Frequently Asked Questions
Table of Contents
- General
- Mental Hygiene Services
- Reduction Implementation
- Retro-Adjustments
- Pharmacy
- Specific Service Details
- Supplemental Payments
- Waiver Services
I. General
| Question Number | Question | Answer |
|---|---|---|
| 1 | What payments will be affected by the reduction? | The following Medicaid payments will be reduced unless otherwise stated. Please note that the final 2011-12 State Budget (chapter 59 of the 2011 Laws) authorizes alternative methods to achieve proportionate savings. To view payments affected by reduction, select here. |
| 2 | What services are exempt from the reduction in accordance with the statue? | To view services exempt from the reduction, select here. |
| 3 | Will provider rates be revised to reflect the 2% Across the board reduction? | No, provider rates of payment will not be revised. NYS statute requires that aggregate payments be uniformly reduced by the 2% amount. The reduction will not be at the claim level nor will any specific claim be adjusted. |
| 4 | Will payees ever be reimbursed for these adjustments? | In accordance with the statue payees will not be reimbursed for the 2% reduction. |
| 5 | If the primary insurer on a claim for clients with dual eligibility is Medicare or other third party payer, which are exempt from the reduction, is the copay and/or deductable paid by Medicaid exempt as well? | All Medicaid payments including copays and deductibles are affected by the 2% reduction unless specifically listed as exemptions. |
| 6 | Is there more detail available concerning what Medicaid programs are affected by the 2% payment reduction? | Yes, please refer to the Medicaid Redesign Phase 1 Work Plan link below for more information on implementation, and for a list of Medicaid programs affected by the 2% Payment reduction. The 2% Across the Board initiative is number 4651-B within the project work plan:Redesigning New York´s Medicaid |
| 7 | Can I get a copy of the State Plan Amendments (SPA) affected by the 2% Across the Board payment reduction? | Yes, copies of the approved 2011 state plan as well as the 2013 updated plans (13-20, 13-21 and 13-22) are available on the State plan ammendment website. |
| 8 | Will Medicaid administrative payment to local social services districts be reduced by 2%? | No, payments to local districts are not subject to the 2% reduction. |
| 9 | Where can I get a more detail list of specific services subject to the 2%? | For a more in-depth list of services please view the proposed and approved state plan amendments. The State plans are available on the Department´s Medicaid State Plan website. Please see SPA 13-20, 13-21 and 13-22 for 2013. A a list may also be found on the 2% ATB Home page. |
| 10 | Will the 1099 tax form reflect the net pay or the actual check amount received because of the 2% reductions? | The 1099 tax form will reflect the check amount (the net pay minus the 2%) |
II. Mental Hygiene Services
| Question Number | Question | Answer |
|---|---|---|
| 1 | Will the 2% reduction apply to programs that operate under the State´s Mental Hygiene agencies (OPWDD, OMH, OASAS) and Department of Health. | In accordance to Statute, Medicaid payments pursuant to article 31, 32, and 16 are exempt with some exceptions. Please refer to the April 2013 - March 2015 section for further details. |
| 2 | Does the 2% Across the Board Reduction apply to the Article 31 mental health clinic services, Article 32 Part 822 chemical dependence clinic services or OPWDD Medicaid Service Coordination? | The 2% Across the Board Reduction does not apply to Article 31 mental health clinic services, Article 32 Part 822 chemical dependence clinic services and OPWDD Medicaid Service Coordination. |
III. Reduction Implementation
| Question Number | Question | Answer |
|---|---|---|
| 1 | When will payments begin to be reduced? | Payments made for dates of service on or after April 1, 2011 will be reduced starting November 3rd, 2011. |
| 2 | How long will payments be reduced? | The payment reduction has been extended and will continue for payments made for dates of service through March 31, 2015 (regardless of date of payment). |
| 3 | Will this payment reduction be for Date of Payment or for Date of Service? | The payment reduction will be for dates of service on or after April 1, 2011. |
| 4 | Will payees be notified of the amount of payment reduction? | Yes, the Medicaid check or EFT amount will reflect the 2% reduction. Paper remittances will display the actual reduction amount as a recoupment identified by Financial Reason Code "FC2" and the corresponding description of "state mandated payment reduction". Similarly, the 835 electronic remittances will carry the reduction amount in the PLB segment with the qualifier J1. |
| 5 | My payment was reduced by less than 2%. Why? | Your payment may have been funded by a combination of appropriations, some exempted from by the reductions, while others are not exempted. Only the non-Federal State Funds portion of the payment appropriated in the Aid to Localities category is subject to the 2% reduction. |
| 6 | My payment was reduced by more than 2%. Why? | Reductions are limited to 2%. There are, however, many additional reasons why payments are reduced: retro rate adjustments, negative balances, audits, levies, etc. The claim may have been subject to one or more of these, in addition to the across the board reduction. Remittance statements detail the specific reductions. |
| 7 | How is the State going to handle cases where reimbursement rates change and the 2% has been applied to the old rate? Will the payment difference be accounted for since the 2% to date has been calculated based on the original payment amount? | The State has implemented into the system a process to generate an offset payment to account for the correct amount of the 2% reduction related to the retroactive rate changes. Retroactive rate changes will continue to be processed as they always have with this minor adaption. |
IV. Retro-Adjustments
| Question Number | Question | Answer |
|---|---|---|
| 1 | Will the State retroactively reduce payments back to the April 1, 2011 effective date? And If so how will this be calculated? | Yes, the State will do a retroactive adjustment back to the April 1, 2011 effective date. As additional information becomes available it will be posted on the website. |
| 2 | If the 2% reduction is inadvertently applied to claims which are on the exempt list, how will this be handled? | If payments to providers were reduced for exempted clients or exempted categories, DOH will separately identify the providers and claims inadvertently reduced and periodically process manual adjustment payments to providers to restore the 2%. |
V. Pharmacy
| Question Number | Question | Answer |
|---|---|---|
| 1 | Will the Department be providing an analysis report of the retroactive ATB reduction related to Pharmacy services? | Once the Pharmacy retroactive amounts are established, reports for Pharmacy only will be available upon request. Please email ppno@health.state.ny.us and a report from pharmacy will be provided as soon as they are available. |
| 2 | Will the Department further explain the alternative proposals that will be used to meet the balance of the pharmacy reduction? | The pharmacy program achieved commensurate savings for generic drugs through an enhanced SMAC initiative intended to optimize the scope and cost effectiveness of the existing SMAC Program. For more information, please see the pharmacy methodology. |
VI. Specific Service Details
| Question Number | Question | Answer |
|---|---|---|
| 1 | Are Preschool Supportive Health Services and School Health Services exempt? | Yes, Supportive Health Services Program and Preschool Supportive Health Services Program settlement agreement and Payments to providers for Preschool Supportive Health Services and School Supportive Health Services under the current rates are EXEMPT from the 2% reduction. |
| 2 | Are Durable Medical Equipment (DME)/Medical supplies included in the 2% ATB Payment Reduction? | Yes, DME/medical supplies are subject to the 2% payment reduction. For a more in-depth list of services please view the non-institutional services Medicaid State Plan Amendment 11-72, page A(5), item Y at: New York State Medicaid Plan Proposed and Approved State Plan Amendments. |
| 3 | Does the 2% Across the Board Reduction apply to medical transportation, ambulance, ambulette and taxi services? | Yes, the 2% Across the Board Reduction applies to medical transportation, ambulance, ambulette and taxi services. |
| 4 | Does the 2% Across the Board Reduction apply to freestanding clinic services? | With the exception of Methadone Maintenance Treatment Programs, the 2% Across the Board Reduction does not apply to free-standing clinic services because commensurate savings will be achieved through an alternative method. |
| 5 | Does the 2% reduction apply to Case Management Services? | The 2% reduction applies to the following case management services:
|
| 6 | Is there an exemption for Nursing Services provided to Medically Fragile Children (under 21 years old)? What impact does the 2% ATB payment have on the 30% Medicaid Reimbursement Fee for Medically Fragile Nursing Services? | There is no exemption for Nursing Services provided to Medically Fragile Children (under 21 years old). The 2% ATB reduction does not affect the reimbursement methodology it is applied against the facility aggregate payment. |
| 7 | Are hearing aids supplies and services subject to the 2% Medicaid payment reductions? | Yes, hearing aids, supplies and services are subject to the 2% payment reduction. For a more in-depth list of services please view the non-institutional services Medicaid State Plan Amendment 11-72, page A(5), item Y at: New York State Medicaid Plan Proposed and Approved State Plan Amendments. |
VII. Supplemental Payments
| Question Number | Question | Answer |
|---|---|---|
| 1 | Are supplemental payments that are not paid through eMedNy claims subject to the 2% Across the Board reductions? | Yes, Offline supplemental payments where the non-federal share is funded with State dollars are subject to the 2% Across the Board payment reductions. Some examples are Voluntary Hospital UPL payments and Hospital Disproportionate payments. |
VIII. Waiver Services
To be added
| Question Number | Question | Answer |
|---|---|---|
| 1 | Does the 2% Medicaid payment reduction apply to waiver programs? | The final 2013-14 State Budget authorizes alternative methods be considered to achieve proportionate savings. The following describes each waiver program´s DOH approved path to achieve commensurate savings.
|
