Partnership Plan Waiver Renewal July 2011

CENTERS FOR MEDICARE & MEDICAID SERVICES
EXPENDITURE AUTHORITY LIST

NUMBER:        11–W–00114/2

TITLE:              Partnership Plan Medicaid Section 1115 Demonstration

AWARDEE:      New York State Department of Health

Under the authority of section 1115(a)(2) of the Social Security Act, expenditures made by New York for the items identified below, which are not otherwise included as expenditures under section 1903 shall, for the period beginning August 1, 2011 until the ending date specified for each authority, be regarded as expenditures under the State´s title XIX plan.

The following expenditure authorities shall enable New York to implement the approved Special Terms and Conditions (STCs) for the New York Partnership Plan Medicaid section 1115 Demonstration.

  1. Demonstration–Eligible Populations. Expenditures for health–care related costs for the following populations that are not otherwise eligible under the Medicaid State Plan. (End Date: December 31, 2013.)
    1. Demonstration Population 5 (Safety Net Adults). Adults who were recipients of or eligible for Safety Net cash assistance.
    2. Demonstration Population 6 (Family Health Plus Adults with children). Parents and caretaker relatives of a child under age 21 who meet the eligibility criteria for Family Health Plus Program.
    3. Demonstration Population 7 (Family Health Plus Adults without children). Childless adults who meet the eligibility criteria for Family Health Plus Program.
  2. Home and Community–Based Service Expansion. Expenditures for home and community–based services identical to those provided under 1915(c) waiver programs entitled “Long–Term Home Health Care Program”, “Nursing Home Transition and Diversion Program” and “Traumatic Brain Injury Program” for Demonstration Population 9 (HCBS Expansion). Married medically needy individuals who have a community spouse and to whom the spousal impoverishment eligibility and post–eligibility rules under Section 1924 of the Act are applied. (End Date: March 31, 2014.)
  3. Family Planning Services. Expenditures for family planning services for Demonstration Population 8 (Family Planning Expansion Adults). Men and women of childbearing age with net incomes at or below 200 percent of the Federal poverty level who are not otherwise eligible for Medicaid and women who lose Medicaid eligibility at the conclusion of their 60– day postpartum period. (End Date: December 31, 2013.)
  4. Twelve–Month Continuous Eligibility Period. Expenditures for health–care related costs for individuals who have been determined eligible under groups specified in Table 1 of STC 18(d) for continued benefits during any periods within a twelve–month eligibility period when these individuals would be found ineligible if subject to redetermination. (End Date: March 31, 2014.)
  5. Medicaid Eligibility Quality Control. Expenditures that would have been disallowed under section 1903(u) of the Act based on Medicaid Eligibility Quality Control findings. (End Date: March 31, 2014.)
  6. Facilitated Enrollment Services. Expenditures for enrollment assistance services provided by organizations that do not meet the requirements of section 1903(b)(4) of the Act, as interpreted by section 438.810(b)(1) and (2). Inasmuch as these services may be rendered by MCOs and therefore included in the MCOs´ capitation payments, no expenditures other than these payments may be submitted for FFP. (End Date: March 31, 2014.)
  7. Designated State Health Programs Funding. Expenditures for the designated state health programs specified in STC 44 which provide health care services to low–income or uninsured New Yorkers in an amount not to exceed $477.2 million over the demonstration period. (End Date: December 31, 2014.)

All requirements of the Medicaid program expressed in law, regulation, and policy statement, not expressly identified as not applicable in the list below, shall apply to Demonstration Populations 6, 7, and 8 beginning August 1, 2011 through December 31, 2013.

Title XIX Requirements Not Applicable to Demonstration Populations 6 and 7:

Amount, Duration, and Scope                                                                                 Section 1902(a)(10)(B)

To enable the State to provide a more limited benefit package to Family Health Plus enrollees.

Cost Sharing                                                                                                                Section 1902(a)(14)

To enable the State to charge more than nominal co–payments for Family Health Plus enrollees.

Retroactive Eligibility                                                                                                 Section 1902(a)(34)

To enable the State to exclude Family Health Plus enrollees from receiving coverage for up to 3 months prior to the date that the application for assistance is made.

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)              Section 1902(a)(43)

To exempt the State from furnishing or arranging for EPSDT services beyond those available under otherwise covered benefits for Family Health Plus enrollees who are 19 or 20 years old.

Title XIX Requirements Not Applicable to Demonstration Population 8:

Methods of Administration: Transportation                                                         Section 1902(a)(4) insofar as it incorporates 42 CFR 431.53

To the extent necessary to enable the State to not assure transportation to and from providers for family planning expansion program recipients.

Amount, Duration, and Scope                                                                                       Section 1902(a)(10)(B)

To the extent necessary to enable the State to provide a benefit package consisting only of approved family planning and family–planning related services and supplies.

Prospective Payment System for Federally                                                              Section 1902(a)(15) Qualified Health Centers and Rural Health Clinics

To enable the State to establish reimbursement levels to these clinics that would compensate them solely for approved family planning and family–planning related services and supplies.

Eligibility Procedures                                                                                                        Section 1902(a)(17)

To the extent necessary to enable the State to not include parental income when determining the eligibility of a minor (an individual under age 18) for the family planning expansion program.

Eligibility Redetermination                                                                                                Section 1902(a)(19)

To enable the State to exempt women, who are eligible for the family planning expansion program under this demonstration by virtue of losing Medicaid eligibility at the conclusion of their 60–day postpartum period (SOBRA women), from reporting changes in income during their 12–month eligibility period, and to allow the State to terminate eligibility for these women at the conclusion of this 12–month period.

Retroactive Eligibility                                                                                                          Section 1902(a)(34)

To enable the State to exclude family planning expansion program recipients from receiving coverage for up to 3 months prior to the date that the application for assistance is made.

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)                      Section 1902(a)(43)

To exempt the State from furnishing or arranging for EPSDT services for family planning expansion program recipients.

Demonstration Approval Period: August 1, 2011 through December 31, 2014