State of the State Book is Now Available & More on Waiver

January 9, 2024

First, here’s a link to the full list of State of the State proposals from Governor Hochul.https://www.governor.ny.gov/sites/default/files/2024-01/2024-SOTS-Book-Online.pdf

And here’s more from the approved Waiver and corresponding documents:

  • Waiver approval is through March 2027
  • The state is authorized to receive federal Medicaid matching funds for services delivered to beneficiaries residing in IMDs with a SUD diagnosis, however it appears the IMD waiver approval is limited to short-term stays.  With this, CMS is concurrently approving the SUD Implementation Plan (SEE ATTACHED DOCUMENT)  

Background on IMD waiver as it impacts certain SUD Programs:
On December 21, 2022, New York submitted an amendment application to its section 1115(a) demonstration. With this approval, the state is authorized to receive federal Medicaid matching funds for services delivered to beneficiaries residing in an institution for mental diseases (IMD) with a SUD diagnosis. New York submitted its SUD Implementation Plan and SUD Health Page 10 – Amir Bassiri Information Technology (HIT) Plan as required by the STCs. The SUD Implementation Plan describes the strategic approach and detailed project implementation plan, with timetables, programmatic content, and the key goals and objectives of the SUD demonstration. The SUD Implementation Plan also includes a HIT Plan that details the necessary health information technology (IT) capabilities in place to support beneficiary health outcomes to address the SUD goals of the demonstration. CMS has completed its review of the SUD Implementation Plan and SUD HIT Plan and has determined that both are consistent with the applicable requirements set forth in the STCs. The agency is, therefore, concurrently approving the SUD Implementation Plan and SUD HIT Plan. 

In addition, the approved NYS Waiver Amendment appears to include:

  • $500 million to support the coverage and provision of Health Related Social Needs for targeted populations, including individuals with SUD, individuals with serious mental illness, individuals enrolled in a NY state designated Health Home, post-release criminal justice-involved population with serious chronic conditions, SUD, or chronic Hepatitis-C,  juvenile justice involved youth, foster care youth, and those under kinship care, children under the age of 6, and, children under the age of 18 with one or more chronic conditions, among other identified populations. Services can include support for nutrition, housing and other needs within strict eligibility and duration parameters;
  • $4.8 million for loan forgiveness programs for psychiatrists, primary care physicians, dentists, nurse practitioners, and pediatric clinical nurse specialists, designed to expand capacity for those practitioners that work in settings with at least 30% Medicaid funding
  • Rate Maintenance of Effort: the state will be required to increase and (at least) sustain Medicaid fee-for-service provider base payment rates and Medicaid managed care payment rates in primary care, behavioral health, and obstetrics care, should the state’s Medicaid-to-Medicare provider rate ratio dip below 80 percent in any of these categories

Here’s further info re:  what appears to be targeted Medicaid rate increases that may/may not include our Programs and Services 

  • $199 million to support a 2% Medicaid rate increase for each year of the waiver (a total of 6% over 3 years) From the document: “At least a two-percentage point payment rate increase will be applied to each of the services in each service category in each of Medicaid managed care and fee-for-service delivery systems that the state operates.”

  • The state will be required to increase and (at least) sustain Medicaid fee-for-service provider base payment rates and Medicaid managed care payment rates in primary care, behavioral health, and obstetrics care, should the state’s Medicaid-to-Medicare provider rate ratio dip below 80 percent in any of these categories

Conditions

The state must attest that the rate increases will be implemented according to the special terms and conditions and that it will not decrease provider payment rates for other Medicaid or demonstration-covered services for the purpose of making state funds available to finance these required provider rate increases (i.e., cost-shifting). 

Duration and flexibility

The state must also sustain the increase for the remaining years of the demonstration and focus on the 3 priority areas (primary, behavioral, obstetrics) but the state may invest into specialty rates such as dental services if the three service domains already have rates close to Medicare