January 16, 2024
COLA: Proposes 1.5% COLA across OCFS, OMH, OASAS, OPWDD and other state agencies, effective April 1, 2024 – March 31, 2025.
Medicaid managed care Reforms
It appears that the executive budget (again) proposes to Competitively Procure MCOs to manage Medicaid managed care benefits.
- Procure Medicaid managed care contracts with Medicaid managed care plans, MLTC plans, Medicare Advantage Plus (MAP) plans and HARP plans
- Eliminates the 1% across the board administrative rate increase to MC plans provided in SFY 2022-23 budget
- Authorizes DOH to impose liquidated damages for MC plans who fail to comply with the state Model Contract that lays out the rules of the road for Medicaid managed care.
Following is excerpted from the Health and Mental Hygiene budget document: Part H – Managed Care Proposals: “Purpose: This bill would make several programmatic changes to the State’s delivery of Medicaid benefits through managed care organizations. This bill would exclude Medicaid from the independent dispute resolution process, require the State to procure Medicaid managed care benefits from Medicaid Managed Care (MMC) plans, Managed Long Term Care (MLTC) plans, Medicaid Advantage Plus (MAP) plans, and Health and Recovery Plans (HARP) plans. Additionally, this bill would eliminate the 1 percent across the board (ATB) administrative rate increase provided to Medicaid managed care organizations as a result of the FY 2022-23 Enacted Budget.
Lastly, this bill would authorize the Department of Health to impose liquidated damages for managed care organizations who fail to comply with the model contract. Summary of Provisions and Statement in Support: This bill would exclude Medicaid services, including emergency services, from the independent dispute resolution (IDR) process administered through the Department of Financial Services.
This bill would also establish a moratorium on the processing and approval of applications seeking authority to establish MMC and MLTC plans, and require that such plans apply for procurement and outlines the criteria for applications. This bill would also eliminate the previous 1% rate increase for all managed care organizations and all future rate adjustments. Lastly, this bill would incorporate a more robust process for holding Medicaid managed care plans accountable when they fail to meet their contractual responsibilities to the Medicaid program by allowing the Department of Health to institute liquidated damages.
Budget Implications: Enactment of this bill is necessary to implement the FY 2025 Executive Budget and the State’s multi-year Financial Plan by keeping overall Medicaid spending within capped levels, which are indexed to the five-year rolling average of Medicaid spending projections within the National Health Expenditure Accounts produced by Office of the Actuary in the Centers for Medicare & Medicaid Services, as prescribed in the FY 2023 Enacted Budget. Effective Date: This act would take effect immediately.”
It appears that the Governor has proposed to align commercial reimbursement rates for in network MH and SUD services with the Medicaid rate, similar to the OMH Article 31 school-based MH clinics provision that was enacted in the last budget. However, this provision does not apply to either inpatient commercial reimbursement rates, or private practitioners. (Excerpted from HMH Bill, the bill language calls out specific Programs that would be impacted by this proposal under OASAS and OMH): Eligible Programs and Services:OASAS: Outpatient, Intensive Outpatient, Outpatient Rehab and Opioid Treatment that are participating in the insurer’s network. OMH: Programs licensed under Article 31, or in a facility operated by OMH, or in a Crisis Stabilization Center that are participating in the insurer’s network.
Section five of the Health and Mental Hygiene bill would amend Chapter 57 of the Laws of 2022, extending payment parity for Medicaid fee-for-service and Medicaid managed care services, whether they are provided in a traditional in-person setting or provided via telehealth modalities, through April 1, 2025.
Opioid Stewardship Fund
Section seven of the Health and Mental Hygiene bill amends Chapter 59 of the laws of 2019, extending the Opioid Stewardship Act, through June 30, 2027.