CNY HFMA
Turning Stone Resort and Casino
Verona, NY
March 12, 2015
Allan S. Filler
Senior Director of Policy Development
Iroquois Healthcare Alliance
Healthcare Alliance
IROQUOIS
Election Results
• Republicans gained clear,
but thin (32 Seats),
majority in State Senate
• Governor Cuomo wins reelection, but enters the
next four years with less
political clout than when
the campaign began.
• Assembly still strongly
Democratic (106
Members) but will be
affected by the sudden
change in the Speakership
Photo Credit: Chang W. Lee/The New York Times
Healthcare Alliance
IROQUOIS
NYC Leading Albany
Governor Cuomo
Commissioner Zucker
Attorney General Schneiderman
Speaker Heastie
NYC Mayor de Blasio
ALL ARE DEMOCRATS FROM NYC
Healthcare Alliance
IROQUOIS
Having a Little Legal Trouble
………Stay Tuned?
IROQUOIS
Healthcare Alliance
Wildcards
Opportunities/Challenges /Unknowns
• NYS Surplus= $525M operating and $5.8B in
one-time insurance settlements
• OPWDD audit liability of $1.26B with
additional audit periods possible (NYS
Appealing)
• Medicaid Global Cap Pressures - 6.2M
Medicaid enrollees (Approximately 33% of the
State)
Complex Health Policy Environment
• $10B Medicaid 1115 Waiver
(DSRIP)
• Medicaid Redesign Team
(MRT) and the Medicaid
Global Cap
• Mandatory Medicaid
Managed Care (MLTC,FIDA,
HARPs, DISCOs)
• New York State of Health
(Health Exchange)
• SHIN-NY
• UPL Dispute with CMS
• $100M State Health
Innovation Plan (SHIP)
• Population Health
Improvement Contractors
(PHIPs)
• All-Payer Claims Database
• Value-Based Payment
• Staffing Ratio Legislation
NYS Hospitals and Health Care Systems by the Numbers
• NYS Hospital Margins are the 2ndd Worst in
the Nation ( Congratulations Rhode Island!)
• ¾ of Hospitals have Fair or Poor Financial
Strength
• Infrastructure 9th Oldest in the Nation
• Nursing Home Margins Also among the Worst
in the Nation
Source: HANYS
2015-2016 Proposed Executive Budget
2015-2016 Proposed Executive Budget
• $1.9B in capital related grants to promote health care transformation
– $700M for capital non-operational in support of health care transformation in
Brooklyn
– $400M for debt retirement, capital and non–capital non operational projects
that facilitate health care transformation for essential community providers
(defined as hospitals or health care systems that in the discretion of the
commissioner offer services within a defined and isolated geographic region
– $300M to support health care transformation by creating and integrated
health care delivery system in Oneida County
– (30 Day Amendment) $500M for economic development projects to enhance
the economic benefits of health care facility transformation
* These funds are in addition to the $1.2B in capital funding in the 2014-2015
enacted state budget primarily related to DSRIP-Performing Provider Systems
Projects
2015-2016 Proposed Executive Budget
• Vital Access Provider (VAP)Program (All Funds)*
– Current VAP Funding in 2015-2016: $372M
– Transformational Operational Support: $500M
– Funding for Single Public PPSs: $80M
• Vital Access Provider (VAP) Program Sub-allocation- (All Funds)*
• $10M for rural and essential community providers (defined,
isolated geographic region). Eligible providers are hospitals, nursing
homes, D&TCs, ambulatory surgery centers and clinics.
• $7.5M for CAHs ($2.5M Increase from 2014-2015) and requires an
examination of permanent Medicaid rate methodology changes.
*Assumes resolution of UPL issues and full financial participation
2015-2016 Proposed Executive Budget
• $12M annualized ($9M in 2015-2016) for federally defined
Sole Community Hospitals (SCHs)
• Inpatient and/or Outpatient rate adjustment,
methodology/mechanism to be determined.
• Other Hospital Investments*:
– $91M for the establishment of a hospital quality pool
– $51M from the elimination of the Potentially Preventable
Negative Occurrence rate cut (PPNO)
– $19.2M from the elimination of the elective C-Section rate
cut
– $15M reduction in the across the board inpatient obstetric
services tax
2015-2016 Proposed Executive Budget
• Other Budget Provisions of Interest:
– Extends the DSH/Indigent Care Funding Methodology until
December 31, 2018. The transition adjustment (the maximum
percentage loss a hospital can experience in a year would
increase by 2.5% per year to 10% in 2016; 12.5% in 2017; and
15% in 2018
– Authorization of a private equity pilot program, limited to 5
demonstrations (non-publicly traded)
– Consolidation of 41 public health programs into 5 targeted
pools with each pool cut by 15% - The Public Health Workforce
Pool includes the Rural Health Development (Network and Care
Access) and Health Workforce Retraining Initiative
2015-2016 Proposed Executive Budget
• Requires 340B Providers to bill Managed Care
Organizations (MCOs) at Acquisition Cost (as
opposed to Charges) - reduces payments to 340B
providers by approximately $22M.
• Effectively eliminates MA co-payment for dually
eligible individuals for physician services in Medicare
Part B and for physicians, hospitals and others for
Medicare Part C- reduces MA spending by
approximately $90M.
• Statutorily authorizes MCOs and DOH to utilize valuebased payments.
Budget Requests
• IHA, in collaboration with others associations
is advocating for increased funding and
changes to the Doctors Across New York
(DANY) Program to further help address the
physician shortage upstate.
Governor Cuomo’s Proposed 30-Day Budget Amendments
"Notwithstanding any inconsistent provision of law, in order to complement and
enhance the fiscal management and programmatic integrity of the Medicaid program,
funds from this appropriation may not be spent unless the director of the budget has
notified the commissioner of health by March 31, 2015 that the legislature has
enacted a chapter or chapters of law that contains part B (sections 1-7, 11-14, 25-34
and 37), part D (sections 1, 2, 4-12, 14-15, 17, 20-24 and 29), part E and part F in a
form identical to legislation submitted by the governor pursuant to article VII of the
New York constitution as legislative bill numbers S. 2007-A/A. 3007-A.“
•
Governor Cuomo strongly pushing for his ethics packages, and teacher evaluation
system among other items including Medicaid investments and cuts
•
Possible but unknown effects of the Governor's amendments are : a late budget, a
constitutional court case, a government shutdown etc.
Delivery System Reform Incentive Payment
Program (DSRIP)
$8 Billion Medicaid 1115 Waiver
DSRIP
$6.4 billion
Interim Access
Assurance Fund
(IAAF)
$500 million
Health Homes
$190 million
Long-Term Care
Behavioral Health
$245 million
$646 million
State Health Improvement Plan
(SHIP)
State Health Improvement Plan (SHIP)
Population Health Improvement
Contractors (PHIPS)
PHIPS
• The Population Health Improvement Program (PHIP) will promote the
Triple Aim of better care, better population health and lower health care
costs.
• PHIP contractors each will work in one of several regions that together
will serve the entire state.
• PHIP contractors will convene stakeholders and establish neutral forums to
support strategic planning for identifying, sharing, disseminating and
helping to implement best practices and local strategies to promote
population health and reduce health care disparities in their respective
regions.
• In particular, the PHIP will help support and advance ongoing activities
related to the New York State Prevention Agenda 2013-2017 and the State
Health Innovation Plan and incorporate strategies to reduce health and
health care disparities.
• In December RFP applicants were awarded an average of $2.4M to serve
as the PHIP contractor in 10 regions of the state. (Finger Lakes HSA was
previously designated as the PHIP for the Finger Lakes Region)
• Capital District: Healthy Capital District
Initiative
$2,440,000
• Central New York: Health Advancement
Collaborative of Central New York, Inc.
$2,439,993
• Long Island: Nassau-Suffolk Hospital
Council, Inc.
$2,400,000
• Mid-Hudson: Taconic Health Information
Network and Community Inc. $2,434,685
• Mohawk Valley: The Mary Imogene Bassett
Hospital
$2,438,819
• New York City: Fund for Public Health in
New York Inc. $5,000,000
• North Country: Adirondack Health Institute
Inc. $2,440,000
• Southern Tier: STHL, Inc. $2,070,848
• Tug Hill Seaway: Fort Drum Regional Health
Planning $2,438,616
• Western New York: P2 Collaborative of
Western New York, Inc. $2,440,000
PHIPS
• DOH and the PHIPs are finalizing contracts and
are locating office space and staffing up.
• PHIPs underwent DOH orientation at the end
of January
• PHIPS will be reaching out to their stakeholder
communities over the next several months
and DOH will be monitoring these efforts
• PHIPs will also have individual websites where
they will provide further information on their
individual PHIP and their work plans.