Weekly Health Care Policy Update – April 22, 2022

April 29, 2022

In this update: 

  • Covid-19 Updates
    • CDC Launches Center for Forecasting and Outbreak Analytics
    • Governor Hochul Extends NYS Covid-19 Emergency Declaration
  • Administration Update
    • Biden Administration Releases National Drug Control Strategy Highlighting Harm Reduction
  • Federal Agencies
    • CMS Outlines Strategy to Advance Health Equity
    • CMS Issues FY 2023 Hospital IPPS and LTCH PPS Proposed Rule
    • HHS Transfers Key ARPA-H Authorities to NIH
    • CMMI Announces Listening Session on Advanced Primary Care
    • HHS Releases New Data and Report on Hospital and Nursing Home Ownership
    • HHS Plans to Withdraw Conscience Rule for Health Care Workers
  • Other Federal
    • Supreme Court Tosses Medicaid Work Requirements Case
    • Study Finds Covid-19 Infection and Mortality Rates Lower in Unionized Nursing Homes
  • Congressional Hearings
  • New York State Updates
    • DOH Announces SFY 2023 Enacted Budget Webinar and Releases Medicaid Scorecard
    • DOH Announces Delayed Implementation Date for New York Independent Assessor
    • OIG Releases Three Audits on Medicaid Payments
    • DFS Issues Guidance to Insurance Plans Regarding End of Coverage Requirements for EIP Services
  • Funding Opportunities
    • HHS Offers $3 Million for Effective Policies to Promote Black Youth Mental Health
    • HRSA Announces Nearly $90 Million for Health Centers to Identify and Reduce Disparities
    • OMH Intensive Training and Consultation on Best Practices in Mental Health Treatment Opportunity
    • OMH Statewide Training on Youth Mental Health First Aid
    • NYC Department of Housing Preservation and Development Concept Paper for “Moving On” Program

COVID-19 Updates

CDC Launches Center for Forecasting and Outbreak Analytics
On April 19th, the Centers for Disease Control and Prevention (CDC) announced the launch of the Center for Forecasting and Outbreak Analytics (CFA). The goal of CFA is to “enable timely, effective decision-making to improve outbreak response using data, modeling, and analytics.” CFA, which is based on the National Weather Service model, will produce forecasts on an outbreak’s status and predicted course. This information will support individual-level decision making as well as inform public health decision makers on potential consequences of deploying control measures. The CFA is funded with $200 million from the American Rescue Plan Act (ARP).
 
More information on the CFA can be found here.
 
Governor Hochul Extends NYS Covid-19 Emergency Declaration
On April 15th, Governor Hochul issued Executive Order 11.5 (available here), which extends New York’s second Covid-19 State Disaster Emergency declaration through May 15th. 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.

Administration Update

Biden Administration Releases National Drug Control Strategy Highlighting Harm Reduction
On April 21st, the Biden Administration sent its inaugural National Drug Control Strategy, a whole-of-government roadmap regarding substance use policy, to Congress. By law (most recently updated in the 2018 SUPPORT Act), the White House must publish an updated Drug Control Strategy document each year after a president’s inauguration. The Strategy includes seven first-year priorities: 

  • Expanding access to evidence-based treatment, particularly medication for opioid use disorder;
  • Advancing racial equity;
  • Enhancing evidence-based harm reduction efforts;
  • Supporting evidence-based prevention efforts to reduce youth substance use;
  • Reducing the supply of illicit substances;
  • Advancing recovery-ready workplaces and expanding the addiction workforce; and
  • Expanding access to recovery support services.

This release is the first such document to list harm reduction programs as a priority. The full document is available here.

Federal Agencies

CMS Outlines Strategy to Advance Health Equity
On April 20th, the Centers for Medicare & Medicaid Services (CMS) published a strategy document to outline its plans to address health equity. CMS identified health equity as the first pillar of its Strategic Plan, and intends to give health equity a central role across all of CMS’s Centers and Offices. CMS’s health equity goals include the following items: 

  • Close gaps in health care access, quality, and outcomes for underserved populations;
  • Build on outreach efforts to enroll eligible people across Medicare, Medicaid/CHIP and the Marketplace;
  • Expand and standardize the collection and use of data, including on race, ethnicity, preferred language, sexual orientation, gender identity, disability, income, geography, and other factors across CMS programs;
  • Incorporate screening for and promote broader access to health-related social needs (including greater adoption of related quality measures, coordination with community-based organizations, and collection of social needs data in standardized formats across CMS programs and activities);
  • Determine how CMS can better support safety net providers;
  • Ensure community engagement and accountability;
  • Promote culturally and linguistically appropriate services;
  • Promote CMS programs as models for other parts of the health care system;; and
  • Promote the highest quality outcomes and safest care for all.

CMS also “calls on private sector partners to engage with this health equity strategy.” It will begin convening stakeholder meetings on these topics this summer, starting with a session on sharing best practices and commitments to strengthen maternal health that will be held sometime this summer.

More information is available here.

CMS Issues FY 2023 Hospital IPPS and LTCH PPS Proposed Rule
On April 18th, CMS issued a proposed rule on the fiscal year (FY) 2023 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). Overall, CMS estimates the proposed rule would result in an increase of 3.2% ($1.6 billion) in operating payment rates to IPPS-paid hospitals that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health records (EHR) users. LTCH payments are expected to increase by $25 million, reflecting an estimated 0.7% increase in the standard LTCH payment rate.
 
CMS is returning to its usual practice of using the most recent available data to set FY 2023 rates (FY 2021 MedPAR claims and FY 2020 cost reports) with some modifications to account for an anticipated decline (though not elimination) of Covid-19 hospitalizations in FY 2023 relative to FY 2021.
 
Some highlights of the proposed rule include: 

  • Revised and new requirements for eligible hospitals and Critical Access Hospitals (CAHs) participating in the Medicare Promoting Interoperability Program.
  • An effective suspension of the Hospital Value-Based Purchasing (VBP) Program for FY 2023 (each participation hospital will receive an incentive payment equal to their reduction), as well as newly established performance standards and other updates to the program.
  • An effective suspension of the Hospital-Acquired Condition (HAC) Reduction Program for FY 2023 (all six measures would be suspended, and no hospital would be scored), as well as other updates to the program.
  • The adoption of ten measures in the Hospital Inpatient Quality Reporting (IQR) Program, as well as other changes, including the “Birthing-Friendly” designation announced last week.
  • Updated policies for a number of programs, including: 
    • Hospital Readmissions Reduction Program;
    • PPS-Exempt Cancer Hospital Reporting Program; and
    • LTCH Quality Reporting Program.
  • The continuation of FY 2020 wage index policies affecting low wage index hospitals, and the enactment of a 5% limit on year-to-year decreases in wage indexes (as proposed in other recent payment rules).
  • Changes to graduate medical education (GME) policies, including: 
    • An adjustment for situations when a hospital’s weighted full-time equivalent (FTE) count is greater than its FTE cap; and
    • Flexibility for teaching hospitals that cross-train residents.
  • Revisions to hospital and CAH conditions of participation for infection prevention and control, antibiotic stewardship, and to require continued reporting of Covid-19 and seasonal influenza reporting after the conclusion of the current PHE.

CMS seeks comment on several policy areas, including: 

  • How reporting of social determinants of health diagnosis codes may improve CMS’ ability to recognize severity of illness, complexity of service, and/or utilization of resources under the MS-DRGs;
  • The appropriateness of payment adjustments, in general and on two possible frameworks in particular, under the IPPS and OPPS to account for additional costs hospitals may incur when purchasing wholly domestically produced NIOSH-approved surgical N95 respirators;
  • How hospitals and other providers can better prepare for the harmful impacts of climate change on beneficiaries and consumers, and how CMS can provide support;
  • Considerations CMS can take into account when advancing the use of measurement and stratification as tools to address health care disparities and advance health care equity; and
  • Continued advancements to digital quality measurement and the use of the Fast Healthcare Interoperability Resources (FHIR) standard for electronic Clinical Quality Measure (eCQM) reporting.

The proposed rule is available here, a general fact sheet is available here, a fact sheet focused on maternal health is available here, and a press release may be found here. Comments on the proposed rule are due June 17th.
 
HHS Transfers Key ARPA-H Authorities to NIH
On April 18th, the Department of Health and Human Services (HHS) published a notice transferring the Advanced Research Projects Agency for Health (ARPA-H) to the National Institutes of Health (NIH). This allows the Director of NIH to “administer the functions, personnel, missions, activities, authorities, and funds of ARPA-H,” support its activities, and make personnel decisions, until a formal ARPA-H leadership appointment is made. The Director of ARPA-H will, however, report directly to the Secretary of HHS once such a Director is appointed. The notice also specifies that NIH may “not subject ARPA-H to NIH policies.”
 
The notice in the Federal Register is available here.
 
CMS Innovation Center Announces Listening Session on Advanced Primary Care
On April 26th from 1pm to 2:30pm, the CMS Innovation Center (CMMI) will hold a listening session on advanced primary care. The session will help inform the Center’s strategy across its portfolio of models. CMS will seek specific input on the following questions: 

  • What are the current challenges facing primary care in the United States? What role should the CMS Innovation Center play in testing innovations to address those challenges?
  • Advancing equity is a core goal for the CMS Innovation Center. What is needed to increase the reach of advanced primary care to underserved populations (e.g., recruitment of safety net providers, learnings supports and tools, financial incentives)?
  • CMS is evaluating how to help all practices move from FFS to value-based payment. If provided with needed financial and other supports, how and when can smaller, independent practices begin assuming initial financial accountability for quality?
  • What are the most significant barriers to improving coordination between primary and specialty care? What strategies can the CMS Innovation Center consider to facilitate coordination for beneficiaries?
  • Within primary care, how can social determinants of health (SDOH) needs be captured appropriately? What are the greatest obstacles to assessing SDOH needs? How can primary care and community-based resources best work together to assist with SDOH needs?

Registration is available here. Attendees may submit written comments or questions to CMMIStrategy@cms.hhs.gov using the subject line, “ADVANCED PRIMARY CARE LISTENING SESSION” or through the Q&A window during the session.

HHS Releases New Data and Report on Hospital and Nursing Home Ownership
On April 20th, HHS released new data on mergers, acquisitions, consolidations, and changes of ownership for hospitals and nursing homes enrolled in Medicare from 2016 through 2021. The Department also released a companion report on trends and changes of ownership over the past six years through the Office of the Assistant Secretary for Planning and Evaluation (ASPE). The report is based on data from the Provider Enrollment, Chain, and Ownership System (PECOS), and details 347 changes in ownership among hospitals and more than 3,000 changes among skilled nursing facilities (SNFs) over the study period. Highlights include: 

  • Medium or larger hospitals, hospitals with low profit margins, and long-term care hospitals were more likely to experience ownership changes;
  • Nationally, 4.6% of hospitals were sold over the study period;
  • South Carolina, New Jersey, and Connecticut experienced the highest rates of hospital ownership changes while New York was among the lowest;
  • Changes in SNF ownership were far more common than changes in hospital ownership; and
  • 62.3% of purchased SNFs now have a single organizational owner while 18.2% have only individual owners.

The data is available here. The companion report is available here.
 
HHS Plans to Withdraw Conscience Rule for Health Care Workers
On April 19th, an HHS spokesperson confirmed that the Biden administration is preparing to end the “conscience” rule for health care workers. The rule allows medical workers to refuse to provide services conflicting with their religious or moral beliefs such as abortions, contraception, gender-affirming care, or HIV/STD care. The rule was originally finalized in 2019, but was blocked by federal courts after several suits and has never been implemented. The rule’s rescission is currently under review at the Office of Management and Budget.

Other Federal

Supreme Court Tosses Medicaid Work Requirements Case
On April 18th, the Supreme Court vacated Becerra vs. Gresham, a case involving the Trump administration’s approval of Medicaid work requirements in Arkansas and New Hampshire. The Court remanded the cases back to the U.S. Court of Appeals for the District of Columbia with instructions to dismiss the case as moot, given that the Biden Administration revoked the states’ authority to impose the work requirements.
 
The Supreme Court originally agreed to hear the cases in late 2020, but canceled oral arguments in March 2021 given the Biden administration’s proposed review of, and opposition to, the policy. The Administration subsequently withdrew the prior approvals requiring Medicaid beneficiaries to work, including withdrawals for Arkansas, New Hampshire, and 10 other states. The states had introduced the policy, which required Medicaid beneficiaries to work, go to school, or volunteer in their communities to remain eligible for benefits, during the Trump administration. The requirements were subsequently struck down by both a lower court and an appeals court, ruling that the policy did not meet the goals of the Medicaid program.
 
The Court’s order is available here.
 
Study Finds Covid-19 Infection and Mortality Rates Lower in Unionized Nursing Homes
On April 20th, Health Affairs published a study which found that labor unions were associated with lower nursing home resident mortality rates as well as worker infection rates. The study examined the period from June 2020 through March 2021, using Service Employees International Union (SEIU) data on a nursing home’s unionization status. It claims that “unions were associated with 10.8 percent lower resident Covid-19 mortality rates, as well as 6.8 percent lower worker Covid-19 infection rates.”
 
The study is available here.

Legislative Hearings

Tuesday, April 26th:

  • At 10am, the Senate Health, Education, Labor, and Pensions (HELP) Committee will hold a hearing to examine Food and Drug Administration (FDA) user fee agreements, with a focus on advancing medical production regulation and innovation. More information is available here.

Wednesday, April 27th:

  • At 10am, the House Appropriations Subcommittee on Agriculture, Rural Development, Food and Drug Administration, and Related Agencies will hold a hearing to examine the Fiscal Year (FY) 2023 Budget Request for the FDA. More information is available here.
  • At 10:15am, the House Energy and Commerce Subcommittee on Health will hold a hearing to examine the FY 2023 Budget Request for HHS. Secretary Xavier Becerra will testify. More information is available here.

Thursday, April 28th:

  • At 10:30am, the House Ways and Means Committee will hold a hearing on the FY 2023 Budget Request for HHS. Secretary Xavier Becerra will testify. More information is available here.

New York State Updates

DOH Announces SFY 2023 Enacted Budget Webinar and Releases Medicaid Scorecard
This week, DOH released the State FY 2023 Enacted Budget Medicaid Scorecard, which describes the fiscal impact of new policies and administrative actions related to the Budget. Some notable policies described in the Scorecard include: 

  • $350 million for distressed hospitals ($100 million which was removed from the local tax intercept will be provided from Financial Plan resources);
  • $61.5 million to support nursing homes in complying with staffing regulations;
  • A re-estimation of the Request for Offers (RFO) for licensed home care services agencies (LHCSAs) which projects a further $25 million of savings next year;
  • $1.2 million for the Center of Medicaid Innovation, which will help connect technology companies with Medicaid data;
  • Restoring the Medicaid Managed Care (MMC) and Managed Long-Term Care (MLTC) Quality Pools;
  • Moving integrated managed care plans to the middle of the rate range;
  • “Additional hospital funding” of $800 million in FY 2023 and $100 million in FY 2024; and
  • Additional Quality Incentive Vital Access Provider Pool (QIVAPP) support of $37.4 million.

DOH will host a webinar on April 26th from 9am-10am that will provide an overview of the Medicaid provisions contained in the Budget. The webinar will also include a question-and-answer period during which participants may submit questions via the “chat” function. Questions may also be submitted ahead of time via email to mrtupdates@health.ny.gov.
 
The Enacted Budget scorecard is available here. Registration for the webinar is available here.
 
DOH Announces Delayed Implementation Date for New York Independent Assessor
On April 15th, DOH issued a notice announcing a further delay to the implementation of the New York Independent Assessor (NYIA). The use of the NYIA for initial assessments for Personal Care Services (PCS) or Consumer Directed Personal Assistance Services (CDPAS) will now begin on May 16th (previously  May 1st). In addition, the NYIA initial assessment process will take effect on July 1st for the following: 

  • Individuals seeking PCS or CDPAS through the immediate needs process at their local department of social services (LDSS); and
  • Mainstream, Health and Recovery Plan (HARP), and HIV Special Needs Plan (HIV-SNP) enrollees seeking an expedited assessment for PCS or CDPAS.

The initial assessment process includes the community health assessment, medical exam and practitioner’s order, and the independent review process conducted by the NYIA (as applicable). Because of the ongoing prohibition on restrictions to home and community-based services (HCBS) eligibility, the use of the NYIA for reassessments for adults 18 and over and the use of the NYIA for children ages 4-17 for both initial assessments and reassessments remains pended until further notice.
 
The notice is available here. Questions may be submitted to independent.assessor@health.ny.gov. DOH also released an Administrative Directive (available here) to provide LDSS with information and guidance regarding the changes to the initial assessment process.
 
OIG Releases Three Audits on Medicaid Payments
On April 19th, the New York State Comptroller issued reports on three audits of the State’s Medicaid program: 

  • The first report found that $965 million of Medicaid claims had errors related to the ordering, prescribing, referring, or attending (OPRA) provider on the claim.
  • The second report found that DOH potentially overpaid $9.6 million for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that should have been paid through all-inclusive nursing home payments.
  • The third report found that in the six-month period from October 1, 2020 to March 31, 2022, DOH made improper payments of about $7.4 million out of a total of more than $36 billion, due to issues such as double reimbursement through fee-for-service and managed care. About $5.6 million had been recovered by the end of the audit fieldwork.

In the OPRA audit, most of the errors were related to inactive Medicaid enrollment of the OPRA provider, and most of the claims were tied to nursing home payments. Only about $5.8 million of the $965 million of claims were tied to providers who were excluded from participating in Medicaid due to past misconduct. The audit covered the period from January 2015 through December 2019. The report notes that while “system processing weaknesses” in the Medicaid claims processing system (eMedNY) allowed improper payments for claims that reported inactive OPRA providers, the volume of improper payments dropped significantly after DOH enhanced eMedNY claim edits in 2018.
 
In response to the audit report, DOH noted that it generally disagreed that the claims were improperly paid. The Comptroller suggested that DOH should review policies and update guidelines to reflect how DOH is handling these policies.
 
A press release on the three audits is available here.
 
DFS Issues Guidance to Insurance Plans Regarding End of Coverage Requirements for EIP Services
On April 21st, the New York State Department of Financial Services (DFS) issued a circular letter (available here) to regulated health insurance plans that provides updates on coverage requirements for Early Intervention Program (EIP) services. EIP services include a range of therapeutic and support services for children from birth to three years old that have a confirmed disability or established developmental delay.
 
Effective January 1, 2022, insurance plans are no longer required to reimburse EIP services. Instead, there will be a statewide EIP assessment of $40 million annually that will fund a pool from which municipalities and the State will be reimbursed for claims for EIP services that are not reimbursed by any medical assistance program. Insurance plans that have already reimbursed claims for EIP services provided on and after January 1, 2022 should contact the State Fiscal Agent via nyeibilling@pcgus.com to initiate a return of payment. Questions may be submitted to health@dfs.ny.gov.

Funding Opportunities

HHS Offers $3 Million for Effective Policies to Promote Black Youth Mental Health
On April 19th, the HHS Office of Minority Health published a Notice of Funding Opportunity (NOFO) for $3 million through the Demonstrating Policy Effectiveness to Promote Black Youth Mental Health Initiative. This initiative will fund projects that demonstrate the effectiveness of policies to improve Black youth mental health, including suicide prevention.
 
Using findings from an HHS-developed policy assessment, award recipients will be expected to implement up to three innovative and culturally-effective policy approaches using an evidence-based model. The policies must be implemented across different implementation settings, such as schools, faith-based organizations, or community health centers. Awardees will also pilot the use of assessment protocols to determine how effective general health and wellness policies are in improving Black youth mental health.
 
HHS will issue eight awards of between $350,000 and $400,000 annually for a project period of up to three years (contingent on appropriations). Contracts are anticipated to begin on September 15th.
 
Additional information is available here. Applications are due on June 22nd.
 
HRSA Announces Nearly $90 Million for Health Centers to Identify and Reduce Disparities
On April 21st, the Health Resources and Services Administration (HRSA) announced the availability of nearly $90 million to support new data-driven efforts for federally qualified health centers (FQHCs) to identify and reduce health disparities. The funding opportunity is part of the American Rescue Plan Uniform Data System Patient-Level Submission (ARP-UDS+), and as such is open to FQHCs and look-alikes who were funded through the FY 2021 ARP appropriation.
 
The funding can be used for various activities that advance Covid-19 response, mitigation, and recovery, and help prepare for future public health emergencies. Such activities include modifying, enhancing, and expanding health care services and infrastructure by improving health information technology, enhancing data collection, and supporting related staff training. “Enhancements” that health centers make under the grant should: 

  • Support patient-level reporting;
  • Enable better identification, measurement, and investigation of disparities in health care use and health outcomes by race, ethnicity, age, and other demographic factors;
  • Standardize patient-level health data to inform potential clinical interventions; or
  • Collect, house, and report standardized patient-level health data to support health surveillance activities during public health emergencies.

Applications are due by 5pm on May 23rd. The Notice of Funding Opportunity is available here.

OMH Intensive Training and Consultation on Best Practices in Mental Health Treatment Opportunity
The New York State Office of Mental Health (OMH) is seeking Letters of Interest for the delivery of intensive training and consultation to mental health care providers serving children and youth who are dually diagnosed with mental health challenges and intellectual/developmental disabilities (I/DD). This funding aims to better equip mental health care providers to serve dually diagnosed individuals and their families, including by building awareness of evidence-based approaches and modifications of typical treatment (e.g., use of visual tools, behavioral techniques, etc.).
 
Eligible applicants are training, technical assistance, and consultation entities or academic institutions with substantial experience:  

  • Developing and delivering training and consultation on best practices in mental health treatment of dually diagnosed children and youth, including specific experience with I/DD populations and in mental health treatment;
  • Training multi-disciplinary groups of mental health providers, including paraprofessional staff as appropriate;
  • Establishing partnerships and collaborations with mental health agencies/organizations that provide services to dually diagnosed children and youth and their families; and
  • Ensuring quality assurance methods are implemented to provide, monitor, and report the efficacy of training, technical assistance, and consultation to organizations.

Additional details are available here and SPG’s summary of the opportunity is here. Letters of Interest are due May 11th.   
 
OMH Statewide Training on Youth Mental Health First Aid
OMH is seeking Letters of Interest from organizations or agencies to increase delivery of the Youth Mental Health First Aid (YMHFA) training statewide. YMHFA training teaches parents, family members, teachers, peers, and other individuals how to identify, understand, and respond to signs of mental illnesses/substance use disorders and crises among adolescents. Funding awarded through this RFP will allow entities to: 

  • Use certified YMHFA instructors to directly train the public; and/or
  • Coordinate the certification of new YMHFA instructors who then directly train the public.

OMH is seeking up to five organizations or agencies to increase delivery of YMHFA training in each of the five OMH regions (outlined here). Respondents should indicate the region(s) in which they are proposing to offer YMHFA training and/or increase YMHFA instructors. Respondents may choose to target any or all of the five regions. 
 
Additional details are available here and SPG’s summary of the opportunity is here. Letters of Interest are due May 11th.   
 
NYC Department of Housing Preservation and Development Concept Paper for “Moving On” Program
On April 15th, the New York City Department of Housing Preservation and Development (HPD) released a Concept Paper announcing a forthcoming Request for Proposals (RFP) for one contractor to provide technical assistance and financial administration for the implementation of the “Moving On” program citywide in permanent supportive housing programs. Moving On programs provide tenants with HPD Housing Choice Vouchers and provide supportive housing agencies with: 

  • Training/technical assistance on how to implement the model; and
  • Flexible funding to help tenants that no longer want or need intensive, on-site supportive services voluntarily transition to an affordable home.

Through this forthcoming RFP, HPD seeks to partner with an organization that can provide technical assistance and financial administration to expand and institutionalize the Moving On program. HPD anticipates providing $800,000 in funding to support the awarded contractor, with additional funding anticipated in the future. Contracts will last for three years starting on January 1, 2023, with renewal options available if funding allows.
 
The Concept Paper is available here. Comments may be submitted to Alyson Zikmund at zikmunda@hpd.nyc.gov with “Moving On Concept Paper” in the subject line through May 30th. HPD anticipates releasing the RFP this summer.