Legislative Update:
Summer 2011
Prepared By Richard Gallo
&
Jamie Papapetros
While tranquility frequently hovers over Albany in the summer months and provides a time for everyone to breathe a sigh of relief following the end of the most recent Legislative Session, this summer has had an atypical frenzied pace as many of the Medicaid Redesign Team's recommendations, included in the budget for 2011-12, are in the process of being implemented. Meanwhile, many of the team's work groups have been established - including the behavioral health reform work group, - and have been tasked with developing proposals for long-term savings to be considered by the members Medicaid Redesign Team and possibly included in Governor Cuomo's budget proposal for 2012-13.
Here is a brief update on a number of fronts NYSPA has been engaged in or is closely monitoring:
MEDICAID GLOBAL SPENDING CAP REPORT FOR JUNE 2011:
EXPENDITURES $18.8 MILLION ABOVE BUDGET PROJECTIONS (OR 0.5 PERCENT); ENROLLMENT UP 1 PERCENT SINCE APRIL
The MRT has posted the Medicaid Global Spending Cap Report for June 2011. As a reminder, the 2011-12 budget enacted a $15.3 billion cap on State share Medicaid spending.
Here are some of the highlights of the June 2011 Medicaid Global Spending cap report:
1.) Total Medicaid fund expenditures for the first quarter of SFY 2011-12 are $18.8 million above projections (or 0.5%).
2.) Cumulative spending for April through June (which factors in all categories of service including inpatient, outpatient/emergency room, clinic, nursing homes, other long term care, Medicaid Managed Care, Family Health Plus, Non-Instutional/Other, Cash audits) was $3.999 billion compared to the estimate of $3.980 billion in the budget.
3.) Since April 2011, enrollment in Medicaid has grown by 48,000 or 1 percent with a majority enrolling in Family Health Plus or Medicaid Managed Care programs.
4.) Through June, Medicaid spending in major fee-for-service categories was $10.5 million below targeted estimates. For example, inpatient hospital spending was $18.6 million below estimates (or 3.2 percent). Outpatient emergency room spending was $13.5 million below estimates, whereas total spending for non-hospital clinics was $7.9 million above targeted estimates.
5.) Medicaid Managed Care expenditures are $7.6 million over targeted estimates due to higher than anticipated enrollment. The report also notes that premium increases have "yet to be processed and therefore not reflected in these expenditures to date."
Finally, the report states, "Based on April through June performance, State spending appears to be on target; however, it should be noted that Medicaid spending on a month-to-month basis is subject to numerous variations due to enrollment swings, provider billing patterns, rate adjustments, and the number of billing cycles within a month."
To access the report: http://www.health.state.ny.us/health_care/medicaid/regulations/global_cap/docs/june_2011_report.pdf
MEDICAID REDESIGN: WORK GROUPS CREATED AS REDESIGN ENTERS PHASE II TO FIND LONG-TERM SAVINGS
Phase II of the Medicaid redesign process is now underway, which provides for the establishment of ten work groups which are tasked with preparing recommendations for long-term savings to be considered by the Medicaid Redesign Team and possibly included in the 2012-13 budget. To date, four of the ten work groups have already begun meeting, which include groups on the following topics: managed long term care implementation and waiver redesign; behavioral health reform; program streamlining and state/local responsibilities; and assist preservation of essential safety-net hospitals, nursing homes and diagnostic and treatment centers. Three other works groups, payment reform/quality measurement, basic benefit review and health disparities have just recently been launched with work groups on affordable housing, workforce flexibility/change of scope of practice and medical malpractice expected to be formed in the near future.
The Department of Health has provided the timeline below for phase II of the Medicaid Redesign Team:
| Work groups will meet three to four times throughout the summer and into the fall. |
| The first "wave" of work groups will report to the MRT in late October or early November. |
| The second "wave" of work groups will report to the MRT in mid-November. |
| The third "wave" of work groups (launched in early August) will report to the MRT in early December. |
| Final MRT recommendations to be presented to Governor Cuomo for his consideration in his proposed FY 12-13 budget. |
MRT Behavioral Health Reform Work Group Update From Last Meeting:
Review Of Outline That Will Serve As Basis For Report; Prepare Recommendations On Health Homes
At its last meeting, on Monday, August 1, 2011, the Medicaid Redesign Team’s Behavioral Health Reform work group reviewed an outline that was developed by State and New York City staff that the co-chairs (Office of Mental Health Commissioner Michael Hogan and Deputy Mayor for Health and Human Services Linda Gibbs) indicated would serve as the “framework” for the work group’s final report/recommendations. As part of the review, Office of Mental Health Commissioner Michael Hogan went over each section of the outline and provided an opportunity for feedback from work group members. Some areas of the outline reviewed included sections on financing/payment and contracting.
Additionally, work group member Gail Nayowith, who is chair of the recently established sub-group focusing on children, provided a recap of the sub-group’s first meeting, which focused on preparing a values statement. Gail Nayowith indicated that the children’s work has five meetings scheduled. Nayowith indicated that there are approximately 15 members on the sub-group including individuals representative of mental health, juvenile justice, education and child welfare. The sub-group has agreed to table discussion of children and health homes until after it completes its report, which is to be completed by September 20, 2011, and be part of the Behavioral Health Reform work group’s report.
Finally, the Behavioral Health Reform work group members spent a considerable amount of time at the last meeting developing recommendations on health homes to be submitted to the Department of Health, which plans to start enrolling individuals in the health homes on November 1, 2011. Ann Sullivan, M.D., member of the work group, suggests that attention and careful consideration be placed on a health home in the behavioral health setting – a comment that OMH Commissioner Hogan concurred with and indicated needed urgent attention. This spawned discussion of having behavioral health oversight of health homes for behavioral health population – behavioral health health homes. This was of a concern among group members about primary care jumping in and trying to manage everything. The co-chairs of the Behavioral Health Reform work group, Office of Mental Health Commissioner Michael Hogan and Deputy Mayor for Health and Human Services Linda Gibbs, indicated they would synthesize the recommendations that the work group members rated into a document to be submitted to the Department of Health.
Upcoming Meetings Of MRT Behavioral Health Reform Work Group:
Tuesday, August 23, 2011
1:00pm - 4:00pm
Albany - OASAS Offices
1450 Western Avenue
4th Floor, Conference Room |
Monday, September 12, 2011
1:00pm - 4:00pm
NYC - NYS Department of Health
Metropolitan Area Regional Office
90 Church Street, 4th Floor
Conference Room A/B, Manhattan |
For more information visit:
http://www.health.ny.gov/health_care/medicaid/redesign/.
Health Homes
From August 2, 2011 through October 3, 2011, the Department of Health will be accepting applications from eligible Health Home providers – a one month extension from the September 1st deadline it originally expected to have for receipt of applications. That being said, the Department of Health is requiring all applicants who intend to apply by October 3rd to file a letter of intent by September 1, 2011 to hh2011@health.state.ny.us with a subject line that begins with "LOI for HH".
A couple of noteworthy highlights from the application:
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Health Home providers will be approved for an initial three year period.
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"Preferred health home applications will include an integrated health care and community provider network that includes 1) managed care plans; 2) hospitals; 3) community based organizations; targeted case management providers; 4) mental health and substance abuse services providers"
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Health home applicants must attest that "contractual arrangements exist for all health home network providers that define the terms of participation, minimum time frames for access to services, provision of crisis intervention and responsibilities of each provider"
As far as reimbursement, the application states:
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"Health homes that meet state and federal standards will be paid a per member per month (PMPM) care management fee that is adjusted based on 1) region, 2) enrollment volume, 3) case mix (based on 3M Clinical Risk Groups ™ [CRG]) , *4) patient functional status. The care management fee will be paid in two increments: case finding and active care management. The case finding PMPM is 80% of the active care management PMPM and is only available for the first three months after a patient is assigned to a given health home.”
The Department Health indicates that the letter of intent must include the following:
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"The host or primary applicant,
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A preliminary list of the proposed Health Home network/partners including direct care providers, TCM, COBRA, MATS, CIDP programs, and community based organizations;
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Proposed service area; and Initial capacity, should specifically identify the number of current TCM, MATS, COBRA, or CIDP slots that will become part of the proposed health home, as well as the number of new (not already in any care management) health home slots by service intensity (low, intermediate, high) the proposed Health Home is prepared to accept as assignments this fall."
For more information or to review the frequently asked questions section the Department has established visit:
http://health.ny.gov/health_care/medicaid/program/medicaid_health_homes/.
Fair Health Inc. Launches Medical Cost Look Up Tool
FAIR Health (FH) Inc., the not-for-profit that was established as a result of then-Attorney General Cuomo's lawsuit against Ingenix, has launched a cost look up tool that allows consumers to research health care costs and estimate out-of-pocket costs. The FH Medical Cost Lookup can be accessed at:
http://www.fairhealthconsumer.org/medicalcostlookup/
RECENT MENTAL HEALTH-RELATED PRESS CLIPS:
FRIDAY, AUGUST 19, 2011
"New York Shaping a New System for Highest-Need Medicaid Recipients," Times Union, Thursday, August 18, 2011
The Department of Health is expecting to enroll 200,000 high-cost Medicaid beneficiaries, who have two more chronic health conditions, or have one chronic condition and are at risk for developing another or have a serious and persistent mental health condition, into to-be-establish health homes starting November 1, 2011. In its first year, the Department of Health expects health homes, which will composed of networks of providers, will produce $33 million in savings as a result of reducing avoiding unnecessary hospitalizations. Over the next four years, the Department of Health expects this initiative to reduce Medicaid costs by $560 million. The Department of Health will be accepting applications for those of interest in becoming a health home up until October 3, 2011 and has indicated that applicants should have a network consisting of a hospital, primary group, home health agency, mental health provider, affordable housing agency and community groups. Each individual enrolled in a health home will have a care plan and case manager who coordinates and manages the individual’s care.
|
Medicaid Statistics (Cited in Article):
5.4 million: Number of Medicaid beneficiaries
$46 billion: Total annual spending on NY's Medicaid program
976,000: Number of Medicaid enrollees with complex health problems.
$26 billion: Total spending on complex Medicaid enrollees
$2,338: Average monthly spending on complex enrollees
$890: Average monthly spending on a typical enrollee |
Link: http://www.timesunion.com/local/article/State-seeks-savings-with-health-homes-2082984.php#ixzz1VNz4MsCK
“State Sen. Saland praises Hudson River Psychiatric Center, asks Cuomo not to close it,” Poughkeepsie Journal, Monday, August 15, 2011
Senator Steve Saland (R-Poughkeepsie) is pushing back against Governor Cuomo’s plan to close the Hudson River Psychiatric Center later this year insisting that the $8 million in savings expected this year and the $15 to $16 million in savings expected next year can be achieved through other “cost saving initiatives” that spares the center’s closure and the jobs of 375 employees. Senator Saland has reportedly met with OMH Commissioner Hogan to discuss possible alternatives, which the Senator has indicated could include transitioning community services from the State to not-for-profit providers, allowing persons who are dually eligible to enroll in Managed Care programs and maximizing third party reimbursement. Senator Saland maintains that the State has an interest in keep the center open given that a 10-year construction plan to modernize the facility is near completion.
Link: http://www.poughkeepsiejournal.com/article/20110816/NEWS01/108160314/State-Sen-Saland-praises-Hudson-River-Psychiatric-Center-asks-Cuomo-not-close-it
“Creating a New Competitive Marketplace,” Healthcare.gov, Friday, August 12, 2011
HHS awarded $185 million dollars in Exchange Establishment grants on Friday, August 12, 2011, to thirtheen states and the District of Columbia, of which New York State received $10,774,898. Here is the section of the press release regarding the award of the Level One Grant to New York's Department of Health:
Administrator: New York State Department of Health
Amount Awarded: $10,774,898
Level of Funding: Level One
Summary: New York has made significant progress under its exchange planning grant, early innovator grant, and consumer assistance program grant. This funding will: support background research; seek stakeholder input through a series of policy discussions focused on Exchange design and operation options; fund IT Systems; expand the capacity of its consumer assistance to serve the needs of small businesses, to expand assistance to individuals in regions of the State that currently have limited in-person access and expand consumer assistance with commercial insurance issues. The proposal also requests funding for key staff to begin the process of implementing the Exchange around governance.
Link: http://www.healthcare.gov/news/factsheets/exchanges05232011a.html
“Judge Won’t Order Inquiry Over Psychologist’s Role in Guantanamo,” The New York Times, Thursday, August 11, 2011
Supreme Court Justice Saliann Scarpulla ruled that the State, via the Education Department’s Office of Professional Discipline, cannot be compelled to investigate John Francis Leso, a psychologist who the Center for Justice and Accountability claims assisted in the development of coercive techniques for use on detainees at Guantanamo. The Center for Justice and Accountability brought the suit on behalf of Steven Reisner, a psychologist and an assistant professor of clinical psychiatry at the New York University School of Medicine. In the 12-page ruling, Supreme Court Justice Scarpulla maintained that Reisner had no standing to force the Education Department’s Office of Professional Discipline to investigate the allegations and stated that nothing in the law requires that the office “formally investigate every single complaint of professional misconduct, no matter the contents or applicability of the complaint.” According to the article, the Education Department’s Office of Professional Discipline insisted it did not have the jurisdiction to investigate the claims against Leso which, according to the Office, did not involve the practice of psychology.
Link: http://www.nytimes.com/2011/08/12/nyregion/judge-wont-order-inquiry-over-psychologists-role-in-guantanamo.html?_r=1&pagewanted=print
“Major Increase in Hospitalization Rates for Children with Psychiatric Disorders,” Stony Brook University Medical Center, Thursday, August 11, 2011
The rate of inpatient hospitalization for psychiatric disorders among children (ages 5 to 13 years) rose 81 percent between 1996 and 2007 from 156 per every 100,000 children to 283 per 100,000, while the rate for adolescents (ages 14 to 19 years) rose 42 percent during that same time period, according to a report published online in the Archives of General Psychiatry and to be published in the journal’s 2011 December print edition. The report, which was authored by Joseph Blader, Ph.D., Assistant Professor in the Department of Psychiatry & Behavioral Science at Stony Brook University School of Medicine, based his study on data obtained from the annual National Hospital Discharge Survey (NHDS). Dr. Blader’s study of the 12-year time period also found that the proportion of care reimbursed by private insurance “dropped considerably,” while reimbursement from government payers increased.
Link: http://www.newswise.com/articles/major-increase-in-hospitalization-rates-for-children-with-psychiatric-disorders
“Medicaid to test expanded mental health coverage,” The Hill’s Healthwatch, Tuesday, August 9, 2011
The Centers for Medicare and Medicaid Services (CMS) announced that it was launching the Medicaid Emergency Psychiatric Demonstration as required by Section 2707 of the Patient Protection and Affordable Care Act of 2010. The law governing the demonstration appropriates $75 million over three years to provide federal matching funds to State for Medicaid payments provided to private psychiatric hospitals with more than seventeen beds for inpatient emergency psychiatric care to Medicaid recipients between the ages of 21 and 64 – payments which are otherwise prohibited under Medicaid. CMS will only accept a limited number of states to participate to ensure there is sufficient funds for the demonstration. CMS hopes the demonstration will “enable an informative assessment of any changes to access and quality of care for behavioral health services from the provision of payments for inpatient emergency psychiatric care.”
Link: http://thehill.com/blogs/healthwatch/medicaid/176089-medicaid-to-test-expanded-mental-health-coverage
Link to CMS: http://www.cms.gov/DemonstrProjectsEvalRepts/MDP/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=3&sortOrder=ascending&itemID=CMS1249074&intNumPerPage=10
“Bronx Judge Finds Constitutional Defect in Sex Offender Law,” New York Law Journal, Tuesday, August 9, 2011
In State v. Enrique T., Supreme Court Justice Colleen Duffy ruled that New York’s law allows sex offenders to be civilly confined after they have completed their prison sentence to be unconstitutional as it requires the sex offenders to be confined before their has been a trial to determine if civil confinement is warranted. Judge Duffy ruled that there are no conditions under Section 10.06 of the Mental Hygiene Law that can be applied constitutionally “because there is no option to release a respondent if lesser conditions than confinement would suffice, and this Court is not empowered to re-write statute to correct its unconstitutionality.” The Attorney General’s Office, who argued on behalf of the State, is currently reviewing the decision and considering its next steps. A Democrat & Chronicle article reporting on the ruling reports that 40 percent of the 237 civilly confined sex offenders were awaiting trial last year. An attorney from the Mental Hygiene Legal Service called the ruling “very significant” and indicated that it marks the first time that a court has challenged the law’s constitutionality.
Link: http://www.law.com/jsp/nylj/PubArticleFriendlyNY.jsp?id=1202510392672