March 17, 2025
Good morning,
Hard to escape the wall-to-wall coverage on Friday and then over the weekend regarding passage of the House’s Continuing Budget Resolution in the Senate late last week. You may recall that the House version had passed at the beginning of last week and we were waiting to see how Minority Leader Chuck Schumer would navigate the having to ‘own’ a federal government shutdown if enough Senate Dems did not vote along with the House to pass the CR and in doing so, avoid a federal government shutdown. At the end of the day enough Dems did in fact join with the House to pass the bill and predictably, President Trump signed the CR into law as soon as he received it. The Continuing Resolution (which is all about spending) does not include cuts to Medicaid, Medicare, Social Security, or SAMHSA (other than funding reductions for surveillance activities performed by the Agency).
For Medicare telehealth providers and Medicare beneficiaries, Congress extended the removal of geographic requirements and expanded originating sites for telehealth services; expanded practitioners eligible to furnish telehealth services; and, extended telehealth services for federally qualified health centers (FQHCs) and rural health clinics (RHCs). The bill also delays the in-person requirements under Medicare for mental health services furnished through telehealth, including at rural health clinics and federally qualified health centers. The C.R. extends the use of telehealth to conduct face-to-face encounter prior to recertification of eligibility for hospice care
For hospitals, the funding bill extends increased inpatient hospital payment adjustment for certain low-volume hospitals, the Medicare-dependent hospital program, and permits hospitals to decline re-classification.
The bill includes an extension of add-on payments for ambulance services, extension of funding for quality measures endorsement, input and selection, extension of funding outreach and assistance for low-income programs, and an extension of the work geographic index floor.
Another key pandemic-era program that Congress extended through September is the Centers for Medicare and Medicaid Services’ acute hospital care at home waiver authorities. It also extended the temporary inclusion of authorized oral antiviral drugs as covered under Medicare Part D drugs, the Medicare Improvement Fund and Medicare sequestration.
Finally, the CR delays cuts to the teaching health center graduate medical education program; delays Medicaid disproportionate share hospital payment cuts for safety-net facilities; and delays funding for state health insurance assistance programs.
So now we have a flat budget (with few exceptions) that reflects current year federal budget spending and will remain in place until September 30 rather than for the next month as many Senate Dems wanted. More importantly, there now appears to be serious discord within the Democratic ranks on The Hill although House Minority Leader Hakeem Jeffries is refraining from a direct confrontation or harsh words for Senator Schumer for the decision he and other Senate Dems made on Friday.
From a NY Times article, 3/16: “Explaining his sudden shift in position, Mr. Schumer argued that a shutdown would empower Mr. Trump and Elon Musk’s Department of Government Efficiency. “A shutdown would shut down all government agencies, and it would solely be up to Trump and DOGE and Musk what to open again, because they could determine what was essential,” he told The New York Times in an interview. “So their goal of decimating the whole federal government, of cutting agency after agency after agency, would occur under a shutdown.” But to critics within his own party, he had squandered the leverage provided by the standoff to negotiate a bipartisan spending bill that would reclaim some of Congress’s power.
The next fight to come is the Budget Reconciliation process that recently saw House leaders send budget instructions to its Energy and Commerce Committee to cut $880B from the Medicaid Program over the next decade.
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As we discussed last week, the Senate one-house budget bill included the language from our new OMIG Audit Reform bill sponsored by Senator Peter Harckham and Assemblywoman Amy Paulin; however, the Assembly was silent on the matter. The Assembly Health Committee meets tomorrow and the bill is on the agenda for discussion. As such, our government relations consultant Marcy Savage just sent the following note to all members of the Assembly and the Senate on behalf of a broad coalition of Medicaid providers and stakeholders represented by many groups/coalitions/associations (listed below). Stand by for an Action Alert.
Dear Assembly Member:
A.1069A, Paulin is on the Assembly Health Committee agenda on Tuesday, March 18th. We are seeking your support and co-sponsorship of this critical legislation to bring fairness and transparency to the Office of the Medicaid Inspector General (OMIG) auditing process for Medicaid providers to ensure they may continue to serve their communities (your districts).
There is a large coalition of organizations across the health, mental hygiene and human services sector strongly in support of this bill and caling for the state to urgently enact these protections in the final state budget. Of note, the Senate one-house budget bill includes the Senate version of this bill so it will be part of the final budget negotiations that take place over the next couple of weeks.
Please cosponsor this bill if you have not already done so, and we ask for your help to ensure that OMIG audit reform is included in the final SFY 2026 state budget.
Below please find the list of organizations in support of this legislation and memos in support of this bill from several of the organizations can be found here: OMIG Audit Bill Memos.
Thank you.
Organizations in Support of A1069A, Paulin/S4955A, Harckham
Alliance for Rights and Recovery (formerly NYAPRS)
Association for Community Living
Alliance of Long Island Agencies
Cerebral Palsy Association of NYS
Citizens’ Committee for Children
Coalition of Downstate Union Home Care Agencies
Coalition of Medication-Assisted Providers and Advocates
Community Health Care Association of New York State
Community Pharmacy Association of New York State
Developmental Disabilities Alliance of WNY
Families Together of NYS
Federation of Mental Health Services
Greater New York Hospital Association (GNYHA)
Healthcare Association of New York State (HANYS)
Inter Agency Council of Developmental Disabilities, Inc.
InUnity Alliance
Legal Action Center
Medical Society of New York State
Mental Health Association in NYS
National Alliance for Mental Illness – NYS
New York Alliance for Inclusion and Innovation
New York Association of Emerging & Multicultural Providers, Inc.
New York Disability Advocates
New York State Academy of Family Physicians
The New York State Association of Health Care Providers, Inc.
New York State Care Management Coalition
New York Chapter American College of Physicians Services, Inc.
New York Providers Alliance
New York State American Academy of Pediatrics, Chapters 1, 2 and 3
New York State Coalition for Children’s Behavioral Health
New York State Council for Community Behavioral Healthcare
New York State Psychiatric Association
New York State Society of Anesthesiologists
New York State Society of Dermatology & Dermatologic Surgery
New York State Society of Plastic Surgeons
NYS Ophthalmological Society
NYS Osteopathic Medical Society
NYS Society of Otolaryngology-Head and Neck Surgery
Pharmacists Society of the State of New York
PEGI Solutions
Primary Care Development Corporation
Supportive Housing Network of New York
The Arc New York
The Addiction Treatment Providers of New York
The Alliance of TBI and NHTD Waiver Providers
The Drug Policy Alliance
The New York State Neurological Society
The New York State Neurosurgical Society
VOCAL NY
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Last week we sent you the letters we drafted along with several association colleagues, to the Hochul administration and the leaders in both houses, requesting a set aside of 25% of the proceeds from the MCO Tax. This is not a new ‘ask’ as we spent 4 months prior to the release of the Governor’s executive budget advocating for this request; however, none of the budgets released to date (Assembly one-house, Senate one-house or Executive) included funds for the OASAS or OMH systems of care. Clearly we are not alone in our request for fairness and balance with several additional proposals being pushed by stakeholder groups that want a piece of the proceeds estimated at $3.7B over the next two years.
(Politico, 3/17/25)
A new tax on managed care organizations is expected to net $3.7 billion over the next two years for Medicaid, and healthcare industry stakeholders all have different ideas for how the state should use it.
SOMOS Community Care, a Bronx-based physician network, will bring hundreds of primary care doctors to Albany this week to push its proposal: a $300 million independent physician investment fund.
Physician associations would apply for funds to expand service offerings, create “risk reserves” so they can enter more advanced value-based payment contracts, distribute staff bonuses or invest in technology for quality improvement, for example.
The program would be funded at $300 million annually for three years and administered by Medicaid managed care plans, in keeping with guidance from the state Department of Health on how funds should be allocated.
“Family doctors are the front line of prevention and wellness, especially those that serve Medicaid patients,” Ramón Tallaj, board chair for SOMOS Community Care, said in a statement to POLITICO. “We maintain health care, not sick care, which significantly improves patient outcomes and saves money.”
“By investing in independent primary care, New York can ensure that doctors across the state can provide the care our communities need, treat conditions before they are critical and make our entire system more effective and efficient,” Tallaj added in the statement.
As SOMOS officials note, hospitals have typically been the primary beneficiaries of the state’s investment pools for health care facilities — and that’s the case under Gov. Kathy Hochul’s executive budget proposal for the MCO tax proceeds.
SOMOS is among several organizations pushing for primary care doctors to get a larger piece of the pie.
Under Hochul’s proposal, $50 million from the tax would support an increase in the Medicaid physician fee schedule, and $10 million would support enhanced rates for health clinics and federally qualified health centers.
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To MHOTRS Agencies & Programs:
The Office of the Medicaid Inspector General (OMIG) has updated and released their audit protocol tool used for MHOTRS audits. MHOTRS programs should familiarize themselves with the tool to ensure compliance with Medicaid requirements under federal and state statutory and regulatory law. Please visit the OMIG website to view: Audit Protocols | Office of the Medicaid Inspector General.
Thank you,
Mental Health Outpatient Treatment and Rehabilitative Services
MHOTRS (formally Article 31 clinic)