MRT II recommends changes to global cap, among other reforms

March 18, 2020

Last night we sent you two documents discussing the group of MRT proposals that are said to have been sent to members of the NYS Legislature for their review.  In the meantime the MRT 2.0 group is said to be meeting tomorrow via conference call, presumably to formally approve the package of proposals discussed in the docs.

Since the proposals would be embedded in the state budget that gets voted on, we assume lawmakers could accept, reject or try to finesse individual proposals in the package (as they can with other proposals) but ultimately the amount of savings on the scorecard document gets very close the Medicaid deficit amount the MRT was tasked with addressing via finding Medicaid savings.

The Governor says he is currently working with Nita Lowey and other members of the NYS delegation to somehow free up / find a work around so NYS can continue with Medicaid Redesign despite the Maintenance of Effort requirements that come along with whatever federal FMAP funds states receive.

All of this is very fluid, changing from moment to moment so stay tuned…

MRT II recommends changes to global cap, among other reforms

By Shannon Young, Politico

03/18/2020 02:40 PM EDT

ALBANY — A redefined Medicaid global cap, a 60-month look-back period for home- and community-based care eligibility and increased across-the-board reductions are among the dozens of proposals the Medicaid Redesign Team II is expected to recommend lawmakers adopt to close New York’s budget shortfall.

The 21-member panel, which Gov. Andrew Cuomo tasked with identifying $2.5 billion in program savings for his fiscal fear 2021 budget, issued a series of recommendations late Tuesday, according to documents provided to POLITICO from multiple sources.

The MRT II, which is set to hold its third and final public meeting Thursday, is expected to discuss the recommendations — outlined in an executive summary and scorecard — during a Wednesday afternoon call, various sources have confirmed.

A budget division spokesperson did not immediately respond to a request for comment on the recommendations.

The recommendations, which include actions affecting hospitals, care management, long-term care, pharmacies, health information technology and mainstream managed-care actions, total $2.5 billion in fiscal 2021 and more than $3 billion in fiscal 2022, according to the documents.

The executive summary notes that recommendations “will be advanced in the budget through appropriation and Article VII language that provides the executive with full discretion with regard to the effective dates of these proposals in light of the health care and economic disruption caused by COVID-19.”

It further states that “it is recommended that a portion of the enhanced [Federal Medicaid Assistance Percentage] funding, to the extent practicable, will be used to mitigate the implications of COVID-19 on impacted health care providers.”

In addition to the proposals, the MRT II will recommend that New York: evaluate the way it manages the Medicaid program to ensure the state has the necessary infrastructure and appropriate organization structure to effectively manage the program; consider future work groups focused on particular aspects of the Medicaid program; and analyze “promising” proposals submitted to the panel, like sepsis screening in community-based settings.

The panel also recommends increasing the 1 percent across-the-board reduction announced in late December to 1.875 percent in the next two fiscal years — a savings of $219 million in fiscal 2021 and $50 million in fiscal 2022.

According to the executive summary, MRT II will recommend the executive branch “negotiate a redefinition of the Medicaid global cap as part of the FY21 budget in a manner that takes into account developments since the state Medicaid global cap was first enacted in 2011.” A redefinition of the cap, which is now the 10-year rolling average of the medical consumer price index, would increase the total spending “through modifications in the base on which spending growth is calculated and/or a different allowable growth metric.”

The largest savings would come from a series of proposed changes to long-term care — a total of $648 million in fiscal 2021 and $1 billion in fiscal 2022 — according to the executive summary.

They include instituting a 60-month look-back period for home- and community-based eligibility; eliminating spousal and legally responsible relative refusal; and changing eligibility criteria for personal care services, the Consumer Directed Personal Assistance Program and enrollment in managed long-term care partial plans.

The MRT II, among other things, further recommends: reducing nursing home capital funding; delaying implementation of the expansion of Community First Choice Option services; and capping the statewide managed long-term care enrollment growth at a target percentage.

The MRT’s proposals for hospitals, meanwhile, would increase the progressivity of indigent care pool distributions, strengthen NYC Health + Hospitals and realize additional savings without impacting core hospital operations, for a total savings of $399 million in fiscal 2021 and $459 million in fiscal 2022, according to the executive summary.

Budget officials had said Tuesday that “the MRT II is progressing as planned” and its proposals “would be considered as part of the budget process” despite an accelerated push to move the spending bill ahead of its March 31 deadline.

Cuomo told reporters Monday that language included in a federal coronavirus bill to prevent Medicaid changes, including proposed adjustments to the local Medicaid share paid by New York City and counties, would essentially prevent the state from passing a budget.

A source close to the federal legislation said Tuesday that Cuomo was “working with [Rep. Nita] Lowey on changes to the Speaker Nancy Pelosi House language that will allow him flexibility to proceed with his Medicaid redesign.”