In this update:
- Legislative Updates
- Congress Passes Short-Term Government Funding through March 22nd
- Federal Agencies
- CMS to Host AHEAD Model Office Hours on March 14th
- CMS Releases 2024 Impact Assessment Report
- White House Issues EO on Personal Data
- DOJ Launches Antitrust Probe of United Healthcare
- DOJ Reports that False Claims Act Settlements Exceeded $2.6 Billion in FY 2023
- Other Updates
- Peterson Launches Digital Health Collaborative
- Health Sector Coordinating Council Cybersecurity Working Group Publishes Plan
- Northwell and Nuvance Health Announce Strategic Merger
- New York State Updates
- Northwell and Nuvance Health Announce Strategic Merger
- DOH Issues Guidance on Upcoming Managed Long Term Care Transportation Carve-Out
- SED Adopts Final Regulations for Mental Health Practitioner Diagnostic Privileges
- DOH Reminds Providers of Last Claiming Period for Health Care Worker Bonus Program
Legislative Update
Congress Passes Short-Term Government Funding through March 22nd
On February 28th, bipartisan House and Senate leaders announced an agreement to avert a partial government shutdown over the weekend. Congress has finished negotiations on the initial set of bills for several departments and intend to introduce legislative text over the weekend. Funding for the first set of departments will now be extended through March 8th. Funding for the rest of the government, including the Department of Health and Human Services (HHS) will also be extended to run through March 22nd. President Biden is expected to sign the legislation imminently.
Federal Agencies
CMS to Host AHEAD Model Office Hours on March 14th
On March 14th at 3pm ET, the Centers for Medicare and Medicaid Services (CMS) will host another office hours session to answer questions related to the Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model’s Notice of Funding Opportunity (NOFO). The Model is currently soliciting applications. Up to $12 million will be available to eight award recipients, including state Medicaid agencies, state public health agencies, and state insurance agencies. Through a cooperative agreement funding structure, the model will test a flexible framework with accountability targets for all-payer and Medicare fee-for-service cost growth, primary care investments, and health equity outcomes. New York State has indicated its intention to participate in the program.
CMS Releases 2024 Impact Assessment Report
On February 28th, CMS released the 2024 National Impact Assessment of CMS Quality Measures Report. This report surveys quality measure results from 2016 to 2021 across 26 programs, including value-based incentive payment programs. Prior to the Covid-19 pandemic, performance measures were on the rise, with improvement or stability on almost 90% of CMS quality measures. However, performance quickly declined during 2020 and 2021, dropping across 47% of measures in 2021. Health systems performed more poorly on measures of wellness and prevention, behavioral health, safety, chronic conditions, and seamless care coordination.
The report is available here.
White House Issues EO on Personal Data
On February 28th, President Biden issued an executive order (EO) to authorize new federal actions to protect personal data from companies and commercial data brokers. The EO authorizes the Attorney General to prevent the large-scale transfer of personal data to countries of concern. It also directs a number of government departments, including the Department of Health and Human Services (HHS), to collaborate on regulations and security standards for health and other personal data.
The announcement is available here.
DOJ Launches Antitrust Probe of United Healthcare
On February 27th, the Wall Street Journal reported that UnitedHealth Group is the subject of a Department of Justice antitrust investigation. According to the report, DOJ is particularly interested in UnitedHealth’s relationship with its subsidiary Optum Health, which operates a range of services, including pharmacy benefit services and group practices totaling about 90,000 physicians. The Biden Administration has indicated that the consolidation in this market between Optum Rx, CVS Caremark, and Cigna’s Express Scripts may be partially to blame for the rising cost of prescription drugs. Beyond prescription drug pricing, investigators are also looking into the company’s Medicare billing practices and ongoing acquisitions of group physician practices.
DOJ Reports that False Claims Act Settlements Exceeded $2.6 Billion in FY 2023
On February 22nd, the DOJ announced that settlements and judgments under the False Claims Act exceeded $2.6 billion in fiscal year (FY) 2023. Over $1.8 billion of these settlements and judgements were related to the health care industry, principally managed care providers, hospitals, and long-term acute care facilities. Within health care industry settlements, the DOJ recovered considerable funds for state Medicaid programs. One of the single largest settlements for FY 2023 was from Cigna ($172 million), regarding allegations of manipulating diagnosis codes in their Medicare Advantage plan. The False Claims Act operates as a safeguard for government programs by imposing penalties for falsely claiming and failing to pay money to the federal government, as well as strengthening incentives for whistleblowers.
The announcement is available here.
Other Updates
Peterson Launches Digital Health Collaborative
On February 22nd, the Peterson Health Technology Institute launched a Digital Health Collaborative to bolster evidence-based digital health solutions. The Collaborative convenes a group of health care and consumer organizations dedicated to advancing digital health initiatives, including the AMA and AHIP. To deliver on these goals, the Collaboration will convene members biannually, facilitate an invite-only Annual Summit, fund research, and commission an annual industry-wide survey.
More information on the Collaborative is available here.
Health Sector Coordinating Council Cybersecurity Working Group Publishes Plan
On February 27th, the Healthcare and Public Health Sector Coordinating Council Cybersecurity Working Group (CWG) released their “Health Industry Cybersecurity Strategic Plan.” Meant as a call to action for health care entities, the Plan was developed over a year and a half with collaboration from working group members and government partners. The Plan includes high-level cybersecurity goals with specific measurable objectives to collectively elevate sector cyber-resilience. CWG plans now to further develop the measurable objectives and appropriate metrics for health care entities.
The announcement is available here.
Northwell and Nuvance Health Announce Strategic Merger
On February 28th, Northwell Health and Nuvance Health announced that they are entering a strategic merger agreement. If approved by regulators, the deal would create a health system of more than 28 hospitals, over 1,000 care delivery sites, 14,500 providers, and nearly 100,000 staff. Nuvance Health operates three hospitals in New York in the Hudson Valley region and four more in Connecticut. As part of the merger, Northwell has indicated it will enhance community health initiatives, seek to expand academic pathways to enhance the workforce, and provide coordinated care across the new, larger service area.
The announcement is available here.
New York State Updates
DOH Issues Guidance on Implementation of Medicaid Coverage for eConsults
Effective April 1st for in fee-for-Service (FFS) and June 1st for Medicaid Managed Care (MMC), New York State (NYS) Medicaid will provide reimbursement for interprofessional consultations (“eConsults”) between a treating/requesting provider and a consultative provider. Eligible consultative providers include physicians (including psychiatrists), physician assistants (PAs), nurse practitioners (NPs), and midwives.
The purpose of an eConsult is to “answer patient-specific treatment questions in which a consultative provider can reasonably answer from information in the request for consultation and the electronic health record, without an in-person visit.” eConsults should not be used to arrange a referral for an in-person visit. Both the treating/requesting provider and the consultative provider can bill for the eConsult, at a FFS rate of $26.56 and $28.46, respectively.
Additional details, including patient consent and documentation requirements, are available in the January Medicaid update here.
DOH Issues Guidance on Upcoming Managed Long Term Care Transportation Carve-Out
Effective March 1st, consistent with the second Medicaid Redesign Team (MRT II) recommendation, DOH will carve out Non-Emergency Medical Transportation (NEMT) from the Medicaid Managed Long Term Care (MLTC) benefit package for all plans except for Programs of All-Inclusive Care for the Elderly (PACE). Following the transition, NEMT services may be accessed by contacting Medical Answering Services (MAS), the statewide contracted transportation broker. Social Adult Day Care (SADC) Programs that provide transportation using their own vehicles or by contracting directly with a transportation provider will continue to manage their own transportation and bill plans accordingly.
Additional details are available in the January Medicaid update here.
SED Adopts Final Regulations for Mental Health Practitioner Diagnostic Privileges
On February 28th, the NYS Education Department (SED) adopted final regulations for mental health practitioner diagnostic privileges. The regulations 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.
The final regulations are available here. Additional details on the regulations are available in SPG’s summary here. Public comments and SED responses are available here.
DOH Reminds Providers of Last Claiming Period for Health Care Worker Bonus Program
The final claim period for submission of employee Health Care Worker Bonus (HWB) payments will open on April 1st and close on May 1st. This is the last opportunity for providers to submit claims on behalf of eligible employees. Providers may use the portal hereto submit claims.
Additional details on the NYS HWB program are available here. Questions may be submitted to NYSWorkersBonus@health.ny.gov.