Weekly Health Care Policy Update – January 3, 2025

January 10, 2025

In this update: 

  • Legislative Updates
    • Congress Passes Short-Term Budget Bill
    • DeGette and Bucshon Outline Cures 2.1
  • Federal Agencies
    • Biden Administration Withdraws Proposed Contraceptive Rule
    • PCORI Advisory Panels Applications Open
    • HRSA Accepts Changes to Women’s Preventive Services Guidelines
    • 2024 UDS Reporting Begins 
  • New York State Updates
    • DOH Submits State Plan Amendments and Announces Additional Modifications to the Medicaid Program
    • OASAS Issues Proposed Rule to Sunset Part 819 and Encourage Providers to Transition to Part 820
    • Governor Hochul Vetoes Grieving Families Act, Signs Other Health Care Legislation

Legislative Updates

Congress Passes Short-Term Budget Bill 
On December 20, 2024, Congress passed a bipartisan plan to temporarily fund the government through March 14th of this year. The bill was the third attempt from Speaker Mike Johnson, who faced considerable headwinds throughout the funding process. Despite President-elect Trump’s request, the bill did not include a debt limit increase. The package funds the government at current levels and includes $100 billion in disaster aid and $10 billion in agricultural assistance. The package also includes a slimmed down health extender package, including three-month extensions of: 

  • Medicare telehealth flexibilities, including:
    • Waiving geographic and originating site requirements;
    • Expanding practitioners eligible to furnish telehealth services;
    • Allowing Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to serve as distant site providers;
    • Delaying the in-person requirements for tele-mental health services; and
    • Allowing audio-only telehealth.
  • Delaying the Medicaid Disproportionate Share Hospital (DSH) cut
  • Raising the Medicare Geographic Practice Cost Index (GCPI) Floor
  • Funding for Community Health Centers ($1.05 billion), National Health Service Corps ($85 million), and Teaching Health Center GME Programs ($43 billion)
  • Funding for the Special Diabetes Program ($78 million)
  • Funding for enrollment outreach to older Americans ($22.5 million)
  • Medicare Add-On Payment for Low-Volume Adjustment (LVA) and Medicare-Dependent Hospital (MDH) Programs
  • Medicare add-on payment for rural ground ambulance services
  • Certain provisions of the Pandemic and All-Hazards Preparedness Act (PAHPA):
    • Temporary Reassignment of State and Local Personnel during a PHE;
    • Biomedical Advanced Research and Development Authority; and
    • The National Advisory Disability Committees.
  • Medicare’s acute hospital care at home (AHCAH) flexibilities

The offset for these extensions is a funding reduction within the Medicare Improvement Fund. A number of key extenders were dropped from the final package including, but not limited to: a Medicare Physician Fee Schedule (PFS) payment boost, Medicare A-APM bonuses, full reauthorization of the Pandemic and All-Hazards Preparedness Act (PAHPA), and the Older Americans Act.

The new Congress will have until March 14th to pass legislation funding the government through the end of the fiscal year (FY) on September 30th, while also working on FY 2026 funding agreements. Republican lawmakers also made an informal agreement to raise the debt limit as part of proposed tax and border packages next year.

President Biden signed the bill on December 21st.

DeGette and Bucshon Outline Cures 2.1 
On December 24th, Reps. Diana DeGette (CO-01) and Larry Bucshon (IN-08) released “A Roadmap for 21st Century Cures: Next Steps for the Cures 2.0 Act and the 21st Century Cures Initiative.” The release follows over 300 responses to a Request for Information issued by the members in June, which offered feedback on improving clinical trials, improving the use of health information technology, expanding the use of real-world data and evidence, improving Medicare coverage policies, ensuring proper Medicare payment for novel technologies, and addressing artificial intelligence.

The white paper outlines a future Cures 2.1 update, which would aim to build three things: 

  • An environment that “enables rapid and appropriate deployment of innovative technologies to improve health outcomes”;
  • A health care infrastructure that “enables information sharing, continuous evidence gathering, and implementation of new knowledge”; and
  • Innovations that “improve public health, promote patient-centric care, reduce the burden of chronic disease, and conserve valuable resources.”

The white paper is available here.

Federal Agencies

Biden Administration Withdraws Proposed Contraceptive Rule
On December 23, 2024, the Departments of Health and Human Services (HHS), Labor, and the Treasury withdrew a rule originally proposed in February 2023 regarding exemptions from the requirement to cover certain contraceptive services without cost-sharing for group health plans, student health insurance coverage, health insurance issuers, and individuals with religious or moral objections. The notice indicates that the Departments wish “to focus their time and resources on other matters,” noting that the proposed rule received more than 44,000 comments and they wish to further consider proposals made in the proposed rule.

The proposed rule would have: 

  • Left the religious exemption in place;
  • Rescinded the moral exemption, noting the “strong public interest in assuring contraceptive coverage to women enrolled in group health plans, or group or individual (including student) health insurance coverage”; and
  • Established a new pathway (“an individual contraceptive arrangement”) for individuals enrolled in plans or coverage sponsored/provided by an objecting entity where a provider or facility that furnishes contraceptive services would be able to be reimbursed for its costs by entering into an arrangement with an insurer on the Federally-facilitated Exchange (FFE), or State-based Exchange on the Federal platform (SBE-FP) which would in turn seek an Exchange user fee adjustment.

The notice of withdrawal of the proposed rule is available here.

PCORI Advisory Panels Applications Open 
On January 2nd, the Patient-Centered Outcomes Research Institute (PCORI) announced an open application period for five Advisory Panels: Clinical Effectiveness and Decision Science, Clinical Trials, Healthcare Delivery and Disparities Research, Patient Engagement, and Rare Disease. Panelists advise PCORI on their work in patient-centered comparative clinical effectiveness research.

Interested individuals can participate in a virtual town hall on February 10th from 3-4pm ET to learn more on how the advisory panels work including expectations of service, hear an overview of each panel, understand the application and nomination process, and ask questions. Webinar registration is available here.

HRSA Accepts Changes to Women’s Preventive Services Guidelines
On December 30, 2024, the Health Resources and Services Administration (HRSA) issued a notice accepting revisions to Women’s Preventive Services Guidelines developed by its Women’s Preventive Services Initiative (WPSI). As such, non-grandfathered group health plans and health insurance issuers offering non-grandfathered group and individual health insurance coverage must cover without cost sharing these revised services beginning one year after publication in the Federal Register. For most plans, this will be the 2026 plan year.

Specifically, changes were made two preventive services and one new service was added: 

  • Screening and Counseling for Intimate Partner and Domestic Violence: minor changes to the title and to clarify that both adolescent and adult women are included in the recommendation;
  • Breast Cancer Screening for Women at Average Risk: minor change to title and addition of language to clarify that if additional imaging and pathology exams are indicated, those services are also included under the guidelines (and must be covered without cost sharing); and
  • Patient Navigation for Breast and Cervical Cancer Screening: this is a new guideline, reflective of research finding effectiveness of these services in reducing barriers to screening and follow-up care, resulting in higher screening rates.

The notice is available here.

2024 UDS Reporting Begins  
On January 1st, the 2024 Uniform Data System (UDS) reporting period began. Each calendar year, HRSA-funded community health centers (CHCs) and look-alikes are required to report a core set of information – both clinical and administrative – including patient characteristics, services rendered, health outcomes, staffing, costs, and revenues. For 2023 reporting, some health centers submitted the first-ever de-identified patient-level UDS data (“UDS+”). For 2024 reporting, health centers will continue to provide legacy UDS submissions as well as some portions of UDS+, as the transition continues to the updated reporting system.

All awardees are required to submit completed reports to HRSA by February 15th. The 2024 UDS Manual is available here.

New York State Updates

DOH Submits State Plan Amendments and Announces Additional Modifications to the Medicaid Program
On December 31, 2024, the New York State (NYS) Department of Health (DOH) submitted the following State Plan Amendments (SPAs) to CMS for approval: 

  • A Treatment in Place (TIP) proposal that would reimburse for emergency medical care provided to Medicaid enrollees by ambulance providers in the absence of transportation (here).
  • A proposal to implement a 5% rate increase for early intervention (EI) services, and a decrease of 22% downstate and 10% in rest of state for EI services delivered via telehealth (here).
  • A proposal to reimburse Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) for medically necessary dental implants and implant-supported services using the dental fee schedule in lieu of the prospective payment system (PPS) base rate (here).
  • A proposal to align the State Plan with New York statute in order to explicitly allow residents of Adult Care Facilities to receive both Hospice and Assisted Living Program services without having to disenroll from either (here).
  • A proposal to amend pharmacy reimbursement for brand prescription drugs to wholesale acquisition cost, and physician-provided drug reimbursement to a lower methodology (here).
  • A proposal to adjust Mental Health Outpatient Treatment and Rehabilitative Services (MHOTRS) clinic rates by 2.8% statewide for providers who participate in the OMH Quality Improvement initiative (here).
  • A proposal to adjust Medicaid rates by 25% statewide for Partial Hospitalization providers (here).
  • A proposal to apply a 20% reduction to both the budgeted and actual capital add-on payments for inpatient Medicaid rates for general hospitals (here).

DOH also issued the following notices in the State Register (here), which will be effective on or after January 1st: 

  • The Consumer Directed Personal Assistance Program (CDPAP) reimbursement will transition from a three-tiered per member per month (PMPM) rate structure to a rate established through the single Fiscal Intermediary (FI) contracting process.
  • In accordance with federal regulations, the State Medicaid program will provide screenings, diagnostic services, and Targeted Case Management (TCM) to eligible juveniles 30 days prior to release from incarceration.
  • DOH will reimburse FQHCs and RHCs a separate payment in lieu of the PPS rate for non-visit services, such as eConsults and remote patient monitoring (RPM).
  • The State Medicaid program will reimburse for the Multi-Dimensional Family Therapy (MDFT) Evidence-Based Practice (EBP) provided to children/youth eligible for Children and Family Treatment and Support Services (CFTSS) by agencies that have completed the MDFT training and certification process.
  • The quality incentive program for non-specialty nursing homes will remove the measure “Percentage of Current Healthcare Personnel Up to Date with Covid-19 Vaccines” and will use an altered measurement period for four other measures.

Comments may be submitted to spa-inquiries@health.ny.gov. 

OASAS Issues Proposed Rule to Sunset Part 819 and Encourage Providers to Transition to Part 820
On December 24, 2024, the Office of Addiction Services and Supports (OASAS) issued a proposed rule that will officially sunset Part 819 “Substance Use Residential Services”, effective February 28, 2026. Providers authorized under Part 819 will need to obtain an operating certificate under other provisions prior to the sunset, such as Part 820 “Residential Services.” OASAS will provide a one-time payment of up to $205,000 to assist with program conversions (details here).

The proposed rule is available here. Public comment may be submitted to Eugene.Martin@oasas.ny.gov through February 22nd. Additional details are available on the OASAS website here and in the State Register here. Technical assistance may be addressed to PICIM@oasas.ny.gov.

Governor Hochul Vetoes Grieving Families Act, Signs Other Health Care Legislation
At the end of 2024, Governor Hochul signed the following health care-related legislation: 

  • S8666A/A8560 requires hospitals to ask patients if they have a disability that requires accommodation under the Americans with Disabilities Act (ADA).
  • S9519A/A10189 establishes an “advanced residential health care for aging adults medical fragility” demonstration program, allowing eligible facilities to construct a new facility or repurpose part of an existing facility to operate specifically for aging adults with medical fragility.
  • S2867/A7369 permanently excludes Traumatic Brain Injury (TBI) and Nursing Home Transition and Diversion (NHTD) waiver services from Medicaid managed care.
  • S1478/A7215 directs the Commissioner of Health and Commissioner of the Office for People with Developmental Disabilities (OPWDD) to conduct a study of service delivery for individuals with TBI.
  • S9294A/A10105 amends the New York Penal Law to expand the definition of “mental health care provider” to include licensed mental health counselors and licensed marriage and family therapists for the purposes of addressing certain sex offenses committed during treatment sessions, consultations, interviews, or examinations.
  • S8760A/A9369 amends the Elder Law by adding a provision to automatically identify enrollees in the Elderly Pharmaceutical Insurance Coverage (EPIC) program who are also eligible for the Home Energy Assistance Program (HEAP) and enroll them in HEAP.
  • S9259/A8162 establishes a maternity care coordination program for pregnant and postpartum veterans.
  • S7833A/A8467 expands the definition of “drug adulterant testing supplies” dispensed by health care professionals or pharmacists to include xylazine and other substances.

Governor Hochul vetoed for the third time the “Grieving Families Act” (S8485B/A9232), which would have significantly expanded the scope and potential damages of wrongful death lawsuits.