Weekly Health Care Policy Update – February 21, 2025

In this update: 

• Administration Updates
  • Trump Administration Expected to Defend ACA in Case Regarding USPSTF Authority
  • DOGE Fires Thousands of HHS Workers
  • Trump Signs Executive Order on Recommendations to Expand Access to IVF
  • Trump Administration to Withhold Money from Schools Requiring Covid Vaccines
• Federal Agencies
  • HHS Indefinitely Postpones Federal Vaccine Advisory Meeting; RFK Plans to Replace Members
  • CMS Reduces Federally-Facilitated Exchange Navigator Funding
  • HHS Rescinds Biden-Era Guidance on Gender Affirming Care, Civil Rights, and Patient Privacy
• Other Updates
  • Federal Judges Block Executive Order on Gender-Affirming Care
• New York State Updates
  • NYS Issues Guidance to Private and Not-for-Profit Organizations on Navigating Federal Immigration Enforcement Activities
  • DOH Issues Guidance to Hospitals on Gender Affirming Care
  • NYS Announces Rate Enhancements for Article 28 Clinic Providers Delivering Mental Health Services
  • NYS Health Homes Now Included on List of Eligible Providers for Medicaid Community Health Worker (CHW) Services
  • NYS Announces Managed Care Reimbursement for Homeless Healthcare Providers
  • DFS Adopts Final Regulations on Behavioral Health Network Adequacy and Access

Administration Updates

Trump Administration Expected to Defend ACA in Case Regarding USPSTF Authority 
On February 14^th, Inside Health Policy reported that “a source close to the issue” confirmed that the Trump administration will argue in support of the Affordable Care Act (ACA) and the United States Preventive Services Task Force (USPSTF) in Braidwood v. Becerra. Last month, the Supreme Court announced it would hear a challenge brought by the Biden Administration to the Fifth Circuit Appeals Court ruling in the case. The Fifth Circuit held that because their recommendations set coverage requirements, members of the USPSTF should be nominated by the president and confirmed by the Senate. Because they were not, the court ruled that the plaintiffs cannot be compelled to cover items and services recommended by the Task Force since March 23, 2010, but that this relief should not be extended to all employers/issuers. Oral arguments in the case are anticipated in March or April with a decision expected by the end of the Court’s current term in June.
 
DOGE Fires Thousands of HHS Workers
On February 13^th, the Department of Health and Human Services (HHS) began firing thousands of probationary workers across virtually all divisions at the direction of the Department of Government Efficiency (DOGE). Initial reports indicate that up to 5,200 employees have lost their jobs at HHS, although reported numbers have varied. The Centers for Disease Control and Prevention (CDC) alone eliminated 1,300 probationary workers with four weeks’ paid administrative leave. An unspecified number of contract workers were also terminated. Notable senior leadership departures include Renee Wegrzyn, the inaugural director for the Advanced Research Projects Agency for Health (ARPA-H) and Jim Jones, Deputy Commissioner at the Food and Drug Administration (FDA).
 
Probationary workers, those in their first years of federal service, are often easier to fire without triggering civil service protections. Per the Administration, HHS expects to save $600 million with the actions. A separate executive order announced on February 11^threquires that agencies hire “no more than one employee for every four employees that depart.” 
 
Trump Signs Executive Order on Recommendations to Expand Access to IVF 
On February 18th, President Trump signed an executive order (EO) seeking recommendations to expand access to in vitro fertilization (IVF). The topic was raised on the campaign trail when, after Roe v. Wade was overturned and the Alabama Supreme Court ruled that frozen embryos were considered children, some IVF providers paused treatments out of fear of legal action. At the time, Trump said the government or health insurers would cover IVF if he were elected. This EO directs the Assistant to the President for Domestic Policy to provide, within 90 days, a list of policy recommendations on “protecting IVF access and aggressively reducing out-of-pocket and health plan costs for IVF treatment.”
 
The executive order is available here.
 
Trump Administration to Withhold Money from Schools Requiring Covid Vaccines
On February 14^th, President Trump ordered that federal funding be withheld from schools and universities that require Covid-19 vaccinations for attendance. It was not immediately clear how impactful this order would be, since no states require Covid-19 vaccinations for K-12 students. As of late last year, approximately 15 universities required Covid-19 vaccinations. It was also unclear whether medical schools, some of which maintained Covid-19 vaccine mandates for patient safety, are affected by this new order. This move mirrors state-level action to undo pandemic-era measures, including bans on local health departments administering Covid-19 vaccines.
 
The announcement is available here.

Federal Agencies

HHS Indefinitely Postpones Federal Vaccine Advisory Meeting; RFK Plans to Replace Members 
On February 20^th, HHS indefinitely postponed next week’s meeting of the Advisory Committee on Immunization Practices (ACIP) “to accommodate public comment in advance of the meeting.” The meeting agenda would have covered presentations and votes on meningococcal, chikungunya, and influenza vaccines; presentation and discussion on RSV, HPV, Mpox, Covid-19, CMV, and pneumococcal vaccines; and an update from the Lyme disease workgroup. Clinicians and insurance companies rely on the recommendations of ACIP to guide practice and reimbursement policy.

In response, over 50 experts and organizations sent a letter to HHS Secretary Robert F. Kennedy, Jr., Senator Bill Cassidy (R-LA), and the CDC’s Acting Director Susan Monarez encouraging them to swiftly reschedule the meeting. The authors wrote: “Each ACIP meeting holds tremendous weight and relevance. Infectious diseases are constantly evolving opponents; vaccines are among the best tools for constantly adapting and responding to the latest public health threats.”

Concurrent with the postponement announcement, Politico reported that Secretary Kennedy was “preparing to remove members” of ACIP and other advisory committees who “he perceives to have conflicts of interest.” The Secretary has not decided which members will be replaced, or how long it will take to replace them. On February 4^th, Senator Cassidy publicly stated in defending his support of Kennedy’s nomination that the Secretary would “maintain the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices without changes.”

The original ACIP meeting agenda is available here. The postponement announcement is available here. The letter protesting the postponement is available here. The Politico report is available here.

CMS Reduces Federally-Facilitated Exchange Navigator Funding
On February 14th, the Centers for Medicare & Medicaid Services (CMS) announced it was reducing funding for Navigators operating in states with Federally-Facilitated Exchanges (FFEs) to $10 million, a 90% reduction from the $98 million the Navigators received in 2024. The announcement noted that Navigators enrolled 92,000 consumers during the 2024 plan year, or 0.6% of plan enrollment, at an average cost of $1,061 per enrollment. The announcement further notes that in 2019, Navigators also enrolled 0.6% of enrollees at a more efficient per enrollment investment of $211. Finally, CMS indicates that reduced Navigator funding will reduce FFE user fees by $360 million over the next four years.

The announcement is available here.

HHS Rescinds Biden-Era Guidance on Gender Affirming Care, Civil Rights, and Patient Privacy
On February 20^th, the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) rescinded Biden Administration guidance entitled “HHS Notice and Guidance on Gender Affirming Care, Civil Rights, and Patient Privacy.” The Biden-era document offered guidance on providing gender-affirming care; the rescission is in accordance with President Trump’s recent executive order prohibiting HHS from supporting “the so-called ‘transition’ of a child from one sex to another.” In issuing the rescission, the OCR Acting Director called the move a “significant step to align civil rights and health information privacy enforcement with a core Administration policy that recognizes that there are only two sexes:  male and female.”

The announcement is available here.

Other Updates

Federal Judges Block Executive Order on Gender-Affirming Care 
On February 13^th and 14^th, federal judges in Baltimore and Seattle issued temporary restraining orders in separate suits against the Trump Administration over its policy restricting gender-affirming care. The suits centered on the order’s alleged violation of the Fifth and Tenth Amendments. The restraining orders will last 14 days, but can be extended, putting the EO on pause while the case proceeds. This move offers some immediate relief for providers struggling to discern the legality of such care in this landscape.
 
The Maryland order is available here, and the Washington order is available here.

New York State Updates

NYS Issues Guidance to Private and Not-for-Profit Organizations on Navigating Federal Immigration Enforcement Activities 
On February 14^th, the Joint Office of the Governor and Office of the New York State (NYS) Attorney General issued guidance to private and not-for-profit organizations on navigating the recent rescission of federal protections against immigration enforcement at “sensitive locations,” which includes health care facilities and social services establishments. Given the potential for increased enforcement activity at these locations, this guidance outlines how to respond to federal immigration enforcement requests while protecting the rights of residents, clients, and staff, including distinctions between public and private areas, the handling of warrants and subpoenas, and best practices for staff training and policy development.

The State also highlighted requirements under the Health Insurance Portability and Accountability Act (HIPAA) and Mental Hygiene Law (MHL), which strictly limit the disclosure of patient information to federal immigration authorities absent appropriate legal process. OMH encourages facilities to “remain vigilant in applying these protections, particularly in response to requests for a person’s records or location inquiries (even related to questions of whether person receives services at your organization).”

Health care providers are reminded that they are not required to disclose protected health information (PHI) to immigration officials except under the following circumstances: 

• A valid court order, subpoena, or search warrant – each of which must be signed by a judge – that specifically authorizes disclosure of PHI;
• A legally executed patient authorization permitting disclosure; or
• Another applicable legal mandate under state or federal law.

The guidance is available here. Providers are encouraged to consult with their legal counsel for any questions or further guidance on these matters.

DOH Issues Guidance to Hospitals on Gender Affirming Care
On February 18^th, the NYS Department of Health (DOH) issued guidance to hospital administrators on continuity of care following recent presidential executive orders (EO 14168 and EO 14187) that limit or pause funding for gender affirming care. Federal courts have temporarily blocked enforcement of the executive orders, including preventing federal agencies from withholding, freezing, or pausing funds to providers offering gender affirming care. As the legal developments continue to unfold, the State is reminding providers that New York law bans discrimination based on sexual orientation, gender identity, or expression. Further, hospitals and diagnostic and treatment centers “must ensure equitable treatment and continuity of care for patients whose care is discontinued or paused.” Providers are also encouraged to consult with legal counsel on the status of the ongoing litigation regarding federal actions.

The guidance is available here. Questions may be submitted to hospinfo@health.ny.gov

NYS Announces Rate Enhancements for Article 28 Clinic Providers Delivering Mental Health Services
Effective January 1, 2025, the NYS Medicaid fee-for-service (FFS) program will provide a nine percent enhancement to the Ambulatory Patient Group (APG) base rate for certain mental health services provided in Article 28 clinics. Such clinics may include hospital outpatient departments, freestanding diagnostic and treatment centers, and Federally Qualified Health Centers (FQHCs) that have opted into APGs. The change aims to bring Article 28 payments for mental health services “in line with the reimbursement rates for the same services offered in Office of Mental Health (OMH) Article 31 clinics” and better support integrated care for individuals with complex health needs.

Additional details, including the applicable Current Procedural Terminology (CPT) codes, are available here. Questions may be submitted to FFSMedicaidPolicy@health.ny.gov.  

NYS Health Homes Now Included on List of Eligible Providers for Medicaid Community Health Worker (CHW) Services 
Effective January 1, 2025 for NYS Medicaid FFS and April 1, 2025 for Medicaid managed care (MMC), Health Home is included on the list of eligible providers for Community Health Worker (CHW) services. CHW services include health advocacy, health education, and health navigation supports provided by a public health worker not otherwise recognized as a licensed or certified NYS Medicaid provider type.

CHW services are not covered for NYS Medicaid members who are enrolled in a Health Home or Health Home Care Coordination Organization (CCO) or who receive care coordination services through a Certified Community Behavioral Health Clinic (CCBHC) or Assertive Community Treatment (ACT). However, Health Homes may be reimbursed for the provision of CHW services when provided to Medicaid members before or after they receive care management services from these programs.

Additional details are available in the Medicaid update here.

NYS Announces Managed Care Reimbursement for Homeless Healthcare Providers
Effective February 1, 2025, NYS MMC plans are required to reimburse credentialed, in-network “Homeless Healthcare Providers” for primary care services provided to an enrollee experiencing homelessness, regardless of whether the provider is the assigned primary care provider (PCP). The MMC plan must reimburse such services at the contracted PCP rates.

“Homeless Healthcare Provider” includes any licensed medical or dental provider who conducts patient visits with homeless individuals in a sheltered or unsheltered location. Medical providers who are not physicians must be supervised by a physician who is knowledgeable about healthcare for individuals experiencing homelessness.

Additional details are available in the Medicaid update here.

DFS Adopts Final Regulations on Behavioral Health Network Adequacy and Access
On February 19^th, the NYS Department of Financial Services (DFS) adopted final regulations that establish network adequacy standards for behavioral health services for regulated commercial insurance plans. The Fiscal Year 2023-24 Enacted Budget required the DOH, in consultation with DFS, OMH, and the Office of Addiction Services and Supports (OASAS) to develop regulations by the end of last year on this topic. DOH has issued identical network adequacy proposed regulations, which are applicable to MMC plans.

The regulations, effective July 1^st, require commercial insurance plans to ensure that its network has adequate capacity and availability to offer behavioral health service appointments within specified timeframes (i.e., within 10 business days for initial outpatient visits, and within 7 calendar days following a hospital discharge or emergency room visit). If the plan is not able to locate a participating provider within the required timeframes, the plan must allow the member to receive services from an out-of-network provider and may not impose additional cost-sharing.

The regulations allow plans to meet appointment wait time requirements using telehealth, unless the patient specifically request an in-person appointment. The regulations also include provider directory requirements, reporting requirements, and additional plan responsibilities regarding network adequacy and access.

The regulations are available here.