Status of original 274 ideas distributed to MRT on Feb. 9

  • Proposal is also available in Portable Document Format (PDF)

Current Status of Feb. 9, 2011 Proposals

DRAFT – Proposals are neither endorsed nor opposed by the Executive.

Proposal # Feb 24th Status Short Title Proposal Description
1 Not Reform Increase the Health Facility Cash Assessment Rates Increases health facility cash assessment percentages (additional revenue to fiscal plan) for hospital inpatient, nursing home, & home care services. These increases are not Medicaid reimbursable.
2 Merged with 4652 Reduce and Control Utilization of Personal Care Services Eliminate Level I personal care services and implement provider‐specific aggregate annual per patient spending limits that are at approximately the 2006 per recipient spending level.
3 Long Term HCRA Streamlining Imposes a uniform surcharge for both Medicaid and private payers; eliminates hospital based physician surcharge; and clarifies other administrative complexities.
4 Not Reform but Savings Inc. Eliminate 2011 Trend Factor (1.7%) Eliminate the 1.7% 2011 trend (inflation) factor for Hospital Inpatient & Outpatient, Nursing Home, Home Care, & Personal Care Services as of 4/1/2011.
5 Still in Package Reduce and Control Utilization of Certified Home Health Agency Services This proposal will implement provider‐specific aggregate annual per patient spending limits on CHHA (Certified Home Health Agencies) services that are at approximately the 2006 per recipient spending level.
6 Not Reform, but Savings Included Reduce MC / FHP Profit (from 3% to 1%) Reduce the underwriting gain used in calculating premium rates from 3% to 1.0% for the Medicaid and Family Health Plus managed care programs.
7 Merged with 2 Elimination of the Personal Care Benefit for Persons who are not NH Certifiable Eliminate the Personal Care benefit for persons who are not Nursing Home eligible.
8 Not Reform but Savings Inc. Eliminate Managed Care, Family Health Plus and Child Health Plus Premium (1.7%) Reduce the projected increase to Managed Care rates by 1.7% as of 4/1/2011.
9 Merged with 89 Eliminate All Targeted Case Management for MC Enrollees Eliminate Medicaid coverage for Targeted Case Management Services for recipients that are in Medicaid Managed Care Plans.
10 Still in Package Eliminate Direct Marketing of Medicaid Recipients and Facilitated Enrollment activities by Medicaid Managed Care Eliminate funding included in Medicaid and FHPlus premiums for direct marketing of Medicaid recipients and facilitated enrollment activities for Managed Care in all counties.
11 Still in Package Bundle Pharmacy into Medicaid Managed Care Move the NYS Medicaid Pharmacy program under the management of Medicaid Managed Care to leverage additional clinical and fiscal benefits.
12 Not Reform Reduce/Redirect Indirect Medical Education (IME) Payments Reduce IME teaching factor from 4.2% to 3.0%, bringing it closer to empirical value of 1.2%, & providing fiscal plan relief while redirecting funds to health home (18M 11/12, 80M 12/13, 108M 13/14).
13 Still in Package School Supportive Health Services Program (SSHSP) Cost Study Increase Federal Medicaid Funding by determining actual costs incurred by school districts and counties providing School Supportive Health Services.
14 Still in Package Restructure Reimbursement for Proprietary Nursing Homes Eliminate the "return on" and "return of" equity and residual reimbursement provided in the capital nursing home rate for proprietary nursing homes.
15 Still in Package Rebuild NY Preferred Drug List (Expanded in New Package to Comprehensive FFS Reforms) Change the way the preferred drug list is developed, in order to increase savings.
16 Not Reform Implement Pricing Reimbursement Methodology for NHs Implement a Statewide pricing methodology for nursing homes, adjusted for differences in labor costs and case mix and includes multi‐year transition pool to smooth impacts.
17 Still in Package Select reductions in fee‐for‐service dental payment Fee‐for‐service dental payments will be reduced to match rates paid by managed care providers on high volume dental procedures.
18 Still in Package Eliminate spousal refusal. Eliminate the loophole that allows legally responsible relatives (spouse, parent) to refuse to financially support them in order for the other relative (spouse, child) to obtain Medicaid.
19 Long Term Eliminate D&TC Bad Debt and Charity Care Eliminating the DTC indigent care pool and the HCRA funds will produce additional HCRA revenue which can be redirected to other purposes.
20 Not Reform Eliminate State Grant Payments to Major Academic Hospitals Eliminate state only grant payments to major academic hospitals.
21 Still in Package Streamline the Processing of Nursing Home Rate Appeals Continue the cap on the annual $ amount of rate appeals to be processed; permanently authorize the Department to prioritize and streamline appeals processing by entering into negotiated settlements.
22 Merge with 29 Pay Ambulette Dialysis Equivalent Rate to Adult Day Health Care Adjust reimbursement fee for ambulette transportation to/from dialysis treatment to the fee paid for adult day health care ambulette transportation.
23 Not Reform Coverage for Dental Prosthetic Appliances Eliminate or limit coverage of dentures for adults.
24 Still in Package Payment for Enteral Formula with Medical Necessity Criteria Limit coverage of enteral formula to individuals who cannot obtain nutrition through any other means.
25 Still in Package APG base rate withhold for physicians carve out Remove physician‐related reimbursement from hospital APG payment rate structure.
26 Still in Package Utilization Controls on Behavioral Health Clinics Reduce payment for excessive clinic utilization by establishing two outlier threshold visit levels upon which payments are reduced by a fixed percentage.
27 Long Term Eliminate Empire Clinical Research Investigator Program (ECRIP) Funding Eliminate funding for the Empire Clinical Research Investigator Program.
28 Merged with 15 Implement a Voluntary Mail Order Program Create a mail order pharmacy benefit for maintenance drugs, to take advantage of higher discounts.
29 Still in Package Accelerate Transportation Manager Contracts (In New Package Comprehensive Transportation Reforms) Accelerate DOH's procurement of regional transportation management contracts in the Hudson Valley, NYC, and other related common medical marketing areas using authority provided by 2010‐11 budget.
30 Still in Package align Payment for Prescription Footwear with Medical Necessity Revise the Medicaid footwear benefit coverage criteria and payment methodology, reducing over utilization and administrative burden.
31 Still in Package Eliminate worker recruitment and retention The Worker Recruitment and Retention add‐on to Medicaid rates will be eliminated due to the significant investment in ambulatory care rates through the implementation of APGs.
32 Merged with 15 Prior Authorization for Exempt Drug Classes Allow prior authorization under the Preferred Drug Program (PDP) for the following drug classes: anti‐depressants, atypical anti‐psychotics, anti‐retrovirals and immunosuppressants.
33 Long Term Chemical Dependence Inpatient Rehabilitation (IPR) Redesign to Enhance FFP Move inpatient rehabilitation services from fee‐for‐service to managed care to lower rates and to allow the State to pursue increased federal funding for these services.
34 Still in Package Establish Utilization Limits for PT, OT, and Speech Therapy/Pathology Establish Utilization Limits for Physical Therapy, Occupational Therapy, Speech Therapy and Speech Language Pathology.
35 Dropped Prescription Limitation to 5/month Limit the number of brand name prescriptions that a beneficiary could receive to five (5) per month.
36 Long Term Contract Dental Management Vendor for FFS & MMC Centralize all dental and orthodontic benefit administration for all Medicaid beneficiaries with a dental benefits management vendor.
37 Still in Package Eliminate Case Mix Adjustment for AIDS Nursing Services in Certain Long Term Care Settings Eliminate CMI adjustment for AIDS Nursing Services in the Certified Home Health Agency and Long Term Home Health Care Program.
38 Merge with 29 Remove Transportation as a Covered Benefit from Managed Care Plans Carveout transportation from the Medicaid managed care organization benefit package, to reduce costs and medical provider administrative burdens through state transportation management initiatives.
39 Not Viable Comprehensive Hemophilia Treatment Centers w/factor programs Obtain blood factor products from Hemophilia Treatment Centers (HTCs), so that Medicaid can access 340B rates.
40 Merge with 200 Allow LPNs to do assessments in LTC settings Modify the education law to would allow LPNs to do assessments on resident conditions.
41 Still in Package Eliminate and Reprogram Area Health Education Center (AHEC) Funding Reprogram current Area Health Education Center Funding (AHEC) funding for a new Public Health Services Corp. initiative.
42 Still in Package Limit Medicaid coverage for compression stockings Limits Medicaid coverage for stockings to the Medicare criteria and includes coverage during pregnancy.
43 Merged with 15 Eliminate Part D Drug Wrap in Medicaid Eliminate Medicaid coverage and reimbursement of drugs that are available to Medicaid/Medicare dual eligible beneficiaries through their Medicare Part D plans.
44 Not Reform Limit Payment for Podiatry to Qualified Medicare Beneficiaries (QMBs) and Recipients under 21 Limit reimbursement for podiatry to Qualified Medicare Beneficiaries (QMB) and recipients under 21.
45 Not Reform Discontinue HIV Specialty Pharmacy Reimbursement Eliminate the HIV Specialty Pharmacy designation and the associated higher reimbursement rate.
46 Merge with 147 Reimburse for Observation Services in Hospital Reimburse for Observation Services in Hospital, may result in decreased inpatient admission.
47 Merged with 15 Allow Denials for Clinical Drug Review Program Amend existing legislation to allow Clinical Drug Review Program (CDRP) prior authorization requests to be denied when clinical criteria are not met.
48 Merged with 15 Enhance NYS Leverage for Direct Supplemental Rebates Allow the Commissioner of Health more flexibility when directly negotiating with drug manufacturers in seeking higher supplemental rebates.
49 Still in Package Reimburse Art 28 clinics for HIV counseling/testing using APGs Incorporate Medicaid payment to Article 28 clinics for HIV counseling and testing services into the Ambulatory Patient Group(APG) payment structure.
50 Long‐term Create a new Medicaid model of care for the existing AIDS Adult Day Health Care program Establish and pay for a less‐intensive AIDS adult day health care service which would be reimbursed at a lower rate than is currently being paid.
51 Not Reform Limit Coverage of Eyeglass Replacement Limit eyeglass replacement once every 24 months.
52 Merged with 15 Tightening The Early Refill Process Tighten up requirements for obtaining authorization to fill a prescription when it is denied because it has been "refilled too soon."
53 Long Term Revise Inpatient Detox Reimbursement to Incentivize Step‐ Down Care Change reimbursement for medically managed withdrawal (detoxification) to incentivize shorter lengths of stay.
54 Still in Package Adjust 340B Drug payment in 340B‐eligible clinics via APGs Adjust payment downward for 340B Drugs in 340B‐eligible clinics, under APGs.
55 Still in Package Increase coverage of tobacco cessation counseling Expand existing tobacco cessation counseling coverage in Medicaid to include all women (not only pregnant women) and men.
56 Merge with 1451 Amend Nursing Home Transition Diversion Waiver to Replace Aggregate Cap with Individual Cap Changes waiver structure to move from aggregate cap to individual cap.
57 Merged with 15 Limit opioids to a four prescription fill limit every thirty days. Limit opioid prescriptions to a four prescriptions fill limit every thirty days for Medicaid beneficiaries.
58 Merged with 15 Designate Preferred Status for Therapeutic Classes Accelerate the collection of supplemental rebates by allowing the Commissioner of Health to designate certain drugs/therapeutic classes as preferred until the Pharmacy and Therapeutics Committee may review.
59 Merge with 1451 Clinical Advisory Committee on Health & Emerging Technologies (CACHET) Create a group of clinical experts to review current Medicaid benefits and technology coverage policies.
60 Still in Package Delink Workers Compensation and No Fault Rates from Medicaid Delink Worker's Compensation and No Fault (WCNF) rates from the Medicaid fee‐for‐service (FFS) inpatient rates.
61 Still in Package Home Care Worker Parity ‐ For Certain Long Term Care Settings Require as a condition of provider enrollment in the Medicaid program that all Certified Home Health Agencies, Long Term Home Health Care Programs, and MLTC to comply with any local living wage law.
62 Merge with 147 IDA Financing Propose legislation to allow Industrial Development Agencies to provide financing for health care facilities, including hospitals, nursing homes, assisted living, retirement communities and Continuing Care Retirement Communities (CCRCs).
63 Long Term Reimbursement for dedicated preconception visits Establish reimbursement for a preconception visit for all women and adolescents.
64 Long Term Provide direct reimbursement for NPs and PAs in clinics. Provide direct reimbursement for Nurse Practitioners and Physician Assistants in clinics.
65 Merge with 104 Eliminate copays for some preventative services The ACA provides 1% additional Federal Financial Participation (FFP) to states that eliminate copayments for select preventative services. FFP increase partially offsets the copay loss.
66 Not Reform Revise Indigent Care Pool Distributions to align with Federal Reform Reduce payment & revise Indigent Care methodology consistent with Federal reform. Option for safety net hospital pool under consideration.
67 Still in Package Assist preservation of essential Safety‐net Hospitals Provide operational and restructuring assistance to safety net hospitals to make critical decisions to either close, merge or restructure.
68 Still in Package Repatriate Individuals in out of state placements This proposal will identify spending on out‐of‐state placements and seek to repatriate these individuals.
69 Still in Package Uniform Assessment Tool (UAT) for LTC This proposal will implement a Uniform Assessment Tool (UAT) for long term care.
70 Still in Package Expand current statewide Patient Centered Medical Homes‐ PCMH Expand the current Statewide Patient Centered Medical Home Program (PCMH) to more payers and broader patient participation.
71 Merged with Proposal 15 Address several issues related to unused medications Ensure the appropriate disposal and/or return of unused medications by long term care facilities and require that unused medications be credited back to the Medicaid program.
72 Merged with 14 Provide Capital Reimbursement for Facilities at End of Useful Life Effective 4/1/09, current law allows the capital rate for proprietary NHs at the end of their useful lives to be adjusted to reflect projects that protect safety of patients or convert beds to an alternative LTC use
73 Long Term Reimburse Local Health Departments for environmental lead investigations for children Implement Medicaid reimbursement to local health departments for investigation and care coordination services provided to children with elevated blood lead levels.
74 Long Term Increase Medicaid payment for vaccine administration. Increase Medicaid immunization administration fees for adults.
75 Merged with 154 Evaluate reimbursement for patients with needs inconsistent with the billed level of care. Use evidence‐based utilization reviews to identify patients whose needs do not support the billed level of care.
76 Merged with 89 Develop less intensive reimbursement model for HIV TCM Cover low intensity HIV Targeted Case Management in Medicaid.
77 Merged with 67 Provide Additional Financial Assistance to Financially Unstable NHs Provide additional funds for financially unstable nursing homes that is based on more current operating losses and require submission of restructuring plans to achieve financial stability.
78 Merged with 67 Hospital/Nursing Home Closure/Conversion Incentive Program Make supplemental funds available on a short‐term basis to assist the receiving hospital/nursing home when an area hospital/nursing home closes or consolidates.
79 Merged with 5 Implement Episodic Pricing for Certified Home Health Agencies Implement a CHHA Episodic Pricing methodology (which is similar to the Medicare Pricing Model) and is based upon 60‐day episodes of care and adjusts for case mix and labor costs.
80 Merged with 15 Reassess Prescription Drug Purchasing Policies Require the State to reassess prescription drug purchasing and to achieve additional savings by obtaining better supplemental rebates on drug purchases.
81 Long Term Implement Statewide Program to Encourage NHs to Refinance Mortgages Reduce nursing home capital costs by encouraging the refinancing of mortgages.
82 Still in Package Reduce Reimbursement for Potentially Preventable Conditions Establish a performance based payment system that reduces hospital reimbursement for potentially preventable conditions (such as bed sores and hospital acquired pneumonia).
83 Still in Package Require Screening Brief Intervention Referral and Treatment (SBIRT) in primary care and ER Provide screening, intervention and referral to treatment (SBIRT) for alcohol/drug use in primary care and ER.
84 Long Term Pay on P4P basis (LTC) This proposal will pay nursing homes and other institutions on a Pay for Performance basis. This may include community based and/or provider specific performance measures.
85 Long Term Pay providers on Pay for Performance (P4P) basis (Ambulatory Care) Pay providers on Pay for Performance (P4P) basis (Ambulatory Care). May include community based and/or provider specific performance measures.
86 Long Term Pay on P4P basis (Behavioral H/IDD) Pay providers on Pay for Performance (P4P) basis (Behavioral Health). May include community based and/or provider specific performance measures.
87 Long Term Reduce Unnecessary Hospitalizations ‐ Community Based Pay for Performance Implement a community based pay for performance (P4P) payment system reform that provides financial incentives to providers to reduce unnecessary hospital admits and readmits thereby lowering cost and improving quality.
88 Long Term Incentivize providers to screen for BH issues in children Pay performance incentives for primary care screening for developmental and mental health problems in children.
89 Still in Package Health homes for high cost/high need enrollees Address High cost, high need patient management through the provision of care coordination (health home) services funded with 90% federal financial participation through the ACA.
90 Still in Package Mandatory Enrollment in MLTC Plans/Health Home Conversion Transition Medicaid recipients age 21 and older in need of community‐based long term care services into Managed Long Term Care (MLTC) plans.
91 Long Term Carve In for Behavioral Health Services into Managed Care Change the Medicaid managed care benefit package to expand the scope of behavioral health services provided by plans to their members.
92 Merged with 1458 Allow Restricted Recipient Program in Managed Care Authorize the Department of Health (DOH) to allow recipients in the Recipient Restriction Program (RRP) to enroll in Medicaid Managed Care.
93 Still in Package Implement Regional Behavioral Health Organizations Contract with regional Behavioral Health Organizations to manage the behavioral health benefit for Medicaid members.
94 Merged with 154 Increase HIV related utilization Reviews Increase utilization reviews for HIV inpatient services, outpatient services provided in hospitals and community health centers, and other HIV‐related services.
95 Merged with 1458 Include Personal Care Benefit in Managed Care Require Medicaid managed care plans to cover personal care services in the benefit package.
96 Merged with 1458 Expand Managed Care Enrollment Authorize the Department of Health (DOH) to enroll additional non‐dually eligible Medicaid recipients into mainstream Medicaid managed care programs.
97 Merged with 70 Assigning Primary Care Providers to Medicaid Enrollees Assign Primary Care Providers to Medicaid Enrollees.
98 Merged with 1458 Streamline Managed care enrollment eligibility process Mandate selection of a Medicaid Managed Care plan as a condition of eligibility for Medicaid.
99 Merged with 1458 Access to services not covered by managed care Require that managed care enrollees receive information pertaining to coverage denials and how to access carved out services.
100 Merged with 1458 Enroll Non‐dual eligible nursing home residents into Medicaid managed care Require enrollment of all non‐dual eligible nursing residents into Medicaid managed care plans which would capitate the full range of health care services, including both acute and long term care services.
101 Still in Package Develop Initiatives for People with Medicare and Medicaid Develop revised reimbursement mechanisms for people who are dually eligible for Medicare and Medicaid.
102 Still in Package Centralize Responsibility for Medicaid Estate Recovery Process Authorize statewide responsibility for making Medicaid recoveries from the estates of deceased recipients, in personal injury actions and in legally responsible relative refusal cases.
103 Still in Package Reduce Inappropriate Use of Certain Services Institute financial disincentives to reduce inappropriate use of C‐sections, Coronary Artery Bypass Grafts (CABG) and Percutaneous Coronary Intervention (PCI).
104 Still in Package Increase Enrollee Copayment Amounts Increase the enrollee copayment amount, services that co‐pays apply to, and the annual co‐pay capped amount.
105 Not Viable Consolidate patient visits Eliminate payment for separate reimbursement where patient care can take place in one visit.
106 Merged with 89 Guidelines for Medicaid Reform Develop Guiding Principles for Medicaid Redesign.
107 Long Term Medicaid patient co‐pay tax deduction or credit Allow relatives (e.g., adult children) of Medicaid nursing home recipients to contribute toward the cost of their care in return for a tax credit/deduction.
108 Merged with 104 Educate and Incentivize Beneficiaries to appropriately use ERs/Urgent Care Centers Educate and Incentivize Beneficiaries to appropriately use primary care providers, when Emergency Room/Urgent Care is not warranted.
109 Still in Package Patient Centered Palliative Care Assure access to palliative care and pain management services for people with advanced, life‐limiting illnesses and conditions.
110 Long Term Promote the sugar sweetened beverage tax Create a consumer tax on all sugar sweetened beverages purchased in NYS; use revenue to fund various health initiatives.
111 Merged with 1462 Limit divestment and encourage private LTC insurance This proposal will create additional plan options for the Partnership for LTC insurance program.
112 Merged with 104 Use incentives to encourage urgent. care/primary care over Emergency Room Create financial incentives including differential copays to encourage Medicaid members to use urgent care/primary care instead of Emergency Room.
113 Not Viable Allow Nursing Homes to Intercept SSI Checks for Long Term NH Stays Encourage nursing home to become representative for resident in order to intercept the Supplemental Security Income (SSI) payment in certain cases.
114 Merged with 1462 Expand public outreach for the Partnership for Long Term Care Create a fund to support marketing of Partnership for LTC Insurance
115 Merge with 200 Nursing/patient direction of HH and PC aides to assist w/ nursing care Permit nurses/patients (under their scope of practice/practice exemption) to orient/direct HHAs and PC workers to provide "nursing care" as nurses/patients are allowed with family members` and aides in the consumer directed program.
116 Still in Package Accelerate IPRO Review of Medically Managed Detox (Hosp) and including Ambulatory Reviews Refocus Island Peer Review Organization (IPRO) reviews of medically managed withdrawal cases based on DRG rates and ambulatory visits based on the new APG billing procedures.
117 Long Term Review Coler & Goldwater Memorial Hospital Rates Reduce reimbursement to Coler‐Goldwater Specialty Hospital from current per diem to facility's alternate level of care payment for patients with HIV for whom a lower level of care is more appropriate.
118 Merged with 1451 Establish a new home and community‐based 1915(c) Medicaid Waiver Consolidate Long Term Home Health Care Program and Nursing Home Transition Diversion into one comprehensive waiver.
119 Long Term Enhance School Based Health Services care to reduce Emergency Room usage Enhance School Based Health Services primary care services to reduce Emergency Room usage.
120 Long Term Move people out of OMH institutions Establish regional forums to bring mental health agencies and housing agencies together to discuss how to give participants appropriate levels of care.
121 Still in Package County/State Nursing Home Governance Flexibility Create a public authority that State or County nursing homes can join.
122 Long Term Seek Federal Recognition under ACAs Balancing Incentive Payments Program Seek recognition under ACA's Balancing Incentive Payments Program. States who effectively expand the delivery of care via home and community based services are eligible for a 2% increase in FMAP.
123 Long Term Streamline ALP admission process Streamline ALP admission process by amending State Law.
124 Long Term Create and deploy a permanent, revolving Primary Care Capital Access Fund (PCCAF). Implement a one‐time HEAL grant of $31 million to create and deploy a permanent, revolving Primary Care Capital Access Fund (PCCAF).
125 Long Term Bonus for high volume Medicaid physicians Pay a bonus to Medicaid Primary Care Physicians doing a higher volume of care to Medicaid patients to assure continued access to primary care services after implementation of any across the board cut.
126 Merged with 67 Bed Exchange Proposal Provide hospitals with financial incentives to voluntarily reduce staffed bed capacity and redirect Medicaid resources to expand outpatient/ambulatory surgery capacity.
127 Long Term Revise Transitional Care Unit Policy Revise Transitional Care Unit policy to allow greater use of these units.
128 Long Term Allow Long Term Home Health Care Providers to offer Hospice This proposal will seek federal approval to allow Long Term Home Health Care Programs to offer hospice services without requiring that patients disenroll from Long Term Home Health Care Program.
129 Still in Package Use State's Authority to Supervise Integration of Health Services and Providers to Minimize Anti‐Trust Exposure State supervision of implementation of Health system reform strategies, (such as medical homes and accountable care organizations), that seek to improve quality, efficiency, and outcomes through increased coordination and integration.
130 Merge with 200 Allow Nurse Practitioners to sign Medical Evaluations for ACF/AL admissions Amend the Social Services Law to allow nurse practitioners to sign Medical Evaluations for ACF residents.
131 Still in Package Medical Malpractice Reform and Patient Safety Create a neurological infant medical indemnity fund, cap non‐economic damages in addition to exploring alternatives such as disclosure and early settlement and judge directed negotiations.
132 Still in Package Expand the Definition of Estate Expand definition of "estate" to include assets that bypass probate in order to recover more assets from a deceased Medicaid recipient over age 55.
133 Still in Package Administrative Renewal for Aged and Permanently Disabled Allow aged and permanently disabled with fixed incomes to be automatically renewed based on cost of living increases.
134 Still in Package Audit of Cost Reports (rather than certification) Contract with independent certified public accounting (CPA) firms licensed in NYS to conduct annual field and desk audits of the Institutional Cost Reports (ICRs).
135 Long Term Flexibility to Convert/Establish Urgent Care Centers Support development of urgent care centers by developing a rate of payment for freestanding emergency services clinics.
136 Long Term Eliminate 60/30 Day Notice Requirement Eliminate the current requirement to provide 60 day or 30 day notice to providers of the proposed Medicaid rates for a future period.
137 Still in Package Disregard retirement assets such as 401K plans for MBI‐WPD As an incentive to participate in the MBI‐WPD program raise the resource standard and disregard retirement accounts.
138 Merge with 200 Eliminate restrictions on nursing practice in Adult Care Facilities Eliminate the restrictions on nurses' ability to function consistent with their scope of practice in adult homes, rather than requiring other nurses (not practicing in the adult home) to perform these basic duties.
139 Still in Package Implement the new waiver for Long Term Home Health Care Program Implement the new enhancements of the Long Term Home Health Care Program waiver, initiating the opportunities for increased Medicaid cost‐savings and performance.
140 Long Term Fast Track Eligibility for Long‐term Care Utilize electronic verification of resources instead of presumptive eligibility.
141 Still in Package State Assumption of Medicaid Administration Centralizing administration of Medicaid to improve efficiency, uniformity, and cost savings in program administration.
142 Long Term Eliminate Barriers to Recruiting and Retaining Healthcare Workforce. Eliminate barriers to retention and recruitment of needed health care workers, including physicians, nurses, and allied health care professionals.
143 Long Term Continue improvements in State CON Program Department will pursue alternatives approaches to architectural reviews and pre and post opening surveys ‐ this will proposal will also be referred to the SAGE Commission process.
144 Still in Package Eliminate Duplicative Surveillance Activities (Labs/psychiatry) Consolidate duplicative laboratory and hospital psychiatric surveillance currently conducted by Doha. This proposal will be referred to the SAGE Commission process.
145 Long Term Explore incentives for private, for‐profit hospitals to enter NY Explore incentives/regulatory or statutory relief for publically traded or for profit companies to assist in management of targeted provider restructuring, such as safety net hospitals.
146 Not Viable Distinct parts for Nursing Homes Eliminate the requirement that every nursing home bed in the State be a certified Medicaid bed.
147 Still in Package Collaborate to eliminate/modify unnecessary regulations There are a number of suggested initiatives that require both statutory and regulatory actions to reduce burdens on hospitals and other health care facilities and expand access to capital.
148 Long Term Reduce or eliminate the local County share of the Medicaid program Explore methods to reduce the local share contribution in Medicaid.
149 Long Term Eliminate the need for a Certified Home Health Agency in the Assisted Living Program Eliminate the requirement for a CHHA or Long Term Home Health Care Program to perform an assessment of the Assisted Living Program participants.
150 Still in Package Automate Eligibility Determinations and Verification Automate eligibility determinations and verifications.
151 Merge with 200 Extension of Medication Aides into Nursing Homes Permitting Medication Aides to administer medication in nursing homes under the appropriate supervision of medical and nursing staff.
152 Long Term Eliminate Private Right of Action for Nursing Homes Repeal 2801d of the Public Health Law which allows individuals to bring a private right of action against nursing homes.
153 Still in Package Develop innovative telemedicine applications by reducing regulatory barriers and providing payment incentives Provide payment incentives and reduce coverage barriers to promote and enhance coverage of telemedicine and telehealth/telehome monitoring services by providing payment incentives and reduce coverage barriers.
154 Still in Package Require Providers to Reconcile Exception & Conflict Reports Statewide Requires that all CHHAs and Personal Care providers statewide utilize a point of service verification vendor, and provide exception and conflict report data to the OMIG, which includes the identity of individual providers.
155 Merged with 154 Mandate Participation in the OMIG Cardswipe Program for all Pharmacies. Requires all pharmacies billing Medicaid to participate in the OMIG Cardswipe Program (landline).
156 Merged with 154 Medicare Coordination of Benefits with Provider Submitted Duplicate Claims This proposal would require the OMIG to review claims approved and paid by Medicare for dual eligible recipients, which are also submitted to Medicaid for payment, and refine existing edit logic to prevent such duplication.
157 Merged with 154 Require Medicare Enrollment for All Ordering Physicians of Home Health Services Require that physicians who order services for dually eligible individuals be enrolled in both Medicare and Medicaid consistent with Medicare Provider Enrollment, Chain and Ownership System (PECOS) requirements.
158 Long Term Requires use of BNE's online Dr. Shopper Program to curb prescription abuse Requiring that prescribers access BNE's on line Dr. Shopper Program before issuing prescriptions for controlled substances.
159 Long Term Each of the Medicaid agencies provides the OMIG with a list of providers which may need closer audit scrutiny Each of the Medicaid agencies provides the OMIG with a list of providers which may need closer audit scrutiny.
160 Merged with 154 Expand the OMIG Restricted Recipient Program Automatic mandatory restriction utilizing revised criteria for recipients without existing full clinical reviews by the State Medical Review Team.
161 Merged with 154 Other Pharmacy Actions (Restock / Re‐dispense, Narcotics Database, ID or Sign for Pharm.) Require the identification and signature for home delivery and receipt of prescriptions at pharmacies; requires pharmacies to restock and re‐dispense returned medications from nursing homes.
162 Not Reform Eliminate Medicaid Payments for Medicare Part B Co‐ insurance Medicaid will no longer reimburse physicians the Medicare Part B coinsurance amount for patients that have both Medicare and Medicaid coverage.
163 Long Term Seek Demonstration Funding to shift volume State Psych Hospitals to Voluntary Hospitals Apply for federal demo funds to shift some of the 4,000 inpatient mental health recipients from State Hospitals (Institutions for Mental Diseases) to voluntary hospitals.
164 Still in Package align Medicare Part B coinsurance with Medicaid coverage Eliminate Payments to Practitioners for Medicare Part B coinsurance for non‐reimbursable Medicaid services.
165 Not Viable Eliminate Funding for Part D Education and Outreach Eliminate State funding for Medicare Part D education and outreach.
166 Merged with 15 Dispense prescriptions for shorter durations in LTC facilities Require long term care (LTC) pharmacies to dispense medications in quantities less than 30 days to prevent waste associated with patient discharges, death or changes in medication.
167 Merge with 1029 Allow Administrative Renewals in the Medicare Savings Program New York has maximized enrollment in MSP. A remaining option is to allow administrative renewals.
168 Long Term ACA Implementation‐ Enact New York Health Insurance Exchange and Consolidate Regulation Authorize a New York Health Benefits Exchange in 2011 as a first step in implementing Affordable Care Act.
169 Long Term Assess Large Employers for Failing to Offer Affordable Coverage (Medicaid Dumping Fine) Assess a financial penalty on employers who do not offer affordable health insurance to their workers and whose workers are enrolled in Medicaid/Family Health Plus.
170 Merge with MRT 935 Change reimburse to pay for needs‐based elder care Create a payment reform work group composed of people with financial expertise in the provision of elder services.
171 Long Term Reduce Medicaid Reimbursement by 4% for All Services Across the board 4% cut.
172 Not Needed Sole‐source contract for eyeglasses Medicaid will enter into a sole‐source contract for the fabrication of eyeglasses for NYC recipients.
173 Long Term Impose Moratorium on Medicaid Rate Cuts Impose Moratorium on Medicaid Rate Cuts
174 Not Viable Federal Medicare reimbursement change Advocate for Federal reimbursement change.
175 Long Term Cost screens for OASAS inpatient rehabilitation programs Establish more detailed cost screens for chemical dependence inpatient rehabilitation programs. Currently, inpatient rehabilitation providers are reimbursed on a cost‐based rate. These rates vary greatly and it is proposed
176 Long Term Site‐specific Cost reporting Require all cost reports to be filed with site specific cost and unit detail.
177 Merged with 90 Reform Delivery and Reimbursement of Medicaid Services to Foster Care Children Revise Foster care per diem payment method and promote more accountable care delivery.
178 Long Term Reduce Spending & Phase‐out Long Term Home Health Care Program Phase out Long Term Home Health Care in counties with sufficient managed care term care capacity.
179 Long Term Establishing reimbursement for services delivered by community health workers. Establish community health workers as enrolled providers and develop a rate of payment in Medicaid.
180 Long Term Ensuring access to effective contraception and other family planning services Promote access to contraception and family planning services.
181 Long Term Coverage for obesity counseling/diabetes prevention services Implement Medicaid coverage of CDC‐recognized diabetes prevention programs.
182 Long Term Enhance coordination of benefits between Medicaid and the Women, Infants, and Children (WIC) Program. Require Medicaid members to utilize WIC benefits prior to using Medicaid paid services.
183 Long Term Submit a 1915i State Plan for home and community‐based services and supports for HIV Medicaid population. Apply for a 1915(i) state plan amendment to include wrap‐around support services to HIV‐infected Medicaid recipients who are at risk of progressing to nursing home eligible status.
184 Long Term Urge Congress to enact a single payer national health care system (H.R. 676) Advocate for a single payer system of care.
185 Long Term Prepaid Medicaid Services Pre‐purchasing of services for Medicaid.
186 Long Term Create and Enhanced Case Mix Adjustment for High Cost Patients with Complex Needs Create an enhanced CMI for high cost complex hard to place patients who are presently in more expensive care settings.
187 Long Term Incentivize to Promote Innovation and Reform Reimbursement innovation will reduce costs by changing incentives to increase the efficiency of care delivery and the cost‐ effectiveness of the health care workforce.
188 Long Term Revise Transitional Care Units (TCU's) Eliminate the authorization for the operation of TCU's in the state.
189 Not Viable Modernize Insurance Law Coverage of Home Care Modernize the insurance coverage benefit for home care to improve access to private coverage and reduce dependence on Medicaid.
190 Long Term Convert Fee‐for‐Service Long Term Home Health Care Program to a Case Payment Based Methodology Convert Fee‐for‐Service Long Term Home Health Care Program Reimbursement to a Case Payment Based Methodology
191 Still in Package Decrease the Incidence and Improve Treatment of Pressure Ulcers Decrease the Incidence and Improve Treatment of Pressure Ulcers through provider collaboration models.
192 Long Term Consolidate Low‐income Health Insurance Programs Consolidate and administer all NYS health coverage programs for low‐income individuals and families on a statewide basis, under one banner (e.g. Empire State Care).
193 Long Term Phase out of Healthy NY Terminate Healthy NY once insurance is available through the Exchange (2014). If done sooner for savings in 2012‐13, 170,000 lose coverage with no alternative.
194 Long Term Capitation Partnership Explore utility of partial and global capitation payment models in maintaining or reducing health care costs while improving patient care coordination.
195 Long Term Coordinate Services for Public Assistance Coordinate Services for Public Assistance ‐ reaching out for more information ‐ may be referred to SAGE.
196 Still in Package Supportive Housing Initiative Establish a supportive housing program to prevent inappropriate nursing home placement.
197 Long Term Reduce regional and provider variation in service efficiency and quality in the arena of Cardiac Surgery and Reduce regional and provider variation in service efficiency and quality in the arena of Cardiac Surgery and Percutaneous Coronary Intervention (PCI).
198 Not Viable Review limitations on use of bedrails in LTC facilities Evaluate Policies on bedrails and restraints.
199 Long Term More marketing of programs such as premium assistance and MBI‐WPD. Implement a marketing campaign for premium assistance and MBI‐WDP.
200 Still in Package Change in scope of practice for mid‐level providers to promote efficiency lower Medicaid costs. Need to more broadly define scope of practice for mid level practitioners and create expanded access to peer based services.
201 Long Term NH/ALP 6,000 Program Elimination Repeal authorization for additional 6000 Assisted Living Program (ALP) beds.
202 Long Term Expand Assisted Living Options for Medicaid‐Eligible Individuals Expand options for Medicaid‐eligible individuals to receive assisted living services, preventing nursing home placement at a greater cost to Medicaid.
203 Long Term Facilitate Enrollment In Federal CLASS ACT Promote and facilitate enrollment in the Community Living Assistance Services and Supports (CLASS ACT)
204 Merge with 196 Re‐establish the BH Housing Shortage Workgroup Re‐establish a multi‐stakeholder housing workgroup to make recommendations on housing shortages that impact patients with mental health, chemical dependency or developmental disabilities.
205 Long Term Improve access to care by utilizing Mobile Health Clinics Improve access to primary and preventive care via mobile clinics for the purpose of reducing the use of emergency departments for non‐emergent care.
206 Long Term Evaluation of Best Practices in Existing LTC Programs Evaluate the existing programs for managing patients in the community to determine best practices.
207 Long Term Establish the Center for Health System Innovation within the Dept of Health Referred to SAGE Commission for further development.
208 Long Term Accelerate State takeover of administration of Medicaid long‐term care programs. Centralize administration of waiver and other LTC programs which would lead to greater accountability and consistency of service authorization.
209 Still in Package Expand Hospice Explore options for expanding hospice in all appropriate settings.
210 Long Term Allow Nursing Homes to resize or develop non institutional alternatives with funding for transition The State to provide financial incentive and offset revenue loss to allow for the elimination of nursing home beds while providing individuals the ability to live in a less restrictive environment.
211 Not Viable Amend patient discharge regulations Amend existing regulations to allow nursing homes to discharge residents for the non‐ payment of the Net Amount Monthly Income (NAMI) and/or failure to provide funds to cover Medicare co‐insurance expenses.
212 Long Term Include Medicaid in Health Information Exchange (HIE) Support policy and technical solutions for health information exchange
213 Merge with 1058 Enhance support for family and other "informal" care givers Evaluate support option for family/informal care givers.
214 Long Term Downsize Nursing Homes through Incentives and Residential alternatives Downsize Nursing Homes through Incentives and Residential alternatives
215 Long Term Enhance Nursing Home Care Coordination Require NHs and MLTC plans in areas where they are available to enter into contractual arrangements to evaluate all potential admissions and to provide care coordination to all residents.
216 Long Term Expand Nursing Home Diversion to Long Term Home Health Care Program Enhance enforcement of section 367‐c of the social services law, which diverts nursing home‐eligible patients to home care.
217 Still in Package Create an office for development of patient‐centered primary care initiatives Create an office for development of patient‐centered primary care initiatives. Reinvest cost from other less critical functions into this office. Refer to SAGE process.
218 Long Term State Take Over and Enforce the Collection of NAMI State Take Over and Enforce the Collection of NAMI Presently facilities are forced to collect Net Available Monthly Income (NAMI) debt.
219 Long Term Advocate Changes to Federal EMTALA Rules Reforming the Emergency Medical Treatment And Labor Act (EMTALA) will decrease unnecessary emergency department care for patients whose conditions are not emergent, increasing efficiency and reducing costs.
220 Long Term Revise NH and HC Documentation Requirements Evaluate current document requirements to eliminate and/or streamline.
221 Long Term Administrative Simplification This proposal will be referred to the SAGE Commission.
222 Long Term Healthcare Information Technology Funding Pursue HIT Funding in consultation with Stakeholders.
223 Long Term Consolidate and create ONE agency who will regulate and oversee ALL Long Term Care needs. Create one agency for regulation and surveillance of Long Term Care. This proposal will be referred to the SAGE Commission.
224 Long Term Allow Electronic Fund Payments (EFT) in Medicaid Allow EFT transfers to improve provider cash flow.
225 Long Term Create an All Payer Claims System (expanded SPARCS system) Expand the State's data collection process to include all services from all payers.
226 Long Term Establish a Rate Setting Advisory Commission This proposal will be referred to the SAGE Commission.
227 Long Term Consolidate Oversight of Health Coverage This proposal will be referred to the SAGE Commission Process.
228 Long Term Adjust cost compared to Similar States Compare NYS payments to other State's and make changes as appropriate.
229 Long Term Assisted Living facility discharge policy change Eliminate the ability of Adult Care Facilities to be able to discharge a resident due to their inability to pay.
230 Merged with 1462 Support affordable legislation that supports affordable, comprehensive LTC insurance products Enhance existing NYS Tax credit for the purchase of certain long term care insurance policies.
231 Merged with 1462 Medical Savings Account (MSA) Establish Medical Savings account demonstration program for Long Term Care.
232 Merged with 1462 Allow IRA, 401K etc. withdrawals without penalty for LTC payments Provide additional options for individual financing of LTC services and supports.
233 Merged with 1462 Create incentive to access home equity as a means to purchase LTC insurance Create incentive to access home equity as a means to purchase LTC insurance
234 Long Term Allow public company's to operate of NHs Allow publicly traded companies (PTCs) to operate facilities in NYS.
235 Long Term Streamline Quality Reporting Quality reporting brings associated costs to the state and hospitals. In order to allow the state to focus on collecting data for the most critical quality and patient safety issues, the state should:
236 Long Term Reorganize ACF/AL survey process to focus on poor performing facilities and "look‐alikes" Reorganize Adult Care Facility and Assisted Living Survey process
237 Long Term More Efficient Home Health Aide Orientation Reform the state's supervision and orientation regulations for home health aides and personal care workers.
238 Merged with 154 Provide Better Audit Coordination OMIG will lead and effort to coordinate in State Audits of the Medicaid Program.
239 Long Term Expedite Medicaid billing align Medicaid's claiming limit with Medicare's rule ‐ 1 year rule (Medicare) versus 90 day (Medicaid).
240 Long Term Audit to confirm consistency for supply and medication claims Develop audit capabilities to ensure that there is consistency between diagnoses recorded in medical records / claims submitted by providers
241 Long Term ACA Implementation ‐ Basic Health Plan/Public Option Adopt the Basic Health Plan option in the Affordable Care Act (ACA). Include a public option as a health insurance choice in the Exchange.
242 Long Term Explore different payment models Explore incentive based payments such as global budgets, bundled payments, and an expansion to selective contracting.
243 Still in Package Implement Accountable Care Organizations (ACOs) for Medicaid Explore reimbursement models to implement Accountable Care Organizations (ACOs) for Medicaid beneficiaries. Need guidance from CMS.
244 Long Term Salary Incentives to Residents in Medically Underserved Communities Provide funds to teaching hospitals for enhanced salaries for medical residents who will work in medically under‐served NYS communities after training; funded from a redirection of current GME.
245 Not Viable Eliminate Optional Services Unless Enrolled in a Medical Home Eliminate Optional Services Unless Enrolled in a Medical Home.
246 Not Viable Limit OTC products This proposal would limit coverage for non‐prescription, Over‐the‐Counter (OTC) drugs.
247 Not Viable Allow only Physicians to Bill for Injectibles Allow only Physicians to Bill for Injectibles ‐ access concerns exist.
248 Not Viable Adopt VA drug formulary Adopt VA drug formulary for Medicaid ‐ VA has closed formulary and Medicaid can not limit drug access in this way.
249 Not Viable County leaders should be allowed to set the breadth of the Medicaid program Give counties the ability to define to what services their Medicaid population would be eligible to receive.
250 Not Viable Require Medicaid Enrollees to obtain a doctors order for Over the Counter (OTC) drugs Require Medicaid Enrollees to obtain a doctors order for Over the Counter (OTC) drugs ‐ fiscal order is already required for OTCs.
251 Merged with 55 Extended coverage of nicotine replacement treatment Extended coverage of Medicaid coverage of nicotine replacement treatment for persons with serious mental illness (SMI) from 6 months to 12 months ‐ linked to proposal 130.
252 Not Viable Medicaid should be a Federal Benefit Relieve states from financial burden by having Medicaid become a Federal benefit.
253 Long Term Allow use of non‐enrolled providers and reimburse up to the FFS rate. Allow use of non‐enrolled providers and reimburse up to the FFS rate.
254 Not Viable Pool drug & supply purchasing contracts Pool non‐Medicaid purchasing for state owned facilities ‐ not a Medicaid proposal.
255 Not Viable Expand the exclusion list of drugs carved out of the nursing home rate. Expand the exclusion list of drugs carved out of the nursing home rate. This proposal is in the process of being implemented.
256 Not Viable Return of For‐Profit Health Plan profits Require For Profit Health Plans to return Medicaid profits back to the community.
257 Not Viable Revenue suggestions Revenue suggestions ‐ seeking clarity on this proposal.
258 Not Viable Utilize sustainable energy technology Utilize sustainable energy technology
259 Not Viable Standardize look back periods in LTC The look back periods are standardized. Need more information.
260 Long Term Permitting continued Medicaid eligibility/coverage for high‐ risk women following a pregnancy Permitting continued Medicaid eligibility/coverage for high‐risk women following a pregnancy and case management services. Seeking clarification Is this eligibility expansion or renewal effort?
261 Not Viable Cap hospital executive salaries included in cost reports for Indigent Care Exclude a certain portion of executive salary from indigent care calculation. Concerns exist with this proposal since indigent care reform will need conform with Federal reform.
262 Not Viable Maximize Medicare utilization to reduce Medicaid cost Maximize Medicare utilization to reduce Medicaid cost ‐ seeking more detail.
263 Done Involvement of Unions in MRT Involvement of Unions in MRT
264 Still in Package Apply HCRA Surcharges to Office Based Surgery Broaden the HCRA surcharge to include accredited office based surgery practices in addition to requiring all insurers to pay a facility fee to these practices
265 Not Viable Eliminate the resource test for SSI disabled individuals, except for those seeking NH level of care Not viable. Federal rules require rules be consistent across category, thus they cannot vary by service. The resource test cannot be eliminated for a subset of the SSI‐related population (non‐LTC).
266 Not Viable Extend MBI‐WPD so that individuals can participate beyond 65th birthday. Not Viable ‐ the age limit is a federal law.
267 Long Term Allow OPWDD disability determinations to be used for Medicaid eligibility The NYSDOH Disability Review Team currently determines disability for OPWDD consumers. Disability determinations for Medicaid must be consistent with Social Security Administration's (SSA's) disability guidelines.
268 Long Term Allow OPWDD Revenue Support Field Offices to administer Medicaid (eligibility) for I/DD Population Allowing OPWDD's Revenue Support Field Offices to administer Medicaid for the developmentally disabled population is contrary to State takeover of the administration of the Medicaid program.
269 Long Term Home Care Regulatory Relief Provide for regulatory relief to reduce state and provider costs and to permit improved, more efficient functioning of the system.
270 Long Term Improve eMedNY Improve eMedNY ‐ seeking clarification
271 Merge with 154 Come down on Medicaid Fraud/Abuse Come down on Medicaid Fraud/Abuse ‐ More specific proposals exists in this area.
272 Not Viable Implement biometric IDs for Medicaid enrollees. Implement biometric IDs for Medicaid enrollees. Potential legal issues.
273 Not Viable Drug Testing Drug Testing of Medicaid Recipients ‐ potential legal issues.
274 Not Viable Criminal Penalty for Prohibitive Asset Transfer State cannot change the Medicaid transfer of asset rule (other than by applying it to home care and personal care) without jeopardizing Federal financial participation.