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2014-15 Executive Budget and Global Cap Update

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  1. 2014-15 Executive Budgetand Global Cap Update February 5, 2014

  2. Agenda • 2013-14 Global Cap Recap • 2014-15 Global Cap Projections • MRT Phase IV Recommendations • Other Programs/Proposals in the Global Cap • Article VII Highlights 2

  3. 2013-14 Global Cap Recap

  4. 2013-14 Global Cap Recap • Reflects annual growth of $512 million (primarily for price and utilization). • $730 million in resources will be transferred from the Global Cap to stabilize Mental Hygiene funding: • Part of the $1.1 billion revenue shortfall for developmental disability services. • Health care coverage will be provided to an additional 127,000 fragile and low income recipients; excludes impact of the ACA. • Monthly Global Cap Report was expanded: • http://www.health.ny.gov/health_care/medicaid/redesign/ 4

  5. 2013-14 Global Cap Recap • Through November spending under the Global Cap was $59 million below estimates; primarily due to: • Lower category of service spending ($80 million), administrative costs ($27 million), and State operations ($9 million); offset by • Higher accounts receivable balances ($25 million) and an advanced SUNY IGT payment ($23 million). • Health care coverage was provided to an additional 102,000 fragile and low income recipients through November: • Medicaid Managed Care enrollment increased by 120,000 recipients. • Fee for Service enrollment decreased by 18,000 recipients. 5

  6. 2013-14 Global Cap Recap • Medicaid expenditures through November 2013 are $59 million or 0.5% below projections. 6

  7. 2013-14 Global Cap Recap • Medicaid enrollment through November 2013 increased by 102,068 recipients since April 1, 2013. 7

  8. 2013-14 Global Cap Recap • Global Cap spending is projected to be under target by $75 million in 2013-14 and $225 million in 2014-15 -- the MRT is working. 8

  9. 2014-15 Global Cap Projections

  10. Medicaid All Funds Spending ($ Millions) 2014-15 2016-17 2015-16 2013-14 State Funds $21,383 $21,996 $23,042 $23,592 DOH State Funds $16,421 $16,962 $17,741 $18,329 OSA State Funds $4,962 $5,034 $5,301 $5,263 Federal Funds $25,445 $27,653 $30,546 $32,428 $8,780 $8,544 $8,419 $8,334 Local Funds All Funds $55,608 $58,193 $62,007 $64,354 2014-15 Global Cap Projections 10

  11. 2014-15 Global Cap Projections • The Global Spending Cap is projected to grow $540 million in 2014-15; highlights include: 11

  12. MRT Phase IV Recommendations

  13. MRT Phase IV Recommendations Fiscally Neutral Package of Savings and Investments 13

  14. Start-up Investment for BHOs/HARPs • Dedicates $120 million to successfully transform the Behavioral Health System as the State transitions to Managed Care: • Targeted VAP program to preserve critical access to behavioral health inpatient and other services ($40M); • Funding new 1915(i) – like services ($30M). • Facilitating the transition of Behavioral Health services for adults and kids into Managed Care ($20M); • Integration of Behavioral and Physical Health ($15M); • Health Homes Plus for Assisted Outpatient Treatment (AOT) ($10M); and • OASAS Residential Restructuring ($5M); 14

  15. Supportive Housing • Dedicates $100 million in SFY 2014-15 to expand access to supportive housing services: • Continue $75 million in MRT dollars to fund various supportive housing initiatives; • Allocate $18 million in new supportive housing dollars; and • Designate $7 million to fund new supportive housing initiatives associated with Medicaid savings derived from the closure of hospital and nursing home beds. 15

  16. VAP/Safety Net Program • 2013-14 Enacted Budget allocated $152 million for VAP/Safety Net Programs and $30 million for Financially Disadvantage Nursing Homes. • 2014-15 Executive Budget includes $194 million for VAP of which $30 million continues to be set aside for Financially Disadvantage Nursing Homes. • 2015-16 funding was expanded to include provider payments linked to performance. • Over 180 applications, with a total estimated request of $1.2 billion (excluding capital), have been received to date. 16

  17. NH Cap and Pharmacy Initiatives • Nursing Home Case Mix Cap ($43 million): • Addresses program integrity issues related to potential up-coding of rehabilitation services by limiting the case mix to a maximum of 2% every six months. • Pharmacy Initiatives ($33 million): • Prior Authorization for Non-Medically Acceptable Indicators for prescription drugs ($20 million); • Reduce Inappropriate Prescribing and Align Point of Sale editing ($7 million); • Require Minimum Supplemental Rebates for Brand Drugs ($3 million); and • Eliminate e-Prescribing Incentive Payment ($3 million). 17

  18. Additional Federal/Other Revenues • Additional Federal/Other Revenues ($91 million): • OMIG Fraud and Abuse Integrity Initiative ($30 million); • Community First Choice Option ($28 million); • Spousal Support ($20 million); and • CHIPRA Performance Bonus Award ($13 million); 18

  19. Basic Health Plan • Basic Health Plan ($300 million in 2015-16): • BHP is an option for states under the ACA; it is funded by 95% of the value of the tax credits available to individuals who would have otherwise enrolled in the Marketplace. • BHP would be available to individuals under age 65 with income between 138-200% of FPL who are not eligible for Medicaid or CHIP and individuals with incomes below 138% of FPL who are ineligible for Medicaid due to immigration status. • Enrollment in BHP would begin April 2015; requires CMS approval. 19

  20. All Other Investments (Savings) 20

  21. Other Programs/Proposals in the Global Cap

  22. A/R Balance – January 2014 • A/R balances are projected to be reduced to $100 million on March 31, 2015. • The A/R reduction proposal: • Negotiates equitable repayment arrangements with providers owing significant liabilities. • Revises collection enforcement policies for providers below the standard recoupment percentage. 22

  23. 2% ATB Restoration • $120 million of the 2% ATB cut was partially restored in 2013-14: • MMC/FHP ($87 million). • Various FFS categories ($33 million). • The balance ($237 million) of the 2% ATB will be restored effective April 1, 2014. 23

  24. Wage Parity • Effective March 1, 2014, Home Care Worker Wage Parity requires compensation be: • “no less than the prevailing rate of total compensation as of 1/1/11 or the total compensation mandated by the living wage law, whichever is greater.” • DOH and DOL collaborated on developing the worker prevailing wage for managed long term care and fee-for-service providers ($20.95): • Rate accommodates wage parity for NYC ($14.09) and Westchester, Nassau and Suffolk counties ($10.93) plus additional costs such as taxes, worker’s compensation, overtime as well as 30% in administration costs. • The Global Cap set aside $350 million (gross) to accommodate this expense. • VAP funding ($20 million) is available to assist Licensed Home Care Service Agencies with consolidation and transition costs. 24

  25. Article VII Highlights

  26. Article VII Highlights • Extends Global Cap through March 2016. • Repeals 2% Across the Board payment reduction effective April 1, 2014. • Provides flexibility in restoring alternate savings measures. • Creates a Global Cap Dividend payment. 26

  27. MRT: Additional Information • MRT Website: http://www.health.ny.gov/health_care/medicaid/redesign/ • Sign up for email updates: http://www.health.ny.gov/health_care/medicaid/redesign/listserv.htm • ‘Like’ the MRT on Facebook: http://www.facebook.com/NewYorkMRT • Follow the MRT on Twitter: @NewYorkMRT 27