April 3, 2025

OMH Announcement:  RFP

Dear Colleagues,

The New York State Office of Mental Health (OMH) announces the availability of funds, through a competitive Request for Proposal (RFP) process, for developing six (6) new Home Based Crisis Intervention (HBCI) programs that will solely serve those dually diagnosed with mental health and intellectual or developmental disabilities. The goal of the funding is to support a statewide effort to strengthen children’s mental health and crisis resources.

HBCI is a community-based, short term, intensive crisis program designed to avert psychiatric hospitalizations and placements for youth ages 5 years to 20 years 11 months experiencing an acute mental health crisis.

Applicants should have demonstrated expertise working in the community with intellectually and developmentally delayed children and youth experiencing a mental health crisis.

The awardees will help ensure that children and youth in acute mental health crisis can remain safe at home, avoid an unnecessary psychiatric hospitalizations or residential treatment, and that they and their families can learn strategies for ongoing stability.

The Requests for Proposal (RFP’s) can be accessed on the NYSOMH website under Procurement Opportunities at https://omh.ny.gov/omhweb/rfp/2025/hbci_mh-idd/index.html

All applications must be completed in and submitted through SFS, Statewide Financial System.

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State Budget 

Emergency Budget Appropriation Extender Bill #2 Introduced

Today, the Senate and Assembly introduced a second Emergency Budget Appropriation Extender bill (S7156, Krueger/ A7635, Pretlow) with a Message of Necessity from the Governor to provide for an emergency appropriation of funding through April 7th, as final state budget negotiations continue.

Both houses passed the extender bill today and sent it to the Governor for approval.  State Legislators will return to their districts for the weekend, as negotiations continue between the Governor and Legislative Leaders and between Executive and Legislative staff in an effort to reach agreement on outstanding issues for a final budget.  

More updates to follow.

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See the attached document for a useful infographic from SCAA depicting the state budget making process, and where we are currently on the road to enacting a new budget for SFY26.

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Please take a moment to weigh in on behalf of New York’s children, youth and families.  The NYS Council has been working with the HealthyMinds, Health Kids Campaign for the past 3 years, with the goal of increasing rates for OASAS and OMH providers serving children youth and families in children’s outpatient services, and specifically, for outpatient clinics, HCBS and CFTSS services.  

Use this link to weigh in today:  

https://healthymindshealthykids.org/take-action/

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PROTECTING MEDICAID

It’s a Cut to Medicaid No Matter What You Call It

By Suzanne Wikle

Republicans in Congress have proposed enormous cuts to Medicaid, which provides insurance to more than 70 million people—or 1 in 5 Americans. One way they plan to cut Medicaid is by increasing red tape and limiting eligibility under the false guise of “work requirements.” This proposal will cause people to lose their health care.

>> View the infographic here

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Reminder: Last week we shared this link:   https://medicaidmattersny.org/federal-issues/  that connects you to the Medicaid Matters NY Website where you can download and use the 26 Fact Sheets created for advocates that tell the story about the importance of Medicaid and the penetration of Medicaid in local communities across the state, etc.   https://medicaidmattersny.org/federal-issues/    Lawmakers in Washington are returning to their districts beginning Friday the 11th through Sunday the 27th of April.  Go get ’em!

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FEDERAL BUDGET 

Budget Reconciliation Update: Senate and House Republicans Set to “Kick the Can” on Medicaid Spending Cuts

The concurrent resolution likely to be considered as soon as tomorrow punts the key decision on the scope of Medicaid cuts – whether to move forward with an $880 billion target that would force termination of Medicaid coverage and benefits for people across the nation or a more moderate cut preferred by Senators.

April 02, 2025

Editors: Patti Boozang, Katie Rubinger and Amanda Eisenberg
Author: Nick Bath, Manatt Health Solutions, 4/3/25

• To unlock the next step in the budget reconciliation process, House and Senate Republicans are close to agreeing on a budget resolution. However, their “agreement” will essentially enable the stalemate to continue until final reconciliation legislation is drafted.
• The budget resolution posted Wednesday preserves the requirement that the House Energy & Commerce (E&C) Committee make big spending cuts (including to Medicaid) but requires much more modest cuts from Senate committees.
• The resolution may be voted on by the Senate Thursday or Friday night. After that, the process will likely unfold with each chamber passing very different reconciliation bills within the guardrails set out in the budget resolution.
• This sets up a scenario where the hard decisions on Medicaid cuts are punted until the end of the budget reconciliation process, continuing to put Medicaid program funding and benefits at risk.

Quick recap on budget reconciliation process

As our Manatt Health colleagues Jocelyn Guyer, Avi Herring and Katie Rubinger wrote in Medicaid Madness: What States and Providers Need to Know About Budget Reconciliation, Congressional Republicans are using the budget reconciliation process to enact the president’s top legislative priorities. The major advantage of the budget reconciliation process is that it can be used to pass legislation in the Senate on a 51-vote majority, rather than requiring the 60 votes that virtually everything else needs to surmount a filibuster. It is tempting to ignore the zigs and zags of the reconciliation process, but it will dictate the future of Medicaid. Here’s where things stand.

What’s happening in the budget reconciliation process this week?

To unlock the next step in the path to budget reconciliation, both chambers need to pass an identical budget resolution. House and Senate Republicans appear to have agreed on a budget resolution, which may be voted on by the Senate Thursday or Friday night. Up to this point, the two chambers disagreed strongly on the level of spending cuts that the budget resolution would require of the (subsequent) budget reconciliation bill; there has always been basic agreement on the spending (or more precisely, revenue loss) side of the ledger — extension of the Trump tax cuts for 10 years at a cost of roughly $4 trillion. 

House fiscal hawks want deep spending cuts to offset (but not come close to fully paying for) those tax cuts – the most controversial of which were $880 billion in cuts over the next 10 years from the jurisdiction of the Energy and Commerce Committee, which oversees Medicaid. Most observers including CBO agree that that majority of those cuts would have to come out of the Medicaid program. Senate Republicans and some moderate House Republicans have serious concerns about the substantive and political consequences of cutting the Medicaid program at that unprecedented level.

The budget resolution posted Wednesday would simply kick the can on this disagreement. It will preserve the requirement that House Committees make big spending cuts, including cuts to Medicaid, but require much more modest cuts from the Senate. This creates the improbable situation of each chamber passing very different reconciliation bills in order to remain within the guardrails set out for each chamber’s committees in the budget resolution. But, in the final analysis, the President can only sign one bill.

Who decides whether the House or Senate approach prevails? And when?

In fact, this hard decision can be postponed to the last possible minute. Assuming the budget resolution passes both chambers, the House can then draft and pass a reconciliation bill that makes the deep cuts that the budget resolution requires.  The Senate can then take up the House bill and strike and replace it with its own, more modest, spending cuts (in fact, this is exactly what the Senate did in 2017 during the ACA repeal and replace debate).

“Decision time” will arrive when the Senate passes its version and sends it back to the House for final passage and delivery to the President’s desk. Speaker Johnson will then have to make the key call – does he try to “roll” his hard liners and put the unchanged Senate bill up for a vote? Or does he bow to the fiscal hawks, amend the Senate bill with deeper cuts, and send it back? We would be lying if we said we could predict a result.

The Bottom Line

Congress is poised to move to the next step in the budget reconciliation process, and the bullseye on federal Medicaid funding is still a key savings generator. That means that all of the proposals we’ve been talking about to cut Medicaid, and the related consequences they carry are very much on the table and could further advance as the House and Senate committees continue their work to draft reconciliation legislation.

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FEDERAL HEALTHCARE: INNOVATION CENTER CHANGES

CMS Shakes Up the Innovation Center Model Landscape: What Comes Next?

March 27, 2025, HMA

This week, our In Focus section focuses on a March 12, 2025, announcement from the Centers for Medicare & Medicaid Services (CMS) regarding CMS Innovation Center programs under the new Administration. After reviewing the Innovation Center’s model portfolio, CMS has elected to discontinue four models ahead of their original end dates: Maryland Total Cost of Care (TCOC), Primary Care First (PCF), End-Stage Renal Disease (ESRD) Treatment Choices (ETC), and Making Care Primary (MCP). The agency also intends to downsize the Integrated Care for Kids Model (InCK) and forgo the launch of two drug pricing initiatives. According to the announcement, CMS appears to be moving forward with other Innovation Center models, but signaled upcoming modifications to models to align with Administration priorities as well as new model announcements.

The following is a discussion of CMS’s announcement and what it may signal about the agency’s commitment to value-based care, key takeaways regarding the four terminated models, and how stakeholders should be preparing to engage with the Innovation Center on current or future models while we await additional details.

CMS’s Strategic Decision

As part of CMS’s recent announcement about the model terminations, the agency reaffirmed its support for testing models that reduce program spending while maintaining or improving quality of care. Furthermore, the Innovation Center “plans to announce a new strategy based on guiding principles to make Americans healthier by preventing disease through evidence-based practices, empowering people with information to make better decisions, and driving choice and competition.” These statements should be seen as a commitment to using the Innovation Center to test new approaches to delivering care but with an expectation that the models will need to demonstrate significant cost and quality improvements as outlined in its statutory authority. According to CMS, the cancellation of these models is projected to save an estimated $750 million.

Because CMS said it may modify additional models in the future, it is reasonable to expect those changes will focus on achieving a higher level of savings or to see savings earlier in the demonstration, as well as aligning model design with the priorities of this Administration. The potential modifications could have an impact on the number of model participants, length of model testing, and financial arrangements, especially with regard to risk and quality improvement approaches.

Models Ending

CMS Innovation Center models are time-limited pilots meant to help the agency test which types of interventions lead to cost savings and improved quality and, if successful, can be scaled on a nationwide basis. These models are evaluated regularly, and CMS has the authority to modify or terminate models if they fall short of the statutory criteria.

The four models the agency plans to terminate are ending for various reasons (e.g., underwhelming performance, forthcoming replacement by successor model, etc.) and, as stated above, the decision should not be seen as a retreat from value-based care, but rather as a signal regarding Administration priorities for Innovation Center models. For example, despite terminating PCF and MCP prior to their original end dates, CMS reaffirmed its support for primary care as a “foundational component of the Center’s strategy” and that future primary care payment reforms will focus on approaches that produce savings. CMS also noted that ending these models early offers an opportunity to move beneficiaries into more permanent programs, such as the Medicare Shared Savings Program (MSSP)—CMS’ flagship accountable care initiative—even going so far as to direct readers to the MSSP’s calendar year 2026 application.

CMS plans to advise current model participants of other options for advanced primary care payment before the models conclude by December 31, 2025. Table 1 presents information on the models scheduled for early termination.

Table 1: Models Ending by December 31, 2025

In addition, the agency is considering options to reduce the size of the InCK model and will no longer pursue the Medicare Two Dollar Drug List and Accelerating Clinical Evidence models. The latter two initiatives were included in a Biden Executive Order on drug pricing and were not implemented. Notably, CMS did not end another drug pricing Innovation Center model, Cell and Gene Therapy Access (CGT) Model.

Innovation Center’s New Strategic Plan

CMS also announced that it will soon release its new vision for the Innovation Center, based on principles designed to improve Americans’ health through evidence-based practices, empower individuals with decision-making information, and drive competition.

This vision will set the direction for future value-based care initiatives and reflect the leadership changes within CMS, including the anticipated confirmation of Mehmet Oz, MD, as CMS Administrator and the appointment of Abe Sutton, as the new Director of the Innovation Center. Mr. Sutton’s experience with value-based care—especially during his time as an advisor to then Department of Health and Services Secretary Alex Azar under the first Trump Administration and his subsequent private sector leadership of value-based companies—positions him to play a key role in shaping CMS’s future efforts.

Stakeholder Considerations

Stakeholders have several critical operational decisions and strategic considerations to address, including:

• Transition Support. Participants in the models scheduled to end must assess their options for sustaining certain components of the payment models without Innovation Center support. This effort will require strategic, operational, and financial analyses to make informed decisions.
• Evaluation of Other Programs. While the Innovation Center has signaled its intentions of announcing new models, participants should not wait to evaluate options. The Administration plans to prioritize permanent payment programs and will continue to support the MSSP as CMS’s permanent model for accountable care organizations (ACOs). Stakeholders interested in participating in the MSSP in 2026 must act quickly to assess their organizational readiness, conduct financial modeling of their potential benchmark and performance, evaluate potential partners, and prepare for the application process. Both existing and new ACOs should be exploring their strategies and infrastructures to optimize performance.
• Adapting to Changes in Existing Models. While CMS discontinued select models, it is likely the agency will make additional changes to the Center’s continuing models. These revisions likely will reflect President Trump’s executive actions and policy priorities. With the increased focus on cost savings, CMS may choose to spend fewer resources on model implementation, including participant support and model engagement.
• Policy and Market Intelligence. Monitoring the dynamic federal policy landscape and seeking strategic advisory support can help stakeholders navigate and inform potential future federal and state alternative payment model opportunities. Stakeholders should expect that existing and potential new models may have stricter requirements and higher expectations for financial risk. Providers, states, insurers, and other interested stakeholders should monitor public and private sector developments to understand the landscape and evolving opportunities.

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From the National Council: