NYSDOH Public Notices: Seeking to Amend Title XIX for Medicaid Redesign – an Update

April 1, 2020

This morning we sent you information regarding two Public Notices in today’s NY State Register.  The analysis we sent was specific to Programs and Services licensed under Articles 31, 32 and 16 of mental hygiene law.

The info below touches on potential impact to other Programs and Services situated across the healthcare continuum of care.

Any questions?  Call me at your convenience at 518 461-8200n or send a note to:  lauri@nyscouncil.org

4/1/20

NYSDOH Public Notices: Seeking to Amend Title XIX for Medicaid Redesign

Today in the State Register, there are two Public Notices by NYSDOH (see attached with sector by sector proposals outlined). The Notices state that NYSDOH proposes to amend the Title XIX (Medicaid) State Plan to pursue significant changes to inpatient, long term care, transportation and non-institutional services.  This means that they are seeking federal approval to make such changes.  While we await the release of the final state budget bills related to HMH/Medicaid, it may be that these are the MRT 2 items that they reached a three-way agreement to move forward this year which require a SPA amendment for (per the notices).

The first public notice states that NYSDOH plans to uniformly reduce all non-exempt Medicaid payments uniformly by $2.5 billion, only to the extent that alternative methods that achieve Medicaid state savings are not achieved (see below).  Note, exempt from reductions are payments pursuant to Article 32, 31 and Article 16 of mental hygiene law, payments for Federally Qualified Health Centers, Early Intervention, Family Planning services, Hospice services, School Supportive Health Services Program, Preschool Supportive Health Services Program, payments provided by other state agencies including OCFS, SED and DOCCS, among others.

The second public notice lays out the specific Medicaid reforms NYSDOH is seeking approval to move forward with to achieve these savings, as recommended by MRT 2.  Again, these proposals apply to inpatient, long term care, transportation and non-institutional services effective on and after April 1, 2020.  We have outlined the items of particular interest below:

Across the Board:

  • 1.875% across the board Medicaid cut: Exempt from such reductions are payments pursuant to Article 32, 31 and Article 16 of mental hygiene law, payments for Federally Qualified Health Centers, Early Intervention, Family Planning services, Hospice services, School Supportive Health Services Program, Preschool Supportive Health Services Program, payments provided by other state agencies including OCFS, SED and DOCCS, among others.

Non-Institutional Care Management:

  • Implements Health Home Improvement.
  • Implements Comprehensive Prevention and Management of Chronic Disease.
  • Children’s Preventative Care and Care Transitions by promoting behavioral health integration in pediatrics.
  • Children and Family Treatment and Support Services (CFTSS) to restore specialized transition rates for CTFSS.
  • Invests in Medically Fragile Children. Improve access to private duty nursing using telehealth, insurance coverage and enhanced rates.
  • Promotes Further Adoption of Patient-Centered Medical Homes.  Continues incentive payments at current levels for lower cost, higher value PCMH program and incorporating a tiered quality component to align with other state initiatives.
  • Promotes Maternal Health to Reduce Maternal Mortality.
  • Addressing Barriers to Opioid Care by implementing a series of interventions including better bundled payments through APG adjustments, reducing Medicaid Coverage limits for Rehab Services and increased utilization of Opioid Medical Maintenance.
  • Expands use of telehealth specifically to assist behavioral health, oral health, maternity care and other high need populations.

Emergency Medical Services:

  • Creates a Community Paramedicine Program to expand the roles of EMTs and Paramedics by providing medical care to patients at home to avoid unnecessary trips to the ED.
  • Discontinues Supplemental Ambulance Rebate Payments to emergency medical transportation (EMT) providers and update and rationalize the ambulance fee schedule consistent with the Department of Health’s Ambulance Rate Adequacy Study.
  • Implements an ambulance diversion-Triage, Treat and Transport (ET3)

Other Transportation:

  • Transitions to a single Medicaid Transportation Broker.
  • Carves transportation out of the MLTC Benefit (excluding PACE) and into FFS.

Pharmacy:

  • Enhancing state purchasing power to lower drug costs to seek supplemental rebates for new blockbuster drugs and gene therapies, and giving the authority to negotiate value-based agreements with manufacturers.
  • Reducing certain OTC coverage and increases copays.
  • Eliminating prescriber prevails under FFS and Managed Care under Medicaid.

Institutional:

  • Reduces voluntary hospital Indigent Care Pool by $75 million state share.
  • Eliminates Indigent Care Pool “Transition Collar” to save $125 million
  • Eliminates Public Hospitals Indigent Care Pool for $70 million
  • Converts Upper Payment Limit payment for public hospitals in NYC into Medicaid reimbursement rates.
  • Reduces hospital inpatient capital rate add ons by 5% and capital reconciliation payments by 10%.
  • Emergency Department Avoidance and Cost Reductions.  Redesigning care pathways for high ED use, expanding access to urgent care through co-location with EDs, exploring a lower ED triage fee and allowing sharing of individualized patient treatment plans for chronic conditions through Qualified Entity.

Long Term Care:

  • Modify the current eligibility criteria for Personal Care and Consumer Directed Personal Assistance Services (CDPAS).
  • Utilize an independent clinician panel to assess patients and order PCS and CDPAS.
  • Institute a Home and Community Based Services lookback period of 60 months for asset transfers in determining Medicaid eligibility for home and community based long term care services and supports as currently applies to nursing home care.
  • Eliminate ability of spouses living together in the community, and parents living with their child, to refuse to make their income and resources available for Medicaid eligibility determinations.
  • Implement an enhanced UR process by an independent assessor for individuals needing more than 12 hours per day on average in a given month.
  • Change the frequency of the Community Health Assessment from every six months to once annually, subject to changes in health status or condition.
  • Implement a uniform tasking tool for use by plans and LDSS to determine service utilization, including hours for personal care and CDPAS.
  • Reduce Workforce Recruitment and Retention funding for home health care workers.
  • Migrate the completion of all Community Health Assessments (CHA) and reassessment to a single, statewide Independent Assessor.

These proposals in total reduce gross Medicaid expenditures by $854 million for SFY 2020-21 and $1.672 billion for SFY 2021-2.

Please let us know if you have any questions.  We will keep you updated as the relevant final budget bills are released.