Plugged Into Health @ Hinman Straub – September 5, 2018

The Realities of Single Payer Coalition Responds to Single Payer Claims Raised During Gubernatorial Debate

Last Wednesday, Governor Andrew Cuomo and Cynthia Nixon faced off in a debate ahead of the September 13th Democratic gubernatorial primary. Among the topics discussed was Ms. Nixon’s endorsement of the move to a single-payer healthcare system. During the debate, Ms. Nixon backed up her support for the proposal by citing a recent study of the New York Health Act that was performed by the RAND Corporation. Following the debate, a coalition of business and healthcare industry stakeholders, known as The Realities of Single Payer, issued a document highlighting a number of erroneous claims that Ms. Nixon made about the conclusions of the RAND study and the purported effects the single-payer proposal. Later in the week, the Empire Center for Public Policy published its own story calling attention to many of Ms. Nixon’s misstatements.

The Realities of Single Payer coalition also issued a letter to the candidates opposing the single payer plan on the grounds that the proposal, which would require an unprecedented and unlikely waiver from the federal government, would result in massive tax increases, cuts to provider payments, and limited coverage options for New Yorkers.

August 2018 Medicaid Update

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

Some of the highlights include:

  • Introducing Care Coordination Organization/Health Homes (“CCO/HH”) For Individuals with Intellectual and Developmental Disabilities (“I/DD”):  On July 1, 2018, OPWDD began the transition of both Medicaid Service Coordination (“MSC”) and Home and Community Based Services (“HCBS”) Waiver Plan of Care Support Services (“PCSS”) to Health Home Care Management. Enrollment into a CCO/HH is voluntary and individuals who elect not to enroll in a CCO/HH may instead choose to enroll in Basic HCBS Plan Support. Seven CCO/HHs have been designated and are now providing comprehensive care management to individuals with I/DD. CCO/HHs are required to develop networks by expanding partnerships with cross-system service providers including medical, developmental disability service providers, long-term supports and service providers, dentists, behavioral health care providers, regional Systemic, Therapeutic Assessment, Resources and Treatment (START) teams, community-based organizations, and social service providers. For more information, click here.
  • Reminder to Sign Up for Electronic Funds Transfer (“EFT”) and Electronic Remittance Advice (“ERA”) or PDF Remittances:  All billing providers that are still receiving paper checks and/or paper remittance statements are required to register for EFT and either ERA or PDF remittances. Medicaid began phasing in this requirement beginning in September 2012.  For information on the benefits of EFT and how to sign up, click here.
  • Health Home Program Announces New Recipient Restriction/Exception Codes:  On July 16, 2018, two new Recipient Restriction/Exception (“RR/E”) codes went into effect for the Health Home Program. The purpose of these RR/E codes is to notify all Medicaid providers that these members are associated with the Health Home program. For more information, click here.
  • Pharmacy Update on Dose Optimization Program:  Effective August 30, 2018, the Medicaid fee-for-service (“FFS”) program will update the Dose Optimization initiative.  Dose optimization is designed to reduce prescription costs by reducing the number of pills a patient needs to take each day. The NYS Department of Health has identified drugs to be included in this program, the majority of which have FDA approval for once-a-day dosing, have multiple strengths available in correlating increments at similar costs, and are currently being utilized above the recommended dosing frequency. Prior authorization (“PA”) will be required to obtain certain medications beyond established limits.  For a list of affected medication and their prescription limits, click here.
  • New Online Provider Directory: HIV, HCV, Buprenorphine, PEP, and PrEP Services:  The Department of Health AIDS Institute (“AI”) has launched a new online provider directory.  This new online directory will allow providers and consumers easier access to information regarding human immunodeficiency virus (“HIV”), hepatitis C virus (“HCV”), Buprenorphine, post-exposure prophylaxis (PEP), and pre-exposure prophylaxis (“PrEP”) service providers across NYS.  This new directory will replace the former HIV and HCV provider directories located on the NYSDOH Health Commerce System (“HCS”).  It will also replace the former PrEP/PEP Provider Voluntary Directory.  Inclusion in this directory is completely voluntary, and does not confer any endorsement by NYSDOH, nor does it establish NYSDOH credentialing or certification in a specialty.  Providers that wish to be included in the directory, or update their information in the directory can do so here.
  • Optical Provider Notice: New Form “Disclosure of Other Business at Same Location”:  Optical Business Providers (COS 0401 & 0402) enrolling, revalidating, reinstating, or changing ownership must now identify other optical providers at the same location.  This form, “Disclosure of other Business at the same location” #436702, can be found on the Optical Business landing page under the section “Additional forms/information which may be required to complete your enrollment.”  In addition, the following information must also be reported on the Business Application (eMedNY – 436701) upon initial enrollment, revalidation, reinstatement, or change of ownership:
    • Disclosure of Ownership and Control, Section 1, For Corporations and Optical Establishment only: Providers are required to report all other business addresses.
    • Disclosure of Ownership and Control, Section 2: Providers are required to complete Ownership in Other Disclosing Entities (ODE).
  • Medicaid Provider Revalidation:  The Affordable Care Act mandates that all Medicaid providers revalidate their enrollment in the program every five years.  The Bureau of Provider Enrollment has sent providers Initial and Final revalidation letters to their correspondence address informing them of the revalidation requirement. The Bureau encourages providers who have not revalidated yet and wish to remain enrolled in NYS Medicaid to watch for this letter, then follow the instructions to revalidate their enrollment. Providers who do not revalidate will receive a termination letter and will be terminated.  Terminated providers will not be able to participate in Medicaid Managed Care (MMC) networks and Children’s Health Insurance Program (CHIP), in addition to being unable to bill for fee-for-service (FFS) Medicaid.
  • Maintaining and Updating Your Enrollment Records:  Section 5006(a) of the 21st Century Cures Act requires all State Medicaid programs to develop and maintain a Provider Directory.  The NYS Medicaid program has made a directory of providers enrolled in the fee-for-service program available here.  In addition, Medicaid providers agree, as a condition of continued enrollment, to notify the Department of Health immediately of any changes supplied in your enrollment agreement, including a change in service location and/or ownership.  For more information, click here.
  • Medicaid Provider Enrollment and Maintenance Feedback Survey is Now Online:  As a means intended to improve the provider experience of enrolling in and maintaining their information with New York Medicaid, DOH and eMedNY are encouraging providers to complete the ten question survey to provide feedback about the various processes that are currently followed.  To access the survey, visit here.  Contact the eMedNY Call Center at 1-800-343-9000 with any questions.  The survey will close two weeks from the publication of this edition of the Medicaid Update.

$574 Million in Essential Plan Funding Restored

Last week, NYS Attorney General Underwood announced that the Trump administration has ordered the restoration of $574 million in funding for New York’s Essential Plan.  The restoration follows a lawsuit filed earlier this year by New York and Minnesota over a funding cut to the federal state operated Basic health Programs (“BHPs”), known in New York as the Essential Plan (“EP”).  Last week’s restoration represents approximately three-quarters of the funding that was taken away by the federal action.  Minnesota received $85 million under the restoration.

It is not clear whether federal officials have agreed to continue the funding beyond 2018.

Health Home Update

Updated Children’s Billing Manuals

The Department of Health has issued an updated New York State Children’s Health and Behavioral Health (BH) Children’s Medicaid System Transformation Billing and Coding Manual and the New York State Children’s Health and Behavioral Health (BH) Services Children’s Medicaid System Transformation Guidance for the Transitional Period January 1, 2019 – January 1, 2020.  Specifically, the documents were updated to reflect stakeholder comments regarding unique procedure and modifier codes for each service in the Billing and Coding Manual and updated language regarding reassessment, found on page 6 of the Transformation Guidance.

These manuals should be used to begin preparation of claiming systems.

 

Legislative Spotlight

Now that the 2018 Legislative session has adjourned, 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.

The following bill is currently on the Governor’s desk and must be acted upon before midnight on Friday, September 7, 2018.

  • 5890-B/A.8176-A (Seward/Woerner): This bill would provide for the continuation of the Managed Care Saving Account demonstration to allow municipalities with large group HMO coverage to offer group high deductible health plans, in conjunction with a health savings account or a health reimbursement account, provided that the municipality contributes an amount at least equal to the deductible required by the plan.  The plan must be offered pursuant to an existing collective bargaining agreement.  The provisions of this bill would sunset on December 31, 2021.

Upcoming Calendar

Friday, September 14, 2018 New York State Department of Health Minority Health Council

9:00 a.m. to 1:00 p.m.

 
Thursday, September 20, 2018

 

 Drug Utilization Review Board (DURB)

9:00 a.m. to 400 p.m.

Meeting Room 3, Empire State Plaza, Concourse Level, Albany, NY

 
Tuesday, October 9, 2018 State Health Innovation Plan Council

10:30 a.m. – 2:30 p.m.