NYS Dept. of Health Resumes Opt-Out Mailings to Medicaid Members The NYS Dept. of Health will resume a mailing this month to new Medicaid members to explain the Delivery System Reform Incentive Payment (DSRIP) program´s statewide efforts on healthcare system change and how Performing Provider Systems (PPS) use Medicaid data to improve patient care. The letter will also review the option to not have the member’s data shared by the PPS with provider partners, known as “opting out.” The last mailing of this nature took place in August 2016 and did not continue due to vendor procurement processes. Any new members since that time have been automatically opted out until a new mailing to notify them of the choice to opt-out could be completed. This new mailing will begin the week of February 19, 2018. Approximately 2 million Opt-Out letters will be sent to Medicaid members who became eligible since August 2016. Smaller mailings to new members as they become eligible for Medicaid will continue on a monthly cadence through 2019.
PPSs are responsible for working to improve health outcomes for their Medicaid members, who are seeing the physicians and providers in the PPS. Data sharing of available Medicaid information is key for effective collaboration among the lead PPS and related network partners for providing and coordinating services to Medicaid members. Data-sharing is very important to getting services to patients and in achieving quality performance and clinical outcomes.
If a Medicaid member agrees to data sharing within the DSRIP program, he/she does not have to take any action and, except for claims related to substance abuse diagnoses and treatment, his/her data will be shared with the PPS. There have been no changes made to how a Medicaid member seeks care or to Medicaid member benefits. If a member chooses to opt out, he/she must sign and return the form sent in the mail or call the Medicaid DSRIP Opt Out Helpline at 1–855–329–8850.
Please see below for important information to help explain DSRIP data sharing and Opt Out:
Click here to access copies of the Opt Out Letter and accompanying form in English, Spanish and 18-Point Font.
A webinar and accompanying slide deck explaining Opt Out is available here.
The Medicaid call center is open to receive questions regarding the content of this DSRIP mailing: 1–855–329–8850.
VBP Bootcamp Materials Now Available Online The NYS Dept. of Health has posted all VBP Bootcamp materials, including the webcast recording of the Albany Bootcamp session, all course presentations, and supplemental materials.on its website. Information regarding additional VBP University semesters will be released in the near future. In the meantime, please continue to complete semesters 1-3 and corresponding quizzes to receive a certificate of completion. Certificates will be sent via email on a quarterly basis. Remember to keep the VBP conversation going online by following @NewYorkMRT on Twitter and using the hashtag #NYSLearnsVBP in your social media posts. Please send any questions to VBP@health.ny.gov.
NYS Dept. of Health Announces Availability of Statewide Health Care Facility Transformation Program II Funding On January 8th, the NYS Dept. of Health announced the availability of funds under the Statewide Health Care Facility Transformation Program II. A total of up to $203,782,888 is available through Request for Applications (RFA) #17648 to health care providers that are deemed by the Commissioner to fulfill or will fulfill a health care need for acute inpatient, outpatient, primary, home care or residential health care services in a community. A minimum of $46,995,507 of this total amount is available for community-based health care providers, which are defined as diagnostic and treatment centers, mental health and alcohol and substance abuse treatment clinics, primary care providers and home care providers. Applications must be submitted in Grants Gateway no later than 4:00 p.m. EST on Wednesday, March 14th. An informational Applicant Webinar will be held on Wednesday, January 31st from 10:30 a.m.-12:00 p.m. To register, click here. Questions regarding the Statewide Health Care Facility Transformation Program II are due by February 9th and should be submitted via e-mail to Statewide2@health.ny.gov.
State Submits Draft Transition Plan for Children’s Medicaid System Transformation to CMS New York State submitted a draft transition plan for Children’s Medicaid System Transformation to the Centers for Medicare and Medicaid Services (CMS) on November 17th - click here to access it. A webinar designed to assist stakeholders in reviewing the document has been scheduled for December 1st from 12:00 – 1:30 p.m. To register, click here.
Recent VBP Social Determinants of Health Webinar and Materials Materials from the NYS Dept. of Health’s August 25 webinar on VBP Social Determinants of Health and Community Based Organizations are now online here. These include a PDF copy of the webinar deck, the live recorded video of the webinar, the Empire Supportive Housing Intervention Video, God’s Love We Deliver Intervention Video and the Social Determinants of Health Intervention Template. Items mentioned during the webinar that the DOH is working to release in the near future include:
Further guidance related to Tier 1 CBOs, including a listing of New York State Tier 1 CBOs
Release of a Q&A document related to VBP SDH and CBOs based on the questions received before and during the webinar
Stakeholder Meetings on the Future of Integrated Care in New York State In July, the NYS Dept. of Health’s Division of Long Term Care, together with the Centers of Medicare and Medicaid Services (CMS), convened a stakeholder meeting on the future of integrated care in New York State. This was a kick-off meeting for a broader stakeholder process that will occur this fall. DOH is seeking active participants for a Future of Integrated Care Stakeholder Work Group, which will meet four times over the next few months as a means for DOH and CMS to gather input and have discussion with stakeholders about various elements of program design. Stakeholders are invited to either attend the meetings in person or via webinar/conference call. Due to space limitations, only two people from each organization or association will be permitted to attend in person. There is no limit on the number of people who will be able to join the webinar/conference calls. Each meeting will be structured to cover select topics. For each topic, there will be a brief presentation followed by discussion. Click here to view the schedule and proposed agenda of topics for each session. Those wishing to participate in today’s (September 7) session via webinar/call should click here to register.
The First 1,000 Days on Medicaid On July 20th, Medicaid Director Jason Helgerson announced a new focus for Medicaid redesign in New York: The First 1,000 Days on Medicaid initiative. “Those first few years are so important,” said Helgerson. “If we do a better job of trying to influence the lives of our youngest children, we can prevent so much cost, so much misery, so many problems in the future.” The First 1,000 Days on Medicaid initiative will be a collaborative effort, bringing together stakeholders in a series of four work group meetings between August and October. The work group will be charged with developing a ten point agenda to focus on enhancing access to services and improving outcomes for children on Medicaid in their first 1,000 days of life.
The First 1,000 Days on Medicaid work group will chaired by the Chancellor of the State University of New York, Nancy Zimpher, a national leader in educational issues and cross-system collaboration. Vice chairs will be Kate Breslin, President and CEO of the Schuyler Center for Analysis and Advocacy, and Jeffrey Kaczorowski, MD, Senior Advisor, The Children’s Agenda, and Professor of Pediatrics, University of Rochester. The group will be built off the successful work and membership of the Value Based Payment Advisory Group on Children’s Health. Other partner organizations will include the United Hospital Fund, Center for Health Care Strategies, and The Albany Promise.
Helgerson’s announcement was made at the United Hospital Fund’s annual Medicaid conference, and can be found here. The first meeting of the group will take place in early August.
VBP University The NYS Dept. of Health has launched VBP University, an online, educational resource designed to raise awareness, knowledge and expertise in the move to Value-Based Payment. VBP University combines informational videos and supplemental materials that stakeholders can use to advance their understanding of this massive transformation effort. Click here to watch NYS Medicaid Director, Jason Helgerson present an overview of the curriculum. Additional information is available here.
2017 VBP Quality Measures Now Online The NYS Dept. of Health has updated the DSRIP – VBP Resource Library to include the VBP Quality Measure Sets for Measurement Year 2017 for the following VBP Arrangements:
Total Care for the General Population/Integrated Primary Care (TCGP/IPC) Quality Measure Set
Health and Recovery Plans (HARP) Quality Measure Set
The measure sets provide a high-level overview of the process for measure set development as well as the listing of measures for the 2017 Measurement Year, and they include all Category 1 and Category 2 measures for use in contracting between Managed Care Organizations and VBP Contractors E-mail DSRIP@health.ny.gov with any questions.
CMS Approves VBP Roadmap Update The Centers for Medicare & Medicaid Services (CMS) has approved the State’s annual update to the Value Based Payment (VBP) Roadmap. The most up-to-date version of the Roadmap may be viewed here.
$700M in Health Care Facility Transformation Funds Available for Kings County Providers The NYS Dept. of Health recently announced the availability of funds under the Health Care Facility Transformation Program: Kings County to strengthen and protect continued access to health care services in communities within Kings County whose residents are experiencing significant levels of health care disparities and health care needs compared to other communities within the county. A total of up to $700 million is to one or more Kings County health care providers, including FQHCs, in support of projects that replace inefficient and outdated facilities as part of a merger, consolidation, acquisition or other corporate restructuring activity intended to create a financially sustainable system of care. Applications are due by 4:00 p.m. EST on May 5. For more information, click here.
CBO Planning Grant Reissue for the Long Island/Mid-Hudson Region The NYS Dept. of Health, Office of Health Insurance Programs is reissuing the Community Based Organization (CBO) Planning Grant Request for Applications (RFA) for the Long Island/Mid-Hudson Region only. This RFA is intended to solicit applications for grants to assist CBO Consortiums in planning activities to identify business requirements and formulate strategies for both short-term needs and longer term plans that they may envision for sustainability in system transformation. The opportunity will allow CBOs to better position themselves for continuing engagement with PPSs in DSRIP projects, and consequently, value-based payment and contracting. The maximum funding amount for this opportunity is $2,500,000. To learn more, click here.
NYS Dept. of Health Releases Integrated Care Workgroup Final Report New York State’s Integrated Care Workgroup (ICWG) released its final report in late December. This report summarizes the work of the ICWG, charged with designing a statewide model for primary care referred to as Advanced Primary Care (APC), over the past year and a half. To access the report,click here.
NYS Dept. of Health Finalizing Provider Contract Guidelines The NYS Dept. of Health is in the process of revising its Provider Contract Guidelines for MCOs, IPAs and ACOs to reflect value-based payment arrangements. It is expected that the final version of the Guidelines will be released within the next few weeks. In the meantime, click here to access the most recent draft.
DOH Releases Shared Space and Co-Location Guidance The NYS Dept. of Health (DOH) recently releasedguidance on shared space and co-location arrangementsbetween two or more providers. Please take a look and contact Lacey Clarke with any issues or comments you may have. CHCANYS is continuing its work to ensure that FQHCs are able to easily create integrated care models, and your feedback will assist us in our ongoing conversations with DOH on this issue.
Value Based Payment Bootcamp: Registration Open for Region 5 Registration for the Value Based Payment (VBP) Bootcamp Series in Region 5 (Queens and Long Island) is now open. Registration is required to attend these sessions in person and may be accessed here. For those who are unable to attend the Bootcamps in your region, Sessions 1, 2, and 3 of Region 1 (Capital region, Mid-Hudson, and the Southern Tier) are available for playback at any time here. While recorded in Region 1, the content is applicable statewide. In addition, the presentation materials from each session can be accessed in theVBP Library. For a complete repository of information related to the VBP Bootcamp series, please visit the VBP Bootcamps webpage.
CMS Approves LARC Reimbursement for NYS FQHCs The Centers for Medicare and Medicaid Services (CMS) recently approved the NYS Dept. of Health’s (DOH)State Plan Amendmentseeking to carve out reimbursement for long-acting reversible contraceptive (LARC) devices from the FQHC PPS rate. Once guidance has been published in the Medicaid Update, FQHCs will be able to receive reimbursement for the acquisition cost of LARC devices in Medicaid retroactive to April 1, 2016. In order to receive reimbursement, an FQHC must be enrolled as an order ambulatory provider. DOH is currently drafting implementation and billing procedure details, which they anticipate will be included in the September Medicaid Update.
Statewide Health Care Facility Transformation Program Application Deadline Extended to September 28 The application deadline for Statewide Health Care Facility Transformation Programfunding has been extended to. September 28 at 4:00 p.m. ET. The NYS Dept. of Health has also released an Addendum that explains a technical issue encountered in completing the Capital Budget in Grants Gateway; click here to view it. Through this program, a minimum of $30 million in funding is allocated for community-based providers, including FQHCs, mental health and alcohol and substance abuse treatment clinics, and home care providers. This is the first time that the State has earmarked capital funding in the budget specifically for community-based providers, and CHCANYS encourages all interested parties to apply.
2015 AHCF Cost Report Submission Deadline Extended The Division of Finance and Rate Setting (DFRS) of the NYS Dept. of Health has extended the deadline for the submission of the 2015 AHCF Cost Report to October 1, 2016. The report will be used to calculate a January 1, 2017 APG clinic capital rate. There have been no changes to the report requirements since last year. Please note that DFRS will be unable to provide an additional extension beyond the October 1 deadline, as time must also be allotted for processing, review, noticing to providers, approval of the January 1 rates by the Dept. of Health and NYS Division of the Budget, and preparation of any distributions developed from the cost report data.
New Legislation Enacted to Limit Initial Opioid Prescribing to a 7-Day Supply for Acute Pain To further reduce overprescribing of opioid medications, effective July 22, 2016, initial opioid prescribing for acute pain is limited to a 7-day supply per New York State Public Health Law section 3331, 5. (b), (c). Click here for additional details on this legislation recently shared by the NYS Dept. of Health.
New SNAP Time Limits Leave Vulnerable New Yorkers Without Food Assistance Thousands of New York State residents began losing SNAP benefits in June due to a federal rule that places a limit on how long certain unemployed, childless adults referred to in federal regulations as able-bodied adults without dependents (ABAWDs) are eligible to participate in SNAP. Under the time limit rule, those considered ABAWDs may only receive SNAP benefits for a total of three months in a 36-month period, unless they live in a waived area, meet an exemption, or are already meeting work requirements.
Medical professionals can help maintain benefits for those who are affected by this rule, but may be unable - or “unfit” - to work, by documenting a medical condition that limits an individual’s ability to meet the work requirement.
Those at risk of losing benefits include SNAP recipients who are between 18 and 49 years old, are not certified as disabled, do not have children under 18, and are not working at least 20 hours a week. These are particularly vulnerable individuals with limited earning potential, low job skills, transportation or language barriers, and limited access to medical services. Many of the people who fall into this group can’t work 20 hours a week, due to an undocumented temporary or permanent physical or mental condition.
Medical professionals can help these individuals to keep needed SNAP benefits by documenting their condition on a medical statement (with FAQ for Medical Providers)created by Hunger Solutions New York, a statewide anti-hunger organization. This form is designed as a template, but any medical statement signed by a healthcare provider should be accepted by most SNAP offices. The standard of unfitness for exemption from the SNAP time limit does not require a diagnosis or medical records.
Patients with a reduced ability to work who qualify for this exemption include those who have difficulty maintaining focus and concentration for two hours at a time, including difficulty with consistently remembering and carrying out tasks.
Others who qualify have mild or moderate anxiety, depression or a maladaptive personality that reduces their ability to work 20 or more hours a week. The symptoms do not need to be “marked” or “severe.”
Also qualifying for the exemption are people who have a physical condition that limits them to light or sedentary work, who cannot stand or walk for extended periods of time, or who cannot engage in physical labor on a sustained basis.
Healthcare professionals simply need to fill out and sign a medical statement to verify that a patient has a reduced ability to work based on his or her condition. The form is then returned to the patient to provide to his or her local SNAP office.
A variety of professionals can sign the form, including: a doctor, doctor assistant, representative of the doctor’s office, a nurse, nurse practitioner, licensed or certified psychologist or social worker.
More resources for helping people considered ABAWDs are available on Hunger Solutions New York’s website. They include a fact sheet, a checklist to screen for exemptions, a flyer for SNAP recipients, a sample medical statement with frequently asked questions for providers, and more.
If you have a patient who needs help understanding how SNAP time limit rules apply, here are some additional resources:
To find the local SNAP/HRA office in your community: Outside New York City, dial 800-342-3009 In New York City, dial 311.
Nutrition Outreach & Education Program (NOEP) provides assistance with SNAP applications or more information about SNAP time limits for individual clients. To find a local NOEP Coordinator, go to FoodHelpNY.org.
Medicaid Matters Survey: Engagement of Community-Based Organizations in DSRIP Medicaid Matters New York (MMNY), the statewide coalition that advocates on the interests of Medicaid beneficiaries, is conducting a survey to assess the degree to which Community-Based Organizations (CBO) are engaged in DSRIP. Community-based entities of any type, in any part of New York State, are encouraged to complete the survey. The results will be used to help MMNY assess what the needs are around the state for advancing community interests in local DSRIP regions. It will also allow MMNY to conduct state-level advocacy to ensure that the DSRIP process engages CBOs in ways that recognize their strengths and address barriers to their participation. To access the survey, click here.
VBP Regional Bootcamp Learning Series The NYS Dept. of Health (DOH) has launched a Value-Based Payment (VBP) Regional Bootcamp Learning Series in an effort to ensure a successful transition to VBP implementation. Geared toward all parties planning to implement Medicaid payment reform but designed specifically for those with little to no experience in executing value-based contracts, the bootcamp series is open to the public free of charge and will take the form of three all-day sessions in each region. Scheduling information, training agendas and additional details are available on DOH’s new VBP Bootcamps web page.
NYC Mayor Releases Plan for Strengthening and Transforming Health + Hospitals Last week, NYC Mayor Bill de Blasio released a new report outlining strategies for strengthening and transforming the Health + Hospitals health system and for addressing a FY16 operating gap currently projected at $600 million. To access the report, click here.
Update: Wrap for Essential Plan Members The NYS Dept. of Health (DOH) has become aware of an issue preventing FQHCs from billing the supplemental payment rate (rate code 1609) for the Aliessa population (former Medicaid) enrolled in the Essential Plan (EP). DOH is working with CSC to add rate codes 1609, 4026-4028 to a bypass edit which will allow these claims to pay. This edit will be effective from April 21, 2016, at which time providers will able to submit or resubmit claims for these rate codes for EP Aliessa members retroactive to January 1, 2016 by utilizing delay reason code 3. Please contact firstname.lastname@example.org with any questions.
Value Based Payments (VBP): An Introduction The NYS Department of Health recently announced the release of “Value Based Payments (VBP): An Introduction,” a video available in both English and Spanish that explains what value based payments are, the important role that they play within the NYS Medicaid program, and how they will help improve patient outcomes. To access the English version, click here. To access the Spanish version, click here.
PCMH Rate Changes Delayed Thanks to our advocacy efforts and collaboration with the Primary Care Development Corporation, the NYS Department of Health has announced that they will delay the rate reductions for Patient-Centered Medical Home recognition under the 2011 NCQA standards until January 2016 instead of April 1, 2015, as previously proposed. Payments for PCMH 2014 standards will be increased as of January 2016.
The delay in rate reductions for PCMH 2011 will give FQHCs the extra time necessary to achieve the 2014 standards and will ensure that health centers are able to continue providing high quality community-based primary care services.
More detailed information on the new PCMH rates, to be implemented in January 2016, is available here.
CHCANYS is on Facebook! CHCANYS is now on Facebook – follow our page for important announcements and links to articles of interest to New York’s FQHCs. Have a photo or a story to share? Send it our way so that we can help spread the word to our online community. Contact Kate Graetzer at email@example.com with your contributions and feedback.