Redesign Medicaid in New York State
Medicaid Redesign Team
Update and Next Steps
Rising to the Challenge
The Coalition of Behavioral Health Agencies, Inc.
January 23, 2014
Jason A. Helgerson, Medicaid Director
NYS Department of Health
Agenda
1)
MRT Implementation to Date

Lowering Costs

Improving Quality
2)
Looking Ahead - Major Implementations
3)
Q&A
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MRT Implementation to Date
Are We Lowering Costs and Improving Outcomes?
The MRT is Bending the Cost
Curve
o
Lowered total Medicaid spending by $4 billion in Year 1.
o
Lived within the Global Spending Cap for two full years.
o
Finished Year Two $200 million under the Global
Spending Cap.
o
Thanks to the MRT the state was able to absorb a $1.1 billion
federal revenue loss due to a change in Medicaid financing for
DD services.
o
Savings has been especially significant in New York City.
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NY Total Medicaid Spending Statewide for All Categories of
Service Under the Global Spending Cap (2003-2012)
$48
Projected
Spending
Absent MRT
Initiatives *
$46
$44
$42
$4.6 billion
Estimated Savings
Aggregate
Spending $40
for all $38
Programs
(in Billions) $36
2011 MRT Actions
Implemented
$34
$32
$30
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Year
2003
# of
Recipients
Cost per
Recipient
2004
2005
2006
2007
2008
4,266,535 4,593,566 4,732,563 4,729,166 4,621,909 4,656,354
$7,635
$7,658
$7,787
$7,710
$8,158
$8,464
2009
2010
4,910,511 5,211,511
$8,493
$8,379
2011
2012
5,396,521
5,578,143
$8,261
$7,864
*Projected Spending Absent MRT Initiatives was derived by using the average annual growth rate between 2003 and 2010 of 4.28%.
NYS Managed Care Plans
#2 in the Nation
Example #1
o
National Committee for Quality Assurance (NCQA) analyzed New
York’s Medicaid health care plans against 76 different quality
measures.
o
NYS plans are especially successful when it comes to offering the right
type of care for common, costly diseases, for example:




o
Diabetes;
Childhood obesity;
Smoking cessation;
Follow-up care for the mentally ill.
NCQA found that New York is a national leader, second only to
Massachusetts.
Source: NCQA: http://www.ncqa.org/Newsroom/NYStateofHealthCare.aspx
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Health Homes Are Reducing
Inpatient Utilization & ER Use
Example #2
o
Health Homes are in their early days.
o
Patients with little or no historic connection to traditional
health care are benefiting the most.
o
Preliminary results are for Phase 1 and Phase 2 counties.
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HH Performance
Inpatient and ED Down Primary Care Up
Looking Ahead:
Major Implementations
Significant Implementations
1)
Affordable Care Act
2)
MRT Waiver Amendment
3)
FIDA Demonstration
4)
Behavioral Health Carve-in/HARP
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Affordable Care Act (ACA)
ACA Implementation & Medicaid
Administration Reform
o
o
The Affordable Care Act (ACA) is a tremendous opportunity
for New York State:

One million New Yorkers will gain access to health insurance;

Additional federal financing for Medicaid will help ensure program
sustainability;

Building a new health insurance exchange will allow the state to
phase-out the out-of-date WMS eligibility system.
New York operates its own exchange and we are using the
launch of the exchange to also facilitate the state takeover of
Medicaid administration from counties.
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ACA Implementation &
Enrollment to Date
o
587,486 New Yorkers have completed their applications and 328,796 have
enrolled for coverage since the launch of the Marketplace on October 1,
2013.
o
New Yorkers continue to enroll each day through the Marketplace, and
individuals who purchase their coverage directly are seeing premium rates
that are 53 percent lower than the rates in effect in 2013 for comparable
coverage.
o
The NY State of Health open enrollment period runs through March 31,
2014. New York is on track to meet or exceed its enrollment goal of 1.1
million people by the end of 2016.
o
NY State of Health Customer Service Center representatives have
answered nearly 463,000 calls since the launch of the Marketplace.
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MRT Waiver Amendment
MRT Waiver Amendment
o
We currently have a waiver amendment pending with CMS that
would allow us to reinvest $10 billion in MRT generated federal
savings back into New York’s health care delivery system.
o
The amendment is essential to both fully implement the MRT
action plan as well as prepare for ACA implementation.
o
The amendment, which requires federal approval, is a unique
opportunity to address the underlying challenges facing NYS health
care delivery:
 Lack of primary care;
 Weak health care safety net;
 Health disparities; and
 Transition challenges to managed care.
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Behavioral Health Opportunities
in Medicaid Waiver
DSRIP Program Opportunities to Reduce Avoidable Hospitalizations

Implementation of transitional care programs.

Integrated Delivery System focused on Evidence-Based Medicine and
Population Health.

Expand Use of Telemedicine and Telepsychiatry to underserved areas.

Integration of Behavioral Health into Primary Care setting (collaborative care
etc).

Increase access to specialty care (including mental health).

Development of evidence based medication adherence programs.

Development of Ambulatory Detoxification programs.

Development of inpatient transfer avoidance programs for nursing homes.
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Behavioral Health Opportunities
in Medicaid Waiver
Managed Care Contracting Opportunities

Development of 1915i programs including:
•
Psychosocial rehab; Community Psychiatric Support and
Treatment (CPST); Crisis and Mobile Crisis;
Empowerment services including Peer Supports;
Habilitation; Respite; Family Support and Training;
Employment and Education Support Services; and Self
Directed Services (Pilot).
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Behavioral Health Opportunities
in Medicaid Waiver
State Plan Opportunities


Health Home Development Fund including:

Member Engagement and Health Home Promotion;

Workforce Training and Retraining;

HIT Implementation – Clinical Connectivity; and

Joint Governance Technical Assistance and Implementation
Funds.
Health Home Development Funds will be distributed
through an application process.

Similar to the process employed for the Vital Access
Program.
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FIDA Demonstration
FIDA Demonstration
o
A key step in the move to “care management for all” is the
proposed Fully Integrated Dual Advantage (FIDA)
demonstration project.
o
Through this effort, over 120,000 dually eligible members
(Medicaid and Medicare) will be enrolled into full-integrated
managed care products.
o
The enrollment process will rely on a “conversion in place”
approach under which duals enrolled in MLTCP plans will see
their Medicare benefit added to their managed care plan’s
portfolio.
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Behavioral Health
Carve-In/ HARP
Goals: Behavioral Health
Transition
o
Key MRT initiative to move fee-for-service populations and
services into managed care.
o
Care Management for all.
o
The MRT plan drives significant Medicaid reform and
restructuring.
o
Triple Aim:



Improve the quality of care;
improve health outcomes; and
Reduce cost and right size the system.
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Behavioral Health Transition:
Project Status
o
Draft RFI/RFQ released (Adults)
http://www.health.ny.gov/health_care/medicaid/redesign/b
ehavioral_health_transition.htm
Comments were due 1/17/14
o
1115 BH Waiver Amendment (Adults)
o
Final amendment submitted to CMS December, 2013
o
Final RFQ scheduled for release February 2014 (Adults)
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Behavioral Health Transition:
Project Status
o
o
Public Outreach

Meet with MRT BH Workgroup early 2014.

Provider/plan readiness meetings anticipated:

February in NYC

March/April ROS
Implementation

Adults in NYC - January 2015

Adults in Rest of State - July 2015

Children - January 2016
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Next Steps
o
RFI comments were due January 17, 2014.
o
Performance metrics are in development and will be shared
with stakeholders in future.
o
Final RFQ scheduled for release February 2013 (Adults).
o
Implementation:



Adults in NYC - January 2015
Adults in Rest of State - July 2015
Children - January 2016
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2014-15
Executive
Budget
o
o
Reinvestment of Medicaid Savings and Rate
Protection to Preserve Capacity and
Access to Community-Based Services
2014-15 Executive Budget proposes to reinvest Medicaid savings for
Behavioral Health services to expand community-based services.

Pre Managed Care - Reinvestments for behavioral health programs
(target - critical inpatient programs) that may close, or have already
closed, will ensure that capacity is preserved in the impacted
communities as the State prepares for the transition to Managed Care.

Post Managed Care - Reinvestment under Managed Care for any
behavioral health savings for inpatient and other reductions to expand
community based services under HARPs/Managed Care including the
development of 1915(i)-like services.
The Budget also extends clinic rate protection and allows for flexible
rate alternatives if the plans, providers and the state agree.
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2014-15
Executive
Budget
$120 Million In Medicaid
Investments for Behavioral Health
Transformation Initiatives
Investment
MC Start-Up Funds: Funding for system readiness activities to develop the infrastructure
and capacity to facilitate the transition of behavioral health services for adults and children
into managed care
$20M
Integrated Care Initiatives: Enhancement to clinic reimbursement to support the
integration of behavioral and physical health and the implementation of collaborative care
model
$15M
Preserve Critical Access: Targeted Vital Access Provider (VAP) program to preserve critical
access to behavioral health inpatient and other services in certain geographic areas
OASAS Residential Restructuring: Establish a Medicaid service for clinical care provided in
OASAS Residential settings
Health Home Plus for AOT: Health Home Plus reimbursement for individuals receiving care
management under a court order for Assisted Outpatient Treatment (AOT)
1915(i)-like Services under HARPS: Funding for new 1915(i)-like services under the Health
and Recovery Plans (HARPs) based on a functional assessment including rehabilitation, peer
supports, habilitation, respite, non-medical transportation, family support and training,
employment supports, education, and supports for self-directed care
$40M
TOTAL
$120M
$5M
$10M
$30M
Questions?
Contact Information
We want to hear from you!
MRT website:
http://www.health.ny.gov/health_care/medicaid/redesign/
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http://www.health.ny.gov/health_care/medicaid/redesign/listserv.htm
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