Budget Update

April 19, 2024

One of the four bills printed today is the Health/Mental Hygiene Article VII final budget bill (S8307C/A8807C).  Following our review of the bill, below is an outline (listed in order of where the item is in the budget bill) of the provisions and outcomes of interest to NYS Council members.  We have heard from several sources that Health Home cuts were ultimately rejected in the final budget agreement but we are waiting to review other bills before locking this down in our own minds.  We will continue to review the other bills as they are released including the all-important Appropriations bills which speak to OMH and OASAS funding lines of interest and will send further updates as we have them.

In the meantime see below and attached SFY25 Medicaid Scorecard.  The Scorecard tracks savings and spending associated with various Medicaid budget provisions that will be enacted as part of the new state budget. (The NYS Legislature is still debating budget bills and will continue to do so today and tomorrow.)  You can watch the proceedings at:https://www.nyassembly.gov/av/live/https://www.nysenate.gov/calendar/sessions/april-19-2024/session-4-19-2024

Health/Mental Hygiene Article VII final budget bill (S8307C/A8807C) Highlights:

  • Global Spending Cap: Extends the cap through 2025-26 (Part A)
  • Telehealth Rate Parity: Extends under Commercial and Medicaid through April 1, 2026 (Part B)
  • Hospital Capital Rate Add On:  Reduced 20% (Part D)
  • Medicaid Managed Care (MMC) Proposals: Includes proposal to no longer provide MMC plans with 1% uniform rate increase.  Proposals to exclude Medicaid from the independent dispute resolution process and to impose liquidated damages on MMC plans for violating model contract were rejected. (Part H)
  • Medicaid Pharmacy Proposals: Rejects proposal to eliminate “prescriber prevails” (Part I)
  • Essential Plan: Includes proposal related to changing the Basic Health Program to the Essential Plan and extending authority.  Also includes proposal related to the 1332 State Innovation Waiver authorizing a new subsidy and adding it to the marketplace (Part J)
  • Continuous Eligibility for Children:  Includes proposal to provide for continuous Medicaid and Child Health Plus eligibility for children aged 0-6 (Part M)
  • Medical Debt: Includes proposal related to Medical debt protections that hospitals must comply with along with a requirement for patient consent for treatment separate from a patients’ consent to pay and limits use of pre-authorization of a credit card before treatment (Part O)
  • Nurse Practitioner Independent Practice: Extends for NPs with 3600 hour practice through 7/1/26 (Part P)
  • Scope of Practice: Rejects proposed scope of practice expansions for Physician Assistants and certain other professionals (Part Q)
  • Joint Interstate Compacts: Rejects proposal for joint interstate compacts in medicine and nursing (Part R) 
  • Healthcare Safety Net Transformation Program: Includes program with some modifications from Executive proposal related to what applications shall demonstrate and an annual reporting requirement for DOH on approved plans (Part S)
  • Ending the HIV, Hepatitis and Syphilis Epidemic:  Executive budget proposals rejected (Part T)
  • PMP & Buprenorphine: Proposals to make changes to the Prescription Monitoring Program and allow for certain providers to distribute a 3-day supply of buprenorphine rejected (Part U)
  • Opioid Stewardship Fund: Proposal to make Fund permanent rejected (Part X)
  • Community Mental Health Support and Workforce Reinvestment Program:  Modifies to extend through March 31, 2027 (Part Y)
  • Mental Hygiene Agencies Time-Limited Demo Programs: Modifies to extend through March 31, 2025 (Part Z)
  • Commercial Rate Mandate for MH/SUD: Includes with specific language on Medicaid rate notification and plan rate approval process (Part AA)
  • Comprehensive Psychiatric Emergency Programs: Modifies to extend through July 1, 2027 (Part BB)
  • Justice Center Notification to OMIG: Rejects proposal (Part CC)
  • Representative Payee Authority for MH Facility Directors: Modifies by extending authority through June 30, 2027 (Part DD)
  • Human Services COLA: Modifies by providing a total COLA of 2.84% for 4/1/24-3/31/25 and imposing restrictions on use for 1.7% for support staff, direct care staff, clinical staff and non-executive administrative staff (Part FF)
  • 1115 Waiver Flexibilities: Includes per Executive 30-day budget amendments (Part GG)
  • CDPAP Reforms: Includes changes to the Consumer Directed Personal Assistance Program to move to 1 Fiscal Intermediary for the state (Part HH)
  • MCO Tax: Includes establishment of a NY Managed Care Organization Provider Tax subject to approval by CMS which applies to Medicaid, Child Health Plus, Essential Plan, Coverage under the NY Health Exchange and other comprehensive insurance coverage under article 32, 42 and 43 of Insurance law and article 44 of public health law (Part II)
  • Healthcare Stability Fund: Creates this fund for monies received through the imposition of a CMS approved MCO tax to pay for increased capitation payments to MCOs, support for the delivery of health care services under Medicaid and other Medicaid and capital funding.  Requires quarterly reports by DOB on the fund (Part II)
  • Doula Programs: Includes a non-patient specific standing order by NYSDOH for doula services 12 months postpartum and a Community Doula Expansion Program (Part KK)
  • Children with Medical Fragility: Includes language related to care for such children up to age 21 with certain conditions in pediatric residential health facilities and pediatric D&TCs (Part LL)
  • SUNY Downstate: Includes funding to prevent closure of SUNY Downstate in Brooklyn and creates a Community Advisory Board for the Modernization and Revitalization of SUNY Downstate Health Sciences University (Part MM)
  • Funding Increases: Includes increased Medicaid funding for Hospitals up to $525 million; Nursing Homes: up to $285 Million and Assisted Living Programs: up to $15 million subject to federal participation for 4/1/24-3/31/25 (Part NN)