November 11, 2025

First a huge AND HEARTFELT THANK YOU FOR YOUR SERVICE to any veteran, spouse of a veteran, loved one of a veteran – today and every day.  The NYS Council is so proud to represent our members who serve veterans and their families.  We are grateful for you and yours every day. 

Onward….

A city-funded initiative to improve access to buprenorphine treatment is broadening its scope.

The New York City Department of Health and Mental Hygiene will partner with primary care clinics to address the health needs of people with various substance use disorders, building on a successful buprenorphine nurse care manager initiative that dates back to 2016.

The initiative added 116 new buprenorphine providers and enrolled more than 1,200 patients between 2016 and 2020, according to a paper in the American Journal of Public Health.

Its team-based model is centered around a nurse care manager who offers structured clinical support and helps primary care providers screen and assess patients.

With the expansion, the city will harness that model to increase the capacity of primary care providers in safety-net clinics to treat opioid, tobacco and alcohol use disorders through medications — which tend to be underutilized, stigmatized and inaccessible.

Participating providers will also focus on addressing other health issues associated with injecting drugs, from HIV and hepatitis C to wounds and skin infections, to improve patients’ overall wellbeing.

Up to eight primary care contractors will receive city funding to stand up the collaborative care model, according to a request for proposals issued Monday.

—————-

Federal Funding Deal in the making: Yesterday, the Senate passed a new Continuing Resolution (CR) to reopen the government, combined with a three-bill “minibus” of full-year appropriations bills to fund specific agencies. This new CR expires at the end of January.  As expected based on the procedural vote on Sunday, eight Democrats voted for the bill in order to reach 60 votes needed for passage. This package did not include any extension of the ACA premium tax credits, which has created massive controversy between the Democrats and some outright calls (as expected) for Minority Leader Chuck Schumer to step down from his leadership role. 

The next step for the package is for the House to pass the bills.  House Members will be back in town tomorrow after 53 days without convening.  When asked specifically about a vote on ACA premium extensions in the House before the end of the year (and the expiration of the credits) House Leader Mike Johnson told reporters that he can not and will not guarantee the disposition of any pending legislation before the House, including legislation to extend the premium tax credits.  Senate Majority Leader John Thune had already made a commitment to hold a vote on the matter in the Senate before the end of the year.  So, the next big drama our country will face is whether or not the House Leader will permit a vote on the matter before the tax credits expire.  

Following the passage of a CR and reopening of government, Democrats are likely to start negotiations (in the Senate, anyway) over the ACA tax credits. As stated previously the House hasn’t yet committed to a vote but Leader Thune has said he’ll call a vote on an ACA bill before the end of December.  Keep in mind that the ACA enhanced premium tax credits have disproportionately benefited Republican states and districts, so they have the most to lose from failure to extend the policy. Whether advocates can create enough pressure to force Republicans to a vote will depend a LOT on how much advocacy and activity there is in their districts.  Those constituents are key to winning this ACA fight, so organizers will have to stretch our reach into the key constituencies that most influence the Republican targets.  

A few cautions: Republicans may have their own ideas about what to include to tweak the ACA tax credits. Some bipartisan “problem solvers” (for instance) want improvements and accountability for brokers, and more safeguards against people gaming the system. Others want expanded “Health Savings Accounts” (HSAs), and further restrictions on eligibility for tax credits (phased-out income levels, etc.)  Minority Leader Jeffries suggested yesterday that Democrats may file and support a discharge petition to force a vote on extending tax credits but it’s not clear how viable this approach is given the December 31 expiration date.

Read more at Punchbowl, New York Times, The Hill, Washington Post

And about Senate Minority Leader Chuck Schumer:  According to many federal policy experts, although Schumer told rallying crowds that he was going to fight and stand firm, ultimately he did not.  His ‘no ‘ vote on the package yesterday was largely seen as symbolic.  And according to these same policy wonks, there are three big problems with his approach:

• • Rallying your own crowds is not the same as governing a country when in the minority. It was a significant challenge that Schumer did not recognize that Democrats did not in fact have enough power in the right places to move the Republicans. Given that the Republicans have been trouncing the Dems since January, their power analysis should have been a bit more sophisticated. It seems pretty clear that no amount of protesting in blue states and districts moves Trump or the GOP.

• • Schumer had no Plan B or exit strategy. He underestimated the opposition, but also had no contingency beyond keeping the government closed indefinitely. Yet the longer the government stays shut down, the more Democrats face diminishing returns as more and more people are directly impacted –and importantly– hurt by the shutdown. That includes many of the Democrats’ own voters like public employees, SNAP recipients, low-income families, etc. These groups care less about the inside baseball of Dems vs. Republicans than they do the government doing their job.

• • Although polls seem to suggest that the public would blame Republicans more than Democrats for the shutdown right now, that margin of difference is not huge and ultimately, may not matter much in the midterm elections. Remember the last shutdown? Polls showed the public blaming Trump but that didn’t impede his re-election a few years later. Voters have a short memory. And, although elevating ACA costs was a good tactic, that message ultimately hasn’t broken though in the same way as SNAP cuts or even airport delays because there’s not much message control across the liberal groups. The largest public mobilization of the last month (No Kings II), for instance, actually had no concrete demand that referenced healthcare or affordability.

I note that MoveOn and Indivisible as well as many other national advocacy groups oppose the deal to reopen the government which may make it difficult to engage their members in lobbying for a better healthcare deal.  C3 nonpartisan groups, however, are focused on the issues while the partisan groups focus on “accountability” vis-à-vis defector Democrats and Schumer. Indivisible in fact launched a primary program Monday and is making opposing Schumer for leader a criteria for candidate endorsement. How significant a breach this government shutdown has created is unclear at this point, but it certainly seems to reflect the growing discontent among factions of the Democratic party who are seeking new direction in their party and exposes some of the cleavages that have led to reduced political power over the last few years. 

About the package passed in the Senate yesterday: Most federal agencies will be funded at current spending levels through the end of January, and this includes HHS.  However, the Department of Veterans Affairs (VA), military construction projects, and the legislative branch would be funded through September 30, 2026.  

Notably, the full-year funding package covers the Supplemental Nutrition Assistance Program (SNAP).  Without getting into the weeds, this should insulate the program from this kind of weaponization should the government shut down again before September 30. 

Here is more from Becker’s Hospital News on the funding bills and the CR:

1. The Nov. 8 60-40 procedural vote sets up a vote later this week on a spending passage that would fund the Department of Agriculture, Food and Drug Administration and Department of Veterans Affairs through the full fiscal year. All other departments, including HHS, would be funded through the end of January. 

2. The spending agreement would allow the Senate to vote in December on legislation extending the enhanced ACA subsidies set to expire at the end of 2025. It would also deliver back pay to federal employees and reverse layoffs of federal workers made during the shutdown.  

3. Senate Majority Leader Nick Thune said it “remains to be seen” how quickly a final vote is reached on the spending bill, according to the report. The agreement also needs to pass the House before the government is reopened. House Minority Leader Hakeem Jeffries said that the chamber’s Democratic leadership will not support any legislation that fails to extend the enhanced ACA subsidies. 

4. The agreement would likely reimburse healthcare providers for Medicare telehealth visits that haven’t been paid during the stoppage, InsideHealthPolicy reported Nov. 10. Telehealth claims would be paid retroactive to Oct. 1, and claims reimbursed at a lower rate because of geographic rule changes would likely be reprocessed.

5. The deal would also fund the Supplemental Nutrition Assistance Program through fiscal 2026, CNN reported Nov. 10. SNAP benefits expired Nov. 1 and have been subject to a legal fight regarding short-term funding. On Nov. 9, a federal appeals court denied the Trump administration’s bid to avoid fully funding the program through November, The Wall Street Journal reported Nov. 10. The ruling means the government will have to make the payments within 48 hours unless the Supreme Court intervenes. Amid funding uncertainty for the program, many health systems have pledged donations to local food banks.

And here is more specific information from Modern Healthcare re: what’s in the deal for healthcare providers:   

Would be funded through Jan. 30, 2026:

• • Funding for community health centers, the National Health Service Corps, and teaching health centers that educate graduate medical students
  • Telehealth flexibilities in Medicare allowing doctors to bill for remote services
  • The Acute Hospital-at-Home initiative allowing Medicare to reimburse for such services

Additional measures that will last until Jan. 30.:

• • Medicaid disproportionate share hospital payment cuts enacted under the ACA are delayed. Remaining cuts for fiscal years 2026 through 2028 will remain on the books, worth $8 billion a year.
  • Increased inpatient payments for Medicare low-volume hospitals resume.
  • Medicare-dependent hospital payments resume.
  • The work geographic index floor boosting Medicare physician pay resumes.
  • Add-on payments under Medicare for certain ground ambulances resume.
  • Funding for implementation of the No Suprises Act is resumed and boosted by $14 million.
  • Funding is restored to the Centers for Medicare and Medicaid Services for its quality measures program and to hire a contractor to carry out related work.
  • Pending payment reductions to the clinical laboratory fee schedule are delayed. The reductions were enacted under the Protecting Access to Medicare Act.
  • Funding for Medicare hospice surveys under the IMPACT Act of 2014 is resumed.

———-

RURAL HEALTH TRANSFORMATION PROGRAM

Note:  Last week NYS filed an application for funds through the new Rural Health Transformation Program. The application seeks $200M/year for five years.  NY’s application focused on 4 core areas for project development (below).

It should be noted that the NYS Council prepared and submitted substantial recommendations to the state seeking development of several programs that focus on increasing access to MH and SUD care, expanding our rural workforce, and creation of an eConsult Program between FQHCs and BH providers.  Attached please find the recommendations we submitted to NYS.  Note that the list below outlining the 4 areas of focus in NY’s application matches the project themes in NY’s application:  
NY’s application focused on the 4 areas discussed (below):

— Create rural health partnerships: The state laid out plans to establish partnerships between rural hospitals and other health care organizations to create a hub of medical and social services in areas where access is limited.  

— Improve access to primary care: The state aims to bolster access through use of artificial intelligence and a patient-centered medical care model that brings together a team of professionals to ensure continuity of treatment for a patient.

— Build a sustainable workforce: The application includes plans to use the money to strengthen workforce development and the hiring pipeline.

— Bolster technology infrastructure: Rural providers cite gaps in technology as a barrier to access for patients. The state is looking to close those gaps through investments aimed at improving telehealth networks and strengthening cybersecurity in rural facilities.