Governor Cuomo’s Justice Center

Editorial Boards across New York agree, Governor Cuomo’s proposed legislation to create a new Justice Center is the right way to protect over 1 million New Yorkers with disabilities and special needs.

 

See what Editorial Boards across the State are saying about Governor’s proposed Justice Center for the Protection of People with Special Needs:

 

  • The New York Times calls the Governor’s legislative package “a sensible, straightforward proposal that legislators and unions should support.” Click here to read the full editorial.

 

  • The Syracuse Post-Standard says, “Our most vulnerable citizens deserve no less.” Click here to read the full editorial.

 

  • Newsday calls the Governor’s plan, “a sweeping and smart new way to get this vital job done.” Click here to read the full editorial.

 

  • The New York Daily News calls it a “critically necessary reform effort.” Click here to read the full editorial.

 

  • The Rochester Democrat & Chronicle writes: “The state Legislature should get behind Cuomo and adopt his proposals before adjourning next month.” Click here to read the full editorial.

  • The Journal News writes: “Gov. Cuomo’s proposed Protection of People with Special Needs Act takes a giant leap toward providing such protection.” Click here to read the full editorial

 

Now we need your help to make the Governor’s proposal a reality this legislative session.

 

Please go to www.Justice4SpecialNeeds.com where you can

·         Submit a video testimonial

·         Support the Governor’s proposal online through Twitter and Facebook

·         Send emails to family and friends encouraging them to take action

·         Stay in touch with the Governor’s Office on the issue

 

Support The Justice Center

ATPA supports the following message from the Justice Center. Please offer your support and share this message on Facebook and Twitter!

Download a PDF version of the flyer here –> Justice Center Flyer

GOVERNOR CUOMO ISSUES EXECUTIVE ORDER ESTABLISHING STATEWIDE HEALTH EXCHANGE

Governor Andrew M. Cuomo today issued an Executive Order to establish a statewide Health Exchange, a move that will significantly reduce the cost of coverage for individuals, small businesses, and local governments. The Exchange will be entirely financed by the federal government and will be instrumental in establishing the first-ever comparative marketplace to bring down the cost of health insurance. By lowering the cost of insurance, the exchange will also help more than one million uninsured New Yorkers afford coverage.

“The bottom line is that creating this health exchange will lower the cost of health insurance for small businesses, local governments, and individual New Yorkers across the state. The sky-high cost of insurance in New York is driving businesses out of the state and preventing lower income New Yorkers from being able to afford needed coverage,” Governor Cuomo said. “Establishing the health exchange will bring true competition into the health care marketplace, driving costs down across the state.”

If New York fails to establish an Exchange, the federal government will step in and establish a federally operated Exchange in the state, in order to comply with the Affordable Care Act.
As required by the Affordable Care Act, the Exchange will be financially self-sustaining, requiring no state subsidy, by January 1, 2015.

The Exchange will allow New Yorkers to obtain health coverage and facilitate the purchase and sale of qualified health plans in this state. Additionally, the Exchange will ensure that eligible small businesses and individuals receive premium tax credits and cost-sharing reductions.

In addition, the Exchange will save New York taxpayers hundreds of millions of dollars each year by helping connect New Yorkers and businesses to health insurance that will be made available by the Affordable Care Act. Currently, state and local governments pay more than $600 million every year to cover the health care costs of uninsured individuals. Unreimbursed costs are passed on to individuals and small businesses, adding an additional $800 in premiums on a family’s average cost each year.

With the Exchange and the tax subsidies that will be available as a result of the Affordable Care Act, individuals who currently buy their coverage directly will see their cost drop by 66 percent. The Exchange will also enable small businesses to cut costs. As a result of the increasing cost of health care, an increasing number of small businesses cannot afford to purchase health insurance coverage for their workers. With the Exchange, small businesses will see the cost of providing coverage to their employees drop by 22 percent.

The Executive Order allows for regional advisory committees consisting of consumer advocates, small business consumer representatives, health care providers, agents, brokers, insurers, labor organizations, and any other appropriate stakeholders to advise and make recommendations on the establishment and operation of the Exchange, including recommendations about relevant regional factors. The advisory committees will provide opportunities for public input.

Patricia Boozang of the Coalition of New York State Public Health Plans said, “We applaud Governor Cuomo’s leadership in establishing a health insurance exchange – New York can now move ahead with building an Exchange that meets our State’s needs and brings more affordable coverage to New York’s citizens and small business.”

Joan Parrott-Fonseca, AARP New York State Director, said, “Governor Cuomo deserves New Yorkers’ praise today for signing an Executive Order to establish a Health Benefit Exchange for state residents. His actions will help millions of uninsured New Yorkers and their families gain access to quality and affordable health care coverage and it will clear the way for New York State to seek additional federal funding to develop the Exchange.”

Karen Scharff, Executive Director of Citizen Action of New York, said, “We applaud the Governor’s leadership in ensuring that New Yorkers have access to quality, affordable health coverage. During these tough economic times, access to quality, affordable health care is more important than ever. By creating New York’s Health Insurance Exchange, over 1 million people who don’t have health coverage will, and costs will be reduced by as much as 66% for individuals and 22% for small businesses.”

Kenneth E. Raske, President of the Greater New York Hospital Association, said, “The Health Exchange is the vehicle through which over one million New Yorkers are expected to gain health insurance coverage beginning in 2014. We support the implementation of the Exchange as a way of alleviating the current crisis facing those that don’t have access to care because of lack of insurance.”

Donald Distasio, Chief Executive Officer of the American Cancer Society of New York and New Jersey, said, “An estimated 10,000 uninsured cancer patients across New York are waiting for relief in the form of a health insurance exchange. Thanks to this executive order from Gov. Cuomo, New York is one important step closer to offering real help. The American Cancer Society thanks Gov. Cuomo for taking bold action on the exchange.”

David Klein, Chief Executive Officer of Excellus Blue Cross Blue Shield, said, “We applaud the Governor’s leadership in establishing New York’s own Health Insurance Exchange that is compliant with federal law and which, if properly operationalized, will ultimately provide an affordable means to assist consumers in the purchase of health insurance. We are especially grateful for the Governor’s recognition of regional differences through the creation of regional advisory boards and also the need to avoid duplicative and unnecessary regulatory jurisdiction.”

Elisabeth R. Benjamin, Vice President for Health Initiatives at the Community Service Society of New York and a co-founder of Health Care for All New York, said, “New York’s families and small businesses applaud Governor Cuomo’s leadership and determination to issue this important Executive Order authorizing a health insurance exchange. This is our best shot for New York to begin to curb out-of-control health insurance costs and it will help individuals, families and small businesses who are desperate to obtain affordable and better-quality health insurance.”

Kevin Finnegan, Political Director of 1199SEIU, said, “Governor Cuomo is right to put in place a statewide Health Exchange that will help ensure that more than one million uninsured New Yorkers will be able to obtain affordable and comprehensive health care coverage. Because of the Governor’s leadership, working families and individuals across the state will see major savings. We thank the Governor for recognizing that soaring health care costs were putting an immense strain on many middle and lower class New Yorkers, and for taking the lead in launching this Exchange.”

The Executive Order is below:

No. 42

E X E C U T I V E O R D E R

 

 

ESTABLISHING THE NEW YORK HEALTH BENEFIT EXCHANGE


WHEREAS,
 the implementation of a Health Benefit Exchange and other reforms in New York will: (1) result in lower premiums for individuals and small businesses; (2) allow individuals and small businesses purchasing coverage through such Exchange to receive $2.6 billion in federal tax credits and cost sharing subsidies; and (3) provide one million additional New Yorkers access to affordable, comprehensive health insurance, reducing the percentage of New Yorkers who are without health insurance;

WHEREAS,
 a state that chooses to operate its own Exchange must demonstrate to the federal government, by January 1, 2013, that its Exchange will be able to begin accepting applications by October 1, 2013, and will be operational by January 1, 2014, and if the state does not demonstrate operational readiness of its own Exchange, its residents will be required to participate in a federal Exchange;

WHEREAS,
 the State of New York is best positioned to: (1) understand the ramifications of operating an Exchange within New York’s commercial insurance market; (2) consider the unique regional and economic needs of the State’s individual and small business health insurance markets; (3) account for the diversity of its population, with its ethnic, cultural and language differences; and (4) decide what benefits will be provided to enrollees in the Exchange, which health plans can participate in the Exchange, what rules should apply to the marketing of products by health plans, and how to operate the Small Business Health Option Program (“SHOP”) for small businesses;

WHEREAS,
 the Affordable Care Act requires an Exchange to evaluate the eligibility of individuals for Medicaid and other public health coverage and enroll them if eligible, meaning that it will be essential to coordinate the operations of the Exchange with the State’s administration of these programs;

WHEREAS,
 the taxpayers of this State subsidize the costs associated with care for the 2.7 million New Yorkers without health insurance, who frequently forego preventive care and other needed treatment, putting them at risk of being sicker throughout their lives and dying sooner than those who have health insurance, which diverts funds from other public uses and costs state and county taxpayers more than $600 million annually just to pay for a portion of the services rendered by hospitals to people without insurance;

WHEREAS,
 New York’s uninsured working families often earn too much to qualify for public health insurance, but not enough to purchase coverage that costs, on average, over $1,200 per month for an individual and $3,450 per month for a family of four;

WHEREAS,
 small businesses, without assistance, cannot afford to purchase health insurance coverage for their workers, nearly 800,000 of whom have lost employer-sponsored coverage over the last decade, and thus face a major competitive disadvantage that inhibits their ability to grow, create jobs and otherwise support the State’s economic development;

WHEREAS,
 the costs associated with care for the uninsured are shifted through increased premiums to those individuals and groups that purchase health insurance coverage, causing working families with health insurance to pay $800 more in premiums on average each year;

WHEREAS,
 the development and operation of an Exchange in New York will impose no cost on the State, but will be funded entirely with federal funds until January 1, 2015, at which time the Exchange will be wholly self-funded, meaning that no State or county taxpayer dollars will be used for such purposes; and

WHEREAS,
 it is therefore critical that the State of New York establish and operate its own Exchange, and that it do so expeditiously;

NOW, THEREFORE, 
I, Andrew M. Cuomo, Governor of the State of New York, by virtue of the authority vested in me by the Constitution and the Laws of the State of New York, do hereby order as follows:

1. There is hereby established within the Department of Health, in conformity with the Affordable Care Act, the New York Health Benefit Exchange (the “Exchange”). The Department of Health, in conjunction with the Department of Financial Services and other state agencies, shall take all necessary steps to effectuate the Exchange, and expedite its ability to perform those functions necessary to carry out the requirements and serve the goals of the Affordable Care Act.
2. The Exchange shall, among other things, facilitate enrollment in health coverage and the purchase and sale of qualified health plans in the individual market in this state, and enroll individuals in health coverage for which they are eligible in accordance with federal law.
3. The Exchange shall, among other things, take such actions necessary to enable eligible individuals to receive premium tax credits and cost-sharing reductions and to enable eligible small businesses to receive tax credits, in compliance with all applicable federal and state laws and regulations.
4. The Exchange shall, among other things, enter into agreements with appropriate entities, including but not limited to federal, state and local agencies, to the extent necessary to carry out its duties and responsibilities, provided that such agreements incorporate adequate protections with respect to the confidentiality of any information to be shared.
5. The Exchange shall, among other things, convene regional advisory committees, consisting of consumer advocates, small business consumer representatives, health care providers, agents, brokers, insurers, labor organizations, and any other appropriate stakeholders, to provide advice and make recommendations on the establishment and operation of the Exchange, including recommendations about relevant regional factors, and shall provide opportunities for public input on such matters.
6. The Exchange shall, among other things, become financially self-sustaining by January 1, 2015, as required by the Affordable Care Act.
7. Nothing in this Order shall be construed to duplicate, preempt, supersede, limit or otherwise restrict the statutory authority, duties and functions of the Department of Health, the Department of Financial Services or any other agency of this State.
G I V E N under my hand and the Privy Seal of the State in the City of Albany this twelfth day of April in the year two thousand twelve.

BY THE GOVERNOR

Secretary to the Governor

Klein Investigation Finds Gaps in Rockefeller Reform Implementation

By Jeffrey D. Klein

Posted by Jeffrey D. Klein on Sunday, February 26th, 2012

NEW YORK, NY – More than half of substance abuse treatment providers have reported no increase in patients in the three years since Rockefeller Drug Law reform, raising serious questions about the implementation of the revamped statutes, according to a report released Sunday by State Senator Jeffrey D. Klein, (D-Bronx/ Westchester), the chairman of the Senate Standing Committee on Alcoholism & Drug Abuse.

The report, “Assessing the Effectiveness of Substance Abuse Treatment Under Rockefeller Drug Law Reform,” also found widespread communication problems between criminal justice agencies and recovery providers, as well as funding issues that threaten the effectiveness of the reforms.

“With Rockefeller Drug Reform we made a commitment to treat addiction instead of warehousing addicts, to simultaneously see that justice was served and help those in need,” Senator Klein said. “This report highlights the serious gaps we still face in meeting that commitment and I intend to use it as a launching pad to ensure that these reforms are implemented correctly and that this state lives up to the promise we made when we reformed New York’s Draconian Rockefeller-era drug laws.”

“With Rockefeller Reform, we rightly said New York must treat addiction as the disease that it is. I’m committed to ensuring that we have a system that works, where people can get the treatment they need, and where no one falls through the cracks,” said Assembly Member Richard Gottfried, Chair of the NYS Assembly Health Committee.

 

Among the findings:

  • Only 47 percent of survey respondents have seen an increase in the number of patients since October 2009 reforms. 46 percent of respondents reported no change in their caseloads and 7 percent actually reported a decrease. These numbers point to an uneven use of judicial diversion across New York State.
  • New York lacks a cohesive state-wide strategy to tackle treatment alternatives to incarceration. For example: Parallel alternative treatment programs, also known as Alternatives-to-Incarceration, that existed before Rockefeller Reform remain in place, yet are underutilized.
  • Widespread communication problems between the treatment providers and the criminal justice agencies were reported. Specifically, the providers have complained about lack of access to criminal tracking numbers, case records, and other documents required to ensure continued care of criminal justice patients.
  • While many providers indicated no post-reform increase, 21 percent of respondents reported that they have wait lists for their programs – some as long as three months. The longer the wait, the greater chance a patient will relapse.
  • Funding for these programs remains an issue. When the reforms were passed, $65 million in state and federal funding over two years has been allocated for expanded treatment programs. Only $40 million of that has been released, according to ASAP. This has been a particular challenge with treating the uninsured.

 

“Treating addiction as a health problem instead of a crime has been an important policy shift,” said John Coppola, Executive Director of the NY Association of Alcoholism and Substance Abuse Providers. “Now practice must catch up with policy. More resources are needed for prevention, treatment, and recovery services and better protocols must be used by the courts to ensure appropriate alternatives to incarceration.”

Senator Klein will be holding a public hearing in March on the implementation of Rockefeller Reform. The purpose of this hearing will be to solicit testimony from all stakeholders on how to best form a cohesive drug treatment strategy in New York State.

The report additionally recommends that:

  • The Legislature, via resolution, or a separate law, set clear, concise and uniform guidelines regarding alternatives for incarceration.
  • Additional funding be secured through the budget process.

Howard Josepher, President & CEO of Exponents, a treatment center based in Manhattan, said: “Having 40 years of experience in the field of addiction treatment, I see how much more skilled and successful we have become in bringing people into recovery but with services being underfunded and underutilized, we continue to send people to prison while better and less expensive options are available.”

 

Alan Brand, CEO of Narco Freedom Inc., a substance abuse treatment program based in Brooklyn, Queens and the Bronx, said: “ A coordinated effort between state agencies and treatment providers utilizing a comprehensive patient centered service model would attract and retain these patients in treatment.

Ricky Cottingham Sr. Clinical Program Director of Queens Village Committee of Mental Health for J-Cap Programs Inc., said: “Incarcerating individuals who have committed crimes because of their substance abuse will never be the answer. The answer lies in alternatives to incarceration and residential treatment. It is there, that custody and control is superseded by love, guidance and support. It is vital that we have the resources and structure to properly implement the Rockefeller Reforms.”

 

 

Senate Passes Bills to Curb Illegal Prescription Drug Abuse

via http://www.nysenate.gov/press-release/senate-passes-bills-curb-illegal-prescription-drug-abuse

With the abuse of illegally-obtained prescription narcotics growing rapidly, the New York State Senate today passed several bills to curb the black market in prescription painkillers.

Senate approval of the bills, sponsored by Senator Kemp Hannon (R, C, I – Garden City), Chairman of the Senate Health Committee, and Senator Jack Martins (R-C-I, Mineola), followed a roundtable discussion on the issue of abuse of prescription painkillers, held today by Senator Hannon and Senator Jeff Klein, Chairman of the Senate Committee on Alcohol and Substance Abuse.  This was a second in a series of public meetings discussing legislation to combat prescription drug abuse and to examine improving New York’s prescription reporting system.

“Abuse of controlled prescription drugs is one of New York’s major public health problems, and it is growing at an alarming rate,” said Senator Hannon. “We have been studying the abuse and fraud surrounding prescription drugs and feel that we have to act now to control this growing problem.”

The roundtable today featured discussion and input from parents of victims whose deaths were attributed to prescription drug abuse; a physician from Bronx-Lebanon Hospital; and representatives from: the New York State Department of Health’s Bureau of Narcotics Enforcement, the Attorney General’s Medicaid Fraud Control Unit, the Long Island Council on Alcoholism and Drug Dependence, Medical Society of the State of New York, Pharmacists Society of the State of New York, the Medical Walgreen’s Pharmacy chain, and drug abuse prevention organizations.

“We are seeing our young people die from prescription overdoses and others committing horrific crimes to obtain pain killers,” Senate Majority Leader Dean G. Skelos said. “We have to update our laws to prevent more tragedies from happening and punish those who illegally make these drugs available.”

Legislation passed by the Senate today would do the following:

> Place greater controls on Hydrocodone and Tramadol, highly addictive prescription pain medications (S.5880A, Senator Hannon);

Prescriptions for opioids, particularly Oxycodone, Hydrocodone and Tramadol, have skyrocketed; among abused drugs, they are second only to marijuana. In New York City, drug related ER visits increased 40% between 2004 and 2009 with fatalities from opioid overdoses alone increasing by 20% between 2005 and 2009.

“Prescriptions for Hydrocodone, deaths from overdoses, and violent pharmacy robberies by addicts have soared as those addicted to these medications or seduced by the lucrative black market continue to access these highly-addictive drugs,” Senator Hannon said. “Hydrocodone was the drug stolen in the June 2011 robbery of a Medford pharmacy, where an addict gunned down four people and stole 10,000 Hydrocodone pills. Moving to a more restricted classification of controlled substances will toughen existing penalties for people who possess or sell large quantities of Hydrocodone.”

>  Increases criminal penalties for physicians and pharmacists who illegally divert prescription drugs, which, in effect, punishes bad actors, protects consumers from compromised medications, and safeguards resources for the Medicaid program (S. 5260C, Senator Hannon);

“The black market in non-controlled substance prescription medications has exploded,” Senator Hannon, said.  “Non-controlled substance prescription medications include AIDS medication, asthma medication, and anti-psychotic medication, among many others. These medications, usually the most expensive, are most often paid for with Medicaid dollars and sold on the street for a fraction of their actual value.  People buy the medications and bring them to a stash house where they are collected and re-sold back to unscrupulous pharmacies or shipped overseas.  This bill would increase penalties for these activities and apply them more broadly.”

In June 2011, Senator Hannon and Senator Stephen Saland (R-I-C, Poughkeepsie), Chair of the Standing Committee on Codes, held a public hearing that examined criminalizing the improper transfer and inappropriate possession of non-controlled substances and the subsequent effects on Medicaid expenditures and public health.

“People buy the medications and bring them to a stash house where they are collected and re-sold to unscrupulous pharmacies or overseas. Sometimes people unknowingly repurchase this medication and suffer complications because the drugs were improperly stored,” remarked Senator Hannon. “This bill would increase penalties for these activities and apply them more broadly.”

>  Criminalize the illegal sale of a controlled substance by a practitioner or pharmacist to address practitioners operating “pill mills,” which fuel the black market for controlled substance medication (S. 6066, Senator Hannon);

Overdose deaths from prescription pain killers have reached epidemic proportions in the United States. In fact, according to a recent report of the Center for Disease Controls and Prevention (CDC), more people die from prescription drug overdoses than heroin or cocaine combined.

“This bill would create another tool for law enforcement to combat New York’s prescription drug abuse epidemic,” Senator Hannon said.  “New York already has a law that deals with physicians who illegally prescribe controlled substances. That law was used to indict Dr. Li who, according to reports, was running a pain clinic in Queens on the weekends where “patients” lined up before the doors opened.”

Dr. Li saw as many as 120 “patients” per day at the clinic. While the indictment of Dr. Li relates to one patient, Michael Cornetta (who ultimately died of an overdose), it is believed as many as nine people died as a result of Dr. Li’s illegal prescribing. He also reported prescribed more than 2,500 pain pills to gunman in the Medford, Long Island pharmacy shooting.

New York law currently lacks a similar provision to address pharmacists and practitioners who illegally dispense controlled substances. This bill fills that hole by creating a new crime: criminal sale of a controlled substance by a practitioner or pharmacist.

>  Criminalize the first-degree illegal sale of a controlled substance to a minor under the age of 14, making it a class A-II felony (S. 3210B, Senator Martins);

“There has been a recent increase in drug use, especially opiate based substances, by young adults and teenagers, as well as an increase in overdose deaths,” Senator Martins said.  “Many of these youngsters start experimenting in their teenage years with addicting prescription drugs and opiate based prescription drugs. This bill is intended to punish those who profit from the enterprise of selling these drugs to our children and provides substantial assistance to law enforcement.”

>  Require the Office of the Medicaid Inspector General (OMIG) to post all administrative law decisions on their website within 30 days of decision to increase the efficiency and transparency of decisions concerning Medicaid fraud and abuse (S. 6271, Senator Hannon);

Anyone wishing to appeal a decision by OMIG must go before an administrative law judge.  However, interested groups expressed concern because, although a public record, these decisions are difficult to access. Currently, each interested group must send a Freedom of Information Law request to OMIG.

“This is a duplicative and burdensome process for both OMIG and individual requesters,” Senator Hannon said.  “For efficiency and transparency, this bill requires OMIG to post all administrative law decisions, in which OMIG is a party, to its website within thirty days.”

Also today, the Senate passed a resolution, in conjunction with the national day, that would designate April 28, 2012 as “Prescription Drug Take-Back Day” in New York State. The day was originally designated in 2008 by the United States Department of Justice’s Drug Enforcement Administration (DEA) in an attempt to have people turn in unwanted, unused, and expired prescription drugs in a safe, convenient way.

Last year, more than 377,000 pounds – equal to 188 tons – of unwanted or expired drugs were returned at the more than 5,300 participating sites across all 50 states on that one day.

The bills were sent to the Assembly.

NYS Medicaid State Plan Amendment (#11-56) Approved for Phase 1 Health Homes

 

via http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/

 

We are extremely happy to report that New York’s Medicaid State Plan Amendment (SPA 11-56) for Phase I Health Homes, with an effective date of January 1, 2012, for Medicaid Members with Behavioral Health and Chronic Conditions was approved.

What this means and next steps:

  • The State will work with existing care management (i.e. TCM, COBRA) programs to bill for patients they are already serving under Health Homes retroactive to January 1, 2012 – specific guidance on this process will be coming shortly from the Department of Health (DOH), the New York State Office of Mental Health (OMH) and the Office of Alcoholism and Substance Abuse Services ( OASAS) – no changes to billing should happen until this guidance is released – please continue to bill for TCM as you are doing now; Phase I Provider-led Health Homes and their partners will immediately begin to consent patients already being served in care management programs (i.e., TCM and COBRA) to the Health Home program (the Health Home consent document is available on the Health Home website under Forms);
  • Provider-led designated Health Homes will get lists of new Health Home Eligible Fee-for-Service Members to enroll into Health Homes in February and may begin outreach and engagement at that time. Outreach and Engagement to members on the lists commencing in February should be billed for in March, using a February 1 date of service. Please see HH website for billing instructions in last webinar:
  • Managed Care Plans are working on contracts with Provider-led Health Homes to allow Managed Care Plans to assign their members into Health Homes as appropriate – Managed Care member assignment into Phase 1 Provider-led health homes will likely commence in March.

A detailed Medicaid Update Article is being prepared and will be posted on the health home website very shortly. As more information becomes available it will be posted to the website and shared during our next Webinar.

Department of Health – Detail on Health Exchange, Compensation, MRT

On Tuesday, January 17, 2012, Governor Andrew Cuomo released his proposed budget for State Fiscal Year (SFY) 2012-13.  The following is a summary of the Executive Budget presentation and a very quick review of the appropriation and Article VII bills. Additional analysis and memorandum will follow on various topics as briefings take place and additional research is undertaken.

 

Budget Overview

Again this year, New York is facing a challenging fiscal environment.  The Executive Budget eliminates a General Fund budget deficit of $3.5 billion in 2012-13 and substantially lowers the budget gaps projected in future years. The gap-closing plan consists of $2 billion in savings by controlling State spending and $1.5 billion in new resources from tax reforms approved in December 2011.  A majority of the gap-closing plan, totaling $1.14 billion, is generated from state agency savings. These include further reductions in State agency operations through strict controls on attrition and hiring; enterprise-wide consolidation of procurement, information technology, and workforce management functions; and a range of operational measures to improve efficiency.  The remaining $756 million in savings is achieved through local assistance program savings initiatives, with most of the savings coming from the elimination of automatic “cost of living” increases and trend factors in 2012-13 for all health and human service providers.

Additionally, the Executive Budget continues the two-year commitment made in 2011-12 to fund School Aid at a level consistent with the growth in NYS personal income and Medicaid at the long-term average growth in the medical component of the Consumer Price Index (CPI). In 2012-13, State funding for both programs increases by approximately 4 percent from 2011-12.

Below is a brief outline of the Governor’s proposed SFY 2012-13 Executive Budget impacting the health care sector:

Health Benefit Exchange

•The Governor’s Executive Budget proposal includes language to establish the New York Health Benefit Exchange.  The language included in the budget is nearly identical to that of A. 8514(Morelle)/S. 5849 (Seward) which passed the Assembly during the 2011 Session but failed to advance to the Senate floor.  In fact, there are no major substantive differences between the 2011 bill and the Governor’s proposal, simply some technical changes and some timeframe adjustments. For example, the Senate and Assembly are directed to make their recommendations for Board of Directors (“Board”) membership within 30 days of enactment, as opposed to 60 in last year’s bill, and the Board is to have its first meeting within 14 days of all directors being appointed, as opposed to 30 days in last year’s bill.  Additionally, studies required by the Bill are due in August of this year as opposed to the April 2012 deadline imposed by the 2011 bill.

 

•The Executive Budget generally tracks the minimum requirements of federal law in establishing the Exchange and to a significant degree adopts provisions from the NAIC Model Exchange Act.  It creates a governance structure but to a large extent defers the more contentious policy issues (e.g. active purchaser, additional benefits, viable market outside the exchange, merger of the markets) to future legislation.  The Exchange is established as a public benefit corporation to be directed by a nine member Board of Directors.  The Board would be comprised of the Commissioner of Health, the Superintendent of Insurance (later to be renamed  the Superintendent of Financial Services) and seven additional Directors appointed by the Governor, two of whom will be appointed upon recommendation of the Temporary President of the Senate and two upon recommendation of the Speaker of the Assembly.

 

•The proposal also establishes five Regional Advisory Committees (“RACs”) representing the New York City region, the metropolitan suburban region, the northern region, the central region and the western region.  The Board will determine which counties make up each region.  All members of the RACs are appointed by the Governor, with two per RAC upon the recommendation of the majority in each house of the Legislature, and serve three year terms.

Limitations on Not for Profits Administrative Expenses and Executive Compensation

The Executive Budget contains broad language impacting not-for-profits that receive payments or financial assistance from the state (e.g. Medicaid or any other source of state funding). The language authorizes all state agencies, including but not limited to, the Department of Health, State Education and other human service agencies, that operate, license, certify, or fund providers of services to limit state payments to be used for administrative expenses, executive compensation and to “adjust” payments made by the state in those instances in which the agency believes the not for profit is not meeting “performance metrics”.

Specifically, the proposal has three key elements:

 

•Payment Adjustments Based on Performance Metrics.  The language requires agencies to develop performance metrics and calculate annual adjustments to established payments based on such metrics.  The performance metrics shall include, but are not limited to: the actual costs of providing services, the percentages of administrative costs, the determination and levels of executive compensation and such other criteria as the agency may determine.  These adjustments would be subject to federal approvals and restrictions as well as the review and approval of the director of the budget. This provision is effective April 1, 2013.

 

•Administrative Expenses Cap.  State agencies are granted the authority to develop an administrative expenses cap which requires that no less than 75% of state financial assistance or state-authorized payments be directed toward the provision of direct care or services and not the administrative expenses of the not-for-profit entity (as such terms are to be defined by the State agency).  This provision is effective April 1, 2012.

 

•Limits on Executive Compensation.   State agencies are also granted the authority to prohibit the use of state funds to be used for purposes of payments to any executive to amounts in excess of $199,000 annually, unless expressly permitted by the relevant State agency. This amount may be adjusted annually, but in no event shall such amount exceed that provided for by the U.S. Office of Personnel Management in its Rates of Basis Pay for the Executive schedule.  As drafted, it does not appear that the $199,000 is a “hard salary cap” but instead appears to limit the use of State funds that can be contributed toward executive compensation. Thus, other non-state revenue can be used to supplement executive compensation for amounts in excess of $199,000. This provision is effective April 1, 2012.

 

Failure to comply with this provision subjects providers, in the sole discretion of the relevant Commissioner, to termination or non-renewal of the program’s contract. The proposal does provide, upon a showing of good cause, for a waiver of the executive compensation provisions by the relevant State agency Commissioner with the approval of the Director of the State Division of Budget.

 

Medicaid Redesign Team Phase II – Implementation

Last year, the Medicaid Redesign Team (“MRT”) was tasked by Governor Cuomo to find ways to reduce costs and increase quality and efficiency in the Medicaid program.  In Phase 1, the MRT developed a package of reform proposals that achieved the Governor’s Medicaid budget target, and introduced significant structural reforms to bend the Medicaid cost curve. In Phase 2, the MRT was directed to create a coordinated plan to ensure that the program could function within a multi-year spending limit and improve program quality. To achieve this goal, ten Workgroups were created to focus on specific health care issues.  These Workgroups, which were comprised of industry stakeholders, met during the summer and fall to develop a series of recommendations.

The following recommendations, as recommended by the MRT Workgroups, were included in the Governor’s proposed budget.

Basic Benefit Review Workgroup

The Workgroup’s charge was to conduct a thorough examination of the current list of covered benefits in the Medicaid program and to develop a series of recommendations to modify the benefit package.

The proposed budget includes the following recommendations from this Workgroup:

 

 

  • Tobacco Cessation Counseling by Dentists.  This proposal would expand Medicaid reimbursement to dentists for providing tobacco cessation counseling, effective April 1, 2012.  This action would cost $4.25 million (state share) in SFY 2012-13. This action will be implemented administratively.

 

  • Medicaid coverage of Harm Reduction Counseling and Services.  This proposal would authorize Medicaid reimbursement for harm reduction counseling and services to reduce or minimize the adverse consequences associated with drug use, when ordered by a physician, physician assistant, nurse practitioner, or licensed midwife, effective April 1, 2012.   This action would provide $410,000 (gross) and $210,000 (state share) in new Medicaid funding in SFY 2012-13. This proposal was recommended by the Health Disparities Workgroup.

 

  • Hepatitis C Services.  This proposal would provide Medicaid coverage for Hepatitis C wrap-around coverage services to promote  care coordination and integration when such services are ordered by a physician, physician assistant, nurse practitioner, or licensed midwife, effective April 1, 2012.   Services include, but are not limited to, client outreach, identification and recruitment, education and counseling, coordination of care and adherence to treatment, assistance in obtaining appropriate entitlement services, peer support, and other supportive service as needed and authorized, effective April 1, 2012.  This action would provide $2.1 million (gross) and $1.05 million (state share) in new Medicaid funding in SFY 2012-13. This proposal was recommended by the Health Disparities Workgroup.

Governor’s Budget Plan Released on Division Of Budget website

Agency Web Site: http://www.oasas.ny.gov/Link to External Website

Mission

The mission of the Office of Alcoholism and Substance Abuse Services (OASAS) is to improve the lives of New Yorkers by leading a premier system of addiction services through prevention, treatment and recovery.

Budget Highlights

The 2012-13 Executive Budget recommends $672 million All Funds ($439 million State Operating Funds; $233 million Other Funds) for OASAS to continue to support a comprehensive system of prevention, treatment and recovery serving more than 260,000 individuals with chemical dependencies and problem gambling issues annually. This represents a decrease of $0.5 million (-0.1 percent) from 2011-12, which is largely attributable to the following actions summarized below.

Major new budget actions to promote cost efficiency, streamline operations, and restructure programs and services include:

Eliminate Planned Cost of Living Adjustments/Rate Increases. Currently, providers receive automatic payment increases with no relation to actual cost growth or performance. The Executive Budget eliminates the planned 3.6 percent annual human services COLA. A new program will be established for 2013-14 which will provide increases based on actual costs and meeting performance outcomes and will include limits on administrative expenses and executive compensation.

OASAS Actions. State Operations savings include implementing enterprise-wide efforts to reduce purchasing costs, streamlining IT applications, and reducing agency administrative staffing levels. The local assistance reforms include expanding services at a lower rate than projected, and continuing reforms begun in 2011.

The Executive Budget reinvests these savings to support 25 new veteran’s beds and 12 new residential treatment opportunities for women with children. In addition, $1.5 million in new funding — previously carried by OTDA — is available to support new supportive housing units for homeless families with members suffering from a chemical dependency in New York City consistent with the NY-NY III agreement.

Centralized 24-hour hotline for reporting allegations of abuse and neglect. Pursuant to the recommendations from the preliminary report from the Governor’s Special Advisor on Vulnerable Persons which is expected to be released in early 2012, a new, centralized 24-hour hotline will be created for the reporting of allegations of abuse and neglect. This reporting system should include all residential programs operated, licensed or certified by OMH, OPWDD, OASAS, the Office for Children and Family Services (OCFS), the Department of Health Adult Care Facilities and State Education Department facilities both in-state and out-of-state. The hotline will have a trained staff to screen, classify and route the report to the appropriate state agency for investigation. Funding will be housed in OCFS.

Behavioral Health Organizations. Consistent with the recommendations of the Medicaid Redesign Team, OMH and OASAS now have the authority to contract jointly with Managed Behavioral Health Organizations (BHOs). These BHOs will be charged with managing behavioral health services for individuals with substance abuse issues and serious mental illness.

For more information on this agency’s budget recommendations located in the Executive Budget Briefing Book, click on the following link:

Briefing Book – Mental Hygiene (PDF)

ALL FUNDS APPROPRIATIONS
All amounts are in dollars
Category Available
2011-12
Appropriations
Recommended
2012-13
Change From
2011-12
Reappropriations
Recommended
2012-13
State Operations 119,013,400 116,951,000 (2,062,400) 6,240,000
Aid To Localities 455,996,000 457,496,000 1,500,000 176,017,000
Capital Projects 97,606,000 97,606,000 0 482,417,000
Total 672,615,400 672,053,000 (562,400) 664,674,000

 

PROJECTED LEVELS OF EMPLOYMENT
Full-Time Equivalent Positions (FTE)
Program 2011-12
Estimated FTEs
03/31/12
2012-13
Estimated FTEs
03/31/13
FTE Change
Executive Direction
Special Revenue Funds – Federal 74 74 0
Special Revenue Funds – Other 281 281 0
Institutional Services
Special Revenue Funds – Federal 16 16 0
Special Revenue Funds – Other 451 442 (9)
Total 822 813 (9)

 

Note: Most recent estimates as of 1/17/2012

Click for additional detailed appropriation tables

NYS Medicaid Health Homes Update

Designated Phase I Health Homes

Provider-Lead Designated Health Homes

Bronx

Montefiore Medical Center (establishing the Bronx Accountable Healthcare Network) with Acacia Network; Albert Einstein College of Medicine; Morris Heights Health Center; St. Barnabas Hospital; & Union Community Health Center

NYC Health and Hospitals Corporation + MetroPlus Health Plan

Visiting Nurse Service of New York Home Care + Institute for Family Health; Argus Community; Help PSI Inc.; Urban Health Plan, Inc.; & Community Healthcare Network

Bronx Lebanon Hospital Center + CBC/FEGS Health and Human Services System, Inc., IHealth/Help PSI Inc.; Bronxworks; Allmed Medical Centers; Corinthian IPA, Essen Medical.

Brooklyn

Maimonides Medical Center + Lutheran Medical Center; Institute for Community Living; FEGS Health and Human Services System, Inc.; Visiting Nurse Service of New York; First to Care Home Care; Jewish Board of Family and Children Services; Promoting Specialized Care and Health; Center for Urban and Community Services

NYC Health and Hospitals Corporation + MetroPlus Health Plan

Community Health Care Network

Institute for Community Living + Coordinated Behavioral Care, Inc.

Long Island /Nassau

North Shore – Long Island Jewish Health System + LI Federally Qualified Health Center (LIFQHC) and Nassau University Medical Center (NuHealth)

FEGS Health and Human Services System, Inc. + Nassau County Mental Health, Chemical Dependency and Developmental Disabilities Services

Schenectady

Visiting Nurse Service of Schenectady County, Inc. + Ellis Hospital; Hometown Health Center; Capital District Physicians Health Plan

Northern Region (Clinton, Essex, Franklin, Hamilton, Warren, Washington cos.)

Adirondack Health Institute, Inc. + Hudson Headwaters Health Network; Community Partners, Inc.; & Adirondack Health

Glens Falls Hospital + Capital District Physicians Health Plan

View the full list of network partners by region and/or county. (XLS, 147KB)

Managed Care Plans

Below are the Managed Care Plans that applied to operate Health Home services by region. While DOH will approve these applications so plans may assist with provider health home services, plans will contract through the above-designated entities to provide members access to Health Home services.

  • Contracting with State Designated Provider Lead Health Homes is required in areas with sufficient approved State Designated Provider Based Health Homes capacity.
  • Plans should only directly provide health home services in areas where such approved capacity is insufficient as agreed upon by the State and the Health Plan.
  • In instances where the plan is contracting with State Designated Provider Lead Health Homes the plan may:
    • choose which State Designated Provider Lead Health home(s) to contract with.
    • assist with the provision of certain health home services (e.g., data management) as contractually agreed to by the State Designated Provider Lead health home and the health plan – in this case any funds retained by the plan shall be proportional to effort.

Bronx

  • Affinity Health Plan
  • Amerigroup New York, Inc.
  • AmidaCare
  • Fidelis Care
  • HealthFirst PHSP, Inc.
  • HealthPlus PHSP
  • NY-Presbyterian System Select Health, LLC
  • UnitedHealthcare Community Plan

Brooklyn

  • Affinity Health Plan
  • Amerigroup New York, Inc.
  • AmidaCare
  • EmblemHealth
  • Fidelis Care
  • HealthFirst PHSP, Inc.
  • HealthPlus PHSP
  • NY-Presbyterian System Select Health, LLC
  • UnitedHealthcare Community Plan

Long Island/Nassau

  • Affinity Health Plan
  • EmblemHealth
  • Fidelis Care
  • HealthFirst, PHSP, Inc.
  • HealthPlus PHSP
  • UnitedHealthcare Community Plan

Schenectady

  • Fidelis Care New York

Northern region (Clinton, Essex, Franklin, Hamilton, Warren, Washington cos.)

  • Fidelis Care
  • UnitedHealthcare Community Plan

via http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/prov_lead_designated_health_homes.htm