NYSBHA Legislative and Political Update & Overview
January 2017

Albany Update, Reid, McNally & Savage

State Election Update

Members of the State Legislature returned to Albany on January 4th to begin the 2017 Legislative Session.  All Legislation introduced in the 2015-16 cycle must be introduced with new bill numbers.

Senate Majority Leader John Flanagan (R) and Assembly Speaker Carl Heastie (D) were unanimously re-elected to their leadership posts by their respective conferences. In the Assembly, the Democrats hold a supermajority. In the Senate, the majority will be ruled by an alliance between 31 Republicans, 8 Independent Democratic Caucus (IDC) members, and Democratic Senator Simcha Felder.  There are 22 “mainline” Democrats.

The Rules of the Senate were changed to allow the IDC leader, Jeff Klein, to share decision making on the final date of the Session and the schedule of Committee meetings. In addition, the new rules permit the IDC leader to influence which bills can be placed on the “active list” for a full vote by the house and to lay aside up to one bill for debate.

The Assembly and Senate announced new Committee Chair assignments. There were no changes in the Committees primarily impacting the Alliance. Assemblyman Richard Gottfried remains the Health Committee Chairman. In the Senate, Senator Kemp Hannon will continue to Chair the Health Committee. In addition, Senator James Seward is the Chair of the Insurance Committee. 

Medicaid Managed Care (MMC) Carve-In

School-Based Health Centers (SBHCs) are scheduled to be carved-in to the Medicaid Managed Care program on July 1, 2017. Initially scheduled for October 2014, the Carve-In date has been extended 3 times due to the Advocacy efforts of the Alliance and the help of the New York State Legislature.

Since February 2013, the Alliance has met regularly with the New York State Department of Health (NYS DOH) and various stakeholders in Work Group meetings to develop a Policy Paper which will serve as guidance for the implementation of the Carve-In.  Work Group members include representatives for health care plans, hospitals, community health centers, the New York City (NYC) Health Department, pediatricians, teacher unions, and dental and behavioral health vendors.

The Policy Paper was finalized at the end of 2016. The next steps include the development of a Frequently Asked Questions (FAQ) document and meetings of “Sub Work-Groups” to tackle specific areas of the implementation phase including: Contracting and Credentialing; Billing/Claims; and Quality Improvement/Utilization Management/Care Coordination. The Alliance has one or more members on each of the Sub Work-Groups.

It is important to note that NYS DOH expects SBHC sponsoring organizations to begin the contracting and credentialing process immediately in order to implement the Carve-In by July, 2017.

Provided below are some highlights from the Paper Policy Paper. For a more in-depth description please see the attached PowerPoint slides from NYS DOH.

  • ·         MMCPs must reimburse SBHCs at the current applicable fee-for-service rate for the two-year transition period from July 1, 2017 to June 30, 2019.

  • ·         Throughout the transition period and continuing thereafter, SBHCs sponsored by FQHCs that do not participate in APGs will be reimbursed utilizing the Prospective Payment System (PPS) rate and wrap around rate.

  • ·         Children in an on-going course of care may continue their course of treatment until January 1, 2018.

  • ·         The current model of comprehensive physical and mental health services will be preserved.
  • ·         No SBHC will be required to be a Primary Care Provider (PCP) as a condition of participation.
  • ·         Students will have direct access to all services provided by SBHCs without the need for referral or prior authorization (PA) with exceptions for certain dental and behavioral health services.
  • ·         Family planning and reproductive health care services will be “carved-out of the MMC benefit.

  • ·         Health plans must contract with all SBHC sponsors in their service area who are willing to contract with the MMCP. MMCPs will assist SBHCs in securing contracts with their sub-contracted benefit vendors, e.g. dental and behavioral health vendors.

  • ·         SBHC sponsors are required to contract with all MMCPs in their service area. For benefits managed by subcontractors the sponsor will be required to contract with subcontractors identified by the MMCP. FQHCs are exempt from this requirement since they may elect to participate in the Medicaid Fee-For-Service system.

  • ·         MMCPs must have a process in place to ensure timely credentialing of SBHC providers. MMCPs are required to have a process in place to expedite credentialing where the SBHC indicates access to care for the enrollees will be adversely impacted or interrupted by the standard credentialing time frames.

New Funding Methodology: Basic Grant

The Department of Health is poised to issue a new Request for Proposal (RFP) for $12.2 million in non-Medicaid, “basic grant” funding. The RFP awards were last made in 2006 with contract awards expiring in 2011. Since 2011, NYS DOH applied for and received contract extensions from the NYS Controller’s Office.  The current contract extension expires on June 30, 2017..

The Alliance met with NYS DOH in early July at their request to discuss a new funding methodology for the distribution of the basic grant funds to centers.  In order to provide a response, the Alliance established a Task Force of a diverse group of large, small, mid-sized, urban, suburban, rural, Upstate and Downstate programs. This Task Force developed a set of recommendations for a new funding methodology as follows:

  • 50% of the $12.2 million distributed statewide equally by site, excluding 12 sites in New York City (NYC) that receive City grants

  • 50% of the funds distributed statewide based on “billable” visits.

  • Allow adjustment of the staffing requirements downward for programs with between 150 and 350 enrollees to lower costs to small programs. 

The letter from the Alliance to NYS DOH provides a more in-depth description of our recommendations.

2017 Advocacy Efforts

Mark your calendars for the 2017 Advocacy Day to be held on Tuesday, February 7th in Albany, New York. The Alliance has already begun to work on the 2017 Advocacy Agenda with a day of meetings held in Albany on October 18th with NYS DOH, the State Division of the Budget, top aides to the Assembly Speaker, the Senate Majority, and Assembly Health Committee Chairman Richard Gottfried. Meetings with staff to Governor Cuomo and others are planned for February 7th.

P.O. Box 8324, Albany, NY 12208   518.694.3423    nysbha@gmail.com    ©NY School-Based Health Alliance, Inc.
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