1. health and fitness

March 16, 2015
Volume 4, Issue 9
In this Issue
New York State Senate and Assembly Release
One-House Health Budgets
Physician Fee Schedules Updated
DSRIP Update
Managed Care Policy and Planning Meeting
Analysis of the “New York Health Act”
Released
Regulatory Updates
Legislative Spotlight
Upcoming Calendar
Quick Links
(External Sites)
Hinman Straub –
Final Health
Budget Summary
NYS Department
of Health
NYS DOH –
Meetings,
Hearings &
Special Events
Medicaid
Redesign Team
Senate Health
Committee
Website
Assembly Health
Committee
Updates
NYS Division of
Budget
Plugged In to
Health – Past
Issues
New York State Senate and Assembly Release One-House Health
Budgets
The Assembly and Senate released their “one-house” budget bills on March 10th and 11th,
respectively. Both houses approved their respective one-house budget bills last Thursday. The
joint budget conference committee process is ongoing and will continue throughout the week.
This chart summarizes the differences between the Legislative and Governor’s Budgets with
regard to health care.
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Physician Fee Schedules Updated
The electronic Medicaid system of New York (eMedNY) recently announced that the Physician
Radiology fee schedule has been updated for 2015. The updated schedule, as well as other
provider information can be found here.
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DSRIP Update
Meeting of the Value Based Payment (VBP) Reform Workgroup
The VBP Reform Workgroup held its third meeting in Albany on Friday, March 13. The third
VBP Roadmap draft was recently posted to the DOH VBP website and is available here. Public
comment on the draft may be submitted to [email protected] by 3:00 p.m. on March 30,
2015. The draft was recently shared with CMS to obtain preliminary feedback. It is the first
draft Roadmap shared thus far.
Workgroup members noted several revisions they would like to see included in a fourth draft.
These include additional quality and performance requirements for providers and revising
some of the references to the PPS to better reflect the flexibility envisioned. Jason Helgerson
stated that the State needs to include the PPS in the discussion on VBP, as CMS does not want
to see the infrastructure they are investing in disappear post-DSRIP.
There was also a lengthy discussion on the new VBP Innovator Program that is intended to
provide multi-year commitments for providers who wish to progress to higher levels of value
based payments in exchange for multi-year commitments and a high percentage of capitation
(95% proposed) from the plans. At the meeting, the State caught many members by surprise
when they indicated this initiative would be open to arrangements other than those where a
PPS intends to manage the total population health needs for its entire system, including
arrangements to manage care by sub-population or sub-specialty, and for VBP Level 2
arrangements, and not just Level 3 (full capitation). The program proposes to require plans to
contract with these “early innovators” who meet certain defined program requirements set
forth by DFS and DOH. Plans pushed back that requiring them to contract would be coercive.
Helgerson expressed that the State is considering whether to adopt criteria for off-menu
payments. One member suggested creating an attestation process or similar disclosure to
certify compliance. Helgerson seemed interested in this suggestion. The State also said they
would develop a process to handle breakdowns in negotiations over VBP arrangements, which
could include an appeals process.
Helgerson said he does not expect VBP to be as big of a lift as many expect, as approximately
20% of all managed care payments currently use some form of VBPs, though not all risk-based
contracts that are currently in place would qualify as VBP Level 1 (the minimum level needed to
count towards the State’s 80-90% target).
The next meeting will be March 24, 2015. DOH has added additional meetings to the
Workgroup agenda and revised its timeline for submission to April 15, 2015. The State hopes to
secure CMS approval of its plan by May 2015.
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Managed Care Policy and Planning Meeting
On Thursday, the Department of Health held the monthly Policy and Planning Meeting with
the State’s Medicaid Managed Care plans. Some highlights from the meeting include:
•
•
Pharmacy Budget Update: Plans asked for the ability to weigh in on clinical criteria
decisions involving negotiations for supplemental rebates with drug manufacturers if
language included in the Executive Budget that provides authority for the State to
negotiate such rebates on behalf of managed care plans is enacted. DOH was noncommittal, but indicated this was a “reasonable request.”
Behavioral Health/HARP: OMH discussed its plan to phase in HARP enrollment in
New York City beginning in July at 20,000 individuals per month. OMH also unveiled
proposed price caps for HCBS services (“1915-i” like services). The RFQ for the
behavioral health/HARP carve-in is tentatively scheduled to be released the end of
March. If this deadline holds, the responses will be due June 2015. OMH is considering
pushing these deadlines and the carve-in out to allow staff to focus on implementation
in New York City. In response to a question about the timeline for the Children’s
Behavioral Health carve-in, OMH indicated that January 1, 2016 remains the official
target date for this carve-in.
•
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FIDA: The first wave of passive enrollment for Region I will be effective April 1, 2015.
The second wave will be effective May 1, 2015. As of March 1, there were 243 enrollees.
The State projects to have 8,667 enrollees by May 1. There have been 31,801 opt-outs
although DOH is hopeful that through outreach from plans and Maximus, these
individuals can be convinced to opt back into FIDA. DOH has requested that FIDA
plans perform additional outreach to their MLTC members to provide education about
FIDA and is discussing increasing the FIDA rates with CMS to better align the rates
with MLTC premium rates.
CFEEC: The CFEEC (Maximus) expanded to the following counties effective March 1:
Albany, Columbia, Dutchess, Erie, Fulton, Greene, Monroe, Montgomery, Onondaga,
Orange, Putnam, Rensselaer, Rockland, Saratoga, Schenectady, Schoharie, Sullivan,
Ulster, Warren, and Washington. DOH noted that 99% of individuals referred to the
CFEEC have been approved for enrollment, while the denial rate remains 1%. 76.5% of
individuals transferred by the CFEEC to a plan enrolled in that plan, while the
remaining 23.5% chose another plan.
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Analysis of the “New York Health Act” Released
Last week Assemblyman Gottfried’s office released a report entitled “Economic Analysis of the
New York Health Act”. The report provides an economic analysis of the “New York Health
Plan” bills introduced by State Legislators Gottfried and Perkins (A.5062/S.3525), which would
create a universal single payer healthcare system in New York. The report was authored by
Gerald Friedman, chairman of the economics department at the University of Massachusetts at
Amherst, and can be found here.
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Regulatory Updates
State Education Department
Off-Premises Delivery of Prescription Medications by New York Resident Pharmacies
Last week, the New York State Department of Education issued a notice of proposed
rulemaking that would require pharmacies registered with the NYS Education Department to
obtain patient consent before automatically delivering off-premises new or refilled
prescriptions. This regulation is required to implement laws passed last year relating to the offpremises delivery of prescription medication.
Comments on the proposed rule will be accepted by the Department through April 27, 2015,
and may be submitted by mail or electronically.
Department of Health
Physician Assistants and Specialist Assistants
The Department of Health recently issued a notice of adoption relating to the scope of duties
and supervision of physician assistants (PAs) and specialist assistants. The proposed rule
implements recent legislative changes to: (1) permit physicians to employ or supervise up to
four PAs, rather than two; and (2) allow PAs to prescribe controlled substances.
Transgender Related Care and Services
The Department of Health recently issued a notice of adoption that includes transgender health
care services under New York State’s Medicaid program. The adopted regulations require New
York State’s Medicaid program to provide treatment for hormone therapy and gender
reassignment surgery.
Under the new regulations, hormone therapy and gender reassignment surgery will be covered
for persons who have referrals from medical professionals. Surgery will be covered for
individuals who are a minimum age of 18 or 21 years old, depending on specific circumstances.
Referring medical professionals are required to document that a patient has persistent gender
dysphoria, has received appropriate hormone therapy a minimum of one year, has lived a
minimum of one year in the gender role consistent with the person’s gender identity, and has
received mental health counseling.
Office of People With Developmental Disabilities
Consolidated Fiscal Report Penalty Amendments
The NYS Office of People with Developmental Disabilities recently issued a notice of proposed
rulemaking that would change requirements for imposing a penalty on providers that fail to
meet filing deadlines for cost reports. The change would eliminate the written notice and 15 day
grace period for providers who fail to submit cost reports. Instead, the penalty would be
automatically imposed after 120 days of failure to submit, unless the provider has applied for
an extension. The proposed rule would also extend penalty applications to Home and
Community Based Health Services (HCBS) Waiver services, including Intensive Behavioral
services, Pathway to Employment, Community Transition Services, and Individual Directed
Goods and Services.
The OPWDD will be holding public hearings on the proposed rule at 10:30 a.m. on April 27 and
28, 2015. Both hearings will be held at The Office for People with Developmental Disabilities,
Counsel’s Office Conference Room., 3rd Floor, 44 Holland Ave., Albany, NY.
Comments on the proposed rule will be accepted by the OPWDD through May 4, 2015, and
may be submitted by mail or electronically.
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Legislative Spotlight
Last Friday, Governor Cuomo signed into law S.2486/A.4274 (Hannon/McDonald), a bill
that delays the requirement that prescribers use electronic prescriptions until March 27, 2016.
This law takes effect immediately.
This week, the Senate and Assembly will be in session today through Thursday, March. 19. The
Senate Insurance Committee is scheduled to meet on Monday, March 16, while the Senate
Health and Higher Education Committees are scheduled to meet on Tuesday, March 17.
Here is a list of priority bills on the agendas:
Senate Health Committee
•
S.1112A (Hannon): This bill would direct the Department of Health to convene a
•
health technology assessment committee to advise the Department of Health regarding
Medicaid coverage of medical devices and surgical procedures. The language of this bill
was included in the Senate “one-house” budget proposal.
S.4297 (Hannon): This bill would direct the Department of Health to establish
standards for universal coding of payment of claims for long term care and provide for
the electronic payment such claims. This is a new bill this year, and its provisions have
also been included in the Senate “one-house” budget proposal.
Senate Insurance Committee
•
•
S.2366 (Seward): This bill would allow health insurers to write stop loss insurance
and to provide administrative services to self-funded employer groups with 51 or more
employees. Currently the Affordable Care Act’s “small group” definition of 1-50
employees prevents this. The bill’s provisions have also been included in the Senate
“one-house” budget proposal.
S.1233 (Little): This bill would require coverage for surgical first assistant services
performed by a registered nurse first assistant who is certified in operating room
nursing and who performs surgical first assistant services within his or her scope of
practice in every policy of insurance in instances where reimbursement for surgical first
assistant services is provided.
Senate Higher Education Committee
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S.2661A (Hannon): This bill would authorize out of state businesses engaged in the
sale of prescriptions and registered with the education department, to deliver
prescriptions to users off the premises of such business. The bill’s provisions have also
been included in the Senate “one-house” budget proposal.
At this time, the Assembly has not yet released their Insurance or Health Committee agendas.
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Upcoming Calendar
Wednesday,
March 18
Maternal and Child Health Services Block Grant Advisory Council
Conference Call/Webinar
11:00 a.m. to 1:00 p.m.
To participate, contact Kimberly Messier at (518) 473-7922 or via email at
[email protected].
Thursday,
March 26
Public Health and Health Planning Council Committee Meeting
10:00 a.m.
Empire State Plaza, Concourse Level, Meeting Room 6, Albany
Thursday,
April 16
Public Health and Health Planning Council Full Meeting
10:00 AM
Empire State Plaza, Concourse Level, Meeting Room 6, Albany
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