Weekly Health Care Policy Update – September 25, 2023

October 2, 2023

In this update:

  • Administration Updates
    • White House to Boost Covid Test Manufacturing
  • Legislative Updates
    • House Fails to Advance Spending Legislation; Shutdown Likely
    • Congress Passes Organ Donation Overhaul Bill
  • Federal Agencies
    • CMS Finalizes Rule to Simplify Medicare Savings Program Enrollment 
    • SAMHSA Awards $128 Million in CCBHC Expansion Grants
    • HHS and Other Agencies Issue New Proposed Rule on IDR Fee Methodology
    • HRSA Awards $8 Million to Train Providers to Care for Patients with Disabilities and Limited English Proficiency
    • CFPB Proposes to Remove Medical Debt from Credit Reports
  • Other Updates
    • Joint Commission to Launch Environmental Sustainability
    • JAMA Publishes Study on Hospital Prices and Shoppable Service Transparency
    • Commonwealth Fund Issues Report on Medicare Affordability
      Measure
  • New York State Updates
    • OMH Hosts Provider Webinar, Seeks Feedback on Draft Guidance for Psychiatric Inpatient Programs and Emergency Rooms
    • OMH to Host In-Person and Virtual Town Hall on November 30th
    • CMS Approves New York SPAs Implementing COLA Rate Increase for CFTSS and CPEP EOB Services
    • OPWDD to Host Stakeholder Town Hall Discussions to Inform Managed Care Assessment
  • Funding Opportunities
    • DOH Releases RFA for Coordination of Gun Violence Prevention Youth-Based Programs
    • DOH Releases RFA for Sexual Risk Avoidance Education Programs
    • HRI and DOH Release Two Funding Opportunities to Promote Colorectal Cancer Screenings

Administration Update

White House to Boost Covid Test Manufacturing 
On September 20th, the Biden Administration announced a new $600 million investment in domestic Covid-19 rapid test manufacturing and the reopening of its free service through COVIDTests.gov. Beginning September 25th, households will again be able to order four free tests. The manufacturing awards were granted to 12 companies, including two in New Jersey, and are expected to yield approximately 200 million new over-the-counter tests for future use, as well as building up capacity to prepare for new threats in the future.
 
The announcement is available here.

Legislative Updates

House Fails to Advance Spending Legislation; Shutdown Likely  
Last week, the House failed to pass legislation to fund the government beyond the end of the fiscal year on September 30th. Republican leadership has been unable to convince its ranks to pass measures to sustain federal funding, including any short-term continuing resolution (CR). Even if Republicans were to craft a bill with such cuts, it stands no chance of passing the Senate. The consensus most likely outcome remains that Congress will eventually pass a clean CR, which would fund government programs at current levels, but a government shutdown in the meantime is now very likely.
 
Along with funding, the authorization of other important legislation will also expire on September 30th. Affected bills and prorgams include the Pandemic and All Hazards Preparedness Act, the SUPPORT Act, Community Health Center Fund, the National Health Service Corps, Food and Drug Administration (FDA) User Fee programs, the Farm Bill, and others. In addition, federal employees and active military service members will stop receiving paychecks, FEMA’s Disaster Relief Fund would be quickly depleted, thousands of Head Start children would immediately lose access to programming, air traffic controllers and TSA offers would stop receiving paychecks, and EPA, FDA, and OSHA inspections would cease. The Medicare program can go on largely uninterrupted for only a period of time.
 
The most recent (and longest) government shutdown occurred under President Trump at the end of 2018, a 35-day closure. That shutdown was estimated to have reduced the gross domestic product by $8 billion.
 
A contingency plan for the Department of Health and Human Services is available here. A contingency plan for the Social Security Administration is available here. A White House statement on the potential closure is available here. The Biden Administration’s contingency plans can be found here. 
 
Congress Passes Organ Donation Overhaul Bill
On September 22nd, President Biden signed into law H.R. 2544, the Securing the U.S. Organ Procurement and Transplant Network Act. In July, the legislation passed the House by voice vote and received unanimous support in the Senate. The Network is a public-private partnership that links organizations and professionals involved in the organ donation and transplant system. Since 1986, the United Network for Organ Sharing (UNOS) has been the sole recipient of a contract to manage the Network. Under the new law, the Health Resources and Services Administration is expressly authorized to award multiple grants, contracts, or cooperative agreements to support operation of the network, and the existing cap on the amount of funding available to support the Network is eliminated.
 
Information on the new law is available here.

Federal Agencies

CMS Finalizes Rule to Simplify Medicare Savings Program Enrollment  
On September 18th, the Centers for Medicare and Medicaid Services (CMS) finalized a rule to streamline enrollment in the Medicare Savings Program (MSPs). MSPs are run through state Medicaid programs and cover Medicare premiums and often cost-sharing for more than 10 million older adults and individuals with disabilities with limited incomes. The rule will simplify the enrollment process, which is viewed as burdensome by many. Given the overlap with people receiving Supplemental Security Income, the rule will automatically enroll recipients in the most comprehensive MSP coverage.
 
The rule is available here.
  
SAMHSA Awards $128 Million in CCBHC Expansion Grants
On September 22nd, the Substance Abuse and Mental Health Services Administration announced the award of $127.7 million for 128 new Certified Community Behavioral Health clinic (CCBHC) expansion grants. CCBHCs provide services to anyone in need, regardless of their ability to pay, location, or age. They receive a single per visit Medicaid rate designed to cover costs.
 
The new grants were awarded in 40 states and Puerto Rico and provide up to $1 million per year for four years. Of these grants, 63 are for CCBHC Planning, Development, and Implementation (PDI) to assist with the development of new programs, while 65 are for CCBHC Improvement and Advancement (IA) to enhance and support existing CCBHCs. Providers in New York received 15 awards, of which nine were for PDI and six were for IA.
 
A full list of awardees can be found here.
 
HHS and Other Agencies Issue New Proposed Rule on IDR Fee Methodology
On September 20th, the Departments of Health and Human Services (HHS), Treasury, and Labor released a new proposed rule to establish the independent dispute resolution (IDR) administrative fee amount and methodology under the No Surprises Act. The rule also establishes the certified IDR entity fee ranges for single and batched determinations. 
 
The proposed rule comes amidst extensive legislation on the IDR process. The Departments previously issued guidance in December 2022 on IDR fees that was vacated by a federal district court in Texas. As a result, the Departments are now issuing a rule rather than subregulatory guidance to establish IDR fees. The IDR process remains paused due to other litigation.
 
Under this rule, the Departments propose to increase the IDR administrative fee to $150 per party. Additionally, the Departments propose to increase the certified IDR entity fixed fee ranges to between $200 an $840 for single determinations, and between $268 and $1,173 for batched determinations. The Departments also propose to continue to permit a certified IDR entity to use a tiered fee structure based on the number of line items within the batch.
 
The proposed rule is available here.
 
HRSA Awards $8 Million to Train Providers to Care for Patients with Disabilities and Limited English Proficiency 
On September 15th, the Health Resources and Services Administration (HRSA) announced more the award of $8 million through 18 awards to train primary care medical students, physician assistant students, and medical residents in providing culturally and linguistically appropriate care for patients with limited English proficiency and patients with physical or intellectual and developmental disabilities. This announcement comes in response to a number of surveys and studies demonstrating that providers are ill-equipped to provide equitable care to patients in these populations. Awardees may focus on either disability-related or linguistic training. 
 
Recipients in New York include Columbia University and Long Island Jewish Medical Center. The announcement is available here.
 
CFPB Proposes to Remove Medical Debt from Credit Reports
On September 21st, the Consumer Financial Protection Bureau (CFPB) announced it is beginning a rulemaking process to remove medical bills from credit reports. Approximately 20% of Americans have medical debt, but the CFPB notes that, “given mistakes and inaccuracies in medical billing,” such data on credit reports is less predictive of future repayment than reporting on traditional credit obligations. The CFPB proposes to remove medical bills from consumers credit reports, stop creditors from relying on medical bills for underwriting decisions, and stop coercive collection practices.
 
More information is available here.

Other Updates

Joint Commission to Launch Environmental Sustainability Measure 
On September 18th, the Joint Commission announced a voluntary certification program for hospitals aiming to bolster sustainable practices and reduce greenhouse gas emissions. The Sustainable Healthcare Certification program will begin in January 2024 and is available to hospitals and critical access hospitals. It gives applicants the opportunity to be publicly recognized for their efforts to increase sustainability and decarbonization. 
 
The announcement is available here.
 
JAMA Publishes Study on Hospital Prices and Shoppable Service Transparency
On September 18th, JAMA published a study reviewing discrepancies between prices for specified shoppable services online relative to estimates given over the phone. The study included 60 hospitals (“20 top-ranked, 20 safety-net, and 20 non-top-ranked, non-safety-net hospitals”) and found that the prices for two services were poorly correlated, showing “wide variation” between self-reported cash prices and the prices offered to a secret shopper seeking care. The authors suggest that their findings “provide evidence of hospitals’ continuing problems in communicating their own prices to patients” and indicate that there remain “substantial barriers to translating newly available hospital price data into actionable information that ultimately facilitates comparison shopping.” The authors included Lenox Hill, Montefiore, Mount Sinai, New York-Presbyterian, NYU-Langone, and several Health + Hospitals sites in its survey.
 
The study is available here.
 
Commonwealth Fund Issues Report on Medicare Affordability 
On September 19th, the Commonwealth Fund released its Biennial Health Insurance Survey. The survey found that about one in five adults 65 and older with Medicare were “underinsured,” meaning their out-of-pocket costs were high relative to income, and the highest rates were among those with incomes below 200% of the federal poverty level. Over a quarter of older Medicare enrollees reported cost-related problems accessing dental care. Similar shares of older adults with either type of Medicare coverage (traditional or Medicare Advantage) reported skipping prescriptions, recommended treatments, and needed specialty care.
 
The report is available here.

New York State Updates

OMH Hosts Provider Webinar, Seeks Feedback on Draft Guidance for Psychiatric Inpatient Programs and Emergency Rooms
On September 21st, the New York State (NYS) Office of Mental Health (OMH) hosted an “All Provider Webinar” that included a discussion of OMH’s vision for improving care coordination across the continuum of care, an outline of current and forthcoming funding opportunities, and an introduction to the upcoming Critical Time Intervention (CTI) programs. The webinar also discussed draft guidance on evaluation and discharge practices for emergency departments/Comprehensive Psychiatric Emergency Programs (CPEPs) (available here) and psychiatric inpatient units (available here).

The webinar slides are available here and the recording of the webinar may be accessed here. Stakeholder feedback on the draft guidance documents may be submitted to planning@omh.ny.gov through September 29th. Questions and other feedback may be submitted to the email address above.

OMH will also host regional planning discussions next week for Long Island and New York City providers, as follows: 

  • Long Island: September 26th from 10am-11am (access here)
  • New York City: September 29th from 11am-12pm (access here)

OMH to Host In-Person and Virtual Town Hall on November 30th
On November 30th from 2pm-4pm, OMH will host a Statewide Town Hall with Commissioner Dr. Ann Sullivan. The Town Hall will seek feedback on the future of the State’s public mental health system. Comments and questions may be received online or in-person for those attending at the OMH Central Office (44 Holland Avenue, Albany, NY). Registration for the event is forthcoming.

Questions and requests for special accommodations to participate in the event may be sent to planning@omh.ny.gov through November 16th.

CMS Approves New York SPAs Implementing COLA Rate Increase for CFTSS and CPEP EOB Services
Last week, CMS approved two New York State Plan Amendments (SPAs) that increase the Children and Family Treatment and Support Services (CFTSS) rates and Comprehensive Psychiatric Emergency Program (CPEP) extended observation bed (EOB) service rates by 4 percent. These rate increases were implemented by the NYS Fiscal Year 2024 Enacted Budget, which included a 4 percent Cost of Living Adjustment (COLA) for eligible human services programs. The rate increases are effective retroactive to April 1, 2023.

The approval letter for CFTSS is available here. The approval letter for CPEP EOB services is available here.

OPWDD to Host Stakeholder Town Hall Discussions to Inform Managed Care Assessment
This fall, the NYS Office for People with Developmental Disabilities (OPWDD) will host virtual Town Hall discussions seeking stakeholder input on the use of managed care payment systems. OPWDD has invested funding from the American Rescue Plan Act to study and explore the potential effectiveness of a managed care payment model for developmental disability services statewide. As part of this effort, OPWDD contracted with Guidehouse, Inc. to evaluate if managed care or a different payment model can help improve access to and quality of services. In addition to the Town Hall discussions to inform this process, Guidehouse will be conducting an online feedback survey to help OPWDD understand service access and coordination challenges. The final report evaluating managed care is expected from Guidehouse in spring 2024.

Additional information and registration links are available here. Invitations for provider-specific sessions on September 26th and 28th will be sent directly to Care Coordination Organizations (CCOs) and provider agencies.

Funding Opportunities

DOH Releases RFA for Coordination of Gun Violence Prevention Youth-Based Programs 
On September 19th, the NYS Department of Health (DOH) released a Request for Applications (RFA) seeking one qualified organization to support grassroots community-based organizations that create and maintain local, safe spaces for youth in neighborhoods experiencing high rates of gun violence. The awarded organization will be responsible for fiscal, contractual, and project management responsibilities for the network of community-based organizations.
 
DOH will award $2.5 million annually to one awardee during the two-year program period ($5 million in total funding). Eligible applicants are not-for-profit 501(c)(3) organizations with at least three years of experience supporting public health approaches to gun violence prevention. The contract is expected to begin on February 1, 2024.
 
The RFA is available here. Applications are due on November 8th. There will be an applicant conference on October 10th at 2pm. Interested applicants may register by sending an email to ogvp@health.ny.gov with the subject line “REGISTRATION:RFA#20350” by October 3rd. Questions may be submitted to Jared.Meagher-Zayas@health.ny.gov through October 10th.
 
DOH Releases RFA for Sexual Risk Avoidance Education Programs
On September 21st, DOH released an RFA seeking to fund community-based projects that implement DOH-recommended, age-appropriate sexual risk avoidance education prevention programs to youth residing in high-need counties as identified by DOH (see Attachment 5 of the RFA). DOH will provide between 12-16 awards of up to $275,000 each in annual funding. Contracts will last for five years, starting on July 1, 2024. Applicants will be required to develop sustainability plans that detail how the proposed project activities will continue after grant funding ends.
 
Eligible applicants are not-for-profit 501(c)(3) youth-serving organizations, including Article 28 health care providers and community-based health and human service providers, that provide programming to one or more of the priority zip codes. Applicants may only apply for one NYS region (upstate or downstate) per application.
 
The RFA is available here. Applications are due on November 9th (changed from November 8th per the RFA Addendum, here). Applicants are encouraged, but not required, to submit a non-binding Letter of Interest by October 4th. Questions may be submitted to SRAERFA@health.ny.gov with the subject line “RFA# 20400 DOH01-SRAE01-2024” and a citation to the RFA section and paragraph to which the question refers through October 11th.  
 
HRI and DOH Release Two Funding Opportunities to Promote Colorectal Cancer Screenings
On September 13th, Health Research, Inc. (HRI), in partnership with DOH, released an RFA seeking organizations to fund community programs that increase colorectal cancer screening, decrease colorectal cancer cases and deaths, and improve health equity in colorectal cancer screening. Awarded organizations will be responsible for conducting community outreach and educational programs, connecting and referring individuals to services, and conducting follow-up.
 
Through this opportunity, HRI will award 12 organizations with $225,000 in total funding each over a 4.5-year grant period. Contracts will begin on January 1, 2024. Eligible applicants are licensed, not-for-profit organizations with an operating budget of less than $1 million. Applicants are not required to have experience or knowledge of cancer screening or prevention.
 
The RFA is available here. Applications are due on November 14th. There will be an applicant conference on October 4th at 10am. Interested parties may register here by October 3rd. Questions may be submitted to canserv@health.ny.gov with the subject line “RFA CCH-2023-04” and a reference to the section and page number to which the question refers through October 17th.
 
HRI and DOH also released a funding opportunity seeking Federally Qualified Health Centers (FQHCs) to participate in a project to increase colorectal cancer screening rates in FQHC primary care practice sites. Up to six clinics across up to four FQHCs will be selected for funding. Each FQHC may submit bids for up to two clinics. The funding opportunity is available here. Applications are due on November 16th. Questions may be submitted to canserv@health.ny.gov with the subject line “Increasing CRC Screening in FQHCs” through October 12th.