12 million in total annual funding to 17 applicants (up to $400,000 annually per awardee) over a five-year program period. Eligible applicants include community-based primary care or behavioral health care providers and emergency departments.
 
The NOFO is available here. Applications are due on May 8th. Questions may be submitted to Michelle Cornette at michelle.cornette@samhsa.hhs.gov.
 
SAMHSA Releases NOFO for Behavioral Health Services and Supports for Transition-Aged Youth
On March 7th, SAMHSA released a NOFO for the provision of services and supports to transition-aged youth and young adults (ages 16-25) who have or are at risk for serious mental health conditions. Funding will support organizations with identifying and providing behavioral health interventions to improve emotional and behavioral health in this population. Activities include, but are not limited to: 

  • Creating, implementing, and expanding services and supports;
  • Improving cross-system collaboration, service capacity, and expertise related to transition-aged youth; and
  • Implementing public awareness and cross-system provider training.

Through this opportunity, SAMHSA will award over $11.3 million in total annual funding to 15 applicants (up to $750,000 annually per awardee) over a five-year program period. Eligible applicants include health facilities and other public and private non-profit entities.
 
The NOFO is available here. Applications are due on May 8th. Questions may be submitted to Kate Perrotta at Kathryn.Perrotta@samhsa.hhs.gov.
 
HRSA Announces $25 Million for School-Based Health Centers with Mental Health Services
On March 10th, the Health Resources and Services Administration (HRSA) released a NOFO for the FY 2023 Health Center Program School-Based Service Expansion (SBSE) program. Under this NOFO, HRSA will offer $25 million to approximately 70 awardees to establish or expand school-based health services. HRSA notes that this is the first time it has required applicants to add or expand mental health services as a condition of the grant.
 
Applicants may establish a new site (up to $350,000 per year per award) or expand an existing one (up to $250,000 per year per award). Contracts will last two years, from September 2023 through August 2025. Applicants must be existing Health Center recipients with an active H80 grant award, and must have documentation of support from the school or school district with which they are partnering.
 
The application requires a two-stage submission process; the first stage, a Grants.gov application, must be submitted by March 31st, and the second stage, HRSA Electronic Handbooks, must be submitted by May 1st. More information is available on HRSA’s website here. The full NOFO is here.
 
HRSA Issues NOFO for Pathway to Registered Nurse Program
On February 27th, HRSA issued a NOFO for the Pathway to Registered Nurse Program (PRNP). Under this NOFO, HRSA is offering up to $1 million per year over four years to fund approximately eight cooperative agreements to offer support for licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) to gain a full credential as a registered nurse (RN). Eligible applicants should be accredited schools of nursing, health facilities (such as FQHCs or nurse-managed health clinics), or a partnership between the two entities.
 
This program, part of the wider Nurse Education Practice, Quality, and Retention program, is intended to support the creation of pathways from academic training to clinical experience for LPNs and LVNs. Funds may be used to: 

  • Develop or enhance an accredited LPN/LVN-to-RN bridge program;
  • Provide direct support to LPN and LVN students of such programs, such as tuition support or stipends;
  • Develop curricula and partnerships between clinical and educational institutions; and
  • Recruit and retain faculty and clinical preceptors for such programs.

Applications will be accepted through April 27th. A technical assistance webinar will be held on March 21st at 1pm. More information is available on HRSA’s website here. The application is available on Grants.gov here.