Weekly Health Care Policy Update – December 1, 2023

December 8, 2023

In this update: 

  • Administration Updates
    • Biden to Use Defense Production Act to Ease Supply Chain Problems
    • Secretary Becerra Announces New NCI Leadership
  • Federal Agencies
    • CMS Extends Application Date for Making Care Primary
    • PCORI Approves $225 Million in New Research Projects
    • HHS Establishes Committee on Long Covid
  • Other Updates
    • UnitedHealth Group Now Employs 10% of U.S. Physicians
    • PCORI Announces Town Halls on Upcoming Funding Announcements
    • AHRQ Study Finds that Increases in Provider Concentration May Reduce Health Care Access
  • New York State Updates
    • DOH Releases Fifth Monthly Edition of the State’s Public Health Emergency Unwind Dashboard
    • DOB Approves Rate Increase and New APG Rate Codes for School-Based Mental Health Services in MHOTRS Programs
    • CMS Approves 1915(c) Children’s Home and Community Based Services (HCBS) Waiver Amendment
    • DOH Issues Proposed Regulations to Amend ADHC Services Settings Requirements
    • SED Issues Revised Proposed Rule on Mental Health Practitioner Diagnostic Privileges

Administration Updates

Biden to Use Defense Production Act to Ease Supply Chain Problems
On November 27th, the Biden Administration announced nearly 30 new actions to ease supply chain problems including the establishment of the new White House Council on Supply Chain Resilience. Additionally, President Biden plans to use authorities under the Defense Production Act to invest in the domestic manufacturing of essential medicines and medical countermeasures to shore up national capacity and mitigate shortages. This is particularly pertinent for reducing reliance on high-risk foreign suppliers.
 
The press release is available here.
 
Secretary Becerra Announces New NCI Leadership 
On November 17th, Department of Health and Human Services (HHS) Secretary Xavier Becerra announced President Biden’s pick, Dr. W. Kimryn Rathmell, to lead the National Cancer Institute (NCI) at the National Institutes of Health (NIH). Dr. Rathmell is currently the chair of Vanderbilt University’s Department of Medicine and will replace Dr. Monica Bertagnolli as the 17th Director of NCI.
 
The press release is available here.

Federal Agencies

CMS Extends Application Date for Making Care Primary 
On November 29th, the Centers for Medicare and Medicaid Services (CMS) announced the extension of the application deadline for the Making Care Primary (MCP) Model. The application is now due two weeks later, on December 14th.
 
The goal of the MCP model is to improve chronic disease prevention, decrease emergency room visits, and strengthen population health through better care coordination. MCP will launch July 1, 2024, in eight states: Colorado, North Carolina, New Jersey, New Mexico, Upstate New York, Minnesota, Massachusetts and Washington.
 
The application is available here.
 
PCORI Approves $225 Million in New Research Projects
On November 28th, the Patient-Centered Outcomes Research Institute (PCORI) announced $225 million in funding for more than two dozen new patient-centered comparative clinical effectiveness research. The majority of the studies will address outstanding research needs in maternal illness and death, youth mental health, older adult health needs, and cardiovascular disease. This funding will support research ventures with contributions from both community organizations and research institutes to jointly assess clinical and social factors of disease outcomes.
 
The announcement is available here.
 
HHS Establishes Committee on Long Covid 
On November 16th, HHS established the Secretary’s Advisory Committee on Long Covid, per the National Research Action Plan for Long Covid. The intent of this Committee is to spur research and innovation in the government’s response to longer-term impacts of Covid-19 with a focus on equity. HHS is currently soliciting nominations for Committee membership.
 
The press release is available here.

Other Updates

UnitedHealth Group Now Employs 10% of U.S. Physicians
On November 29th, Amar Desi, CEO of UnitedHealth’s Optum Health division, stated at the company’s investor day that UnitedHealth Group now has roughly 90,000 employed or affiliated doctors, or 10% of all U.S. physicians. The number includes roughly 20,000 physicians who were acquired or hired in 2023 alone, making UnitedHealth the largest physician employer in the United States.
 
PCORI Announces Town Halls on Upcoming Funding Announcements
On November 21st, the Patient-Centered Outcomes Research Institute (PCORI) announced applicant town halls for upcoming PCORI Funding Announcements (PFAs). Starting January 9, 2024, PCORI will begin accepting Letters of Intent for PFAs. Attendees of the town halls will hear from staff about the PFAs and the application process. Each town hall will focus on a distinct topic.
 
The registration is available here.
 
AHRQ Study Finds that Increases in Provider Concentration May Reduce Health Care Access
The Agency for Healthcare Research and Quality (AHRQ) announced the results of a study which found that increases in provider concentration may reduce, rather than increase, health care access. Between 2008 and 2019, the percentage of Americans living in zip codes with concentrated provider markets has increased. Americans in these concentrated zip codes were nearly 6 percentage points less likely to report having access to immediate care, a trend that was particularly pronounced among Medicaid beneficiaries. Authors also found that as the market share of multispecialty firms increased in a zip code, the volume of routine checkups decreased.
 
The study is published in the September 26th issue of Health Services Research, and is available here.

New York State Updates

DOH Releases Fifth Monthly Edition of the State’s Public Health Emergency Unwind Dashboard
On November 27th, the New York State (NYS) Department of Health (DOH) released the fifth 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 over the course of the next year, through May 31, 2024.

This fifth issue includes the renewal status, demographics, and program transitions of enrollees who had an October 31, 2023 coverage end date. The report shows that 78 percent of the 634,159 individuals in this cohort have renewed their coverage across the NY State of Health 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 fifth issue and previous reports may be accessed here. This process will continue each month until each enrollee cohort has had their eligibility redetermined.

DOB Approves Rate Increase and New APG Rate Codes for School-Based Mental Health Services in MHOTRS Programs
On November 17th, the NYS Division of the Budget (DOB) approved the 25 percent rate increase to Ambulatory Patient Group (APG) rate codes for School-Based Mental Health (SBMH) services in Mental Health Outpatient Treatment and Rehabilitation Services (MHOTRS) clinic programs. To receive the enhancement, MHOTRS clinics must use the new rate codes 1030 (non-hospital) and 1033 (hospital).

The rate increase is effective retroactive to July 1, 2023. As soon as possible, but no later than 90 days from the date of DOB approval (November 17th), Medicaid Managed Care Plans must complete necessary systems edits to ensure payable claims for applicable programs and dates of service. Additionally, plans are required to conduct retrospective reconciliation to adjust payments for clean claims as necessary.

Questions may be submitted to BHO@omh.ny.gov.   

CMS Approves 1915(c) Children’s Home and Community Based Services (HCBS) Waiver Amendment
On November 27th, DOH announced that CMS approved the State’s amendment to the Children’s Home and Community Based Services (HCBS) Waiver. The amendment includes the following changes: 

  • Rate Adjustments: Revised rates (available here) are currently pending final state approvals and include the following:
    • Permanent HCBS rate increases implemented during the Covid-19 Public Health Emergency;
    • 4% Cost of Living Adjustment (COLA), effective November 1, 2023;
    • New rate for Group Respite involving two children/youth (the size of allowable groups is no more than 3 youth/children); and
    • Higher rates for HCBS provided in seven rural counties, effective December 1, 2023;
  • Service Adjustments:
    • Removes references to “life threatening,” “terminal,” and “end of life” in Palliative Care service definitions;
    • Adjusts Palliative Care provider qualifications to reduce the years of experience required to serve the medically fragile pediatric populations from three years to one year;
    • Authorizes driver modifications within the Vehicle Modification service definition; and
    • Updates the qualifications of professionals permitted to perform HCBS Level of Care Eligibility Determinations to include Children’s Single Point of Access (C-SPOA) for children/youth meeting Serious Emotional Disturbance (SED) criteria.

These changes are effective November 1, 2023. The approval of the transition of Environmental Modifications, Vehicle Modifications, and Adaptive and Assistive Technology services to a Financial Management Services (FMS) contractor is dependent upon submission of another amendment, which is in process. This amendment will allow an FMS contractor, instead of the Local Department of Social Services or managed care plan, to manage requests for these services. The amendment will also authorize these services to be paid fee-for-service, regardless of the child’s managed care enrollment status.

The DOH announcement is available here. The approved amendment is available here. Questions may be submitted to BH.Transition@health.ny.gov.

DOH Issues Proposed Regulations to Amend ADHC Services Settings Requirements
On November 22nd, DOH issued a proposed rule that aims to ensure compliance among Adult Day Health Care (ADHC) services in non-residential settings with the CMS HCBS Final Rule. Specifically, the proposed regulations require that: 

  • The setting should be selected by the individual from among setting options, including non-disability specific options;
  • The setting options must be identified and documented in the person-centered plan and based on the individual’s needs and preferences;
  • The setting should ensure an individual’s rights of privacy, dignity, and respect, and freedom from coercion and restraint; and
  • Should optimize, not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to daily activities, physical environment, and with whom to interact.  

The proposed regulations are available here. Public comment may be submitted to reqsqna@health.ny.gov through February 14, 2024.

SED Issues Revised Proposed Rule on Mental Health Practitioner Diagnostic Privileges 
On November 29th, the NYS Education Department (SED) issued revised proposed amendments to regulations that allow licensed mental health counselors (LMHCs), licensed marriage and family therapists (LMFTs), and licensed psychoanalysts (LPs) to earn a “diagnostic privilege” by meeting specified requirements. These professions did not previously have the authority to perform diagnosis, but were permitted to do so under the “social worker exemption” that expired on June 24, 2022. The State enacted legislation to address the expiration of the exemption, allowing such professionals to continue to diagnose and develop treatment plans without additional requirements through June 24, 2025. During this period, they must apply to receive limited permits and gain experience for the diagnostic privilege. Last year, SED finalized initial regulations allowing such professionals to continue to diagnose and develop treatment plans (see SPG summary here).

The proposed amendments implement sections 2 and 3 of Chapter 230 of the Education Law to:  

  • Clarify acceptable clinical content in education for applicants for the diagnostic privilege;
  • Define acceptable experience in diagnosis, psychotherapy, and assessment-based treatment plans;
  • Set forth application and registration requirements; and
  • Establish that the diagnostic privilege should be valid for the life of the holder unless otherwise revoked, annulled, or suspended.

The revised proposed rule clarifies that an applicant who is licensed in New York prior to June 24, 2024 may meet the experience requirement for the diagnostic privilege by either: 

  1. Submitting verification of completion of a supervised experience of at least 2,000 hours of supervised, direct client contact, that includes (but is not limited to) diagnosis, psychotherapy, and the development of assessment-based treatment plans; or
  2. Submitting an attestation of at least three years of experience engaged in direct client contact that includes diagnosis, psychotherapy, and the development of assessment-based treatment plans.

The privilege application and fee must be submitted by June 24, 2027.

The proposed regulations are available here. Public comment may be submitted to regcomments@nysed.gov through January 13, 2024.