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NYS MRT II Releases Proposals to ‘Improve Medicaid Services, Funding’

by The Alliance for Rights and Recovery

NYAPRS Note: Yesterday, New York State’s Medicaid Redesign Team II released a series of proposals that were submitted “to improve the state’s Medicaid services and funding” and to find $2.5 billion in savings by the April 1 state budget. Over 2,200 individual submissions were transmitted or recorded from a variety of individuals, associations including NYAPRS, beneficiaries, providers, MCOs, county government and community based organizations.

Recommendations included replacing the global cap, which puts a self-imposed limit on Medicaid spending, with a different budgeting process or eliminating the cap altogether.

See the attached state presentation and a sampling of proposals put together by NYAPRS below, with some highlighted sections to which we are paying special attention. Note in particular the recommendations related to the Social Determinants of Health, Health Homes, Workforce, Managed Care and the Global Cap. We will offer comments later this week.

The state’s presentation noted the following themes that emerged from the comments:

  • High Medicaid growth must be addressed

  • The disability community in particular expressed concern that actions not impact services on which they rely

  • Access to care is a cornerstone of New York’s Medicaid program, especially for the most vulnerable populations, and it must be preserved

  • Care management plays an important role in healthcare delivery, but improvements can be made

  • Considerable progress was made under DSRIP and VBP and it is important to continue that work, especially in the support of community-based organizations that address the social determinants of health

  • Maximizing the use of telehealth and integrated data exchange may help reduce costs and streamline care delivery

  • Considerations to protect safety net providers and enable them to be successful must be part of the delivery system redesign

From Politico: “Critics of the MRT II process have said the state has had no intention of taking proposals. Rather, the Cuomo administration has made cuts to various programs ahead of the April 1 budget deadline, and the MRT II process is a thinly veiled attempt to quash criticism that the public did not provide any input, they argue. Senate Health Committee Chairman Gustavo Rivera, a Bronx Democrat and vocal critic of the MRT II, said he’s concerned the growing threat of coronavirus has distracted the public from the impending budget and its $4 billion funding hole, mostly due to the Medicaid gap. “There certainly are ideas in there, but it is March 10. We are just a few weeks away from when we have to vote on a budget, and we don’t have the actual proposals that we’re going to have to vote on — not yet. I remain concerned that the process is not being as transparent as it needs to be — that it’s not including the people it needs to.”

Next steps: MRT members will be asked to rate key proposals which will help inform the final package of proposals to be voted on by the MRT and, assumedly, incorporated into the state’s revised budget proposal.

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A SAMPLING of PROPOSALS of NOTE EXCERPTED by NYAPRS

INCREASE BUDGET SAVINGS AND/OR REVENUES

Budget Actions in SFY 2020 and SFY 2021

  • Discontinue Enhanced Safety Net Hospital Payments, DSRIP Equity Pools, MLTC Quality Payments, VBP Stimulus Payments

  • Supportive Housing Payment Reduction

General Savings

  • Increase the 1% across-the-board FY 20 Budget action if necessary to achieve the $2.5 billion MRT II target

Raise healthcare-related revenue to help reach the $2.5 billion target

  • Utilize the existing “for-profit” insurance tax structure and increase the tax  from 1.75% to 3.00% of premiums; use additional assessment funding to  finance State spending for Medicaid

  • Implement insurance plan profit caps and/or more stringent medical loss ratio (MLR) requirements to generate increased revenue to the State (limit profits by health plans and hike the percentage of state payments that can go to pay for provider services: NYAPRS).

  • Implement a State-level Individual mandate in place of the federal ACA  mandate that was repealed in 2019 and use additional revenue to support  insurance premium tax credits and to finance State spending on Medicaid

HEALTH HOMES

Implement Health Home reforms that drive efficiencies while preserving core programs

  • Eliminate Outreach payments

  • Move low acuity members into less intensive case management

  • Increase accountability by penalizing health homes that do not meet quality standards

  • Achieve administrative efficiencies by reducing unnecessary documentation

  • Consolidate and geographically optimize Health Home networks

MANAGED CARE

  • Require Plans to contract with Behavioral Health providers willing to accept the Medicaid FFS rate

  • Create a Member Incentive Workgroup and knowledge sharing library to support best practices

LONG TERM CARE PROPOSAL

  • Eliminate requirement in model contract for MLTC plans to make monthly care management calls, and promote alternatives for care management.

  • There are a large number of recommendations regarding the Consumer Directed Personal Assistance program. See attachment for details.

INCREASE ENROLLMENT IN INTEGRATED PLANS FOR DUAL ELIGIBLES

  • Implement a comprehensive suite of strategies for integrated care to Medicaid’s  770,000+ Dual Members (Members in Medicare and Medicaid)

PHARMACY

  • Full Carve Out of the Pharmacy Benefit from Managed Care to Fee-for-Service (FFS) to achieve full transparency, administrative simplification and standardization and lower net pharmacy costs

  • Implement a Statewide Formulary/Preferred Drug Program to leverage the States purchasing power and standardize the Medicaid formulary across FFS and Managed Care

  • Enhance Purchasing Power to Reduce Drug Costs

    • Enable further savings from the Medicaid Drug Cap by pursuing deeper volume-based discounts or alternative payment arrangements for super high cost drugs (e.g., new gene therapies) and require manufacturers to disclose pricing information to level the playing field in price negotiations

  • Limit Coverage of Over the Counter (OTC) Drugs to no longer reimburse for certain lower cost OTCs.

  • Eliminate Prescriber Prevails to reduce the use of higher cost and sometimes lower value medications.

TRANSPORTATION

Increase the overall efficiency, quality and access for non-emergency Medicaid transportation by:

  • Transitioning to a Medicaid Transportation Broker

  • Carving transportation out of the MLTC Benefit (excluding PACE)

  • Maximizing Public Transit in New York City and other urban areas

  • Reducing Taxi/Livery Rates and promoting other modes of transportation

  • Implementing an ambulance diversion – Triage, Treat and Transport (ET3) support program to reduce avoidable hospitalizations

IMPROVEMENTS TO COUNTY ADMINISTRATION

  • Improve fraud referrals between NY State of Health and local districts

  • Provide greater oversight over Pooled Trusts

  • Provide reimbursement to counties for eligibility verification contracts

  • Maximize use of Veteran Affairs Benefits

  • Accelerate State takeover of all Medicaid administration

WORKFORCE

Advance workforce training and support initiatives to address workforce shortages

  • Evaluate, promote and improve training and support programs for direct care workforce, Certified Nurse Assistants, Home Health Aides, Personal Care Aides, Health Home Care Managers.

  • Explore potential opportunities for loan forgiveness programs

Develop a universal worker training program for direct care workers and establish Pilot Regional Training Centers

HEALTH INFORMATION TECHNOLOGY

Expand the utilization of telehealth services

  • Explore a state-wide, hosted Telehealth platform to reduce interoperability barriers

  • Expand telehealth models, especially to address behavioral health, oral health, maternity care and high-need populations

  • Explore increases to telehealth reimbursement to encourage payor and provider participation

  • Enhance broadband for telehealth to ensure connectivity in rural areas and among all provider types, including specialists

SOCIAL DETERMINANTS OF HEALTH

  • Create regional Social Determinant of Health Networks (SDHN).

    • Create a single point of contracting for SDH services

    • Establish a regional referral network with multiple CBOs and health systems

    • Utilize a state-wide IT platform to coordinate a regional referral network

    • Assess Medicaid members for the key State-selected SDH social risk factors (using a State-selected assessment tool) and make appropriate referrals based on need

  • Standardize SDH screening to identify unmet resource needs and establish an SDH quality measure

  • Expand access to medical respite programs to address those without stable housing needing medical care which does not meet inpatient hospital level of care need

  • Authorize medically tailored meals as a Medicaid benefit

  • Permit Level 1 VBP contracts for SDOH to count as “Other Medical” costs on the Plan Cost Report

Re-Define the Global Cap Growth Metric (NYS had developed a “global cap” on the state share of Medicaid to limit its annual growth).  

  • Redefine the Global Cap such that the spending limits are solely placed on programs and  services that receive Federal financial participation; are required under CMS rules; or are  required under the State Plan

  • Adjust Medicaid Global Cap Growth Rate in place of the current Consumer Price Index  (CPI) to either utilize a different metric and/or account for enrollment increases

  • Expand the Global Cap to cover all Medicaid spending, including labor costs associated  with the minimum wage, and stop the State practice of diverting state Medicaid funding to  the General Fund

Replace the Global Cap with a global budgeting process overseen by an independent  commission; alternatively, eliminate the Global Cap altogether