30 Day Amendments Webinar Presentation

Redesign Medicaid in New York State

OPWDD Rate Solution

  • Presentation is also available in Portable Document Format (PDF, 420KB)

A True Partnership: State and Health Care Providers Working Together

Anatomy of the Partnership

  • The state needs to replace the existing, long-standing financing system for developmental disability services.
  • Replacing the system will reduce federal Medicaid revenue by $1.1 billion annually.
  • The changes will begin April 1, 2013.
  • The state needs a comprehensive solution that ensures that vital services are provided even when the federal funding is lost.
  • This solution must be balanced and must rely on a partnership with the entire health care community (not just DD providers/members) to assist during this challenging time.
  • It is time to get this issue behind us so we can move forward with the MRT waiver amendment and overall Medicaid/Health Care reform.
  • This partnership must rely on and build off the continuing success of the MRT.

Partnership - Solving the DD Problem

  • Required State Actions:
    • MRT is working better than anticipated! $200 million in 2012-13 under spending contributes to the solution.
    • Acceleration of MRT initiatives and other reforms/investment delays ($180M).
    • DD provider rate reduction = 6% Across the Board ($120M).
      *Eliminates Cost of Living Adjustment (COLA) increases received in 2009-10 and 2010-11.
  • Additional Federal Revenue/Investments/Savings:
    • Federal revenue from additional emergency Medicaid claiming and other possible efforts ($250M).
    • CMS waiver amendment to invest in comprehensive DD reform in a manner modeled on MRT ($250M).
    • Additional savings produced by the Affordable Care Act (ACA) ($100M).

Partnership - Benefits to the Health Care Industry

  • Restore 2% provider rate cut (beginning end of 2013-14).
  • Most Affordable Care Act (ACA) savings reinvested in health care.

MRT Initiatives Are Bending The Cost Curve


  • New York is a national model for Medicaid reform.
  • Thanks to Governor Cuomo and the MRT savings is exceeding expectations which helps the state address the loss of federal revenue due to replacing the system for financing OPWDD services.
  • Additionally, reform of the DD delivery system needs to continue. This reform will be partly financed by a new Medicaid waiver amendment.
  • Unfortunately, the challenge caused by the loss of federal revenue does require DD providers to return previously approved COLA's in order to close the remaining gap.
  • Now is the time to fix this problem and move on to both comprehensive DD system reform and the MRT waiver.

30-Day Amendments

30-Day Amendments

  • Creates Mental Hygiene Stabilization Fund (supported by Medicaid resources under the Global Cap).
  • Restores 2% ATB cut (starting end of 2013-14).
  • Allows the department to delay 2013-14 MRT investments.
  • Allows base year updates for hospital displaced residents (in event of teaching hospital closure).
  • Provides flexibility to adjust Voluntary Inpatient UPL Payments (for potential additional DSH reductions).
  • Eliminates reference to NYC for additional ALP beds.
  • Changes effective date of repeal of FHP buy-in program (from 1/1/15 to 1/1/14).
  • Various amendments related to ACA.