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NYS MRT 2 Recommendations include 1.875% Medicaid Cut

by The Alliance for Rights and Recovery

NYAPRS Note: The Cuomo Administration has provided the NYS Legislature with a series of recommendations that they believe will address the state’s Medicaid deficit. Apparently the MRT II panel will meet later today and likely approve this package. Legislators may then reject or alter or add to the recommendations in the development of a final budget agreement that is expected for Friday.  
NYAPRS urges policymakers to continue to exempt mental hygiene providers from the recommended cut increase, fully preserve the essential CDPAP program, reject the elimination of prescriber prevails protections and strongly expand the role of social determinants of health.

Following is a brief summary of these recommendations taken from the attached materials. Some notables include:

  • Increase the Across the Board Reduction from 1 percent to 1.875 percent (it’s our hope that once again, mental hygiene programs are exempt from these cuts).

  • Implement Health Home Improvement, Efficiency, Consolidation and Standardization

  • Promote Encounter Data Accountability and Partially Restore Managed Care Quality Incentive Pools

  • Change Eligibility Criteria for Personal Care Services (PCS) and Consumer Directed Personal Assistance Program (CDPAP) and Eligibility Criteria for Enrollment in MLTC Partial Plans; Make Administrative Reforms to PCS and CDPAP Program; Implement Comprehensive CDPAP Programmatic Reforms and Efficiencies

  • Provide Integrated Care to Dual Eligible Members

  • Require all Uniform Assessment System Community Health Assessments (CHA) and reassessments to be conducted by an Independent Assessor

  • Carve Out the Pharmacy Benefit from Medicaid Managed Care to Fee-for-Service

  • Reduce Medicaid Drug Cap Growth by Enhancing Purchasing Power to Lower Drug Costs

  • Eliminate Prescriber Prevails

  • Increase the Efficiency, Quality and Access for Non-Emergency Medicaid Transportation

  • Advance Social Determinants of Health (SDH) to Improve Care and Reduce Medicaid Costs

See below and the attached for more details. Again, legislators may accept some and reject or reshape others within the next few days until an expected Friday budget deal. Stay tuned!

MRT II
Executive Summary of Proposals March 17, 2020

Introduction
Governor Andrew M Cuomo formed the Medicaid Redesign Team II (MRT II) on February 4th, 2020 with the objective of restoring financial sustainability to the Medicaid program while connecting other programmatic initiatives that would advance the core healthcare strategies he has pursued since taking office in 2011. The MRT II process and the $2.5 billion MRT II target were established before the outbreak of the COVID-19 public health emergency which has created significant disruption to the health care system and the broader economy.

The request of MRT II members is to approve recommendations that are consistent with Governor Cuomo’s original charge to the group and to send those recommendations to the Governor for further consideration. MRT II recommendations will be advanced in the Budget through Appropriation and Article VII language that provides the Executive with full discretion with regard to the effective dates of these proposals in light of the healthcare and economic disruption caused by COVID-19. In addition, it is recommended that a portion of the enhanced FMAP funding, to the extent practicable, will be used to mitigate the implications of COVID-19 on impacted healthcare providers.

The MRT II proposals described in this Executive Summary reflect recommendations and proposals submitted by the stakeholders, including a number of proposals advanced by MRT II members. The proposals represent a balanced approach that put in place programmatic reforms that advance the State’s core healthcare strategies, while restoring fiscal sustainability to the Medicaid program. The major proposals and FY 21 savings are described below.

In addition to the proposals described below, three other recommendations will be included in the final MRT II recommendations:

  • First, while the MRT II has identified programmatic areas needing reform, a further review should evaluate the way in which the State manages the $75 billion Medicaid program, to ensure that the State has the necessary infrastructure and appropriate organizational structure to most effectively manage the program. This structural review would include the respective roles of the State and counties, information technology infrastructure, data analytic capacity, and other functions.

  • Second, the experience of the MRT II with the Long Term Care Advisory group indicates the value of workgroups that focus on particular aspects of the Medicaid program. Among the areas that would benefit from workgroups include Integration and Alignment of Incentives and managed care, addressing the needs of individuals with disabilities, and continued reform opportunities in behavioral health and developmental disabilities. A number of MRT II members have expertise in these areas and could be asked to serve as the Chair of one or more of future workgroups. This list of workgroups is not intended to be exhaustive.

  • Third, many proposals submitted to the MRT II that were promising but not ready to be adopted or implemented without further analysis. While the proposals below highlight specific issues that the State should explore, these references are not intended to be exhaustive. An example of a potentially promising idea that was not ready for adoption as a recommendation by the MRT was a proposal to include sepsis screening in community- based settings. There are many others that should be further examined with the goal of determining whether they can be made actionable.

Executive Recommendations

Redefining the State Medicaid Global Cap
The MRT II has recommended that the Executive negotiate a redefinition of the Medicaid Global Cap as part of the FY 21 budget in a manner that takes into account developments since the State Medicaid Global Cap was first enacted in 2011. The current “Global Cap” growth metric is the 10-year rolling average of the medical CPI. This redefinition would increase the amount of total spending under the Global Cap through modifications in the base on which spending growth is calculated and/or a different allowable growth metric. Changes to the “Global Cap” would become effective beginning in the FY 22 Budget and would not have an impact on the FY 21 Budget.

Hospitals – FY21: ($399M), FY22: ($459M)

  • Increase the progressivity of Indigent Care Pool distributions – FY21: ($157M), FY22: ($157M)

  • Strengthen NYC Health + Hospitals – FY21: ($186M), FY22: ($193M)

  • Realize additional savings without impacting core hospital operations – FY:21 ($56M), FY22: ($109M)

Care Management – FY21: ($43M), FY22: ($69M)

  • Implement Health Home Improvement, Efficiency, Consolidation and Standardization – FY21: ($33M), FY22: ($37M)

  • Promote Further Adoption of Patient-Centered Medical Homes (PCMH)– FY21: ($6M), FY22: ($18M)

  • Promote Effective and Comprehensive Prevention and Management of Chronic Disease– FY21: ($5M), FY22: ($14M)

  • Promote Maternal Health to Reduce Maternal Mortality – FY 21: $1M, FY 22: ($1M)

Managed Care – FY21: ($108M), FY22: ($63M)

  • Promote Encounter Data Accountability and Partially Restore of Managed Care Quality Incentive Pools– FY21: ($114M), FY22: ($81M)

  • Enact statutory reforms intended to reduce inappropriate payment denials – FY21: $9M, FY22: $37M

  • Standardized Medicaid Managed Care Prior Authorization Data Set – FY21: $0, FY22: ($1M)

  • Explore new efforts to facilitate Value Base Payment (VBP) arrangements – FY21: $0, FY22: ($9M)

  • Explore integrated delivery system and global budget demonstrations for the Bronx and rural areas – FY 21: $0, FY22: ($5M)

  • Authorize Electronic Notifications – FY21: ($2M), FY22: ($5M)

Long-Term Care—FY21: ($648M), FY22 ($1,092M)

  • Institute a Home and Community Based Eligibility Lookback Period of 60 Months (to be consistent with look-back for nursing homes) FY21: ($20M), FY 22: ($24M)

  • Eliminate Spousal and Legally Responsible Relative Refusal FY21: ($2M), FY22: ($2M)

  • Change Eligibility Criteria for Personal Care Services (PCS) and Consumer Directed Personal Assistance Program (CDPAP) and Eligibility Criteria for Enrollment in MLTC Partial Plans – FY21: ($154M), FY 22: ($360M)

  • Make Administrative Reforms to PCS and CDPAP Program – FY21: ($82M), FY 22: ($263M)

  • Implement Comprehensive CDPAP Programmatic Reforms and Efficiencies – FY21: ($33M), FY 22: ($41M)

  • Provide Integrated Care to Dual Eligible Members – FY21: ($5M), FY 22: ($42M)

  • Reform the Fair Hearing Process – FY21: ($0), FY 22: ($1M)

  • Delay Implementation of the Expansion of Community First Choice Option (CFCO) Services– FY21: ($47M), FY 22: ($47M)

  • Cap Statewide Managed Long Term Care (MLTC) Enrollment Growth at a Target Percentage – FY 21: ($215M), FY 22: ($215M)

  • Enhance Wage Parity Enforcement – FY21: $0, FY22: $0

  • Issue a Request for Offers for License Home Care Services Agencies (LHCSA) – FY21: $0, FY22: $0

  • Reduce Workforce Retraining and Retention Funding– FY21: ($45M), FY 22: ($45M)

  • Require all Uniform Assessment System Community Health Assessments (CHA) and reassessments to be conducted by an Independent Assessor (IA) – FY21: ($8M), FY 22: ($16M)

  • Implement Changes to the Community Spouse Resource Amount – FY21: ($6M), FY 22: ($7M)

  • Offer Non-Medicaid Long-Term Care Programs to Encourage Delayed Enrollment in Medicaid including a private pay option for consumers to purchase on NYSoH – FY21: ($0), FY 22: ($0)

  • Reduce Nursing Home Capital Funding– FY21: ($30M), FY22: ($30M)

Pharmacy – FY21: ($71M), FY22: ($214M)

  • Carve Out the Pharmacy Benefit from Medicaid Managed Care to Fee-for-Service (FFS) – FY 21: $11M, FY22: ($125M)

  • Reduce Medicaid Drug Cap Growth by Enhancing Purchasing Power to Lower Drug Costs – FY21: ($46M), FY22: ($43M)

  • Limit Coverage of Over the Counter (OTC) Drugs – FY21: ($14M), FY22: ($19M)

  • Eliminate Prescriber Prevails – FY21: ($22M), FY22: ($27M)

Transportation – FY21: ($93M), FY22: ($243M)

  • Increase the Efficiency, Quality and Access for Non-Emergency Medicaid Transportation – FY21: ($93M), FY22: ($243M) 

Program Integrity—FY21: ($60M), FY22 ($74M)

  • Modernize Regulations Related to Program Integrity – FY21: ($60M), FY 22: ($67M)

  • Modernize Third Party Health Insurance– FY21: ($0), FY 22: ($6M)

FY 20 Budget Actions and General Savings Proposals

  • Increase the Across the Board Reduction from 1 percent to 1.875 percent – FY21: ($219M), FY22: ($50M). This proposal would increase the 1 percent across the board reduction that was implemented under the FY20 budget to 1.875 percent in the next two fiscal years.

Healthcare Workforce Proposals

  • Modernize scope of practice and other workforce related statutes, regulations and administrative barriers

  • Advance workforce training and support initiatives to address workforce shortages

Health Information Technology (HIT) – FY21: ($8M), FY22: ($13M)

  • Expand telehealth services

  • Modernize Medicaid information technology and expand access to data

Social Determinants of Health (SDH)– FY21: $4M, FY22: $17M

  • Advance Social Determinants of Health (SDH) to Improve Care and Reduce Medicaid Costs