State Budget Outcomes: Items of Interest
April 2, 2020
NYS Council members,
First, we compared the final Aid to Localities (ATL) bill for OASAS and OMH to the Executive Budget proposal Please find some notes below:
For Final OASAS ATL Budget:
- Community Treatment Services funding is up $2.6M by adding: $2M for NYC DoE to hire additional substance abuse prevention and intervention specialists and $600,000 for the Family & Children’s Association
- Includes $1.4M to support minimum wage payments, $9.6M to support continuation of worker salary increases and $3M for the SUD/MH ombudsman, among other funds.
For Final OMH ATL Budget:
- Adult Services Program funding is up by over $2M by adding: $175,000 for the South Fork Behavioral Health Institute, and $2,017,500 for the Joseph P. Dwyer Veteran Peer to Peer Services program.
- Includes $4M to support minimum wage payments, $22.3M to support continuation of worker salary increases, among other funds.
Final Budget Items re: Pharmaceuticals & OMIG from Final ELFA Article VII Budget Bill:
- Shift Pharmacy Benefit to FFS: Includes language stating that it is in the best interest of the Medicaid program/patients to move the pharmacy benefit from Medicaid MC back to Fee for Service and DOH has the administrative authority to do so. NYSDOH shall not implement the transition sooner than April 1, 2021 and upon federal approval. NYSDOH is authorized to establish uniform standards, payment policies and reimbursement methodologies based on actual acquisition costs and professional dispensing fee. NYSDOH is required to convene an advisory group of stakeholder representatives for the purposes of providing non-binding recommendations to the department by 10/1/20 on available methods of achieving savings beginning on and after 4/1/21.
- Extend Immunizer Law: Extends the sunset date on NY’s pharmacist immunizer law two years to July 1, 2022;
- Extend CDTM Law: Extends the sunset date on NY’s CDTM in hospitals law two years to July 1, 2022;
- Reject PBM Regulation: Rejects the Executive Budget proposal to regulate Pharmacy Benefit Managers (PBMs);
- Insulin Cap: Caps the out of pocket cost to patients for insulin at $100/30 days supply;
- Extend E-Prescribing Waiver: Extends the e-prescribing exemption for prescribers writing 25 or less scripts per year through June 1, 2023;
- Add to CS Schedule: Adds a series of fentanyl analogs to the state’s schedule of controlled substances;
- DOH Direct Negotiations for Rebates: Authorizes NYSDOH for the period through March 31, 2023 to negotiate directly with manufacturers for supplemental rebates under Medicaid for certain drug classes including gene therapies and high cost “blockbuster” drugs;
- Establishing a Statewide Formulary for Opioid Dependence Agents and Opioid Antagonists which shall be published by NYSDOH and shall include “preferred drugs” in such classes with no prior authorization required; Under MC, If the drug prescribed is not on the statewide formulary, the prescriber shall consult the plan based on criteria (similar to what is in place for step therapy) for approval of the non-preferred or non-formulary drug; MC plans may not require prior authorization for methadone when used for an opioid disorder or part of a program;
- Drug Pricing Investigations: Grants the Superintendent of DFS discretion and authority to investigate drug prices that have increased over the course of a 12-month period by more than 50% to an amount greater than $5 per unit;
- Creates a Drug Accountability Board of 9 members appointed by DFS with one member appointed by the Senate and Assembly each respectively to 3 year terms; The Board shall aid in drug pricing investigations when DFS determines it would be needed; Following review the Board would report its findings to DFS and can be kept confidential;
- Revises compliance program requirements under the Office of the Medicaid Inspector General (OMIG) that Medicaid providers must adopt and implement to prevent, detect and correct fraud, waste and abuse;
Part KKK of Education Budget bill re: Regional demos using a value based model:
§ 10. Contingent upon the availability of federal financial partic-
11 ipation or other federal authorization from the centers of medicare and
12 medicaid services, the commissioner of health, in consultation with the
13 superintendent of the department of financial services, is authorized to
14 implement one or more five-year regional demonstration programs that
15 would be designed to improve health outcomes and reduce costs, using a
16 value based model that pays providers an actuarially sound global, pre-
17 paid and fully capitated amount for individuals in the designated region
18 who are enrolled in the state’s plan for medical assistance established
19 pursuant to title XIX, or any successor title, of the federal social
20 security act; the Medicare program established pursuant to title XVIII,
21 or any successor title, of the federal social security act; and insur-
22 ers, corporations, and health care plans authorized pursuant to the
23 insurance law or public health law. The demonstration program may offer
24 funding and incentives designed to improve health outcomes for attri-
25 buted individual beneficiaries designed to improve health outcomes,
26 develop necessary infrastructure and systems; and connect individuals to
27 community based organizations that address the social determinants of
28 health. Notwithstanding any provision of law to the contrary, the
29 commissioner or the superintendent of the department of financial
30 services may waive any regulatory requirements as are necessary to
31 implement the demonstration program; provided however, that regulations
32 pertaining to patient safety, patient autonomy, patient privacy, patient
33 rights, due process, scope of practice, professional licensure, environ-
34 mental protections, provider reimbursement methodologies, or occupa-
35 tional standards and employee rights may not be waived, nor shall any
36 regulations be waived if such waiver would risk patient safety. Partic-
37 ipation in such program shall be voluntary. One year after this section
38 shall take effect and annually thereafter the commissioner of health
39 shall provide a report detailing the activities and outcomes of such
40 program, including any regulatory requirements that are waived, to the
41 speaker of the assembly and the temporary president of the senate.
42 § 11. Contingent upon the availability of federal financial partic-
43 ipation or other federal authorization from the centers of medicare and
44 medicaid services, the commissioner of health, in consultation with the
45 superintendent of the department of financial services, is authorized to
46 design and implement a five-year demonstration, with implementation
47 beginning January 2022, utilizing an actuarially sound global budget and
48 global approach, and which is aimed at accelerating regional population
49 health improvement initiatives; adopting value-based models in accord-
50 ance with the state department of health Medicaid Value-Based Payment
51 Roadmap; and aligning care incentives under an integrated health system.
52 The demonstration may include the safety net hospitals in one or more
53 counties or regions of the state providing a high percentage of services
54 to individuals in the designated region who are enrolled in the state’s
55 plan for medical assistance established pursuant to title XIX, or any
56 successor title, of the federal social security act; and insurers,
1 corporations, and health care plans authorized pursuant to the insurance
2 law or public health law, as well as regional providers, to deliver and
3 promote quality and performance through an integrated model. The
4 provisions of this paragraph shall not take effect unless all necessary
5 approvals under federal law and regulation have been obtained to receive
6 federal financial participation in the costs of services provided under
7 this paragraph, and shall be subject to the terms of a binding memoran-
8 dum of understanding executed between the department of health and the
9 demonstration’s participants. Participation in such program shall be
10 voluntary. One year after this section shall take effect and annually
11 thereafter the commissioner of health shall provide a report detailing
12 the activities and outcomes of such program to the speaker of the assem-
13 bly and the temporary president of the senate. Effective date April 1, 2020
Part II of the Education bill (page 253) creates a public health emergency charitable trust fund.
19 § 99-hh. Public health emergency charitable gifts trust fund. 1.
20 There is hereby established in the joint custody of the commissioner of
21 taxation and finance and the state comptroller a special fund to be
22 known as the “public health emergency charitable gifts trust fund”.
23 2. The public health emergency charitable gifts trust fund shall
24 consist of monetary grants, gifts or bequests received by the state for
25 the purposes of the fund, and all other moneys credited or transferred
26 thereto from any other fund or source. Moneys of such fund shall be
27 expended only for goods and services necessary to respond to a public
28 health disaster emergency or to assist or aid in responding to such a
29 disaster. Nothing in this section shall prevent the state from solicit-
30 ing and receiving grants, gifts or bequests for the purposes of such
31 fund and depositing them into the fund according to law.
32 3. Moneys in such fund shall be kept separate from and shall not be
33 commingled with any other moneys in the custody of the comptroller or
34 the commissioner of taxation and finance. Any moneys of the fund not
35 required for immediate use may, at the discretion of the comptroller, in
36 consultation with the director of the budget, be invested by the comp-
37 troller in obligations of the United States or the state, or in obli-
38 gations the principal and interest on which are guaranteed by the United
39 States or by the state. Any income earned by the investment of such
40 moneys shall be added to and become a part of, and shall be used for the
41 purposes of such fund.
42 § 53. This act shall take effect immediately and shall be deemed to
43 have been in full force and effect on and after April 1, 2020; provided,
44 however, that the provisions of sections one, one-a, two, three, four,
45 five, six, seven, eight, twelve, thirteen, fourteen, fifteen, sixteen,
46 seventeen, eighteen, nineteen, twenty-one, twenty-four, and twenty-six-a
47 of this act shall expire March 31, 2021 when upon such date the
48 provisions of such sections shall be deemed repealed.
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The Education bill also includes language regarding a opioid alternative pilot pg. 284:
12 § 4. Paragraph (b) of subdivision 4 of section 365-a of the social
13 services law, as amended by chapter 444 of the laws of 1979, is amended
14 to read as follows:
15 (b) care and services of chiropractors and supplies related to the
16 practice of chiropractic, except as provided for by the commissioner
17 pursuant to a pilot program approved under federal law and regulation;
18 § 5. The commissioner of health is authorized to establish pilot
19 programs in one or more counties or regions of the state for the purpose
20 of promoting the use of alternatives to opioid treatment for individuals
21 suffering from chronic lower back pain by offering access to nonpharma-
22 cologic treatments such as acupuncture and chiropractic services. Such
23 access may be provided in select areas that have the highest need for
24 such services and for select populations. The provisions of this
25 section shall not take effect unless all necessary approvals under
26 federal law and regulation have been obtained to receive federal finan-
27 cial participation in the costs of services provided under this section.