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 […]

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  The Act aims “to reduce unnecessary and outdated burdens on nonprofits and to enhance nonprofit governance and oversight to […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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. […]

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 […]