Weekly Health Care Policy Update – April 8, 2022

April 15, 2022

In this update: 

  • Covid-19 Updates
    • Medicare Implements Free At-Home Covid Tests, Second Booster Shots
    • President Biden Announces “Long Covid” Initiative
    • CMS Phases Out Certain Covid-19 Policies in Facility Settings
    • HRSA Will Consider Requests for Late PRF Reporting
    • Updated SPG Covid-19 Health-Related Regulatory Waiver Tracker
  • Congressional Updates
    • Senate to Resume Negotiations on Covid Supplemental Appropriations Act After Easter
  • Federal Agencies
    • CMS Issues Final 2023 MA Rate Announcement
    • CMS Issues Final Rule with Comment Period on MA MOOP and Cost-Sharing Limits
    • IRS Proposes Rule to Fix Family Glitch
    • CMS Indefinitely Delays Start of Radiation Oncology Model
    • CMS Issues Further Guidance on Good Faith Estimates for Self-Pay Patients
    • CMS Issues Final NCD on Aduhelm
    • OCR Issues RFI on HIPAA Covered Entities’ Security Practices
    • NCI Director Ned Sharpless to Step Down
  • Other Federal
    • National Academies Publishes Report on Nursing Home Quality
  • Congressional Hearings
  • New York State Updates
    • Governor Hochul Announces Budget Agreement
    • SED Adopts Amendment Allowing Certain Out-of-State Psychologists to be Licensed by Endorsement in New York
    • CMS Approves Temporary Extension of Children’s Waiver
    • Class Action Lawsuit Filed Against DOH and OMH on Behalf of Medicaid-Eligible Children with Mental Health Needs
    • OMH to Hold Webinar on Clinic Services Under the Rehabilitative Option
    • DFS Issues Guidance on Required Preventive Care for Colorectal Cancer
  • Funding Opportunities
    • HRSA Issues $39 Million NOFO for Public Health Scholarship Program
    • OMH Issues RFP for $500,000 for Student Mental Health Support Grants to School Districts
    • RWJF Offers One-Time Grants of $40,000 for Data Projects on SDH and Health Equity

COVID-19 Updates

Medicare Implements Free At-Home Covid Tests, Second Booster Shots
On April 4th, the Biden Administration announced the implemntation of its initiative to make free over-the-counter (OTC) Covid-19 tests available to Medicare beneficiaries. Medicare beneficiaries may now receive up to eight Food and Drug Administration (FDA)-approved OTC Covid-19 tests per calendar month from participating pharmacies and health care providers for the duration of the federal Covid-19 public health emergency (PHE). The policy applies both to traditional Medicare beneficiaries as well as those enrolled in a Medicare Advantage plan.
 
For Medicare-enrolled providers, no separate enrollment process is required. Providers will be considered to begin participating as soon as they submit a Medicare claim for an OTC Covid-19 test using HCPCS code K1034. Any pharmacy, physician, facility or other health care provider currently offering services such as vaccines, lab tests or other clinic-type visits may participate in this initiative. However, Medicare will not reimburse OTC tests: 

  • If the provider is enrolled only as a Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) supplier; or
  • When given to a patient during an inpatient stay, including in a skilled nursing facility (SNF) or hospital.

On April 6th, the Centers for Medicare and Medicaid Services (CMS) also announced that Medicare will pay for a second Covid-19 booster shot of either mRNA vaccine without cost sharing for Medicare beneficiaries. Medicaid beneficiaries also remain eligible for Covid-19 vaccines, including boosters, without cost-sharing.
 
CMS’s guidance for providers on billing for OTC tests is available here.
 
President Biden Announces “Long Covid” Initiative
On April 5th, President Biden issued a Presidential Memorandum on the Administration’s actions to address “Long Covid,” defined as lasting symptoms after the resolution of an acute Covid-19 infection. In particular, the Memorandum directs HHS to: 

  • Coordinate the development of an interagency national research action plan on Long Covid, which will build on the existing Researching COVID to Enhance Recovery (RECOVER) initiative; and
  • Issue a report outlining the services available to people experience Long Covid and others affected by the pandemic.

The Memorandum also describes other parts of the Administration’s efforts to address Long Covid, including: 

  • Proposing, as included in the President’s budget, to launch Centers of Excellence in Long Covid through the Agency for Healthcare Research and Quality (AHRQ);
  • Launching the Health+ project through the Office of the Assistant Secretary for Health (OASH) to gain insights into the experiences of patients with Long Covid at hospitals and health systems across the country, to help inform high-quality care and contribute to standardized best practices;
  • Launching education efforts for clinicians and medical coders on the ICD-10-CM code (U09.9) that supports diagnosis, billing and tracking of Long Covid; and
  • Assessing opportunities to bolster health insurance coverage and enhance access to care for Long Covid. 

The Administration will also continue to update guidance on Long Covid as a disability, building on the Social Security Administration’s (SSA) existing guidance, as further scientific evidence emerges, with the goal of supporting “inclusive disability policy and claims adjudication processes through the Social Security Disability (SSDI) and Supplemental Security Insurance (SSI) programs for individuals experiencing Long Covid.”
 
The White House statement can be found here.
 
CMS Phases Out Certain Covid-19 Policies in Facility Settings
On April 7th, CMS released a Quality, Safety, and Oversight memo that will phase out certain Covid-19-related emergency waivers and flexibilities in facility settings. CMS considers these waivers to no longer be necessary due to improvements in the pandemic situation and care processes. Facilities for whom blanket waivers will be ended include: 

  • SNFs and other nursing facilities;
  • Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs);
  • Inpatient hospices; and
  • End-stage renal disease (ESRD) facilities.

As such, various requirements for such facilities will resume in two phases, 30 and 60 days after the publication of the memo. Requirements returning on May 7th include (among others) those pertaining to in-person resident groups, physician visits, and physician delegation. Requirements returning on June 7th include (among others) those related to facility and equipment inspections, testing, and maintenance, as well as training and certification for nursing aides.
 
CMS will retain flexibility for certain requirements if there are document capacity issues, and may issue specific waivers or reissue blanket waivers if the Covid-19 situation changes again.
 
The press release is available here. The full QSO memo is here.

HRSA Will Consider Requests for Late PRF Reporting
On April 6th, the Health Resources and Services Administration (HRSA) announced a process for providers who missed required reporting deadlines Provider Relief Fund (PRF) to request the opportunity to submit their reporting late. The “Request to Report Late Due to Extenuating Circumstances” process will be available to providers whose reporting was incomplete due to an allowable extenuating circumstance, if approved by HRSA.
 
The Request window for providers who missed required reporting during Reporting Period 1 (covering payments received before June 30, 2020) is from April 11th to April 22nd, and the Request Form will be available April 11th. More information from HRSA is available here.
 
Updated SPG Covid-19 Health-Related Regulatory Waiver Tracker
SPG has updated its Regulatory Waiver Tracker document following the recent continuation and expiration of certain waiver flexibilities. This resource also includes a summary of New York State and federal policy, including extensions and proposed permanent amendments to telehealth regulations.
 
Our updated resource is available here.

Congressional Updates

Senate to Resume Negotiations on Covid Supplemental Appropriations Act After Easter
On April 4th, Senate Majority Leader Chuck Schumer (D-NY) and Senator Mitt Romney (R-UT) announced a bipartisan deal to allocate a supplemental $10 billion for the Department of Health and Human Services (HHS) for domestic Covid-19 response programs. The agreement includes: 

  • $9.25 billion for the Biomedical Advanced Research and Development Authority (BARDA), including at least $5 billion for purchasing oral antivirals and other Covid-19 therapeutics; and
  • At least $750 million for the Public Health and Social Services Emergency Fund (PHSSEF) for the expansion of vaccine manufacturing capacity and for research, clinical trials, and development of vaccines for emerging variants.

The new spending is offset fully by rescinding unspent balances of various existing Covid-19 relief programs, including the Shuttered Venues Operators Grants, Economic Injury Disaster Loans, the Aviation Manufacturing Jobs Program, the Higher Education Emergency Relief Fund, and others.
 
On April 5th, the bill failed to advance in the Senate, as Democrats refused to grant a Republican demand for a vote on an amendment that would continue certain Covid-19-related immigration limits. Talks on the bill stalled, although Senator Romney said that he still expects that, once an agreement is reached on the amendment process, there will be “well more than 60 votes” in favor of the bill in the Senate. However, the bill also faces potential opposition in the House from some Democrats, who have criticized the removal of previously-proposed funding for global vaccination efforts.
 
The bill text is available here.

Agency Updates

CMS Issues Final 2023 MA Rate Announcement
On April 4th, CMS released the final Announcement of Calendar Year (CY) 2023 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (known as the MA Rate Announcement). CMS expects the policies in the Rate Announcement will increase overall MA plan revenue by 8.5% relative to 2022, higher than the 7.98% revenue increase estimated in the 2023 Advance Notice. This change was driven by an increase in the effective growth rate (from 4.75% to 4.88%) and the addition of the rebasing/repricing impact, which was unavailable when the Advance Notice was released.
 
CMS made limited changes to its MA risk adjustment policies: 

  • The risk adjustment models for MA overall and for PACE plans remain unchanged, but CMS did finalize changes to the risk adjustment model for enrollees with ESRD.
  • CMS finalized changes to the risk adjustment model for Part D benefits, updating the hierarchical condition codes to use ICD-10-CM diagnoses (rather than ICD-9-CM) and updating the data years used.
  • CMS chose to continue using the minimum MA coding pattern adjustment required by statute (5.9%) this year. However, it noted that it received comments recommending the adjustment should be increased to address concerns about risk score growth, and will consider these comments in future rulemaking.
  • CMS finalized its proposal to not update the years in the trend data used to calculate the normalization factor, due to concerns that the changing use of services in 2020 would have resulted in anomalous 2021 risk scores.

Finally, regarding MA Star Ratings, CMS finalized a number of measure specification changes for 2023 but did not add new measures or eliminate existing measures. CMS will begin confidential reports to plan sponsors that stratify Star Ratings by disability status, low-income subsidy (LIS) status, and dual-eligible status as part of the Administration’s work to advance racial equity and support underserved communities.
 
The Rate Announcement is available here and a fact sheet is available here.
 
CMS Issues Final Rule with Comment Period on MA MOOP and Cost-Sharing Limits
On April 7th, CMS issued a final rule with comment period that addresses regulations on MA maximum out-of-pocket (MOOP) and cost-sharing limits. The rule addresses the last two proposals from the February 2020 proposed rule for MA and Part D that were not previously finalized or rescinded. The rule sets specific MOOP and cost sharing limits for contract year 2023, as well as setting out the following policies for future rules: 

  • Codifying CMS’s authority to set three different MOOP limits (mandatory, intermediate, and lower);
  • Transitioning ESRD costs into the methodology for setting MOOP limits, to reflect the ability of ESRD patients to enroll in an MA plan;
  • Establishing a cap on how much MOOP limits may increase year-over-year;
  • Codifying the interpretation that coinsurance of 50 percent of the total MA plan financial liability is discriminatory;
  • Modifying the cap on cost-sharing for certain professional services to be stratified by the plan’s MOOP (50 percent for plans with a lower MOOP, 40 percent for plans with an intermediate MOOP, and 30 percent for a plan with the maximum mandatory MOOP);
  • Adjusting the maximum per-visit cost sharing for emergency care to be stratified by the plan’s MOOP ($150 for plans with a lower MOOP, $130 for plans with an intermediate MOOP, and $115 for a plans with a mandatory MOOP);
  • Requiring MA plans to limit cost sharing to the cost sharing in Original Medicare for an additional set of services, including home health services, DMEPOS for plans with a mandatory MOOP, and Part B drugs other than chemotherapy.

The rule also seeks comment on new or different ways to update and change cost sharing limits in future years for other service categories, including mental health services.
 
The full text of the final rule is available here. Comments will be accepted through June 13th.
 
IRS Proposes Rule to Fix Family Glitch
On April 5th, the Internal Revenue Service (IRS) published a proposed rule that would change its policy to end the “family glitch” in eligibility for Affordable Care Act (ACA) premium tax credits. Under the ACA, individuals who are offered “affordable” employer-sponsored coverage are ineligible for premium tax credits to purchase Marketplace coverage. Currently, the affordability determination is based on the premium for an individual (self-only coverage) as a percentage of family income (9.5% indexed annually). Therefore, if self-only coverage is determined “affordable” for an employee, then the coverage is also considered affordable for a spouse and any dependents, regardless of the actual family coverage premium. An estimated 5.1 million Americans, most of whom are children, are ineligible for premium tax credits under the current regulations.
 
In the proposed rule, the IRS has “preliminarily determined” that the ACA’s text does not compel this result. It would therefore reinterpret the statute to define employer-sponsored coverage as “affordable” for individuals related to the employee if the employee’s portion of the premium for family coverage does not exceed 9.5% (indexed annually) of household income. Family coverage includes all employer plans that cover any related individuals, including self plus-one plans. The IRS estimates that 200,000 uninsured individuals would gain coverage and 1 million would have more affordable coverage if the rule is finalized.
 
Notably, the proposed rule does not make any changes to the employer mandate. As such, employers will continue to meet the ACA’s requirement to offer affordable coverage so long as the portion of the premium the employee must pay for self-only coverage does not exceed 9.5% (indexed annually) of household income, regardless of the cost of family coverage.
 
A fact sheet from the White House on the rule is available here. The full text of the proposed rule is available here. Comments will be due on June 6th. The IRS has scheduled a public hearing on the proposed rule for June 27th at 10am, which will be held telephonically. Individuals who wish to attend or testify must send an email to publichearings@irs.gov with the regulation number (REG-114339-21) and the word TESTIFY or ATTEND.

Biden Issues Executive Order on Strengthening Coverage
On April 5th, President Biden issued an Executive Order that aims to “continue to strengthen Americans’ access to affordable, quality health coverage.” The Order notes various components of the American Rescue Plan that expanded coverage, as well as the the promulgation of the family glitch fix described above, and directs HHS and other federal agencies to review agency actions to identify additional ways to expand the availability and quality of coverage, including: 

  • Policies that make it easier for consumers to enroll in and retain coverage;
  • Policies that strengthen benefits and improve access to providers;
  • Policies that improve the comprehensiveness of coverage;
  • Policies to expand eligibility for and lower the cost of government-sponsored coverage;
  • Policies to improve linkages between the health system and other stakeholders; and
  • Policies to reduce the burden of medical debt.

The Executive Order is available here.
 
CMS Indefinitely Delays Start of Radiation Oncology Model
On April 6th, CMS issued a proposed rule that would indefinitely delay the start of the mandatory Radiation Oncology Model. The model would implement site-neutral, prospective, episode-based payments for radiation therapy among: 

  • Hospital outpatient departments;
  • Physician group practices; and
  • Freestanding radiation therapy centers for radiation therapy.

It is intended to test whether such site-neutral payments will improve care quality and reduce spending. However, there have been two legislative delays to the Model’s start, creating uncertainty for Model participants who have made financial, operational, and administrative investments. Stakeholders have also requested changes to the Model’s payment methodology, including scaling down the Model’s discount factor, and other aspects of design and participation requirements. CMS will set a new start date in a future rule, which will be at least six months after that rule’s publication.
 
The proposed rule can be found here. Comments will be accepted for 60 days after publication in the Federal Register on April 8th.
 
CMS Issues Further Guidance on Good Faith Estimates for Self-Pay Patients
On April 5th, CMS published a new guidance document outlining further guidance related to the No Surprises Act’s requirement that providers offer a good faith estimate (GFE) of their expected charges to uninsured or self-pay individuals. Stakeholders have noted that mental health providers are burdened by this requirement, as it is difficult to estimate in advance how long a patient may be in treatment. The updated guidance addresses some of these issues, as follows: 

  • If the provider does not know the diagnosis at the time of scheduling a visit, a GFE does not need to include a diagnosis code. However, it should still include expected charges and service codes for that visit.
  • Providers are not expected to provide expected charges for future visits in a GFE provided for an initial visit.
  • For recurring services, such as mental health counseling, a provider may issue a single GFE that covers recurring primary items or services for up to 12 months, rather than a GFE for each visit.
  • The GFE is part of an uninsured or self-pay patient’s medical record and should be maintained as such.
  • A GFE is not required if the visit is scheduled less than three days in advance, or if the patient becomes uninsured or self-pay after the scheduling of the visit.

The guidance is available here.
 
CMS Issues Final NCD on Aduhelm
On April 7th, CMS issued a final National Coverage Determination (NCD) on Medicare coverage of Aduhelm and any future drugs that are monoclonal antibodies directed against amyloid for the treatment of Alzheimer’s disease. The final NCD confirms CMS’s original proposal to cover such drugs only under coverage with evidence development (CED). As such, Medicare will pay for Aduhelm only in the context of CMS-approved studies or National Institutes of Health (NIH) or FDA-supported clinical trials. However, it notes that related drugs that are approved through FDA’s traditional process (unlike Aduhelm, which was approved on an accelerated basis) may be covered by Medicare under less rigorous study designs than Aduhelm. CMS therefore states that this NCD creates a “predictable pathway” for drugs in this class that meet its criteria.
 
CMS also noted the effects on other government payers’ coverage: 

  • Medicare Part D plans may exclude coverage for a drug that would not be determined to be reasonable and necessary under Original Medicare.
  • Medicaid will be required to include coverage for Aduhelm because it meets the definition of a covered outpatient drug. However, CMS notes that Medicaid does not cover any Part D drug for full-benefit dual eligibles. For Medicaid-only individuals, Medicaid programs must cover Aduhelm, but may implement appropriate medical necessity criteria and utilization management.

CMS’s announcement is available here. A fact sheet is available here.
 
OCR Issues RFI on HIPAA Covered Entities’ Security Practices
On April 6th, the HHS Office for Civil Rights (OCR) issued a Request for Information (RFI) soliciting public comment on current implementations of security practices for protecting personal health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA). The Health Information Technology for Economic and Clinical Health (HITECH) Act requires OCR to consider whether HIPAA-covered entities implemented “recognized security practices” in the process of determining fines for violations of the HIPAA Security Rule.
 
OCR therefore seeks information on how regulated entities are voluntarily implementing recognized security practices, how they demonstrate that such practices are in place, and other implementation issues. OCR plans to use the RFI input to inform future guidance or rulemaking that will clarify how OCR will set fines in such circumstances. The RFI also seeks comment on recommended methodologies for sharing Civil Monetary Penalties (CMPs) or monetary settlements with harmed individuals.
 
The RFI includes 30 high-level questions, with many additional sub-questions. Questions are grouped into areas of: 

  • Security practices;
  • Compensable harm;
  • Settlements and penalties;
  • Identifying harmed individuals;
  • Distribution methodology; and
  • Appeals.

The RFI is available here. Comments will be accepted through June 5th.
 
NCI Director Ned Sharpless to Step Down
On April 4th, Dr. Ned Sharpless announced that he will step down from his position as Director of the National Cancer Institute (NCI) at the National Institutes of Health (NIH) at the end of April. Dr. Sharpless has led the NCI since 2017, the largest of the NIH’s 27 institutes, with a budget of roughly $7 billion. During his tenure as NCI director, Dr. Sharpless also briefly served as Acting Commissioner for Food and Drugs at the FDA in 2019. Dr. Douglas Lowy, currently the NCI Principal Deputy Director, will serve as Acting Director beginning April 30th, a position he also held from April 2015 through October 2017.

Other Federal

National Academies Publishes Report on Nursing Home Quality
On April 6th, the National Academies of Sciences, Engineering, and Medicine published a report entitled “The National Imperative to Improve Nursing Home Quality,” the conclusion of an 18-month process intended to make “bold, actionable recommendations to improve nursing home care.” The 17-member committee agreed on seven key conclusions: 

  1. The way in which the United States finances, delivers, and regulates care in nursing home settings is ineffective, inefficient, fragmented, and unsustainable.
  2. Immediate action to initiate fundamental change is necessary.
  3. Federal and state governments, nursing homes, providers, payers, researchers, and others need to make clear a shared commitment to the care of nursing home residents.
  4. Extreme care needs to be taken to ensure that quality improvement initiatives are implemented using strategies that do not exacerbate disparities in resources, quality of care, or resident outcomes.
  5. High-quality research is needed to advance the quality of care in nursing homes.
  6. The nursing home sector has suffered for many decades from underinvestment in ensuring the quality of care in nursing homes and a lack of accountability in how resources are allocated.
  7. All relevant federal agencies need to have authority and resources from the U.S. Congress to implement the recommendations of this report.

The report also included a list seven broad goals: 

  1. Deliver comprehensive, person-centered, equitable care that ensures the health, quality of life, and safety of nursing home residents; promotes resident autonomy; and manages risks.
  2. Ensure a well-prepared, empowered, and appropriately compensated workforce.
  3. Increase transparency and accountability of finances, operations, and ownership.
  4. Create a more rational and robust financing system.
  5. Design a more effective and responsive system of quality assurance.
  6. Expand and enhance quality measurement and continuous quality improvement.
  7. Adopt health information technology in all nursing homes.

The full report may be downloaded here.

Congressional Hearings

The House and Senate are in recess through April 22nd.

New York State Updates

Governor Hochul Announces Budget Agreement
On April 7th, Governor Kathy Hochul announced that she had come to an agreement with the New York Legislature on the State’s Fiscal Year (FY) 2022-23 budget. Hochul noted that the agreement includes various health care proposals, including: 

  • One-time bonuses for frontline health care workers, as originally proposed, totaling $1.2 billion; and
  • Increased funding to support a $3 per hour wage increase for home health care aides, totaling $7.4 billion.

As of this morning (April 8th), Senate Finance Committee Chair Liz Krueger said that negotiations were “almost complete but not fully complete.” The Article VII Health and Mental Hygiene (HMH) bill, which includes most health care proposals, was introduced and printed this morning, but has not yet passed the Legislature. Some notable items include: 

  • The proposed $1.4 billion Statewide Health Care Facility Transformation Program (SHCFTP) Round 4 has been included, with additional types of eligible providers and allocations for provider types;
  • Scope of practice modifications from the Executive Budget are included, including the complete exemption of nurse practitioners with more than 3,600 hours of experience from the written collaborative agreement requirement.
  • The proposal for DOH to conduct a procurement of Medicaid managed care organizations (MCOs) has been replaced with a direction for DOH to select an independent contractor to report on the status of Medicaid MCOs to inform a plan for future reform.
  • Telehealth parity provisions in Medicaid and commercial coverage have been included similar to the proposal in the Executive Budget, with an exemption for facility fees.

SPG will distribute a full summary of the Budget once it has been officially passed next week. The Governor’s announcement is available here. The HMH bill text is available here.
 
SED Adopts Amendment Allowing Certain Out-of-State Psychologists to be Licensed by Endorsement in New York
On March 30th, the New York State Education Department (SED) posted a notice of adoption in the State Register (available here) of an amendment that creates a pathway for licensure by endorsement for doctoral-level psychologists that are licensed in other states, countries, or territories. Such psychologists must: 

  • Be licensed based on standards “substantially equivalent” to those of New York State;
  • Have at least five years of experience practicing psychology during the ten years before submitting their application; and
  • Have no disciplinary action in other jurisdictions.

In response to public comments, SED noted that licensure by endorsement provides an expedited licensure pathway for experienced psychologists who have met similar out-of-state licensure requirements and who seek to practice in New York State, either in-person or through telehealth technology. The updated regulations also note that face-to-face supervision may include the use of acceptable technology, including secure videoconferencing.
 
The updated regulations are available here.
 
CMS Approves Temporary Extension of Children’s Waiver
On April 4th, the New York State Department of Health (DOH) issued a notice (available here) that CMS approved a 90-day extension of New York’s Children’s Waiver, which was otherwise set to expire on March 31st. The notice, which was sent to children’s Home and Community-Based Service (HCBS) providers, Health Home care managers, and Medicaid Managed Care (MMC), notes that the temporary extension gives the State additional time to appropriately address CMS’s feedback on the waiver renewal application. The State has requested a five-year extension of the Children’s Waiver (through March 31, 2027).
 
DOH also sent a notice (available here) to MMC plans indicating that the requirement for plans to pay government rates (i.e., Medicaid fee-for-service rates) for children’s HCBS continues to be effective for dates of service through September 30th.
 
Questions may be submitted to bh.transition@health.ny.gov. The temporary extension is effective through June 29th.
 
Class Action Lawsuit Filed Against DOH and OMH on Behalf of Medicaid-Eligible Children with Mental Health Needs
On March 31st, a set of plaintiffs filed a class action lawsuit in the federal District Court of Eastern New York against DOH Commissioner Mary Bassett and Office of Mental Health (OMH) Commissioner Ann Marie Sullivan for the State’s “well-known and longstanding failure to provide Medicaid-eligible children with legally required mental health care.” The plaintiffs are Medicaid-eligible children with mental health conditions who were determined to require intensive mental health conditions requiring home and community-based services (HCBS).
 
The lawsuit asserts that DOH and OMH failed to provide adequate behavioral health HCBS that would have prevented this class of children from being unnecessarily institutionalized. The lawsuit specifically addresses the package of Children and Family Treatment and Support Services (CFTSS) and claims that these services are not comprehensive and are not provided to all children for whom they are medically necessary. Further, the lawsuit asserts that New York State lacks an adequate number of practitioners to provide services and that State officials have known about these gaps in care for years but have failed to address them.
 
The lawsuit is available here.
 
OMH to Hold Webinar on Clinic Services Under the Rehabilitative Option
On April 11th from 1:30pm to 2:30pm, OMH will host a webinar for Article 31 clinics to review the provision of clinic services under the Medicaid rehabilitative services benefit. Last year, CMS approved an amendment to enable this provision, which allows Medicaid to reimburse outpatient mental health services when provided in a community setting or in an individual’s place of residence. The webinar will provide a high-level overview of such services, including peer support, offsite services, and the role of the Licensed Practitioner of the Health Arts (LPHA).
 
Registration for the webinar is available here.
 
DFS Issues Guidance on Required Preventive Care for Colorectal Cancer
On March 31st, the New York State Department of Financial Services (DFS) issued a circular letter (available here) to regulated health insurance plans outlining coverage requirements for preventive care and screenings for colorectal cancer. In accordance with New York State Insurance Law and updated guidance from the United States Preventive Services Task Force, all plans (except for “grandfathered” health plans) must provide coverage with no cost-sharing for: 

  • Preventive screenings for colorectal cancer in adults starting at age 45; and
  • Follow-up colonoscopies after an abnormal or positive non-invasive stool-based screening test or direct visualization screening test.

These requirements apply to policies to contracts issued or renewed on and after November 30, 2021. Questions may be submitted to health@dfs.ny.gov.

Funding Opportunities

HRSA Issues $39 Million NOFO for Public Health Scholarship Program
On April 4th, HRSA released a new Notice of Funding Opportunity for the Public Health Scholarship Program (PHSP). PHSP supports organizations to develop scholarship programs that incentivize individuals to pursue careers in public health. The program provides funds to award recipients to provide scholarships to individuals (including grant recipient employees) receiving training and professional, graduate, and/or certificate programs in public health.
 
The program will award approximately $39 million to 26 grantees. Applicants are required to have an existing public health training program, public health partnerships, and a system for scholarship recipients to maintain or be transitioned into employment and public health after finishing training. Eligible applicants include: 

  • An accredited health professions school;
  • An academic health center;
  • A state or local government; or
  • Any other appropriate public or private nonprofit entity.

Applications are due on June 1st. The funding opportunity can be found here.
 
OMH Issues RFP for $500,000 for Student Mental Health Support Grants to School Districts
On March 29th, OMH issued a Request for Proposals (RFP) that offers grants of up to $500,000 annually to school districts to improve student access to mental health resources and support students who have experienced stress, anxiety, and/or trauma. Eligible applicants are school districts with a rate of economically disadvantaged students that is above the state average (see Appendix A for list of eligible districts). Applicants may choose to enhance mental health services using an existing or new partnership with an OMH-licensed, designated, or authorized community-based organization that has experience serving children and families with mental health needs. Contracts will last for five years starting on July 1st
 
The RFP is available here. Applications are due on May 25th. Applicants must submit a non-binding Letter of Intent by May 18th.
 
RWJF Offers One-Time Grants of $40,000 for Data Projects on SDH and Health Equity
On March 30th, the Robert Wood Johnson Foundation (RWJF) released a Call for Proposals for grants that build data capacity in communities to advance health equity. Through this opportunity, RWJF will award up to 35 organizations with one-time grants of $40,000 each to improve community conditions shaped by structural racism using data. Community conditions generally include social determinants of health (SDH), such as the built environment, employment, food insecurity, housing, and transportation, among others. The performance period will be nine months, starting on September 1st.

Proposed projects should focus on the needs of local geographies, such as neighborhoods, cities, counties, or metropolitan areas, and should engage with community members and local leaders. Proposals may expand the scope of an ongoing project that is aligned with the objectives of this funding opportunity.
 
Eligible applicants are not-for-profit organizations based in the United States or its territories. Applicants may only submit one proposal. Up to 50 percent of the total proposed budget may be allocated to collaborating organizations.
 
Additional details are available here. Interested applicants must register their intent to apply by April 20th. Registrants who are determined by RWJF to be eligible for funding will be invited to submit a full proposal, which will be due on May 26th.