August 1, 2024
Good afternoon,
As we discussed this morning on our weekly Thursday morning NYS Council Member Support and Public Policy call, this year the NYS Council will make securing a set aside of funds from the much discussed MCO Tax NYS is seeking CMS approval for, to address the needs of New Yorkers with mental health and substance use needs. All areas of NYS healthcare beginning with mental health and substance use disorder care should be a priority for these funds. When we first informed NYS Council members of the state’s plan to implement the Tax, we looked to California and other states that had already implemented such a tax, and we let members know that it has not been a smooth ride for many of these states. Recently enacted state budget language requires the state to pursue the MCO Tax however the language is rather vague as to the uses of these funds. There were promises made to hospitals and nursing homes specifically, but the rest is hazy. Should the Tax be implemented in New York, we will fight hard to ensure equitable distribution of these resources. They should stay in the healthcare domain.
Here’s some interesting information from Politico about what’s happening in California on this issue:
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BUDGET MAGIC: It was a small miracle when Gov. Gavin Newsom and California lawmakers found a way to close a $48 billion budget deficit without massive cuts. They did so, in part, with billions in proceeds from an enormous tax on health insurance plans.
But a November ballot measure would take away that budgeting magic trick by requiring the bulk of those funds to be spent on health care, blowing a hole in the precariously-balanced budget deal. Newsom’s Department of Finance estimates the initiative would sideline money each year until 2027, amounting to $12 billion the state had planned on using to balance the budget.The governor has made no secret about his aversion to Proposition 35.“This initiative hamstrings our ability to have the kind of flexibility that’s required at the moment we’re living in,” he told reporters earlier this month. “I haven’t come out publicly against it, but I’m implying a point of view. Perhaps you can read between those many, many lines.”His opinion holds a lot of weight on a crowded ballot. The budget pressure is amping up the stakes on Prop 35, which has no formal opposition but is driving a wedge between the governor and some of his closest allies. The measure was crafted by some of the most powerful health care players in California, like Planned Parenthood, SEIU, The California Medical Association and the California Hospital Association. Prop 35 would require most of the money — known to nerds as the MCO tax — to be funneled into the state’s Medi-Cal program, raising pay for certain doctors, facilities and services like ambulances that serve low-income people in the state. Its champions say the spending plan is essential to funding Medi-Cal programs Newsom and the Legislature have implemented in recent years — but that it also leaves plenty of room to contribute to the general fund. In 2025 and 2026, the initiative sets aside $2 billion per year for the budget.The tax, they argue, shouldn’t be viewed as a limitless source of money to balance the budget. It’s health care money, and it should be used for health care, said Jodi Hicks, the Prop 35 committee co-chair and CEO of Planned Parenthood Affiliates of California. The Prop 35 campaign is pointing to a different analysis it says is the most accurate, which puts the overall cost to the state between $1 billion and $2 billion annually if it passes. Though the initiative language can’t be changed anymore, Hicks said she is still talking to Newsom to get him comfortable with it and that she will work with his administration to implement Prop 35 if voters approve it.“Every year the budget has a finite amount of dollars, and it’s the choices that we have to spend them,” Hicks said. “These dollars were always intended to go back into health care.” |
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Yesterday The United Hospital Fund hosted its Annual Medicaid Conference in Manhattan and online. As we expected, State Medicaid Director Amir Bassiri walked participants through a PowerPoint presentation regarding the new 1115 waiver. He also informed attendees that announcements such as the awards for the Social Care Networks will be made sometime later this month (August). I’m waiting for the recording of the event to be posted online and will send it to you as soon as it is available.
State’s $7.5B Medicaid experiment to kick off this month
AMANDA D’AMBROSIO, CRAIN’S HEALTH PULSE, 8/1
Cash will finally start to flow this month from a federal program that enables the state to use Medicaid to pay for housing, nutrition and transportation.
The $7.5 billion pilot program, called the 1115 waiver, unlocks federal money to revamp the Medicaid program, allowing New York state to use Medicaid in ways it’s never been used before. The state will offer Medicaid benefits for rent payments, cooking tools and non-medical transportation, for example, to attempt to improve health among enrollees and address disparities.
After years of state planning, the money is starting to flow. Nine networks tasked with administering the pilot program are set to receive $500 million in contracts from the state in August, marking the official start of the revamp, said Amir Bassiri, New York state’s Medicaid director, in a presentation at the United Hospital Fund’s annual Medicaid conference on Wednesday.
Those networks, called social care networks, will consist of community-based organizations and medical providers that coordinate care – and payments – for the newly covered Medicaid services. The networks are spread across several regions, with multiple locations in New York City, Bassiri said.
“It will take an entire village to see this through,” Bassiri said.
The goal of the pilot program is vast: it is expected to screen the state’s 7 million Medicaid members for social determinants of health and provide services to address their housing, nutrition and transportation needs. The state is racing against the clock to get the program off the ground, as the waiver only extends through March of 2027.
The pilot program targets groups of individuals with high health risks, including pregnant individuals, people involved in the criminal justice system and those with severe mental illness or substance use. Those high-risk individuals make up 30% of all Medicaid enrollees, yet account for between 50% and 60% of spending, Bassiri said.
The pilot program stems from efforts to expand public health dollars by the U.S. Centers for Medicare and Medicaid Services. New York asked the federal government to approve a $13.5 billion, five-year program to test out new ways to use Medicaid dollars. The state negotiated with the federal government for 15 months, ultimately scoring a $7.5 billion, three-year waiver in early January.
While addressing social needs is a cornerstone of New York’s pilot program, it also will deliver funds to financially distressed providers and allocate resources to training the healthcare workforce.
Many have expressed concerns about whether the state will be able to pull off the pilot program in an expedited timeline – concerns that Bassiri has acknowledged.
“We are a little behind our schedule,” Bassiri said at the conference Wednesday. “A lot of things are going to happen in August.”
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| WEBINAR ALERT |
| The New Administrative State: Implications of Recent Landmark Supreme Court Rulings for Federal Regulations, Agency Deference, and State Implementation |
| Tuesday, August 13 1 p.m. ET / 10 a.m. PT |
| Hi Lauri Cole, While legal experts assess the recent U.S. Supreme Court rulings, federal and state agency leaders face significant questions about how their agencies and their responsibilities will be impacted. Join us for an insightful webinar with former federal and state agency leaders exploring the known and yet-to-be determined impacts of recent rulings on federal regulations, rulemaking and actions, and agency deference, and also explore the impact on state agencies implementing federal rules. The webinar will address the impact of the pivotal Loper Bright Enterprises v. Raimondo and West Virginia v. EPA decisions. Together these decisions overturned the longstanding Chevron deference doctrine, are pushing Congress to craft more specific legislation, and are directing courts to interpret ambiguous statutes. The discussion will explore the most appropriate responses of agency leaders, anticipate the ways that these decisions impact federal and state agency decision-making, and identify areas of growing uncertainty. |
| Learning Objectives |
| Understand what we know about the impact of these decisions on agency rulemaking and decision making, consider the impact on federal agency discretion, and understand the shift in power towards Congress and judicial interpretation. |
| Analyze the likely impact on agency rulemaking processes. |
| Explore state governance issues, both as a partner to federal agencies and as an implementer of federal policy and funds. |
| Identify the most important questions yet to be answered. |
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CMS to bump inpatient psychiatric Medicare payments: 5 updates to know
Rylee Wilson – 3 hours ago, Becker’s, 8/1/24
CMS will bump inpatient psychiatric payments slightly in 2025.
The agency published its final rule detailing prospective payments for inpatient psychiatric facilities July 31.
Here are five key updates to know:
- CMS will increase inpatient payment rates by 2.8%, a slight increase from the 2.7% CMS proposed in March.
- The agency will reduce rates for outlier payments. Updating the outlier threshold will result in an estimated 0.3% decrease in aggregate payments, the agency said. CMS estimates it will pay inpatient psychiatric facilities $65 million more in 2025 than in 2024, an increase of 2.5%. In March, the agency estimated it would pay facilities $70 million more in 2025 than in 2024.
- CMS will nearly double reimbursement for electroconvulsive therapy treatments. In 2025, the agency will reimburse facilities $661.52 per treatment, up from $385.58 in 2024.
- The agency will shift the wage index to the latest core‑based statistical area designations. For counties that will shift from rural to urban designations, CMS will phase out rural adjustment payments over three years.
- CMS will require facilities to report 30-day, all-cause emergency department visits for patients discharged. The agency will not require facilities to report this metric on a quarterly basis, as it proposed in its March proposed rule.
Read more here.