In this update:
- Legislative Updates
- Senator Wyden Sends Letter to CMS on Fraudulent ACA Enrollments
- Federal Agencies
- CMS Launches Portal to Report EMTALA Violations
- ARPA-H Launches Program to Automate Cybersecurity at Health Care Facilities
- CDC Asks States to Maintain Flu Surveillance
- Other Updates
- Senator Wyden Sends Letter to CMS on Fraudulent ACA Enrollments
- SEIU Elects April Verrett as Next President
- KFF Publishes Report on Readiness of LTC for New Staffing Requirements
- New York State Updates
- NYS DOH Issues Updated Medicaid Telehealth Policy Manual
- OMH Issues Guidance on Forthcoming ACT Reimbursement and Billing Changes
- SED Issues Proposed Regulations on Social Worker and Mental Health Practitioner Virtual Supervision, Accrediting Bodies for Social Work Education Programs, and the Social Work Psychotherapy Privilege
- SED Issues Final Regulations on Histotechnology Profession and Other Laboratory Clinicians
Legislative Update
Senator Wyden Sends Letter to CMS on Fraudulent ACA Enrollments
On May 21st, Senate Finance Committee Chair Ron Wyden (D-OR) sent a letter to the Centers for Medicare and Medicaid Services (CMS) urging the agency to enforce civil monetary penalties on health insurance brokers who fraudulently change enrollees’ health plans. Recently, news reports highlighted the ease with which brokers can submit plan and enrollment changes on HealthCare.gov. CMS subsequently masked the first six digits of consumers’ social security numbers, but Wyden urged the agency to go further, including by issuing clear rules and guidelines on acceptable marketing practices. Wyden further indicated he intends to introduce legislation to hold criminally responsible any brokers, agencies, and lead generators participating in fraudulent enrollment schemes.
The letter is available here.
Federal Agencies
CMS Launches Portal to Report EMTALA Violations
On May 21st, CMS launched a portal for patients and health care workers to report potential violations of the Emergency Medical Treatment and Labor Act (EMTALA). EMTALA guarantees patients the right to emergency, stabilizing medical care. The Biden Administration is currently arguing before the Supreme Court that EMTALA covers abortion services in the case over Idaho’s abortion ban; the decision is expected in the next few months. The goal of the portal is to expedite the review of complaints against hospital emergency departments.
The announcement is available here.
ARPA-H Launches Program to Automate Cybersecurity at Health Care Facilities
On May 20th, the Advanced Research Projects Agency for Health (ARPA-H) launched the Universal PatchinG and Remediation for Autonomous Defense (UPGRADE) program. UPGRADE will invest more than $50 million in information technology tools to better support and defend the cybersecurity of hospital environments. This platform will proactively test and probe digital hospital environments for software weaknesses, deploying a patch when necessary. UPGRADE will accept proposals across a number of technical areas including vulnerability mitigation software, digital twins creation, and methods for vulnerability detection and defense.
The announcement is available here. ARPA-H will hold a virtual proposer’s day on June 20th at 12pm, registration for which is available here.
CDC Asks States to Maintain Flu Surveillance
On May 21st, the Centers for Disease Control and Prevention (CDC) issued recommendations that influenza surveillance systems–operated by state and local health departments–continue to operate at enhanced levels throughout the summer. In a typical year, influenza monitoring drops off in the summer months. With more samples of influenza A submitted to clinical laboratories, the CDC will be able to track rare cases of human H5N1 virus (also known as bird flu) through the process of subtyping. Given the fragmentation of public health data sharing, this effort by the CDC represents a concerted effort to harmonize preparedness and response. To date, there have been two confirmed human cases in this current H5N1 outbreak.
The announcement is available here.
Other Updates
SEIU Elects April Verrett as Next President
On May 21st, the Service Employees International Union (SEIU) elected their new president, April Verrett. Verrett previously served as the Union’s Secretary-Treasurer and is the first Black president in the organization’s history. The election took place at the Union’s convention where Vice President Kamala Harris delivered the keynote speech; the Union has endorsed the Biden-Harris ticket. Verrett has a background in organizing long-term care providers in nursing homes and private homes. Verrett follows Mary Kay Henry, who served as President of SEIU since 2010 and was the first woman to lead the union.
More information on April Verrett is available here.
KFF Publishes Report on Readiness of LTC for New Staffing Requirements
On May 21st, the Kaiser Family Foundation (KFF) published a report on long-term care (LTC) facilities’ current staffing levels. The analysis found that LTC facilities are unprepared to meet CMS’s new minimum staffing requirement rule. In 45 states, including New York, New Jersey, and Connecticut, fewer than half of all facilities currently meet the staffing minimums. Despite having a two-year delay in compliance (May 2027 compared to May 2029), rural facilities have comparable staffing levels to urban facilities. Across the U.S., fewer than 1 in 5 facilities are currently in compliance, a proportion that is lower among for-profit facilities.
The report is available here.
New York State Updates
NYS DOH Issues Updated Medicaid Telehealth Policy Manual
This month, the New York State (NYS) Department of Health (DOH) issued an updated telehealth policy manual for Medicaid providers. The manual includes definitions, provider requirements, confidentiality and consent considerations, billing rules, and restrictions for specific services/populations.
The telehealth policy manual is available here. The State will update this manual directly with any changes to telehealth policy in the future, and changes will be announced in the State’s monthly Medicaid update and available in the Appendix A Change Log.
OMH Issues Guidance on Forthcoming ACT Reimbursement and Billing Changes
On May 23rd, the NYS Office of Mental Health (OMH) issued guidance to Medicaid managed care plans and providers of Assertive Community Treatment (ACT) regarding forthcoming ACT reimbursement and billing changes. The guidance provides an overview of forthcoming rate increases, which will be effective retroactive to October 1, 2023 pending final approval from CMS and the Division of Budget (DOB). The guidance also outlines changes to ACT slots, including the new 100 slot ACT for adults and new 28 slot ACT team for youth.
The guidance is available here. Questions may be submitted to BHO@omh.ny.gov (plan inquiries) or OMH-Managed-Care@omh.ny.gov (provider inquiries).
SED Issues Proposed Regulations on Social Worker and Mental Health Practitioner Virtual Supervision, Accrediting Bodies for Social Work Education Programs, and the Social Work Psychotherapy Privilege
On May 22nd, the New York State Education Department (SED) issued proposed regulations to:
- Amend the supervision requirements for social work and mental health professions to allow the use of secure technology, such as video conferencing;
- Update the provision regarding acceptable accrediting bodies for social work education programs; and
- Repeal the requirements for the “psychotherapy privilege” for licensed clinical social workers (LCSW), which is no longer required effective January 1, 2023.
Additional details are available in the State Register here. Public comment may be submitted to regcomments@nysed.gov through July 21st.
SED Issues Final Regulations on Histotechnology Profession and Other Laboratory Clinicians
On May 22nd, SED issued final regulations that establish regulations and requirements for histotechnologist licensure. The regulations also add the following clinical laboratory professionals to the general misconduct provisions for health professions:
- Clinical laboratory technician;
- Clinical laboratory technologists;
- Cytotechnologist;
- Histotechnician; and
- Histotechnologist.
Additional details are available in the State Register here.