Weekly Health Care Policy Update – February 25, 2022

March 4, 2022

In this update: 

  • Covid-19 Updates
    • HRSA Distributing $560 Million In PRF Payments
    • SCOTUS Declines to Hear Arguments on Maine Health Worker Vaccine Mandate
    • NYS DOH Rescinds Deadline for Health Care Worker Booster Requirement
  • Federal Administration
    • Bob Otto Valdez Named AHRQ Director
  • Federal Agencies
    • CMMI Revamps Current Direct Contracting Model as ACO REACH, Cancels Geographic Model
    • CMMI Removes ACO Transformation Track from CHART Model
    • CMS Continues Issuing Price Transparency Non-Compliance Notices, But No Fines Yet
    • ASPE Releases Report Comparing MA Supplemental Benefits and Medicaid LTSS
    • FDA Commissioner Califf Announces Priorities
    • FCC Issues Notice on Rural Health Care Program and Seeks Further Comment
    • CMS Opens Nominations for Technical Expert Panel on SNF VBP Program
  • Other
    •  Federal Judge Strikes Down IDR Provisions in Surprise Billing Rule
  • Legislative Hearings
  • New York State Updates
    • Governor Hochul Announces New Investments to Improve Access to Mental Health Services
    • OMH Releases Guidance Emphasizing Flexibility for Involuntary Emergency Psychiatric Admissions
  • Funding Opportunities
    • HCR Releases Winter 2022 Multifamily Programs RFP

COVID-19 Updates

HRSA Distributing $560 Million In PRF Payments
On February 24th, the Health Resources and Services Administration (HRSA) at the Department of Health and Human Services (HHS) announced the distribution of more than $560 million in Provider Relief Fund Phase 4 General Distribution payments to more than 4,100 providers. This brings total distributions from the PRF Phase 4 to $11.5 billion. At this point, less than 15 percent of Phase 4 applications remain to be processed, which HRSA plans to do over the next several months.

The press release is available here. Phase 4 distributions by state can be found here. A comprehensive data set on HHS Provider Relief Fund distributions can be found here. 

SCOTUS Declines to Hear Arguments on Maine Health Worker Vaccine Mandate
On February 22nd, the U.S. Supreme Court declined to hear arguments in a suit challenging Maine’s Covid-19 vaccine mandate for health care workers. Health care workers sued the State on the grounds that the law does not include a religious exemption. The vaccine requirement, which has been in effect since October, includes only a medical exemption. No explanation was provided by the Court with the decision. The Court is still reviewing an application by a group of New York City teachers challenging the city’s mandate, although it does include limited religious accommodations.

NYS DOH Rescinds Deadline for Health Care Worker Booster Requirement
On February 18th, the New York State Department of Health (DOH) announced that, to avoid potential staffing issues and give health care workers more time to get boosted, the State will no longer enforce the booster requirement for health care workers that was due to go into effect on February 21st. The original two-dose vaccination requirement for health care workers remains in effect. The State will reassess in three months whether additional steps are necessary to increase booster rates among the health care workforce.

According to DOH’s data, about 75 percent of the health care workforce statewide have either received or are willing to receive a booster. This included 88 percent of direct care staff in hospitals, but only 51 percent of such staff in nursing homes. The DOH press release is available here.

Federal Administration

Bob Otto Valdez Named AHRQ Director
On February 22nd, Dr. Bob Otto Valdez was named Director of the HHS Agency for Healthcare Research and Quality (AHRQ). Dr. Valdez, an expert in health services research, previously served as the Robert Wood Johnson Foundation (RWJF) Professor Emeritus of Family & Community Medicine and Economics at the University of New Mexico. Dr. Valdez also previously served as the Founding Executive Director of the RWJF Center for Health Policy at the University of New Mexico, the Dean of the Drexel University School of Public Health, and as a Professor of Health Services at the UCLA School of Public Health. From 1993 through 1997, he worked at HHS as a Deputy Assistant Secretary for Health and Director of Interagency Health Policy. Dr. David Meyers, who has been working as the Agency’s acting director since January 2021, will now resume his role as deputy director.

Federal Agencies

CMMI Revamps Current Direct Contracting Model as ACO REACH, Cancels Geographic Model
 
On February 24th, the Center for Medicare and Medicaid Services (CMS) Innovation Center (CMMI) announced a revamp of the Direct Contracting program. Starting in 2023, the Global and Professional Direct Contracting (GPCD) models, which are currently being implemented by 99 Direct Contracting Entities, will be replaced by the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. Although the design of ACO REACH is fundamentally similar to that of GPDC, notable new elements include: 

  • New requirements on governance and organizational history, meant to ensure that REACH ACOs are provider-led and their ownership is aligned with CMMI’s vision;
  • Modifications to the financial parameters of the model, which will increase the funds available to REACH ACOs but further limit potential increases in population risk scores;
  • New health equity initiatives, including a benchmark adjustment for ACOs who have more high-need individuals attributed and a requirement to develop a Health Equity Plan and collect social needs data; and
  • Additional plans for monitoring and compliance efforts.

CMMI released an accompanying Request for Applications (RFA) for organizations wishing to newly participate in ACO REACH in 2023. Applications will be accepted from March 7ththrough April 22nd. CMMI also released an official list (available here) of all current GPDC participants, including the 50 who remain from the 2021 cohort and the 49 entities who joined the program in 2022. All current GPDC Model participants will be required to transition to ACO REACH and to meet all ACO REACH Model requirements by January 1, 2023 to continue their participation.
 
In addition, CMS announced the permanent cancellation of the Geographic Direct Contracting Model (Geo). CMS had previously paused the implementation of the Geo model, which was announced under the previous administration, in March 2021.
 
The National Association of ACOs (NAACOs) issued a statement in support of the changes. Representative Pramila Jayapal (D-WA), who led a request by 54 House Democrats to end the GPDC program, said she was “glad to see the administration taking steps to redesign this flawed program” but that “more needs to be done.”
 
SPG will distribute a more detailed summary of the ACO REACH model early next week. CMS will host an overview webinar on the ACO REACH Model RFA on March 1st at 4pm. Registration is available here. A fact sheet on ACO REACH is available here. A comparison of ACO REACH and GPCD is available here.
 
CMMI Removes ACO Transformation Track from CHART Model
On February 22nd, CMMI announced the removal of the ACO Transformation Track from the Community Health and Rural Transformation (CHART) Model. The CHART Model was released under the Trump Administration with two tracks, one for hospital-led collaboratives to operate under a version of a global budget (the Community Transformation Track), and one to provide extra subsidies to rural ACOs (the ACO Transformation Track).
 
Before canceling it now, CMMI previously delayed the release of the ACO Transformation Track RFA in March 2021. However, CMMI is continuing with the Community Transformation Track, which awarded $20 million to four participants in September 2021. CMS remains committed to ACO adoption in rural areas and is examining lessons learned from its ACO Investment Model to inform future policies. CMS expects to announce additional ACO development proposals for rural areas soon.
 
More information on CHART is available here.
 
CMS Continues Issuing Price Transparency Non-Compliance Notices, But No Fines Yet
This week, Becker’s Hospital Review and several other news organizations published articles on hospital compliance with price transparency requirements that went into effect on January 1, 2021. These regulations were initially issued under the Trump Administration but have been supported by the Biden Administration, which expanded the maximum penalty from $300 per day to $10 per bed per day, up to $5,500 per day, or about $2 million per year.
 
According to a CMS spokesperson, as of early February 2022, it had sent “approximately 342” initial warning notices to non-compliant hospitals and 124 requests for corrective action plans to hospitals that had received warning notices but not corrected their deficiencies. Of these, 77 hospitals had addressed their deficiencies and received case closure notices. These figures were up from 335 warning notices and 98 correction plans as of December 2021. However, CMS has yet to issue any monetary penalties, because each cited hospital “has resolved its deficiencies or is in the process of doing so.” CMS maintains that it will not publicly release the names of cited hospitals unless and until they do receive a penalty.
 
ASPE Releases Report Comparing MA Supplemental Benefits and Medicaid LTSS
On February 15th, the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report entitled “Comparing New Flexibilities in Medicare Advantage with Medicaid Long-Term Services and Supports.” The report examines the structure and utilization of the supplemental benefits that Medicare Advantage (MA) plans were newly able to offer starting in 2019 and 2020. These include the option for more narrowly targeted benefits through the Value-Based Insurance Design (VBID) model and the new Special Supplemental Benefits for the Chronically Ill (SSBCI), which do not need to be primarily health-related. To date, only a limited number of MA plans offer such benefits, but the number is increasing.
 
For this report, ASPE conducted a literature review and interviewed four MA plans that offered SSBCI. Some items noted include: 

  • The potential for supplemental benefits to offer access to LTSS to partial duals or to full duals not enrolled in a Home and Community-Based Services (HCBS) waiver;
  • Difficulties that plans had in designing, pricing, and operationalizing new benefits; and
  • Issues related to duplication and integration with Medicaid LTSS.

The report is available here.
 
FDA Commissioner Califf Announces Priorities
On February 17th, Dr. Robert Califf, the new Commissioner of the Food and Drug Administration (FDA), issued a staff memo (available here) outlining his priorities for the Agency. In addition to confirming that Janet Woodcock will continue at the Agency in the role of Principal Deputy Commissioner, Dr. Califf outlined the following priorities: 

  • Pandemic response, including “speeding the successful development” of therapeutics, diagnostics, PPE, and vaccines;
  • Speeding the development of new treatments and medical devices across the medical landscape;
  • Strengthening the response to the opioid and stimulant crisis;
  • Reducing harm from tobacco products, including e-cigarettes;
  • Strengthening the safety of the nation’s food supply and informing the public of the benefits of health nutrition;
  • Awareness of the link between veterinary products and antimicrobial resistance/future pandemics; and
  • Countering misinformation about science and the FDA.

Califf also posted a brief version of this list of priorities on his official Twitter account, which is available here.
 
FCC Issues Notice on Rural Health Care Program and Seeks Further Comment
On February 18th, the Federal Communications Commission (FCC) issued a Further Notice of Proposed Rulemaking on the Rural Health Care (RHC) Program. The RHC Program assists rural health care providers with the costs of broadband and other communications services via two programs: the Telecom Program, which subsidizes the difference between urban and rural rates for providers in rural areas; and the Healthcare Connect Fund (HCF) Program, which provides a flat 65 percent discount on certain services. The proposed rule primarily concerns the Telecom Program, and seeks comment in four areas: 

  • Options for determining support in the Telecom Program and potential revisions to the Telecom Program forms to improve quality and consistency of Telecom Program data;
  • Changes to the Rates Database, as well as alternative rate determination mechanisms, to improve the accuracy of urban and rural rates in the Telecom Program;
  • Reforms to the Commission’s funding cap rules to more efficiently and effectively handle the internal cap on multi-year commitments and upfront payments in the HCF Program; and
  • Simplification of invoicing in the RHC Program by harmonizing the process between the Telecom and HCF Programs.

In particular, the FCC seeks comment on whether its existing definition of “rural area” is applicable today, and its appropriateness for purposes of RHC Program participation. Although the FCC proposes to maintain the current definition, the Commission expresses openness to public input, and encourages commenters to describe the effects of potential modifications to the current definition on Program participants.
 
The proposed rule can be found here.
 
CMS Opens Nominations for Technical Expert Panel on SNF VBP Program
On February 22nd, CMS announced the opening of a nomination period for members of a Technical Expert Panel to advise CMS’s contractors, Mathematica and RTI International, as they update the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program’s scoring methodology. The work will generate up to nine additional measures for the SNF VBP Program for services furnished after October 1, 2023. Mathematica and RTI International are seeking 8 to 15 individuals with varying expertise in areas such as: 

  • Clinical expertise around SNF quality/safety improvement;
  • Statistical/methodological expertise;
  • Value-based care/model design expertise;
  • SNF quality measure expertise;
  • Healthcare disparities expertise;
  • SNF stakeholder perspective; and
  • SNF patient or family (caregiver) perspective.

More information on submitting a nomination may be found here.

Other Updates

Federal Judge Strikes Down IDR Provisions in Surprise Billing Rule
On February 23rd, a federal judge in the Eastern District of Texas struck down the framework for independent dispute resolution (IDR) of surprise bills that was part of the Biden Administration’s regulation implementing the No Surprises Act. The case, which was brought by the Texas Medical Association, concerned only the portion of the rule governing resolution of payment disputes between payers and providers over out-of-network claims. Judge Jeremy Kernodle ruling that the Administration had steered too far away from the legislative text when issuing its regulations. The regulations instruct arbiters to presume that the median in-network rate is the appropriate payment amount for providers, but Judge Kernodle ruled that this “rewrites clear statutory terms.” The ruling halts implementation of this part of the dispute resolution process across the country. The Texas case is one of many legal challenges moving through the courts concerning the surprise billing rule.

The NAACOS letter is available here.

Legislative Hearings

Tuesday, March 1st:

  • At 10:15am, the House Education Subcommittee on Health, Employment, Labor, and Pensions will hold a hearing entitled “Improving Retirement Security and Access to Mental Health Benefits.” More information is available here.

Wednesday, March 2nd:

  • At 10am, the House Ways and Means Committee will hold a hearing entitled “Substance Use, Suicide Risk, and the American Health System.” More information is available here.
  • At 10:30am, the House Energy and Commerce Subcommittee on Oversight and Investigations will hold a hearing entitled “Lessons from the Frontline: COVID-19’s Impact on American Health Care.” More information is available here.
  • At 2pm, the House Select Subcommittee on the Coronavirus Crisis will hold a hearing entitled “COVID Child Care Challenges: Supporting Families and Caregivers.” More information is available here.

New York State Updates

Governor Hochul Announces New Investments to Improve Access to Mental Health Services
On February 18th, Governor Hochul announced the following investments to support improved access to acute mental health care and hospital psychiatric beds statewide: 

  • $27.5 million annually to increase Medicaid reimbursement by 20 percent for inpatient psychiatric beds;
  • $9 million annually to recruit psychiatrists and psychiatric nurse practitioners into the community-based mental health workforce and provide loan forgiveness; and
  • $12.5 million annually for 500 additional supportive housing beds to house people experiencing homelessness.

The Governor’s announcement was made together with New York City Mayor Eric Adams, who simultaneously released his Subway Safety Plan (available here) that will implement teams to conduct outreach to unhoused individuals on the subway and connect them to care, support, and housing.

The Governor’s press release is available here.

OMH Releases Guidance Emphasizing Flexibility for Involuntary Emergency Psychiatric Admissions
On February 18th, the New York State Office of Mental Health (OMH) released guidance on the involuntary and custodial transportation of individuals for emergency assessments and for emergency and involuntary inpatient psychiatric admissions. The guidance offers a summary of relevant New York State statutes and provides examples of individuals who may meet criteria for involuntary or emergency admissions to support clinicians and other community providers make clinically appropriate determinations.

The guidance emphasizes that individuals do not need to be considered “imminently dangerous” or to have engaged in a specific “recent dangerous act” to meet the criteria for involuntary psychiatric admission. An individual who appears to be mentally ill and who displays an inability to meet basic living needs may be taken into custody when they are conducting themselves in a manner which is likely to result in serious harm to self or others. Providers are encouraged to contact their local OMH Field Office to discuss specific cases and ask questions regarding involuntary care.

The guidance is available here.

Funding Opportunities

HCR Releases Winter 2022 Multifamily Programs RFP
On February 17th, New York State Homes and Community Renewal (HCR) released a Request for Proposals (RFP) that consolidates the availability of funding for the HCR Multifamily Programs. These programs support affordable rental housing for low-to-moderate income individuals and families as part of the State’s five-year plan to combat homelessness and advance the construction and preservation of affordable housing. Awards include 9% Low-Income Housing Tax Credits and subsidy financing to sponsors proposing affordable and supportive multifamily housing projects. Projects may include new construction, rehabilitation, and/or adaptive reuse of site-specific projects that provide multifamily rental housing. Funding is not available for projects proposing to use tax-exempt bond financing.

The full RFP is available here. Additional information, including maximum award amounts for each program, is available in each program’s term sheet (accessible here). Applications are due on March 31st.

All applicants are required to request and participate in a TA session prior to application submission. The deadline to request a TA session is March 17th. Additional information on the updated TA process and the TA request form is available here. Questions may be submitted to 9%RFP@hcr.ny.gov.