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121 State Street Albany, New York 12207-1693 Tel: 518-436-0751 Fax: 518-436-4751
TO: Memo Distribution List
FROM: Hinman Straub P.C.
RE: 2020-21 Final Health & Medicaid Budget Overview
DATE: April 2, 2020
NATURE OF THIS INFORMATION: This is general information you might find helpful or
informative.
DATE FOR RESPONSE OR IMPLEMENTATION: None – this is for your information.
HINMAN STRAUB CONTACT PEOPLE: Sean Doolan, Caron Crummey, Wendy Saunders,
Matthew Leonardo, David Previte, Deborah Kozemko, Stephanie Piel, Jonathan Gillerman, and
Michael Paulsen
THE FOLLOWING INFORMATION IS FOR YOUR FILING OR ELECTRONIC RECORDS:
Category: #7 Legislature (NYS) Suggested Key Word(s):
©2020 Hinman Straub P.C.
Hinman Straub P.C. Date: April 2, 2020 Page: 2
On April 2, 2020, Governor Andrew Cuomo and legislative leaders announced an agreement on
New York State’s Fiscal Year (SFY) 2021, covering 2020-21. The following is a summary of the
final budget agreement and a high-level review of the pertinent health care related items included
in the final budget agreement. All provisions are effective as of April 1, 2020, unless otherwise
noted below, provided that the Director of Budget has been granted the authority to delay the
effective date for up to 90 days following the conclusion of the declared State Disaster Emergency
for most health-related items. Additional analysis and memoranda will be forthcoming as
additional information becomes available.
Budget Overview
In January, the Governor proposed a $178 billion budget for Fiscal Year (“FY”) 2021, an increase
of 1.2% over FY 2020 projected spending. A key aspect of the budget was addressing New York’s
Medicaid spending, which was projected to exceed the Medicaid Global Cap by a $4.0 billion.
Instead of proposing specific cuts to the Medicaid program within the Executive Budget, the
Governor reconvened the Medicaid Redesign Team (MRT II) to identify cost-containment
measures to provide $2.5 billion in gap-closing savings in FY 21 and ensure Medicaid spending
in future years adheres to the indexed rate.
The MRT II held three public meetings and a number of stakeholder meetings to develop and
advance recommendations to the Executive and Legislature in order to achieve $2.5 billion in
Medicaid savings. The recommendations, which included actions impacting managed care plans,
hospitals, nursing homes, care management, and pharmacy, total $2.5 billion in FY21 and more
than $3 billion in FY22. A number of the recommendations advanced by the MRT II were included
in the final budget agreement which attained $2.201 billion in savings in FY 21 and $2.737 billion
in FY 22.
While the MRT II was reviewing the State’s Medicaid program, New York began facing an
unprecedent public health crisis as a result of the rapid spread of the Coronavirus (COVID-19).
This crisis has put a significant strain on state resources and finances, hospitals, and the overall
healthcare system. Within this context, the final budget was enacted with a number of safeguards
in place in order to address the uncertainty that lies ahead.
New York’s constitution requires a balanced budget each year, and the new state budget confronts
a massive deficit estimated to be as high as $15 billion. The new budget reduces revenues by an
estimated $10 billion, the first year-to-year cut since 2011. It authorizes the State to issue up to $8
billion in short term bonds to provide funds in case of reduced revenues during the year. The
budget also allows two state authorities to provide the State with a $3 billion line of credit in the
new fiscal year.
Most significantly, the appropriation legislation provides significant authority to the Director of
Budget (DOB) to adjust or reduce any general and/or state special revenue fund as necessary to
ensure that the General Fund is balanced on a cash accounting basis. Adjustments or reductions
are to be done uniformly, across the board, or by specific appropriations, as needed. The legislation
creates three time periods for which forecast estimates and revisions will be compared against
actual receipts and spending: April 1 to April 30; May 1 to June 30; and July 1 to December 31.
Hinman Straub P.C. Date: April 2, 2020 Page: 3
DOB must notify the legislature 10 days prior to any reduction or adjustment. The Legislature
may, by concurrent resolution, reject the proposed reduction or adjustment and present its own
plan, but the failure to do so within 10 days automatically implements DOB’s plan. In addition,
prior to expenditure of any funds received from the federal government in response to the COVID-
19 pandemic, DOB may require that the agency or public authority making such expenditures
submit an allocation plan to DOB for approval.
While the enacted budget generally reflects the anticipated spending and program funding as
outlined in the Executive Budget, the authority granted to DOB to adjust or reduce funding as
needed to ensure the General Fund remains balanced is expected to have a significant impact on
the funding of State programs, especially during the first two review periods.
General Health Highlights
Included in the final Budget are the following items:
Across the Board Cuts (“ATB”). The final budget extended the 1% ATB cut
implemented on all providers and plans effective 1/1/20. In addition, the final budget
anticipates an additional .5% ATB cut effective 4/1/20.
Healthcare Liability for COVID-19. The final budget limits the liability for healthcare
professionals, health care facilities, and organizations that provide treatment and services
related to the COVID-19 pandemic response during the duration of the COVID-19 state of
emergency. The professionals, facilities, and organizations would remain liable for harm
caused by willful or intentional criminal misconduct, gross negligence, reckless
misconduct, or intentional infliction of harm. This will apply to any health care services
that are impacted by the facility or professional’s decisions or activities in response to the
COVID-19 outbreak and in support of the state’s directives. The term "health care facility"
means a hospital, nursing home, or other facility licensed or authorized to provide health
care services for any individual under article twenty-eight of this chapter, article sixteen
and article thirty-one of the mental hygiene law or under a COVID-19 emergency rule.
Health care professionals encompass agents, volunteers, contractors, employees or
otherwise that is a licensed or certified physician, physician’s assistant, specialist assistant,
chiropractor, pharmacist, pharmacy technician, nurse, midwife, psychologist, social
worker, mental health practitioner, respiratory therapist, clinical lab technician, nursing
attendant, certified nurse aide, nursing student, EMT, home care worker, health care facility
administrator, supervisor, executive, board member, trustee or other person responsible for
directing or managing a facility, or anyone else providing health care within the scope of
authority permitted by a COVID-19 emergency rule.
HCRA Extension. The final budget extends the Health Care Reform Act (HCRA) and all
surcharges and assessments until March 31, 2023. The final budget eliminates the Area
Health Education Centers, Ambulatory Care Training, and Health Workforce Retraining
programs that are currently funded through HCRA.
Hinman Straub P.C. Date: April 2, 2020 Page: 4
Distressed Provider Assistance Program. The final budget modifies the Governor’s
proposal to shift local Medicaid costs to localities by creating the Distressed Provider
Assistance Program. This program establishes a new funding pool to assist financially
distressed hospitals and nursing homes. Under the program, counties are responsible for
contributing their respective share and fifty million dollars annually beginning April 15,
2020, while New York City is responsible for an amount of two hundred million annually
beginning in 2021.
Excess Medical Malpractice. The Legislature rejects the Executive’s proposal to require
doctors to pay 50% of the premiums for participation in the Excess Medical Malpractice
Insurance Program. The final budget extends the current excess medical malpractice
insurance program for one year through June 30, 2021 at a funding level of $105 million,
which is reduced from previous years by $22 million. The Executive maintains that, based
on recent trends, the $105 million is sufficient funding to support the physicians enrolled
in the Program for the policy year.
Prevailing Wage to be Paid on Certain Private Construction Projects. The Final
Budget includes prevailing wage requirement to be paid on construction projects that cost
more than $5 million, which are paid for with at least 30 percent public funds. Exemptions
include not-for-profit corporations with gross annual revenues less than $5 million and
certain affordable, subsidized and supportive housing projects. A public subsidy board
would be empowered to examine and make any necessary adjustments to thresholds
included in the bill, provide additional exemptions, and make determinations related to
applicability of this section to projects undertaken with benefits stemming from certain
programs. The new requirements will take effective on January 1, 2022 and apply to
contracts for construction or applications for building permits applied for on or after that
date. It expressly excludes appropriations or re-appropriations of public funds made prior
to January 1, 2022.
Electronic Verification System (“EVV”). The final budget includes $202 million for
contractual services to operate an electronic Medicaid eligibility verification system,
Medicaid override application system, and Medicaid management information system. It
is our understanding that this amount represents a one-year appropriation for this service.
All Payers Database. The final budget includes $10 million in funding to support the
establishment and operation of the All Payers Database (APD).
SHIN-NY. The final budget includes an appropriation of $30 million for the continued
funding of the SHIN-NY. The funding is directed to the New York eHealth Collaborative,
which will administer the funding for the SHIN-NY and Qualified Entities – formerly
known as Regional Health Information Organizations (RHIOs).
Health Benefit Exchange Funding. The final budget allocates approximately $90 million
in new funds in FY 21 to fund the New York Health Benefit Exchange (New York State
of Health).
Hinman Straub P.C. Date: April 2, 2020 Page: 5
Statute of Limitations for Medical Debt. The final budget accepts the Executive’s
proposal to reduce time frame to bring an action to collect medical debt from six (6) years
to three (3) years.
Disclosure Requirements for Charitable Nonprofit Entities. The final budget modifies
the Executive’s proposal to require any registered charitable organization that is required
to file a funding disclosure report or financial disclosure report to file such annual report
with the Department of Law. It also requires covered entities to file a completed IRS Form
990, Schedule B with the Department of State, regardless of whether such form is required
to be submitted to the IRS.
Healthcare Capital Funding. The final budget includes a re-appropriation of the
remaining funds available for Statewide Transformation III. The RFA for this funding
opportunity has not been released.
Extension of SPARCS. The Executive proposes to extend the authorization to operate the
statewide planning and research cooperative system (SPARCS) for three (3) years through
2023.
Medical Indemnity Fund. The final budget accepts the Executive’s proposal to extend
this Program through December 31, 2021.
Gestational Surrogacy. The final budget includes an agreement on the legalization of
gestational surrogacy.
Rejected from the final Budget are the following items:
Legalization of Adult-Use Cannabis. The final budget does not include an agreement on
the legalization of adult-use cannabis.
Market-Rate Interest on Court Judgments. The final budget rejects the Executive’s
proposal to amend the statutory interest rate on judgments (currently 9%) to the weekly
average one-year constant maturity treasury yield, which is the same rate utilized by the
Federal court system.
Certificate of Need (CON) Fees. The final budget rejects the Executive’s proposal to
impose a surcharge equal to 3% of the total capital value of hospital (includes hospitals,
nursing homes, D&TCs) construction application.
Employer-Related Obligations Paid Sick Leave. The final budget includes the Executive’s proposal to require all
employers to provide sick leave to their employees each calendar year as follows:
o 0-4 employees must provide up to 40 hours of unpaid sick leave;
o 0-4 employees with a net income greater than $1 million must provide up to 40
hours of paid sick leave;
o 5-99 employees must provide up to 40 hours of paid sick leave; and
o 100 or more employees must provide up to 56 hours of paid sick leave.
Hinman Straub P.C. Date: April 2, 2020 Page: 6
The amount of sick leave earned is based upon hours worked, with the rate of accrual being
no less than one (1) hour of sick leave per every thirty (30) hours worked. An employer
must allow employees to use accrued leave, after January 1, 2021, for the following
purposes:
o For a mental or physical illness, injury, or health condition of such employee or
such employee's family member, regardless of whether such illness, injury, or
health condition has been diagnosed or requires medical care at the time that such
employee requests such leave;
o For the diagnosis, care, or treatment of a mental or physical illness, injury or health
condition of, or need for medical diagnosis of, or preventive care for, such
employee or such employee's family member; or
o For an absence from work when the employee or employee's family member has
been the victim of domestic violence (as is similar to the Human Rights Law, time
off for such reasons would not extend to the perpetrator of domestic violence).
Employers are obligated to allow employees to roll their unused sick leave to the next year
up to the max hours that can be earned.
The law does not require employers to pay employees for unused sick leave nor does it
preclude employers from having policies that provide time that is more robust than the law.
Employers can also front load the time to their employees at the beginning of the year to
eliminate the obligation to track how it is earned. Nonetheless, employers must maintain
records of sick leave earned and used and provide same to employees upon request within
three (3) business days.
Hospitals
Included in the final Budget are the following items:
Hospital Capital Reimbursement. The final budget reduces hospital capital
reimbursement by 5% relative to the rate that is in effect on the date this legislation is
effective. Reconciled payments for capital add-ons are additionally reduced by 10% and
reconciliation recoupment amounts are increased by 10%.
Enhanced Safety Net Hospital Program. The final budget repeals the Enhanced Safety
Net Hospital Program and the current criteria for an Enhanced Safety Net Hospital. The
budget re-establishes the Enhanced Safety Net Hospital Program as part of the Indigent
Care Pool (ICP) and establishes new criteria for an Enhanced Safety Net Hospital.
Enhanced safety net hospitals are defined as critical access hospitals, sole community
hospitals, public hospitals operated by counties, municipalities, public benefit corporations
or SUNY, and hospitals that have the following payer mix: not less than fifty percent
Medicaid or uninsured, not less than forty percent Medicaid inpatient discharges, not less
than twenty-five percent overall Medicaid discharges, not less than three percent
uninsured, and provides care to uninsured in ER, hospital based and community based
clinics.
Hinman Straub P.C. Date: April 2, 2020 Page: 7
Indigent Care Pool. The final budget amends the indigent care pool distribution
methodology and extends the pool to 2023. Reduces total pool from $994M to $969M and
includes an additional reduction in ICP distributions by $150M in the aggregate, annually,
from 2020 through 2022, but holds enhanced safety net hospitals harmless from this
reduction if they are not major public hospitals. Requires commissioner to promulgate a
methodology for such reduction. Removes the “transition collar” from pool. The transition
collar had limited 2019 reductions in ICP funding to hospitals to no greater than 17.5% of
2013 payments and was scheduled to increase to no greater than 20% in 2020. Instead of
the collar, hospitals, other than major public hospitals, that experience a reduction in ICP
payments will be eligible for $64.6M in funding under a methodology established pursuant
to regulation and proportional to the reductions experienced by such hospital.
Hospital Funding Pools. The final budget repeals the Hospital Quality Pool and enhanced
reimbursement for Sole Community Hospitals ($12 million).
H+H Rate Adjustments. The final budget authorizes rate adjustments for H+H hospitals
pursuant to a memorandum of understanding executed by DOH and H+H. The purpose of
these sections is to convert upper payment limit payments (UPL) made to H+H into rates.
The UPL conversion to a rate adjustment applies to FFS and Managed Care, inpatient and
outpatient demonstrations. In FFS NYC will advance the non-federal share of its estimated
UPL payment to DOH, which will then be utilized to draw down federal financial
participation in the form of a rate adjustment. The total amount of the rate adjustment will
be reconciled with actual utilization of services and then applied against the UPL
demonstration. Depending on the room calculated under the UPL demonstration, NYC may
be required to increase or decrease its non-federal contribution in a subsequent
reconciliation. In managed care, NYC will similarly advance the non-federal share of its
estimated member months that will receive a premium increase, again subject to the UPL
demonstration and subsequent reconciliation. If the rate adjustments pierce the Global Cap
the State may cancel or reduce such payments. Likewise, if such payments are disallowed
by CMS, H+H will hold the State harmless from any losses.
Medical Services for Victims of Sexual Assault. The final budget modifies the
reimbursement by the Office of Victim Services to a tiered structure based on the level of
services provided and age of the victim. It modifies the current required distribution of
post exposure prophylaxis to require hospitals to provide a seven-day starter pack for those
over the age of 18, and a full regimen for victims under 18. Hospitals are required to
coordinate the provision of transportation with a rape crisis or victim assistance
organization providing assistance in the hospital’s geographic area upon the conclusion of
medical services. Lastly, it requires DOH to produce an annual report on the cost of
reimbursement for medical examinations and treatment by the State on an annual basis.
Extend DSRIP Regulatory Waiver Authority. The final budget modifies the
Executive’s proposal to extend the authority of the commissioners of DOH, OMH,
OPWDD, and OASAS to waive regulations as necessary to allow the efficient scaling and
replication of promising DSRIP practices, as determined by the authorizing commissioner,
through April 1, 2021.
Hinman Straub P.C. Date: April 2, 2020 Page: 8
Rejected from the final Budget are the following items:
Hospital Resident Compliance Audits. The final budget rejects the Executive’s proposal
to repeal existing law requiring DOH to audit hospital resident hours annually and require
that hospitals certify that they are in compliance with applicable working hour and working
condition requirements annually.
Antimicrobial Resistance Prevention. The final budget rejects the Executive’s proposal
to establish a new requirement for all hospitals and nursing homes to establish
antimicrobial stewardship programs.
Sexual Assault Forensic Examiner (SAFE) Program Expansion. The final budget
rejects the Executive’s proposal require all hospitals with Emergency Departments to
establish SAFE programs. Hospitals without Emergency Departments would be required
to transport victims of sexual assault to hospital with SAFE programs.
Nursing Homes
Included in the final Budget are the following items:
Nursing Home Capital Reimbursement. The final budget includes the recommendation
of the MRT to reduce the capital cost component of nursing home Medicaid rates by 5%
for facilities that elect to refinance their mortgage loans.
Residual Equity. The final budget includes the recommendation of the MRT to eliminate
funding associated with residual equity reimbursement in the capital cost component of
Medicaid rates to nursing homes. This action and the reduction in capital reimbursement
is projected to reduce funding by $30 million annually (state-share).
Nursing Home Upper Payment Limit. The final budget accepts the Executive’s proposal
to extend the nursing home upper payment limit and intergovernmental transfers for public
residential health care facilities through March 31, 2023.
Health Care Facility Refinancing Shared Savings Program. The final budget accepts
the Executive’s proposal to extend the authority of the Commissioner to modify health care
facility real property costs to effectuate a shared savings program where facilities would
share a minimum of fifty percent of the savings from electing to refinance their mortgage
loans, through March 31, 2025.
Medicare Maximization Program. The final budget accepts the Executive’s proposal to
extend the Nursing Home Medicare Maximization program through February 1, 2023.
Health Occupation Development and Workplace Demonstration Program. The final
budget accepts the Executive’s proposal to repeal this program with the elimination of the
Health Workforce Retraining Initiative (HWRI) under HCRA.
Adult Day Health Care Transportation. The final budget allows ADHC providers to
elect to use the services of the State’s transportation manager, but does not require use.
Hinman Straub P.C. Date: April 2, 2020 Page: 9
Home Based Primary Care for the Elderly Demonstration Project Extension. The
final budget extends the Project for an additional five (5) years through 2026. The
demonstration program allows nursing homes that also provide a variety of community-
based care to provide home based physician, nurse practitioner and physician assistant
services to elderly patients in their homes.
Vital Access Provider (VAP) Funding. The final budget includes $66 million in
continuing funding to support critical health care providers through the State’s Vital Access
Provider (VAP) program.
Miscellaneous Appropriations. The final budget includes the following appropriations
impacting the Nursing Home sector:
o Continuing Care Retirement Community Account = $121,000 (increase in
$21,000)
o Nursing Home Receivership Account = $2,000,000 (re.)
o Quality of Care Improvement Account = $1,000,000
o Program for background checks on patient contact personnel in Long-term care
facilities = $3,000,000
Rejected from the final Budget are the following items:
Antimicrobial Resistance Prevention. The final budget rejects the Executive’s proposal
to establish a new requirement for all hospitals and nursing homes to establish
antimicrobial stewardship programs.
Spousal Refusal. The Legislature rejects the recommendation of the MRT and Executive
to eliminate ability of spouses living together in the community and parents living with
their child to refuse to make their income and resources available during the determination
of an applicant’s eligibility for Medicaid (known as Spousal Refusal).
Adult Home/Assisted Living
Included in the final budget are the following items:
EQUAL. The final budget amends EQUAL by changing the allocation methodology and
grant purposes. In addition to the financial status and size of the facility, as well as resident
need, the commissioner’s allocation methodology must now also consider the population
of residents who receive SSI, Medicaid or safety net assistance. Grant purposes are to fund
either projects that include clothing allowances, resident training for independent living
skills, improve food quality, outdoor leisure projects and culturally recreational and other
leisure events, as well as capital improvements that enhance the physical environment of
the facility. Expenditure plans to DOH for EQUAL funding must now detail how the funds
will be used to improve resident quality of life consistent with the new grant purposes.
Supplemental Social Security (SSI). The final budget accepts the traditional statutory
authority to pass-through any Federal COLA that becomes effective on or after January 1,
2021. The provision is effective as of July 1, 2020.
Hinman Straub P.C. Date: April 2, 2020 Page: 10
Respite Support. The final budget extends for three years, the authority of adult homes,
residences for adults, and enriched housing programs to provide respite support to non-
residents for up to 120 days.
ACF Criminal History Record Check. The final budget maintains funding at $1.3 million
for the administration of the criminal history record check system for staff at ACFs.
Miscellaneous Appropriations.
o Adult Homes Advocacy Program: $170,000
o Adult Home Resident Council Support Project: $60,000
o Assisted Living Residence Quality Oversight Account $2,110,000
o Adult Home Quality Enhancement Account: $500,000
o Enriched Housing Operating Assistance: $380,000
o Enhancing abilities and life experience (EnAbLE) appears to have been
discontinued.
Home Health Care
Included in the final Budget are the following items:
LHCSA Authorization Requirement. The final budget includes the recommendation of
the MRT to require all LHCSAs to be authorized by the DOH to provide services under
Medicaid. The Department is required to contract with a sufficient number of LHCSAs to
ensure Medicaid enrollees have access to care and services. The Department is required to
publicly post for at least 30 days the method for LHCSAs to submit a proposal for selection
and the eligibility criteria, which is limited to licensed LHCSAs.
Home Care Provider ID. The final budget adds a provision that requires home care
workers and personal assistants providing services under CDPAP to obtain an individual
“unique identifier” from the State by a date to be determined by the Commissioner in
consultation with OMIG.
Medicare Maximization Program. The final budget accepts the Executive’s proposal to
extend the Home Care Medicare Maximization program through February 1, 2023.
Home Care Workforce and Recruitment. This program is extended through March 31,
2023.
Home Health Aide Registry: $1,800,000
Personal Care Workforce Recruitment and Retention. This Program is extended
through March 31, 2023.
Wage Parity. The final budget includes the recommendation of the MRT to require
LHCSAs and FIs to provide annual written certification of compliance with wage parity
requirements and establishes criminal penalties and sanctions for false certifications of
compliance. All entities will be required to certify that no portion of the funds spent to
Hinman Straub P.C. Date: April 2, 2020 Page: 11
satisfy the wage or benefit portion shall be returned as a refund, dividend, or profit.
LHCSAs and FIs will be required to provide an annual statement of wage parity hours and
expenses accompanied by an independently-audited financial statement verifying such
expenses.
The amendments replace the requirement that MCOs, CHHAs, and/or LTHHCPs that
contract with LHCSAs and FIs obtain a written certification on a quarterly basis from the
LHCSA or FI which attests to its Wage Parity compliance, and replaces this requirement
with an annual certification. MCOs, CHHAs, and/or LTHHCPs are required to review the
annual compliance statement and make a written referral to the Department of Labor for
any reasonably suspected failures of LHCSAs or FIs to conform with Wage Parity
requirements.
The amendment removes FIs from being exempt from liability for recoupment of payments
or a penalty for services provided in which the LHCSA or FI failed to comply with Wage
Parity requirements. MCOs, CHHAs, and LTHHCPs continue to be exempt from liability
provided they conduct the monitoring and reporting now required.
The amendment also requires notification to home care aides of the benefit portion of the
minimum rate of their total compensation.
These provisions are effective as of October 1, 2020.
Primary Care, Clinics, and other Providers Included in the final budget are the following items:
Electronic Prescriptions. The final budget accepts the Executive’s proposal to extend the
“small provider” exception from the requirement for electronic prescriptions for an
additional three (3) years through June 1, 2023. The exemption applies to prescribers that
certify to DOH that they prescribe 25 or less prescriptions annually.
Physician Profile Website. The final budget accepts the Executive’s proposal to extend
the provision allowing the use of funds of the Office of Professional Medical Conduct for
use for the Physician Profile Website through 2023.
Clinic Bad Debt and Charity Care Payments. The final budget extends the authorization
for clinic bad debt and charity care payments through March 31, 2023 at $7.5 million
annually.
Clinic Safety Net Funding. The final budget includes level funding of $54.4 million for
the Diagnostic and Treatment Centers (D&TC) Safety Net Program. This funding helps
cover the cost of bad debt and charity care provided by federally qualified health centers
(FQHCs) and other D&TCs.
Hinman Straub P.C. Date: April 2, 2020 Page: 12
Health Homes: The Final Budget includes annual funding of $279.35 million for the
Health Home program. This reflects an annual decrease of $48.7 million from last year,
consistent with the MRT proposals related to Health Homes.
Patient Centered Medical Homes: The Final Budget reflects level annual funding of $110
million for Patient Centered Medical Homes (PCMH).
Rejected from the final Budget are the following items:
Physician Profile Enhancements. The final budget rejects the Executive’s proposal to
require additional information to be included on the online physician profiles, which would
have included hours of operation, availability of assistance technology, and availability to
take new patients as mandatory elements of a physician’s profile.
Physician Integrity and Accountability. The final budget rejects the Executive’s
proposal to amend the Education Law to eliminate indefinite licensure of physicians and
requires fingerprint-based criminal history background checks prior to licensure.
Commercial Health Insurance
Included in the final Budget are the following items:
Independent Dispute Resolution for Emergency Services. The final budget accepts the
Executive’s proposal to permit members to assign claims for emergency services, including
inpatient services following an emergency room visit, to a physician or hospital and the
Plan would be required to pay the physician or hospital for the services directly. The
Budget also prohibits physicians and hospitals from billing patients who assigned their
benefits, other than collecting appropriate cost sharing.
However, the Legislature rejected the Governor’s proposal to repeal the exemption safety
net hospitals from the dispute resolution process for emergency services.
Hospital Administrative Denials. The final Budget made a number of revisions to the
Governor’s proposal regarding hospital administrative denials. The Final Budget amends
existing law which prohibits denials of medically necessary inpatient services following an
emergency admission based solely on a hospital’s failure to notify a Plan of the services
by extending this prohibition to all types of administrative denials and to emergency
services, observation stays, and all inpatient admissions. Exceptions to the prohibition
include denials based on: (1) fraud or intentional misconduct resulting in misrepresentation
of patient diagnosis or the services provided or abusive billing; (2) when required by a state
or federal government program (e.g. Medicaid, if required by the State) or for coverage
provided by the state or a local government (e.g. NYSHIP or coverage for municipal
employees); (3) non-covered benefits; (4) services for which preauthorization was denied
prior to the delivery of services; (5) untimely claim submissions; and (6) out-of- network
providers. Further, Plans may deny claims on this basis that a hospital failed to seek prior
authorization if a hospital has “repeatedly and systemically” over the previous 12-month
period failed to seek preauthorization for services for which preauthorization was required.
Hinman Straub P.C. Date: April 2, 2020 Page: 13
The Final Budget also changes the maximum amount of the penalty to which Plans and
hospitals may contractually agree. Plans may now impose a penalty of no more than 7 ½
per cent of the amount otherwise due for failing to comply with a Plan’s administrative
requirements, rather than the current penalty of no more than the lesser of $2,000 or 12%.
Prompt Pay. The final Budget modified the Governor’s proposal to require Plans to notify
members or providers through the internet or other electronic means for claims submitted
electronically (in addition to in writing which is currently required), that the claim is denied
or additional information is necessary to pay the claim, and to include the specific type of
plan or product in which the member is enrolled.
The final Budget also adds a definition of the plans and products that are subject to the
prompt pay law. Specifically, it includes Medicaid managed care, Child Health Plus,
Essential Plan, qualified health plans purchased on the New York State of Health, and any
other comprehensive coverage subject to Articles 32, 43, and 47 of the Insurance Law or
Article 44 of the Public Health Law.
The final Budget deleted the requirement that interest would be due back to the original
date in which additional information was requested.
In the event that additional information is requested by the plan after submission of the
claim, Plans are required to make any additional payments they determine are due within
15 days of the determination. The final Budget deleted the proposal to require the payment
of interest on such payment computed from the date the claim was submitted.
Coding Disputes. The final Budget revised the Governor’s proposal to require Plans to
review disputes regarding coding based on national coding guidelines accepted by CMS or
the AMA, including ICD-10 guidelines, with the addition of language clarifying that such
codes must be used to the extent they exist. The language also clarifies that the use of the
national coding guidelines does not apply when the plan undertakes fraud, waste and abuse
efforts; any subsequent payment adjustments, however, must be made consistent with the
national guidelines. Current law also permits the parties to agree to an alternative process
for the reconciliation of coding disputes.
Plans are required to pay interest on the increased amount when they increase payment on
a claim after reviewing information provided by a hospital to substantiate the coding.
Interest is computed starting from 30 days after receipt of the initial claim, if electronic,
and 45 days after receipt of an initial paper claim.
Health Care Claims Reports. The final Budget included the proposal to require Plans to
submit quarterly and annual health care claims reports with respect to comprehensive
products to DFS, within 45 days of the end of a quarter or year. The reports would include
the number and dollar value of all claims, broken down by those received, paid, pended,
and denied. They would be reported in the aggregate, as well as broken down by type of
provider. The reports would be posted on the DFS website. The final Budget added a
Hinman Straub P.C. Date: April 2, 2020 Page: 14
provision that requires reports to address any patterns or suspected areas of revenue
maximization that may have contributed to the number of denials.
Health Care Administrative Simplification Workgroup. The final budget accepts the
Executive’s proposal to convene a health care administrative simplification workgroup
comprised of insurers, hospitals, physicians, and consumers. The workgroup would study
and evaluate mechanisms to reduce administrative costs and complexities through
standardization, simplification, and technology. The workgroup would examine claims
submission and payment, claims attachments, preauthorization practices, provider
credentialing and insurance eligibility verification. The workgroup’s report and
recommendations must be submitted within 18 months of the effective date of the law.
Utilization Review for Inpatient Rehabilitation Services. The final Budget modified the
Governor’s proposal to require preauthorization determinations for inpatient rehabilitation
services provided by a skilled nursing facility or hospital to be conducted within one
business day by limiting the applicability to only when the inpatient rehabilitation service
follows an inpatient stay. The final Budget also accepted the reduction in the timeframe to
file a utilization review appeal to 30 days, down from 60, and to require Plans to make any
additional payments on an overturned denial within prompt pay timeframes.
Provisional Credentialing. The final Budget modified the Governor’s proposal regarding
provisional credentialing. It requires Plans to treat as “provisionally credentialed” newly-
licensed physicians; physicians who newly relocate to New York; physicians who receive
a new tax ID number based on a corporate change when the physician previously had a
contract with the Plan immediately prior to the event that changed his or her corporate
relationship. Such provisional credentialing applies when the physician becomes employed
by a general hospital, diagnostic and treatment center, or OMH-licensed facility which has
a contract with the Plan and whose other employed physicians participate in the Plan’s
network. Such physicians are considered participating in a Plan’s network upon
submission of a completed credentialing application and the Plan being notified in writing
that the physician has been granted hospital privileges. A provisionally credentialed
physician would not be permitted to act as a member’s primary care physician. Plans would
not be required to pay a hospital, diagnostic and treatment facility, or OMH facility for
services provided by a provisionally credentialed physician until the physician is fully
credentialed and would only be required to pay for services provided by physician for up
to 60 after submission of the completed application.
The Legislature rejected the Governor’s proposal to require Plans to pay the out-of-
network rate when a physician’s application is denied. Rather, if a physician’s application
is denied, no payments are required.
Mental Health and Substance Use Disorder Parity Compliance. The final budget
modifies the Executive’s proposal to require penalties imposed on Plans for violation of
state mental health parity requirements to be deposited into a newly established “behavioral
health parity compliance fund”. The final budget removes the proposal to require DOH to
establish mental health and substance use disorder parity compliance program
Hinman Straub P.C. Date: April 2, 2020 Page: 15
requirements through regulation. Under the final language, all penalties collected for
violations related to mental health and substance use disorder parity compliance are to be
deposited in the Fund. As a result, the Department will not be required to establish
requirements for compliance.
COVID-19 Claims. The final budget precludes plans from retrospectively denying
emergency department and inpatient hospital services rendered by general hospital to treat
COVID-19 during the declared state of emergency.
Insulin Copay Limit. The final budget includes a limit on the out-of-pocket expense for
insulin to $100 for every 30-day supply of insulin, regardless of the type or amount of
insulin needed. This provision applies to coverage issued or renewed on or after January
1, 2021.
Essential Plan. New York will continue to support the Essential Plan. The final budget
provides $5.2 billion for the Essential Plan Program.
Gestational Surrogacy. The final budget provides for the legalization of gestational
surrogacy. With respect to health insurance, it requires the intended parents to pay for a
comprehensive health insurance policy for the surrogate that extends throughout the
duration of the expected pregnancy and for twelve months after the birth of the child, a
stillbirth, a miscarriage resulting in termination of pregnancy, or termination of the
pregnancy. It also requires the intended parents to pay for or reimburse the person acting
as surrogate for all co-payments, deductibles and any other out-of-pocket medical costs
associated with the pregnancy, childbirth, or postnatal care that accrue through twelve
months after the birth of the child, a stillbirth, a miscarriage, or the termination of the
pregnancy. A surrogate who is not receiving compensation may waive the right to have the
intended parents make such payments or reimbursements. The legislation also creates
“Donor medical Expense Insurance” which provides insurance to indemnify an intended
parent for medical and hospital expenses which they are obligated to pay when the
expenses result from medical complications associated with the donation of gametes.
Health Insurer Notice Procedures. The final Budget includes a requirement that health
insurers and utilization review agents have procedures for obtaining an insureds preference
for receiving notifications. To the extent practicable, written notice to an insureds provider
shall be transmitted electronically.
Cap on Long-Term Care Insurance Credit. The final budget accepts the Executive’s
proposal to limit the credit to up to $1,500 (currently 20% with no maximum credit amount)
and to taxpayers with incomes under $250,000.
Stop Loss Coverage for Small Groups and Municipal Consortiums. The final budget
extends the provisions authorizing the continued ability of small groups and municipal
corporations to purchase stop loss coverage to December 28, 2022.
Hinman Straub P.C. Date: April 2, 2020 Page: 16
Third Party Health Insurance Coverage for Medicaid Services. The final budget
includes a recommendation of the MRT to prohibit denials by third-party health insurance
(TPHI) carriers of Medicaid claims solely due to a lack of prior authorization. Liable
TPHI carriers are required to respond to a request for payment within 60 days after the
receipt of a claim for payment for health care services provided to a Medicaid enrollee who
is covered by TPHI and is prohibited from charging a fee to process or adjudicate a claim.
Property/Casualty Filing Exemption. The final budget extends for 3 years the exemption
from certain rate and policy form filing requirements for a domestic property/casualty
insurance company that maintains at least twice the minimum surplus to policyholders
required or an insurer licensed pursuant to Article 61 of the Insurance Law as a reciprocal
insurer that maintains at least the minimum surplus to policyholders, provided that the
insurer has total direct premiums comprised of at least 90% medical malpractice insurance,
assumes reinsurance premiums in an amount that is less than 5% of total direct premiums
written, and writes 90% of its total direct premiums in New York.
Health Insurance Entertainment Workers Continuation Assistance Demonstration
Program. The final budget adds language authorizing the extension this program, set to
expire July 1, 2020, for one additional year, until July 1, 2021.
Health Workforce Retraining Program. This Program, established under HCRA, is
repealed. This Program was established to make grants to eligible organizations to support
the training and retraining of health care employees to address changes in the health
workforce.
Rejected from the final Budget are the following items:
DFS Authority to Regulate Unfair and Abusive Acts and Increases Fines. The final
budget rejects the Governor’s proposal to expand the jurisdiction of DFS and increase the
fines and penalties that DFS may impose on entities regulated by DFS. The proposal would
have increased the civil penalty that DFS may impose for fraud, misrepresentation, unfair,
deceptive or abusive acts, and increased the penalty for violations under the Insurance Law
from $1,000 to $10,000 for each offense.
Pay & Pursue. The final Budget did not include any of the Governor’s proposal relating
to paying all medical necessity claims and then retrospectively negotiating or reconciling
the claims through a technical committee process.
Early Intervention. The final budget rejects the Executive’s proposal to implement a “pay
and pursue” model for early intervention (EI), which would have required insurers to pay
for early intervention services by in-network providers and pursue disputes thereafter via
appeal.
Department of Financial Services (“DFS”) Funding
The DFS is funded entirely by assessments on insurers and banks. The final budget accepted the
Governor’s proposed funding for SFY 2021, an increase of $1.325 million from 2019-20 funding
to, $439,155,963 with $83,715,000 earmarked for the Administration Program; $88,183,000
earmarked for the Banking Program, and $267,257,963 earmarked for the Insurance Program. As
Hinman Straub P.C. Date: April 2, 2020 Page: 17
in prior years, the legislature included an additional $75,000 in funding for the Pilot Program for
the Entertainment Industry Employees. While sub-appropriations from DFS remained mostly
consistent as prior years, the sub-appropriation to the Department of State for expenses incurred
in the enforcement, development and maintenance of the state building code increased continues
to be increased by $2 million, and the sub-appropriation for services and expenses related to the
Healthy New York Program decreased by $2 million from prior years. The Healthy NY decreased
funding may result in a lesser plan subsidy for the Healthy NY stop loss program.
State Employee Health Insurance
Rejected from the final Budget are the following items:
Medicare Part B Reimbursement Cap. The Governor proposed to standardize Medicare
Part B reimbursement for all retirees at $144.60 and cap state reimbursement at that level
to eligible retirees and their dependents effective January 1, 2020.
Income Related Medicare Adjustment Amounts (IRMAA) Reimbursement. The
Governor proposed to amend the Civil Service Law to cease reimbursement of additional
IRMMA premiums paid by higher-income state retirees retroactive to January 1, 2020.
Sliding Scale Reimbursement for Health Care Costs. The Governor included a proposal
that would require new civilian, non-disability State employees who begin their
employment on or after October 1, 2020 and subsequently retire with less than 30 years of
service would receive health insurance coverage benefits calculated on a graduated scale
based on years of service.
Medicaid
Included in the final Budget are the following items:
Medicaid Global Cap. The final budget includes a recommendation by the MRT to amend
the Global Cap by substituting the concept of a savings allocation plan with a savings
allocation adjustment. Previously, if the Cap was not balanced, the Commissioner was
required to develop a savings allocation plan that would detail the programs and services
that would be cut to bring the Cap back into balance. These amendments replace the savings
allocation plan with a savings allocation adjustment. The adjustment applies across the
board, unless projections demonstrate a specific category of service is causing the growth
in expenditures that pierces the Cap. The Commissioner is required to notify impacted
providers at least 30 days prior to implementation and must comply with State Plan
Amendment notice requirements for Medicaid reimbursement changes. If the
Commissioner develops a plan to avoid the adjustment, the Commissioner, subject to the
approval of DOB, may institute such plan in place of an adjustment. Additionally,
adjustments to plan premiums and rates of payment must be actuarial sound.
Medicaid Program Funding. The final budget increases state share of Medicaid funding
by 3%, or $500 million, growing from $19.4 billion to $20 billion (state share).
Eligibility for Personal Care Services and CDPAP. The final budget modifies a
recommendation by the MRT for eligibility for personal care services to require an
Hinman Straub P.C. Date: April 2, 2020 Page: 18
individual to be assessed: (1) as needing at least limited assistance with physical
maneuvering with more than two activities of daily living (ADLs); (2) diagnosed with
dementia or Alzheimer’s and needing at least supervision with more than one ADL. This
requirement will be applicable in FFS, mainstream managed care, and MLTC. The change
in eligibility is prospective and does not apply to individuals who received initial
authorization prior to October 1, 2020.
Medicaid Monetary Penalties. The final budget authorizes OMIG, in consultation with
DOH, to apply monetary penalties to providers, MCOs and MLTCs for: (1) the failure to
grant timely access to facilities and records, upon reasonable notice, for the purpose of
audits, investigations, or reviews; (2) knew or should have known that an overpayment has
been identified and it is not reported; (3) arranges or contracts with any individual or entity
that is known or should be known to be suspended or excluded from Medicaid. The final
budget removes language limiting the amount of an overpayment that may be recovered to
the amount paid for such claim. It also removes the limitation on monetary penalties
currently in effect when less than 25% of the claims subject to an audit result in an
overpayment.
Medicaid Compliance Program. The final budget requires providers, MCOs and MLTCs
to adopt and implement an effective compliance program that includes measures to prevent,
detect, and correct non-compliance with Medicaid requirements and to prevent, detect and
correct fraud, waste and abuse. OMIG is authorized to impose a penalty of $5,000 per
month for the failure to adopt and implement a compliance program that meets statutory
requirements ($10,000 per month if in second year of non-compliance).
Medicaid Integrity and Efficiency Initiative. The final budget extends for two years, the
authority of the department of health to establish a statewide Medicaid integrity and
efficiency initiative for audit recoveries.
Coverage for Speech, Occupational and Physical Therapy. The final budget amends
the fee for service Medicaid benefit to remove visit limitations for the coverage of speech,
occupation and physical therapy. This provision is effective as of October 1, 2020.
DOH Contracting Authority. The final budget authorizes DOH to amend or extend the
terms of a contract awarded for Enrollment Broker and Conflict-Free Evaluation Services
under the Medicaid program for a period of six years, through 2023, without a competitive
bid, upon a determination that the existing contractor is qualified to continue to provide
such services.
Private Duty Nursing. The final budget authorizes the Commissioner to increase fees for
private duty nursing services provided under Medicaid to medically fragile children by fee
for service private duty nursing service providers. The Commissioner of DOH is also
authorized to develop a directory of qualified fee for service private duty nursing providers.
Hinman Straub P.C. Date: April 2, 2020 Page: 19
Look-Back Period for HCBS. The final budget includes a modified recommendation of
the MRT to apply a 30-month look-back period to home and community based long-term
care services (home health care, private duty nursing, personal care, assisted living).
Community Spouse Resource Amount. The final budget includes a recommendation of
the MRT to apply transfer of asset rules currently applicable to nursing home services to
community based long-term care services (home health care, private duty nursing, personal
care, assisted living).
Medicaid Rates for Taxis/Livery. The final budget reduces rates of payment to
taxis/livery by 7.5% for periods between April 1, 2020 and November 30, 2020 and an
additional 7.5% from rates on and after December 1, 2020.
Transportation Provider Cost Reports. The final budget authorizes DOH to require
transportation providers to report costs of providing transportation services to Medicaid
beneficiaries.
Ground Emergency Medical Transportation Services. The final budget authorizes
DOH to establish a program for the federal financial participation in reimbursement for
ground emergency medical transportation services provided to Medicaid beneficiaries and
establish a methodology for supplemental reimbursement.
Transportation Broker and Carve Out. The final budget authorizes DOH, for periods
on and after April 1, 2021, to contract with a transportation broker for non-emergency
medical transportation on a regional or statewide basis under the Medicaid program. The
broker will also assume management of transportation services provided by MLTC plans,
except for PACE and FIDA programs. Adult day health providers are not required to enroll
with the broker.
Medicaid Managed Care (MMC), Managed Long Term Care (MLTC), Child
Health Plus (CHP), and Essential Plan
Included in the final Budget are the following items:
Quality Pool. The final Budget includes savings from a reduction in the Medicaid
Managed Care (“MMC”) and MLTC quality pools. For MMC, the quality pool payments
are reduced by 50% effective 10/1/19 ($60m in savings). For MLTC, the quality pool
payments are reduced by 25%, effective 4/1/20 ($17.25m in savings) (source: scorecard;
to be confirmed).
Rate Range Reductions. The final Budget includes savings from a reduction in the
Medicaid Managed Care (“MMC”) and MLTC rates to the lowest level of the actuarial
soundness rate range. This action, first implemented in the 1/1/20 rate will be continued in
FY 21. Provided, however, according to DOH, the rate range reduction may limit the ATB
rate cuts in that the rate will not be reduced below the lowest level of the actuarial
soundness rate range.
Hinman Straub P.C. Date: April 2, 2020 Page: 20
DSRIP Equity Pool. Consistent with the MRT recommendations, the final budget
included savings from the elimination of the DSRIP equity pools (source: scorecard)
Enhanced Safety Net Program. Consistent with the MRT recommendations, the final
budget included savings from the elimination of this Program.
VBP Stimulus. Consistent with the MRT recommendations, the final budget included
savings from the elimination of this funding.
Penalties for Misstated Cost Reports. The final budget authorizes OMIG to impose a
penalty on managed care organizations (MCOs) and MLTCs whose filed cost report
contains a misstatement of fact, including unsubstantiated or improper costs, number of
member months, or number of events. For misstatements of the number of member
months, the penalty shall be the amount of the premium capitation paid for the region per
member month. The penalty amount for including unsubstantiated or improper costs will
be the amount of the misstatement multiplied by two. This provision applies to costs
reports submitted on or after January 1, 2014.
Fraud, Waste and Abuse Prevention. The final budget requires MCOs and MLTCs to
implement policies and procedures designed to detect and prevent fraud, waste and abuse,
including the implementation of a compliance program. For plans with an enrolled
population of 1,000 enrollees in the aggregate annually, the plan must establish a special
investigation unit with the primary responsibility of implementing policies to detect and
prevent fraud, waste and abuse. OMIG is authorized to promulgate regulations establishing
standards and requirements for fraud, waste and abuse activities, including requirements
for special investigation units.
Medicaid Overpayments and Self-Disclosure Program. The final budget requires
MCOs and MLTCs to implement programs and processes related to overpayments,
consistent with statutory requirements. The program must require that overpayments
received by providers, MCOs and MLTCs be reported and returned to DOH within 60 days
of identifying the overpayment or the date any cost report is due, and provide written
notification to OMIG of the reason for the overpayment. The deadline for returning
overpayments is to be tolled when OMIG acknowledges receipt under the self-disclosure
program and in the absence of fraud, the overpayment may be repaid in installments. Any
overpayment retained after the deadline is subject to monetary penalties. OMIG is directed
to establish a Self-Disclosure Program to allow eligible providers, MCOs and MLTCs to
return overpayments.
Encounter Data Penalties. The final budget adds penalties for inaccurate data submitted
at a category of service level. DOH and OMIG, when assessing such penalties must
consider the degree and frequency to which the MCO submitted (or failed to submit)
inaccurate data at category of service level. Penalties are now assessed against the
premium, rather than the administrative component. Applicable penalties have been
increased from .5% to 1.33% percent for MCOs. For MLTC plans, penalties for
submissions past deadlines is .25%; for incomplete or inaccurate data at a category of
Hinman Straub P.C. Date: April 2, 2020 Page: 21
service level the penalty is 1%; for data that results in a rejection rate of over 10% the
penalty is .25%, and for incomplete or inaccurate data identified in audit the penalty is 1%.
MLTC Moratorium. The final budget adopts a recommendation by the MRT to establish
a moratorium on applications for a Certificate of Authority to operate an MLTC and
applications to expand the service area or scope of eligible enrollee population of an
existing MLTC. The moratorium is effective April 1, 2020 to March 31, 2022, but does
not apply to applications submitted to DOH prior to 1/1/20. The moratorium shall not
apply to: (i) applications to transfer ownership or to consolidate MLTCs; (ii) applications
which demonstrate that they address a “serious concern with care delivery”; or (iii) PACE
or dual eligible applications. During the moratorium, the Department is required to assess
the public need for MLTCs that are not integrated with an affiliated Medicare plan and the
ability of such plans to provide high quality, cost-effective care for members, and is
required to develop an orderly wind-down and elimination of such plans to coincide with
the expiration of the Moratorium.
MLTC Enrollment Cap. For the duration of the MLTC Moratorium, each MLTC will be
assigned an annual cap on total enrollment, based on a percentage of each plan’s reported
enrollment as of October 1, 2020, and have a premium withholding of 3% of the base rate.
In the event a plan exceeds its annual enrollment cap, the Commissioner is authorized to
retain all or a portion of the premium withheld, based on the amount over which a plan
exceeds its enrollment cap ($215m in savings). The enrollment cap will be based on: (i)
the ability of eligible enrollees to access care; (ii) plan quality scores; (iii) historical plan
disenrollment; (iv) the projected growth of individuals eligible for such plans in a particular
geographic region; (v) historical plan enrollment; (vi) other factors deemed appropriate by
the DOH to ensure federal compliance and access. If an MLTC exceeds its cap, the DOH
is authorized to withhold all or a portion of the withheld premium.
MLTC Auto-Assignment. The final budget requires that individuals automatically
assigned to an MLTC by the Department of Health shall take into account consistency with
any prior community-based direct care workers having recently served the recipient, and
authorizes individuals to receive services under FFS Medicaid prior to being assigned to a
new MLTC.
Independent Assessor for Personal Care and CDPAP. The final budget includes a
recommendation by the MRT to require DOH to establish or procure an independent
assessor to take over from LDSSs, MCOs, and MLTCs the UAS Community Health
Assessments and reassessments required for determining needs for personal care services.
The use of the independent assessor must be implemented by October 1, 2022.
MLTC Eligibility. The final budget modifies a recommendation by the MRT to amend
MLTC eligibility criteria to require an individual to be assessed: (1) as needing at least
limited assistance with physical maneuvering with more than two activities of daily living
(ADLs); (2) diagnosed with dementia or Alzheimer’s and needing at least supervision with
more than one ADL. The change in eligibility is prospective and does not apply to
individuals continuously enrolled prior to October 1, 2020.
Hinman Straub P.C. Date: April 2, 2020 Page: 22
MLTC Assessment. The final budget adopts a recommendation by the MRT to change
the frequency in which the Community Health Assessment is conducted from every six
months to once annually, subject to requiring reassessments based on changes in health
condition or status.
Notice of Consumer Directed Program. The final budget adopts a recommendation by
the MRT to eliminate requirement that managed care plans and LDSS educate consumers
about the availability of the CDPAP program annually. The final budget expands this
provision to limit the ability of individuals to apply for participation in CDPAP only once
annually.
MLTC Coverage of Behavioral Health Services. The final budget authorizes MLTC
plans to cover behavioral health services.
Integration of Dual Eligibles. The final budget includes a recommendation by the MRT
to require dual eligible enrolled in a Medicare Dual Eligible Special Needs Plan who do
not require 120 days of community-based LTC to enroll in an available affiliated MLTC.
Home Care Assessment Tool. The final budget includes a recommendation by the MRT
to development and implement a uniform task-based assessment tool to assist plans and
LDSS with determinations for utilization of home care services, including the number of
personal care and CDPAP hours each day and other options for needs for assistance with
ADLs can be met, such as through telehealth and family/social supports. The use of the
Home Care Assessment Tool must be implemented by April 1, 2021.
Independent Review for CDPAP and Personal Care Cases. The final budget includes
a recommendation by the MRT to establish an independent panel of clinicians to determine
eligibility for CDPAP cases.
Fully Integrated Products. The final budget extends the authority of the Commissioner
of the Office of Temporary Disabilities Assistance (OTDA) to conduct fair hearings to all
fully integrated products for three (3) years to January 1, 2024.
Managed Care Enrollee Notifications. The final budget authorizes enrollees to receive
notifications electronically, requires integrated delivery systems to have procedures for
receiving an enrollees preference for written or electronic notification, and eliminates
requirement that utilization review agents make notice of pre-authorization by written
notification, and to the extent practicable, utilize electronic notification. MCOs are
required to have procedures for receiving an enrollees preference for written or electronic
notification for purposes of pre-authorization utilization review.
Value-Based Payment Demonstration Program. The final budget authorizes DOH, in
consultation with DFS, to implement one or more five-year demonstration programs
designed to improve health outcomes and reduce costs, using a value-based model that
pays providers an actuarially sound pre-paid, capitated rate. The demonstration may offer
Hinman Straub P.C. Date: April 2, 2020 Page: 23
funding and incentives designed to improve health outcomes, develop infrastructure and
systems and connect individuals to community-based organizations that address social
determinants of health.
Regional Population Health Improvement Initiative. The final budget authorizes DOH,
in consultation with DFS, to implement one or more five-year demonstration programs,
beginning January 2022, that is designed to accelerate regional population health
improvement initiatives, adopting value-based models and aligning care incentives under
an integrated health system.
Pharmacy
Included in the final budget are the following items:
Prescription Drug Pricing and Accountability Board. The final budget modifies the
Governor’s proposal to give DFS broad authority to investigate the circumstances
involving drug price increases and also proposes to establish a Drug Accountability Board
(DAB):
o Prescription Drug Price Review: The Superintendent would be permitted to
investigate any prescription drug that is sold or offered for sale that is set to
increase, or has increased by more than 50 percent within a one-year time period to
an amount greater than five dollars per unit, if the Superintendent believes there to
be evident of false pretenses or fraud and it is in the public interest that an
investigation be made.
DFS may also require other data and information, such as independent
investigations and would be empowered to subpoena witnesses and compel
attendance under oath, and require the production of any books or materials deemed
relevant to the inquiry. Any individual that fails to perform any action required by
DFS under such an investigation would be guilty of a misdemeanor and would be
subject to a civil penalty not to exceed one thousand dollars per day for the duration
of the failure.
o Drug Accountability Board: The final budget establishes a nine-member drug
accountability board with members to be selected by DFS. The Board membership
would consist of: (i) individuals licensed and actively engaged in the practice of
medicine and pharmacy; (ii) individuals with expertise in DUR who are health care
professionals licensed under the Education Law and are Pharmacologists; (iii)
consumer representatives; (iv) health care economists; (v) actuaries; and, (vi)
experts from the Department of Health. The purpose of the DAB would be to aid
in investigations related to drug price increases, and allow DFS to refer drugs to the
DAB for a report to be prepared. If a drug is referred to the DAB, the Board, would
be required to determine:
- The drug’s impact on the premium costs for commercial insurance in the
state, and the drug’s affordability and value to the public;
Hinman Straub P.C. Date: April 2, 2020 Page: 24
- Whether increases in the price of the drug over time were significant and
unjustified;
- Whether the drug may be priced disproportionately to its therapeutic
benefits; and, any other question DFS may certify to the Board to aid an
investigation.
Papers and information considered by the Board as part of their review, and any Board
report prepared, would be considered confidential and exempt from disclosure; however,
the Superintendent would be permitted to determine that the release of the information
would not harm an ongoing investigation and would be in the public interest, and would
therefore be permitted to release the report or any portion thereof to the public.
Additionally, DFS may call a public hearing on the determinations of the board.
DFS is also authorized to promulgate regulations relating to the operations of the
accountability board.
Expansion of Supplemental Rebate Authority. The Final Budget expands the
Executive’s authority to negotiate supplemental rebates directly with drug manufacturers
by adding: (1) “gene therapies”, (2) “high cost drugs”, (3) Medication Assisted Treatment
(MAT) drugs on the new Medicaid single Statewide formulary, and (4) any other “class or
drug designated by the commissioner” to the categories of drugs DOH is permitted to
negotiate supplemental rebate arrangements for with drug manufacturers. DOH already has
authority under Section 367-a to enter into supplemental rebate arrangements for Hepatitis
C agents and HIV/AIDs drugs. The final budget also accepts the Executives’ proposal to
extend the authorization for the State to negotiate, in lieu of a managed care provider, with
a pharmaceutical manufacturer for the provision of supplemental rebates through March
31, 2023.
Under the law, drug manufacturers would not be permitted to enter into any supplemental
rebate arrangements with MMC plans and PBMs if a supplemental rebate arrangement with
DOH is in place for the drug, and standard clinical criteria are imposed on the MMC plan.
Consistent with existing statutory requirements, DOH is required to establish adequate
rates of reimbursement for MMC plans in such situations. The authority for DOH to enter
into such rebates is extended until March 31, 2023, and the rebate arrangement itself may
not extend beyond this date.
Additionally, the Final Budget authorizes DOH to refer “high cost” drugs that are not
currently on a managed care plan formulary or on the FFS preferred drug list to DURB for
a target supplemental rebate. DOH is required to follow similar protocols used in
connection with the Medicaid Drug Cap to first attempt to negotiate a rebate arrangement
with the drug’s manufacturer. However, if unsuccessful, the Final Budget authorizes DOH
to use other tools available under the Medicaid Drug Cap statute (280 of the PHL),
including information disclosures and DURB review and recommendation of a target
rebate, to facilitate rebate arrangements with drug manufacturers.
Under the Final Budget language, a “high cost drug” means either:
Hinman Straub P.C. Date: April 2, 2020 Page: 25
o a brand name drug or biologic that has a launch wholesale acquisition cost of
thirty thousand dollars or more per year or course of treatment;
o a biosimilar drug that has a launch wholesale acquisition cost that is not at least
fifteen percent lower than the reference brand biologic at the time the biosimilar
is launched, or a generic drug that has a wholesale acquisition cost of one hundred
dollars or more for a thirty-day supply or recommended dosage approved for
labeling by the FDA; or
o a brand name drug or biologic that has a wholesale acquisition cost increase of
three thousand dollars or more in any twelve-month period, or course of treatment
if less than twelve months.
Additionally, a “Gene therapy” means:
o a drug approved by the FDA or licensed under the Federal Public Health Services
Act, that “treats a rare disease or condition” as this term is defined under 21 USC
Section 360bb(a)(2) or is “life-threatening” as defined under 42 CFR Section
321.18;
o is considered a gene therapy by the FDA for which a biologics license is held;
o if administered in accordance with the labeling of such drug, is expected to result
in either the cure of such disease or reduction in the disease’s symptoms that
materially improves patient’s length or quality of life; and,
o is expected to achieve the results in not more than three administrations.
The provisions of this section technically take effect immediately; however, DOH is
permitted to delay the effective date by up to ninety days following the conclusion of the
COVID-19 declared state of emergency.
Carve Out the Pharmacy Benefit from Managed Care to Fee-for-Service (FFS). The
final budget includes the MRT recommendation to authorize DOH to carve the Medicaid
pharmacy benefit out of managed care and back into FFS Medicaid, no sooner than April
1, 2021. The language also adds that an advisory board would be created to make non-
binding recommendations by October 1, 2020 with respect to how the State would achieve
proposed savings associated with the carve-out, and how FFS reimbursement would be
adjusted for 340B covered entities.
The Final Budget also includes language that DOH will examine all “reasonably available
methods” for determining actual acquisition cost (AAC) and the professional dispensing
fee for entities that purchase drugs under the 340B program. The language provides that
changes to the AAC and dispensing fee would be reviewed and adjusted for such drugs “no
sooner than April 1, 2023.” As a result, it appears that the 340B providers will be “held
harmless” of any rate reductions from the date of the carve-out (4/1/20) until 4/1/23.
Additionally, the language notes any proposed reimbursement modification for 340B
would be subject to the availability of Federal Financial Participation (FFP).
Align the Medicaid Drug Cap with the Medicaid Global Cap. The final budget revises
the year-to-year growth allowed under the Medicaid Drug Cap. For the current SFY,
Hinman Straub P.C. Date: April 2, 2020 Page: 26
growth would be limited to the CPI plus 2%, a reduction from CPI plus 4%. For SFY 2021-
22, and thereafter, annual growth would be aligned with the growth rate of the Medicaid
Global Cap.
Expand DOH Authority Under the Medicaid Drug Cap to Limit Reimbursement for
Drugs Provided by Medical Practitioners. The Final Budget Agreement adds that if
projected drug expenditures are expected to pierce the Drug Cap for the fiscal year, and a
manufacturer has not entered into a supplemental rebate agreement with DOH after the
DURB has recommended a target rebate amount for a particular drug, DOH is now
authorized, and “may” direct MMC plans to limit or reduce reimbursement for a drug
provided by a “medical practitioner”.
Statewide Formulary for Medication Assisted Treatment. The Final Budget accepts
the Executive’s proposal to establish a single statewide formulary for Medication Assisted
Treatment (MAT) drugs in FFS and MMC. The MAT Formulary would be separate from
the FFS preferred drug program, and consist of all MAT drugs that are on a managed care
plan formulary or in the FFS preferred drug program that DOH is able to obtain at a cost
that is less than the lowest cost paid for the drug by any managed care plan or the FFS
preferred drug program, net of all rebates, as of the date the single statewide formulary is
implemented. This “lowest cost” provision means in cases where there is a generic version
of a brand drug, DOH must be able to obtain the brand drug at the same lowest cost
available in FFS or MMC as its generic bioequivalent.
In addition, other MAT drugs not currently on a managed care plan formulary or covered
under the FFS preferred drug program may be added to the single statewide formulary if
DOH is able to obtain the drug at a cost that is equal to or less than the lowest cost to DOH
for comparable drugs in the class, net of all rebates.
Under the law, MAT drugs on the single statewide formulary would not be subject to prior
authorization under FFS. Current law already prohibits prior authorization for initial or
renewal prescriptions for preferred or formulary forms of MAT in MMC and FFS.
In addition, the Final Budget adds new exception criteria for beneficiaries to request
coverage of a MAT drug under FFS and MMC, that is not on the single statewide
formulary. The language notes a MMC plan’s failure to comply with the requirements of
this section would subject them to a $1,000 fine per violation.
As for the effective date of the single statewide formulary, DOH is required to implement
the single MAT Statewide formulary within six months of these provisions becoming law.
However, DOH is permitted to delay the effective date by 90 days following the conclusion
or termination of the COVID-19 State of emergency.
No Prior Authorization for Methadone. The Final Budget Agreement adds that no prior
authorization will be required for Methadone when used for opioid use disorder and
administered or dispensed in an opioid treatment program, in FFS and MMC.
Hinman Straub P.C. Date: April 2, 2020 Page: 27
Pharmacy Reimbursement. The final budget accepts the Governor’s proposal to extend
provisions of law related to methodologies for reimbursement of pharmacy under Medicaid
through 2023.
CPI Penalties for Generic Drugs. The final budget accepts the Executive’s proposal to
extend CPI penalties for generic drugs through March 31, 2022. An additional rebate is
triggered under existing law when a generic price increases more than 75% of SMAC. Prior
to April 1, 2017, the rebate was not triggered unless the price increase was more than 300%
of SMAC in 12 months.
Rejected from the final Budget are the following items:
Pharmacy Benefit Manager Regulation. The Legislature rejects the Executive’s
proposal to regulate and require the registration and licensure of PBMs.
Prescriber Prevails. The Legislature rejects the MRT II’s proposal to eliminate
“prescriber prevails” in both the Fee-For-Service (FFS) and the Medicaid Managed Care
(MMC) programs.
Limit Coverage of Non-Prescription (OTC) Drugs in Medicaid. The Legislature rejects
the MRT’s proposal to allow “modifications” to the list of non-prescription drugs that may
be covered by Medicaid to be filed as regulations without notice and comment.
Rx Copays in Medicaid. The Legislature rejects the MRT’s proposal to increase
copayments from .50 cents to $1.00 for certain OTC drugs. This proposal has been put
forward by the Executive since 2017-18.
Optimize Pharmacist Services. The Legislature rejects the MRT’s proposals to expand
immunizations that may be provided by pharmacists and expand the Collaborative Drug
Therapy Management (CDTM) program involving pharmacists and Article 28 facilities to
the community setting. The Final Budget Agreement also sunsets the existing authority for
pharmacists to provide immunizations under the CDTM, March 31, 2022. Further, the
Legislature rejects the MRT proposal to add pharmacists as participating providers eligible
for reimbursement under the Medicaid smoking cessation program.
Health Planning, Medical Education and Public Health
Included in the final budget are the following items:
Telehealth Expansion. The final Budget includes an MRT proposal to expand telehealth
services. It adds care managers in Health Homes, Patient Centered Medical Homes
(PCMH), Hospice, OPWDD settings and Foster Care as allowable providers. In addition,
if federal financial participation is available, DOH is also authorized to add additional
modalities for the provision of telehealth services, including audio-only and on-line portals,
to expand access to care for behavioral health, oral health, maternity care and other high-
need populations.
Social Determinants of Health Pilot Programs. The final budget modifies a
recommendation by the MRT to establish pilot programs for the purpose of promoting
social determinant of health interventions, including: (1) up to 3 projects for medically
tailored meals; (2) up to 5 projects for medical respite programs to provide care to homeless
Hinman Straub P.C. Date: April 2, 2020 Page: 28
patients; and (3) a street medicine program to allow D&TCs to bill for services provided
at offsite locations to serve the chronic homeless population. The authorization for these
programs is effective on September 1, 2020. The final budget removed the
recommendation to invest $4.3 million toward the development of Social Determinants of
Health networks.
Maternal Health Promotion Pilot. The final budget includes a recommendation by the
MRT to authorize a program to provide Medicaid reimbursement for prenatal maternal
childbirth education and preparation classes, and transportation for classes, to improve
maternal outcomes and reduce maternal-infant mortality.
Chronic Back Pain Pilot. The final budget includes a recommendation by the MRT to
authorize Medicaid payment for chiropractor services under a pilot program to promote the
use of alternatives to chronic lower back pain by providing access to acupuncture and
chiropractic services.
Diabetes and Chronic Disease Self-Management Pilot. The final budget includes a
recommendation by the MRT to authorize the Diabetes and Chronic Disease Self-
Management Pilot program in one or more counties to improve clinical outcomes.
Payment may be made for education, consultation and peer support services. The
Commissioner is authorized to establish fees for counseling services under the program.
Public Health Programs. The final budget accepts the Executive’s proposal to discontinue
funding for the Area Health Education Center, Ambulatory Care Training, and Health
Workforce Retraining programs funded through HCRA.
Autism Awareness and Research Fund. The final budget accepts the Executive’s
proposal to transfer responsibility for this fund from DOH to OPWDD.
Banning Fentanyl Analogs. The final budget modifies the Executive’s proposal to ban
fentanyl analogs by adding 13 fentanyl analogs to Schedule I and 1 to Schedule II list of
Controlled Substances. The legislature rejected the proposal to authorize the
Commissioner of Health to classify any substance as a State Schedule I Controlled
Substance when already listed on the Federal Schedules of Controlled Substances.
Comprehensive Care Centers for Eating Disorders. The final budget rejects the
Executive’s proposal to transfer responsibility for this fund from DOH to OMH, and
transfers the provisions governing this program to the Mental Hygiene Law.
Accountable Care Organizations. The final budget accepts the Executive’s proposal to
extend the certificates of authority to Accountable Care Organizations (ACOs) through
December 31, 2024.
Health Occupation Development and Workplace Demonstration Program. The
Executive proposes to repeal this program with the elimination of the Health Workforce
Hinman Straub P.C. Date: April 2, 2020 Page: 29
Retraining Initiative (HWRI) under HCRA. The Program currently applies to nursing
homes, hospice, CHHAs, and D&TCs.
Children and Youth with Special Health Care Needs (CYSHCN) Program. The final
budget makes technical amendments to the CYSHCN programs within a county with a
population of less than 150,000, where the county health director may serve as the director
of the CYSHCN program.
Adult Cystic Fibrosis Assistance Program. The final budget accepts the Executive’s
proposal to repeal this program.
Environmental Health Program Fee Increases. The Final Budget rejects the increase
in the permit fee for summer camps, but includes the increases proposed by the Governor
for fling realty subdivision plans, licensing and inspection of tanning facilities, and
asbestos training programs.
Tobacco and E-Cigarette Products. The Final Budget includes a series of measures
designed to reduce tobacco use and the use of vapor products, including electronic
cigarettes (e-cigarettes) but with several modifications from the proposals advanced by the
Governor. All measures take effect on July 1, 2020, except the ban on flavored vapor
products, which takes effect 45 days after enactment:
o Flavored Vapor Products: The Final Budget modifies the Governor’s proposal to
bans the sale of all flavored nicotine vapor products, other than tobacco-flavored
by adding a new exemption for any product approved by the federal Food and Drug
Administration (FDA).
o Sale in Pharmacy: The Final Budget modifies the Governor’s proposal to prohibit
the sale of tobacco products, herbal cigarette, electronic cigarette or other vapor
product within a pharmacy by continuing to allow the sale in retail establishments
in which a pharmacy is operated.
o Carrier Oil Restrictions: The Final budget modifies the Governor’s proposal by
limiting DOH’s ability to regulate or prohibit the sale of carrier oils, which are used
to control the consistency and characteristics of vapor products, to those that are
suspected of causing illnesses and have been identified as a “chemical of concern”
by the CDC.
o Shipping Ban on Vapor Products to New York Consumers: The Final Budget
includes the Governor’s proposal to prohibit the shipment of any vapor products in
New York, except to registered vapor dealers.
o Tobacco and Vapor Coupons and Discounts: The Final Budget includes the
Governor’s proposal to add vapor products to the current prohibition of coupons
for tobacco products. It also expands the definition to include vouchers, rebates,
cards, etc. whether paper or digital and prohibits the use of multi-pack discounts,
discounts of multi-product purchases, and sales below the list price.
o Ingredient Disclosure: The Final Budget modifies the Governor’s proposal by
adding toxic metals used in heating elements to the required manufacturer
disclosure to DOH of ingredients in its products, including any “chemicals of
concern” designated by DOH. It also includes the proposal to require disclosure of
any manufacturer research on health effects of its products and ingredients.
Hinman Straub P.C. Date: April 2, 2020 Page: 30
o Penalty Increases: The Final Budget modifies the proposed penalty increases
leaving the initial minimum penalty unchanged ($300) and raising the maximum
from $1000 to $1500, instead of the Governor’s proposal to set initial penalties at
$1000-$2000. Subsequent penalties will increase from $500-$1000 to $1000-
$2000, rather than $1500-$3000 proposed by the Governor. The Final Budget
includes the Governor’s proposal to double length of suspension of retailers ability
to sell tobacco and vapor products from six months to one year.
o Vapor Advertising: The Final Budget modifies the advertising restriction to
prohibit advertising for tobacco and vapor products and paraphernalia in store
fronts located within 1500 feet of a school, or 500 feet in New York City.
o Tobacco Displays: The Final Budget rejects the Governor’s proposal to prohibit
the display of tobacco and vapor products and associated paraphernalia in stores
where people under the age of 21 are permitted entrance.
o Clarification of Clean indoor Air Ban: The Final Budget rejects the Governor’s
proposal to clarify that the workplace tobacco and vapor restrictions apply to
outdoor covered areas.
o Tobacco and Vaping Awareness and Control Programs: The Final Budget adds
new provisions expanding tobacco prevention, awareness and control programs to
include vaping and increases the targeted audience to age 21. It also adds a new
vaping prevention, awareness and control program specifically targeted for
students, parents and schools.
Doctors Across New York: The Final Budget includes level funding of $9.065 million for
the Doctors Across New York physician loan repayment and Physician Practice Support
programs.
Maternal and Infant Community Health Collaboratives (MICHC). The Final Budget
includes level funding of $1,835,000 for the MICHC program (prenatal care assistance).
Family Planning Services. The Final Budget includes total base funding of $40.6 million
for Family Planning services. Funding is provided through a sub-allocation from the
Department of Financial Services to DOH ($19.9 million), and two appropriations in DOH
totaling $20.7 million. This is an increase intended to support the loss of $14.2 million
federal Title X funding due to changes in the federal rules governing the program that
forced New York to stop participating in the program. In addition, the Legislature provided
an additional $938,000 in funding to the program.
Nurse-Family Partnership. The Final Budget includes $3 million in base funding for the
Nurse Family Partnership Program. The Legislature also provided an additional $800,000
for the program.
Maternal Mortality. The Final Budget includes level annual funding of $4 million in
funding for reducing maternal mortality. This includes funding for expanding community
health workers through the MICHC program, developing a training curriculum on implicit
racial bias, and creating a data warehouse to help analyze maternal outcomes. It also
Hinman Straub P.C. Date: April 2, 2020 Page: 31
includes funding for a Maternal Mortality and Morbidity Review Board and the Advisory
Committee on Maternal Mortality.
Tobacco Programs. The Final Budget includes level funding for tobacco related
programs, including $2.1 million for tobacco enforcement and education, and $33.1 million
for the tobacco use prevention and control program.
Women Infant Children (WIC). The Final Budget includes level funding of $26.2 million
for WIC.
Hunger Prevention and Nutrition Assistance Program (HPNAP). The Final Budget
includes level annual base funding of $34.5 million for HPNAP. The Legislature also
provided an additional $500,000 for the program.
Migrant Health: The Final Budget includes $406,000 in level funding for health centers
that provide primary care to migrant and seasonal farm workers.
Rural Health Care Access and Development: The Final Budget includes the Governor’s
proposal to combine the two separate appropriations for Rural Health Care Access and
Rural Health Care Development into a single $9.4 million appropriation, which reflects
reduction in approximately 25% of total funding. However, the Legislature added $1.9
million in funding to the program, resulting in an overall cut of $1.3 million (about 11%).
Population Health Improvement: The Final Budget reflects level annual funding of $7.5
million for the Population Health Improvement Program, which supports regional
coordination and collaboration between local health providers to implement the State’s
public health Prevention Agenda.
Mental Health & Human Services
Included in the final budget are the following items:
Oversight of Medicaid Community Based Services for the Developmentally
Disabled. The Final Budget includes the Governor’s proposal to transfer oversight of
Medicaid funded community-based services, including those provided by Health Homes,
to the Office of People with Developmental Disabilities (OPWDD). Providers of these
services will be subject to OPWDD oversight for all aspects of care delivery and will no
longer be subject to the separate requirement for DOH Criminal History Record Checks.
Pre-Admission Process for Residential Treatment Facilities. The final budget modifies
the Executive proposal to streamline the pre-admission process for children and youth with
mental illness entering residential treatment facilities (RTF’s) by expanding the newly
created advisory board to include family representatives and appropriate medical
personnel, requiring the advisory board to issue an annual report to the Governor and
Legislature, limiting medical necessity checks to be done no sooner than 14 days after
Hinman Straub P.C. Date: April 2, 2020 Page: 32
admission to a RTF, and require OMH to consult with the RTF regarding placement of
children and youth at the facility before placement of that child at the facility.
Applied Behavioral Analysis Exemption. The final budget extends the exemption
allowing for OPWDD, OMH and OCFS to employ qualified professionals to provide
services which may otherwise fall within the scope of practice for Applied Behavior
Analysis through July 1, 2025. The exemption is currently set to expire on July 1, 2020.
Sex Offenders Requiring Confinement. The final budget accepts the Executive’s
proposal to establish a separate appointing authority of secure treatment and rehabilitation
center within OMH for the care and treatment of dangerous sex offenders requiring
confinement. Transfers employees substantially engaged in the care and treatment of such
offenders to the secure treatment and rehabilitation center and retains employee geographic
location and civil service title and status.
Comprehensive Psychiatric Emergency Programs (CPEP). The final budget accepts
the Executive’s proposal to extend the authority of the Commissioner of OMH to designate
facilities to operate CPEP, for 4 additional years, provides that triage and referral services
be provided by psychiatric nurse practitioners or physicians, and if the patient is not
discharged within 6 hours, to be further examined by a staff physician. Designated
hospitals are permitted to operate CPEPs at satellite facilities, upon the Commissioner’s
approval. The Legislature rejects the Executive proposal to expand the time a person may
stay in a CPEP program from 72 hours to 96 hours.
Notification Requirements for Closure or Transfer of State Operated Individualized
Residential Alternative (IRA). The final budget extends the notification requirements
upon the closure or transfer of state operated IRAs, until March 31, 2022.
Rejected from the final budget are the following items:
Justice Center Child Abuse Central Registry Check: The final budget rejects the
Executive’s proposal to allow the Justice Center the discretion of checking the Statewide
central register of Child Abuse and maltreatment only when it considers it relevant during
an investigation. Currently, the Justice Center must check it during every investigation.
Housing Nursing Home Transition and Diversion Waiver: The Final Budget includes level
annual funding of $1,842,000 for housing subsidies through the NHTD program.
Bioscience Funding
Stem Cell Funding. The final budget maintains funding for the Empire State Stem Cell
Research Account at $44,800,000.
Spinal Cord Injury Research Fund Account. The final budget continues to allocate $8.5
million for the Spinal Cord Injury Research Program (SCIRP). 4823-4955-5897, v. 1