MRT II Issues Final Recommendations

Stephen Hanse and Allison Gold in Finance & Reimbursement

The MRT II conducted its final meeting today and issued approximately 40 recommendations to the Governor and the Legislature.  At the start of the meeting, Robert Mujica, the State’s Budget Director, noted that the Federal Relief legislation will provide an increase in the FMAP and that these increased funds will result in several of the recommendations being changed, delayed or modified in some manner. Recommendations forwarded by the MRT II include the following:

  • Recommend the Executive redefine the Medicaid Global Cap as part of the FY 21 budget to reflect developments which have occurred since the State first enacted the cap in 2011. This would increase the amount of total spending under the Global Cap thru modifications in the base on which spending growth is calculated as well as potential increases in the annual growth metric.
  • Increase the Across the Board Medicaid payment reduction from 1.0 percent to 1.875 percent for the next two fiscal years.
  • Reduce nursing home capital reimbursement by 5 percent and eliminate funding associated with “return on equity payments.” (Note: NYSHFA is seeking clarification, as “return ON equity” was eliminated in MRT I). The proposed reduction is consistent with the MRT IIs proposal to reduce hospital capital reimbursement. 
  • Implement significant changes to the State’s CDPAP program, including changing eligibility criteria for Personal Care Services (PCS) and Consumer Directed Personal Assistance Program (CDPAP) and Eligibility Criteria for Enrollment in MLTC Partial Plans. 
  • Institute a Home and Community Based Eligibility Lookback Period of 60 Months (consistent with 60-month SNF look-back) for asset transfers in determining eligibility for Medicaid for those seeking home and community based long-term care services and supports as currently applies to those seeking Medicaid eligibility for nursing home care.
  • Promote workforce training and support initiatives to address workforce shortages and greater reciprocity to out-of-state but nationally credentialed professionals. 
  • Cap Statewide MLTC Enrollment Growth at a Target Percentage: Under this proposal, the State would establish a target growth rate for individual partial capitation MLTC plans. The State would withhold a percentage of the premium from MLTC premiums, which plans could recoup provided that actual enrollment growth did not exceed the target. MLTC plans would need to manage their business in order to not exceed the enrollment target, or they would forfeit some of the withheld premium amount. 
  • Expand telehealth services and reimbursement to address behavioral health, oral health, maternity care and other high-need populations. This proposal contemplates a statewide hosted telehealth platform to help mitigate interoperability barriers, as well as to enhance broadband to ensure telehealth connectivity in rural areas. 
  • Modernize Medicaid information technology and expand access to data to integrate claims and clinical data and strengthen program integrity efforts. Adoption of this proposal would also streamline the patient data-sharing consent process to promote data exchange among providers. 
  • Eliminate Spousal and Legally Responsible Relative Refusal to eliminate the 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.

Additional MRT II recommendations also include a general restructuring of the Medicaid program, a continuation of special focus advisory groups, and continuing to explore proposals submitted to MRT II but are not ready to be implemented at this time.

Although many of our NYSHFA/NYSCAL recommendations were accepted by the MRT II, NYSHFA/NYSCAL continues to oppose any increases in the ATB Medicaid payment reduction or any cuts to nursing home capital reimbursement.

NYSHFA/NYSCAL CONTACTS:

Stephen B. Hanse, Esq.
President & CEO
518-462-4800 x11

Allie Gold, Esq.
Director of Policy & Reimbursement
518-462-4800 x25