Clinic Uncompensated Care Amendment Request (Pending)

  • Complete (Pending) Amendment Request is also available in Portable Document Format (PDF, 3.1MB)
Eliot Fishman Director
Center for Medicaid and CHIP Services (CMCS)
Centers for Medicare & Medicaid Services
7500 Security Blvd., Mail Stop S2-26-12
Baltimore, MD 21244-1850

August 21, 2015

Dear Mr. Fishman,

New York State is seeking approval from the Federal Centers for Medicare and Medicaid Services (CMS) to amend the 1115 Waiver Partnership Plan to extend the Clinic Uncompensated Care Program (authorized in STC section VII # 10,11), previously included as part of New York's Partnership Plan Waiver. The Waiver authority for this program was inadvertently allowed to sunset by the State which eliminated the State's ability to receive vital Federal matching funds. The State funds continue for the program through March 31, 2017. As such, New York is seeking authorization to extend the program concomitantly with this timeframe. Tribal notice was issued on May 21, 2015 and public notice was published on June 17, 2015. No comments were received.

Consistent with the prior Standard Terms and Conditions of the Partnership Plan, New York will provide grants to eligible voluntary, nonprofit, and publicly sponsored diagnostic and treatment centers (D&TCs) for services delivered to the uninsured. In order to be eligible, these facilities will be required to provide a comprehensive range of primary/mental health care services, provide at least five percent of their visits to uninsured individuals and must have a process for collecting payments from third-party payors.

On an annual basis, the Clinic Uncompensated Care Program distributes approximately $110 million in Federal and State dollars to Article 28 and 31 clinics consistent with the requirements above (see attached chart for additional information). In meetings with facility representatives, it is clear these funds have been vital in allowing them to provide important primary and preventive health care services to the uninsured.

Since the initial federal approval of funding in 2011 the number of Article 28 and 31 clinics eligible and receiving funding has been relatively consistent. Annually approximately 75 Article 28s and 100 Article 31s meet the qualifying criteria described above. On average, these funds have covered 50% of their uncompensated care costs.

For example, in 2014 it was determined there was a regular (not including supplemental to new providers/sites) uncompensated care. need of $223 million which was reduced to $191 million after collections. Of this amount, approximately $103 million was paid meaning just under $100 million in costs remained that impacted the provider's financial condition (see attached chart).

Finally, it is important to note that while numerous individuals will pick up coverage under the federal ACA there will still be New Yorkers who will still be uninsured after full implementation. Many of these uninsured people will continue to receive medical services, including behavioral health services, from the clinics currently receiving these uncompensated care payments. Elimination of this funding source will severely limit access to these services for the uninsured currently served in these clinics. Note that in 2014 approximately 1.9 million uncompensated visits were eligible for reimbursement under this program.

New York appreciates CMS' willingness to review the State's request and its consideration in continuing Federal funding for these essential providers. As always, my staff are available to discuss this issue with you more thoroughly. If questions, please contact Mike Ogborne at (518) 473-8822.

Sincerely,

John E. Ulberg, Jr.
Medicaid Chief Financial 0fficer
Division of Finance and Rate Setting
Office of Health Insurance Programs

cc: Jessica Woodard, CMS
     Mike Melendez, CMS
     John Guhl, CMS
     Jason Helgerson, DOH
     Priscilla Smith, DOH

Enclosure


May 20, 2015

Dear Colleague:

The New York State Department of Health is submitting a request to the federal Centers for Medicare and Medicaid Services (CMS) to amend the 1115 Partnership Plan Waiver.

Specifically , New York is seeking approval to extend the Clinic Uncompensated Care Funding authorized in Special Terms and Conditions (STC) VII 10 and 11, which expired on December 31, 2014. The proposed amendment would extend the federal funding agreement through March 31, 2017.

The clinic uncompensated care program provides funding to qualifying clinic providers including mental health clinics to assist in covering the uncompensated costs of services provided to the uninsured population. In order to receive these funds, each provider must:

  • provide a comprehensive range of health care or mental health services;
  • have at least five percent of their annual visits providing services to uninsured individuals;and
  • have a process in place to collect payments from third party payers.

I appreciate the opportunity to share this information with you and look forward to responding to any comments or concerns that you may have. Please forward your comments or concerns to the Waiver Management Unit email at: 1115waivers @ health.ny.gov. We look forward to your continued collaboration.

Sincerely,

John Ulberg
Chief Financial 0fficer
Office of Health Insurance Programs

cc: Karina Aguilar,CMS
     Wendy Stoddart, NYSDOH
     Priscilla Smith, NYSDOH