At a Managed Care Policy Meeting held last week with managed care plans, New York’s Medicaid Director, Jason Helgerson, spoke about the importance for plans to submit timely and accurate encounter data. He noted that managed long term care plan submissions are particularly late. He indicated that if the lack of reporting continues there is the possibility that Statements of Deficiencies (which can result in halting enrollments) will be issued and that the Department of Health will consider referrals to the OMIG for investigation and audit. The plans responded by explaining that the challenge, in part, is that they are not receiving the required information from the providers (home care, nursing facilities, adult day health care, etc). Continue reading
New York State Governor Andrew Cuomo has made three major appointments to top posts in the state’s health-related agencies. The Governor today announced that he has appointed Courtney Burke as the Deputy Secretary for the New York State Department of Health, Laurie Kelley as the Acting Commissioner of the Office for People with Developmental Disabilities (OPWDD), and Dr. Ann Sullivan as the Acting Commissioner of the Office of Mental Health (OMH). The Governor’s announcement indicated that he intended to nominate both Ms. Kelley and Dr. Sullivan as Commissioners of their respective agencies in the next legislative session.
If confirmed by the Senate, Ms. Kelley would replace Ms. Burke at OPWDD, while Dr. Sullivan would replace Kristin Woodlock, the current Acting Commissioner at OMH. Dr. Sullivan will take over at OMH in November of 2013; beginning at the end of July and until November, John Tauriello, Esq., will serve as Acting Commissioner for OMH.
The Governor’s release may be viewed here: http://www.governor.ny.gov/press/07192013-omh-opwdd-deputy-secretary-appts
The Medicaid Redesign Team (“MRT”) Affordable Housing Work Group has allocated $86 million in 2013-14 to fund various supportive housing initiatives throughout the state. The Notice of Funding Availability is available here. Of this amount, $36.376 million is targeted to expand supportive housing units for high cost Medicaid populations. These funding opportunities can be found on the MRT website, as well as on the HCR and OTDA websites. Continue reading
The Office of Children and Family Services announced that funding is available under the Federal Social Services Block Grant for health and human service providers impacted by Superstorm Sandy. In total, $200,034,600 in federal Superstorm Sandy Social Services Block Grant (Sandy SSBG) funding will be distributed through a solicitation for proposals. Sandy SSBG resources are dedicated to covering necessary expenses resulting from Superstorm Sandy, including social, health and mental health services for individuals, and for repair, renovation and rebuilding of health care facilities, mental hygiene facilities, child care facilities and other social services facilities. Continue reading
The managed care company WellPoint Inc. has reached a Resolution Agreement with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) to settle allegations that it violated the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules. WellPoint agreed to pay $1.7 million in connection with this settlement. The OCR enforces federal standards governing the privacy of individually identifiable health information, including the standards that cover the security of electronic individually identifiable health information. Continue reading
Following confirmation of Jeffrey Wise as the head of the Justice Center for the Protection of People with Special Needs (“Justice Center”), the Department of Health released a Dear Administrator Letter concerning new requirements that the Justice Center will enforce. The Department has indicated that it will communicate with covered facilities about compliance with the Justice Center’s new rules.
All custodians of people with special needs—which includes directors, operators, employees, volunteers of a facility or provider agency—must read and sign a Code of Conduct, which should have been sent to all affected institutions on June 11, 2013. Each custodian must read and sign the document by June 30, 2013, when they are hired or begin working for the facility, and once a year after that. The facility must retain copies if these signed documents on file.
The Justice Center will staff a 24-hour hot-line to receive reports about the safety of people with special needs. If the Justice Center receives a call, it will then contact the facility involved. If the administrator is not present in the facility, a responsible person must be designated to act on behalf of the operator during the administrator’s absence concerning the health, safety, comfort and well-being of residents. Although it is not clear from the law itself that this designated responsible person is the contact person for the Justice Center, it does seem clear from the DAL that covered facilities should expect that if the Justice Center calls when the administrator is not on site, they will expect a responsible person to know to field the call.
Posters concerning the hot-line were mailed to providers on June 21, 2013, and should be displayed prominently, replacing old Commission on Quality of Care and Advocacy for Persons with Disabilities (CQC) Helpline posters to avoid confusion. The hot-line posters must be displayed by July 1, 2013.
Earlier this week a team from New York State’s Office of Mental Health (OMH), Office of Alcoholism and Substance Abuse Services (OASAS) and the Department of Health (DOH) presented a webinar describing progress made on managed care program design activities intended to bring behavioral health into Care Management for All. Care Management for All is a program proposed by the Medicaid Redesign Team (MRT) that is supposed to improve benefit coordination, quality of care, and patient outcomes over a range of health care services. Continue reading
At its recent meeting on June 13, 2013, the N.Y.S. Department of Health Medicaid Managed Care Advisory Review Panel (MMCARP) was updated about enrollment in Managed Long Term Care. DOH staff announced that enrollment across the state in 3 types of managed long term care plans has crested the 100,000 mark. The partial caps, PACE and MAP are the 3 types of Plans available to those who are Medicaid and Medicare eligible, over 21, and in need of more than 120 days of community based long term care services. Enrollment is now mandatory in New York City, Nassau, Suffolk and Westchester. Notice letters will be going to residents of Orange and Rockland Counties this week. In December 2013, DOH will begin mandatory enrollment in Albany, Erie, Monroe and Onondaga Counties. There are currently 24 partial cap plans, 8 PACE plans and 10 MAP plans approved to operate in various counties throughout the state. With mandatory enrollment beginning last September in NYC, this Medicaid program has doubled in size.
This post was contributed by Carla Williams.
The Office of the New York State Comptroller (OSC) has just announced that it will be conducting an audit of the New York State Office of the Medicaid Inspector General (OMIG). The audit, which is scheduled to be commenced June, is said to have been sparked by a congressional report (entitled “Billions of Federal Tax Dollars Wasted Annually by New York’s Medicaid Program”), newspaper articles, the recommendation of New York State Senate Republicans, and criticism by current and former employees of the OMIG alleging that the office has not been effective at pursuing Medicaid fraud, waste and abuse.
The OSC audit seeks to review performance results and outcomes at the OMIG. It is not known what metrics will be employed by the OSC in conducting its audit of the OMIG, which oversees the largest statewide expenditure of Medicaid funds in the entire country.
The Albany Times Union reported that Mark Johnson, a spokesman for the OSC, stated “New York’s Medicaid program is the largest in the country, and the widespread abuse found by various agencies over the years has been well-documented.” He also said that the OMIG “is the principal overseer of the program, conducting thousands of investigations a year and finding hundreds of millions of dollars in abuse. Given the enormity of the program, and recent cutbacks ordered by the federal government, the comptroller believes a thorough look at OMIG and its practices is warranted.”
For more information, please contact the author, David R. Ross, who served as Acting Medicaid Inspector General under governors Pataki and Spitzer, as well as General Counsel, Deputy Medicaid Inspector General, and Director of Audits and Investigations for the Office of the Medicaid Inspector General (OMIG).