Plugged Into Health @ Hinman Straub – December 10, 2018

NY State of Health (“NYSOH”) Update

2019 Enrollment is Up in First Month of Open Enrollment Period

The NYSOH has announced that marketplace enrollment is up compared to the same period last year.  As of December 1, 2018, total Qualified Health Plan (“QHP”) and Essential Plan (“EP”) enrollment stands at 933,254.  More than 170,000 consumers have already renewed coverage or are newly enrolled in a QHP for 2019, and Essential Plan enrollment has reached more than 760,000.

Insurance Enrollment Webinar

NY State of Health is hosting an online webinar on Wednesday, December 12, in advance of the deadline to Enroll for January 1, 2019 Coverage.  The interactive webinar will help New Yorkers find a low-cost plan that’s right for them. During the webinar, trained local representatives will answer questions and guide viewers through the process of enrolling in the state’s health plan marketplace and finding in-person enrollment assistance. There will also be versions of the webinar offered in Spanish and Mandarin.

To register for the webinar, click here.

VBP Updates

Public Comment for 2019 VBP/QARR Measure Specifications

The Department of Health has published the draft technical specifications for newly proposed quality measures for both the 2019 Value Based Payment (VBP) Quality Measure Set and the 2019 Quality Assurance Reporting Requirements (QARR). The public comment period will occur for the next 30 days.  The Department is seeking feedback on the proposed new measures.

The draft technical specifications, the New York State Value Sets, and the Public Comment Submission Form are linked below.

Comments and questions specifically relating to the measures should be submitted in writing via the Public Comment Submission Form to [email protected] by December 21, 2018.

Medicaid Compliance Program Certification Information for 2018 Now Available on the OMIG Website

Compliance Program Certification information and forms for 2018 are now available on the New York State Office of the Medicaid Inspector General’s (OMIG) Certification Page under the “SSL Certification” button.  Now that certification form for 2018 is “live”, providers subject to the certification requirement have until December 31, 2018 to complete the certification.  Entities subject to the compliance certification requirement should use the current online form to complete the annual certification for 2018.

To assist providers, OMIG has posted answers to frequently asked questions (“FAQs”), as well as a brief webinar explaining the SSL mandatory compliance program and certification requirements.

As a reminder, all New York State Medicaid providers (and managed care plans) who are subject to the mandatory compliance program obligation set out in NYS Social Services Law Section §363-d and 18 NYCRR Part 521 must certify annually during the month of December that they have adopted and implemented a compliance program that meets all statutory and regulatory requirements via the certification form on the OMIG website.  Those entities that are subject to the mandatory compliance certification requirement include:

  • Article 28 providers (e.g., hospitals, D&TCs, clinics, and skilled nursing facilities);
  • Article 36 providers (CHHAs and LHCSAs);
  • Article 16 and 31 providers (OASAS and OMH licensed and certified programs); and,
  • Any person or provider or affiliate (including MCOs) who either has claimed or reasonably expects to claim $500,000 in Medicaid payments in any consecutive twelve month period.  This would include pharmacy providers and drug manufacturers, DME suppliers, primary care practitioners, surgical specialists, assisted living program providers (ALPs), or any Medicaid provider or MCO who meets the $500,000 standard.

In addition to the certification required under NYS Social Services Law Section §363-d, those providers that make $5 million or more in Medicaid payments during the Federal fiscal year (October through September) will also need to complete a separate Federal Deficit Reduction Act of 2005 (DRA) Certification that is also available on the OMIG website.  Similar to the NYS certification obligation, providers subject to the DRA must complete the DRA certification on or before January 1.

Additional guidance materials on OMIG’s compliance requirements are available here.

Questions about compliance certification in general should be directed to OMIG’s Bureau of Compliance at (518) 408-0401 or via email at: [email protected].

Adult Home Resident SSI Cost of Living Adjustment

Last week, the Department issued a Dear Administrator Letter (DAL: 18-26 SSI Cost of Living Adjustment (COLA)) to inform Operators/Administrators of adult homes and enriched housing programs of impending increases in the 2019 Supplemental Security Income (“SSI”) and Safety Net benefits provided to residents of such facilities as a result of the 2.8% federal cost of living increases scheduled for January 1, 2019.

Chapter 59 of the Laws of 2018 authorized a pass through of the January 1, 2019 cost of living increases to SSI recipients.  The January 1, 2019 increases will result in increases of $21.00 per month for individuals and $42.00 per month for couples. The law also requires that SSI residents receive a $6.00 increase in their Personal Needs Allowance, effective January 1, 2019.

The Department has included a draft notice to residents who receive SSI. The notice is to be conspicuously posted where it is accessible to residents, and must be available to any resident who would like one.

Governor Cuomo Announces Doula Medicaid Pilot in Erie County and Parts of Brooklyn to Launch in Early 2019

Governor Cuomo has announced that the Department of Health will launch a pilot expansion of the State’s Medicaid program to cover doula services beginning in Erie County and parts of Kings County. A doula is a non-medical birth coach who assists a woman before, during or after childbirth if needed. According to the announcement, the use of doulas has been shown to increase positive health outcomes, including reducing birth complications for the mother and the baby.

The doula pilot, scheduled for launch March 1, 2019, is a part of the Governor’s initiative to target maternal mortality and reduce racial disparities in health outcomes.

Current and updated information is available here.

NYS Assembly Holding Public Hearing on Funding for Addiction Prevention, Treatment

On Tuesday, December 11, the NYS Assembly Standing Committee on Alcoholism and Drug Abuse will be hosting a public hearing to examine the adequacy of funding for addiction prevention, treatment, and recovery services provided by state operated facilities as well as community based providers within the context of the State Fiscal Year (SFY) 2018-2019 Enacted Budget.

The hearing will be held in the Assembly Hearing Room on the 19th floor of 250 Broadway, New York, NY 10007.

Persons wishing to present testimony should complete and return the reply form by Friday, December 7, at 1:00 p.m.

Regulatory Updates

Department of Health

Controlled Substances

The Department has issued a notice of emergency rulemaking that reclassifies certain drugs containing cannabidiol (“CBD”) from a schedule I controlled substance to a schedule V controlled substance. The US Drug Enforcement Agency (“DEA”) recently reclassified these controlled substances due to the FDA-approved CBD products being found to be effective for the treatment of seizures associated with certain forms of epilepsy. This emergency rule is the result of a new law passed in 2018 that allows the DOH Commissioner to reschedule a drug under New York State law when a drug a rescheduled by the federal government.

The emergency rule is effective as of October 30, 2018, and will expire on January 27, 2019.  The Department has stated that it intends to adopt this emergency rule as a permanent rule and will publish a notice of proposed rulemaking at a future date.

Medical Staff — Sepsis Protocols

The Department has issued a notice of adopted rulemaking that refines the guideline requirements for all hospitals required to have in place evidence-based protocols for the early identification and treatment of severe sepsis and septic shock.

The rule, as adopted, contains non-substantive changes from the proposed rule that was published in the June 20, 2018 edition of the NYS Register.

Prescription Contraceptive Drugs

The Health Department has issued a notice of adopted rulemaking that allows for a written order of prescription contraceptives for family planning purposes to be filled 12 times within one year after the date of issuance.

The rule, as adopted, contains no changes from the proposed rule that was published in the July 25, 2018 edition of the NYS Register.

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 of interest were recently signed into law by the Governor:

  • S.766 (Stewart-Cousins) / A.8159 (Wright):  This bill requires the Department of Health to provide written notification to residents of all adult homes, enriched housing programs, residences for adults and assisted programs where a temporary operator has been appointed.

The following bill was vetoed by the Governor:

  • S.7940-B (Seward) / A.10486-B (Cahill):  This bill exempts continuing care retirement communities (“CCRCs”) from Department of Financial Services (“DFS”) regulations related to cybersecurity policies for financial services companies.  In order to qualify for the exemption, CCRCs are required to adopt a written cybersecurity policy that is designed to protect the confidentiality of nonpublic information and is in compliance with all applicable cybersecurity and privacy laws and protections governing nursing homes, adult care facilities and assisted living residences.  CCRCs would also be required to self-certify their cybersecurity policies and file such self-certification with the DFS.  DFS will review the accuracy and reasonableness of the self-certification.  Unless DFS objects to such attestation within sixty (60) days from submittal, the attestation would be deemed approved.

Upcoming Calendar

Wednesday, December 12, 2018

 

 Early Intervention Coordinating Council

10:15 a.m. to 3:00 p.m.

Empire State Plaza Convention Center, Meeting Room 1, Albany, NY
Thursday, December 13, 2018

 

 Public Health and Health Planning Council

10:00 a.m.

Empire State Plaza, Concourse Level, Meeting Room 6, Albany, NY