Proposals to Redesign NYS Medicaid
• All savings and spending estimates are preliminary and many are being refined or revised.
• This table is a draft summary extract of each proposal – Title and Proposal Description
Columns are abbreviated. Full one page descriptions of each proposal are being finalized.
PRELIMINARY DRAFT – Preliminary Proposal List and Savings – Proposals are neither endorsed nor opposed by the Executive.
| Proposal # | Short Title | Theme | Proposal Description | State Savings 2011–2012 |
Timeframe |
|---|---|---|---|---|---|
| 1 | Increase the Health Facility Cash Assessment Rates | Recalibrate Medicaid Benefits and Reimbursement Rates | Increases health facility cash assessment percentages (additional revenue to fiscal plan) for hospital inpatient, nursing home, & home care services. These increases are not Medicaid reimbursable. | ($305) | Short Term |
| 2 | Reduce and Control Utilization of Personal Care Services | Recalibrate Medicaid Benefits and Reimbursement Rates | Eliminate Level I personal care services and implement provider–specific aggregate annual per patient spending limits that are at approximately the 2006 per recipient spending level. | ($150) | Short Term |
| 3 | HCRA Streamlining | Recalibrate Medicaid Benefits and Reimbursement Rates | Imposes a uniform surcharge for both Medicaid and private payers; eliminates hospital based physician surcharge; and clarifies other administrative complexities. | ($125) | Short Term |
| 4 | Eliminate 2011 Trend Factor (1.7%) | Recalibrate Medicaid Benefits and Reimbursement Rates | Eliminate the 1.7% 2011 trend (inflation) factor for Hospital Inpatient & Outpatient, Nursing Home, Home Care, & Personal Care Services as of 4/1/2011. | ($102) | Short Term |
| 5 | Reduce and Control Utilization of Certified Home Health Agency Services | Recalibrate Medicaid Benefits and Reimbursement Rates | This proposal will implement provider–specific aggregate annual per patient spending limits on CHHA (Certified Home Health Agencies) services that are at approximately the 2006 per recipient spending level. | ($100) | Short Term |
| 6 | Reduce MC / FHP Profit (from 3% to 1%) | Recalibrate Medicaid Benefits and Reimbursement Rates | Reduce the underwriting gain used in calculating premium rates from 3% to 1.0% for the Medicaid and Family Health Plus managed care programs. | ($94) | Short Term |
| 7 | Elimination of the Personal Care Benefit for Persons who are not NH Certifiable | Recalibrate Medicaid Benefits and Reimbursement Rates | Eliminate the Personal Care benefit for persons who are not Nursing Home eligible. | ($90) | Short Term |
| 8 | Eliminate Managed Care, Family Health Plus and Child Health Plus Premium (1.7%) | Recalibrate Medicaid Benefits and Reimbursement Rates | Reduce the projected increase to Managed Care rates by 1.7% as of 4/1/2011. | ($84) | Short Term |
| 9 | Eliminate All Targeted Case Management for MC Enrollees | Recalibrate Medicaid Benefits and Reimbursement Rates | Eliminate Medicaid coverage for Targeted Case Management Services for recipients that are in Medicaid Managed Care Plans. | ($58) | Short Term |
| 10 | Eliminate Direct Marketing of Medicaid Recipients and Facilitated Enrollment activities by Medicaid Managed Care | Recalibrate Medicaid Benefits and Reimbursement Rates | Eliminate funding included in Medicaid and FHPlus premiums for direct marketing of Medicaid recipients and facilitated enrollment activities for Managed Care in all counties. | ($57) | Short Term |
| 11 | Bundle Pharmacy into Medicaid Managed Care | Recalibrate Medicaid Benefits and Reimbursement Rates | Move the NYS Medicaid Pharmacy program under the management of Medicaid Managed Care to leverage additional clinical and fiscal benefits. | ($50) | Short Term |
| 12 | Reduce/Redirect Indirect Medical Education (IME) Payments | Recalibrate Medicaid Benefits and Reimbursement Rates | Reduce IME teaching factor from 4.2% to 3.0%, bringing it closer to empirical value of 1.2%, & providing fiscal plan relief while redirecting funds to health home (18M 11/12, 80M 12/13, 108M 13/14). | ($50) | Short Term |
| 13 | School Supportive Health Services Program (SSHSP) Cost Study | Recalibrate Medicaid Benefits and Reimbursement Rates | Increase Federal Medicaid Funding by determining actual costs incurred by school districts and counties providing School Supportive Health Services. | ($50) | Short Term |
| 14 | Restructure Reimbursement for Proprietary Nursing Homes | Recalibrate Medicaid Benefits and Reimbursement Rates | Eliminate the "return on" and "return of" equity and residual reimbursement provided in the capital nursing home rate for proprietary nursing homes. | ($44) | Short Term |
| 15 | Rebuild NY Preferred Drug List | Recalibrate Medicaid Benefits and Reimbursement Rates | Change the way the preferred drug list is developed, in order to increase savings. | ($38) | Short Term |
| 16 | Implement Pricing Reimbursement Methodology for NHs | Recalibrate Medicaid Benefits and Reimbursement Rates | Implement a Statewide pricing methodology for nursing homes, adjusted for differences in labor costs and case mix and includes multi–year transition pool to smooth impacts. | ($38) | Short Term |
| 17 | Select reductions in fee–for–service dental payment | Recalibrate Medicaid Benefits and Reimbursement Rates | Fee–for–service dental payments will be reduced to match rates paid by managed care providers on high volume dental procedures. | ($30) | Short Term |
| 18 | Eliminate spousal refusal. | Recalibrate Medicaid Benefits and Reimbursement Rates | Eliminate the loophole that allows legally responsible relatives (spouse, parent) to refuse to financially support them in order for the other relative (spouse, child) to obtain Medicaid. | ($28) | Short Term |
| 19 | Eliminate D&TC Bad Debt and Charity Care | Recalibrate Medicaid Benefits and Reimbursement Rates | Eliminating the DTC indigent care pool and the HCRA funds will produce additional HCRA revenue which can be redirected to other purposes. | ($27) | Short Term |
| 20 | Eliminate State Grant Payments to Major Academic Hospitals | Recalibrate Medicaid Benefits and Reimbursement Rates | Eliminate state only grant payments to major academic hospitals. | ($25) | Short Term |
| 21 | Streamline the Processing of Nursing Home Rate Appeals | Recalibrate Medicaid Benefits and Reimbursement Rates | Continue the cap on the annual $ amount of rate appeals to be processed; permanently authorize the Department to prioritize and streamline appeals processing by entering into negotiated settlements. | ($20) | Short Term |
| 22 | Pay Ambulette Dialysis Equivalent Rate to Adult Day Health Care | Recalibrate Medicaid Benefits and Reimbursement Rates | Adjust reimbursement fee for ambulette transportation to/from dialysis treatment to the fee paid for adult day health care ambulette transportation. | ($18) | Short Term |
| 23 | Coverage for Dental Prosthetic Appliances | Recalibrate Medicaid Benefits and Reimbursement Rates | Eliminate or limit coverage of dentures for adults. | ($16) | Short Term |
| 24 | Payment for Enteral Formula with Medical Necessity Criteria | Recalibrate Medicaid Benefits and Reimbursement Rates | Limit coverage of enteral formula to individuals who cannot obtain nutrition through any other means. | ($15) | Short Term |
| 25 | APG base rate withhold for physicians carve out | Recalibrate Medicaid Benefits and Reimbursement Rates | Remove physician–related reimbursement from hospital APG payment rate structure. | ($15) | Short Term |
| 26 | Utilization Controls on Behavioral Health Clinics | Recalibrate Medicaid Benefits and Reimbursement Rates | Reduce payment for excessive clinic utilization by establishing two outlier threshold visit levels upon which payments are reduced by a fixed percentage. | ($13) | Short Term |
| 27 | Eliminate Empire Clinical Research Investigator Program (ECRIP) Funding | Recalibrate Medicaid Benefits and Reimbursement Rates | Eliminate funding for the Empire Clinical Research Investigator Program. | ($9) | Short Term |
| 28 | Implement a Voluntary Mail Order Program | Recalibrate Medicaid Benefits and Reimbursement Rates | Create a mail order pharmacy benefit for maintenance drugs, to take advantage of higher discounts. | ($8) | Short Term |
| 29 | Accelerate Transportation Manager Contracts | Recalibrate Medicaid Benefits and Reimbursement Rates | Accelerate DOH´s procurement of regional transportation management contracts in the Hudson Valley, NYC, and other related common medical marketing areas using authority provided by 2010–11 budget. | ($8) | Short Term |
| 30 | align Payment for Prescription Footwear with Medical Necessity | Recalibrate Medicaid Benefits and Reimbursement Rates | Revise the Medicaid footwear benefit coverage criteria and payment methodology, reducing over utilization and administrative burden. | ($7) | Short Term |
| 31 | Eliminate worker recruitment and retention | Recalibrate Medicaid Benefits and Reimbursement Rates | The Worker Recruitment and Retention add–on to Medicaid rates will be eliminated due to the significant investment in ambulatory care rates through the implementation of APGs. | ($7) | Short Term |
| 32 | Prior Authorization for Exempt Drug Classes | Recalibrate Medicaid Benefits and Reimbursement Rates | Allow prior authorization under the Preferred Drug Program (PDP) for the following drug classes: anti–depressants, atypical anti–psychotics, anti–retrovirals and immunosuppressants. | ($6) | Short Term |
| 33 | Chemical Dependence Inpatient Rehabilitation (IPR) Redesign to Enhance FFP | Recalibrate Medicaid Benefits and Reimbursement Rates | Move inpatient rehabilitation services from fee–for–service to managed care to lower rates and to allow the State to pursue increased federal funding for these services. | ($5) | Short Term |
| 34 | Establish Utilization Limits for PT, OT, and Speech Therapy/Pathology | Recalibrate Medicaid Benefits and Reimbursement Rates | Establish Utilization Limits for Physical Therapy, Occupational Therapy, Speech Therapy and Speech Language Pathology. | ($5) | Short Term |
| 35 | Prescription Limitation to 5/month | Recalibrate Medicaid Benefits and Reimbursement Rates | Limit the number of brand name prescriptions that a beneficiary could receive to five (5) per month. | ($4) | Short Term |
| 36 | Contract Dental Management Vendor for FFS & MMC | Recalibrate Medicaid Benefits and Reimbursement Rates | Centralize all dental and orthodontic benefit administration for all Medicaid beneficiaries with a dental benefits management vendor. | ($3) | Short Term |
| 37 | Eliminate Case Mix Adjustment for AIDS Nursing Services in Certain Long Term Care Settings | Recalibrate Medicaid Benefits and Reimbursement Rates | Eliminate CMI adjustment for AIDS Nursing Services in the Certified Home Health Agency and Long Term Home Health Care Program. | ($3) | Short Term |
| 38 | Remove Transportation as a Covered Benefit from Managed Care Plans | Recalibrate Medicaid Benefits and Reimbursement Rates | Carveout transportation from the Medicaid managed care organization benefit package, to reduce costs and medical provider administrative burdens through state transportation management initiatives. | ($3) | Short Term |
| 39 | Comprehensive Hemophilia Treatment Centers w/factor programs | Recalibrate Medicaid Benefits and Reimbursement Rates | Obtain blood factor products from Hemophilia Treatment Centers (HTCs), so that Medicaid can access 340B rates. | ($3) | Short Term |
| 40 | Allow LPNs to do assessments in LTC settings | Recalibrate Medicaid Benefits and Reimbursement Rates | Modify the education law to would allow LPNs to do assessments on resident conditions. | ($3) | Short Term |
| 41 | Eliminate and Reprogram Area Health Education Center (AHEC) Funding | Recalibrate Medicaid Benefits and Reimbursement Rates | Reprogram current Area Health Education Center Funding (AHEC) funding for a new Public Health Services Corp. initiative. | ($2) | Short Term |
| 42 | Limit Medicaid coverage for compression stockings | Recalibrate Medicaid Benefits and Reimbursement Rates | Limits Medicaid coverage for stockings to the Medicare criteria and includes coverage during pregnancy. | ($2) | Short Term |
| 43 | Eliminate Part D Drug Wrap in Medicaid | Recalibrate Medicaid Benefits and Reimbursement Rates | Eliminate Medicaid coverage and reimbursement of drugs that are available to Medicaid/Medicare dual eligible beneficiaries through their Medicare Part D plans. | ($1) | Short Term |
| 44 | Limit Payment for Podiatry to Qualified Medicare Beneficiaries (QMBs) and Recipients under 21 | Recalibrate Medicaid Benefits and Reimbursement Rates | Limit reimbursement for podiatry to Qualified Medicare Beneficiaries (QMB) and recipients under 21. | ($1) | Short Term |
| 45 | Discontinue HIV Specialty Pharmacy Reimbursement | Recalibrate Medicaid Benefits and Reimbursement Rates | Eliminate the HIV Specialty Pharmacy designation and the associated higher reimbursement rate. | ($1) | Short Term |
| 46 | Reimburse for Observation Services in Hospital | Recalibrate Medicaid Benefits and Reimbursement Rates | Reimburse for Observation Services in Hospital, may result in decreased inpatient admission. | ($1) | Short Term |
| 47 | Allow Denials for Clinical Drug Review Program | Recalibrate Medicaid Benefits and Reimbursement Rates | Amend existing legislation to allow Clinical Drug Review Program (CDRP) prior authorization requests to be denied when clinical criteria are not met. | ($1) | Short Term |
| 48 | Enhance NYS Leverage for Direct Supplemental Rebates | Recalibrate Medicaid Benefits and Reimbursement Rates | Allow the Commissioner of Health more flexibility when directly negotiating with drug manufacturers in seeking higher supplemental rebates. | ($1) | Short Term |
| 49 | Reimburse Art 28 clinics for HIV counseling/testing using APGs | Recalibrate Medicaid Benefits and Reimbursement Rates | Incorporate Medicaid payment to Article 28 clinics for HIV counseling and testing services into the Ambulatory Patient Group(APG) payment structure. | ($1) | Short Term |
| 50 | Create a new Medicaid model of care for the existing AIDS Adult Day Health Care program | Recalibrate Medicaid Benefits and Reimbursement Rates | Establish and pay for a less–intensive AIDS adult day health care service which would be reimbursed at a lower rate than is currently being paid. | ($1) | Short Term |
| 51 | Limit Coverage of Eyeglass Replacement | Recalibrate Medicaid Benefits and Reimbursement Rates | Limit eyeglass replacement once every 24 months. | ($1) | Short Term |
| 52 | Tightening The Early Refill Process | Recalibrate Medicaid Benefits and Reimbursement Rates | Tighten up requirements for obtaining authorization to fill a prescription when it is denied because it has been "refilled too soon." | ($1) | Short Term |
| 53 | Revise Inpatient Detox Reimbursement to Incentivize Step– Down Care | Recalibrate Medicaid Benefits and Reimbursement Rates | Change reimbursement for medically managed withdrawal (detoxification) to incentivize shorter lengths of stay. | ($1) | Short Term |
| 54 | Adjust 340B Drug payment in 340B–eligible clinics via APGs | Recalibrate Medicaid Benefits and Reimbursement Rates | Adjust payment downward for 340B Drugs in 340B–eligible clinics, under APGs. | $0 | Short Term |
| 55 | Increase coverage of tobacco cessation counseling | Recalibrate Medicaid Benefits and Reimbursement Rates | Expand existing tobacco cessation counseling coverage in Medicaid to include all women (not only pregnant women) and men. | $0 | Short Term |
| 56 | Amend Nursing Home Transition Diversion Waiver to Replace Aggregate Cap with Individual Cap | Recalibrate Medicaid Benefits and Reimbursement Rates | Changes waiver structure to move from aggregate cap to individual cap. | $0 | Short Term |
| 57 | Limit opioids to a four prescription fill limit every thirty days. | Recalibrate Medicaid Benefits and Reimbursement Rates | Limit opioid prescriptions to a four prescriptions fill limit every thirty days for Medicaid beneficiaries. | $0 | Short Term |
| 58 | Designate Preferred Status for Therapeutic Classes | Recalibrate Medicaid Benefits and Reimbursement Rates | Accelerate the collection of supplemental rebates by allowing the Commissioner of Health to designate certain drugs/therapeutic classes as preferred until the Pharmacy and Therapeutics Committee may review. | $0 | Short Term |
| 59 | Clinical Advisory Committee on Health & Emerging Technologies (CACHET) | Recalibrate Medicaid Benefits and Reimbursement Rates | Create a group of clinical experts to review current Medicaid benefits and technology coverage policies. | $0 | Short Term |
| 60 | Delink Workers Compensation and No Fault Rates from Medicaid | Recalibrate Medicaid Benefits and Reimbursement Rates | Delink Worker´s Compensation and No Fault (WCNF) rates from the Medicaid fee–for–service (FFS) inpatient rates. | $0 | Short Term |
| 61 | Home Care Worker Parity – For Certain Long Term Care Settings | Recalibrate Medicaid Benefits and Reimbursement Rates | Require as a condition of provider enrollment in the Medicaid program that all Certified Home Health Agencies, Long Term Home Health Care Programs, and MLTC to comply with any local living wage law. | $0 | Short Term |
| 62 | IDA Financing | Recalibrate Medicaid Benefits and Reimbursement Rates | Propose legislation to allow Industrial Development Agencies to provide financing for health care facilities, including hospitals, nursing homes, assisted living, retirement communities and Continuing Care Retirement Communities (CCRCs). | $0 | Short Term |
| 63 | Reimbursement for dedicated preconception visits | Recalibrate Medicaid Benefits and Reimbursement Rates | Establish reimbursement for a preconception visit for all women and adolescents. | $0 | Short Term |
| 64 | Provide direct reimbursement for NPs and PAs in clinics. | Recalibrate Medicaid Benefits and Reimbursement Rates | Provide direct reimbursement for Nurse Practitioners and Physician Assistants in clinics. | $0 | Short Term |
| 65 | Eliminate copays for some preventative services | Recalibrate Medicaid Benefits and Reimbursement Rates | The ACA provides 1% additional Federal Financial Participation (FFP) to states that eliminate copayments for select preventative services. FFP increase partially offsets the copay loss. | $1 | Short Term |
| 66 | Revise Indigent Care Pool Distributions to align with Federal Reform | Recalibrate Medicaid Benefits and Reimbursement Rates | Reduce payment & revise Indigent Care methodology consistent with Federal reform. Option for safety net hospital pool under consideration. | $140 | Short Term |
| 67 | Assist preservation of essential Safety–net Hospitals | Recalibrate Medicaid Benefits and Reimbursement Rates | Provide operational and restructuring assistance to safety net hospitals to make critical decisions to either close, merge or restructure. | TBD | Short Term |
| 68 | Repatriate Individuals in out of state placements | Recalibrate Medicaid Benefits and Reimbursement Rates | This proposal will identify spending on out–of–state placements and seek to repatriate these individuals. | TBD | Short Term |
| 69 | Uniform Assessment Tool (UAT) for LTC | Recalibrate Medicaid Benefits and Reimbursement Rates | This proposal will implement a Uniform Assessment Tool (UAT) for long term care. | TBD | Short Term |
| 70 | Expand current statewide Patient Centered Medical Homes– PCMH | Recalibrate Medicaid Benefits and Reimbursement Rates | Expand the current Statewide Patient Centered Medical Home Program (PCMH) to more payers and broader patient participation. | TBD | Short Term |
| 71 | Address several issues related to unused medications | Recalibrate Medicaid Benefits and Reimbursement Rates | Ensure the appropriate disposal and/or return of unused medications by long term care facilities and require that unused medications be credited back to the Medicaid program. | TBD | Short Term |
| 72 | Provide Capital Reimbursement for Facilities at End of Useful Life | Recalibrate Medicaid Benefits and Reimbursement Rates | Effective 4/1/09, current law allows the capital rate for proprietary NHs at the end of their useful lives to be adjusted to reflect projects that protect safety of patients or convert beds to an alternative LTC use | TBD | Short Term |
| 73 | Reimburse Local Health Departments for environmental lead investigations for children | Recalibrate Medicaid Benefits and Reimbursement Rates | Implement Medicaid reimbursement to local health departments for investigation and care coordination services provided to children with elevated blood lead levels. | TBD | Short Term |
| 74 | Increase Medicaid payment for vaccine administration. | Recalibrate Medicaid Benefits and Reimbursement Rates | Increase Medicaid immunization administration fees for adults. | TBD | Short Term |
| 75 | Evaluate reimbursement for patients with needs inconsistent with the billed level of care. | Recalibrate Medicaid Benefits and Reimbursement Rates | Use evidence–based utilization reviews to identify patients whose needs do not support the billed level of care. | TBD | Short Term |
| 76 | Develop less intensive reimbursement model for HIV TCM | Recalibrate Medicaid Benefits and Reimbursement Rates | Cover low intensity HIV Targeted Case Management in Medicaid. | TBD | Short Term |
| 77 | Provide Additional Financial Assistance to Financially Unstable NHs | Recalibrate Medicaid Benefits and Reimbursement Rates | Provide additional funds for financially unstable nursing homes that is based on more current operating losses and require submission of restructuring plans to achieve financial stability. | TBD | Short Term |
| 78 | Hospital/Nursing Home Closure/Conversion Incentive Program | Recalibrate Medicaid Benefits and Reimbursement Rates | Make supplemental funds available on a short–term basis to assist the receiving hospital/nursing home when an area hospital/nursing home closes or consolidates. | TBD | Short Term |
| 79 | Implement Episodic Pricing for Certified Home Health Agencies | Recalibrate Medicaid Benefits and Reimbursement Rates | Implement a CHHA Episodic Pricing methodology (which is similar to the Medicare Pricing Model) and is based upon 60–day episodes of care and adjusts for case mix and labor costs. | TBD | Short Term |
| 80 | Reassess Prescription Drug Purchasing Policies | Recalibrate Medicaid Benefits and Reimbursement Rates | Require the State to reassess prescription drug purchasing and to achieve additional savings by obtaining better supplemental rebates on drug purchases. | TBD | Short Term |
| 81 | Implement Statewide Program to Encourage NHs to Refinance Mortgages | Recalibrate Medicaid Benefits and Reimbursement Rates | Reduce nursing home capital costs by encouraging the refinancing of mortgages. | TBD | Short Term |
| 82 | Reduce Reimbursement for Potentially Preventable Conditions | Pay Providers Based On Performance | Establish a performance based payment system that reduces hospital reimbursement for potentially preventable conditions (such as bed sores and hospital acquired pneumonia). | ($2) | Short Term |
| 83 | Require Screening Brief Intervention Referral and Treatment (SBIRT) in primary care and ER | Pay Providers Based On Performance | Provide screening, intervention and referral to treatment (SBIRT) for alcohol/drug use in primary care and ER. | ($2) | Short Term |
| 84 | Pay on P4P basis (LTC) | Pay Providers Based On Performance | This proposal will pay nursing homes and other institutions on a Pay for Performance basis. This may include community based and/or provider specific performance measures. | $0 | Short Term |
| 85 | Pay providers on Pay for Performance (P4P) basis (Ambulatory Care) | Pay Providers Based On Performance | Pay providers on Pay for Performance (P4P) basis (Ambulatory Care). May include community based and/or provider specific performance measures. | $0 | Short Term |
| 86 | Pay on P4P basis (Behavioral H/IDD) | Pay Providers Based On Performance | Pay providers on Pay for Performance (P4P) basis (Behavioral Health). May include community based and/or provider specific performance measures. | $0 | Short Term |
| 87 | Reduce Unnecessary Hospitalizations – Community Based Pay for Performance | Pay Providers Based On Performance | Implement a community based pay for performance (P4P) payment system reform that provides financial incentives to providers to reduce unnecessary hospital admits and readmits thereby lowering cost and improving quality. | $0 | Short Term |
| 88 | Incentivize providers to screen for BH issues in children | Pay Providers Based On Performance | Pay performance incentives for primary care screening for developmental and mental health problems in children. | TBD | Short Term |
| 89 | Health homes for high cost/high need enrollees | Ensure That Every Medicaid Member is Enrolled in Managed Care | Address High cost, high need patient management through the provision of care coordination (health home) services funded with 90% federal financial participation through the ACA. | ($42) | Short Term |
| 90 | Mandatory Enrollment in MLTC Plans/Health Home Conversion | Ensure That Every Medicaid Member is Enrolled in Managed Care | Transition Medicaid recipients age 21 and older in need of community–based long term care services into Managed Long Term Care (MLTC) plans. | ($16) | Short Term |
| 91 | Carve In for Behavioral Health Services into Managed Care | Ensure That Every Medicaid Member is Enrolled in Managed Care | Change the Medicaid managed care benefit package to expand the scope of behavioral health services provided by plans to their members. | ($9) | Short Term |
| 92 | Allow Restricted Recipient Program in Managed Care | Ensure That Every Medicaid Member is Enrolled in Managed Care | Authorize the Department of Health (DOH) to allow recipients in the Recipient Restriction Program (RRP) to enroll in Medicaid Managed Care. | ($8) | Short Term |
| 93 | Implement Regional Behavioral Health Organizations | Ensure That Every Medicaid Member is Enrolled in Managed Care | Contract with regional Behavioral Health Organizations to manage the behavioral health benefit for Medicaid members. | ($5) | Short Term |
| 94 | Increase HIV related utilization Reviews | Ensure That Every Medicaid Member is Enrolled in Managed Care | Increase utilization reviews for HIV inpatient services, outpatient services provided in hospitals and community health centers, and other HIV–related services. | ($4) | Short Term |
| 95 | Include Personal Care Benefit in Managed Care | Ensure That Every Medicaid Member is Enrolled in Managed Care | Require Medicaid managed care plans to cover personal care services in the benefit package. | ($2) | Short Term |
| 96 | Expand Managed Care Enrollment | Ensure That Every Medicaid Member is Enrolled in Managed Care | Authorize the Department of Health (DOH) to enroll additional non–dually eligible Medicaid recipients into mainstream Medicaid managed care programs. | ($1) | Short Term |
| 97 | Assigning Primary Care Providers to Medicaid Enrollees | Ensure That Every Medicaid Member is Enrolled in Managed Care | Assign Primary Care Providers to Medicaid Enrollees. | ($1) | Short Term |
| 98 | Streamline Managed care enrollment eligibility process | Ensure That Every Medicaid Member is Enrolled in Managed Care | Mandate selection of a Medicaid Managed Care plan as a condition of eligibility for Medicaid. | $0 | Short Term |
| 99 | Access to services not covered by managed care | Ensure That Every Medicaid Member is Enrolled in Managed Care | Require that managed care enrollees receive information pertaining to coverage denials and how to access carved out services. | $0 | Short Term |
| 100 | Enroll Non–dual eligible nursing home residents into Medicaid managed care | Ensure That Every Medicaid Member is Enrolled in Managed Care | Require enrollment of all non–dual eligible nursing residents into Medicaid managed care plans which would capitate the full range of health care services, including both acute and long term care services. | TBD | Short Term |
| 101 | Develop Initiatives for People with Medicare and Medicaid | Ensure That Every Medicaid Member is Enrolled in Managed Care | Develop revised reimbursement mechanisms for people who are dually eligible for Medicare and Medicaid. | TBD | Short Term |
| 102 | Centralize Responsibility for Medicaid Estate Recovery Process | Ensure Consumer Protection and Promote Personal Responsibility | Authorize statewide responsibility for making Medicaid recoveries from the estates of deceased recipients, in personal injury actions and in legally responsible relative refusal cases. | ($39) | Short Term |
| 103 | Reduce Inappropriate Use of Certain Services | Ensure Consumer Protection and Promote Personal Responsibility | Institute financial disincentives to reduce inappropriate use of C–sections, Coronary Artery Bypass Grafts (CABG) and Percutaneous Coronary Intervention (PCI). | ($18) | Short Term |
| 104 | Increase Enrollee Copayment Amounts | Ensure Consumer Protection and Promote Personal Responsibility | Increase the enrollee copayment amount, services that co–pays apply to, and the annual co–pay capped amount. | ($6) | Short Term |
| 105 | Consolidate patient visits | Ensure Consumer Protection and Promote Personal Responsibility | Eliminate payment for separate reimbursement where patient care can take place in one visit. | ($2) | Short Term |
| 106 | Guidelines for Medicaid Reform | Ensure Consumer Protection and Promote Personal Responsibility | Develop Guiding Principles for Medicaid Redesign. | $0 | Short Term |
| 107 | Medicaid patient co–pay tax deduction or credit | Ensure Consumer Protection and Promote Personal Responsibility | Allow relatives (e.g., adult children) of Medicaid nursing home recipients to contribute toward the cost of their care in return for a tax credit/deduction. | $0 | Short Term |
| 108 | Educate and Incentivize Beneficiaries to appropriately use ERs/Urgent Care Centers | Ensure Consumer Protection and Promote Personal Responsibility | Educate and Incentivize Beneficiaries to appropriately use primary care providers, when Emergency Room/Urgent Care is not warranted. | TBD | Short Term |
| 109 | Patient Centered Palliative Care | Ensure Consumer Protection and Promote Personal Responsibility | Assure access to palliative care and pain management services for people with advanced, life–limiting illnesses and conditions. | TBD | Short Term |
| 110 | Promote the sugar sweetened beverage tax | Ensure Consumer Protection and Promote Personal Responsibility | Create a consumer tax on all sugar sweetened beverages purchased in NYS; use revenue to fund various health initiatives. | TBD | Short Term |
| 111 | Limit divestment and encourage private LTC insurance | Ensure Consumer Protection and Promote Personal Responsibility | This proposal will create additional plan options for the Partnership for LTC insurance program. | TBD | Short Term |
| 112 | Use incentives to encourage urgent. care/primary care over Emergency Room | Ensure Consumer Protection and Promote Personal Responsibility | Create financial incentives including differential copays to encourage Medicaid members to use urgent care/primary care instead of Emergency Room. | TBD | Short Term |
| 113 | Allow Nursing Homes to Intercept SSI Checks for Long Term NH Stays | Ensure Consumer Protection and Promote Personal Responsibility | Encourage nursing home to become representative for resident in order to intercept the Supplemental Security Income (SSI) payment in certain cases. | TBD | Short Term |
| 114 | Expand public outreach for the Partnership for Long Term Care | Ensure Consumer Protection and Promote Personal Responsibility | Create a fund to support marketing of Partnership for LTC Insurance | TBD | Short Term |
| 115 | Nursing/patient direction of HH and PC aides to assist w/ nursing care | Empower Patients and Rebalance Service Delivery | Permit nurses/patients (under their scope of practice/practice exemption) to orient/direct HHAs and PC workers to provide "nursing care" as nurses/patients are allowed with family members` and aides in the consumer directed program. | ($20) | Short Term |
| 116 | Accelerate IPRO Review of Medically Managed Detox (Hosp) and including Ambulatory Reviews | Empower Patients and Rebalance Service Delivery | Refocus Island Peer Review Organization (IPRO) reviews of medically managed withdrawal cases based on DRG rates and ambulatory visits based on the new APG billing procedures. | ($2) | Short Term |
| 117 | Review Coler & Goldwater Memorial Hospital Rates | Empower Patients and Rebalance Service Delivery | Reduce reimbursement to Coler–Goldwater Specialty Hospital from current per diem to facility´s alternate level of care payment for patients with HIV for whom a lower level of care is more appropriate. | ($1) | Short Term |
| 118 | Establish a new home and community–based 1915(c) Medicaid Waiver | Empower Patients and Rebalance Service Delivery | Consolidate Long Term Home Health Care Program and Nursing Home Transition Diversion into one comprehensive waiver. | ($1) | Short Term |
| 119 | Enhance School Based Health Services care to reduce Emergency Room usage | Empower Patients and Rebalance Service Delivery | Enhance School Based Health Services primary care services to reduce Emergency Room usage. | $0 | Short Term |
| 120 | Move people out of OMH institutions | Empower Patients and Rebalance Service Delivery | Establish regional forums to bring mental health agencies and housing agencies together to discuss how to give participants appropriate levels of care. | $0 | Short Term |
| 121 | County/State Nursing Home Governance Flexibility | Empower Patients and Rebalance Service Delivery | Create a public authority that State or County nursing homes can join. | $0 | Short Term |
| 122 | Seek Federal Recognition under ACAs Balancing Incentive Payments Program | Empower Patients and Rebalance Service Delivery | Seek recognition under ACA´s Balancing Incentive Payments Program. States who effectively expand the delivery of care via home and community based services are eligible for a 2% increase in FMAP. | $0 | Short Term |
| 123 | Streamline ALP admission process | Empower Patients and Rebalance Service Delivery | Streamline ALP admission process by amending State Law. | $0 | Short Term |
| 124 | Create and deploy a permanent, revolving Primary Care Capital Access Fund (PCCAF). | Empower Patients and Rebalance Service Delivery | Implement a one–time HEAL grant of $31 million to create and deploy a permanent, revolving Primary Care Capital Access Fund (PCCAF). | $0 | Short Term |
| 125 | Bonus for high volume Medicaid physicians | Empower Patients and Rebalance Service Delivery | Pay a bonus to Medicaid Primary Care Physicians doing a higher volume of care to Medicaid patients to assure continued access to primary care services after implementation of any across the board cut. | $2 | Short Term |
| 126 | Bed Exchange Proposal | Empower Patients and Rebalance Service Delivery | Provide hospitals with financial incentives to voluntarily reduce staffed bed capacity and redirect Medicaid resources to expand outpatient/ambulatory surgery capacity. | $8 | Short Term |
| 127 | Revise Transitional Care Unit Policy | Empower Patients and Rebalance Service Delivery | Revise Transitional Care Unit policy to allow greater use of these units. | TBD | Short Term |
| 128 | Allow Long Term Home Health Care Providers to offer Hospice | Empower Patients and Rebalance Service Delivery | This proposal will seek federal approval to allow Long Term Home Health Care Programs to offer hospice services without requiring that patients disenroll from Long Term Home Health Care Program. | TBD | Short Term |
| 129 | Use State´s Authority to Supervise Integration of Health Services and Providers to Minimize Anti–Trust Exposure | Empower Patients and Rebalance Service Delivery | State supervision of implementation of Health system reform strategies, (such as medical homes and accountable care organizations), that seek to improve quality, efficiency, and outcomes through increased coordination and integration. | TBD | Short Term |
| 130 | Allow Nurse Practitioners to sign Medical Evaluations for ACF/AL admissions | Empower Patients and Rebalance Service Delivery | Amend the Social Services Law to allow nurse practitioners to sign Medical Evaluations for ACF residents. | TBD | Short Term |
| 131 | Medical Malpractice Reform and Patient Safety | Eliminate Government Barriers to Quality Improvement and Cost | Create a neurological infant medical indemnity fund, cap non–economic damages in addition to exploring alternatives such as disclosure and early settlement and judge directed negotiations. | ($234) | Short Term |
| 132 | Expand the Definition of Estate | Eliminate Government Barriers to Quality Improvement and Cost | Expand definition of "estate" to include assets that bypass probate in order to recover more assets from a deceased Medicaid recipient over age 55. | ($1) | Short Term |
| 133 | Administrative Renewal for Aged and Permanently Disabled | Eliminate Government Barriers to Quality Improvement and Cost | Allow aged and permanently disabled with fixed incomes to be automatically renewed based on cost of living increases. | $0 | Short Term |
| 134 | Audit of Cost Reports (rather than certification) | Eliminate Government Barriers to Quality Improvement and Cost | Contract with independent certified public accounting (CPA) firms licensed in NYS to conduct annual field and desk audits of the Institutional Cost Reports (ICRs). | $0 | Short Term |
| 135 | Flexibility to Convert/Establish Urgent Care Centers | Eliminate Government Barriers to Quality Improvement and Cost | Support development of urgent care centers by developing a rate of payment for freestanding emergency services clinics. | $0 | Short Term |
| 136 | Eliminate 60/30 Day Notice Requirement | Eliminate Government Barriers to Quality Improvement and Cost | Eliminate the current requirement to provide 60 day or 30 day notice to providers of the proposed Medicaid rates for a future period. | $0 | Short Term |
| 137 | Disregard retirement assets such as 401K plans for MBI– WPD | Eliminate Government Barriers to Quality Improvement and Cost | As an incentive to participate in the MBI–WPD program raise the resource standard and disregard retirement accounts. | $0 | Short Term |
| 138 | Eliminate restrictions on nursing practice in Adult Care Facilities | Eliminate Government Barriers to Quality Improvement and Cost | Eliminate the restrictions on nurses´ ability to function consistent with their scope of practice in adult homes, rather than requiring other nurses (not practicing in the adult home) to perform these basic duties. | $0 | Short Term |
| 139 | Implement the new waiver for Long Term Home Health Care Program | Eliminate Government Barriers to Quality Improvement and Cost | Implement the new enhancements of the Long Term Home Health Care Program waiver, initiating the opportunities for increased Medicaid cost–savings and performance. | $0 | Short Term |
| 140 | Fast Track Eligibility for Long–term Care | Eliminate Government Barriers to Quality Improvement and Cost | Utilize electronic verification of resources instead of presumptive eligibility. | $2 | Short Term |
| 141 | State Assumption of Medicaid Administration | Eliminate Government Barriers to Quality Improvement and Cost | Centralizing administration of Medicaid to improve efficiency, uniformity, and cost savings in program administration. | TBD | Short Term |
| 142 | Eliminate Barriers to Recruiting and Retaining Healthcare Workforce. | Eliminate Government Barriers to Quality Improvement and Cost | Eliminate barriers to retention and recruitment of needed health care workers, including physicians, nurses, and allied health care professionals. | TBD | Short Term |
| 143 | Continue improvements in State CON Program | Eliminate Government Barriers to Quality Improvement and Cost | Department will pursue alternatives approaches to architectural reviews and pre and post opening surveys – this will proposal will also be referred to the SAGE Commission process. | TBD | Short Term |
| 144 | Eliminate Duplicative Surveillance Activities (Labs/psychiatry) | Eliminate Government Barriers to Quality Improvement and Cost | Consolidate duplicative laboratory and hospital psychiatric surveillance currently conducted by Doha. This proposal will be referred to the SAGE Commission process. | TBD | Short Term |
| 145 | Explore incentives for private, for–profit hospitals to enter NY | Eliminate Government Barriers to Quality Improvement and Cost | Explore incentives/regulatory or statutory relief for publically traded or for profit companies to assist in management of targeted provider restructuring, such as safety net hospitals. | TBD | Short Term |
| 146 | Distinct parts for Nursing Homes | Eliminate Government Barriers to Quality Improvement and Cost | Eliminate the requirement that every nursing home bed in the State be a certified Medicaid bed. | TBD | Short Term |
| 147 | Collaborate to eliminate/modify unnecessary regulations | Eliminate Government Barriers to Quality Improvement and Cost | There are a number of suggested initiatives that require both statutory and regulatory actions to reduce burdens on hospitals and other health care facilities and expand access to capital. | TBD | Short Term |
| 148 | Reduce or eliminate the local County share of the Medicaid program | Eliminate Government Barriers to Quality Improvement and Cost | Explore methods to reduce the local share contribution in Medicaid. | TBD | Short Term |
| 149 | Eliminate the need for a Certified Home Health Agency in the Assisted Living Program | Eliminate Government Barriers to Quality Improvement and Cost | Eliminate the requirement for a CHHA or Long Term Home Health Care Program to perform an assessment of the Assisted Living Program participants. | TBD | Short Term |
| 150 | Automate Eligibility Determinations and Verification | Eliminate Government Barriers to Quality Improvement and Cost | Automate eligibility determinations and verifications. | TBD | Short Term |
| 151 | Extension of Medication Aides into Nursing Homes | Eliminate Government Barriers to Quality Improvement and Cost | Permitting Medication Aides to administer medication in nursing homes under the appropriate supervision of medical and nursing staff. | TBD | Short Term |
| 152 | Eliminate Private Right of Action for Nursing Homes | Eliminate Government Barriers to Quality Improvement and Cost | Repeal 2801d of the Public Health Law which allows individuals to bring a private right of action against nursing homes. | TBD | Short Term |
| 153 | Develop innovative telemedicine applications by reducing regulatory barriers and providing payment incentives | Eliminate Government Barriers to Quality Improvement and Cost | Provide payment incentives and reduce coverage barriers to promote and enhance coverage of telemedicine and telehealth/telehome monitoring services by providing payment incentives and reduce coverage barriers. | TBD | Short Term |
| 154 | Require Providers to Reconcile Exception & Conflict Reports Statewide | Eliminate Fraud and Abuse | Requires that all CHHAs and Personal Care providers statewide utilize a point of service verification vendor, and provide exception and conflict report data to the OMIG, which includes the identity of individual providers. | ($23) | Short Term |
| 155 | Mandate Participation in the OMIG Cardswipe Program for all Pharmacies. | Eliminate Fraud and Abuse | Requires all pharmacies billing Medicaid to participate in the OMIG Cardswipe Program (landline). | ($13) | Short Term |
| 156 | Medicare Coordination of Benefits with Provider Submitted Duplicate Claims | Eliminate Fraud and Abuse | This proposal would require the OMIG to review claims approved and paid by Medicare for dual eligible recipients, which are also submitted to Medicaid for payment, and refine existing edit logic to prevent such duplication. | ($10) | Short Term |
| 157 | Require Medicare Enrollment for All Ordering Physicians of Home Health Services | Eliminate Fraud and Abuse | Require that physicians who order services for dually eligible individuals be enrolled in both Medicare and Medicaid consistent with Medicare Provider Enrollment, Chain and Ownership System (PECOS) requirements. | ($8) | Short Term |
| 158 | Requires use of BNE´s online Dr. Shopper Program to curb prescription abuse | Eliminate Fraud and Abuse | Requiring that prescribers access BNE´s on line Dr. Shopper Program before issuing prescriptions for controlled substances. | ($8) | Short Term |
| 159 | Each of the Medicaid agencies provides the OMIG with a list of providers which may need closer audit scrutiny | Eliminate Fraud and Abuse | Each of the Medicaid agencies provides the OMIG with a list of providers which may need closer audit scrutiny. | ($5) | Short Term |
| 160 | Expand the OMIG Restricted Recipient Program | Eliminate Fraud and Abuse | Automatic mandatory restriction utilizing revised criteria for recipients without existing full clinical reviews by the State Medical Review Team. | ($2) | Short Term |
| 161 | Other Pharmacy Actions (Restock / Re–dispense, Narcotics Database, ID or Sign for Pharm.) | Eliminate Fraud and Abuse | Require the identification and signature for home delivery and receipt of prescriptions at pharmacies; requires pharmacies to restock and re–dispense returned medications from nursing homes. | ($2) | Short Term |
| 162 | Eliminate Medicaid Payments for Medicare Part B Co– insurance | Better align Medicaid with Medicare and ACA | Medicaid will no longer reimburse physicians the Medicare Part B coinsurance amount for patients that have both Medicare and Medicaid coverage. | ($42) | Short Term |
| 163 | Seek Demonstration Funding to shift volume State Psych Hospitals to Voluntary Hospitals | Better align Medicaid with Medicare and ACA | Apply for federal demo funds to shift some of the 4,000 inpatient mental health recipients from State Hospitals (Institutions for Mental Diseases) to voluntary hospitals. | ($10) | Short Term |
| 164 | align Medicare Part B coinsurance with Medicaid coverage | Better align Medicaid with Medicare and ACA | Eliminate Payments to Practitioners for Medicare Part B coinsurance for non–reimbursable Medicaid services. | ($5) | Short Term |
| 165 | Eliminate Funding for Part D Education and Outreach | Better align Medicaid with Medicare and ACA | Eliminate State funding for Medicare Part D education and outreach. | ($1) | Short Term |
| 166 | Dispense prescriptions for shorter durations in LTC facilities | Better align Medicaid with Medicare and ACA | Require long term care (LTC) pharmacies to dispense medications in quantities less than 30 days to prevent waste associated with patient discharges, death or changes in medication. | ($1) | Short Term |
| 167 | Allow Administrative Renewals in the Medicare Savings Program | Better align Medicaid with Medicare and ACA | New York has maximized enrollment in MSP. A remaining option is to allow administrative renewals. | $0 | Short Term |
| 168 | ACA Implementation– Enact New York Health Insurance Exchange and Consolidate Regulation | Better align Medicaid with Medicare and ACA | Authorize a New York Health Benefits Exchange in 2011 as a first step in implementing Affordable Care Act. | $0 | Short Term |
| 169 | Assess Large Employers for Failing to Offer Affordable Coverage (Medicaid Dumping Fine) | Better align Medicaid with Medicare and ACA | Assess a financial penalty on employers who do not offer affordable health insurance to their workers and whose workers are enrolled in Medicaid/Family Health Plus. | TBD | Short Term |
| 170 | Change reimburse to pay for needs–based elder care | Recalibrate Medicaid Benefits and Reimbursement Rates | Create a payment reform work group composed of people with financial expertise in the provision of elder services. | $0 | Long Term |
| 171 | Reduce Medicaid Reimbursement by 4% for All Services | Recalibrate Medicaid Benefits and Reimbursement Rates | Across the board 4% cut. | $0 | Long Term |
| 172 | Sole–source contract for eyeglasses | Recalibrate Medicaid Benefits and Reimbursement Rates | Medicaid will enter into a sole–source contract for the fabrication of eyeglasses for NYC recipients. | TBD | Long Term |
| 173 | Impose Moratorium on Medicaid Rate Cuts | Recalibrate Medicaid Benefits and Reimbursement Rates | Impose Moratorium on Medicaid Rate Cuts | TBD | Long Term |
| 174 | Federal Medicare reimbursement change | Recalibrate Medicaid Benefits and Reimbursement Rates | Advocate for Federal reimbursement change. | TBD | Long Term |
| 175 | Cost screens for OASAS inpatient rehabilitation programs | Recalibrate Medicaid Benefits and Reimbursement Rates | Establish more detailed cost screens for chemical dependence inpatient rehabilitation programs. Currently, inpatient rehabilitation providers are reimbursed on a cost–based rate. These rates vary greatly and it is proposed | TBD | Long Term |
| 176 | Site–specific Cost reporting | Recalibrate Medicaid Benefits and Reimbursement Rates | Require all cost reports to be filed with site specific cost and unit detail. | TBD | Long Term |
| 177 | Reform Delivery and Reimbursement of Medicaid Services to Foster Care Children | Recalibrate Medicaid Benefits and Reimbursement Rates | Revise Foster care per diem payment method and promote more accountable care delivery. | TBD | Long Term |
| 178 | Reduce Spending & Phase–out Long Term Home Health Care Program | Recalibrate Medicaid Benefits and Reimbursement Rates | Phase out Long Term Home Health Care in counties with sufficient managed care term care capacity. | TBD | Long Term |
| 179 | Establishing reimbursement for services delivered by community health workers. | Recalibrate Medicaid Benefits and Reimbursement Rates | Establish community health workers as enrolled providers and develop a rate of payment in Medicaid. | TBD | Long Term |
| 180 | Ensuring access to effective contraception and other family planning services | Recalibrate Medicaid Benefits and Reimbursement Rates | Promote access to contraception and family planning services. | TBD | Long Term |
| 182 | Enhance coordination of benefits between Medicaid and the Women, Infants, and Children (WIC) Program. | Recalibrate Medicaid Benefits and Reimbursement Rates | Require Medicaid members to utilize WIC benefits prior to using Medicaid paid services. | TBD | Long Term |
| 183 | Submit a 1915i State Plan for home and community–based services and supports for HIV Medicaid population. | Recalibrate Medicaid Benefits and Reimbursement Rates | Apply for a 1915(i) state plan amendment to include wrap–around support services to HIV–infected Medicaid recipients who are at risk of progressing to nursing home eligible status. | TBD | Long Term |
| 184 | Urge Congress to enact a single payer national health care system (H.R. 676) | Recalibrate Medicaid Benefits and Reimbursement Rates | Advocate for a single payer system of care. | TBD | Long Term |
| 185 | Prepaid Medicaid Services | Recalibrate Medicaid Benefits and Reimbursement Rates | Pre–purchasing of services for Medicaid. | TBD | Long Term |
| 186 | Create and Enhanced Case Mix Adjustment for High Cost Patients with Complex Needs | Recalibrate Medicaid Benefits and Reimbursement Rates | Create an enhanced CMI for high cost complex hard to place patients who are presently in more expensive care settings. | TBD | Long Term |
| 187 | Incentivize to Promote Innovation and Reform | Recalibrate Medicaid Benefits and Reimbursement Rates | Reimbursement innovation will reduce costs by changing incentives to increase the efficiency of care delivery and the cost– effectiveness of the health care workforce. | TBD | Long Term |
| 188 | Revise Transitional Care Units (TCU´s) | Recalibrate Medicaid Benefits and Reimbursement Rates | Eliminate the authorization for the operation of TCU´s in the state. | TBD | Long Term |
| 189 | Modernize Insurance Law Coverage of Home Care | Recalibrate Medicaid Benefits and Reimbursement Rates | Modernize the insurance coverage benefit for home care to improve access to private coverage and reduce dependence on Medicaid. | TBD | Long Term |
| 190 | Convert Fee–for–Service Long Term Home Health Care Program to a Case Payment Based Methodology | Recalibrate Medicaid Benefits and Reimbursement Rates | Convert Fee–for–Service Long Term Home Health Care Program Reimbursement to a Case Payment Based Methodology | TBD | Long Term |
| 191 | Decrease the Incidence and Improve Treatment of Pressure Ulcers | Pay Providers Based On Performance | Decrease the Incidence and Improve Treatment of Pressure Ulcers through provider collaboration models. | TBD | Long Term |
| 192 | Consolidate Low–income Health Insurance Programs | Ensure That Every Medicaid Member is Enrolled in Managed Care | Consolidate and administer all NYS health coverage programs for low–income individuals and families on a statewide basis, under one banner (e.g. Empire State Care). | TBD | Long Term |
| 193 | Phase out of Healthy NY | Ensure That Every Medicaid Member is Enrolled in Managed Care | Terminate Healthy NY once insurance is available through the Exchange (2014). If done sooner for savings in 2012–13, 170,000 lose coverage with no alternative. | TBD | Long Term |
| 194 | Capitation Partnership | Ensure That Every Medicaid Member is Enrolled in Managed Care | Explore utility of partial and global capitation payment models in maintaining or reducing health care costs while improving patient care coordination. | TBD | Long Term |
| 195 | Coordinate Services for Public Assistance | Ensure Consumer Protection and Promote Personal Responsibility | Coordinate Services for Public Assistance – reaching out for more information – may be referred to SAGE. | TBD | Long Term |
| 196 | Supportive Housing Initiative | Ensure Consumer Protection and Promote Personal Responsibility | Establish a supportive housing program to prevent inappropriate nursing home placement. | TBD | Long Term |
| 197 | Reduce regional and provider variation in service efficiency and quality in the arena of Cardiac Surgery and | Ensure Consumer Protection and Promote Personal Responsibility | Reduce regional and provider variation in service efficiency and quality in the arena of Cardiac Surgery and Percutaneous Coronary Intervention (PCI). | TBD | Long Term |
| 198 | Review limitations on use of bedrails in LTC facilities | Ensure Consumer Protection and Promote Personal Responsibility | Evaluate Policies on bedrails and restraints. | TBD | Long Term |
| 199 | More marketing of programs such as premium assistance and MBI–WPD. | Ensure Consumer Protection and Promote Personal Responsibility | Implement a marketing campaign for premium assistance and MBI–WDP. | TBD | Long Term |
| 200 | Change in scope of practice for mid–level providers to promote efficiency lower Medicaid costs. | Empower Patients and Rebalance Service Delivery | Need to more broadly define scope of practice for mid level practitioners and create expanded access to peer based services. | $0 | Long Term |
| 201 | NH/ALP 6,000 Program Elimination | Empower Patients and Rebalance Service Delivery | Repeal authorization for additional 6000 Assisted Living Program (ALP) beds. | $0 | Long Term |
| 202 | Expand Assisted Living Options for Medicaid–Eligible Individuals | Empower Patients and Rebalance Service Delivery | Expand options for Medicaid–eligible individuals to receive assisted living services, preventing nursing home placement at a greater cost to Medicaid. | $3 | Long Term |
| 203 | Facilitate Enrollment In Federal CLASS ACT | Empower Patients and Rebalance Service Delivery | Promote and facilitate enrollment in the Community Living Assistance Services and Supports (CLASS ACT) | TBD | Long Term |
| 204 | Re–establish the BH Housing Shortage Workgroup | Empower Patients and Rebalance Service Delivery | Re–establish a multi–stakeholder housing workgroup to make recommendations on housing shortages that impact patients with mental health, chemical dependency or developmental disabilities. | TBD | Long Term |
| 205 | Improve access to care by utilizing Mobile Health Clinics | Empower Patients and Rebalance Service Delivery | Improve access to primary and preventive care via mobile clinics for the purpose of reducing the use of emergency departments for non–emergent care. | TBD | Long Term |
| 206 | Evaluation of Best Practices in Existing LTC Programs | Empower Patients and Rebalance Service Delivery | Evaluate the existing programs for managing patients in the community to determine best practices. | TBD | Long Term |
| 207 | Establish the Center for Health System Innovation within the Dept of Health | Empower Patients and Rebalance Service Delivery | Referred to SAGE Commission for further development. | TBD | Long Term |
| 208 | Accelerate State takeover of administration of Medicaid long–term care programs. | Empower Patients and Rebalance Service Delivery | Centralize administration of waiver and other LTC programs which would lead to greater accountability and consistency of service authorization. | TBD | Long Term |
| 209 | Expand Hospice | Empower Patients and Rebalance Service Delivery | Explore options for expanding hospice in all appropriate settings. | TBD | Long Term |
| 210 | Allow Nursing Homes to resize or develop non institutional alternatives with funding for transition | Empower Patients and Rebalance Service Delivery | The State to provide financial incentive and offset revenue loss to allow for the elimination of nursing home beds while providing individuals the ability to live in a less restrictive environment. | TBD | Long Term |
| 211 | Amend patient discharge regulations | Empower Patients and Rebalance Service Delivery | Amend existing regulations to allow nursing homes to discharge residents for the non– payment of the Net Amount Monthly Income (NAMI) and/or failure to provide funds to cover Medicare co–insurance expenses. | TBD | Long Term |
| 212 | Include Medicaid in Health Information Exchange (HIE) | Empower Patients and Rebalance Service Delivery | Support policy and technical solutions for health information exchange | TBD | Long Term |
| 213 | Enhance support for family and other "informal" care givers | Empower Patients and Rebalance Service Delivery | Evaluate support option for family/informal care givers. | TBD | Long Term |
| 214 | Downsize Nursing Homes through Incentives and Residential alternatives | Empower Patients and Rebalance Service Delivery | Downsize Nursing Homes through Incentives and Residential alternatives | TBD | Long Term |
| 215 | Enhance Nursing Home Care Coordination | Empower Patients and Rebalance Service Delivery | Require NHs and MLTC plans in areas where they are available to enter into contractual arrangements to evaluate all potential admissions and to provide care coordination to all residents. | TBD | Long Term |
| 216 | Expand Nursing Home Diversion to Long Term Home Health Care Program | Empower Patients and Rebalance Service Delivery | Enhance enforcement of section 367–c of the social services law, which diverts nursing home–eligible patients to home care. | TBD | Long Term |
| 217 | Create an office for development of patient–centered primary care initiatives | Eliminate Government Barriers to Quality Improvement and Cost | Create an office for development of patient–centered primary care initiatives. Reinvest cost from other less critical functions into this office. Refer to SAGE process. | $0 | Long Term |
| 218 | State Take Over and Enforce the Collection of NAMI | Eliminate Government Barriers to Quality Improvement and Cost | State Take Over and Enforce the Collection of NAMI Presently facilities are forced to collect Net Available Monthly Income (NAMI) debt. | $0 | Long Term |
| 219 | Advocate Changes to Federal EMTALA Rules | Eliminate Government Barriers to Quality Improvement and Cost | Reforming the Emergency Medical Treatment And Labor Act (EMTALA) will decrease unnecessary emergency department care for patients whose conditions are not emergent, increasing efficiency and reducing costs. | TBD | Long Term |
| 220 | Revise NH and HC Documentation Requirements | Eliminate Government Barriers to Quality Improvement and Cost | Evaluate current document requirements to eliminate and/or streamline. | TBD | Long Term |
| 221 | Administrative Simplification | Eliminate Government Barriers to Quality Improvement and Cost | This proposal will be referred to the SAGE Commission. | TBD | Long Term |
| 222 | Healthcare Information Technology Funding | Eliminate Government Barriers to Quality Improvement and Cost | Pursue HIT Funding in consultation with Stakeholders. | TBD | Long Term |
| 223 | Consolidate and create ONE agency who will regulate and oversee ALL Long Term Care needs. | Eliminate Government Barriers to Quality Improvement and Cost | Create one agency for regulation and surveillance of Long Term Care. This proposal will be referred to the SAGE Commission. | TBD | Long Term |
| 224 | Allow Electronic Fund Payments (EFT) in Medicaid | Eliminate Government Barriers to Quality Improvement and Cost | Allow EFT transfers to improve provider cash flow. | TBD | Long Term |
| 225 | Create an All Payer Claims System (expanded SPARCS system) | Eliminate Government Barriers to Quality Improvement and Cost | Expand the State´s data collection process to include all services from all payers. | TBD | Long Term |
| 226 | Establish a Rate Setting Advisory Commission | Eliminate Government Barriers to Quality Improvement and Cost | This proposal will be referred to the SAGE Commission. | TBD | Long Term |
| 227 | Consolidate Oversight of Health Coverage | Eliminate Government Barriers to Quality Improvement and Cost | This proposal will be referred to the SAGE Commission Process. | TBD | Long Term |
| 228 | Adjust cost compared to Similar States | Eliminate Government Barriers to Quality Improvement and Cost | Compare NYS payments to other State´s and make changes as appropriate. | TBD | Long Term |
| 229 | Assisted Living facility discharge policy change | Eliminate Government Barriers to Quality Improvement and Cost | Eliminate the ability of Adult Care Facilities to be able to discharge a resident due to their inability to pay. | TBD | Long Term |
| 230 | Support affordable legislation that supports affordable, comprehensive LTC insurance products | Eliminate Government Barriers to Quality Improvement and Cost | Enhance existing NYS Tax credit for the purchase of certain long term care insurance policies. | TBD | Long Term |
| 231 | Medical Savings Account (MSA) | Eliminate Government Barriers to Quality Improvement and Cost | Establish Medical Savings account demonstration program for Long Term Care. | TBD | Long Term |
| 232 | Allow IRA, 401K etc. withdrawals without penalty for LTC payments | Eliminate Government Barriers to Quality Improvement and Cost | Provide additional options for individual financing of LTC services and supports. | TBD | Long Term |
| 233 | Create incentive to access home equity as a means to purchase LTC insurance | Eliminate Government Barriers to Quality Improvement and Cost | Create incentive to access home equity as a means to purchase LTC insurance | TBD | Long Term |
| 234 | Allow public company´s to operate of NHs | Eliminate Government Barriers to Quality Improvement and Cost | Allow publicly traded companies (PTCs) to operate facilities in NYS. | TBD | Long Term |
| 235 | Streamline Quality Reporting | Eliminate Government Barriers to Quality Improvement and Cost | Quality reporting brings associated costs to the state and hospitals. In order to allow the state to focus on collecting data for the most critical quality and patient safety issues, the state should: | TBD | Long Term |
| 236 | Reorganize ACF/AL survey process to focus on poor performing facilities and "look–alikes" | Eliminate Government Barriers to Quality Improvement and Cost | Reorganize Adult Care Facility and Assisted Living Survey process | TBD | Long Term |
| 237 | More Efficient Home Health Aide Orientation | Eliminate Government Barriers to Quality Improvement and Cost | Reform the state´s supervision and orientation regulations for home health aides and personal care workers. | TBD | Long Term |
| 238 | Provide Better Audit Coordination | Eliminate Fraud and Abuse | OMIG will lead and effort to coordinate in State Audits of the Medicaid Program. | TBD | Long Term |
| 239 | Expedite Medicaid billing | Eliminate Fraud and Abuse | align Medicaid´s claiming limit with Medicare´s rule – 1 year rule (Medicare) versus 90 day (Medicaid). | TBD | Long Term |
| 240 | Audit to confirm consistency for supply and medication claims | Eliminate Fraud and Abuse | Develop audit capabilities to ensure that there is consistency between diagnoses recorded in medical records / claims submitted by providers | TBD | Long Term |
| 241 | ACA Implementation – Basic Health Plan/Public Option | Better align Medicaid with Medicare and ACA | Adopt the Basic Health Plan option in the Affordable Care Act (ACA). Include a public option as a health insurance choice in the Exchange. | TBD | Long Term |
| 242 | Explore different payment models | Recalibrate Medicaid Benefits and Reimbursement Rates | Explore incentive based payments such as global budgets, bundled payments, and an expansion to selective contracting. | TBD | Long /Short Term |
| 243 | Implement Accountable Care Organizations (ACOs) for Medicaid | Ensure That Every Medicaid Member is Enrolled in Managed Care | Explore reimbursement models to implement Accountable Care Organizations (ACOs) for Medicaid beneficiaries. Need guidance from CMS. | TBD | Long /Short Term |
| 244 | Salary Incentives to Residents in Medically Underserved Communities | Empower Patients and Rebalance Service Delivery | Provide funds to teaching hospitals for enhanced salaries for medical residents who will work in medically under–served NYS communities after training; funded from a redirection of current GME. | $0 | Long /Short Term |
| 245 | Eliminate Optional Services Unless Enrolled in a Medical Home | Recalibrate Medicaid Benefits and Reimbursement Rates | Eliminate Optional Services Unless Enrolled in a Medical Home. | TBD | Concerns – Under Review |
| 246 | Limit OTC products | Recalibrate Medicaid Benefits and Reimbursement Rates | This proposal would limit coverage for non–prescription, Over–the–Counter (OTC) drugs. | TBD | Concerns – Under Review |
| 247 | Allow only Physicians to Bill for Injectibles | Recalibrate Medicaid Benefits and Reimbursement Rates | Allow only Physicians to Bill for Injectibles – access concerns exist. | TBD | Concerns – Under Review |
| 248 | Adopt VA drug formulary | Recalibrate Medicaid Benefits and Reimbursement Rates | Adopt VA drug formulary for Medicaid – VA has closed formulary and Medicaid can not limit drug access in this way. | TBD | Concerns – Under Review |
| 249 | County leaders should be allowed to set the breadth of the Medicaid program | Recalibrate Medicaid Benefits and Reimbursement Rates | Give counties the ability to define to what services their Medicaid population would be eligible to receive. | TBD | Concerns – Under Review |
| 250 | Require Medicaid Enrollees to obtain a doctors order for Over the Counter (OTC) drugs | Recalibrate Medicaid Benefits and Reimbursement Rates | Require Medicaid Enrollees to obtain a doctors order for Over the Counter (OTC) drugs – fiscal order is already required for OTCs. | TBD | Concerns – Under Review |
| 251 | Extended coverage of nicotine replacement treatment | Recalibrate Medicaid Benefits and Reimbursement Rates | Extended coverage of Medicaid coverage of nicotine replacement treatment for persons with serious mental illness (SMI) from 6 months to 12 months – linked to proposal 130. | TBD | Concerns – Under Review |
| 252 | Medicaid should be a Federal Benefit | Recalibrate Medicaid Benefits and Reimbursement Rates | Relieve states from financial burden by having Medicaid become a Federal benefit. | TBD | Concerns – Under Review |
| 253 | Allow use of non–enrolled providers and reimburse up to the FFS rate. | Recalibrate Medicaid Benefits and Reimbursement Rates | Allow use of non–enrolled providers and reimburse up to the FFS rate. | TBD | Concerns – Under Review |
| 254 | Pool drug & supply purchasing contracts | Recalibrate Medicaid Benefits and Reimbursement Rates | Pool non–Medicaid purchasing for state owned facilities – not a Medicaid proposal. | TBD | Concerns – Under Review |
| 255 | Expand the exclusion list of drugs carved out of the nursing home rate. | Recalibrate Medicaid Benefits and Reimbursement Rates | Expand the exclusion list of drugs carved out of the nursing home rate. This proposal is in the process of being implemented. | TBD | Concerns – Under Review |
| 256 | Return of For–Profit Health Plan profits | Ensure That Every Medicaid Member is Enrolled in Managed Care | Require For Profit Health Plans to return Medicaid profits back to the community. | TBD | Concerns – Under Review |
| 257 | Revenue suggestions | Ensure Consumer Protection and Promote Personal Responsibility | Revenue suggestions – seeking clarity on this proposal. | TBD | Concerns – Under Review |
| 258 | Utilize sustainable energy technology | Ensure Consumer Protection and Promote Personal Responsibility | Utilize sustainable energy technology | TBD | Concerns – Under Review |
| 259 | Standardize look back periods in LTC | Ensure Consumer Protection and Promote Personal Responsibility | The look back periods are standardized. Need more information. | TBD | Concerns – Under Review |
| 260 | Permitting continued Medicaid eligibility/coverage for high– risk women following a pregnancy | Ensure Consumer Protection and Promote Personal Responsibility | Permitting continued Medicaid eligibility/coverage for high–risk women following a pregnancy and case management services. Seeking clarification Is this eligibility expansion or renewal effort? | TBD | Concerns – Under Review |
| 261 | Cap hospital executive salaries included in cost reports for Indigent Care | Empower Patients and Rebalance Service Delivery | Exclude a certain portion of executive salary from indigent care calculation. Concerns exist with this proposal since indigent care reform will need conform with Federal reform. | TBD | Concerns – Under Review |
| 262 | Maximize Medicare utilization to reduce Medicaid cost | Empower Patients and Rebalance Service Delivery | Maximize Medicare utilization to reduce Medicaid cost – seeking more detail. | TBD | Concerns – Under Review |
| 263 | Involvement of Unions in MRT | Empower Patients and Rebalance Service Delivery | Involvement of Unions in MRT | TBD | Concerns – Under Review |
| 264 | Apply HCRA Surcharges to Office Based Surgery | Eliminate Government Barriers to Quality Improvement and Cost | Broaden the HCRA surcharge to include accredited office based surgery practices in addition to requiring all insurers to pay a facility fee to these practices | TBD | Concerns – Under Review |
| 265 | Eliminate the resource test for SSI disabled individuals, except for those seeking NH level of care | Eliminate Government Barriers to Quality Improvement and Cost | Not viable. Federal rules require rules be consistent across category, thus they cannot vary by service. The resource test cannot be eliminated for a subset of the SSI–related population (non–LTC). | TBD | Concerns – Under Review |
| 266 | Extend MBI–WPD so that individuals can participate beyond 65th birthday. | Eliminate Government Barriers to Quality Improvement and Cost | Not Viable – the age limit is a federal law. | TBD | Concerns – Under Review |
| 267 | Allow OPWDD disability determinations to be used for Medicaid eligibility | Eliminate Government Barriers to Quality Improvement and Cost | The NYSDOH Disability Review Team currently determines disability for OPWDD consumers. Disability determinations for Medicaid must be consistent with Social Security Administration´s (SSA´s) disability guidelines. | TBD | Concerns – Under Review |
| 268 | Allow OPWDD Revenue Support Field Offices to administer Medicaid (eligibility) for I/DD Population | Eliminate Government Barriers to Quality Improvement and Cost | Allowing OPWDD´s Revenue Support Field Offices to administer Medicaid for the developmentally disabled population is contrary to State takeover of the administration of the Medicaid program. | TBD | Concerns – Under Review |
| 269 | Home Care Regulatory Relief | Eliminate Government Barriers to Quality Improvement and Cost | Provide for regulatory relief to reduce state and provider costs and to permit improved, more efficient functioning of the system. | TBD | Concerns – Under Review |
| 270 | Improve eMedNY | Eliminate Fraud and Abuse | Improve eMedNY – seeking clarification | TBD | Concerns – Under Review |
| 271 | Come down on Medicaid Fraud/Abuse | Eliminate Fraud and Abuse | Come down on Medicaid Fraud/Abuse – More specific proposals exists in this area. | TBD | Concerns – Under Review |
| 272 | Implement biometric IDs for Medicaid enrollees. | Eliminate Fraud and Abuse | Implement biometric IDs for Medicaid enrollees. Potential legal issues. | TBD | Concerns – Under Review |
| 273 | Drug Testing | Eliminate Fraud and Abuse | Drug Testing of Medicaid Recipients – potential legal issues. | TBD | Concerns – Under Review |
| 274 | Criminal Penalty for Prohibitive Asset Transfer | Eliminate Fraud and Abuse | State cannot change the Medicaid transfer of asset rule (other than by applying it to home care and personal care) without jeopardizing Federal financial participation. | TBD | Concerns – Under Review |
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