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Congressional Updates
SUPPORT Act Update
Before recessing for the holidays last month, the full House and the Senate Health, Education, Labor and Pensions Committee passed their respective versions of the Support for Patients and Communities Reauthorization Act (HR 4531/S 3393), which would renew the SUPPORT Act. Passed in 2018 with strong bipartisan backing, the SUPPORT Act was an effort to combat the opioid epidemic. The next move is in the Senate, where the full chamber must pass the bill, after which it will likely head to conference committee for reconciliation.
Key provisions include:
House (HR 4531):
- Extends grants for opioid recovery centers for five years.
- Permits states to use federal funds for test strips.
- Makes xylazine a Schedule III controlled substance for three years.
- Requires Medicaid to cover medication assisted treatment for opioid use disorder.
- Makes permanent Medicaid coverage for short-term treatment of substance use disorder in mental health hospitals.
- Permits pregnant people in pretrial detention to keep Medicaid coverage.
- Prohibits states from disenrolling incarcerated people from Medicaid (can suspend but not terminate).
Senate (S 3393):
- Provides a 70% increase in funding to train behavioral health professionals.
- Provides a 24% increase for student loan forgiveness to counselors who agree to practice in underserved areas.
- Directs the FDA to review clinical methodology for approving new opioids.
- Requires the HHS to study how states screen people to provide peer supports for people with opioid use disorder.
Administration Updates
Spending Extension on ARPA ESSER Funds Now Available
The letter describes the process for states and districts to request an extension of the deadline for spending funds as part of the American Rescue Plan Act Elementary and Secondary School Emergency Relief (ARPA ESSER).
Currently, states and districts must obligate all ARPA ESSER funds by Sept.30, 2024, and spend the funds by January 2025. States or districts can request a 14-month extension of the spending deadline from the department.
The process for late liquidation requests for ARPA ESSER funds will be the same as that for the earlier sets of ESSER funds under the Coronavirus Aid, Relief and Economic Security Act, and the Coronavirus Response and Relief Supplemental Appropriations Act. States can submit requests for districts in a single application and must include an explanation of how the request contributes to the acceleration of student academic success. Requests should be submitted to the department by Dec. 31, 2024. Read more.
Department of Education Issues Letter on Maintenance of Effort Requirements
States must submit waiver requests by March 15 for the fiscal year 2023 maintenance of effort (MOE) provisions for K-12 and higher education funds under the American Rescue Plan Act. Unlike past MOE provisions, ARPA requires states to spend the same share of their total budget on K-12 and higher education separately as they had in the three fiscal years prior to the pandemic.
Based on interim FY 2023 data provided by states, the department notes that 33 states are on track to meet MOE requirements for elementary and secondary education, and 41 states are on track to do so for higher education. All states met MOE requirements in FY 2022, including states that submitted waiver requests. Read more.
Enhanced Federal Funding for State Direct Care Registries
The Center for Medicaid and CHIP Services (CMCS) reminded states in December of the availability of enhanced federal matching funds for costs associated with worker registries (90%/10% federal/state match for design, development and implementation and a 75%/25% match for ongoing operations). The CMCS considers the registries an important strategy available to states for connecting workers and participants with provider agencies and to connect people self-directing their home- and community-based services with qualified staff.
The CMCS provides states with considerable flexibility in standing up worker registries—federal approval is not needed and states choose the workers to be included: home care workers, home care attendants, home health aides, personal care attendants, direct support workers, direct care workers, direct support professionals, etc. It is also up to states to determine which workers are not eligible for the registry—such as someone with a particular criminal background and individuals who don’t meet the state’s minimum education and training requirements. Registries vary in structure and purpose across states and may be used for worker recruitment, background checks, verification of worker qualifications, health insurance and training. Read more.
Trusted Exchange Framework and Common Agreement Goes Live
The initiative, known as TEFCA, launched last month with just five organizations known as “qualified health information networks,” or “QHINs.” The hope is that providers across the country will opt to join the exchange to realize the goal of universal interoperability—the connection of the nation’s various medical data-sharing networks. Two more networks were close to being onboarded at launch time. Once a network is connected, electronic health records can flow seamlessly, enabling patients to securely access their medical records from anywhere.
Beyond the initial focus on treatment and individual access services (two of six stated purposes of the exchange), TEFCA may also be used for public health and government benefits determination. Public health agencies may opt to join TEFCA by connecting with an appropriate QHIN and begin sharing and receiving data that may, among other benefits, enhance public health analysis of state prevention and mitigation measures. Medicaid providers and managed care organizations would also have the option to join the exchange, which will permit states to leverage their existing information exchanges. As part of its strategy to advance interoperable public health data, the Centers for Disease Control and Prevention plans to launch at least two public health pilots by the end of the year.
More detailed information on TEFCA can be found here and information on the potential benefits of TEFCA to state governments may be found here.
FDA Approves First State Request to Import Drugs From Canada
Florida’s request to import medications from Canada was approved earlier this month pursuant to section 804 of the Federal Food, Drug and Cosmetic Act. The act permits importation of certain prescription drugs from Canada if a state or Indian tribe can demonstrate, among other things, that importation will significantly reduce costs to the American consumer without imposing additional risk to public health and safety. Florida’s application indicates that the program could save $150 million in the first year of operations.
Other states that have laws authorizing a drug importation program are considering applying, or have already applied, to the Food and Drug Administration, including Colorado, whose application is pending. However, neither Canada, nor the pharmaceutical industry is celebrating the FDA’s approval. For its part, Canada has concerns about the limits of its drug supply chain, which is structured to meet the demands of its 40 million residents. Florida’s population alone tops 22 million people. It was this concern that led to passage of a Canadian rule in 2020 preventing importation of drugs in short supply. PhRMA, the pharmaceutical industry’s lobbying arm, characterized the FDA’s decision as a threat to public health and stated it is “considering all options for preventing this policy from harming patients.”
More information on Florida’s approval can be found here, and more information on the FDA’s importation program can be found here.
CMS Announces New Maternal Health Care Model
Against the backdrop of high US maternal mortality rates, the Centers for Medicare & Medicaid Services has announced the establishment of Transforming Maternal Health (TMaH), a new payment and care model that will provide $17 million each for 15 state Medicaid agencies over 10 years. The model is structured as a whole-person approach to pregnancy, childbirth and postpartum care with the goal of improving maternal and child health outcomes for women and their infants enrolled in Medicaid and the Childrens’ Health Insurance Program.
Pregnant and postpartum mothers participating in the program will receive evidenced-based personalized care designed to support their physical and mental health, including monitoring women at home who are at higher risk for pregnancy-related complications. States are also expected to foster clear connections with community providers to address social drivers of health, including access to nutritious food, stable housing and/or substance use disorder treatment. TMaH also seeks to expand access to midwives, birth centers and doula services.
The CMS will release a notice of funding opportunity for state Medicaid agencies in spring 2024, with applications due in summer 2024. Read more.
Overview of State Spending on Home- and Community-Based Services Under the American Rescue Plan
The Centers for Medicare & Medicaid Services released an overview of how states have used or will be using the enhanced funding for home- and community-based services (HCBS) provided by the American Rescue Plan Act. The largest category of funding went to direct care worker recruitment and retention, followed by workforce training, reduction of waiting lists and expanded use of technology. Forty-three states are using some of the funds to address social determinants of health, particularly in housing.
ARPA, the $1.9 trillion stimulus bill passed during the COVID pandemic, provided states with a temporary 10 percentage point increase to the federal medical assistance percentage for certain Medicaid expenditures for HCBS beginning April 1, 2021, and ending March 31, 2022. Funds must be spent by March 31, 2025. HCBS delivers care to people in their homes and communities.
More information on state spending trends and on specific state expenditures can be found here.
Department of Housing and Urban Development Releases Annual Homelessness Assessment Report
The report uses point-in-time estimates from data collected in January 2023 to analyze national and state trends in homelessness by population. The report finds that between 2022 and 2023, there was a 12% increase in the overall number of people experiencing homelessness, including a 16% increase among families with children and a 15% increase among unaccompanied youth. Read more.