Weekly Health Care Policy Update – March 28, 2023

April 4, 2023

In this update: 

  • Congressional Updates
    • CBO Tells Senate Budget Committee It Overestimated Health Care Spending
  • Federal Agencies
    • CMMI Extends VBID through 2030 and Announces New Equity and HRSN Requirements
    • HRSA Announces Organ Procurement and Transplantation Network Modernization Initiative
    • SAMHSA Awards CCBHC Planning Grants to 15 States
    • HHS Distributes $560 Million in Home Energy Grants
    • HHS Announces New Office of Family Violence Prevention and Services
  • Other Updates
    • CDC Report Shows Rise in Autism Rates
    • Covid States Project Estimates 73% National Vaccination Rate, Finds CDC Errors
    • JAMA Publishes Analysis of Hospital Price Transparency Data
  • New York State Updates
    • Governor Hochul Nominates Dr. James McDonald to Serve as Commissioner of Health
    • Governor Hochul Extends Statewide Disaster Emergency Due to Health Care Staffing Shortages
    • NYS DOH Releases Updated Guidance for Nursing Home Visitation
    • DOH Proposes to Maintain MCO Contingent Reserve Requirement at 7.25%
  • Funding Opportunities
    • SAMHSA Releases NOFO for SUD Treatment for HIV/AIDS High Risk Populations
    • OPWDD Publishes Opportunity for Telephone Triage Nursing Services in Lower Hudson Region
    • OASAS Releases RFA for Substance Use Prevention on College Campuses
    • Lever for Change Offers Unrestricted Grants of $1 Million for Smaller CBOs
    • NYC DOHMH Releases RFP for Family Acceptance of LGBTQ+ Youth Project

Congressional Update

CBO Tells Senate Budget Committee It Overestimated Health Care Spending
On March 17th, the Congressional Budget Office (CBO) wrote a letter to Senate Budget Chairman Sheldon Whitehouse (D-RI) responding to the Committee’s request to “gauge the accuracy of its projections of federal health care spending over time.”
 
In response, CBO compared its 10-year projections from August 2010, the first created after the passage of the Affordable Care Act (ACA), with the actual spending from 2010 to 2020. Over that time, mandatory outlays (mostly composed of Medicare and Medicaid) were 9 percent less than the original projections. CBO noted that the discrepancy was mostly due to an overestimate in spending per beneficiary, as opposed to an overestimate of the number of beneficiaries. Specifically, lower Medicare Part D prescription drug spending, and lower Medicaid spending for long-term services and supports accounted for significant projection errors.
 
CBO also noted that the growth in federal mandatory health care spending per beneficiary has “slowed sharply” since 2005. Between 1987 and 2005, spending grew at an annual rate of 6.6%; it grew only 2.2% annually between 2013 and 2019. Despite this slowdown, the United States still spends a larger share of its gross domestic product on health care than other advanced economies, while achieving worse health outcomes than many of those same countries.
 
The full letter is available here.

Federal Agencies

CMMI Extends VBID through 2030 and Announces New Equity and HRSN Requirements
On March 23rd, the Center for Medicare and Medicaid Innovation (CMMI) announced that it will extend the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model by another five years, through 2030. Under VBID, MA plans may offer targeted and modified benefits (e.g., reduced cost-sharing or reward/incentive programs) to certain types of enrollees, including those with certain clinical conditions or a specific socioeconomic status.  
 
As part of the extension, CMMI will introduce changes to address “the health-related social needs (HRSN) of patients, advance health equity, and improve care coordination for patients with serious illness.” CMMI will describe these changes in more detail in the 2024 Request for Applications (RFA), but they will include: 

  • Requiring all VBID participants to submit a health equity plan (currently, only applicants for the Hospice benefit component have this requirement); and
  • Requiring VBID participants to report on beneficiary-level utilization of supplemental benefits addressing priority HRSN areas: 
    • Food and nutritional insecurity;
    • Transportation barriers; and
    • Access to general supports for living (e.g., housing, utilities).

More information about the current VBID program can be found here.
 
HRSA Announces Organ Procurement and Transplantation Network Modernization Initiative
On March 22nd, the Health Resources and Services Administration (HRSA) announced a “modernization initiative” to “strengthen accountability and transparency” in the Organ Procurement and Transplantation Network (OPTN). The OPTN was established by the National Organ Transplant Act in 1984 to “coordinate and operate the nation’s organ procurement, allocation, and transplantation system” and to “increase access to donor organs for patients with end-stage organ failure.”  This includes managing the national list of individuals who need organs and a system to match organs with those individuals. Today, more than 104,000 adults and children are on the waitlist.
 
The modernization initiative seeks to enhance accountability, equity, and performance of the OPTN. It includes five main pieces: 

  1. Data dashboards detailing individual transplant center and organ procurement organization data on organ retrieval, waitlist outcomes, and transplants, and demographic data on organ donation and transplant;
  2. Modernization of the OPTN IT system in line with industry-leading standards, improving OPTN governance, and increasing transparency and accountability in the system;
  3. HRSA’s intent to issue contract solicitations for multiple awards to manage the OPTN in order to foster competition and ensure OPTN Board of Directors’ independence;
  4. A proposed doubling of investments in organ procurement and transplantation in the President’s budget—a $36 million increase over Fiscal Year 2023, for a total of $67 million; and,
  5. A request to Congress to update the National Organ Transplant Act to remove the appropriations cap on the OPTN contract(s) to allow HRSA to better allocate resources, and to expand the pool of eligible contract entities to enhance performance and innovation through increased competition.

With the announcement, HRSA debuted the first initiative, a new data dashboard, offering de-identified information on organ donors, organ procurement, transplant waitlists, and transplant recipients. HRSA also launched an “OPTN Modernization Website” to keep stakeholders informed about the initiative via progress updates.
 
More information on the Modernization Initiative is available here.
 
SAMHSA Awards CCBHC Planning Grants to 15 States
On March 16th, the Substance Abuse and Mental Health Services Administration (SAMHSA) awarded 15 states with one-year, $1 million Certified Community Behavioral Health Clinic (CCHBC) planning grants. CCBHCs were created to “transform mental health and substance use treatment” and “provide sustainable funding for robust community outpatient mental health treatment.” This is the first time such grants have been available since the program’s inception in 2015. Funding for the planning grants was made available through the Bipartisan Safer Communities Act in 2022.
 
This set of grants is the first of two award rounds. A funding opportunity for an additional 15 states is expected to be made available in fiscal year (FY) 2024. Ten of these initial awardees will be able to join the federal CCBHC Demonstration (in which New York already participates) in 2024.
 
More information on this latest round of funding is available here.
 
HHS Distributes $560 Million in Home Energy Grants
On March 16th, the Department of Health and Human Services (HHS) Administration for Children and Families (ACF) announced the award of $560 million to help American households cover the costs of home heating and cooling. The grants are the third funding release to states, territories, Indian tribes, and tribal organizations from the Low Income Home Energy Assistance Program (LIHEAP) for FY 2023. LIHEAP provides assistance to low-income households with energy costs, including costs associated with crisis and weatherization assistance. The program received increased funding through the American Rescue Plan Act and the Bipartisan Infrastructure Bill, bringing FY 2023 spending to a total of $6.1 billion.
 
New York State received $48,056,240 as part of this distribution. More information is available here.
 
HHS Announces New Office of Family Violence Prevention and Services
On March 20th, HHS announced the opening of the ACF Office of Family Violence Prevention and Services (OFVPS). OFVPS will support “a comprehensive approach to domestic violence prevention across ACF, HHS, and the federal government.” This reorganization essentially promotes the ACF’s Division of Family Violence Prevention and Services, which existed underneath ACF’s Family and Youth Services Bureau (FYSB) to an office directly under ACF. Shawndell Dawson, the Division’s current Director, will remain the Director of the new OFVPS.
 
OFVPS will have three main priorities 

  • Developing an ACF-wide strategy and action plan for preventing and responding to domestic violence across social service programs;
  • Maintaining and leading coordination and collaboration efforts across agency partners; and
  • Prioritizing the continued implementation appropriations to support survivors of domestic violence and sexual assault.

More information is available here.

Other Updates

CDC Report Shows Rise in Autism Rates
On March 23rd, the Centers for Disease Control and Prevention (CDC) published new data from its Autism and Developmental Disabilities Monitoring Network (ADDM). ADDM collects information about the number of 4- and 8-year-olds with autism from 11 different areas in the United States. Among 4-year-old children: 

  • Children born in 2016 were 56% more likely to receive an autism diagnosis by age 4 compared with children born in 2012.
  • For every one girl identified with autism, three boys were identified with autism.
  • More Black, Hispanic, and Asian or Pacific Islander children were identified with autism than White children.

Among 8-year-old children: 

  • One in every 36 children (2.8%) had autism. One in every 44 children had autism in CDC’s previous study.
  • More Black, Hispanic, and Asian or Pacific Islander children were identified with autism than White children. This is the first time the ADDM Network observed this finding among 8-year-old children.
  • For every one girl identified with autism, four boys were identified with autism.
  • More Black children with autism also had an intellectual disability (i.e., an IQ of 70 or less) than White and Hispanic children with autism.

More information is available here.
 
Covid States Project Estimates 73% National Vaccination Rate, Finds CDC Errors
On March 22nd, the Covid States Project (CSP), a joint project of Harvard, Northeastern, Northwestern, and Rutgers Universities, published a report entitled “Estimating Current Vaccination Rates.” The report found that the current national rate of vaccination for the primary series (at least 2 shots of an mRNA vaccine or one of the Johnson & Johnson vaccine) is 73%, and that 29% of adults have received a bivalent booster.
 
The report notes that Centers for Disease Control and Prevention (CDC) data “deviate quite substantially” from their own and from that of the Kaiser Family Foundation, both survey-based measures of vaccination rates. For example, CDC estimates that 79% of individuals have completed the primary series of vaccinations but that only 20% of individuals received a bivalent booster. CSP concludes that the deviations “almost certainly reflect” errors in the underlying records used by CDC, distorted by states’ inabilities to link records of multiple shots given to a single individual.
 
The report makes several other key findings: 

  • Rates for the primary series of vaccinations have plateaued since Fall 2021;
  • The Northeast and the West Coast (plus Hawaii) have the highest vaccination rates;
  • The South, and the upper West/Midwest (Dakotas, Montana, Wyoming, and Idaho) have the lowest rates.

The full report is available here.
 
JAMA Publishes Analysis of Hospital Price Transparency Data
On March 21st, JAMA Network Openpublished one of the first analyses of hospital price transparency data. Using data compiled by Turquoise Health, researchers compared commercial negotiated prices for brain MRIs. The researchers found that non-profit and government hospitals had higher commercial negotiated prices for brain MRI (median price of $1,938 and $2,149, respectively) compared to for-profit hospitals (median price of $1,509). Hospitals in rural areas, hospitals with more health plan contracts, and hospitals treating more Medicare patients had higher median prices, likely reflecting these hospitals’ stronger bargaining power in their local markets.
 
The analysis is available here.

New York State Updates

Governor Hochul Nominates Dr. James McDonald to Serve as Commissioner of Health
On March 24th, Governor Hochul announced the nomination of Dr. James V. McDonald to serve as Commissioner of the New York State (NYS) Department of Health (DOH). Dr. McDonald has served as acting DOH commissioner since January 1, 2023.
 
Dr. McDonald joined DOH in July 2022, serving as the medical director of the Department’s Office of Public Health. He was later appointed Interim Director of the Center for Community Health. Dr. McDonald is a board-certified physician in pediatrics and preventive medicine, and has previously held multiple roles at the Rhode Island Department of Health.
 
The Governor’s press release is available here.
 
Governor Hochul Extends Statewide Disaster Emergency Due to Health Care Staffing Shortages
On March 23rd, Governor Hochul issued Executive Order 4.19 which extends through April 22nd the provisions in Executive Order 4 and its successors that reinstated many workforce and scope of practice flexibilities that applied during the original NYS Covid-19 public health emergency. Certain provisions of the Order have previously expired, including those related to prior authorization, nursing home staffing, revenue requirements, and scope of practice for health care program graduates and volunteers or personnel affiliated with different hospitals.
 
The Executive Order is available here.
 
NYS DOH Releases Updated Guidance for Nursing Home Visitation
On March 17th, DOH released updated guidance to align nursing home visitation rules with CMS regarding Covid-19 screening and visitor testing. Consequently, nursing homes are no longer required to verify that visitors have a negative Covid-19 test before entry or conduct active Covid-19 screening. DOH recommends that facilities continue to conduct passive screening, including instructional signage and visitor education on Covid-19 signs and symptoms and infection control precautions. Facilities may continue visitor testing and/or active screening at their discretion.
 
The guidance is available here. Questions may be sent to covidnursinghomeinfo@health.ny.gov or icp@health.ny.gov.
 
DOH Proposes to Maintain MCO Contingent Reserve Requirement at 7.25%
On March 22nd, DOH issued a proposed rule to maintain the contingent reserve requirement at 7.25 percent through 2023 for Medicaid managed care organizations (MCOs), including mainstream plans, HIV Special Needs Plans (HIV SNPs), and Health and Recovery Plans (HARPs). Although the contingent reserve has been scheduled to eventually increase to 12.5%, DOH has annually continued the 7.25% level for several years now. The lower reserve requirement allows DOH to maintain the current 2 percent reduction in the premium rates while maintaining actuarial soundness.
 
The proposed rule is available in the State Register here. Public comment may be submitted to regsqna@health.ny.gov through May 21st.

Funding Opportunities

SAMHSA Releases NOFO for SUD Treatment for HIV/AIDS High Risk Populations
On March 22nd, SAMHSA released a Notice of Funding Opportunity (NOFO) seeking applicants to provide outreach and substance use disorder (SUD) treatment to racial and ethnic medically underserved individuals who are at risk for or living with HIV. Funding will support direct services, including but not limited to: 

  • Providing SUD treatment and recovery support services, including screening, outpatient services, and FDA-approved medication;
  • Providing HIV and viral Hepatitis testing;
  • Providing education, preventative services, referral/linkages to care, and care management; and
  • Developing and implementing a continuous outreach strategy.

Through this opportunity, SAMHSA will award $20.9 million in total annual funding to 42 applicants (up to $500,000 annually per awardee) over a five-year program period. Eligible applicants include health facilities and other public and private non-profit entities.
 
The NOFO is available here. Applications are due on May 22nd. Questions may be submitted to Kirk James at TCE-HIV@samhsa.hhs.gov.
 
OPWDD Publishes Opportunity for Telephone Triage Nursing Services in Lower Hudson Region
On March 14th, the NYS Office for People with Developmental Disabilities (OPWDD) released an Invitation for Bids (IFB) for one contractor to provide Telephone Triage Nursing Services in Orange, Rockland, Sullivan, and Westchester Counties. Telephone Triage Nursing is a service in which a Registered Nurse (RN) screens an individual’s symptoms during a telephone call and triages care. These services will support staff caring for individuals living in OPWDD Community Residences, comprising approximately 660 individuals living in approximately 145 homes throughout the identified region. OPWDD anticipates an average utilization of 200 calls per month.
 
Eligible applicants include not-for-profit or for-profit organizations. Applicants must employ RNs who are licensed to practice in NYS and who have any specialized training or qualifications necessary to perform the triage service. OPWDD will make payments to the contractor based on actual services rendered. Payment will be based on the monthly administrative fee plus a rate per call.
 
The IFB is available here. SPG’s summary of the opportunity is available here. Applications are due on April 25th. Questions may be submitted to eny.ny.li.contracthub@opwdd.ny.gov through March 28th.
 
OASAS Releases RFA for Substance Use Prevention on College Campuses
On March 22nd, the NYS Office of Addiction Services and Supports (OASAS) released a Request for Applications (RFA) seeking applicants to implement evidence-based practices (EBPs) and environmental change strategies (ECS) on City University of New York (CUNY) community college campuses and/or downstate Educational Opportunity Centers (EOC) to prevent or reduce substance abuse. Awarded applicants will be required to implement a three-pronged ECS approach or one or more EBPs listed in Appendix A of the RFA.
 
Through this opportunity, OASAS will issue five grants of up to $100,000 for one year. OASAS may extend the contract by issuing time or cost extensions for all awardees or a subset of awardees. Eligible applicants must: 

  • Be OASAS State Aid funded providers of primary prevention services under program code 5520; and
  • Provide services or be located within the five NYC counties (Richmond, Kings, Bronx, New York, & Queens).

The RFA is available here. Applications are due on April 27th. Questions may be submitted to COVIDFunds@oasas.ny.gov with the subject line “Requests for Applications – OASAS Project No. SUPP1019” through April 6th.
 
Lever for Change Offers Unrestricted Grants of $1 Million for Smaller CBOs
Lever for Change, an affiliate of the John D. and Catherine T. MacArthur Foundation, has announced the “Yield Giving Open Call” program, which will provide $250 million in unrestricted grants to organizations working with disadvantaged and/or marginalized individuals and families. The program will award unrestricted gifts of $1 million each to 250 organizations nationwide.
 
Eligible applicants are community-led, community-focused not-for-profit organizations that work with the target population, such as organizations providing: 

  • Access to health care;
  • Stable and affordable housing;
  • Education and job training;
  • Support for sustained employment;
  • Asset ownership; and/or
  • Civic Engagement.

Organizations must have an annual operating budget of at least $1 million and no more than $5 million for at least two of the last four fiscal years, and must have been in existence for at least three years. Applications will be reviewed through an extensive process, including “peer feedback” (in which applicants will rate each other), based on the organization’s equity focus, track record, community leadership, and team capacity.
 
Additional details are available here. Interested applicants must register to apply by May 5th. Applications are due on June 12th.   
 
NYC DOHMH Releases RFP for Family Acceptance of LGBTQ+ Youth Project
On March 24th, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) released an RFP for the Family Acceptance of LGBTQ+ Youth project. This program is designed to promote family and community acceptance of LGBTQ+ youth and create safer, healthier spaces for LGBTQ+ youth and the adults in their lives. Through this opportunity, DOHMH will award $1.5 million in total funding to up to two organizations during the two-year program period. There will be an option to renew the contract for one additional year.
 
Eligible applicants are not-for-profit 501(c)(3) organizations that operate a brick-and-mortar site in NYC and that have at least two years of experiencing delivering relevant services (e.g., workshops, support groups). Organizations must be able to articulate the needs of LGBTQ+ youth and craft thoughtful and intentional services, programming, and other opportunities to encourage parents, caregivers, family members, and communities to accept and support their LGBTQ+ youth.

The RFP is available here. Applications are due April 21st.