[NYAPRS Enews] MRT Scrutinizes Medicaid Benefits, Prepares Final Recommendations

[Harvey Rosenthal]

New York's Medicaid Enrollment Grows; Reform Panel Readies Study

By Cara Matthews  Gannett News Service  December 13, 2011

 

Medicaid enrollment increased by an estimated 101,500 people from April
through October, to 4.99 million, and the continued growth is the
greatest challenge to staying under the program's spending cap, the
state Medicaid director said Tuesday.

Director Jason Helgerson gave the update at the last meeting of the
Medicaid Redesign Team before the panel hands in its report to Gov.
Andrew Cuomo by Dec. 31.

"We remain challenged in some areas, in particular enrollment," he said
of the 2 percent rise, adding that it "continues to grow, but at a
relatively slow pace."

Medicaid spending for those seven months was $9.14 billion, nearly
$125,000 less than estimated.

The Redesign Team on Tuesday approved the recommendations of
subcommittees that had not presented their reports to the full panel at
a previous meeting, including committees focused on payment reform and
affordable housing. The Medical Malpractice Reform work group has not
reported its final recommendations.

Helgerson said Health Department staffers have put together a draft of
the final report, which includes a five-year action plan. The
recommendations of the 10 subcommittees will be in the report, submitted
to Cuomo .

The governor formed the panel in January to recommend short-term
measures to curb growth in the roughly $53 billion health-care program
for the poor and long-term measures to improve efficiency and quality of
care.

Cuomo and legislators largely incorporated the team's recommendations
for reducing costs into the current budget. There is a cap of $15.3
billion on New York's share of Medicaid this year. The savings are
expected to be $2.2 billion over what would have been spent this fiscal
year, which ends March 31.

The governor and legislators agreed in developing the current year's
budget that they would increase Medicaid spending by 4 percent in the
2012-13 fiscal year, which starts April 1.

Redesign Team member Lara Kassel asked what would happen after the
report was submitted. Some groups devised principles and guidelines but
did not get a chance to recommend actual initiatives. Kassel is
coordinator of Medicaid Matters New York, which advocates on behalf of
beneficiaries.

"So clearly there's a lot left to be done," she said.

Other questions arose, such as what the follow-up would be on the
report, what the monitoring and oversight would be and how savings would
be reinvested.

James Introne, Cuomo's deputy secretary for health, said state officials
haven't planned a formal successor to the Medicaid Redesign Team.

"That's not to say that we're not interested in working with those
stakeholders that do have an interest in continuing on a volunteer
basis," he said.

Helgerson said it would take years to fully implement all the
recommendations.

Experts have attributed the explosion in Medicaid's ranks largely to the
poor economy. Other factors include reductions in employer-based health
insurance and an expansion of Medicaid programs for low-income adults.

Counties, which pay about 15 percent of Medicaid expenses, have pushed
for the state to assume financial responsibility for the state and
county shares of the program. Most states do not require local
governments to pay for Medicaid. The Medicaid Redesign Team has
recommended the state develop a Medicaid-financing plan that phases out
reliance on local taxes.

http://www.lohud.com/article/20111214/NEWS05/312140014/New-York-s-Medica
id-enrollment-grows-reform-panel-readies-study

 

Medicaid Panel Spells Out Reforms

Suggestions Include New Limits, Payments For Cuomo's Review

By Cathleen Crowley  Albany Times Union  December 13, 2011

 

ALBANY - The Medicaid Redesign Team
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Medicaid+Redesign+Team%22> 's
latest recommendations suggest refusing payment for medically
unnecessary procedures like human growth hormone injections for short
children and reining in the most expensive enrollees - the elderly and
disabled with complex medical needs.

The MRT, which was formed earlier this year by Gov. Andrew Cuomo
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Andrew+Cuomo%22>  to reform
Medicaid, adopted another round of major recommendations Tuesday during
a meeting at Empire State Plaza. The recommendations will be sent to the
governor on Dec. 31.

Medicaid is the public health program for low-income and disabled New
Yorkers. The state program serves nearly five million people and costs
$52 billion.

State Sen. Kemp Hannon
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Kemp+Hannon%22> , a Garden City
Republican who sits on the MRT, said the recommendations bring positive
and systemic change to the state's Medicaid program. In general, the new
recommendations reduce or eliminate payments for unproven medical
treatments, loosen restrictions on health professionals like nurse
practitioners and dental hygienists to allow them to practice more
independently, move administration duties from counties to the state,
and attempt to better manage expensive "dual eligible" enrollees.

Dual eligibles are people who qualify for both Medicaid and Medicare,
the federal health program for the elderly. This group has patients with
complex medical needs and account for nearly half of Medicaid spending,
although they make up only 14 percent of Medicaid recipients. The
current system of serving dual eligibles splits their care between the
federal and state government and has led to a disorganized, expensive
hodgepodge of care. MRT proposed that New York's Medicaid program take
full responsibility for their medical care, including Medicare services
that cost about $10 billion.

In return, the federal government would pay New York a capped amount to
care for the patients, but New York assumes the financial risk if costs
exceed the cap.

It would be a sweeping change for the state, said Jason A. Helgerson
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Jason+A.+Helgerson%22> , state
Medicaid director. Health officials believe that costs can be reduced by
better managing dual eligibles' health problems and avoiding expensive
hospitalizations.

"New York is putting its faith that better care management and
coordination will improve outcomes for patients and make this program
more efficient in the long run," Helgerson said.

The MRT's new recommendations also include:

*         Limiting coverage of arthroscopic knee surgery for patients
with osteoarthritis.

*         Paying private podiatrists who treat diabetic Medicaid
patients.

*         Limiting or excluding coverage of certain steroid injections
to the back.

*         Refusing payment for angioplasties (opening blood vessels in
the heart with stents or balloons) that are not medically appropriate
according to nationally recognized standards.

*         Reducing payments for elective C-sections and induced labor
unless it is medically necessary.

*         Eliminating payments for human growth hormone for children who
are short.

*         Paying for intensive behavioral therapy for obese patients.

*         Paying for dentists to counsel patients to stop smoking.

*         Allowing nurse practitioners to practice independently without
a collaborative agreement with a physician.

*         Allowing dental hygienists to practice independently with a
collaborative agreement with a dentist.

*         Paying for lactation consultants to help new mothers breast
feed, and supporting a program where nurses visit new mothers.

Lara Kassel, coordinator for the advocacy group Medicaid Matters and a
member of the MRT, said there is still a lot of work to do, but she was
encouraged by the recommendations of the MRT's various committees.

"The overall theme for the Medicaid Redesign Team has been how to make
the program more efficient and effective and that was certainly
reflected in the work of the workgroups," Kassel said.


http://www.timesunion.com/local/article/Medicaid-panel-spells-out-reform
s-2401226.php#ixzz1gVoomWPr

----------------

 

New York State Scrutinizes Medicaid Benefits

Crain's Health Pulse  December 14, 2011

 

New York state's Medicaid program could stop covering health care
treatments whose effectiveness is not supported by data, if the state
implements the recommendations of the Medicaid Redesign Team work group
on benefits.

Yesterday, the MRT recommended that the guiding principle for deciding
whether Medicaid should cover a treatment should be evidence of its
efficacy. "If we focus on the value, it makes [decisions] apolitical and
rational," said Health Comissioner Dr. Nirav Shah. The most important
factor for assessment is the benefit to a patient's health, he said,
adding, "There are marginal treatments out there with no benefits."

The work group presented findings on 10 benefits. Knee arthroscopies are
often unnecessary and lead to infections, Dr. Shah said. Back pain
treatments "can be the Wild West," and only 38% of elective percutaneous
coronary interventions performed in New York state are clearly
indicated, Dr. Shah said. At $14,000 per PCI, he added, "millions are
being spent."

The work group also wants to cut payments for elective C-sections
performed at less than 39 weeks of gestation, because many procedures
are done for convenience rather than for the patient's health.

One benefit that is not medically necessary is growth hormones, which
Dr. Shah said the state should not cover just so someone who is "5-5 can
be 5-7'' with $20,000 in shots."

But Dr. Shah said the state should invest in treatments that, while
costly, would save money in the long term. These include
tobacco-cessation counseling by dentists, obesity counseling, podiatry
for adult diabetics, lactation counseling and the nurse family
partnership program, where nurses visit first-time mothers.

The added costs of covering the benefits will not be part of the
Medicaid global cap.


http://www.crainsnewyork.com/article/20111214/PULSE/111219964#ixzz1gVT5x
uLf

 

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