Plugged Into Health @ Hinman Straub – July 10, 2018

New York State of Health (“NYSOH”) Update

Centers for Medicare and Medicaid Services Releases Reports on the Performance of the Exchanges and Individual Health Insurance Market

The Centers for Medicare and Medicaid Services (“CMS”) recently released three reports on the current condition of the Federal and State-based Exchanges and state individual health insurance markets. The three reports released include the Early 2018 Effectuated Enrollment Snapshot, Exchange Trends Report, and new for this year, Trends in Subsidized and Unsubsidized Enrollment. The reports include data on effectuated Exchange enrollment for 2017 and 2018, overall trends on the operational and programmatic performance of the Exchange, and trends in subsidized and unsubsidized individual market enrollment from 2014 to 2017.  These data provide a number of insights on how well state individual health insurance markets and Exchanges are serving the American consumer.

According to the CMS press release, the reports show that state markets do not adequately cover people who do not qualify for federal subsidies. Steps taken by CMS in 2017 improved the performance of the Exchanges and began addressing market stability issues. However, rising premiums have left unsubsidized people with poor health coverage options and dramatically increased the federal cost of premium subsidies.

Governor Issues DFS Directives in Response to White House Actions

Affordable Health Access Action Plan

On Monday morning, Governor Cuomo directed the NYS Department of Financial Services (“DFS”) to review the impact and implement an affordable health access action plan in light of the Trump Administration’s suspension of the Affordable Care Act’s Risk Adjustment Program.

The Governors directive comes as the Centers for Medicare and Medicaid Services (“CMS”), last Saturday, announced that a recent United States District Court decision prevents further collections or payments under the risk adjustment transfer formula established under the Affordable Care Act, including amounts for the 2017 benefit year.  As part of the Governor’s Affordable Health Access Action Plan, the Governor directed DFS to review all options and prepare to implement an expanded State Risk Adjustment Program that controls health cost increases as much as possible in case the federal program is not reinstated.

Proposed Reproductive Rights Regulations

On Monday afternoon, Governor Cuomo announced new proposed regulations that would require insurers to cover over the counter emergency contraception in addition to all other contraceptive drugs, devices or other products for women approved by the Federal Food and Drug Administration and, as well as the dispensing of 12 months of contraceptive at one time, all without co-insurance, co-pays or deductibles.  The Governor today also called on the Senate to reconvene and vote on codifying the protections of Roe. v. Wade into State law.

The proposed regulations, which can be viewed here, would mandate that health insurers:

  • Cover contraceptive drugs, devices, generic equivalents, or other products for women approved by the FDA, including (1) over-the-counter contraceptive drugs, (2) over-the-counter contraceptive devices or other products for women, under the prescription or order of a health care provider, and (3) voluntary sterilization procedures for women.  Insurers would also be required to defer to the attending health care provider’s determination of medical necessity when he/she recommends a particular contraceptive item or service.
  • Cover emergency contraception with no cost sharing when provided pursuant to a prescription, a non-patient specific regimen order, over the counter, or when otherwise lawfully provided;
  • Cover in-network voluntary sterilization procedures for women without cost-sharing;
  • Permit a woman to fill 12 months of a prescribed contraceptive at one time, removing the previously required three-month trial period;
  • Not place restrictions or delays, including quantity limits on any mandatory contraceptive coverage.

The Governor’s actions are in response to President Trump’s nomination of Brett Kavanaugh to the Supreme Court.  According to the Governor’s press release, Kavanaugh is an “extreme conservative” who “could roll back advancements in reproductive health.”

June 2018 Medicaid Update

DOH has released the June 2018 edition of its monthly Medicaid Update publication.

Some of the highlights include:

  • Revision in Hepatitis C Prescriber Requirements:  Effective August 1, 2018, the HCV-direct-acting antiviral (“DAA”) prescriber experience and training clinical criteria implemented by the Medicaid program based on past Drug Utilization Review (“DUR”) Board action will no longer be required.  In addition, the Department will no longer utilize the Medicaid Hepatitis C Practitioner Information Request Form process and will remove the HCV Approved Practitioners List from the website.  For more information on these changes, click here.
  • 2018-2019 Enacted Budget Initiative: MLTC Partial Capitation Plans Enrollment Lock-In:  Beginning December 1, 2018, Managed Long Term Care (“MLTC”) plans will have enrollment lock-in periods.  This applies to those who enroll either by new enrollment or plan-to-plan transfer effective December 1, 2018 or later.  These individuals will have a 90-day grace period to elect a plan transfer and then experience a lock-in period for nine months after the end of their grace period (for a total period of one year from the date of enrollment). After the initial 90-day grace period, enrollees will have the ability to disenroll or transfer if they can present evidence of good cause.  After the completion of the lock-in period, an enrollee may transfer without cause, but is subject to a grace period and subsequent lock-in as of the first day of enrollment with the new MLTC partial capitation plan.  For more information, click here.
  • Harm Reduction Services as a New Medicaid Benefit:  Effective July 1, 2018, Medicaid fee-for-service (“FFS”) and Medicaid Managed Care (“MMC”) plans will begin covering harm reduction services (“HRS”).  This change applies to mainstream MMC, HIV Special Needs Plans (HIV SNP) and Health and Recovery Plans (HARP).  HRS will be delivered by Department of Health authorized and waivered syringe exchange programs (“SEP”) that are enrolled as Medicaid providers.  For information on the scope of benefits, billable services, billing and payment, and billing instructions, click here.
  • Provider Training Schedule and Registration: eMedNY offers various types of educational opportunities to providers and their staff.  Training sessions are available at no cost to providers and include information for claim submission, Medicaid Eligibility Verification, the eMedNY website, and ePACES.  Training is available in both seminar and webinar format.  For more information, click here.

Check out the “What’s New” section on the eMedNY Website:  The eMedNY.org website has a resource available called the “What’s New” tab.  The first tab on the eMedNY.org website lists recent additions and updates to the site, as well as links to the affected sections.  This is a way for providers to keep up to date with items such as Fee Schedule updates, Procedure Code changes, and Prior Approval Guideline changes.  Click here for more information.

ACF Reporting of Deaths, Attempted Suicide, and Felony Crimes

Last week, the Department of Health issued a Dear Administrator Letter (DAL 18-09 Reporting of Deaths, Attempted Suicide, and Felony Crimes) to adult care facilities  (“ACF”) to inform administrators that NYS laws have been amended to address reporting requirements related to resident deaths, attempted suicides, and incidents that the operator believes or reasonably should believe would constitute a felony crime committed against residents residing in Adult Homes and Enriched Housing Programs, and to better coordinate with provisions governing reporting to the NYS Justice Center for the Protection of People with Special Needs (Justice Center).

Effective immediately all Adult Homes and Enriched Housing Programs must:

  • Report any death or attempted suicide of a resident to the Department of Health within 24 hours;
  • Report to an appropriate law enforcement authority if the operator discovers an incident that is believed or reasonably should believe would constitute a felony crime against a resident as soon as possible, or in any event within twenty-four hours; and
  • Report to the Justice Center any attempted suicides and incidents that the operator believes or reasonably should believe would constitute a felony, involving residents who at any time received mental hygiene services.
    • NOTE: Current NYS regulation only requires Adult Homes and Enriched Housing Programs that are subject to the jurisdiction of the Justice Center to send incident reports to the Justice Center.  The Justice Center reporting requirement included in this DAL may change to reflect this regulatory limitation.

Reporting to the Department of Health must be made on the DOH-5175 (DSS-3123) Incident Report and faxed to the appropriate Regional Office.  Reporting to the Justice Center must be made by calling the Vulnerable Persons Central Register Hotline at (855) 373-2122.

ACF 2nd Quarter Statistical Information Report

The DOH Division of Adult Care Facility and Assisted Living Surveillance recently issued a Dear Administrator Letter (DAL#: 18-18: 2018 Adult Care Facility 2nd Quarter Statistical Information Report) reminding adult care facility (“ACF”) operators that they are required to complete the 2018 ACF 2nd Quarter Statistical Information Report, encompassing the time period from April 1, 2018 to June 30, 2018.  The DAL also specifies additional requirements for facilities with a certified bed capacity of 80 beds or more, in which 20% or more of the resident population are persons with serious mental illness.

The 2018 ACF 2nd Quarter Statistical Information Report (and Roster of Adult Home Residents, if applicable) must be submitted to the Department no later than July 31, 2018.  Operators will be able to access and complete these reports on the HCS effective July 2, 2018.  The survey forms can be accessed by logging onto HCS, here.

Children’s SPA/HCBS List of Designated Providers

The Department recently published a list of the designated children’s providers for the new Children and Family Treatment and Support Services (formerly referred to as SPA services) and Aligned Home and Community Based Services, as of June 27, 2018.  The list can be found here.

Beginning July 1, 2018, providers must be designated through the provider designation process to provide newly aligned Children´s SPA/HCBS services under the NYS Medicaid program (both fee–for–service Medicaid and Medicaid Managed Care).

The designation process remains open and providers may continue to apply to be designated.  The list will be continuously updated to reflect the addition of newly designated providers and for expansions in the array of approved services a provider may be designated to offer.

Legislative Spotlight

Now that the 2018 Legislative session has officially ended, bills that have passed both houses of the Legislature will be delivered to the Governor in “batches” over the next several months.  Once a bill has been delivered to the Governor, he has 10 days (excluding Sundays) to either sign the bill into law or veto the bill.

Here are notable pieces of legislation that the Governor recently signed into law:

  • 10613 Cymbrowitz / S.8499 Seward:  This bill extends the statutory clarification that the Medical Malpractice Insurance Pool (“MMIP”) is not required to offer a second layer of excess medical malpractice insurance coverage until July 1, 2023.
  • 10758 Morelle / S.8962 Robach:  This bill extends the “Residential care off-site facility demonstration project” for an additional three (3) years through 2021.  Under the demonstration project, the Department of Health is authorized to approve up to three residential health care facilities to provide physical, occupational and speech therapy, as well as related educational services, at an off-site facility as a means to assess reimbursement methodologies and delivery methods related to such services.
  • 10221-A Gottfried / S.8093-A Hannon:  This bill extends a number of health related programs currently in effect that are set to expire this year.  These include:
    • Extending the Nursing Home Disaster Preparedness and/or Energy Efficiency Demonstration program until July 1, 2021.  This program, implemented as part of the 2015 Budget, authorizes the Department of Health to conduct an energy audit and/or disaster preparedness review of the real property capital aspects of each facility and develop a cost/benefit analysis of potential modifications for each facility;
    • Extending the approval of and reimbursement to Limited Licensed Home Care Services Agencies (“Limited LHCSAs”) that serve individuals who are residents of adult homes and Enriched Housing Programs until June 30, 2019;
    • Extending Fully Integrated Duals Advantage (“FIDA”) appeals allowing the Commissioner of the Office of Temporary Disabilities Assistance (“OTDA”) to utilize contracted staff, as well as State staff, to conduct FIDA fair hearings, until January 1, 2021;
    • Extending laws relating to professional misconduct proceedings until July 1, 2023; and
    • Extending laws providing immunity from liability for members of any physician committee acting without malice and within the scope of such member’s functions, until July 1, 2023.
  • 8217 Lavalle / A.10381-A Pichardo:  This bill extends the authorization for physical therapy assistants to provide services in home care settings for an additional four (4) years, until 2022.

The following bill is currently on the Governor’s desk and must be acted upon before midnight on Tuesday, July 10, 2018:

  • 9576-B Gunther / S.9100 Hannon:  This bill requires pharmaceutical manufacturers to develop a drug take back program, or enter into an agreement with the Department of Health to operate a drug take back program on its behalf.  The program will require manufacturers to be responsible for all administrative and operational fees associated with their take back program, including the cost of collecting, transporting and disposing of covered drugs from pharmacies and other authorized collectors and the recycling or disposal, or both, of packing collected with the covered drug.  This Act further requires chain pharmacies and mail-order pharmacies to provide for the collection of covered drugs by providing consumers with on-site collection, prepaid mail-back envelopes or other Drug Enforcement Agency (DEA) approved methods.

Grants/Funding Opportunities

Scattered-Site Supportive Housing for Adults with Serious Mental Illness Re-allocation RFP

The NYS Office of Mental Health (“OMH”) has issued a Request for Proposals (“RFP”) for the operation of a 56 bed Scattered-Site Supportive Housing Program located in Brooklyn that is currently operated by a not-for-profit agency.  Of the 56 beds, 40 are funded for individuals with a serious mental illness and/or co-occurring substance use disorder who are eligible under the NY/NY III Initiative (10 beds for Population A and 30 beds for Population B) and 16 beds target with a SMI referred from State prison.

Funding for Scattered-Site Supportive Housing is a combination of client rent payments and OMH funds.  Residents of Scattered-Site Supportive Housing are required to pay 30 percent of their net income for rent and reasonable utilities.  Contractors will receive annual funding for units developed under this initiative though an OMH contract at the New York City Scattered-Site Supportive Housing rate ($17,375 per unit, effective July 1, 2018).  This funding is for rent stipends, housing case management services and funding to cover consumer emergencies, as specified in the Scattered-Site Supportive Housing Guidelines.

Eligible applicants are not-for-profit agencies with 501(c) (3) incorporation that:

  • currently have a contract with New York City or New York State to operate scattered site supportive housing in NYC for persons with serious mental illness; and,
  • are in good standing with the Office of Mental Health or the Department of Health and Mental Hygiene (DOHMH).

Key Events/Timeline

  • Questions Due:  Monday, July 16, 2018
  • Questions and Answers Posted on Website:  Monday, July 30, 2018
  • Proposals Due:  Monday, August 13, 2018 by 4:00 PM
  • Anticipated Award Notification:  Monday, September 17, 2018
  • Anticipated Contract Date:  Tuesday, January 1, 2019

Upcoming Calendar

Thursday, July 19, 2018 Committee Meetings of the Public Health and Health Planning Council

10:15 a.m.

Empire State Plaza, Concourse Level, Meeting Room 6, Albany, NY
Thursday, August 2, 2018

 

 Public Health and Health Planning Council

10:00 a.m.

Empire State Plaza, Concourse Level, Meeting Room 6, Albany, NY
Thursday, August 23, 2018 Public Hearing on the Conversion of  Medical Liability Mutual Insurance Company

10:00 a.m.

Department of Financial Services, One State St., 6th Fl., New York, NY