Updated Summary of Article VII Health Bill Proposals

January 16, 2018


2019 Executive Budget: Art. VII Health Budget Bill 


Part C
Pages 23-31

HEALTH HOMES: Establishes enrollment targets for special needs managed care plans and compels plans to work collaboratively with health home providers to achieve targets.  Penalties may be assessed on plans.


Requires criminal background checks for employees of health homes and direct observation is required by health homes for those serving individuals with disabilities or who are under 21 while criminal history information checks/determinations are pending.


Includes reimbursement, subject to available funds for expanded criminal history record checks for health homes.


Provides health homes and other entities serving those with developmental disabilities or under age 21 with access to the Statewide central register of child abuse.  Also requires such entities to report child abuse or maltreatment.


Includes penalties (0.85% reduction in a plan’s monthly capitated reimbursement rate) for failure to submit a PPS partnership plan by July 1, 2018.


Part D

Pages 38-39


OPIOID MONITORING: Requires a treatment plan and attestation of prescriber monitoring including a patient-prescriber agreement when opioids are being prescribed for pain lasting more than 3 months.  Patients with cancer that is not in remission or in hospice are exempt form these requirements.


PRESCRIBER PREVAILS: Eliminates prescriber prevails provisions in Medicaid and instead the program will consider additional information and justification presented for use of drug that is not on the PDL


Part F

Pages 42-43


MMC PLAN RATE ADJUSTMENTS: Allows NYSDOH to make Medicaid rate adjustments in the case of Medicaid managed care plans with reserves in excess of the minimum contingent reserve requirement.


Part G

Pages 43-52


RETAIL PRACTICES: Authorizes certain health care services in retail settings (pharmacies, grocery stores, shopping malls) by “retail practices.”  Must be staffed at all times by a physician, PA or NP. Allowed services include treatment for minor acute episodic illnesses or conditions, periodic wellness treatments, administration of opioid antagonists and limited behavioral health screening and referral.  May include certain lab tests.  May not include procedures using sedation or anesthesia for patients under 24 months old, vaccines for those under 18 except flu shots, educational courses or services provided on a time-limited basis like a flu clinic or health fair. Such practices must accept Medicaid and walk ins, post a list of services/prices and must have at least one collaborative relationship with a hospital, physician, ACO or PPS.  Must ask about PCP and refer if patients do not have one.  Must participate in EHRs and SHIN-NY and attain and maintain accreditation.  Retail practice sponsors can be business entities, professional corps., business corps. and other entities licensed under Art. 28 like hospitals, D&TCs and FQHCs.  Projected to save $5 million annually.


Part I

Pages 58-63


OMIG AUTHORITY: Clarifies OMIG’s authority to recover overpayments with Medicaid Managed Care and Managed Long Term Care programs.  Projected to save $5 million in 2019 and $10 million in 2020.


Part K

Pages 64-65


GLOBAL CAP: Extends the global cap under Medicaid through 2020.


Part L

Pages 65-67


CHP: Provides the Governor with the authority to make changes to the Child Health Plus program in the event that Congress does not reauthorize Federal funding


Part Q

Pages 107-111


HC FACILITY TRANSFORMATION: Creates the third Health Care Facility Transformation Program with funding in the amount of $425 million for eligible systems.  $60 million must be made available for community-based health care providers including mental health clinics, alcohol and SA treatment clinics, primary care, D&TCs, home care and assisted living providers ($20 million). An additional $45 million is earmarked for residential health care facilities.


Part S, Subpart B & Subpart C

Pages 120-126


MH/PC INTEGRATION: Clarifies that Art. 28 or Art. 31/32 providers may provide integrated primary care, mental health and/or substance use disorder services when authorized to do so by OMH or OASAS per regulation without needing a second or third license/certification.


TELEHEALTH: Expands definition of originating site for Medicaid reimbursement for telehealth to include the patient’s home or other location that they may be temporarily located.  Also adds credentialed Alcoholism and Substance Abuse Counselors and other providers as department by Department regulations to list of professionals eligible for telehealth services.


Part U

Page 129


DEMONSTRATION PROGRAM FOR SPECIALIZED INPATIENT PSYCHIATRY UNITS: Extends certain time-limited demo programs for evaluating new methods of services for individuals with intellectual and/or developmental disabilities through March 31, 2021.


Part V

Pages 129-130


COMMUNITY REINVESTMENT:  Extends for three years community reinvestment for State psych center closings at a rate of $110,000 per bed.


Page WW

Pages 130-131


VOLUNTARY RESTORATION TO COMPETENCY PROGRAMS: Authorizes OMH to permit restoration to competency within local and State operated jail-based residential settings.


Part X

Pages 131-132


OMH/OPWDD AS REPRESENTATIVES: Extends three years the authority of OMH and OPWDD facility directors to act as representative payees to use funds.


Part Y

Pages 132-145


SOCIAL WORK LICENSING: Clarifies the tasks and assignments performed by persons employed by a program or service operated or approved by OMH, OPWDD, OASAS, DOH, SOFA, OCFS, DOCCS, OTDA and/or local government which require licensure in psychology, social work or as a mental health practitioners (see attached).  Note it permits those who have been employed or obtain employment on or before July 1, 2020 to continue to fall wihtin the current exemption in the law. Costs from this proposal are estimated to be $324 million annually.


Part AA

Pages 156-157


COLA: Defers Human Services COLA until after March 31, 2019; Earlier section of bill eliminated COLA for certain DOH providers.



Includes continued funding for the 3.25 percent increase for our direct care workforce and clinical staff. 


Proposes a 2% surcharge (2 cents on the dollar/mg) on opioid manufacturers to raise $170 million with goal of using funding raised to continue to fight epidemic.