November 18, 2024
On Friday I received the document (attached) from the OMIG along with a note requesting input/feedback re: the draft OMH Outpatient Clinic services audit protocol. I sent the draft to the members of the NYS Council Compliance committee for review and feedback. The next meeting of our Compliance Workgroup is December 6 from 10-11:30 via Zoom. We seek member feedback and will collect comments during this meeting. If you do not have a representative from your agency participating on the NYS Council Compliance Workgroup, we invite you to send a note to Cindy Levernois at: cindy@nyscouncil.org and request that you or your representative be added to our committee listserv. We will send your representative an invite to the 12/6 meeting.
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As we told you over the weekend, the Drug Enforcement Administration is set to once again extend a COVID-19 era rule that allows clinicians to remotely prescribe controlled medications, such as Adderall and Vicodin (and Buprenorphne).
The DEA is set to publish the rule tomorrow that will temporarily extend providers’ ability to remotely prescribe Schedule II-V controlled medications via telemedicine to new and existing patients through Dec. 31, 2025. Current flexibilities were set to expire at the end of this year.
On Friday, an unpublished version of the rule was released on the Federal Register. We sent that document to all members over the weekend.
In February 2023, the DEA released a proposed rule that would require an in-person visit for prescriptions of Schedule II substances like Vicodin, OxyContin, Adderall and Ritalin. Schedule III-V substances like codeine, Xanax and Ambien—as well as buprenorphine, a narcotic used to treat opioid addiction—would have only been prescribed over telehealth for an initial 30-day dose. After the 30 days, patients would need to see a doctor once to get a refill. The rule was widely criticized by the telehealth industry and the DEA said it received a record 38,000 comments.
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Last week we sent an article to everyone outlining some of the outstanding issues facing Congress before it adjourns for the year, to include whether or not to extend current Medicare telehealth flexibilities beyond the end of this year. Here in NY many of the telehealth flexibilities MH and SUD providers have been operating under since the beginning of the COVID-19 pandemic are set to expire in April 2025. This is a top priority for the NYS Council as we head into the next legislative session.
The incoming House and Senate will both be Republican led. The article below points to a potential bright spot for the future of telehealth in terms of incoming leadership in the Senate where the new Senate Majority Leader will be John Thune (R- South Dakota). Thune is apparently big on telehealth, rural hospitals, and increasing transparency for drug middlemen. Makes sense given the geography of his state. As the new Majority Leader, Thune will be in charge of coordinating the entire Republican policy agenda, and it’s not clear how health care will fit into the mix. However he represents a state that does not have much in the way of special interests in the healthcare industry beyond hospitals, doctors, and pharmacists. Let’s hope that’s a good thing.
A little (potential) good news is warranted right now so I thought I would share the article below.
STAT, 11/14
What the new Congress means for telehealth
As the Republican tilt of Congress for the next two years takes shape, so too do the prospects for important telehealth policy.
Here’s the good news for advocates: Newly elected Senate majority leader John Thune (R-S.D.) has a long history of supporting telehealth. As STAT’s John Wilkerson reports, Thune’s largely rural home state of South Dakota benefits from the expansion of virtual care services because people often live large distances from doctors.
In a key policy shift, lawmakers during the pandemic expanded the services people on Medicare could receive over telehealth. Those flexibilities are set to expire at the end of the year, and Thune supports making them permanent. There’s a bipartisan bill progressing through the House of Representatives that would extend the flexibilities for two years.
But the lame duck policy agenda is up in the air as lawmakers may choose to only pass a stopgap bill to fund the government into the next session. As John reports in another story on what to expect now that Republicans control both houses of Congress, it’s not clear what that would mean for extensions to expiring Medicare policies.
Sources in Washington over the last few months have told me this is one of the scenarios they feared might play out. By leaving telehealth extensions to the last second, the legislation was at risk of getting lost or modified in the lame duck shuffle. And this creates uncertainty for providers and Medicare enrollees who may be counting on telehealth access to services on Jan. 1 — 48 days from today.
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The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Center for Financing Reform Innovations (CFRI) will be hosting a webinar on Advancing Measurement-Based Care (MBC) in Behavioral Health, a clinical approach that tracks client progress through standardized assessments to inform treatment decisions. MBC has been shown to improve outcomes in mental health and substance use disorder treatment, but its adoption has been slow, largely due to financing challenges. This webinar will explore reimbursement options and potential solutions to help expand MBC use in community behavioral health settings. The session will feature a panel of experts from SAMHSA and national leaders in the behavioral health field, followed by a Q&A. (Article here)
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Rogers Behavioral Health, a national nonprofit provider of mental health and addiction services, is incorporating a third-party AI-based virtual assistant to navigate more patients to care.
Limbic Access is an AI-powered virtual assistant that streamlines patient intake and improves access to mental health and addiction care. The chatbot offers personalized, evidence-based assessments in under 30 minutes, providing a more efficient, stigma-free alternative to traditional intake methods. It screens patients for care pathways and integrates directly into Rogers’ electronic health records. Limbic Access has been shown to increase referral rates, reduce assessment times, and improve patient outcomes, including higher recovery rates. The tool is also equipped with safety features to flag crises and connect patients to support resources. (Article here)
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Our governor is very anxious’: States rush to secure Medicaid approvals before Trump’s inauguration
By: Rachel Bluth, Maya Kaufman, Kelly Hooper, Robert King | 11/17/2024, Politico
California Gov. Gavin Newsom was in Washington this past week, hoping to secure billions in Medicaid money before the clock runs out on the Biden administration.
He is not alone. State officials from New York to Hawaii are clamoring to have their requests approved before the Trump administration — which is certain to have a very different view of Medicaid spending — takes over.
Some are pushing for waivers that will affect their state budgets and bottom lines, but other pending requests are for programs that speak to Democrats’ ideologies on what constitutes health care. Many applications are to have Medicaid pay for social services, an innovation of the Biden administration that ties health to social well-being.
Hawaii and California, for example, want waivers to use federal money to help low-income people with rent; Pennsylvania and Rhode Island both want to use their Medicaid dollars to help with nutrition.
While Trump has yet to nominate an administrator for the Centers for Medicare and Medicaid Services, blue states are operating under the assumption that whoever takes on the role will favor smaller government spending, especially with the president-elect’s new focus on efficiency.
“There’s always the nagging concern,” said Judy Mohr Peterson, Hawaii’s Medicaid director, who was in Washington last week for a fall conference of Medicaid agency staffers. “Our governor is very anxious also to get this through — addressing homelessness is one of his top priorities, so he’s asking me a lot — when are you going to get this done?”
CMS does not discuss pending waiver requests.
California has five waivers awaiting approval from Washington, but Newsom’s trip focused mostly on behavioral health and updates to the state’s tax on managed care organizations (the MCO tax) — a levy on some health care plans used to draw down more federal dollars.
Though California’s MCO tax is approved through 2026, state lawmakers updated it in the last year to squeeze even more money out of CMS. Those changes are still pending, and Newsom needs them to go through: he already counted on that money for last year’s state budget.
“California is working closely with the White House over the next two months to deliver the critical protections and resources our communities need,” Newsom said in a statement.
New York Gov. Kathy Hochul said her administration is working with CMS to receive approval in the coming weeks of its own MCO tax, modeled after California’s. The state’s goal is to secure billions of dollars in additional federal revenue for higher Medicaid reimbursement rates for hospitals and other health care providers, following a temporary, state-supported hike approved in the spring.
“These are issues that we’ve been working on for months with the administration,” Hochul said during a press conference earlier this month. “They know we have a timetable. We know we have a timetable to get them done.”
The concept of an MCO tax is widely viewed as a temporary gimmick, given its reliance on an obscure loophole that CMS said it plans to close. That puts the federal agency in a bind because officials know how important it is for New York’s Medicaid budget, said one person familiar with the state’s request who was granted anonymity to speak candidly about the negotiations.
“With the election … it’s either now or never, because there’s no way a Trump administration would approve it,” the person said.
While there is generally anxiety among state officials about pending waivers whenever a national administration turns over, there’s heightened stress about the new Trump team in particular, especially given how Trump’s last administration tried to rein in Medicaid.
New York is awaiting approval of a significant eligibility expansion for its Medicaid program for working people with disabilities. California has a request that was submitted over a year ago to explicitly protect the state’s reproductive health infrastructure from funding cuts by a hostile federal administration.
“They think they’re all really critical. We know there will be attacks on Medicaid generally,” said Kim Lewis, a Los Angeles-based attorney with the National Health Law Program, a legal nonprofit that often litigates Medicaid issues. “We know they may be rolling back policies on what they think Medicaid should pay for.”
While in Washington, Newsom pushed for the approval of California’s “BH Connect” waiver, a mental health funding stream meant to bolster the state’s infrastructure outside of institutionalized settings, so there are enough treatment options at varying levels of intensity.
Hawaii is seeking a five-year extension for one of its Medicaid waivers, including new expansions of pre-release coverage for incarcerated people, nutrition supports, and “continuous coverage” for young children, so they don’t fall off the Medicaid rolls for bureaucratic reasons. The state’s target date for approval is just before the presidential transition in January, according to Peterson.
She added that she is working very closely with CMS to get the extension approved in time.
“Quite frankly, I don’t know what the new administration’s [priorities are], whether those are the same or not,” she said. “There’s a lot of unknowns.”
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New Congress brings churn in health policy leadership
House Energy and Commerce, Senate Finance, to see dramatic shifts in health policy players
Congress’ most influential health panels will see dramatic changes next year, with several advocates on specific issues like mental health, Medicare and drug pricing retiring or losing their reelection bids.
The biggest changes will be in store at the House Energy and Commerce Committee, whose wide-ranging jurisdiction includes health insurance, biomedical research, and drug and device safety.
Five of the 12 Democrats on the Health Subcommittee will not be returning: Ranking member Anna G. Eshoo of California and Reps. John Sarbanes of Maryland, Tony Cárdenas of California and Ann McLane Kuster of New Hampshire did not seek reelection this year. And Rep. Lisa Blunt Rochester of Delaware was elected to the Senate.
Eshoo was active in Democrats’ efforts to negotiate the price of some prescription drugs under Medicare and has pushed for increasing biomedical research and expanding access to health insurance. Cárdenas has been a proponent of the three-digit 988 suicide hotline and helped found the Bipartisan House 988 and Crisis Services Task Force.
Republicans will see at least four fewer familiar faces: Former Health Subcommittee Chair Michael C. Burgess of Texas and Larry Bucshon and Greg Pence of Indiana will retire at the end of this year. Full Committee Chair Cathy McMorris Rodgers, R-Wash., is also retiring. Iowa Rep. Mariannette Miller-Meeks’ race has not yet been called, though she currently holds a narrow lead.
Rodgers has led the committee on oversight of the Centers for Disease Control and Prevention, and she unveiled a framework to overhaul the National Institutes of Health with Labor-HHS-Education Appropriations Subcommittee Chair Robert B. Aderholt, R-Ala., earlier this year.
She’s been an advocate on disability rights issues and a co-chair of the Congressional Task Force on Down Syndrome.
Bucshon, who worked closely on Medicare reimbursement issues, penned a 2023 organ transplant law and portions of the 2016 opioid law related to expanding access to medication-assisted treatment. His efforts to reform diagnostic lab tests and replace the 2010 health care law with a Republican alternative fell short.
The number of spots open for either party on the panel next will depend on the outcome of the remaining House elections.
The Education and the Workforce Committee, meanwhile, will be under new leadership after Virginia Foxx, R-N.C., announced she would not seek another term as chairwoman earlier this year.
The committee is responsible for health benefits under the Employee Retirement Income Security Act and some programs housed under the Administration for Children and Families, such as Head Start, the Child Care and Development Block Grant and the Temporary Assistance for Needy Families program.
The Education and the Workforce Subcommittee on Health, Employment, Labor and Pensions will lose its chair, Bob Good, R-Va., who lost his primary; Jim Banks, R-Ind., who was elected to the Senate; Susan Wild, D-Pa., who lost reelection; and Kathy Manning, D-N.C., who is retiring.
Reps. Michelle Steel, R-Calif., and Lori Chavez-DeRemer, R-Ore., are in races that are still too close to call, according to The Associated Press.
Senate
The Senate Finance Committee, which has jurisdiction over Medicare and Medicaid, parts of the Administration for Children and Families and the Office of Inspector General, will see big changes to its Democratic membership.
Six of its 14 members will not be returning: Sens. Debbie Stabenow of Michigan, Benjamin L. Cardin of Maryland and Thomas R. Carper of Delaware are retiring. Sens. Sherrod Brown of Ohio and Bob Casey of Pennsylvania lost their reelection bids. And Sen. George S. Helmy, D-N.J., who was appointed to replace former Sen. Bob Menendez, will also not return.
Stabenow, along with former Sen. Roy Blunt, R-Mo., have pushed for the expansion of Certified Community Behavioral Health Clinics.
No Republicans are slated to leave the committee, but it’s unclear whether Sen. John Thune, R-S.D. will remain on the committee now that Republicans have elected him Senate majority leader.
The Finance Committee will also be charged with the task of renewing and expanding the Trump-era tax law under a likely Chairman Michael D. Crapo, R-Idaho.
The Senate Health, Education, Labor and Pensions Committee will lose Republicans Mike Braun of Indiana — who was elected governor — and retiring Sen. Mitt Romney of Utah, as well as Democrat Casey.
Policy gaps
In the wake of the departures, it’s unclear who will carry the torch next on some key issues.
Rep. Barbara Lee, D-Calif., is retiring after losing the Senate primary to replace the late Sen. Dianne Feinstein. Lee is the ranking member on the State, Foreign Operations, and Related Programs Appropriations Subcommittee, whose purview includes funding global health issues. She was a key player in the creation of the President’s Emergency Plan for AIDS Relief, parts of which are up for reauthorization next year. She is also a longtime co-chair of the Pro-Choice Caucus.
The GOP Doctors Caucus will lose half of its leadership with co-chairs Burgess and Select Subcommittee on the Coronavirus Pandemic Chairman Brad Wenstrup, R-Ohio, retiring. Bucshon is also a member.
The 11-term Burgess also chairs the House Budget Committee’s health task force. He has shaped a number of issues related to Medicare physician payments including spearheading the Medicare Access and CHIP Reauthorization Act of 2015.
But the House will have at least two new Republican doctors — Reps.-elect Bob Onder of Missouri and Mike Kennedy of Utah.
The Bipartisan Mental Health and Substance Use Disorder Task Force will lose both of its Democratic co-chairs, Kuster as well as Rep. David Trone of Maryland. Trone lost the Maryland Senate Democratic primary earlier this year. The Task Force was formed in 2021 with the merging of the Bipartisan Opioid Task Force — established in 2015 by Kuster and then-Rep. Frank Guinta, R-N.H. — and the Freshmen Working Group on Addiction, which was created in 2019 by Trone.
With Rep. Earl Blumenauer, D-Ore., a member of the Ways and Means Health Subcommittee, retiring, Congress will lose its leading advocate for cannabis legalization. Blumenauer founded the Congressional Cannabis Caucus and pushed for the enactment of his bill that expanded research on medical marijuana. His successor, Rep.-elect Maxine Dexter, also a Democrat, however, also has medical expertise: She’s a pulmonologist.