Tag Archives: New York Department of Health

Jason Helgerson Makes MLTC Encounter Data a Priority

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

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Filed under Managed Long Term Care, Medicaid

Governor Announces Three Major Agency Appointments

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

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Filed under New York State Agencies

Justice Center Operations to Begin; DOH Advises Facilities on Compliance

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.

If you have any questions about the Justice Center or this DAL, please contact the author, Caitlin Monjeau.

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Filed under Adult Homes, Announcements, Home Health Agency, Long Term Care, Nursing Homes

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

Medicaid Director Announces House Oversight Committee Interest in Managed Long Term Care

On June 20, 2013, at the Managed Care Policy Meeting, Jason Helgerson announced that the House Oversight Committee has asked CMS to investigate managed long term care plans related to the use and possible abuse of social day care programs in New York City.  Mr. Helgerson reminded Plans that enrollment from Social Day Care Programs will be reviewed by the Office of Medicaid Inspector General (OMIG) and that referrals have been made to the Attorney General’s Medicaid Fraud Control Unit. He indicated that any premiums paid inappropriately will be recouped. This announcement regarding the proliferation of social day care programs and the individuals enrolled in some of these programs was recently the subject of a New York Times article. Continue reading

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Filed under Announcements, Managed Long Term Care

New York Managed Long Term Care Enrollment Hits 100,000

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.

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Filed under Long Term Care, Managed Long Term Care, Medicaid

OMIG Releases Annual Report for Calendar Year 2011

Today, the New York State Office of the Medicaid Inspector General (“OMIG”) posted its 2011 Annual Report.  We will post a detailed analysis in the coming days. In the meantime, the report may be accessed here.

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Filed under Fraud and Abuse, Medicaid, Medicaid Fraud, NY Office of Medicaid Inspector General

NYSDOH Agrees to Pay Beechwood Nursing Home $25 Million in Settlement

On Wednesday, August 22, 2012, the New York State Department of Health (“DOH”) agreed to pay the owners of the Beechwood Nursing Home, located in Rochester, New York, $25 million dollars to settle litigation in which a federal jury had already determined that DOH officials had illegally revoked the operating license of the facility in 1999 in a retaliation against its owners, resulting in Beechwood’s closure. The jury was scheduled to decide how much to award in damages when the parties reached a settlement.

The Rochester Democrat and Chronicle filed this report on the settlement. According to that article, the presentation of provocative e-mails, written by DOH officials in the wake of Beechwood’s closure, was a key point in the case. Jurors in the case “pointed to the emails as the proof they needed of the state’s malice.”  Although Beechwood’s owners sued multiple DOH officials at the outset of the litigation in 2002, five were eventually found liable for the illegal revocation of the operating license: current Health Department officials Susan Baker and Cynthia Francis, and former officials Laura Leeds, Sanford Rubin, and Sharon Carlo. These individuals will not be personally liable for the $25 million settlement; New York State will pay the award.

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Filed under Long Term Care, Medicaid, Nursing Homes

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

NY State Seeks Medicaid Waiver to Redesign Health Care System

Governor Andrew Cuomo announced on Tuesday, June 5, that New York State will seek to spend $10 billion in Medicaid savings to redesign the state’s health care system.

The state must ask the Federal Department of Health and Human Services (“HHS”) for a waiver that would allow the state to use up to $10 billion of the $17 to $18 billion it is projected to save in its Medicaid redesign program.  The state achieved these savings through the Medicaid Redesign Team’s (“MRT”) recommendations; the Governor and Legislature and tasked the MRT with reforming and redesigning the state’s health care system in January of 2011. Continue reading

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Filed under Announcements