Tag Archives: New York

CMS Audit of OPWDD ICFs Seeks Recovery of $1.26 Billion from New York State

New York State is appealing to the Secretary of the United States Department of Health and Human Services (“HHS”) for reconsideration of a July 25, 2014 Centers for Medicare and Medicaid Services (“CMS”) final audit report that found the State liable for $1,257,499,670 in federal Medicaid overpayments.  In its letter to the State, CMS indicated it would be initiating similar reviews of the State’s two subsequent fiscal years based upon the audit findings.  To make matters worse, this federal cost recovery  is in addition to an agreement between the State and CMS to lower Medicaid rates for developmental disability centers, effective April 1, 2013, resulting in an approximately $1.1 billion reduction in federal Medicaid funding annually. Continue reading

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Filed under Health Care Reform, HHS OIG, Medicaid, New York State Agencies

Not-for-Profits, Revitalized

On December 18, 2013, Governor Cuomo signed the New York Non-Profit Revitalization Act of 2013 (“NPRA”).  This is the first time there has been a major change in the New York Not-for-Profit Corporation Law since 1970.  The Act aims “to reduce unnecessary and outdated burdens on nonprofits and to enhance nonprofit governance and oversight to prevent fraud and improve public trust.”

Re-Categorization of Corporations Types

The new Act eliminates the categorizations of Type A, B, C, and D corporations.  Nonprofit corporations formed on or after July 1, 2014 will be defined as either a “Charitable” or a “Non-Charitable” corporation. Charitable corporations are any nonprofits with a “charitable purpose,” defined as educational, religious, scientific, literary, cultural, or prevention of cruelty to children or animal purposes. “Non-charitable” corporations are all other corporations formed under the N-PCL.

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Filed under Not for Profits

New York and CMS Announce Partnership to Coordinate Care for Medicare-Medicaid Dual Enrollees

Today, CMS issued a Press Release announcing that it is conducting a demonstration project with New York State known as the Fully Integrated Duals Advantage (FIDA) demonstration.  Under this capitated demonstration, approximately 170,000 New Yorkers who are people eligible for Medicaid and Medicare in NYC, Long Island and Westchester County will be able to join a health plan that includes all the benefits of under Medicare (Parts A and B, and Part D)  and Medicaid and additional support for care coordination and community living.  Those who are eligible can opt in starting in July 2014 for community based individuals and October 2014 for individuals living in nursing homes.  Continue reading

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Filed under Long Term Care, Medicaid, Medicare, Nursing Homes

New York State Releases Funding RFP for Sandy Relief

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

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Filed under Announcements

OMH, OASAS and DOH Unveil Behavioral Health Managed Care Update

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

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Filed under Behavioral Health, special needs Health and Recovery Plans

Eco-Friendly Cleaning Supplies in Nursing Homes and Adult Homes on Senate Agenda

The New York State Senate Health Committee will consider a bill that may ultimately require nursing homes, adult homes, senior centers, and other residential health care facilities to use environmentally-sensitive cleaning and maintenance products.  Senator Diaz will introduce the bill on January 9.

The bill, S.866-2013, would require the Commissioner of Health to create “guidelines and specifications” for the use of environmentally-sensitive cleaning supplies in covered facilities, which include nursing homes and adult care facilities.  § 1.  The act would become part of the Public Health Law and would be effective as of September 1st after the date the bill passes.  § 2.  The Department of Health would have to consult federal and other relevant environmental guidance documents concerning such supplies before issuing any guidelines.  § 1. Continue reading

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Filed under Adult Homes, Nursing Homes

New York State Legislative Bill Mandating Direct Payment To Out Of Network Clinical Laboratory Providers

The New York State Senate and Assembly have introduced a bill (S.1083/A.636) to amend the Public Health Law (Section 4406) and the Insurance Law (Section 4084), in relation to reimbursement of out-of-network clinical laboratory providers by a commercial health benefit plan.

The bill would require commercial health benefit plans to make payment for laboratory services directly to the out-of-network provider and deem any payment to the enrollee as insufficient to satisfy the payment obligation.

An interesting provision within the proposed mandate is that the enrollee remains responsible for any applicable copayment, deductible or coinsurance. However, the provision does not expressly condition the direct payment upon the clinical laboratory’s collection of the copayment, deductible or coinsurance from the enrollee.

The bill will be referred on January 9, 2013 to the Senate Committee on Health and the Assembly Committee on Insurance.

This post is contributed by Charles Dunham.

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Filed under Uncategorized

Health Planning Committee of the Public Health and Health Planning Council Proposes Significant Certificate of Need Redesign

The Health Planning Committee of the Public Health and Health Planning Council is proposing a significant Certificate of Need (“CON”) redesign. The Committee and Council are expected to make twenty-two (22) recommendations to the Department of Health next week, affecting the CON process.  Five of the recommendations refer to an initiative to shift towards regional planning for CON applications.

New entities – called Regional Health Improvement Collaboratives (“RHICs,” pronounced “Ricks”) – would be responsible for increasing patient experience of care, decreasing the per capita cost of care, reducing the disparities in coverage, and more effectively managing the health of New York’s citizens.  Continue reading

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Filed under Announcements, Public Health and Health Planning Council

New York State Allegedly Overbilled $15 Billion for State-Operated Facilities for Developmentally Disabled

On May 17, 2012, the U.S. Department of Health and Human Services, Office of Inspector General (OIG) released a report that found Medicaid overpayments to New York State-operated developmental centers. The OIG concluded that, in 2009, State-operated  facilities for the developmentally disabled received $1.7 billion in Medicaid payments in excess of the reported costs of these facilities. The Medicaid rates paid to these New York State-operated facilities were ten times higher than the rates paid to private Intermediate Care Facilities in New York, which the OIG found comparable. The OIG determined that these overpayments had occurred for two decades and that they are still occurring in 2012. In fact, in fiscal year 2011, the daily payment rate to New York’s developmental centers was $5,118, which represented a 24 percent increase since 2009 and means that State-run developmental facilities are being paid approximately $1.9 million per year for each individual patient. This surprising increase was triggered by the formula for Medicaid payment rates for patients in developmental centers, which allows State-operated facilities to collect roughly two-thirds of the total Medicaid payment after an individual who has left the facility. Continue reading

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Filed under Fraud and Abuse, Medicaid, Medicaid Fraud, Uncategorized

OIG finds DOH should refund nearly $8 million to federal government

In a recent audit of the New York State Department of Health (DOH), the Office of the Inspector General of the United States Department of Health and Human Services (OIG) found that several New York City area providers billed Medicaid for services that did not meet state and federal requirements.  OIG recommended that DOH refund nearly $7.8 million to the federal government and that the both DOH and the New York State Office for People with Developmental Disabilities (OPWDD) alter its policies and procedures. Continue reading

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Filed under Medicaid