On December 22, 2003, NYS Senate Majority Leader Joseph L. Bruno released the recommendations of the Senate Medicaid Reform Task Force. This past June, Senator Bruno had been charged with developing Medicaid cost-saving proposals. Below is a summary ofthe Task Force recommendations.
Disease Management: The Task Force recommends that the State develop pilot programs to test different disease management models for chronically ill Medicaid enrollees who are currently not required to be enrolled in Medicaid managed care plans.
Utilization Review: The Task Force recommends that the State strengthen current utilization review programs, including medical necessity reviews, the Medicaid Utilization Thresholds program, the Recipient and Provider Restriction Programs, and Drug Utilization Review. In addition, the Task Force recommends utilization review for nursing home residents (see the section on "Long Term Care" below).
Efficiency Through IT: The Task Force recommends that the State try to achieve efficiencies through the use ofinformation technology (IT),including piloting the use of computerized physician order entry systems at provider sites with high Medicaid patient loads, changing the State's Medicaid management system from primarily a claims payment system to one that manages care and conducts utilization review,and creating "smart cards"f or Medicaid recipients to cut down on fraud and abuse.
FHP, CHP, Medicaid Managed Care: The Task Force recommends reducing benefits under the Family Health Plus (FHP) program (no details provided), and imposing an asset test and copayments for FHP enrollees. The Task Force recommends enforcing "crowd out" provisions to discourage employers from dropping health insurance coverage for their employees and encouraging them to sign up for FHP as well as allowing individuals who are over the FHP eligibility guidelines to purchase FHP insurance at full cost. In addition, the Task Force recommends transferring certain children from Medicaid to Child Health Plus (CHP) to take advantage of the higher Federal matching rate available under CHP; allowing rural counties to require Medicaid recipients to enroll in managed care plans; standardizing Medicaid, CHP, and FHP plan requirements as well as administrative requirements imposed by plans on providers (a key recommendation of GNYHA); and creating medical savings accounts for Medicaid recipients to encourage more financial responsibility.
Transitional Care Units: The Task Force recommends a pilot program to allow hospitals to establish transitional care units for patients who cannot yet be discharged but no longer need acute care services. Transitional care units would enable hospitals to gain access to Medicare reimbursement for those services.
Tracking Provider Finances: The Task Force recommends creating an independent entity to monitor the financial stability of providers and to recommend ways for financially challenged institutions to restructure or reorganize before the State needs to step in with emergency financing.
Fiscal Relief to Local Governments: In order to relieve local governments of some of the economic responsibility for providing the local share of Medicaid, the Task Force recommends that the State assume the local share of FHP over two years, reallocate to the counties a portion ofexisting funding for facilitated enrollment of Medicaid clients into managed care, and authorize demonstration programs to facilitate local government innovation and approaches to managing Medicaid services. The Task Force also supports implementation of greater financial incentives for counties to perform asset recoveries, provision of better local access to State administrative data bases, and continued work on a Federal level to sustain more equity in the level of Federal Medicaid matching funds for New York.
EMS Dispatch Triage Fees and Field Treatment Programs: The Task Force recommends using demonstration programs to develop triage and treatment options that would discourage the use of ambulances for nonemergent care, particularly outside NYC, either by directing nonemergent patients to less costly forms of transport or by treating patients who do not need emergency services at the scene or in more appropriate settings.
Long Term Care: The Task Force recommends providing incentives for counties to more aggressively pursue asset recovery from individuals and couples who have inappropriately transferred assets in order to become eligible for Medicaid financed long term care services. The Task Force also recommends extending the "look-back period" (no details provided) within which assets cannot be legally transferred without penalty and applying look-back periods to non-institutional long term care services; restricting the ability of spouses to refuse to contribute financially to the cost of their spouses' long term care benefits; and examining the income and asset limits ofcommunity spouses. The Task Force also recommends expanding access to private long term care insurance plans by enhancing tax incentives and expanding benefits packages to include more services along the long term care continuum. The Task Force recommends further the acceleration of life insurance benefits and the use ofreverse mortgages to create more opportunities for private long term care financing. In addition, the Task Force recommends increasing recoveries from payers other than Medicaid and requiring Medicare appeals before Medicaid begins covering the costs oflong term care for eligible individuals. The Task Force recommends creating alternatives to nursing home care by filling in perceived "holes" in the spectrum of long term care services, including increasing the current 4,200 statewide cap on assisted living program slots, increasing access to the long term home health care program, creating a "cash and counseling" program to enable Medicaid recipients to choose a variety of long term care services, increasing use of adult day care, providing support for caregivers through respite care programs, expanding hospice care, expanding managed long term care and PACE programs, and enabling the creation of Continuing Care Retirement Communities. Finally, the Task Force recommends intensive utilization review to determine whether nursing home residents could be more appropriately served in alternate settings. In addition, the Task Force proposes allowing nursing homes to "right size" by converting nursing home beds to other uses. The Task Force also proposes single, uniform licensure so that a long term care provider could provide long term care services across the continuum with one license, and proposes a "single point ofentry" for all long term care services.
Regulatory Reform: The Task Force recommends that the State examine regulatory reforms to reduce paperwork for providers and local governments. The Task Force also urges a comprehensive look at the State's certificate-of-need system to determine how it might operate more efficiently.
Tort Reform: The Task Force recommends an examination ofthe State's tort system to determine whether tort reforms may help improve the efficiency ofthe State's health care system.
Pharmacy: The Task Force recommends that a preferred drug list and prior authorization be established to ensure effective use of drugs and maximize supplemental manufacturer rebates; that the use of generic drugs be expanded through physician and consumer education and amendment of the mandatory generic drug list; that the development of varied drug reimbursement rates reflecting differences in pharmacies' acquisition costs be explored; that a 14-day supply for first-time users of a long-term pharmaceutical be implemented; and that ways to avoid unnecessary waste of prescription drugs be explored. The State Senate Web site contains the full report at www.senate.state.ny.us, under "Senate Reports." If you have any questions, please call David Rich, Patricia Wang, or Scott Amrhein at GNYHA.