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Learn about state budget proposals, Medicaid funding, and advocacy priorities in healthcare. Get insights on funding allocation and key focus areas for the upcoming period.#Advocacy #Medicaid #Funding #Healthcare
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HANYS/Allied Association Briefing 2018-19 State Budget and Policy Dialogue January 2018
2018 HANYS Overall Priorities insert #hashtag
Major Revenue Proposals • State tax reform • Insurer conversion proceeds • Insurer windfall profit tax • Opioid surcharge fee • Defer corporate tax credits • Internet tax
Budget Timeline Executive budget released Health/Medicaid Budget Hearing One-House budget bills Mar. 31 Mar. 7 Jan. 23-Feb. 8 Jan. 16 Feb. 12 Early-Mid March On-time budget deadline Advocacy Day HANYS/allied association regional budget and policy briefings
HANYS Federal Priorities • Relief from Medicaid DSH cuts • Reinstate rural and small community Medicare “extenders” (MDH-LV) • Protect 340B Program • Fund CHIP • Fund CSRs for Essential Plan coverage
Priorities and Messages • First, do no harm • Federal threats are real and alarming • No more State cuts or damaging new mandates • Second, go further • Support transformation and stabilization • New capital dollars • Funding for financially struggling and safety net hospitals statewide • Healthcare Shortfall Fund • Regulatory modernization • Payment adequacy • Third, tell your stories • Providing care 24/7 • Special role in communities • Significant economic impact • Improving care
Capital Investment • $425 million total • $125 million in flexible funding • $60 million to community-based providers ($20 M for assisted living facilities) • $45 million to nursing homes
Capital Investment Current scope of state-funded capital and capital related investments
Capital Investment Areas where the state has funded capital and capital-related projects Based on funded projects under the CRFP, Essential, and Statewide I programs 80% hospital; 20% non-hospital Hospitals that have not yet accessed awards
Supportive FundingFive-Year View: SFYs 2015-19 Note: Table excludes general VAP investments funded by NYS
Medicaid DSH: Indigent Care Pool Extension • Extends current methodology 1 year to December 31, 2019 • Increases loss threshold to 17.5% • Retains 1% withhold for financial assistance compliance • Administration has promised stakeholder workgroup to determine how to implement ACA cuts if they occur
Medicaid DSH: ACA Cuts • ACA-mandated Medicaid DSH reductions were scheduled to begin in FFY 2014 and would have sunset in 2020 • The first reductions were delayed to FFY 2018 (Oct. 1, 2017) and cuts were extended by a total of five years (through 2025) through additional legislation • The ACA and subsequent legislation mandates specific federal Medicaid DSH allotment reductions that total $43 billion nationwide between 2018 and 2025
ACA’s Medicaid DSH Cuts and CMS’ Proposed Implementation • Generally,ACA requires the following to implement the cuts: • Impose a smaller percentage reduction on low DSH states • Impose the largest percentage reductions on: • States with the lowest percentages of uninsured individuals • States that do not target their DSH payments to hospitals with high levels of uncompensated care • States that do not target their DSH payments on hospitals with high volumes of Medicaid inpatients NYS aligned its DSH program with this formula in 2013 NYS’s current share of DSH funding = 14.7%
NYS Medicaid DSH Funding Detail • Medicaid DSH program = $3.5 billion in funding in 2017 • The program is divided into 4 distinct pools: $339 M in UPL payments are also provided as DSH-like funding to voluntary hospitals making their actual DSH payments about $995 M. This level of funding is required by state law.
Healthcare Shortfall Fund • $1 billion • Financed from portion of funds from health insurer conversions • Spending plan developed by Commissioner of Health
Insurance Conversions/Sales from Not-for-Profit to For-Profit Entities • For example, Fidelis sale to Centene • Proceeds considered public assets (similar to Empire Blue Cross conversion) • Similarly directed to HCRA • $750 million per year over 4 years
Minimum Wage Funding • Continues state’s commitment to fund Medicaid’s share of state-mandated minimum wage hike • $1.4 billion (total Medicaid) for providers(majority to home care) • Continues to fund direct labor costs only Funding Comparison (millions) Source: NYS DOH FY 2019 Executive Budget Highlights document
Nursing Home 1% ATB Payback • Nursing homes are owed $280 million (total Medicaid) retroactively back to SFY 2014-15 • The proposal would stretch the payback over a 4 year period ($70 million total annually) • In addition to payback nursing home rates will be increased by 1% going forward (another $70 million) • DOH is determining whether the payback is subject to the provider assessment
Medicaid Global Cap Source: DOB • Extends Commissioners’ “superpowers” through 2019-20 • Redirects Medicaid funding to state’s general fund ($425 million) • Legislature must “buy back” restoration of cuts and finance new spending initiatives • Pharmacy: ($90 M) • LTC: ($365 M) • Managed care: ($142 M) • Hospitals (direct): ($26 - $34 M) • Transportation and other : ($49 -$158 M)
Quality Initiatives • $34.1 million
Rate-Based Capital Reimbursement • $13.4 million reduction • Establishes workgroup to streamline Medicaid capital rate methodology for hospitals and nursing homes • For hospitals, likely to change current inpatient method • DOH priority • Workgroup recommendation must include a 1% reduction in capital expenditures but reduction to be taken April 1, 2018 prior to workgroup activity
Outpatient Payments • $10 million reduction • Reduces the outpatient payment for saline bags in hospital emergency rooms and clinics • $500 to $250 per bag • Attempts to align with costs and Medicare payment • DOH had initially grouped saline bags and higher cost medical equipment into the same APG
LTC/MLTC Funding • Acute focus on LTC/MLTC for reductions — $365 million • Restricts MLTC eligibility for those placed in nursing homes for more than 6 months • Limits eligibility to individuals with a UAS score of 9 or more who need community-based LTC services for a continuous 120 days • Lock-in provision that limits changing plans in a 12-month period • Additional 2% cut for low quality performance • 1% cut to rate based capital • Reduction to payments for case-mix
Program Integrity • $60 million in savings • Allows OMIG, if unsuccessful in recovery of an improper payment to a provider, to recover from the MCO • MCO would then be required to recover the payment from the provider within 6 months and can collect up to a 5% collection fee • Requires MCOs to promptly report any fraud, waste, and abuse • $5,000 fines on individuals and entities that violate any law, rule, or directive of the Medicaid program • Penalizes MCOs that report inaccurate data on cost reports
VBP Initiatives • $55 million reduction • Increases penalties to MCOs that fail to meet VBP targets ($20 million) • Creates new baseline/benchmark rate for providers that are not advancing VBP goals ($15 million) • Modifies PCMH add-ons and differentiates for VBP contracting ($20 million) Allocates $44 million of state-only funds in SFY 2019-20 to fund supportive housing for high cost Medicaid members. Funding could be accessed by health plans, VBP contractors, and PPSs.
Community Paramedicine • Authorizes emergency medical personnel to provide services other than the initial emergency medical care and transportation of patients • Requires collaboration with at least one hospital, one physician, one emergency services provider and, if the services are provided in the home, one home care services agency
Opioids • Eliminates Medicaid coverage of opioids prescribed for more than three months unless the medical record has: • a written treatment plan w/pain management goals • information on non-opioid therapies tried • A patient assessment and evaluation • Requires treatment plan to be updated twice within the first year and annually thereafter • Does not apply to cancer patients not in remission, hospice/other end-of-life care, or in palliative care.
