Weekly Health Care Policy Update – September 20, 2024

September 27, 2024

In this update: 

  • Legislative Update
    • House Energy and Commerce Committee Advances Health Legislation
  • Federal Agencies
    • CMS Issues RFI on AI Technologies to Improve Health Outcomes and Delivery
    • HHS Finalizes Rule on Research Integrity
    • HHS Announces 2024 LEAP in Health IT Awards
    • HRSA Makes Multi-Vendor Contract Award for Organ Transplant System
    • HRSA Announces $240 Million in Behavioral Health Awards
    • HRSA Announces $100 Million for Health Care Workforce
    • NIH Establishes Pandemic Preparedness Research Network
    • CDC Launches Program to Improve Patient Safety
  • Other Updates
    • KFF Publishes Report on MA Bonus Payments
    • NCQA Releases 2024 Health Plan Ratings
    • Commonwealth Publishes Comparison Report of U.S. and Other Health Systems
  • New York State Updates
    • Governor Hochul Signs Legislative Package Expanding the Scope of Ambulance Services
    • OMH, OASAS, and SED to Host Joint Webinar on Diagnostic Privileges for LMHCs, LMFTs, and LPs
    • CMS Approves New York SPA Revising Payment Eligibility Criteria for FQHCs and RHCs
    • CMS Posts Approved FY 2025 SDP for Financially Distressed Hospitals

Legislative Update

House Energy and Commerce Committee Advances Health Legislation
On September 18th, the House Energy and Commerce Committee convened a full committee markup to consider 16 bills, including several health care-related proposals. Most notably, the Committee advanced the Telehealth Modernization Act, which would extend Medicare telehealth flexibilities for two years, but without an official score from the Congressional Budget Office (CBO), raising questions about whether adequate funding can be found for including the bill in a potential end-of-year spending package.
 
More information on the session is available here.

Federal Agencies

CMS Issues RFI on AI Technologies to Improve Health Outcomes and Delivery
On September 9th, the Centers for Medicare and Medicaid Services (CMS) issued a Request for Information (RFI) seeking input on existing artificial intelligence (AI) technologies that support health care outcomes and service delivery. CMS will seek to understand AI’s role in health care by selecting organizations who respond to the AI to provide demonstrations of their products at “CMS AI Demo Days.”

Demonstrations will be selected by a CMS technical panel on a rolling quarterly basis, starting in October. RFI responses should include a description of a proposed product demonstration. Each presentation should be no more than 15 minutes.

The full RFI is available here. RFI responses are due October 7th. Questions on the RFI may be submitted to cmsdemodays@cms.hhs.gov through September 27th.

HHS Finalizes Rule on Research Integrity 
On September 12th, the Department of Health and Human Services (HHS) finalized the 2024 Public Health Service (PHS) Policies on Research Misconduct, updating regulations from 2005. This rule clarifies requirements for addressing and remediating PHS-funded research misconduct. Specifically, the final rule clarifies the roles of the Office of Research Integrity (ORI) and PHS-funded organizations in oversight and proactive monitoring, respectively. HHS intends for the final rule to support the creation of institutional best practices, comprehensive appeals processes, and more realistic inquiry timelines. The rule will take effect January 2, 2025, and becomes applicable January 1, 2026.

The announcement is available here, and the final rule is available here.

HHS Announces 2024 LEAP in Health IT Awards 
On September 17th, HHS announced two awards totaling $2 million under the Leading Edge Acceleration Projects in Health Information Technology (LEAP in Health IT) program. The LEAP in Health IT program aims to develop methods and tools to support interoperable health IT. The recent Special Emphasis Notice sought applications that focused on: 

  • Innovative ways to strengthen the quality of data used by AI tools. This award was made to Columbia University for Scalable, Shareable, and Computable Clinical Knowledge for AI-Based Processing of Hospital-Based Nursing Data (SC2K).
  • Ways to accelerate the adoption of health IT for behavioral health. This award was made to Oregon Health & Science University (OHSU).

The announcement is available here.

HRSA Makes Multi-Vendor Contract Award for Organ Transplant System 
On September 19th, the Health Resources and Services Administration (HRSA) announced the first ever multi-vendor contract awards to improve the nation’s Organ Procurement and Transplantation Network (OPTN). The awards mark the end of 40 years of a single vendor operating the OPTN, which manages the transplant network for more than 100,000 people currently on the organ transplant waitlist. The OPTN has come under heavy criticism for transparency, performance, governance, and efficiency problems. In this announcement, HRSA gave out five awards. Recipients include: 

  1. Arbor Research Collaborative for Health to improve patient safety;
  2. General Dynamic Information Technology to support OPTN IT modernization;
  3. Maximus Federal to increase transparency and public engagement in OPTN policy development;
  4. Deloitte to strengthen patient-centered communications; and
  5. Guidehouse Digital to improve OPTN financial management.

The awards are part of a larger OPTN Modernization Initiative that began in March 2023, including a new OPTN Board of Directors named in August 2024. More information is available here.

HRSA Announces $240 Million in Behavioral Health Awards
On September 19th, HRSA announced the award of $240 million in Behavioral Health Service Expansion Awards for federal fiscal year (FY) 2024. Today, health centers are only able to meet about 27% of the demand for mental health services among their patients, and only 6% of the demand for substance use disorder treatment. The goal of the awards is to launch and expand mental health and substance use disorder services in more than 400 community health centers across the country, addressing both the nation’s mental health and opioid crises, two pillars of the Biden’s Administration’s Unity Agenda. In New York, 21 health centers received roughly $600,000. 

The announcement is available here. A list of New York health centers receiving funding is available here.

HRSA Announces $100 Million for Health Care Workforce 
On September 17th, HRSA announced nearly $100 million in awards to support health care workforce development through its Health Workforce Initiative, focusing on nurses, primary care physicians, and the community-based behavioral health workforce. HRSA granted awards across four programs: 

  • Medical Student Education;
  • The Opioid-Impacted Family Support Program;
  • The Nurse Education, Practice, Quality and Retention (NEPQR) Workforce Expansion Program (WEP); and
  • The Pediatric Mental Health Care Access Program.  

The announcement is available here.

NIH Establishes Pandemic Preparedness Research Network 
On September 13th, the National Institutes of Health (NIH) established the Research and Development of Vaccines and Monoclonal Antibodies for Pandemic Preparedness network (ReVAMPP). This network will conduct research to develop vaccines and monoclonal antibodies for high-priority pathogens. NIH’s National Institute of Allergy and Infectious Diseases (NIAID) expects to commit approximately $100 million per year to fund ReVAMPP. The Albert Einstein College of Medicine is among the first award recipients, for a project entitled Prepositioning Optimized Strategies for Vaccines and Immunotherapeutics against Diverse Emerging Infectious Threats (PROVIDENT).

The announcement is available here.

CDC Launches Program to Improve Patient Safety 
On September 17th, the Biden Administration announced a multi-agency effort to address patient and workforce safety. In partnership with the Departments of Health and Human Services (HHS), Defense, and Veterans Affairs, as well as private industry partners, the Biden Administration formed the National Action Alliance for Patient and Workforce Safety. Partners include the Association of American Medical Colleges (AAMC) and a number of prominent health systems, though none in the tri-state area. As part of the effort, the Centers for Disease Control and Prevention (CDC) will release new guidance for hospitals, including programs to track patient safety, reduce diagnostic and screening errors, and target the threat of sepsis in medical settings. CDC will also work to address workplace violence with programming through the National Institute for Occupational Safety and Health (NIOSH).

Other Updates

KFF Publishes Report on MA Bonus Payments
On September 11th, the Kaiser Family Foundation (KFF) published a report on the Medicare Advantage (MA) quality bonus program, which adjusts Medicare payments to plans based on a five-star rating system. Federal spending on MA bonus payments increased more than 400% from 2015 to 2023, but is set to decline slightly in 2024 as pandemic-era policies expire. Despite the decline, MA plans will receive at least $11.8 billion in bonus payments this year. The average bonus payment per enrollee is highest for employer- and union-sponsored Medicare Advantage plans and lowest for special needs plans for dually-eligible individuals (D-SNPs).
 
The report is available here.
 
NCQA Releases 2024 Health Plan Ratings
On September 16th, the National Committee for Quality Assurance (NCQA) released its annual health plan rankings. NCQA’s process includes commercial, Medicare, and Medicaid plans, assessing about 50 metrics across patient experience and clinical quality on a scale of one to five stars. This year, NCQA incorporated additional measures f0r health equity. Of the 1,019 plans reviewed, only five received a five-star rating (three commercial plans and two MA plans), including Independent Health Association, Inc. in New York.
 
The ratings are available here.
 
Commonwealth Publishes Comparison Report of U.S. and Other Health Systems
On September 19th, the Commonwealth Fund released Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System, an annual report that compares health system performance across 10 countries. Using 70 health system performance measures across five domains (access to care, care process, administrative efficiency, equity, and health outcomes), the report lists Australia, the Netherlands, and the United Kingdom as the countries with the strongest systems. Other countries surveyed are clustered together on most measures—except for the United States, which is dramatically worse. The Fund says that the United States is “in a class by itself in the underperformance of its health care sector.”
 
The report is available here.

New York State Updates

Governor Hochul Signs Legislative Package Expanding the Scope of Ambulance Services
On September 17th, Governor Hochul signed the following legislation related to ambulance care: 

  • S8486C/A9102C codifies flexibilities in the federal Emergency Triage, Treat, and Transport (ET3) model. Specifically, it requires Medicaid to provide reimbursement when an ambulance service administers treatment in place (including telehealth visits) or transports an individual to an alternative care setting instead of a general hospital.
  • S6225A/A5789A authorizes ground ambulance and advanced life support first response services to store and distribute blood and initiate and administer blood transfusions.

The Governor’s press release is available here.

OMH, OASAS, and SED to Host Joint Webinar on Diagnostic Privileges for LMHCs, LMFTs, and LPs
On October 2nd from 10am-11:30am, the NYS Office of Mental Health (OMH), Office of Addiction Services and Supports (OASAS), and State Education Department (SED) will host a joint webinar on the “diagnostic privilege” for OMH and OASAS providers in licensed settings. Private practice and other service settings will not be covered during the webinar.

The diagnostic privilege allows licensed mental health counselors (LMHCs), licensed marriage and family therapists (LMFTs), and licensed psychoanalysts (LPs) to continue to diagnose and develop treatment plans following the sunset of the “social worker exemption” in 2022. The presentation will provide an overview of diagnostic privilege and will review the common questions received from individuals and programs.

Registration is available here.

CMS Approves New York SPA Revising Payment Eligibility Criteria for FQHCs and RHCs 
On September 18th, CMS approved New York’s State Plan Amendment (SPA) revising the payment eligibility criteria for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) that are eligible for an additional annual payment under the Alternative Payment Methodology (APM). The revised language indicates that, in the event of a change of ownership of the entire FQHC or RHC entity that was eligible for a payment under the APM, the new owner will retain the most recently approved payment of the former owner.

The SPA is available here. The CMS approval letter is available here.

CMS Posts Approved FY 2025 SDP for Financially Distressed Hospitals
CMS has posted the latest approved version of New York’s state-directed payment (SDP) preprint for financially distressed hospitals, which applies to state FY 2025 (April 2024 through March 2025). The SDP, which was approved on July 18th, is broadly similar to previous years, but includes some notable changes: 

  • The Medicaid payer mix threshold for hospitals to be eligible for the program was decreased from 36% to 34%, using a three-year average from 2020 through 2022. This applies to both inpatient days and outpatient visits.
  • The payment methodology tiering system, which groups hospitals into categories that receive a given add-on payment per Medicaid service, has been modified, and the add-on amounts for each category of service (i.e., inpatient acute, inpatient psychiatric, etc.) also been adjusted. The public preprint does not provide further specifics.
  • The total potential amount of the SDP increased from $1.56 billion to $1.86 billion.

More information is available on CMS’s website here.