January 18, 2022

Look at this, NYS Council members!  This is your work and advocacy to compel the state to return carve-in savings to our field!!

From the Budget Briefing Book (page 131) (page 66 of the pdf doc) 

Reinvest Medicaid Managed Care Recoupments from Underspending on Behavioral Health Services.

Insurers are contractually required to dedicate a portion of premiums toward behavioral health services, and failure to meet the threshold spending results in a recoupment. The FY 2023 budget reinvests these recovered funds into behavioral health services. The Executive Budget appropriates $111 million for OMH and OASAS to fund rate increases for community mental health and addiction services, including clinics, and expansion of other essential community-based services and supports.

Regarding the $111M we reported on earlier – funds that are now proposed to go to OMH and OASAS due to the recoupment from MMC plans that we advocated for over the last two years:  

More information from the Budget Briefing book.  

First, note one sentence in Briefing Book info ((below) that mentions ‘imposition of new procurement quality requirements for managed care contracts’.  It is our hope the actual budget bills will reflect language that makes a change such that MCOs will have to compete to participate in the carve in of BH services going forward (rather than merely checking all the boxes to participate). 

More From the Briefing Book (PDF) | NYS FY 2023 Executive Budget

Medicaid:

Human Services/Mental Hygiene Cost-of-Living Increase. Funding is included to support a 5.4 percent wage increase for human services workers.  

The Executive Budget proposes basing the Global Cap index on the five-year rolling average of Centers for Medicare & Medicaid Services (CMS) annual projections of health care spending. The CMS projections account for enrollment, including specific populations, such as the aging or disabled populations. The new index would account for enrollment and population changes, which are significant drivers of costs, and supports additional Medicaid spending growth of $366 million in FY 2023, growing to $3.1 billion

in FY 2027. The total Global Cap spending growth in FY 2023 is estimated at $966 million using the new index ($366 million above the existing cap). The increase in the allowable spending growth, another quarter of the Enhanced Federal Medical Assistance Percentage (eFMAP), and savings actions are sufficient to fund forecasted growth and new investments.

The Executive Budget proposes several investments in health care, including a restoration of the 1.5 percent across-the-board (ATB) reduction to fee-for-service providers implemented in the FY 2021 Budget, as well as an increase of 1 percent to all provider reimbursement rates. The increased rates recognize growth in service costs and will provide flexibility to respond to market needs and compete in the labor market to attract qualified workers. Funding is also proposed for hospitals, nursing homes, health professional schools, and other organizations as they seek to build the health workforce. Other investments include increased aid to safety-net hospitals to support urgent operating needs and address pandemic-related impacts, additional funding for nursing homes to adhere to minimum staffing requirements, increased reimbursement rates to promote primary care, children’s behavioral health services investments, increases to orthotics and prosthetics rates, and funding to improve the quality of health care. The Financial Plan reserves $1 billion of additional resources to further support multi-year investments in healthcare transformation and sustainability efforts.

The FY 2023 Budget proposes Medicaid savings actions including the maximization of Federal resources to provide enhanced pregnancy coverage and postpartum care; utilization of the temporary 10 percent increase to the Federal Medical Assistance Percentage (FMAP) for specific Medicaid Home and Community-Based Services (HCBS) to support workforce investments, capacity increases, and digital infrastructure; imposition of new procurement quality requirements for managed care contracts; elimination of the ability for providers to prescribe pharmaceutical drugs for purposes outside of the clinical criteria; and leveraging additional Federal resources for enhanced pregnancy coverage through the Children’s Health Insurance Program.

eFMAP Extension. On January 14, 2022, the Federal government extended the public health emergency through June 30, 2022, which will authorize the eFMAP provisions through June 2022, the end of the quarter in which the emergency period is set to expire. Accordingly, the Executive Budget Financial Plan assumes an additional $746 million in new resources, increasing the projected benefit in FY 2023 to nearly $1 billion. In total, the benefit in FY 2022 is nearly $3 billion, unchanged from the Mid-Year Update. The savings from eFMAP are partly offset by increased costs associated with Federal enrollment and program restructuring prohibitions.

Healthcare/Frontline Worker Bonus. The State will provide frontline healthcare workers a bonus payment of up to $3,000 to incentivize the recruitment and retention of qualified frontline healthcare and direct support professionals. The amount of the bonus will be based on hours worked and length of time in service. Direct Care State employees will also receive bonuses. The total State cost is estimated at $1.2 billion ($1.07 billion for non-State employees; $120 million for State employees).

Public Health/Aging. The Budget adds funding for public health programs including Nourish New York; General Public Health Work (GPHW) for counties including New York City, and outreach, education, and social services crisis management for COVID-19.

Mental Hygiene. Executive Budget increases funding for mental health residential programs to assist providers with housing cost increases and establishes new teams of mental health professionals performing Critical Time Intervention directly with homeless individuals to ensure access to services and housing. In addition, funding is included to implement a 988 crisis hotline and enhanced crisis response services for children and families, as well as, prevention, treatment, and recovery efforts in response to the opioid epidemic funded outside the general fund.

Health Care Transformation. The Financial Plan reserves $1 billion of additional resources to further support multi-year investments in healthcare transformation and sustainability. 

The Executive Budget provides an increase of $402 million (56 percent) in operating and capital support for OASAS to enhance prevention, treatment and recovery programs targeted toward addiction services, residential service opportunities, and primary prevention activities consistent with state opioid settlement agreements; and invests more than $100 million in new resources from the Opioid Stewardship Tax and litigation settlements with pharmaceutical manufacturers and distributors. Of these funds, $113 million will pass through the State to local municipalities, consistent with settlement agreements.