Weekly Health Care Policy Update – May 6, 2022

In this update: 

• Covid-19 Updates
  • FDA Limits Use of J&J Vaccine; Will Consider EUAs for Novavax Vaccine and Pfizer and Moderna Extensions to Children
  • Biden Administration Launches Oral Antiviral Initiative
• Administration Updates
  • White House Asks Providers to Sign Climate Pledge
  • January Contreras Sworn In as Assistant Secretary for Administration of Children and Families at HHS
• Federal Agencies
  • CMS Finalizes CY 2023 Policy Changes for MA and Part D
  • CMS Releases 2023 Notice of Benefit and Payment Parameters Final Rule
  • CMS Proposes Changes to Medicare Eligibility and Enrollment Rules
  • CMS Finalizes Rule on Ownership Changes at Accreditation Organizations
  • CMS Reweights 2021 MIPS Cost Performance Category
  • HRSA to Host National Telehealth Conference
  • OIG Report Finds Significant Proportion of Incorrect Denials by MA Plans
  • HHS Report Finds Uninsured Rate Near Historic Low
• Other Updates
  • MACPAC Announces New Executive Director and Members
  • KLAS Publishes Report on EMR Market Share
  • Health Affairs Study Shows Increased Telehealth Access in Disadvantaged Neighborhoods
  • AHRC Nassau to Host Diversity, Equity & Inclusion Virtual Conference
• Legislative Hearings
• New York State Updates
  • Governor Hochul Extends Health Care Staffing Emergency Declaration
  • DOH Hosts Hearing on 1115 Waiver Proposal, Reschedules Second Hearing to May 10^th, and Extends Comment Period
  • DOH Hosts Webinar on Fiscal Year 2022-23 Enacted Budget
  • New York State of Health Releases 2023 Invitation for Participation
• Funding Opportunities
  • DOH Releases RFP for Regional Health Emergency Preparedness Training Centers
  • NYSHealth Opens RFP Process for the 2022 Special Projects Fund
  • NYC HRA Releases RFP for $15 Million for Tenant Services in Senior Affordable Housing
  • DOH Releases SOI for Round 5 of the Primary Care Service Corps

COVID-19 Updates

FDA Limits Use of J&J Vaccine; Will Consider EUAs for Novavax Vaccine and Pfizer and Moderna Extensions to Children
On April 29^th, the Food and Drug Administration (FDA) announced a schedule of meetings to consider applications for Emergency Use Authorization (EUA) and other topics related to Covid-19 vaccines: 

• On June 7^th, the FDA plans to consider an EUA request from Novavax for a Covid-19 vaccine for individuals over 18. Novavax filed the EUA request on January 31^st. If approved, it would become the fourth available vaccine for adults in the United States.
• FDA has held several other dates (June 8^th, June 21^st, and June 22^nd) to consider EUA requests from Pfizer/BioNTech and Moderna: 
  • On April 26^th, Pfizer/BioNTech requested an EUA to provide booster doses for children aged 5 through 11, six months after the original two-dose series. In their Phase 2/3 clinical trial, boosters were provided six months after the original two-dose series and showed a strong immune response with no new side effects.
  • On April 28^th, Moderna requested an EUA for two-dose regime of its Covid-19 vaccine for children under the age of 6. The two doses would each be a quarter of the adult dose (25 micrograms). Moderna’s trial found that this dose was 40 to 50 percent effective against symptomatic infection. Moderna is the first manufacturer to seek an EUA for vaccinating all children under 6. Its EUA applications for children between 6 and 18 are still pending.
• On June 28^th, the FDA will hold a meeting to discuss whether the strain composition of vaccines should be modified to account for new variants, and if so, which strains should be selected for Fall 2022.

On May 5^th, the FDA announced that it was implementing limits on the EUA for the Johnson & Johnson (J&J) Covid-19 vaccine, due to the risk of side effects related to blood clots and the Centers for Disease Control and Prevention (CDC) preferential recommendation for the use of mRNA vaccines. The J&J vaccine is still authorized for adults 18 and over: 

• For whom other approved vaccines are not accessible or clinically appropriate; or
• Who choose to receive the J&J vaccine because they would otherwise not receive any vaccine.

The FDA announcement on June meetings is available here. The announcement on J&J’s vaccine is available here.
 
Biden Administration Launches Oral Antiviral Initiative
On April 26^th, the Biden Administration announced an initiative to increase access to Covid-19 oral antiviral treatments and to boost patient and provider awareness of such treatments. The initiative will include four main components: 

1. Increasing the number of places oral antivirals are available: The Administration will allow all pharmacy partners in the federal antiviral pharmacy program to order free oral antiviral treatments directly from the federal government. The Administration expects that oral antivirals will soon be available in more than 30,000 locations.
2. Expanding the number of federally-supported Test-to-Treat sites: The federal government will work to expand beyond the current 2,200 Test-to-Treat sites in pharmacies and other clinical settings, including an expansion of telehealth options.
3. Providing medical providers with guidance: The Administration will continue offer health care providers toolkits and resources to assess what treatments are appropriate for their patients, and additional guidance and outreach around eligibility, accessibility, and contraindications and prescribing considerations for Covid-19 treatments. The Administration is also calling on electronic health record companies to incorporate information about oral antivirals directly into their health records interface.
4. Public awareness and education: The Administration will ramp up its public awareness and education efforts on Covid-19 treatments, ensuring that people know that oral antiviral treatments must be taken within the first five days of symptom onset and that they understand an oral antiviral’s role in reducing the risk of severe disease and death from Covid-19.

More information is available here.

Administration Updates

White House Asks Providers to Sign Climate Pledge
On April 22^nd, the White House and the Department of Health and Human Services (HHS) jointly issued a call to action for health care stakeholders to commit to tackling the climate crisis by signing a pledge to reduce greenhouse gas emissions and increase their climate resilience. The voluntary pledge specifically asks health systems to: 

• Reduce their organization’s emissions by 50% by 2030 and to net zero by 2050 and publicly report on their progress;
• Complete an inventory of supply chain emissions;
• Develop a climate resilience plans for their facilities and communities; and
• Designate an executive to lead the work. 

The health care sector currently contributes 8.5% of total U.S. emissions. More information on the initiative is available here. The pledge can be downloaded and submitted here. Pledges are due by June 3^rd.
 
January Contreras Sworn In as Assistant Secretary for Administration of Children and Families at HHS
On April 25^th, January Contreras was sworn in as the new Assistant Secretary at the Administration for Children and Families at HHS. During the Obama Administration, Contreras previously served as ombudsman for citizenship and immigration services at the U.S. Department of Homeland Security, and as a designee to the White House Council on Women and Girls. Prior to her work in Washington, she oversaw the Arizona Department of Health Services, and served as assistant director of the Arizona Health Care Cost Containment System, Arizona’s Medicaid agency.

Federal Agencies

CMS Finalizes CY 2023 Policy Changes for MA and Part D
On April 29th, the Centers for Medicare & Medicaid Services (CMS) released a final rule outlining Contract Year (CY) 2023 policy and technical changes for Medicare Advantage (MA) and Part D plans. While most of the provisions are applicable to CY 2023, CMS notes that, after considering public comments, it has delayed the applicability of some policy changes to CY 2024. Some important provisions of the rule include:
 
Pharmacy Price Concessions at the Point of Sale
CMS finalized its proposed policy to re-define the “negotiated price” as the lowest amount a pharmacy could receive as reimbursement for a covered Part D drug under its contract with the Part D plan sponsor or the sponsor’s intermediary. This change will take effect 60 days after publication of the final rule and apply beginning on January 1, 2024.
 
In response to comments on the proposed rule, CMS will apply this definition to all phases of the Part D benefit, including the coverage gap phase. Currently, the negotiated price plans report is defined to include price concessions from network pharmacies, but exclude performance-based concessions that “cannot reasonably be determined at the point of sale.” These concessions lower the price that a plan sponsor ultimately pays for the drug and may result in lower premiums, but they do not reduce plan enrollees’ cost-sharing burden.
 
In addition, CMS finalized its proposal to define the term “price concession” in a broad manner to include all forms of discounts, subsidies, and rebates. The term is currently not defined in statute, regulations, or sub-regulatory guidance. CMS expects that requiring pharmacy price concessions in the negotiated price will, between 2024 and 2032, reduce total beneficiary costs by over $26 billion and reduce Part D costs by $46.8 billion. The agency expects that manufacturers will save nearly $17 billion over the same period.
 
Maximum Out-of-Pocket (MOOP) Limit
CMS finalized its proposal to redefine the MOOP calculation to include all Medicare cost-sharing in the plan benefit, regardless of the entity that pays the cost-sharing and whether the cost-sharing remains unpaid. This will create parity between D-SNPs and other MA plans because the current practice excludes Medicaid contributions to beneficiaries’ OOP costs from the MOOP, which disadvantages D-SNPs and providers who serve those enrollees. CMS estimates the 10-year impact of this change will increase payment to D-SNP providers by $8 billion, save State Medicaid agencies $2 billion, and increase federal spending by $614.8 million.
 
D-SNP Policies to Promote Alignment
CMS finalized proposals to incorporate lessons learned from fully aligned Medicare-Medicaid Plan (MMP) demonstrations into the broader MA program. These include: 

• Requiring all MA organizations that offer a D-SNP to direct input on enrollee experience by establishing at least one enrollee advisory committee in each state in which it operates;
• Requiring, beginning in 2025, that all FIDE SNPs have exclusively aligned enrollment and cover Medicaid home health, DME, and behavioral health through a capitated contract with the state Medicaid agency;
• Requiring, also beginning in 2025, that each HIDE SNP’s capitation contract with the state apply to the entire service area for the D-SNP.
• Codifying a limited number of carve-outs for both FIDE and HIDE SNPs, consistent with existing policy;
• Codifying new mechanisms through which State Medicaid agencies may use D-SNP contract to require certain D-SNPs with exclusively aligned enrollment to: 1) Establish contracts that only include one or more D-SNPs within a state, which will allow Star Ratings to reflect the plan’s local performance; and 2) Integrate materials and notices to help enrollees more easily understand the full scope of Medicare and Medicaid benefits; and
• Expanding the universe of D-SNPs to which the unified appeals and grievance process applies to include, beginning in 2025, all FIDE SNPs and a subset of coordination-only D-SNPs.

Expansion of Oversight Requirements
CMS finalized several proposals to expand oversight requirements, including its proposal to reinstate the detailed medical loss ratio (MLR) reporting requirements that were in effect for contract years 2014 through 2017. These requirements include reporting of underlying data used to calculate and verify the MLR and any remittance amount. In addition, CMS proposes to collect additional details regarding plan expenditures so that it may better assess the accuracy of MLR submissions by plans. In addition, CMS will require MA plan applicants for new and expanding service areas to demonstrate that they meet new network adequacy standards.
 
In a change from the proposed rule, CMS will permit applicants to use letters of intent (LOIs) in lieu of signed provider contracts at the time of application and during application review. CMS also finalized its proposal to provide an automatic 10 percentage point credit toward meeting the standards for application evaluation purposes only. The credit would not apply once the contract is operational.
 
The final rule is available here and a fact sheet may be found here.
 
CMS Releases 2023 Notice of Benefit and Payment Parameters Final Rule
On April 28^th, CMS issued the final Notice of Benefit and Payment Parameters (NBPP) for plan year 2023, which regulates qualified health plans (QHPs) provided in the individual and small group markets. Notable provisions of the final rule include:

• Essential Health Benefits: CMS did not finalize its proposal to restore discrimination protections for LBGTQ individuals that were removed in 2020 under the Trump Administration. In the final rule, CMS notes that it is developing a proposed rule prohibiting discrimination based on sex in health coverage under Section 1557 of the Affordable Care Act (ACA). CMS has therefore determined it will revisit these proposals later to ensure they are consistent with the Section 1557 rulemaking.
• Quality Improvement Strategy (QIS): CMS finalized as proposed a requirement that QHP issuers address health and health care disparities as a specific topic area within their QIS, in addition to at least one other topic area.
• Risk Adjustment: CMS finalized two of three risk adjustment model changes intended to improve prediction in the adult and child models for the lowest-risk enrollees, the highest-risk enrollees, and partial-year enrollees. CMS will continue to use enrollee-level EDGE data from 2017, 2018, and 2019 to recalibrate the model for 2023.
• MLR: CMS finalized two changes to tighten how issuers calculate MLRs. First, CMS clarified that, to be included in the MLR numerator, incentives or bonuses paid to a provider must be tied to clearly defined, objectively measured standards that are based on well-documented clinical or quality improvement standards. Second, insurers may only count expenses for quality improvement activities that are directly related to improving care quality. This may include the salaries of staff directly performing quality improvement functions, but may not include indirect expenses, such as a portion of overhead, marketing, office space, etc.
• Essential Community Providers (ECPs): CMS finalized its proposal to increase the required proportion of ECPs that a plan must contract with to 35%. This standard was originally set at 30% under the Obama Administration, but was reduced to 20% under the Trump Administration. CMS will also add substance use disorder treatment centers to the list of “other ECP providers.”
• Prorating Premium Calculations: CMS finalized its proposal regarding premium proration for Federally-facilitated Marketplaces (FFMs) only. In a change from the proposed rule, CMS finalized a policy which would, beginning in 2024, require state-based marketplaces (SBMs) to implement a methodology to ensure that an enrollee’s total monthly advance premium tax credit (APTC) amount does not exceed an enrollee’s monthly premium tax credit eligibility, in compliance with HHS and IRS regulations.

CMS finalized as proposed a requirement that issuers in all FFMs and State-based Marketplaces on the Federal Platform (SBM-FPs) offer plans with standardized cost-sharing parameters at every product network type, metal level, and service area in which that the issuer offers non-standardized plan options. CMS does not propose to limit the number of non-standardized plans that issuers may offer.
 
The final rule may be found here.  A fact sheet may be found here.
 
CMS Proposes Changes to Medicare Eligibility and Enrollment Rules
On April 22^nd, CMS issued a proposed rule implementing portions of the Consolidated Appropriations Act of 2021 to make changes to Medicare enrollment rules, to extend coverage of immunosuppressive drugs for former end-stage renal disease (ESRD) beneficiaries, and to update rules on state subsidies for the Medicare buy-in.
 
Changes on enrollment policies include: 

• Coverage begins the month after enrollment. Medicare coverage will now become effective the month after enrollment for almost all individuals, including those who enroll in the last three months of their initial enrollment period or during the General Enrollment Period (January 1^st through March 31^st). Currently, these enrollments may take between two and six months to take effect.
• New special enrollment periods (SEPs) related to exceptional conditions. CMS is establishing new SEPs which would allow the following groups of individuals to enroll in Medicare without being subject to a late penalty: 
  • Individuals impacted by an emergency or disaster;
  • Individuals affected by a health plan or employer error;
  • Individuals who have been released from a correctional facility;
  • Coordination with individuals whose Medicaid coverage is terminated; and
  • Other exceptional conditions, which may be evaluated on a case-by-case basis.

CMS also proposes to implement Section 402 of the CAA to extend coverage of immunosuppressive drugs for kidney transplant patients. Most individuals with ESRD are eligible for Medicare regardless of age. When these beneficiaries receive a transplant, their Medicare eligibility is terminated after 36 months. Under the CAA and this proposed rule, individuals who do not have another form of insurance coverage would be eligible to enroll in Part B for the very limited purpose of coverage of immunosuppressive drugs. If finalized, enrollment in the new benefit would begin in October 2022 and coverage would begin in January 2023.
 
Finally, the proposed rule would update rules governing state payment of the Medicare Part A and Part B premium on behalf of low-income individuals (the “Medicare buy-in”). The first change would codify the current practice of states and CMS using the Medicaid State Plan and State Plan Amendments to document the buy-in policy in each state (rather than the free-standing buy-in agreements each state enacted in 1992, which have not been updated). The second change would limit states’ retroactive liability for Medicare Part B premiums to 36 months. In some cases, the Social Security Administration may retroactively establish Medicare Part A entitlement for a beneficiary, which can make states liable for Part B premiums going back several years.
 
Comments on the proposed rule are due June 27^th. The proposed rule may be found here, and a fact sheet is available here.
 
CMS Finalizes Rule on Ownership Changes at Accreditation Organizations
On April 27^th, CMS finalized a rule requiring Accreditation Organizations (AOs) to notify the agency 90 days in advance of an ownership change. Most types of Medicare-certified providers may apply to an AO for accreditation to demonstrate their compliance with Medicare’s health and safety requirements as part of the Medicare Conditions of Participation. There are 11 AOs currently approved by CMS.
 
Under the final rule, if an AO’s ownership changes, CMS may then determine whether the new owner continues to meet requirements. This rule was originally proposed three years ago, but the Joint Commission opposed it, and CMS had not finalized it until now. Prior to this final rule, CMS would only be informed of ownership changes at accreditation organizations voluntarily or when the organization applied for renewal of CMS approval.
 
The full text of the rule is available here. The rule is effective June 28^th.
 
CMS Reweights 2021 MIPS Cost Performance Category
On April 25^th, CMS announced that it will reweight the cost performance category from 20% to 0% due to the impact of Covid-19 on cost measures. This weight will be redistributed across other performance categories. CMS had already reweighted the cost performance category to 0% for all individual MIPS-eligible clinicians, but in examining the underlying data, CMS found similar cost impacts at the group and virtual group level and decided to extend the policy to all participants, regardless of how they report data.
 
To provide clinicians insight into their cost performance, CMS will provide patient-level reports on 2021 cost measures on which clinicians, groups, or virtual groups met the case minimum. For the 2022 performance year, CMS notes that the CY 2022 Medicare Physician Fee Schedule rule permits CMS to suppress individual cost measures if they are impacted by significant changes, rather than reweighting the entire performance category, if necessary.
 
More information on this change is available from CMS here.
 
HRSA to Host National Telehealth Conference
On May 16^th and 17^th, the Health Resources and Services Administration (HRSA) and Telehealth.HHS.gov will host a National Telehealth Conference to discuss telehealth best practices and lessons learned during the pandemic. Topics will include: 

• Achieving health equity through increased access and adoption of telehealth including the improvement of broadband connectivity;
• The role of telehealth as a tool to improve the quality of care for patients, especially those in and underserved communities;
• Tele-behavioral health as a model and example of the success of integrating telehealth during the pandemic and beyond;
• Sharing clinical telehealth best practices and lessons learned; and
• Identifying health policy implications for telehealth to inform the future of telehealth in an evolving health care environment.

The conference will take place virtually. Registration and a full agenda are available here.
 
OIG Report Finds Significant Proportion of Incorrect Denials by MA Plans
On April 27^th, the HHS Office of the Inspector General (OIG) published a report assessing Medicare Advantage (MA) plans’ denials of beneficiary access to services and payments to providers. The report, “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care,” contained the following key findings: 

• About 18 percent of payments denied by MA plans to providers met Medicare coverage rules and MA billing rules;
• About 13 percent of prior authorizations denied by MA plans met Medicare coverage rules; and
• In cases of prior authorization denials, MA plans often: 
  • Used clinical criteria that are not contained in Medicare coverage rules; or
  • Requested additional documentation that OIG found to be unnecessary to support medical necessity.

OIG recommended that CMS should: 

• Issue new guidance on the appropriate use of internal MA plan clinical criteria in medical necessity reviews;
• Update its audit protocols to address MA plans’ use of clinical criteria and to target particular service types with a history of inappropriate denials; and
• Direct MA plans to take additional steps to identify and address vulnerabilities that can lead to manual review errors and system errors.

CMS agreed with these recommendations and said that it plans to issue such guidance and update auditor training materials as necessary.
 
The complete report can be found here.
 
HHS Report Finds Uninsured Rate Near Historic Low
On April 29^th, HHS issued an analysis of 2021 National Health Interview Survey data which showed that about 8.8% of individuals in the United States were uninsured in the fourth quarter of 2021. This rate is 1.5 percentage points lower than in Q4 2020, reflecting 4.9 million newly-insured individuals. Coverage gains were observed across all racial and ethnic groups, with Latinos experiencing the largest gains, at a 3.5 percentage point drop in the uninsured rate. Overall, a record high of 35 million Americans had Affordable Care Act (ACA)-related coverage at the beginning of 2022, either through the Marketplace, Basic Health Program, or Medicaid expansion.
 
The full analysis is available here.

Other Updates

MACPAC Announces New Executive Director and Members
On April 29^th, the Medicaid and CHIP Payment and Access Commission (MACPAC) announced the appointment of Kate Massey as its new executive director. Massey is currently the director of Michigan’s Medicaid program. She is replacing Anne Schwartz, whose retirement was effective in April.
 
On May 2^nd, the Government Accountability Office (GAO) announced the appointment of four new members and the reappointment of two existing members to MACPAC for terms that will expire in April 2025. The new members are: 

• Sonja Bjork, the Chief Operating Officer of Partnership HealthPlan of California (PHC);
• Jennifer L. Gerstorff, a principal and consulting actuary with Milliman;
• Dr. Angelo P. Giardino, the Chair of the Department of Pediatrics at the Spencer Fox Eccles School of Medicine and Chief Medical Officer at Intermountain Primary Children’s Hospital; and
• Dr. Rhonda M. Medows, the president of Providence Population Health Management.

The announcement of Massey’s appointment is here. The announcement of the MACPAC member appointments is here.
 
KLAS Publishes Report on EMR Market Share
On April 26^th, KLAS Research published its annual report on electronic medical record (EMR) market share in 2021. Highlights include: 

• Overall, 32.9% of acute care hospitals used Epic, 24.4% used Cerner, 16.7% used Meditech, 8.7% used CPSI, 4.3% used Allscripts, and 3.1% used Medhost;
• Epic expanded its market share from 31 to 33% and far exceeded growth of all other EMR vendors;
• Epic signed 43 new customers (representing 78 total hospitals) and lost two customers, while Cerner signed 41 new customers but lost 25;
• Allscripts lost 26 net hospitals, with most of their lost customers migrating to Epic;
• 342 hospitals changed EMR vendors or upgraded to a new version of their current EMR in 2021, up 44% from 2020; and
• Epic is now the EMR for nearly half of all acute care beds nationally.

The full report is available here.
 
Health Affairs Study Shows Increased Telehealth Access in Disadvantaged Neighborhoods
On May 2^nd, Health Affairs published a study showing that patients in the most disadvantaged neighborhoods experienced the highest increases in the use of telehealth during the Covid-19 pandemic. The research found that telemedicine access increased for all minority groups during the pandemic, but likelihood of use consistently decreased with age.
 
The study, “Medicare Beneficiaries in Disadvantaged Neighborhoods Increased Telemedicine Use During The COVID-19 Pandemic,” examined roughly 30 million Medicare fee-for-service claims both before and after implementation of the Medicare telemedicine coverage waiver in March 2020. Before the waiver less than 1 percent of patients had at least one outpatient telemedicine visit. However, after the waiver was put in place, nearly 10 percent of patients had such a visit.
 
The full study can be accessed here.

AHRC Nassau to Host Diversity, Equity & Inclusion Virtual Conference
On May 18^th, AHRC Nassau, in collaboration with The Arc of the United States, will be holding its inaugural Diversity, Equity & Inclusion Virtual Conference to examine the history, challenges and opportunities impacting people with intellectual and developmental disabilities (I/DD) and the staff who work with them.

Speakers at this free, online conference include:

• Dr. Kimberlé W. Crenshaw, Professor of Law at Columbia Law School and University of California, Los Angeles – Keynote Speaker
• Kerri Neifeld, Commissioner of the Office for People with Developmental Disabilities, New York State – Plenary Session: “Meeting Challenges: Strengthening the Direct Support Workforce and Advancing Diversity, Equity and Inclusion”
• Tawara Goode, Associate Professor of Pediatrics at Georgetown University Medical Center – Plenary Session: “Achieving Diversity, Equity & Inclusion in the I/DD Space: The Essential Role of Cultural and Linguistic Competence”
• Atif Choudhury, Social Entrepreneur – Plenary Session: “A Conversation with Atif Choudhury: Social Innovation, The Transformational Power of Lived Experiences and the Diversity of Thought”

Free NASW-NYS continuing education credits are available for participating in the conference.

Registration for the conference is available here.  More information on the conference, including a full list of sessions and speakers, can be found here.

Legislative Hearings

Past Hearings:

• On May 3^rd, the Senate Health, Education, Labor, and Pensions (HELP) Subcommittee on Employment and Workplace Safety held a hearing entitled “Connecting Workers and Communities: Preparing and Supporting the Broadband Workforce.” A recording of the hearing is available here.
• On May 4^th, the Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education, and Related Agencies held a hearing to examine the Fiscal Year (FY) 2023 Budget Request for the Department of Health and Human Services (HHS). More information is available here.
• On May 5^th, the Senate Commerce, Science, and Transportation Subcommittee on Consumer Protection, Product Safety, and Data Security held a hearing to examine actions that can be taken to ensure transparency and fair practices in the prescription drug market. A recording of the hearing is available here.

Wednesday, May 11^th:

• At 10am, the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies will hold a hearing to examine the FY 2023 Budget Request for the National Institutes of Health (NIH). More information is available here.

Thursday, May 12^th: 

• At 10:00am, the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies will hold a hearing entitled “Healthy Aging: Maximizing the Independence, Well-being, and Health of Older Adults.” More information is available here.

New York State Updates

Governor Hochul Extends Health Care Staffing Emergency Declaration
On April 30^th, Governor Hochul issued Executive Order 4.8, which extends through May 30^th the provisions in Executive Order 4 and its successors that reinstate many workforce and scope of practice flexibilities that applied during the original New York State Covid-19 public health emergency.
 
However, the Order discontinues the provision allowing nurse practitioners (NPs) to provide medical services without a written practice agreement or collaborative relationship with a physician. This requirement was modified by the 2023 Enacted Budget, which placed a moratorium on this requirement for NPs with over 3,600 hours of practice through March 2024.
 
The Executive Order is available here.
 
DOH Hosts Hearing on 1115 Waiver Proposal, Reschedules Second Hearing to May 10^th, and Extends Comment Period
On April 28^th, the New York State Department of Health (DOH) held a virtual public hearing on its proposal for a new 1115 Waiver Amendment. DOH provided an overview of the waiver’s components and outlined its proposed timeline. Specifically: 

• DOH is extending the initial public comment period through May 20^th.
• DOH intends to formally submit the waiver to CMS by the end of July, which will start a 30-day CMS public comment period through August. Further negotiations with CMS will be ongoing through the summer.
• DOH is targeting an implementation date of January 1, 2023.

The second virtual public hearing has been rescheduled to May 10^th from 1pm-4pm. Individuals who were registered to speak at the April 28^th session (and who did not speak during the May 3^rd session) may register to provide oral comments on May 10^th here. Individuals must register with an “SP” in front of their name (i.e., SP Jane Doe) and must email 1115waivers@health.ny.gov before May 9^th at 4pm to confirm registration. Individuals will speak in the order of registration. Comments will be limited to five minutes per presenter.
 
DOH Hosts Webinar on Fiscal Year 2022-23 Enacted Budget
On April 26^th, DOH hosted a briefing and question-and-answer session on the Fiscal Year 2022-23 Enacted Budget Medicaid provisions. The briefing reviewed the recently released Medicaid Scorecard and covered budget proposals related to the State’s Medicaid program, including but not limited to: 

• Modifications to the Global Cap;
• Nursing home reforms;
• Medicaid, Essential Plan, and Child Health Plus Program coverage expansions;
• Telehealth parity; and
• Health care workforce bonuses.

The State plans to issue additional guidance on implementation of several proposals, including implementation of the health care workforce bonuses.
 
The presentation is available here. 
 
New York State of Health Releases 2023 Invitation for Participation
On May 4^th, New York State of Health (NYSOH), New York’s state-based insurance exchange, released the 2023 Invitation for Participation. Insurers seeking to offer coverage under the Essential Plan, Qualified Health Plans (QHPs), or stand-alone dental plans (SADPs) may submit their bids to offer products on the Marketplace through this process.
 
Letters of Interest are due to NYSoH by May 11^th. NYSoH will accept participation proposals through May 25^th, and written questions may be submitted through that date.
 
The Invitation for Participation is available here.

Funding Opportunities

DOH Releases RFP for Regional Health Emergency Preparedness Training Centers
On April 29^th, DOH released a Request for Proposals (RFP) seeking one organization in each of the four Health Emergency Preparedness Coalition (HEPC) regions of the state (see Attachment 5) to serve as Health Emergency Preparedness Training Centers. These centers directly support or enhance regional HEPC efforts by identifying training gaps, delivering training, and evaluating the effectiveness of training with the goal of furthering the emergency preparedness and response needs of the health care system.
 
Any organization may apply; however, preference will be given to applicants with in-depth knowledge of hospitals and health systems, knowledge of DOH regulations and requirements, expertise in adult learning models, and knowledge of emergency preparedness. Applicants should have expertise in training development, execution, and evaluation.
 
Budget proposals may not exceed $250,000 per region. Contracts will last for one year, starting on July 1^st. There will be four annual renewals (dependent on satisfactory performance and continued funding) ending on June 30, 2027.
 
The RFP is available here. Optional Letters of Interest are due on May 13^th and applications are due on May 27^th. Questions may be submitted to prepedap@health.ny.gov through May 6^th.
 
NYSHealth Opens RFP Process for the 2022 Special Projects Fund
On May 5^th, the New York State Health Foundation (NYSHealth) began accepting online inquiries for the second cycle of the 2022 Special Projects Fund. This Fund provides a total of about $2.5 million per cycle for projects that support NYSHealth’s mission to improve the health of all New Yorkers, especially the most vulnerable populations. In order to extend its mission across different focus areas, projects selected for funding are not permitted to address any of the following NYSHealth priorities: 

• Healthy Food, Healthy Lives;
• Empowering Health Care Consumers; and
• Veterans’ Health.

NYSHealth will provide a one-time, nonrenewable grant between $50,000 and $300,000 to successful applicants. Special Projects Fund grants are typically in the $250,000 range, with about five to fifteen awards made annually. Applicants must be not-for-profit 501(c)(3) organizations or for-profit organizations that can demonstrate their ability to significantly impact the health of New Yorkers in alignment with NYSHealth’s mission. 
 
The full RFP is available here and an FAQ is available here. The required online inquiry form for the second cycle of funding is due June 9^th, which was updated from its original deadline of March 2^nd. The full proposal (for invited applicants only) will be due on August 18^th. Applicants are not required to have applied for the first cycle of funding.
 
NYC HRA Releases RFP for $15 Million for Tenant Services in Senior Affordable Housing
On May 3^rd, the New York City (NYC) Human Resources Administration (HRA) released an RFP offering a total of about $15 million over five years for qualified organizations to develop and provide high-quality services for senior households residing in newly developed, affordable senior housing projects.
 
This permanent affordable housing program aims to help seniors to live independently and age in place, with an emphasis on supporting formerly homeless seniors. The program provides gap financing in the form of low-interest loans to support the construction and renovation of affordable housing for seniors (age 62 and older) with low incomes. Projects are expected to set aside 30 percent of units for homeless seniors referred by a NYC agency.
 
Through this RFP, HRA will support approximately 500 units and will provide approximately $5,000 per year for each homeless unit. Contracts will last for five years, with an option to renew for four additional years. Proposals may be submitted by: 

• A service provider in conjunction with an identified housing developer; or
• An organization with the capacity and experience to act as both housing developer and service provider.

Eligible applicants are not-for-profit 501(c)(3) organizations with relevant experience. Contractors may propose to serve one or more affordable senior housing projects, each of which will require a Letter of Support from NYC Housing Preservation and Development (HPD) that identifies the proposed housing site location and the status of financing the site.
 
The RFP may be accessed in the PassPort system here by searching “Provision of Senior Affordable Housing.” The RFP is open-ended, and applications will be accepted on an ongoing basis in the order received. Questions may be submitted to Bukola Olode at olodeb@hra.nyc.gov.
 
DOH Releases SOI for Round 5 of the Primary Care Service Corps
On April 25^th, DOH released a Solicitation of Interest (SOI) for the fifth round of the Primary Care Service Corps (PCSC) Loan Repayment Program. PCSC is a service-obligated loan repayment program for clinicians working part-time (20-39 hours per week) in primary care or behavioral health and is intended to increase the supply of such clinicians in underserved settings. The Fiscal Year 2021-22 New York State Budget allocated up to $1 million in funding to support existing contracts and new awards through this program. Clinicians who receive new awards through this SOI will receive up to $30,000 in loan repayment funding if they commit to practicing for three years at a National Health Service Corps Approved Site.  
 
Clinicians eligible to apply for loan repayment funding under the program must be licensed in New York State at the time of application and may include the following: 

• Dentists (full-time dentists may receive up to $60,000)
• Dental hygienists
• Nurse practitioners
• Physician assistants
• Midwives
• Clinical psychologists
• Licensed clinical social workers
• Licensed marriage and family therapists
• Licensed mental health counselors

Applicants may not have previously received, or currently be receiving, an award from PCSC. The three-year employment commitment will begin on or before August 1^st.
 
The SOI is available here. Applications may be submitted through June 13^th and will be reviewed in the order in which they are received. Questions may be submitted to sch_loan@health.ny.gov with the subject line “PCSC Round 5 Question” through May 9^th. Questions and answers will be posted on May 23^rd.