In this update:
- Covid-19 Updates
- Pfizer/BioNTech and Moderna Ask FDA to Grant EUA for 2nd Booster
- Ashish Jha to Become New White House Covid-19 Coordinator, Focusing on Preparedness
- Governor Hochul Extends NYS Covid-19 Emergency Declaration
- Federal Administration
- Shalanda Young Confirmed as OMB Director
- Biden Administration Announces Initiative to Improve Supply Chain Data Flow
- Federal Legislature
- Biden Signs Omnibus Spending Bill; Covid-19 Supplemental Stalls
- Congressional Progressive Caucus Releases Executive Action Agenda
- Federal Agencies
- CMMI Announces ACO REACH Webinars
- OMB Receives Family Glitch Rule for Review
- HHS OIG Releases Report on Medicare Beneficiaries’ Use of Telehealth
- CMS Publishes FFY 2018-2021 Medicaid DSH Allotments
- CMS Reissues LTCH and IRF Provider Preview Reports
- Legislative Hearings
- New York State Updates
- NYS Assembly and Senate Release One-House Budget Bills
- OPWDD Releases Memo Outlining the Housing Subsidy Program
- CMS Approves SPA Updating Article 16 Clinic APG Base Rates
- CMS Approves SPA Implementing 1% COLA to OMH Reimbursement Rates
- HHS OIG Audit of New York ALPs Recommends Refunding $1.9 Million of Improper Claims
- Funding Opportunities
- Affinity Legacy Hosts Webinar on Community Grant Program
- Senator Gillibrand Accepts Applications for Directed Spending Requests
- OMH Announces One-Time Targeted Investments for Benefits & Work Incentives Navigator Training
- HRSA Opens 2022 NHSC New Site Application Period
COVID-19 Updates
Pfizer/BioNTech and Moderna Ask FDA to Grant EUA for 2ndBooster
On March 15th, Pfizer/BioNTech asked the Food and Drug Administration (FDA) to grant emergency use authorization (EUA) for a second booster dose for Americans 65 and older. The request is based on data from Israel suggesting that a second booster offers protection against the Omicron variant. On March 17th, Moderna submitted a similar request to authorize a second booster, but asked that the EUA apply to all adults, not just seniors, to “provide flexibility” for the Centers for Disease Control and Prevention (CDC) and medical providers to determine appropriateness criteria.
Currently, only severely immunocompromised people are authorized to receive a fourth mRNA vaccine dose, while anyone over 12 can receive a first booster five months after receiving a primary series.
Ashish Jha to Become New White House Covid-19 Coordinator, Focusing on Preparedness
On March 17th, President Biden announced that Dr. Ashish Jha, the current Dean of the Brown University School of Public Health, will replace Jeffrey Zients as the White House Covid-19 Response Coordinator, a role with overall responsibility for orchestrating the implementation of the Administration’s Covid-19 policies. Dr. Jha, a practicing internist, previously directed a global health institute at Harvard’s School of Public Health, and has been a highly-visible expert throughout the pandemic. Jha has become an informal White House advisor over the past year, with much of his advice already incorporated into Biden’s pandemic road map. Jha’s appointment begins on April 5th, and he will take a “short-term leave” from Brown to serve in the role.
Biden’s statement notes that the transition marks “a new moment in the pandemic,” and that Dr. Jha’s focus would be “executing on my National Covid-19 Preparedness Plan and managing the ongoing risks from Covid.” Concurrently, the White House announced the launch of the Clean Air in Buildings Challenge, part of the Preparedness Plan, which calls for building owners and operators to assess indoor air quality and improve ventilation, and will support state and local governments in using American Rescue Plan funds to do so.
The White House announcement on Dr. Jha is available here. The announcement on the Clean Air in Buildings Challenge is available here.
Governor Hochul Extends NYS Covid-19 Emergency Declaration
On March 16th, Governor Hochul issued Executive Order 11.4 (available here), which extends the second Covid-19 State Disaster Emergency declaration through April 16th. The Order continues the implementation of the State’s Comprehensive Emergency Management Plan and the “Surge and Flex” system, which allows the Department of Health (DOH) to limit non-essential elective procedures at health systems with limited capacity. Limited capacity is defined as having below 10% staffed bed capacity available, or as otherwise determined by DOH. The Order also continues the waiver of certain State Finance Law provisions around procurement to expedite purchasing of pandemic-related supplies.
Federal Administration
Shalanda Young Confirmed as OMB Director
On March 15th, the Senate voted 61 to 36 to confirm Shalanda Young as Director of the Office of Management and Budget (OMB). Young is the Deputy Director of OMB and has been serving as the acting Director since March of 2021. She was officially nominated by President Biden to lead the Office in November. Young previously served as Majority Staff Director of the House Appropriations Committee, the first Black woman in that role. She will also be the first Black woman to lead OMB. President Biden nominated Nani Coloretti, former deputy secretary of the Department of Housing and Urban Development, to replace Young as Deputy Budget Director.
Biden Administration Announces Initiative to Improve Supply Chain Data Flow
On March 15th, the Biden Administration announced the Freight Logistics Optimization Works (FLOW) initiative, an effort to address longer-term weaknesses in the U.S. supply chain. FLOW is an information-sharing initiative that will pilot digital freight information exchange between parts of the goods movement supply chain. The goal is to offer supply chain stakeholders “reliable, predictable, and accurate information about goods movement.” FLOW will develop a proof-of-concept information exchange pilot, involving 18 participants, including private businesses, trucking, warehousing, logistics companies, and ports. The effort will be led by the Department of Transportation, which aims to produce a concept of the freight information exchange by the end of the summer.
More information on FLOW, including initial participants, can be found here.
Federal Legislature
Biden Signs Omnibus Spending Bill; Covid-19 Supplemental Stalls
On March 15th, President Biden signed the Consolidated Appropriations Act of 2022, an omnibus spending package for federal fiscal year (FFY) 2022. As described previously, the bill did not include additional funding for the Covid-19 pandemic response, due to Democratic House members’ objections to the proposed reclaiming of unused state aid to pay for it. The White House is urging Congress to immediately provide at least $22.5 billion in Covid-19 funding to continue the government’s response and prepare for the next wave, now occurring in Europe.
The House released a standalone bill including nearly $10 billion in additional pandemic funding without any offsets, which it had been expected to vote on this week. However, Democrats are now seeking a “four corners” bipartisan agreement among both parties’ House and Senate leadership. On March 17th, Speaker Nancy Pelosi said that the House is “going to have to pass it” and that “to have bipartisan votes, we want it to be paid for.”
The omnibus bill text is available here and a summary is available here.
Congressional Progressive Caucus Releases Executive Action Agenda
On March 17th, the Congressional Progressive Caucus, a group of 97 House members led by Rep. Pramila Jayapal (D-WA), released an “executive action agenda” with items that it proposes that the Biden Administration should implement without the need for additional legislation. The agenda covers eight policy area, which include: lowering health care costs, canceling federal student loan debt, expanding worker power and raising wages, advancing immigrants’ rights, equal justice under the law, climate change and reducing fossil fuel dependence, investing in care economy jobs and standards, and regulating for economic and tax fairness.
The agenda lists various health care proposals, typically without details on proposed implementation. Key items include:
- Fixing the “family glitch” in the Affordable Care Act;
- “Transitioning away” from the ACO Realizing Equity, Access, and Community Health (REACH) model;
- Build public manufacturing capacity to ensure availability of critical medicines such as insulin;
- Requiring all government funding contracts to include a reasonable-pricing clause using a standard such as the median price in other OECD countries, as well as licensing conditions to ensure affordable global access;
- Establishing minimum staffing standards for skilled nursing facilities, expanding training opportunities, and tying Medicaid payments to adequate wages; and
- Robust implementation of the Medicaid Equal Access Rule including establishing a public process to ensure that payment levels for home care providers are adequate, and that rate increases are passed on to workers in the form of higher wages.
The full document can be found here.
Regulatory Updates
CMMI Announces ACO REACH Webinars
On March 17th, the Center for Medicare and Medicaid Innovation (CMMI) announced a schedule for a set of webinars providing more information on the ACO REACH model during the application period, which runs through April 22nd. There will be five webinars:
- March 22nd at 4pm: ACO REACH Model Overview Webinar (register here)
- March 28th at 4pm: ACO REACH Financial Methodology Webinar (register here)
- March 29th at 4pm: ACO REACH Application Office Hours (register here)
- April 5th at 4pm: ACO REACH Health Equity Webinar (register here)
- April 12th at 4pm: ACO REACH General Office Hours (register here)
Questions may be submitted in advance to ACOREACH@cms.hhs.gov.
OMB Receives Family Glitch Rule for Review
On March 11th, OMB received a proposed rule from the Internal Revenue Service (IRS) entitled “Guidance Under Section 36B Regarding the Premium Tax Credit.” This rule is expected to address the “family glitch” in the interpretation of the Affordable Care Act. Currently, if employees are determined to be eligible for affordable individual insurance from their employer (less than 9.61% of income in 2022), they are ineligible for ACA premium subsidies, even if they would be purchasing family insurance that would not meet the same standard.
The OMB notice is available here.
HHS OIG Releases Report on Medicare Beneficiaries’ Use of Telehealth
On March 15th, the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) published a report titled “Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic.” Overall, the report shows that two in five Medicare beneficiaries used telehealth during the first year of the pandemic, or more than 28 million Medicare beneficiaries, and that overall, 12% of services were provided through telehealth that year.
This is the second in a series of OIG briefs on the use of telehealth in both Medicare fee-for-service and Medicare Advantage during the first year of the pandemic. The first report examined the characteristics of beneficiaries who used telehealth during the pandemic, and a third report will identify program integrity concerns related to telehealth during the pandemic. The analysis was based on Medicare fee-for-service claims data and Medicare Advantage encounter data from March 2019 through February 2021.
In total, beneficiaries used 88 times more telehealth services during the first year of the pandemic than they used in the prior year, with usage peaking in April 2020 but remaining high through early 2021. The most common services included office visits, particularly for behavioral health services. Beneficiaries used telehealth for 43 percent of all behavioral health services.
The full report is available here.
CMS Publishes FFY 2018-2021 Medicaid DSH Allotments
On March 16th, the Centers for Medicare and Medicaid Services (CMS) published the final federal share disproportionate share hospital (DSH) allotments for FFYs 2018 and 2019, and the preliminary federal share DSH allotments for FFYs 2020 and 2021. CMS also announced final FFY 2018 and 2019 and preliminary FFY 2020 and 2021 limits on the aggregate DSH payments that states may make to institutions for mental disease (IMDs) and other mental health facilities. The allotments become effective 30 days after publication in the Federal Register.
Allotments for New York are as follows:
- FFY 2018 Final DSH Allotment: $1,800,118,873
- FFY 2019 Final DSH Allotment: $1,843,321,726
- FFY 2020 Preliminary DSH Allotment: $3,756,689,678
- FFY 2021 Preliminary DSH Allotment: $3,813,040,024
- FFY 2018 Final IMD DSH Limit: $302,500,000
- FFY 2019 Final IMD DSH Limit: $302,500,000
- FFY 2020 Preliminary IMD DSH Limit: $340,010,000
- FFY 2021 Preliminary IMD DSH Limit: $340,010,000
Full data can be found in the Federal Register here.
CMS Reissues LTCH and IRF Provider Preview Reports
On March 14th, CMS reissued Long-Term Care Hospital (LTCH) and Inpatient Rehabilitation Facility (IRF) preview reports related to the March 2022 refresh of Care Compare. The provider previews are being reissued due to errors in measure calculations in several measures:
- Ventilator Liberation Rate measure (LTCH);
- National Healthcare Safety Network (NHSN) Facility-Wide Inpatient Hospital-onset Clostridium difficile Infection (CDI) Outcome Measure (LTCH and IRF);
- Change in Mobility Score for Medical Rehabilitation Patients (IRF); and
- Discharge Mobility Score for Medical Rehabilitation Patients (IRF).
The IRF Quality Reporting Program Public Reporting website can be found here. The LTCH Quality Reporting Program Public Reporting website can be found here.
Legislative Hearings
Wednesday, March 23rd:
- At 10am, the Senate Health, Education, Labor, and Pensions (HELP) Committee will hold a hearing entitled “Strengthening Federal Mental Health and Substance Use Disorder Programs: Opportunities, Challenges, and Emerging Issues.” More information is available here.
- At 10am, the Senate Special Committee on Aging will hold a hearing entitled “An Economy That Cares: The Importance of Home-Based Services.” More information is available here.
New York State Updates
NYS Assembly and Senate Release One-House Budget Bills
Last weekend, the New York State Senate and Assembly released their one-house budget proposals in response to Governor Hochul’s Executive Budget proposal. Some highlights from the one-house bills are outlined below.
Medicaid Reform and Funding
- Both houses would eliminate the Medicaid Global Cap.
- Both houses accept eliminating all resource tests in Medicaid and raising the income eligibility levels for non-MAGI groups to match the 138% MAGI standard.
- Both houses remove the proposed Medicaid Managed Care Organization (MCO) procurement.
- Both houses accept the $111 million reinvestment of medical loss ratio refunds into OMH and OASAS, with the Senate adding further reporting and transparency requirements.
Capital
- Both houses accept the creation of a new Statewide Healthcare Facility Transformation Program (SHCFTP IV) with modifications, included an expanded list of eligible applicants proposed by the Assembly.
Insurance Changes
- Both houses accept and expand the Essential Plan eligibility expansion by making it also available regardless of immigration status, with state funding of $345 million dedicated for this purpose.
- Both houses accept aligning the Child Health Plus (CHP) benefit with the Medicaid benefit package.
- Both houses accept extending Medicaid postpartum coverage eligibility to 12 months and including prenatal and postpartum care services under “standard coverage,” with the Senate extending this provision to undocumented individuals.
Provider Relief
- The Assembly proposal seeks to change the Governor’s proposed one-time health care worker bonuses to ongoing rate increases. Specifically, the one-time bonuses would be limited to certain governmental employees, while the remainder of the funding would be reallocated to increase the Cost of Living Adjustment (COLA) to 11% and to continue COLAs annually going forward, based on a CPI-U index. The Assembly proposal also includes Health Homes as eligible recipients for the COLA. The Senate accepts the 5.4% COLA and continues the adjustment for fiscal year 2023-2024.
- Both houses accept the implementation of a 1 percent across-the-board Medicaid rate increase.
- Both houses accept temporary rate adjustments or lump sum payments to financially distressed skilled nursing facilities and adult care facilities.
- Both houses include essential community providers and behavioral health Vital Access Provider (VAP) funding.
- Both houses accept the APG extension for Office of Mental Health (OMH) and Office of Addiction Services and Supports (OASAS) providers through 2027.
- Both houses enact the “Fair Pay for Home Care” proposal that would set a wage floor for personal care aides at 150% of the minimum wage.
Provider Oversight and Scope of Practice
- The Assembly rejects, but the Senate accepts, the Interstate Licensure Compact for physicians and nurses.
- The Senate would seek to combine the agencies of OMH and OASAS.
- Both houses reject moving the oversight of health professions from the State Education Department (SED) to DOH.
- Both houses reject the scope of practice expansions for pharmacists and nurse practitioners.
- The Assembly rejects, but the Senate accepts, the comprehensive statewide emergency medical services (EMS) plan and community paramedicine provisions.
Telehealth Reimbursement Parity
- The Assembly rejects the proposed telehealth reimbursement parity provisions, while the Senate accepts and expands these provisions. Specifically, the Senate would expand the definition of “telehealth provider” and, unlike the Executive proposal, would not allow payments to be reduced for facility fees or other factors.
The one-house bills are available here under the Budget Tab. Negotiations between the Legislature and the Governor’s office will continue over the next few weeks with the goal of passing a final budget by the March 31st deadline.
OPWDD Releases Memo Outlining the Housing Subsidy Program
On March 10th, the Office for People with Developmental Disabilities (OWPDD) released an Administrative Directive Memorandum (ADM) that defines the OPWDD Housing Subsidy Program, formerly Individual Supports and Services (ISS). The Housing Subsidy Program is intended to support eligible individuals who choose to live independently in the community and who are or will be financially and legally responsible for their residence. The ADM provides information on eligibility requirements, responsibilities of providers and care managers, application process, denial/termination occurrences, and decision appeals. The ADM applies to all individuals who are seeking, or are currently in receipt of, an OPWDD Housing Subsidy, including individuals with self-directed budgets.
Since stakeholder review of the ADM in 2021, the following changes have been included:
- Removal of the limit of 25 percent of the units in a building having a resident receiving an OPWDD Housing Subsidy; and
- Creation of a new process to request support letters for groups of housing subsidies.
The ADM is available here. Questions may be submitted to housing.initiatives@opwdd.ny.gov. OPWDD has also made changes to the Self-Direction Guidance for Providers (available here), specifically related to guidelines regarding sharing staffing resources.
CMS Approves SPA Updating Article 16 Clinic APG Base Rates
On March 15th, CMS approved a State Plan Amendment (SPA) submitted by New York to update the Ambulatory Patient Group (APG) base rates for OPWDD certified or operated clinics. This change will result in a 2 percent increase to total salaries for direct care staff, direct support professionals, clinical staff, and associated fringe compensation effective April 1, 2020.
The SPA is available here and the CMS approval letter is available here.
CMS Approves SPA Implementing 1% COLA to OMH Reimbursement Rates
On March 15th, CMS approved a SPA submitted by New York to implement a 1 percent COLA to the reimbursement fees for OMH licensed outpatient and rehabilitative programs. The amendment was approved with an effective date of July 1, 2021.
The SPA is available here and the CMS approval letter is available here.
HHS OIG Audit of New York ALPs Recommends Refunding $1.9 Million of Improper Claims
On March 16th, HHS OIG posted an audit report of New York’s assisted living program (ALP) providers, which found that ALP programs met safety and emergency planning requirements, but made some improper claims for unallowable services. Of the 100 beneficiary-months examined, OIG found that nine were improper. As a result, it recommended that New York refund $1.9 million of payments. New York did not concur or dissent from the findings, but stated that it currently performs oversight that reflects OIG’s recommendations and that it plans to issue additional guidance to ALPs.
The OIG report is available here.
Funding Opportunities
Affinity Legacy Hosts Webinar on Community Grant Program
On March 15th, Affinity Legacy hosted a webinar for interested applicants on the Community Grant Program, which will provide one-time grants between $25,000 and $1 million to organizations in New York City, Long Island, and Orange, Rockland, and Westchester counties.
Key updates from the webinar include the following:
- Only one Letter of Intent (LOI) is permitted per organization.
- Affinity Legacy is not able to disclose the total amount of funding, and will not designate a total allocation per category for the four priority areas of the grant (mental health, nutrition, justice-involved populations, and consumer education and workforce training).
- Entities must choose only one priority category; however, projects may address other categories as part of the project.
- Affinity Legacy will not require that all funding is spent within one year. Multi-year implementation is permitted, but progress reports will be expected.
- Additional funding sources for the project are permitted but not required.
- Affinity Legacy will consider whether to require a sustainability plan for projects.
The webinar recording is available here. LOIs are due on April 15th and select applicants will be invited to submit a full application on June 15th. Additional details are available here and an FAQ, which will be updated following the webinar, is available here.
SPG is looking to support clients who are applying to this opportunity. Please let us know if you would be interested in a webinar or individual discussion around your applications.
Senator Gillibrand Accepts Applications for Directed Spending Requests
On March 17th, U.S. Senator Kirsten Gillibrand announced an open application period for programmatic and Congressionally Directed Spending (CDS), or earmarks, for the FFY 2023 budget. CDS projects should be high-impact projects in New York that can reach completion with assistance from the federal government. For-profit entities and defense contractors are not eligible for CDS.
Organizations may also submit requests for programmatic funding, which encompasses the majority of federal discretionary spending. Such requests should include a requested amount of funding and proposed legislative language, if necessary, and must justify the impact on New York.
Applications may be submitted through April 10th via the portals here.
OMH Announces One-Time Targeted Investments for Benefits & Work Incentives Navigator Training
On March 15th, OMH announced a total of $1 million in one-time targeted investments to train Benefits & Work Navigators in OMH-licensed, funded, or designated programs to improve consumer experience and outcomes. Agencies may apply for a one-time reimbursement of $5,000 per eligible staff that will be trained for certification as Benefits & Work Navigators or Community Work Incentives Coordinators. An emphasis on staff with lived experience of receiving social benefits who have utilized work incentives to achieve full-time work is recommended, but not required.
Each county will receive a minimum of three awards, except Broome and Onondaga Counties, which will receive five awards each, and Albany, Monroe, and Suffolk Counties, which will receive six awards each. Applications will be reviewed based on capacity within established OMH counties and the ability of applicant agencies to provide access to Certified and Credentialed Benefits & Work Incentives Navigator services to a variety of populations and individuals.
The opportunity may be accessed here. Applications are due on May 17th. Questions may be submitted to carol.swiderski@omh.ny.gov with “Benefits & Work Incentives Navigator Training Investments” in the subject line by March 31st.
HRSA Opens 2022 NHSC New Site Application Period
The Health Resources and Services Administration (HRSA) at HRSA is accepting applications for eligible health care facilities interested in becoming National Health Services Corps (NHSC)-approved sites. NHSC-approved sites provide outpatient, primary health care services to individuals in Health Professional Shortage Areas (HPSAs). Sites are required to contact their State Primary Care office when applying for, or inquiring about, a HPSA designation. Benefits of becoming a NHSC-approved site include assistance with efforts to recruit, hire, and retain clinicians.
Applicants should be sites that:
- Have never received approval for NHSC, including sites that have applied and had their application denied or cancelled; or
- Are currently an inactive NHSC site due to expiration or past compliance issues.
Eligibility requirements are available here. Behavioral and mental health providers are required to practice in a community-based setting that provides access to comprehensive mental and behavioral health services. NHSC sites that do not offer all required services must demonstrate referral agreements with facilities that provide these services.
Applications will be accepted until May 10th. Additional information is available here. HRSA will host the following informational webinars: