2014-15 MRT Executive Budget Matrix

2015-16 Executive Budget -- MEDICAID Proposals
Investments / (Savings)

($ in Millions)

  • Matrix is also available in EXCEL Format (XSL, 133KB)
No. Initiative Staff Effective Date Art VII 2014-2015 Impact 2015-2016 Impact Description
Yes/No Gross State Gross State
Affordable Housing
  Supportive Housing Liz M., Mark K. April 2014 No $18.4 $18.4 $85.0 $85.0 This proposal would increase the total supportive housing funding to $100 million in 2014-15 and $160 million in 2015-16. Included is funding generated from Medicaid savings ($6.6 million State) associated with the closure of three nursing homes and four hospitals, and the decertification of nursing homes and hospital beds, effective April 1, 2014. Funding will be used for MRT supportive housing initiatives.
Totals         $18.4 $18.4 $85.0 $85.0  
 
MRT/Other Investments (includes delayed items from 2013-14)
  Start-up Investment for Implementation of BHOs/HARPs John U., Greg A. April 2014 Yes $120.0 $60.0 $120.0 $60.0 This proposal will fund the resources needed to successfully transform the Behavioral Health system as it transitions to Managed Care and includes the following:
  • Facilitate the transition of BH Services for kids into Managed Care ($20.0M Gross; $10.0M State).
  • Integration of Behavioral Health and Physical Health (Delayed MRT investment includes APG rate enhancement and Collaborative Care) ($15.0M Gross; $7.5M State).
  • Targeted Behavioral Health IP rate increases ($40.0M Gross; $20.0M State).
  • OASAS Residential Restructuring ($5.0M Gross; $2.5M State).
  • Health Home Plus for AOT ($10.0M Gross; $5.0M State).
  • Funding new 1915(i) like services ($30.0M Gross; $15.0M State).
  Increase VAP Funding/Increase Provider Payments Linked to Performance (2015-16 initiative) John U. April 2014 Yes $40.0 $20.0 $304.0 $152.0 This proposal includes the expansion of VAP funding for Licensed Home Care Service Agencies ($20 million gross).
  CoP Investment Mark K. April 2014 No $17.0 $8.5 $18.0 $9.0 CMS clarified that all skilled Home Care services in Managed Care settings must be delivered by agencies that are in the compliance with the Federal conditions of participation (CoP).
  Transition of Foster Care to Managed Care Greg A. April 2014 Yes $5.0 $2.5 $15.0 $7.5 Facilitate the transition of Foster Care children to Managed Care. Joint initiative with OCFS to assist foster care agencies with Managed Care readiness and obtains encounter data to inform premium and rate setting for Managed Care, Health Homes, and Foster Care per diem.
  Health Home Criminal Justice Initiative Greg A. April 2014 Yes $5.0 $2.5 $5.0 $2.5 Amend the statutory authority to distribute Health Home infrastructure grants to include the distribution of funds to be used for establishing better linkages between Health Homes and the Criminal Justice system.
  MRT Waiver Implementation John U./Greg A. April 2014 Yes $6.0 $3.0 $6.0 $3.0 Funds to assist OHIP with the work involved with managing waiver application process, funds distribution, and performance management.
  Regional Health Planning Pat R. April 2014 Yes $7.0 $3.5 $16.0 $8.0 Funds to establish regional health planning entities in 11 regions of the State.
  All Payer Database/SHIN-NY Pat R. April 2014 No $30.0 $3.0 $30.0 $3.0 Funds are requested to support the building and maintenance of the State's All Payer Database and the Statewide Health Information Network.
  Various MRT Investments Greg A./Jackie T. April 2014 No $6.3 $3.2 $7.3 $3.7 Various MRT Investments include:
  • Tobacco Cessation Counseling by Dentists. This proposal will expand access to tobacco counseling by reimbursing dentists and will provide greater access to effective, high quality smoking cessation treatment for members. Various meta-analyses have found that smoking-interventions delivered by non-physician clinicians are effective in increasing abstinence rates among smokers. Increased abstinence rates are associated with better health and lower cost ($3.0M Gross; $1.5M State).
  • Hepatitis C Treatment. This proposal integrates Hepatitis C (HCV) screening, treatment, and supportive services into primary care settings. Capacity building Annual incentive payments to clinics for capacity building will pass through managed care reimbursement. Related HCV care and treatment standards are developed by the AIDS Institute ($2.1M Gross; $1.0M State).
  • Harm Reduction Counseling. This proposal creates a Medicaid reimbursable harm reduction counseling service to be provided by community-based organizations certified by the AIDS Institute as Syringe Exchange Programs (SEP) ($0.8M Gross; $0.4M State).
  • Consumer Assistance Program. This program will provide post-enrollment navigational assistance to consumers who have enrolled in health coverage. Assistance will be provided by specialist agencies and will focus on access to health services, transitions between different types of health insurance and financial assistance programs, and issues around premium tax credits ($0.4M Gross; $0.2M State).
Totals         $236.3 $106.2 $521.3 $248.7
 
Other Initiatives
  Reduce Inappropriate Prescribing and align Point of Sale Editing Across Fee For Service and Managed Care Greg A. July 2014 Yes ($7.3) ($3.6) ($13.9) ($7.0) This proposal will reduce inappropriate prescribing for drugs that do not meet clinically established/evidenced-based criteria and includes the following:
  • Eliminates Prescriber Prevails for brand name drugs that have FDA A-rated generic equivalents (FFS & MC) ($0.7M Gross; $0.4M State).
  • aligns statewide Drug Utilization Review programs by expanding point of sale clinical pharmacy editing in Managed Care plans to be consistent with FFS to include consideration of non-pharmacy claims data elements such as diagnoses and relevant services (FFS & MC) ($6.3M Gross; $3.1M State).
  • Expands Clinical Drug Review Program (CDRP) in order to prior authorize drugs meeting the CDRP criteria until such time the DUR Board makes a recommendation to the Commissioner (FFS) ($0.3M Gross; $0.2M State).
  Minimum Supplemental Rebate Greg A. April 2014 Yes ($2.8) ($1.4) ($3.8) ($1.9) Require manufacturers of brand drugs to provide a minimum level supplemental rebate to the state. If the minimum supplemental rebate is not provided, the manufacturer's drugs may be subject to prior authorization.
  Eliminate e-Prescribing Incentive Payment Greg A. April 2014 Yes ($3.1) ($1.5) ($4.3) ($2.2) To encourage the use of e-Prescribing, NYS implemented a payment of an incentive to prescribers for each approved FFS Medicaid e-prescription. There is no longer a need for this due to Federal incentives and the State mandate for electronic prescriptions.
  Prior Authorization for Non-Medically Acceptable Indicators for Prescription Drugs Greg A. October 2014 Yes ($19.8) ($9.9) ($39.6) ($19.8) This proposal would require verification of FDA or Compendia supported use for certain drugs or drug classes where there is evidence of significant off label prescribing in order for coverage to be provided.
  Basic Benefit Initiatives Greg A. April 2014 No ($5.0) ($2.5) ($5.0) ($2.5) These initiatives further the alignment of Medicaid-covered services with evidence-informed practice.
  Community First Choice Option Mark K. April 2014 No ($27.6) ($27.6) ($21.3) ($21.3) The State has submitted a State plan to adopt the community first choice option under the ACA. This option will allow for additional FMAP for certain home and community based services. This option will enhance the self-directed options available.
  CHIPRA Performance Bonus Award Judy A. April 2014 No ($13.0) ($13.0) $0.0 $0.0 CMS awards bonuses to states that have exceeded performance targets in enrolling uninsured children in Medicaid.
  OMIG Fraud and Abuse Integrity Initiative John U. April 2014 No ($30.0) ($15.0) ($30.0) ($15.0) This proposal includes better oversight and a more coordinated effort on the following projects: -Audits & Reviews. HMS will review nursing homes not reviewed by OMIG DMA for inappropriate reserved bed payments. HMS will review the claims inappropriately billed for OPWDD recipients for services included in their residential rates. Medicaid providers must return Medicaid overpayments identified through self-review and its compliance programs. Providers can report these overpayments directly to OMIG or through the HMS portal. Rx claims paid by both Medicaid and Medicare will be identified and recovered ($20.0M Gross; $10.0M State). -Denied Claims Project. The object of this project is to identify partially denied Medicare claims that were crossed over from Medicare to Medicaid and were paid in full by Medicaid ($5.0M Gross; $2.5M State). -County Demonstration UMASS. Review dual Medicare/Medicaid eligibility for home health services to ensure Medicaid is the payer of last resort ($5.0M Gross; $2.5M State).
  Program Integrity Initiatives Judy A. April 2014 Yes ($4.0) ($2.0) ($4.0) ($2.0) Include resolving duplicate CINs and ensuring accurate eligibility determinations.
  Spousal Support Judy A. April 2014 Yes ($20.0) ($10.0) ($42.0) ($21.0) State Social Services law is amended to conform to Federal law with regard to spousal contributions and responsibilities for spouses residing together in the community. This amendment, which has been proposed in the past, will eliminate the ability of non-applying spouses to refuse to contribute toward the cost of care for the applicant spouse.
  Nursing Home Case Mix Cap Initiative John U. April 2014 Yes ($42.9) ($21.5) ($32.2) ($16.1) This proposal is to address a program integrity issue related to upcoding of rehabilitation services.
  Reduce/Eliminate A/R Balances (within 2 to 3 years) John U. April 2014 No ($16.5) ($16.5) $0.0 $0.0 DOH will work with provider groups to develop a plan to reduce liabilities owed to the State.
  Medicaid Reestimate John U. April 2014 No ($600.0) ($300.0) ($450.0) ($225.0) This represents $75 million of savings in 2013-14 and $225 million in 2014-15.
  Financial Plan Relief John U. April 2014 No $300.0 $300.0 $300.0 $300.0  
Totals         ($491.9) ($124.6) ($346.1) ($33.7)  
 
Federal Health Care Reform
  Basic Health Program Judy A. January 2015 Yes $0.0 $0.0 ($300.0) ($300.0)  
Totals         $0.0 $0.0 ($300.0) ($300.0)  
 
Grand Totals ($237.2) $0.0 ($39.8) ($0.0)  
 
Net MRT IV Investments/(Savings) $62.8 $0.0 $410.2 $225.0  
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Open Items

Scorecard
ACA HMO Tax 1.5% = $75M Gross; include on scorecard? John
 
Retail Clinic MA Savings valued at $20M to $60M Gross; may be used to support regional
planning initiatives
DOB
 
Start-Up Investment for
BHOs/HARPS
Should proposals be "bundled" or "separate" on scorecard DOH/OMH/DOB
 
Financial Plan Savings Need to discuss how we transfer $300 Million from the GC to the
financial plan
DOH/DOB
 
OMH Base Transfer Need to discuss the transfer from OMH to DOH DOH/OMH/DOB
 
Article VII
HC Wage Parity DOH to review and approve John
 
Nursing Home Case Mix Language changes needed John
 
Shift RTR Funding to Base Language changes needed John