[NYAPRS Enews] MRT Update: Separate BH Integration Proposals for NYS, NYC

[Harvey Rosenthal]

NYAPRS Note: Hearty congratulations are due once again to all who worked
so hard and successfully to prevent the turnover of the state's
behavioral health recovery net services to generic health plans. Two
different strategies were ultimately approved by the Governor's Medicaid
Redesign Team last week including:

*         The proposal backed by 41 BH advocacy groups to design and
implement an integrated and improved behavioral health (mental health
and substance use) service system with strong links to health, housing
and local supports. Over the next two years, recovery net services will
remain in fee for service and be managed by behavioral health
organizations towards improving care integration and reductions in
avoidable inpatient and detox admissions. By April 2013, the state would
have the option of establishing " Special Needs Plans for high-need
enrollees with behavioral health problems where the capacity exists for
specialized plans, or develop fully capitated arrangements directly with
integrated provider systems with demonstrated capacity to serve the
behavioral and physical health needs of enrollees." As of now, this plan
would apply to all areas of the state except for New York City. 

*         Due to a last minute proposal put forth by New York City, it
appears that the City's Health and Hospitals Corporation (HHC) will have
the opportunity to construct a managed care design that integrates HHC's
inpatient and outpatient mental health services with health services
provided by MetroPlus Health Plan, a wholly owned HHC subsidiary. It's
unclear how this design will apply to beneficiaries who are not
connected with HHC or MetroPlus nor how the services of non-HHC operated
Medicaid and state aid services will fit: we'll share more once those
details are available.

Next steps include legislative approval of these and other MRT
proposals, topics which will be a big focus of this week's joint
legislative budget hearings for mental hygiene (Wednesday) and
health/Medicaid (Thursday) and which will need final approval by the
full legislature and the Governor, hopefully by April 1. 

 

Medicaid Panel Finishes Work, But Obstacles Remain in Legislature

By Cara Matthews Gannett News Service  February 25, 2011

ALBANY -- While divergent groups including hospitals and health care
unions are backing a plan to overhaul New York's $52 billion Medicaid
program, it faces opposition from some patients-rights groups.

The Greater New York Hospital Association and 1199 Service Employees
International Union, which traditionally have been at odds, both voted
to approve the Medicaid Redesign Team's recommendations Thursday. They
later issued a joint statement, calling the proposed spending cap on
Medicaid "groundbreaking" and saying the proposals would lower costs and
improve quality in the health care program for 4.7 million low-income
New Yorkers.

Gov. Andrew Cuomo, who appointed members of the panel, on Friday spoke
highly of their work. Their plan would place a cap on Medicaid spending
and reduce the program's cost for 2011-12 by $2.3 billion.

"I believe this is a major positive for the budget because we're not
going to have the opposition from Greater New York and 1199, which
historically has been the main opposition through this process," the
governor said on an Albany radio station Friday.

But a number of advocacy groups, such as the Rochester-based Center for
Disability Rights and the Save Our Safety Net campaign, said they are
not happy with the final product, which doesn't include some of the
recommendations they pushed for and has others they fought against. They
said they were disappointed the panel voted on the package Thursday
afternoon -- hours after the recommendations were made public -- rather
than continue deliberations Friday as scheduled and vote Tuesday, the
deadline for submitting a plan to Cuomo.

"We are really exasperated by the whole process. We don't think this is
the way policy and law should be made in New York state," said Nisha
Agarwal, director of the Health Justice Program at New York Lawyers for
the Public Interest. The organization is a member of the Save our Safety
Net campaign.

The campaign opposes a recommendation to give financial aid to hospitals
that want to close, merge or restructure. That would disproportionately
affect poor communities, Agarwal said.

"They don't live in the communities that are likely to lose these
hospitals," she said of the Medicaid Redesign Team.

A proposal the group supported to allow Medicaid to reimburse for
language assistance did make it into the final cut, Agarwal said.

Four of the Medicaid Redesign Team members who were present Thursday
abstained, including Assembly Health Committee Chairman Richard
Gottfried, D-Manhattan.

Gottfried said members had been told they would have an opportunity
before the vote to make motions to strike a proposal in the package or
add a proposal that had been evaluated by the team.

But he changed his position Friday, saying the report overall is
positive.

"Despite the concern I voiced yesterday about the speed with which the
MRT voted, I believe, on the whole, that the final report contains
needed reforms that will place our Medicaid system on a path to long
term fiscal sustainability while safeguarding quality health care for
New Yorkers in need, the elderly and the disabled," he said.

The governor said Friday that change is difficult, and it triggers
reaction from anyone who will lose as a result.

"This is a major system that we're changing. There are many vested
interests who are vested in protecting the status quo," he said.

Healthcare Association of New York State spokesman William Van Slyke
described the process as "an imperfect but in the end effective method
of generating the compromises that were necessary to move forward" and
do so with the least amount of negative impact on the public as
possible.

The governor's administration will submit the plan to lawmakers as
proposed budget legislation for the 2011-12 fiscal year, which starts
April 1.

A spokesman for Senate Majority Leader Dean Skelos, R-Nassau County, and
a statement from Assembly Speaker Sheldon Silver, D-Manhattan, said the
leaders looked forward to reviewing the plan and passing an on-time
budget.

But disability and consumer groups were less optimistic about the
outcome.

Disability-rights groups offered a proposal that would save $1 billion
over five years, but it wasn't given serious consideration and wasn't in
the final plan, said Bruce Darling, president of the Center for
Disability Rights. The recommendation from his group and the New York
Association on Independent Living was to shift more people from
institutional to community-based settings; transition to a
consumer-directed model of care; and take advantage of federal
health-reform funds for community-based programs.

"New York has an over-reliance on institutional models of care, which
are very expensive and honestly inconsistent with people's right to live
in the community," he said.

The New York Association of Psychiatric Rehabilitation Services and 40
other groups pushed against a proposal that would have folded into the
managed-care system Medicaid recipients who need mental-health and
substance-abuse treatment and have major physical-health problems. The
groups were successful in keeping the proposal out of the plan.

The groups believe the proper way to treat this population is through
managed-care behavioral-health organizations. A recommendation to do
that is in the plan, said Harvey Rosenthal, the association's executive
director.

The association opposes, however, a proposal to restrict access to
certain medications for people with psychiatric disabilities, AIDS/HIV
and organ-transplant patients.

 

Medicaid reform plan

The Medicaid Redesign Team reform plan for Medicaid would:

* Place a cap on state Medicaid expenditures and limit future growth to
4 percent annually.

* Change the Medicaid payment and program structure, which would save
$1.14 billion.

* Eliminate automatic rate increases built into state law, which would
save $186 million.

* Implement a 2 percent across-the-board rate reduction to save $345
million.

* Work with the health-care industry to implement cost-containment
measures, but give the state Health Department authority to put controls
in place and reduce rates if needed to prevent costs from exceeding the
cap. This would save $640 million.

* Place a limit of $250,000 on non-economic damaged for medical
malpractice and create an indemnity fund for brain-damaged babies.

* Place a million Medicaid recipients in patient-centered medical home
programs, which provide more coordinated care for people with complex
health problems and can prevent unnecessary hospitalizations and visits
to emergency rooms.

* Transfer the entire Medicaid population to managed-care programs
within three years.

* Pre-pay certain Medicaid payments to get $66 million in federal
matching funds.

 

http://www.stargazette.com/article/20110225/NEWS10/102250360/Medicaid-pa
nel-finishes-work-obstacles-remain-legislature?odyssey=tab|topnews|text|
FRONTPAGE

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

MRT IDs $2.3 Billion in Saving; Beats Deadline by a Week


New York Nonprofit Press   February 25, 2011

 

Governor Andrew Cuomo's Medicaid Redesign Team (MRT) knocked off early
yesterday after identifying $2.3 billion savings almost a full week
ahead of schedule.   The vote on a package of 79 individual proposals -
including a global Medicaid cap, 2% across the board cuts and much, much
more - came as a surprise to both outside observers and at least some
MRT members.  The group had originally planned to spend yesterday and
today discussing individual proposals and vote on a final package on
March 1st - next Tuesday.

Many of the 79 proposals to "redesign and restructure" Medicaid
represented conceptual goals or statements of strategic intent.  Much of
the meat of the MRT's work remains to be fleshed out in the form of
concrete policy and regulatory changes.   The new global cap on Medicaid
which would limit State expenditures to $15.109 billion and restrict
future growth to 4% annually, for example, will entail a variety of
monitory and enforcement mechanisms that have yet to be spelled out in
detail.  Similarly it remains unclear whether the 2% across the board
reduction in Medicaid spending will be met through a range of program
cuts already proposed as part of State agency spending plans - outside
of the MRT process - or would require a 2% across the board reduction in
rates paid to providers.

Behavioral health and substance abuse service providers were pleased
that the package included a proposal to implement Regional Behavioral
Health Organizations to coordinate care for individuals mental health
and substance abuse disorders.  These individuals are currently "carved
out" of mainstream Medicaid Managed Care plans.

"We are grateful that amidst a very unpredictable MRT process, one of
the outcomes is approval of plans for a Regional Behavioral Health
Organization carve out," said Harvey Rosenthal, Executive Director of
the New York State Association of Psychiatric Rehabilitation Services.
"The alternative, which would have turned over the care for tens of
thousands of New Yorkers with serious needs to generic health plans,
would have been disastrous for them and for the community recovery
network we have worked so hard to build.  This design should bring us to
a more integrated behavioral health system that links healthcare,
housing and supports.  We look forward to helping to shape that system."

"This is a victory," said Philip Saperia, Executive Director of the
Coalition of Behavioral Health Agencies.  "It was very important that
these services did not get folded into the Medicaid Managed Care plans."
At the same time, however, he stressed that there were considerable
details yet to be worked out with respect to how RHBOs would be
structured. "We are going to get time to plan the next phase," he said.
"It is important that we are at the table during that planning process."

Providers and advocates did raise concerns about several other
proposals.

One would impose utilization controls on behavioral health clinics and
reduce reimbursements levels if patients exceeded specified numbers of
visits during a 12-month period.  Claims that exceeded a lower threshold
number of visits would be paid at a 25% discount.  Claims that exceed
the higher threshold would be paid at a 50% discount.   The current
proposed lower and higher threshold levels of annual visits are 65 and
85 for OASAS programs, 30 and 50 for OMH programs and 90 and 120 for
OPWDD programs.   "This is awful," said Philip Saperia.  "This means
that certain high needs children and adults may not receive the care
they need... or that services will have to be provided at less than the
actual cost.  This is a rate cut."

Advocates also expressed concerns about a proposal that would restrict
patient and provider choice with respect to behavioral drug choices.

Yesterday's vote on the package of proposals had not been expected by
providers and advocates.   And, two MRT members objected to the decision
to end discussion - and possible further modification - of proposals
which had not previously been seen as a complete package of
recommendations.  Team members had initially scored a package of
preliminary 49 proposals, many of which were dropped from the staff
recommendations presented for consideration yesterday.  As a result,
more than half of the recommendations in the final package had not been
rated by the Team members prior to yesterday's meeting.

Assembly Member Richard Gottfried said that he was "shocked... At the
end of our first and it appears only opportunity to ask questions and
talk in an open forum... to be told there will not be an opportunity for
any modifications in the plan before a vote... I think it is
inappropriate."

Lara Kassel, Coordinator of Medicaid Matters New York, also objected. "I
feel unprepared and extraordinarily uncomfortable...  I walked into this
meeting today thinking this was a two day discussion with an opportunity
for a few days to mull things over, talk to some partners, consider some
of what is in the package, consider what a yes or no vote would mean."

Other MRT members felt that it was time for a vote. "A lot of work was
done over the last two weeks to bring the package into line with
concerns that had been expressed," said Ann Monroe, President of the
Community Health Foundation of Western New York.  "When it comes to an
up-or-down vote, I ask myself whether there is anything in the package
that would cause me to vote the whole thing down. The answer was no."
Monroe argued that the MRT had been able to reach its target without
recommending any real cuts to eligibility or services - things which
have been implemented in other States.

Ed Matthews, CEO of UCP of New York City, agreed.  "The proposals that
we had scored lowest -- the real 'deal breakers' that would have made
Medicaid recipients second, if not third class citizens - had been
dropped from the package.  People were talking about process, but i
didn't hear people say they had different ideas.  Most of us didn't see
where more debate would have gotten us to a different outcome."

 

http://www.nynp.biz/breaking-news/5332-mrt-ids-23-billion-in-saving-beat
s-deadline-by-a-week 

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