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2011 02 23 redesign team 4057 proposals (Excel)

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2011 02 23 redesign team 4057 proposals (Excel) Powered By Docstoc
					Complete Listing of all 4,057 NYS Medicad Redesign Team Proposals as of February 23, 2011
  #                   Author                                                                                                                              Proposal
   1   DOH                                     Increase health facility cash assessment percentages (additional revenue to fiscal plan) for nursing home and home care services. These increases are not Medicaid reimbursable.

   2   DOH                                     This proposal will control personal care utilization and will transition personal care recipients to Managed Long Term Care by imposing provider-specific aggregate annual per patient spending caps and limiting the
                                               personal care benefit to no more than 240 hours per month in areas of the State where Managed Care is available (i.e., New York City in 2011-12; New York City, Westchester, Nassau and Suffolk in 2012-13; and
   3   DOH                                     Imposes a uniform surcharge for both Medicaid and private payers; eliminates hospital based physician surcharge; provides additional State revenue and clarifies other administrative complexities.

   4   DOH                                     Eliminate the statutory provision for trend factor (inflation factor) adjustments across Hospital Inpatient and Outpatient, Nursing Home, Home Care, and Personal Care Services.

   5   DOH                                     To control utilization and reduce costs, the proposal will transition long-term CHHA patients to Managed Long Term Care by implementing:

   6   DOH, Anonymous                          Reduce the profit component included in the plan rates from 3% to 1% for the Medicaid and Family Health Plus managed care programs.

   7   DOH                                     This proposal eliminates the PC benefit for persons who are not NH eligible.

   8   DOH                                     Reduce the projected increase to Managed Care rates by 1.7% as of 4/1/2011, by reducing the trend factor by 1.7%.

   9   DOH                                     This proposal will eliminate Medicaid coverage for Targeted Case Management Services for recipients that are in Medicaid Managed Care Plans.

  10   Senate Medicaid Task Force              Eliminate funding included in Medicaid and Family Health Plus premiums for direct marketing of Medicaid recipients for Managed Care.

  11   GNYHA; CNYHSA;Onondaga                  Move the NYS Medicaid Pharmacy program under the management of Medicaid Managed Care to leverage additional clinical and fiscal benefits.
       County;NYS Catholic Conference;
  12   DOH                                     Reduce IME teaching factor from 4.2% to 3.0%, bringing it closer to empirical value of 1.2%, & providing fiscal plan relief while redirecting funds to health home (18M 11/12, 80M 12/13, 108M 13/14).

  13   Eastern Suffolk Boces                   Increase Federal Medicaid Funding by determining actual costs incurred by school districts and counties providing Preschool/School Supportive Health Services (SSHSP).

  14   DOH                                     Eliminate the "return on" and "return of" equity and residual reimbursement provided in the capital nursing home rate for proprietary nursing homes.

  15   NYSCHP;DOH;Blossom View Nursing Consolidates all pharmacy fee-for-service proposals into one reform package which includes several initiatives that optimize rebate opportunities, reduce waste, rationalize coverage and reimbursement, or remove
       Home;PSSNY;NYSHFA;NYSCAL;Sc statutory limits that drive cost.
  16   DOH                             Implement a Statewide pricing methodology for nursing homes that is adjusted for differences in labor costs and case mix, provides for a multi-year transition pool to facilitate a smooth transition to the new price, and
                                       promotes quality care by funding quality incentive payments. This proposal will also transition AIDS specialty rates to the new price for nursing homes. Beginning in the Fall of 2013, nursing home patients will begin
  17   DOH                             Fee-for-service dental payments should be reduced to match rates paid by managed care providers on high volume dental procedures.

  18   MRT Member (Eli Feldman,                Eliminate the loophole that allows legally responsible relatives (spouse, parent) to refuse to financially support them in order for the other relative (spouse, child) to obtain Medicaid.
       Metropolitan Jewish Health System),
  19   DOH                                     Eliminate State Funded Diagnostic and Treatment Center (D&TC) Indigent Care Pool funding. Current law provides $54.4 million to be distributed to eligible voluntary, non-profit and publicly sponsored diagnostic
                                               and treatment centers (D&TCs).
  20   DOH                                     This proposal will eliminate the $24.5M state only grant program for non-major public academic medical centers included in the 2009-2010 budget. These funds were to be distributed as non-Medicaid grants to provide
                                               funding for various purposes and to mitigate the elimination of the professional education pool beginning in January 2010. Refer to Attachment #1 for a funding distribution chart.
  21   DOH                                     This proposal would streamline the processing of nursing home rate appeals by prioritizing and amending processing timeframes, authorizing negotiated settlements, and temporarily capping the annual dollar amount of
                                               appeals authorized to be processed.
  22   DOH                                     Reduce the reimbursement for ambulette transportation for dialysis treatment to the fee level currently paid for ambulette transportation for Adult Day Health Care programs (ADHC).



                                                                                                                                                                                                                                                                        1
#                  Author                                                                                                                         Proposal
23   DOH                                 Eliminate or limit coverage of dentures for adults.

24   DOH                                 This proposal would provide coverage of enteral formula to individuals who cannot obtain nutrition through any other means.

25   DOH                                 Remove physician related reimbursement from hospital ambulatory patient groups (APGs) payment/rate structure.

26   OMH/OASAS/OPWDD; Nassau             Under this proposal, mental hygiene clinic rates would be lowered at two outlier threshold levels based on the number of clinic visits a given patient receives during a 12 month period. This would reduce overall
     County DSS; Suffolk County DSS      payment levels to providers with higher visits per patients, than peers.
27   DOH                                 Eliminate funding for the Empire Clinical Research Investigator Program (ECRIP).

28   DOH                                 Create a mail order pharmacy benefit for maintenance drugs, to take advantage of higher discounts.

29   MRT Member (Steve Acquario          Achieve Medicaid transportation savings through state procured regional management and resulting targeted reimbursement adjustments.
     NYSAC); HANYs; Website (Joanne
30   DOH                                 This proposal would update the Medicaid footwear benefit coverage criteria and payment methodology, reducing over utilization and administrative burden.

31   DOH                                 The Worker Recruitment and Retention add-on to Medicaid rates should be eliminated due to the significant investment in ambulatory care rates through the implementation of APGs.

32   DOH, MRT Member Dr. Nirav Shah      Allow prior authorization under the Preferred Drug Program (PDP) for the following drug classes: anti-depressants, atypical anti-psychotics, anti-retrovirals and immunosuppressants.

33   OASAS                               Move inpatient rehabilitation services for SSI enrollees from fee-for-service to managed care to lower rates and to allow the State to pursue increased federal funding for these services.

34   DOH                                 Establish Utilization Limits for Physical Therapy, Occupational Therapy, Speech Therapy and Speech-Language Pathology forpractitioner and clinic.

35   DOH                                 Limit the number of brand name prescriptions that a beneficiary could receive to five (5) per month.

36   DOH - (Dr. Gus Birkhead)            Centralize all dental and orthodontic benefit administration for all Medicaid beneficiaries with a dental benefits management vendor.

37   DOH                                 This proposal will eliminate the case mix adjustment factor for AIDS Nursing Services provided by Certified Home Health Agencies and Long Term Home Health Care Programs.

38   Laura E. Staff, MD lstaff@pol.net   Carveout transportation from the Medicaid managed care organization benefit package, to reduce costs and medical provider administrative burdens through state transportation management initiatives.

39   Linda Mugford, Hemophilia           Obtain blood factor products from Hemophilia Treatment Centers (HTCs), so that Medicaid can access 340B rates.
     Association of New York, Inc
40   Blossom View Nursing Home           Modify the education law to would allow LPNs to do assessments on resident conditions, such as falls, change in condition, IV therapy, PICC lines in residential long term care setting.

41   DOH                                 Establish a new program called the Public Health Services Corps.

42   DOH                                 This proposal limits Medicaid coverage for stockings to the Medicare criteria and includes coverage during pregnancy.

43   DOH                                 Eliminate Medicaid coverage and reimbursement of drugs that are available to Medicaid/Medicare dual eligible beneficiaries through their Medicare Part D plans.

44   DOH                                 This proposal will limit coverage of podiatry to Qualified Medicare Beneficiaries (QMB), recipients under 21, and no longer reimburse Art 28 clinics for podiatry provided to non-eligible enrollees.

45   DOH                                 Eliminate the HIV Specialty Pharmacy designation and the associated higher reimbursement rate.




                                                                                                                                                                                                                                                               2
#                   Author                                                                                                                             Proposal
46   DOH                                     Reimburse for Observation Services in Hospital, may result in decreased inpatient admission.

47   DOH                                     Amend existing legislation to allow Clinical Drug Review Program (CDRP) prior authorization requests to be denied when clinical criteria are not met.

48   DOH                                     Allow the Commissioner of Health more flexibility to add drugs/classes to the PDP and in negotiating with manufacturers.

49   DOH - Dr. Gus Birkhead                  Medicaid will incorporate payment to Article 28 clinics for HIV counseling and testing services into the Ambulatory Patient Group (APG) payment structure.

50   DOH (Dr. Gus Birkhead)                  AIDS Adult Day Health Care Programs provide a comprehensive range of services in a community based, non-institutional setting. General medical care including treatment adherence support, nursing care,
                                             rehabilitative services, nutritional services, case management, HIV risk reduction, substance abuse and mental health services are among the services provided. The programs receive a fixed price for services delivered
51   DOH                                     This proposal limits coverage of vision services, to include eyeglass replacement once every 24 months.

52   DOH                                     Tighten up requirements for obtaining authorization to fill a prescription when it is denied because it has been ―refilled too soon.‖

53   OASAS                                   This proposal will change the current practice of determining reimbursement for an entire medically managed withdrawal hospitalization from the first and third day, to a per diem rate.

54   DOH                                     Adjust payment downward for 340B Drugs in 340B-eligible clinics, under APGs.

55   MRT Member (Linda Gibbs City of         Expand existing tobacco cessation counseling coverage in Medicaid to include all women (not only pregnant women) and men.
     New York); American Heart Assoc.;
56   DOH                                     Amends nursing home transition diversion waiver specifically, the proposal replaces the current aggregate expenditure cap on services, set at 100 percent of the cost of comparable nursing facility care for waiver
                                             participants considered as a group, with a 100 percent individual participant cap.
57   DOH                                     Limit opioid prescriptions to a four prescriptions fill limit every thirty days for Medicaid beneficiaries.

58   DOH                                     Accelerate the collection of supplemental rebates by allowing the Commissioner of Health to designate certain drugs/therapeutic classes as preferred until the Pharmacy and Therapeutics Committee may review.

59   MRT Member (Senator Tom Duane)          Create a group of clinical experts to review current Medicaid benefits and technology coverage policies.

60   GNYHA, DOB; Strong Memorial;            Worker's Compensation and No Fault (WCNF) rates can be delinked from the Medicaid fee-for-serice (FFS) inpatient rates and not receive the benefits of the Medicaid reimbursement cuts enacted in Medicaid. In
                                             addition, a short term solution to assist in preserving essential community hospitals can also be implemented by requiring commercial insurers to pay rates that are no lower than the delinked WCNF rates.
61   DOH                                     This proposal will significantly help reduce turnover in the home and community based long term care system. There are two distinct elements; the first element is a provision that requires as a condition of provider
                                             enrollment in the Medicaid program that all CHHAs, LTHHCPs, and MLTC comply with any local living wage law within a geographic area in which they serve Medicaid recipients. This enrollment requirement
62   Budget, NYAHSA, NYSHFA                  Propose legislation to allow Industrial Development Agencies to provide financing for health care facilities, including hospitals,nursing homes, assisted living, retirement communities and Continuing Care Retirement
                                             Communities (CCRCs).
63   DOH                                     Establish reimbursement for a preconception visit for all women and adolescents.

64   HANYs; Mary Kargbo, Sheehan Health Provide direct reimbursement for Nurse Practitioners (NPs) and Physician Asistants (PAs) in clinics.
     Network
65   NYSHEPA, Bronx Health Link         Eliminate co-payments for preventive services such as obesity and diabetes prevention and immunizations provided to adults in Article 28 clinic settings.

66   DOH GNYHA                               Revise Indigent Care methodology for voluntary hospitals to be based on 100% Medicaid and uninsured losses (consistent with federal reform) and reduce pool by $140M (gross). Options for a rural and high-Medicaid
                                             safety net hospital allocation, and a phase-in\transition allocation, are under consideration.
67   MRT Member (Ken Raske, GNYHA);          Provide operational and restructuring assistance to safety net hospitals, nursing homes and clinics to make critical decisions to either close, merge or restructure. Potential sources of assistance are Medicaid, HEAL, debt
     Empire Justice Center, NYS Catholic     restructuring capacity and temporary operator.
68   HANYs                                   This proposal will identify spending on out-of-state placements in nursing homes and seek to repatriate these individuals within 3 years




                                                                                                                                                                                                                                                                              3
#                   Author                                                                                                                               Proposal
69   MRT Member (Eli Feldman,                7.80This proposal will develop and implement a Uniform Assessment Tool (UAT) for long erm care services.
     Metropolitan Jewish Health System);
70   Elizabeth Swain, CHCANYS/ PCC,          Expand the current Statewide Patient Centered Medical Home Program (PCMH) to more payers and broader patient participation.
     HANYS, NYASHA, Assembly Richard
71   DOH, NYSFHA / NYSCAL, Scott C.          Ensure the appropriate disposal and/or return of unused medications by long term care facilities and require that unused medications be credited back to the Medicaid program.
     Amrhein, CLLC; Robert J. Murphy,
72   NYSHFA / NYSCAL; Leonard Russ of        This proposal will be effective 4/1/09, current law allows the capital rate for proprietary NHs at the end of their useful lives to be adjusted to reflect projects that protect safety of patients or convert beds to an alternative
     Bayberry Nursing Home and Aaron         LTC use
73   DOH - Dr. Gus Birkhead                  Implement Medicaid reimbursement to local health departments for investigation and care coordination services provided to children with elevated blood lead levels.

74   DOH                                     Medicaid will increase Medicaid immunization administration fees for adults.

75   Daniel                             Use evidence-based utilization reviews to identify patients whose needs do not support the billed level of care.
     Rawlingsrawlingsdd@roadrunner.com,
76   DOH - Dr. Gus Birkhead             Cover low intensity HIV Targeted Case Management in Medicaid.

77   DOH                                     This proposal will provide additional financial assistance to financially unstable nursing homes that have operating losses of 5% or more of total operating revenue and Medicaid utilization of 70% or more, and require
                                             the submission of restructuring plans to achieve financial stability.
78   DHCF/BPACR/Barbara M.                   Make available supplemental funds on a short-term basis to assist the receiving hospital/nursing home when an area hospital/nursing home closes or consolidates.

79   HCA,CCLC                                Implement a CHHA Episodic Pricing methodology (which is similar to the Medicare Pricing model) and is based upon 60-day episodes of care and adjusts for case mix and labor costs. Independent physician
                                             assessments for initial and subsequent episodes of care would be required.
80   MRT Member (Linda Gibbs City of         Develop a forum to bring mental health agencies and housing agencies together to discuss how to give participants appropriate levels of care. Possible link to NYNYIII, an existing OMH program to provide service-
     New York)                               enriched SRO housing.
80   Ed McGill- HANYS, Dolly Sanchez;        Require the State to reassess prescription drug purchasing and to achieve additional savings by obtaining better supplemental rebates on drug purchases.
     vicndol@yahoo.com
81   CCLC; Jamaica Hosp. NH, Wm              This proposal will reduce nursing home capital costs by encouraging the refinancing of mortgages.
     Smith/Michael Irwin of Aging in
82   DOH                                     Establish a performance-based payment system that reduces hospital reimbursement for Hospital Acquired Consitions and potentially preventable conditions (e.g. Congestive Heart Failure and Urinary Tract Infection).

83   Carl Hatch-Feir, OASAS; NYS ASAP        Expand screening, intervention and referral to treatment (SBIRT) for alcohol/drug use beyond the ER setting. Untreated addictions drive up hospital readmissions and over-utilization of ERs.

84   DOH                                     This proposal will pay nursing homes and other institutions on a Pay for Performance basis. Allowing across the board funding cuts and for institutions to earn the money back by improving performance in areas of
                                             quality and efficiency.
85   DOH; HANYS,Beacon Health                Pay providers on Pay for Performance (P4P) basis (Ambulatory Care).
     Strategies,
86   DOH; HANYS, Jason Turner, former        Provide penalties to a discharging hospital if a discharged individual is readmitted to the same or another hospital within 30 days. Provide offsets i.e., incentive payments for positive outcomes.
     NYC Welfare Commissioner (NY
87   MRT Members (Dennis Rivera /Jeffrey     The Federal Health Care Reform bill (the Affordable Care Act, ACA) provides States the financial incentive tools to encourage providers in a community to set up networks and work together to provide coordinated
     Sachs/Ann Monroe); DOH; Jason           care to the most vulnerable populations in the health care system.
88   MRT Member (Mike Hogan Office of        Provide incentives for primary care screening for developmental and mental health problems in children.
     Mental Health)
89   HANYS, GNYHA, Senator Kemp              High cost, high need patient management can be addressed through the provision of care coordination (health home) services funded with 90% federal financial participation through the ACA.
     Hannon, Mike Hogan, Steve
90   MRT Member (Eli Feldman,                Transition Medicaid recipients age 21 and older in need of community-based long term care services into Managed Long Term Care (MLTC) plans.
     Metropolitan Jewish Health System);



                                                                                                                                                                                                                                                                                     4
#                    Author                                                                                                                                 Proposal
91    MRT Members (Jeffrey Sachs JFK Jr. Change the Medicaid managed care benefit package to expand the scope of behavioral health services provided by plans to their members.
      Institute for Work Education at City
92    DOH                                  Authorize the Department of Health (DOH) to allow recipients in the Recipient Restriction Program (RRP) to enroll in Medicaid Managed Care.

93    OMH; OASAS; MHA of Nassau Co;             OMH and OASAS recommend establishment of Behavioral Health Organizations (BHOs) to manage behavioral health services not ―covered‖ under the State’s various Medicaid Managed Care (MMC) plans.
      NAMI; NYSASAP; NYS Conference
94    DOH (Dr. Gus Birkhead/AIDS Institute      IPRO is currently under contract with the AIDS Institute to devlop and continually refine the AIMS (AIDS Intervention Management System) progam a mechanism for improving care delivered to persons with
      Staff)                                    HIV/AIDS. An effective AIMS program ensures that services provided to persons with HIV?AIDS optimally meet professionally recognized standards of care consistent with the protocols and guidelines developed by
95    MRT Members (Jeffrey Sachs JFK Jr.        Require Medicaid managed care plans to cover personal care services in the benefit package.
      Institute for Work Education at City
96    HANYs; MRT Member (Jeffrey Sachs          This proposal would authorize the Department of Health (DOH) to enroll additional non-dually eligible Medicaid recipients into mainstream Medicaid managed care programs.
      JFK Jr. Institute for Work Education at
97    HANYs; GNYHA                              Assign Primary Care Providers to Medicaid Enrollees.

98    HANYs; NYS Association of Counties Mandate selection of a Medicaid Managed Care plan as a condition of eligibility for Medicaid recipients in counties with mandatory enrollment.

99    Bob Ingram, EMPOWER                       Require that managed care enrollees receive information pertaining to coverage denials and how to access carved out services.

100   DOH; NY Hospital Queens                   Require enrollment of all non-dual eligible nursing residents into Medicaid managed care plans which would capitate the full range of health care services, including both acute and long term care services.

101   MRT Members Jeffrey Sachs, , Ed           The State will develop care models and reimbursement mechanisms for people who are dually eligible for Medicare and Medicaid to address people residing in the community and in nursing homes. Possible initiatives
      Matthews, Carol Raphael, Steve            to be examined include, but are not limited to New York State assuming risk for all Medicare services for duals, and developing a gainsharing demonstration that would allow New York to share in the savings from
102   NYAHSA/CCLC, NYSAC, Senate                The proposal would give statewide responsibility for making Medicaid recoveries from the estates of deceased recipients, in personal injury actions and in legally responsible relative refusal cases.
      Medicaid Reform Task Force, Senior
103   DOH                                       This proposal would institute financial disincentives to reduce inappropriate use of cesarean deliveries.

104   MRT Member (Senator Tom Duane);         For Medicaid fee-for-service and Family Health Plus: increase co-pays, add new co-pays, increase annual cap; implement co-pay for CHPlus. Exemptions include: pregnancy; under age 21; nh residents.
      Dr. Anandavalli Menon, Ruth Kelleher,
105   Timothy Lisberg                         Consolidate patient visits for better management of care, reduced utilization.
      clintonp@rochester.rr.com , Clinton
106   Center for Independence of the Disabled Develop Guiding Principles for Medicaid Redesign.

107   NYSFHA / NYSCAL, Leonard Russ of Allow relatives (e.g., adult children) of Medicaid nursing home recipients to contribute toward the cost of their care in return for a tax credit/deduction.
      Bayberry Nursing Home and Aaron
108   HANYs                            Educate and Incentivize Beneficiaries to appropriately use primary care providers, when Emergency Room/Urgent Care is not warranted.

109   MRT Member (Eli Feldman,                  Require hospitals and nursing homes to provide access to palliative care and pain management services for people with advanced, life-limiting illnesses and conditions.
      Metropolitan Jewish Health System);
110   MRT Member (Linda Gibbs City of           Create a consumer tax on all sugar sweetened beverages purchased in NYS; use revenue to fund various health initiatives.
      New York)
111   MRT Member (Steve Acquario                This proposal will create additional plan options for the Partnership for LTC insurance program (PLTC).
      NYSAC; Eli Feldman, Metropolitan
112   MRT Member (Senator Tom Duane);           Create financial incentives including differential copays to encourage Medicaid members to use urgent care/primary care instead of Emergency Room.
      Dr. Anandavalli Menon; Nurse
113   DOH                                       This proposal will allow nursing home to become representative for resident in order to intercept the Supplemental Security Income (SSI) payment in certain cases.




                                                                                                                                                                                                                                                                      5
#                   Author                                                                                                                             Proposal
114   DOH                                    This proposal will create a fund to support marketing of Partnership for LTC Insurance by utilizing voluntary contributions to increase consumer awareness and participation to reduce dependence on Medicaid for LTC
                                             costs.
115   HCA                                    This proposal permits nurses/patients (under their scope of practice/practice exemption) to orient/direct HHAs and PC workers to provide ―nursing care‖ as is currently allowed in the consumer directed personal
                                             assistant program.
116   OASAS                                  Refocus Island Peer Review Organization (IPRO) reviews of medically managed withdrawal cases from those based on DRG rates to those using the new per diem billing.

117   DOH (Dr. Gus Birkhead/AIDS Institute   Coler-Goldwater Memorial Hospital is a combination acute long-term care specialty hospital and nursing facility. Long-term care hospitals (LTCHs) furnish extended medical and rehabilitative care to individuals who
      Staff)                                 are clinically complex and have multiple acute or chronic conditions. Both facilities are treated as specialty hospitals for rate-setting purposes because they care for patients whose hospital stay is expected to exceed 25
118   Finger Lakes Health Systems Agency     DOH currently operates three separately administered home and community based 1915(c) Medicaid (MA) waivers for a similar targeted group of adults with physical disabilities who require a nursing home level of
      aka Sage Commission, Website -         care: Long Term Home Health Care Program (LTHHCP), and Nursing Home Transition Diversion (NHTD).
119   HANYS; Glens Falls Hospital            Enhance School Based Health Services primary care services to reduce Emergency Room usage and provide access to mental health services.

121   MRT Member (Steve Acquario             This proposal will create a state authority that county nursing homes can join at their option.
      NYSAC)
122   CCLC;BCID;

123   NYAHSA                                 Eliminate the requirement that a CHHA or LTHHCP must priovde assessment for ALP participant.

124   Primary Care Development Corp,         Implement a one-time HEAL grant of $31 million to create and deploy a permanent, revolving Primary Care Capital Access Fund (PCCAF).
      Primary Care Coalition
125   Nurse Practitioner's Association       Pay a bonus to Medicaid Primary Care Physicians doing a higher volume of care to Medicaid patients to assure continued access to primary care services after implementation of any across the board cut.

126   DOH                                    Provide hospitals with financial incentives to voluntarily reduce staffed bed capacity and redirect Medicaid resources to expand outpatient/ambulatory surgery capacity. Hospital opting into program would receive an
                                             APG rate enhancement and would be eligible to seek HEAL grant funding if extended to deveope new outpatient capacity.
127   MRT Member (Senator Tom Duane)

128   MRT Member (Eli Feldman,               Hospice care can only be provided in NYS through an organization certified under Article 40 of Public Health Law. This proposal will seek federal approval to allow LTHHCPs to offer hospice services without
      Metropolitan Jewish Health System),    requiring that patients disenroll from LTHHCP.
129   OHSM DoH                               Health system reform strategies, such as medical homes and accountable care organizations, that seek to improve quality, efficiency, and outcomes through increased coordination and integration are also likely to raise
                                             anti-trust concerns.
130   NYAHSA                                 This proposal will amend the Social Services Law to allow nurse practitioners to sign Medical Evaluations for ACF residents.

131   DOH, GNYHA, HANY; Nassau-              Create a neurologically impaired infant medical indemnity fund and establish a cap on non-economic damages in medical malpractice cases in addition to exploring alternatives such as disclosure and early settlement
      Suffolk Hosp. Council; NY Hospital     and judge-directed negotiations.
132   MRT Member Eli Feldman, OPWDD;         Expand definition of "estate" to include assets that bypass probate in order to recover more assets from a deceased Medicaid recipient over age 55.
      Jamaica Hosp. NH; Onondaga County,
133   Buffalo Regional Forum;                Allow aged and permanently disabled with fixed incomes to be automatically renewed based on cost of living increases.

134   DOH                                    The Department of Health (DOH)seeks to contract with independent certified public accounting (CPA) firms licensed in NYS to conduct annual field and desk audits of the Institutional Cost Reports (ICRs). Beginning
                                             in the SFY 2011-2012 these audits would replace currently required certifications by CPAs.
135   HANYs, DOH                             Support development of urgicare by developing a rate of payment for freestanding emergency services clinics.

136   Budget                                 Eliminate the current requirement to provide 60 day or 30 day notice to providers of the proposed Medicaid rates for a future period.

137   OPWDD                                  As an incentive to participate in the MBI-WPD program raise the resource standard and disregard retirement accounts.




                                                                                                                                                                                                                                                                              6
#                    Author                                                                                                                              Proposal
138   HCA                                     This proposal will eliminate the restrictions on nurses’ ability to function consistent with their scope of practice in adult homes, rather than requiring other nurses (not practicing in the adult home) to perform these basic
                                              duties.
139   HCA                                     This proposal will implement the new enhancements of the LTHHCP waiver, initiating the opportunities for increased Medicaid cost-savings and performance. The Department is in the process of implementing these
                                              enhancements.
140   MRT Member (Eli Feldman,                To solve the problem of delays in nursing home eligibility determinations, DOH recommends securing electronic verification of resources instead of presumptive eligibility.
      Metropolitan Jewish Health System),
141   HANYs, CBC, OPWDD, Empire               Accelerate State assumption of Medicaid program authorization for Managed Long Term Care.
      Justice, Constituent Correspondance;
142   HANYs; GNYHA, Finger Lakes Health       Eliminate barriers to retention and recruitment of needed health care workers, including physicians, nurses, and allied health care professionals.
      Systems Agency aka The Sage
143   HANYs, Nassau-Suffolk Hospital          Department will pursue alternative approaches to architectural reviews and pre and post opening surveys - this proposal will also be referred to the SAGE Commission process.
      Council; NY Hospital Queens;
144   HANYs; Nassau-Suffolk Hosp.             Consolidate duplicative laboratory and hospital psychiatric surveillance currently conducted by DoH. This proposal will be referred to the SAGE Commission process.
      Council; NY Hospital Queens
145   MRT Member (Steve Berger                Explore incentives/regulatory or statutory relief for publically traded or for profit companies to assist in management of targeted provider restructuring, such as safety net hospitals.
      Partnership for NYC)
146   MRT Member (Eli Feldman,                This proposal will eliminate the requirement that every nursing home bed in the state be a certified Medicaid bed.
      Metropolitan Jewish Health System),
147   MRT Members (Eli Feldman,               There are a number of suggested initiatives that require both statutory and regulatory actions to reduce burdens on hospitals and other health care facilities and expand access to capital.
      Metropolitan Jewish Health System;
148   Jim Hancock,                            Explore methods to reduce the local share contribution in Medicaid.
      hancock_jim@verizon.net; Onondaga
149   DOH                                     This proposal will amend the Social Services Law to eliminate the requirement for a CHHA or LTHHCP to perform an assessment of the ALP participant.

150   OPWDD, Empire Justice; NYS              The most important redesign with greatest potential for efficiency will come from creating an automated Exchange/Medicaid eligibility system.
      Catholic Conference; CNYHSA;
151   SNYA and NYSHFA                         Permitting Medication Aides to administer medication in nursing homes under the appropriate supervision of medical and nursing staff.

152   NYSHFA                                  Repeal 2801d of the Public Health Law which allows individuals to bring a private right of action against nursing homes.

153   HANYS, Blossom View Nursing        Medicaid will promote and enhance coverage of telemedicine by providing payment incentives and reduce coverage barriers.
      Home, Home Care Association of New
154   OMIG                               Enhance and improve the State's Medicaid program integrity efforts through coordination of audit and other fraud, waste and abuse activities and collaboration with other State and Federal entities, and use of new
                                         technologies, including:
155   OMIG                               Requires all pharmacies billing Medicaid to participate in the OMIG Cardswipe Program (landline).

156   OMIG                                    This proposal would require the OMIG to review claims approved and paid by Medicare for dual eligible recipients, which are also submitted to Medicaid for payment, and refine existing edit logic to prevent such
                                              duplication.
157   OMIG                                    Require that physicians who order services for dually eligible individuals be enrolled in both Medicare and Medicaid consistent with Medicare Provider Enrollment, Chain and Ownership System(PECOS)requirements.

158   Jennifer Treacy                         Requiring that prescribers access BNE's on line Dr. Shopper Program before issuing prescriptions for controlled substances.

159   DOH

160   OMIG, Senate Republican Task Force      Automatic mandatory restriction utilizing revised criteria for recipients without existing full clinical reviews by State Medical Review Team.
      on Medicaid Fraud; Senator Hannon,



                                                                                                                                                                                                                                                                                  7
#                      Author                                                                                                                         Proposal
161   OMIG                                   Requires the identification and signature for home delivery and receipt of prescriptions at pharmacies; requires pharmacies to restock and re-dispense returned medications from nursing homes.

162   DOH                                    Medicaid will no longer reimburse physicians the Medicare Part B coinsurance amount for patients that have both Medicare and Medicaid coverage.

163   DOH                                    OMH can apply for federal demo funds to shift some of their 4,000 inpatient mental health recipients from State op. inpatient hospitals (Institutions for Mental Diseases) to voluntary hospitals.

164   DOH                                    The Medicare Part B coinsurance will not be paid for certain physician services not covered by Medicaid. If Medicare's payment to a clinic exceeds the Medicaid rate, Medicaid will not pay the Medicare Part B
                                             coinsurance.
165   DOH                                    Eliminate State funding for Medicare Part D education and outreach.

166   Blossom View Nursing Home, PSSNY, Ensure the appropriate disposal and/or return of unused medications and require long term care (LTC) pharmacies to dispense in quantities less than 30 days
      NYSHFA, NYSCAL,Scott C. Amrhein,
167   Empire Justice Center             New York has maximized enrollment in MSP. A remaining option is to allow administrative renewals.

168   MRT Member (Assemblyman Richard        Authorize a New York Health Benefits Exchange in 2011 as a first step in implementing Affordable Care Act.
      Gottfried), Lisa Sbrana, Legal Aid
169   Richard Brennan                        Assess a tax on large employers whose workers are enrolled in Medicaid/Family Health Plus.

170   Finger Lakes Health Systems Agency     Create a payment reform work group composed of people with financial expertise in the provision of elder services.
      aka Sage Commission
171   Robert E. Detor, CFO Long Island       Across the board 4% cut.
      Home
172   DOH                                    Medicaid will enter into a sole-source contract for the fabrication of eyeglasses for NYC recipients.

173   GNYHA; NYS Catholic Conference;
      Jamaica Hosp. NH; Strong Memorial,
174   MRT Member (Eli Feldman,
      Metropolitan Jewish Health System)
175   DOH; OASAS                             Currently, inpatient rehabilitation providers are reimbursed on a cost-based rate. These rates vary greatly and it is proposed that a fee be established to provide a standardized payment.

176   DOH                                    Require all cost reports to be filed with site specific cost and unit detail.

177   DOH                                    Reform delivery and reimbursement of Medicaid Services to Foster Care children.

178   Budget                                 Effective April 1, 2011, all new LTHHCP applicants from counties where there is sufficient MLTC capacity (as defined by the Commissioner) will be required to enroll in a MLTC plan in lieu of LTHHCP enrollment.
                                             MLTC enrollment outside the designated counties will remain voluntary. Federal approval of a LTHHCP waiver amendment will be required to accommodate the change in eligibility criteria.
179   DOH - Dr. Gus Birkhead                 Establish community health workers as enrolled providers and develop a rate of payment in Medicaid.

180   DOH - Dr. Gus Birkhead                 Promote access to contraception and family planning services.

181   Jonathan Lever, Vice President for   Implement Medicaid coverage of CDC-recognized (Centers for Disease Control and Prevention) diabetes prevention program. (YMCA)
      Health Strategy and Innovation, YMCA
182   DOH - Dr. Gus Birkhead               Require Medicaid members to utilize WIC (Women, Infants and Children) benefits prior to using Medicaid paid services.

183   AIDS Institute                         Apply for a 1915(i) state plan amendment to include wrap-around long term care support services currently available in the AIDS Home Care program to HIV-infected Medicaid recipients who are at risk of progressing
                                             to nursing home eligible status. In an effort to maximize exisitng administrative resources, this initative can be achieved by expanding AIDS Home Care programs to serve those at risk for SNF level care or expanding



                                                                                                                                                                                                                                                                       8
#                   Author                                                                                                                           Proposal
184   Carl Fitzsimmons                       Advocate for a single payer system of care.

185   Scott Utey

186   NYSHFA                                 Create an enhanced CMI for high cost complex hard to place patients who are presently in more expensive care settings.

187   HANYS, NCBHN                           Reimbursement innovation will reduce costs by changing incentives to increase the efficiency of care delivery and the cost-effectiveness of the health care workforce.

188   NYSHFA                                 Eliminate the authorization for the operation of TCU’s in the state.

189   HCA                                    Modernize the insurance coverage benefit for home care to improve access to private coverage and reduce dependence on Medicaid.

190   HCA

191   HANYS, Department of Health            Decrease the Incidence and Improve Treatment of Pressure Ulcers.

192   DOH                                    Consolidate and administer all NYS health coverage programs for low-income individuals and families on a statewide basis, under one banner (e.g. Empire State Care).

193   GNYHA                                  Terminate Healthy NY once insurance is available through the Exchange (2014). If done sooner for savings in 2012-13, 170,000 lose coverage with no alternative.

194   GNYHA                                  Explore utility of partial and global capitation payment models in maintaining or reducing health care costs while improving patient care coordination.

195   GNYHA, New York State Association Need More Information
      of Counties
196   Finger Lakes Health Systems Agency, Create a supportive housing interagency work group with a goal of a proposal submitted to the MRT by October 1, 2011. The goal of the workgroup is to create between 5000 and 10,000 housing opportunities for
      HANYS; MRT Member (LInda Gibbs); persons at risk of nursing home or other institutional placements.
197   DOH

198   Blossom View Nursing Home              Evaluate regulations governing the use of bed rails in the long term care setting.

199   OPWDD                                  Implement a marketing campaign for premium assistance and MBI-WDP.

200   MRT Members (Carol Raphael Visiting Expand the scope of practice for RNs, LPNs and home health aides to improve access to services and decrease associated costs in delivering services.
      Nurse Service Karen Ballard, NYSNA);
201   Budget                               This proposal would repeal Chapter 58 of the Laws of 2009, which authorized up to 6000 Assisted Living Program (ALP) beds. The approval of such beds is contingent upon an equal number of nursing home beds
                                           being decertified over a 5 year period beginning 01/01/2009.
202   NYAHSA                               New York should expand options for Medicaid-eligible individuals to receive assisted living services, preventing nursing home placement at a greater cost to Medicaid.

203   MRT Member (Eli Feldman,               Promote and facilitate enrollment in the Community Living Assistance Services and Supports (CLASS ACT)
      Metropolitan Jewish Health System);
204   HANYs                                  Re-establish a multi-stakeholder housing workgroup to make recommendations on housing shortages that impact patients with mental health, chemical dependency or developmental disabilities.

205   HANYs                                  Improve access to primary and preventive care via mobile clinics for the purpose of reducing the use of emergency departments for non-emergent care.

206   GNYHA; Joann Casado, The Bronx         Evaluate the existing programs for managing patients in the community to determine best practices.
      Health Link, Inc



                                                                                                                                                                                                                                                           9
#                   Author                                                                                                                                Proposal
207   MRT Member (Assembly Member            Referred to SAGE Commission for further development.
      Richard Gottfried) MRT Member
208   MRT Member (Eli Feldman,               Centralize administration of waiver and other LTC programs which would lead to greater accountability and consistency of service authorization.
      Metropolitan Jewish Health System),
209   MRT Member (Eli Feldman,               This proposal will expand hospice:
      Metropolitan Jewish Health System),
210   Robert Meiss, Beechwood Homes,         The State to provide financial incentive and offset revenue loss to allow for the elimination of nursing home beds while providing individuals the ability to live in a less restrictive environment.
      rmeiss@beechwoodcare.org,Disabled in
211   NYSFHA / NYSCAL; Leonard Russ of       Amend existing regulations to allow nursing homes to discharge residents for the non- payment of the Net Amount Monthly Income (NAMI) and/or failure to provide funds to cover Medicare co-insurance expenses.
      Bayberry Nursing Home and Aaron
212   DOH, Lisa Sbrana - Legal Aid Society   Advance a coordinated strategy to increase health inforamtion technology adoptions and use health information exchange.

213   Finger Lakes Health Systems Agency     Give informal care givers (family, friends, neighbors) the info. and service options they need to make informed care decisions: utilize the NY Connects program to enhance caregiver outreach; advocate for the creation
                                             of regional caregiver support centers; review the Older Americans Act (Title III-E Caregiver Support) and provide recommendations to the local Congressional delegation for the reauthorization of the Act in 2011;
214   Finger Lakes Health Systems Agency

215   Keith Chadwick of United Methodist     Require NHs and MLTC plans in areas where they are available to enter into contractual arangements to evaluate all potential admissions and to provide care coordination to all residents.
      Home
216   HCA                                    Eliminate the cost, system and consumer consequences of premature and unnecessary institutionalization by rigorously enforcing section 367-c of the social services law, which strictly diverts nursing home-eligible
                                             patients to home care.
217   MRT Member (Elizabeth Swain,           Create an office for development of patient-centered primary care initiatives.
      CHCANYS/ PCC)
218   NYSHFA, SNYA                           Presently facilities are forced to collect Net Available Monthly Income (NAMI) debt. The state is in far better position to maximize such collections and thereby maximize savings.

219   HANYs                                  Reforming the Emergency Medical Treatment And Labor Act (EMTALA) will decrease unnecessary emergency department care for patients whose conditions are not emergent, increasing efficiency and reducing costs.

220   HANYs; Blossom View Nursing Home; Eliminate and streamline nursing home and home care documentation requirements
      Island Nursing and Rehab Ctr.
221   HANYs; anonymous                  This proposal will be referred to the SAGE Commission.

222   MRT Member (Linda Gibbs City of        Pursue HIT Funding in consultation with Stakeholders.
      New York); MRT Member (Eli
223   Website - anonymous                    This proposal would create one agency for regulation and surveillance of Long Term Care. This proposal will be referred to the SAGE Commission.

224   Website (Brian Son brianmson@          Allow EFT transfers to improve provider cash flow.
      gmail.com)
225   MRT Member                             Implement a centralized database that will aggregate insurance claims information all medical encounters in the State.

226   MRT Member (Assemblyman Richard        This proposal will be referred to the SAGE Commission.
      Gottfried)
227   MRT Member                             This proposal will be referred to the SAGE Commission Process.

228   Daniel Rawlings                        Compare NYS payments to other states and make changes as appropriate.
      rawlingsdd@roadrunner.com
229   DOH                                    The proposal is to eliminate the ability of Adult Care Facilities to discharge a resident due to their inability to pay.




                                                                                                                                                                                                                                                                        10
#                  Author                                                                                                                                 Proposal
230   NYSFHA / NYSCAL; Leonard Russ of       Currently there is a 20% NYS Income tax credit for the purchase of tax qualified LTC insurance policies. By increasing the benefit to 40% of the policy premium for Partnership policy holders an additional incentive is
      Bayberry Nursing Home and Aaron        created for these high quality policies which have benefit amounts designed to result in Medicaid savings. Surveys indicate that policy purchasers are generally aware of and consider the existing tax deduction when
231   NYSFHA / NYSCAL; Leonard Russ of       One method of encouraging individual responsibility for payment of LTC costs is creating an incentive for people to save money for this purpose. This proposal is for a Medical Savings Account Demonstration Project
      Bayberry Nursing Home and Aaron        for 10,000 people/ couples. By offering the ability to save in a special account with (state) pre-tax dollars; and later access these funds for medical/LTC expenses; individuals will be more likely to be prepared for LTC
232   NYSFHA / NYSCAL, Southern New          This proposal contains three options for innovations in individual financing of LTC services and supports. These can be considered individually or in combination.
      York Association; Leonard Russ of
233   NYSFHA / NYSCAL; Leonard Russ of
      Bayberry Nursing Home and Aaron
234   NYSFHA / NYSCAL;MRT Member             The proposal allows publicly traded companies to operate nursing homes in NYS. This will lead to additional capital in the system as well as bring New York in line with 49 other states.
      Berger, Leonard Russ of Bayberry
235   HANYS, MRT Member Dr. Nirav Shah       Quality reporting brings associated costs to the state and hospitals. In order to allow the state to focus on collecting data for the most critical quality and patient safety issues, the state should:

236   NYAHSA                                 Reorganize ACF/AL survey process to focus on poor performing facilities and ―look-alikes".

237   HCA                                    This proposal reforms the state’s supervision and orientation regulations for home health aides and personal care workers.

238   GNYHA,Cerebral Palsy Association of    OMIG will lead an effort to coordinate State audits of the Medicaid program.
      NYS
239   MRT Member (Eli Feldman,               Aligns Medicaid's claiming limit with Medicare's rule -1 year rule (Medicare) versus 90 day (Medicaid).
      Metropolitan Jewish Health System)
240   Website (Joanne Buschor: jobuschor@    Develop audit capabilities to ensure that there is consistency between diagnoses recorded in medical records / claims submitted by providers.
      yahoo.com), Anne Weeks,Frances
241   MRT Member (Assemblyman Richard        Adopt the Basic Health Plan option in the Affordable Care Act (ACA). Include a public option as a health insurance choice in the Exchange.
      Gottfried), NYSAC
242   MRT Member (Carol Raphael Visiting     Explore incentive based payments such as global budgets, bundled payments, and an expansion to selective contracting.
      Nurse Service) ; MRT Member (Senator
243   MRT Member (Assemblyman Richard        Explore reimbursement models to implement Accountable Care Organizations (ACOs) for Medicaid beneficiaries. Need guidance from CMS.
      Gottfried); HANYs; GNYHA; HHS,
244   GNYHA, Anne Weeks,                     Provide enhanced salaries beginning with 300 medical residents in July 2012 who agree to work in medically underserved communities in New York State upon completion of training by reallocating existing graduate
                                             medical education (GME) funding. Medical students will be targeted for recruitment purposes and will be required to commit to the Medically Underserved Service Corps before commencement of their resident training
245   DOH                                    Eliminate Optional Services Unless Enrolled in a Medical Home.

246   DOH, Ruth Kelleher NP                  This proposal would limit coverage for non-prescription, Over-the-Counter (OTC) drugs.

247   DOH                                    Allow only physicians to bill for injectibles - access concerns exist.

248   MRT Member (Steve Acquario             Adopt VA drug formulary for Medicaid - VA has closed formulary and Medicaid can not limit drug access in this way.
      NYSAC), Jody L Lomeo, Erie County
249   Chris Collins, Erie Co. Executive      Give counties the ability to define what services their Medicaid population would be eligible to receive.
      (Buffalo News story),MRT Member
250   Laura E. Staff, MDlstaff@pol.net,      Require Medicaid Enrollees to obtain a doctor's order for Over-the-Counter (OTC) drugs - fiscal order is already required for OTCs.
      Janice Benedek
251   DOH, MassHealth, American Heart        Extended coverage of Medicaid coverage of nicotine replacement treatment for persons with serious mental illness (SMI) from 6 months to 12 months - linked to proposal 130.
      Association, American Stroke
252   Jack Keenan                            Relieve states from financial burden by having Medicaid become a Federal benefit.




                                                                                                                                                                                                                                                                            11
#                    Author                                                                                                                            Proposal
253   OPWDD                                   Allow use of non-enrolled providers and reimburse up to the FFS rate.

254   OPWDD, MRT Member Jeffrey Sachs Pool non-Medicaid purchasing for state owned facilities - not a Medicaid proposal.

255   Robert J. Murphy, NY Health Facilities Expand the exclusion list of drugs carved out of the nursing home rate. This proposal is in the process of being implemented.
      Association
256   HANYs                                  Require for-profit health plans to return profits back to the community.

257   Website (Brian Son brianmson@    Revenue suggestions - seeking clarity on this proposal.
      gmail.com)
258   NYSFHA / NYSCAL; Leonard Russ of Utilize sustainable energy technology
      Bayberry Nursing Home and Aaron
259   NYSFHA / NYSCAL                  The look back periods are standardized. Need more information.

260   DOH- Dr. Gus Birkhead; Alere            Need more information. This appears to be a vendor with a proposal for case management for pregnant women.
      Womens and Children's Health
261   CPHS                                    Impose a cap on the amount of executive salary\compensation that is used in the calculation of the Medicaid reimbursement rate.

262   NYSFHA / NYSCAL; Leonard Russ of Encourage facilities to maximize Medicare utilization lessening the reliance on Medicaid.
      Bayberry Nursing Home and Aaron
263   Evelyn Evans                     Involvement of unions in MRT

264   DOH                                     Implement a broad based and uniform surcharge on surgery and radiology services provided by physicians in office based settings, including non-licensed urgent care centers, in accordance with Current Procedure
                                              Terminology (CPT)codes. Payment of the surcharge would be the responsibility of all third-party payors who have voluntarily agreed to make HCRA surcharge and assessment payments directly to the State. These
265   OPWDD                                   Not viable. Federal rules require rules be consistent across category, thus they cannot vary by service. The resource test cannot be eliminated for a subset of the SSI-related population (non-LTC).

266   OPWDD                                   Not Viable - the age limit is a federal law.

267   OPWDD                                   Need more information. The NYSDOH Disability Review Team currently determines disability for OPWDD consumers. Disability determinations for Medicaid must be consistent with Social Security Administration's
                                              (SSA's) disability guidelines. Are SSA's disability guidelines used in OPWDD's determination of Developmental Disability?
268   OPWDD                                   Allowing OPWDD's Revenue Support Field Offices to administer Medicaid for the developmentally disabled population is contrary to State takeover of the administration of the Medicaid program.

269   HCA                                     Provide for regulatory relief to reduce state and provider costs and to permit improved, more efficient functioning of the system.

270   HANYs                                   Improve eMedNy-seeking clarification

271   Website - Anonymous; Timothy            More specific proposals exists in this area.
      Lisberg clintonp@rochester.rr.com ,
272   MRT Member (Eli Feldman,
      Metropolitan Jewish Health System);
273   Website (Barry bshanck@
      yahoo.com); Janice Benedek
274   DOH                                     State cannot change the Medicaid transfer of asset rule (other than by applying it to home care and personal care) without jeopardizing Federal financial participation.

869   NYS Adult Day Health Care Council       Currently the primary source of payment for adult day health care (ADHC) is Medicaid (94 percent) with a small portion of ADHC services/visits paid by private insurance or through contracts with the Veterans
      (ADHCC)                                 Administration (six percent). In a minimum visit of five hours through an all-inclusive rate, ADHC program must provide nursing services; physical, occupational and speech rehabilitation (maintenance and restorative);



                                                                                                                                                                                                                                                                      12
#                   Author                                                                                                                            Proposal
870   DOH; HANYS                             Pay for performance in hospitals that will...

871   DOH                                    Reduce OPWDD day programs from 5 to 4 days per week, for persons with residential placements. Day program and transportation cost savings would be partially offset by increased residential costs.

872   DOH                                    Reduce OPWDD residential staffing by 5%; use regression analysis to compare disability level and bed size to determine adequate staffing levels.

873   DOH                                    Reduce OPWDD residential administrative staffing by 5%; use regression analysis to compare disability level and bed size to determine adequate staffing levels.

874   DOH                                    Impose a moratorium on development of new community residential options while lower cost options are explored, parity should be maintained with prevailing housing market rate.

875   DOH                                    Restructure residential care. House residents (on a voluntary basis) in 280 bed, campus-like facilities with on-site day treatment programs. Improve quality of care, provide greater socialization.

876   DOH                                    Eliminate approvals for cosmetic braces which are being approved against Medicaid policy.

877   DOH; GNYHA; CNYHSA; Onondaga
      County, New York Health Plan
878   DOH                          Allow the State Medicaid Director to act as the Commissioner's designee in responding to the P&TC recommendations.

879   MRT Member (Steve Acquario
      NYSAC;Eli Feldman, Metropolitan
880   HANYs; Website (Joanne Buschor         Develop a program for emergency responders dedicated to working with repeat 911 callers to help them solve their problems before calling, and thereby avoid unnecessary ambulance transport and emergency room
      jobuschor@ yahoo.com); Timothy         visits. Coordinate with Ambulatory care and transportation
881   MRT Member (Eli Feldman,               Need more information. Could be merged with #145 if goal is to expedite eligibility determinations for long-term care.
      Metropolitan Jewish Health System);
882   HANYs and Citizens Budget
      Commission
883   HANYs                                  Strengthen the All Inclusive Care for the Elderly (PACE) Program

884   HANYs; Website
      richherman@gmail.com 3- Website
885   HANYs, Blossom View Nursing Home,
      Home Care Association of New York
886   HANYs

887   GNYHA

888   MRT Member (Jeffrey Sachs JFK Jr.
      Institute for Work Education at City
889   DOH                                    Redesign the NYS bedhold policy for nursing homes.

890

891   MRT Member (Steve Acquario             Counties are required to provide 25% share on most Medicaid services. The ability to limit to what services their Medicaid population would be eligible would enable the counties to better predict and manage local
      NYSAC)                                 share, for which the county is held fiscally responsible.
892   Jason Turner, former NYC Welfare       Provide reimbursement incentives for mental health and substance abuse programs based on outcomes; look at models used by the welfare system, e.g., monitored and mandatory welfare-to-work programs.
      Commissioner (NY Times editorial);



                                                                                                                                                                                                                                                                    13
#                    Author                                                                                                                              Proposal
893   MRT Member (Eli Feldman,
      Metropolitan Jewish Health System),
894   MRT Member (Eli Feldman,                Eliminate the LTHHCP waiver by transferring current and prospective participants to NHTD or to children's 1915(c) waivers; amend the NHTD participant service cost limit.
      Metropolitan Jewish Health System)
895   DOH (Dr. Gus Birkhead/AIDS              HIV counseling and testing will be subsumed into APG reimbursement.
      Institute Staff)
896   Website - anonymous                     DOH currently operates three separately administered home and community based 1915(c) Medicaid (MA) waivers for adults with physical disabilities who require a nursing home level of care: Long Term Home
                                              Health Care Program (LTHHCP), Nursing Home Transition and Diversion (NHTD), and Traumatic Brain Injury (TBI).
897   Website - Anonymous

898   Daniel                             If the State cannot afford rograms, we have to do without.
      Rawlingsrawlingsdd@roadrunner.com,
899   Janice Benedek
      shack23@roadrunner.com
900   Betty Haag, bettyhaag@verizon.net;
      Joyce Brown RN
901   Jim Hancock,
      hancock_jim@verizon.net, Ellie
902   Meredith Howard,                   Allow developmentally disabled individuals to have a greater say in the type of services their day programs offer and flexibility in choosing the programs they participate in.
      meredith.wade@gmail.com, Dolly
903   DOH                                Require architectural and engineering reviews of new OPWDD facilities to fully address scope of work and cost.

904   DOH                                     As an alternative to excluding the optional benefit of adult denture coverage, this proposal would limit coverage to full dentures every 10 years and partial dentures every 8 years, allowing repairs. Preventative care must
                                              be the cornerstone of an optional Dental benefits program. In light of the current fiscal crisis, the proposal to limit dentures for adults is presented as an alternative to loss of critical services related to preventative and
905   DOH                                     Seeks to extend and increase the across the board Medicaid payment reduction in order to meet State financial plan deficiencies.

906   DOH

907   DOH - Budget

908   DOH - Budget

909   DOH - Budget

910   DOH - Budget

911   DOH                                     Assess a financial penalty on employers who do not offer affordable health insurance to their workers and whose workers are enrolled in Medicaid/Family Health Plus.

912   NYSFHA / NYSCAL; Leonard Russ of
      Bayberry Nursing Home and Aaron
913   DOH; NYSFHA; NYSCAL; Web

914   NYSHFA,Wm Smith/Michael Irwin of Explore a series of proposals to reduce the expense of medical malpractice libailites for nusring homes through tort reform and statutory changes.
      Aging in America
915   DOH                              Maximize Federal Financial Participation (FFP) owed to the State by the Federal Government for payments made by the State for the Part D transition.




                                                                                                                                                                                                                                                                                    14
#                   Author                                                                                                                           Proposal
916   Jennifer Treacy- DOH/OHSM            1)According to BNE data, 46% of all oxycodone prescriptions obtained by Medicaid patients in 2010 were obtained by patients that exhibited dr shopping behavior (obtained prescriptions from 2 or more practitioners
                                           and 2 or more pharmacies in same month).
917   DOH                                  This adoption is essential to advance the broader goals of Medicaid redesign by improving quality and safety while reducing costs. EHRs provide a gateway for health information exchange that supports patient
                                           centered medical homes and other coordinated care models. In a survey done last year which targeted Medicaid providers, of approximately 700 physicians, 59% reported using EHRs in their practice. Although the
918   DOH

919   DOH                                  Require that all practitioners utilize the Bureau of Narcotic Enforcement’s (BNE) on-line doctor shopper program before issuing controlled substance prescriptions for Medicaid patients (merged with 362).

920   DOH

921   DOH

922   DOH

923   DOH                                  The Department proposes initiatives that require both statutory and regulatory actions to reduce burdens on hospitals and other health care facilities and expand access to capital. The legislative initiatives are:

924   DOH

925   DOH                                  DOH currently operates two separately administered home and community based 1915(c) Medicaid (MA) waivers for a similar targeted group of adults with physical disabilities who require a nursing home level of
                                           care: Long Term Home Health Care Program (LTHHCP), and Nursing Home Transition Diversion (NHTD).
926   DOH

927   DOH

928   DOH

929   DOH (Dr. Gus Birkhead), Housing
      Works
930   DOH (Dr. Gus Birkead)

931   Empire Justice Center, OPWDD;
      Jamaica Hosp. NH
932   Empire Justice Center

933   Empire Justice Center

934   Empire Justice Center, DC 37 Local   providers serving vulnerable communities will always need more support from public dollars and rate reform should be carefully targeted so as to ensure their survival .
      1549
935   Bob Ingram, EMPOWER

936   Sharon Hoffman,Ann Gordon            Allow patient to choose and purchase the services s/he needs within their budgeted annual amount.

937   Robert Lebman;                       Improve the effectiveness of care by integrating primary medical care and behavioral care; place Article 28 clinics (diagnostic and treatment centers) in OASAS clinics.
      rlebman@hutherdoyle.com
938   Carl Hatch-Feir




                                                                                                                                                                                                                                                                   15
#                    Author                                                                                                                           Proposal
939   Carl Hatch-Feir

940   Blossom View Nursing Home

941   Vernon Smith

942   DOH                                    This proposal would provide coverage for enteral formula to individuals who cannot obtain nutrition through any other means or who are underweight and would eliminate payment for formula consumed as a
                                             convenient food substitute.
943   Blossom View Nursing Home              No proposal description provided

944   Finger Lakes Health Systems Agency     Explore options that will assist in targeted development of healthcare professional recruitment and retention. These include ideas to:
      aka The Sage Commission
945   Finger Lakes Health Systems Agency

946   Finger Lakes Health Systems Agency
      aka Sage Commission
947   Finger Lakes Health Systems Agency     Merged with 121
      aka Sage Commission
948   Finger Lakes Health Systems Agency
      aka Sage Commission; CNYHSA;
949   Citizen's Budget Commission

950   Citizens Budget Commission;
      CNYHSA
951   OPWDD

952   OPWDD

953   OPWDD

954   OPWDD

955   NYAHSA                                 The intent of the Interagency Council would be to problem solve the regulation barriers and investigate funding opportunities to assist seniors and people with disabilities to live more independently with home and
                                             community based services.
956   DOH

957   NYSDOH                                 DOH currently operates two separately administered home and community based 1915(c) Medicaid (MA) waivers for a similar targeted group of adults with physical disabilities who require a nursing home level of
                                             care: Long Term Home Health Care Program (LTHHCP), and Nursing Home Transition Diversion (NHTD).
958   OASAS                                  Update billing systems for general hospital inpatient detoxification services to accurately reflect the level of the delivered service and the associated costs.

959   Office For People With Developmental   Allowing OPWDD's Revenue Support Field Offices to administer Medicaid cases for all develpmentally disabled individuals is contrary to State takeover of the administration of the Medicaid program.
      Disabilites (OPWDD)
960   Office For People With Developmental   Need more information. The NYSDOH Disability Review Team currently determines disability for OPWDD consumers. What OPWDD disability determinations are being referred to in this proposal, determinations
      Disabilities (OPWDD)                   for OPWDD Home and Community-Based Waiver Program?
961   OASAS                                  Update billing systems for medically managed hospital withdrawal services to accurately reflect the level of the delivered service and the associated costs.




                                                                                                                                                                                                                                                                     16
#                    Author                                                                                                                         Proposal
962   OASAS                                Eliminate dual enrollment in outpatient drug treatment clinics and methadone treatment programs, except for individuals deemed to need both services i.e., intensive outpatient services.

963   OASAS                                Mandate case management enrollment for individuals who exceed a threshold for detoxification services, to divert these individuals from high-cost settings (e.g., ERs) to a more appropriate setting.

964   Southern New York Association

965   Robert J. Murphy, NY State Health    Allow return and credit for unused medication which are now being destroyed.
      Facilities Association
966   Effie Batis, Southern New York       Capture adequate information for SNF drug costs in order to collect rebates - Nursing Home Carve Out proposal addresses this and is in the process of being implemented.
      Association
967   Scott C. Amrhein, CCLC,Robert J.     New York should create a program to facilitate the return by providers of unused, unexpired pharmaceuticals already paid for through Medicaid, and determine whether there is a mechanism to score Medicaid savings
      Murphy, NY State Health Facilities   by utilizing returned medications in charity care or other programs
968   HANYS                                Adopt Guiding Principles for Developing Quality-Related Payment Policies

969   NYAHSA                               Expand Assisted living options for Medicaid Eligible individuals.

970   NYAHSA                               Consumers with complex care needs that require more personal care assistance (PCA) hours costing more than 75% of the average nursing home cost for that region would enroll in a care management program of their
                                           choosing. Programs that currently have a care management component are the Long Term Home Health Care Program (LTHHCP), Nursing Home Transition and Diversion (NHTD) program, the Program for All-
971   NYAHSA and CCLC, Wm                  At this time, DSS or HRA reviews enrollment packets and performs assessments of individuals enrolling into managed long term care (MLTC) to ensure that the individual qualifies for the program. This is in addition
      Smith/Michael Irwin of Aging in      to a similar assessment done by the plan. Delays in the DSS or HRA review or assessment may result in delays in plan enrollment in some areas of the state, especially in NY City where the bulk of MLTC is currently
972   HCA

973   NYASHA                               Based on a desire of the state to increase the use of managed care that integrates Medicaid and Medicare, state policy prohibits the establishment or expansion of Medicaid-only (―Partial-Cap‖) MLTC plans.
                                           Enrollments into some integrated Medicaid Advantage Plus plans has been slow. Meanwhile, the largest and most experienced MLTC providers are prohibited from expanding into new areas due to the moratorium
974   HANYS; HHS; Nassau-Suffolk Hosp.     The state should implement state and federal initiatives to better manage and coordinate care delivery and reimbursement for services provided to dually-eligible beneficiaries. (individuals enrolled in both Medicaid and
      Council; NY Hospital Queens          Medicare). High-cost Medicaid populations include 682,000 dual-eligibles, representing 14% of Medicaid enrollees and accounting for more than 40% of Medicaid spending, with much of that spending for long-term
975   CCLC                                 For the nursing home-dwelling chronically-ill population, NYS should undertake a statewide initiative to promote widespread adoption of programs that provide enhanced care for fragile dually-eligible nursing home
                                           residents (using Medicare Institutional Special Needs Plans as a funding model) to better manage high cost populations and share in federal savings. Under this model:
976   New York PACE Alliance               1.Assure consumer choice, provide unfettered access to PACE and managed long term care, and level the competitive playing field among long term care programs by establishing a mechanism to allow immediate
                                           enrollment and commencement of services in managed long term care programs, especially PACE. Note that consumers seeking long term care typically need services immediately. Paradoxically, frail seniors in need of
977   CCLC                                 For the community dwelling population of frail elderly who are dually eligible for Medicare and Medicaid, New York State should undertake a coordinated initiative to expand existing programs such as PACE, the
                                           Managed Long Term Care Program, Medicaid Advantage Plus (MAP) and the Long Term Home Health Care Program (LTHHCP) while simultaneously pursuing strategies to increase enrollment in these programs. The
978   OPWDD                                Promote OPWDD reform that ensures appropriate and cost-effective services by adjusting residential/ non-residential rates, prices, contracts and promote opportunities for individual self direction of care.

979   NYS Managed Long Term Care and       1. Reform Personal Care - Those who require higher levels of home and community based services and/or care management (again, as determined by the assessment tool) should be directed to Managed Long Term
      PACE Coalition                       Care, PACE, Medicaid Advantage Plus (MAP) and/or the Long Term Home Health Care Program (LTHHCP). They would not have the option to enroll in personal care directly, but would be given the choice of
980   DOH; HHS; Julia Garver               Eliminate select optional services for adults. Including dental, Private Duty Nursing, DME, Clinical Psychologist, Eye Care, Therapists (PT, OT, Speech).

981   Planned Parenthood Nassau            Develop one credentialing system across insurers and one Medicaid provider enrollment application.
      County,Housing Works, Children's
982   G. Podsiadlo ltr to Gov              If (claim payment) statements went out (to beneficiaries) people could call and dispute the vendor claim, and if calls were made to substantiate the services rendered.

983   C. Wink, ltr to Gov                  Medicaid needs to be more accessible to those that truly need it. It takes months to get approved for special needs equipment. There are special needs bikes for children available but not approved by Medicaid. Along
                                           with all-terrain wheelchairs.
984   NYS Dietetic Association; Cindy      Medicaid should expand coverage for alternative treatment modalities including: acupuncture, chiropractor, biofeedback, homeopathy, and herbal/nutritional treatment.
      Perlin, LCSW,Dolly Sanchez;



                                                                                                                                                                                                                                                                     17
 #                   Author                                                                                                                             Proposal
985    Dr. David Gottesman                     MH services may be rationed or denied to children if managed by BHOs.

986    Tom Cronin/Neighborhood Diabetes        The authors is requesting that Medicaid change the preferred diabetic supply list.

987    Planned Parenthood of North Country Medicaid will reimburse Article 28 clinics for services provided by Registered Nurses (RN) and Licensed Practical Nurses (LPN).
       New York, Inc., Kathie Wunderlich
988    Joseph Addabbo Family Health Center Federally Qualified Health Centers (FQHC)will be carved out of Medicaid managed care, thereby permitting FQHCs to bill Medicaid directly for services provided to managed care enrollees.

989    Primary Care Coalition, Vicki White,    Medicaid will increase Medicaid reimbursement for primary care to the Medicare payment levels.
       United Way of Long Island
990    Commission on the Public's Health       Explore the establishment of reimbursement rates to support providers' efforts to offer culturally competent care and undertake measures to address health disparities based on race, ethnicity, gender, age, disability,
       System - Judy Wessler, Director, Mark   sexual orientation, and gender expression.
991    GMHC                                    Recalibrate reimbursement to empahsize community-based primary and preventive care, care coordination and managed care.

992    Commission on the Public's Health       Bolster safety-net providers to ensure that public hospitals are not stressed and hospitals do not close in medically under-served communities.
       System - Judy Wessler, Director and
993    Primary Care Coalition/Rimary Care      Expand Patient-Centered Medical Homes and leverage opportunities of the Accountable Care Act
       Development Corporation
994    New York Presbyterian Hospital          Lower costs and improve quality through proven care coordination models and malpractice reform.

995    Commission on the Public's Health       In 5 years, over $1 billion can be saved via federal reform initiatives by moving people from institutions like nursing homes into community-based settings, where they can live with independence and dignity.
       System - Judy Wessler, Director
996    William Smith, MD and Michael Irwin     Hospital savings can be achieved by enactment of new nursing home bed reservation policy.
       MD of Aging in America
997    Wm Smith/Michael Irwin of Aging in
       America
998    Wm. Smith/Michael Irwin of Aging in     Implement a single long term care assessment instrument
       Amercia
999    Aging in America                        Streamline Managed Long Term Care enrollment process

1000   Aging in America

1001   Aging in America                        Eliminate the certification of classes and require 2801(d) to be an exclusive remedy. Also emiminate strict liability on "deprivation of rights" claims and provision of attorney's fees to be awarded separately.

1002   Aging in America                        Include more staffing indicators in quality add-ons to Medicaid rate. Current proposal is for RNs only to qualify.

1003   Aging in America                        Use the QIS survey to reduce the number of surveyors.

1004   Aging in America

1005   Jeanette Goldstein, Monroe County       Do not cover pregnancy-related services for unwed mothers. This proposal is not permissable under federal law.

1006   Jeanette Goldstein, Monroe County       It is unclear whether the proposal relates to cash assistance or Medicaid. Cash assistance is well below the minimum wage. The value of Medicaid for the vast majority of enrollees (non-disabled, non-elderly) is also
                                               well below the minimum wage.
1007   Jeanette Goldstein, Monroe County       Do not differentiate the benefits based on family size. The Medicaid benefits are the same by program and do not vary by family size. Eligibility varies by family size.




                                                                                                                                                                                                                                                                           18
 #                    Author                                                                                                                               Proposal
1008   Jeanette Goldstein                      Do not allow Medicaid beneficiaries to receive free legal representation. This is not a Medicaid issue. It relates to the eligibility for legal aid.

1009   Jeanette Goldstein, Monroe County       Do not provide more than one rent check. This is not related to Medicaid.

1010   Jeanette Goldstein, Monroe County       Time limit benefits similar to unemployment.

1011   Long Island Coalition of Behavioral     Develop a regional medical home system for the SPMI population, as an alternative to a carve in to Medicaid managed care.
       Health Providers
1012   Association for Community Living        Disenroll clients in residential care from redundant outside case management programs;turn over State community residences to non-profits;move people from State hospitals to less expensive care.

1013   New York Association of Alcoholism      Management of those with substance abuse disorders should be administered by a BHO with oversight by OMH and OASAS; suggest improvements to detoxification, case management and screening services.
       and Substance Abuse Providers
1014   Westchester Disabled on the Move        Take advantage of federal initiatives to shift funding to consumer-directed service coordination to keep individuals with disabilities and multiple diagnoses out of nursing facilities.

1015   Long Island Recovery Association        Successful rehabilitation and recovery can be achieved through the cost-effective use of recovery homes, peer services, and counseling.

1016   Dr. Richard Bossert, Member of the      Move people from State group homes and day programs to private facilities; close five remaining State institutions; reserve State operated programs for short-term stabilization, respite & crisis care.
       OPWDD Commissioner Advisory
1017   Mental Health Association of Nassau     Allow OMH-licensed PROS program to attain status as a "Health Home", support regional behavioral healthcare carve-outs similar to Pennsylvania.
       County
1018   Long Island OCD Support Network         Establish Medicaid reimbursement for peer services through a State Plan Amendment to reduce the cost of psychiatric recovery.

1019   New York State Psychiatric Association Establish medical home for those with SPMI and use reimbursement rates to incentivize clinics to treat SPMI.

1020   Mark Lane, Fideliscare MCO              The recommendation is to prohibit services being performed by out of state

1021   Charles King                            Allow approved DOH, OMH, OASAS and OMRDD facilities to add services licensed by another agency through a streamlined process to facilitate integration of physical, behavioral, and developmental disability
                                               services.
1022   DOH                                     Require managed long term care plans (MLTCP)to enter into contracts with nursing homes and establish a relationship with one or more Medicare Advantage plan in the service area.

1023   Anonymous, K. Kilenny, United Way       Ensure that oral health care is considered an integral part of the care that Medicaid recipients receive.
       of LI
1024   Jeffrey Sachs MRT Member                The State should immediately pursue a gainsharing arrangement with Medicare, targeting dual eligible individuals in nursing homes. All dual eligibles residing in a nursing home should be enrolled in a managed care
                                               program. The State should share in savings to the Medicare program that result from decreased hospitalizations and Medicare-financed rehabilitation in nursing homes. The State should be able to recover any increased
1025   Senate Medicaid Reform Task Force,      Currently there are several programs addressing appropriate utilzation including medical necessity and quality of care reveiws, Medicaid Utilziation Thresholds, the Recipient and Provider REstriction Programs and the
       New York County Health Services         Drug Utilization Review program. These programs should be strengthened to form the basis of a more comprehensive structure for utilization review.
1026   Jeffrey Sachs MRT Member                Consolidate the Long Term Home Health Care Program and the Managed Long Term Care Program. Enroll all individuals receiving home health care and personal health care services in managed long term care.

1027   Joan Flender                            Medicaid should use the standard code sets for payment.

1028   Hudson Health Plan                      The proposal includes a range of streamlining initiatives focused on technology.

1029   Hudson Health Plan, GMHC, Empire        Implement several enrollment and retention simplification initiatives.
       Justice
1030   Horizon Health                          Cover intensive residential treatment; carve-out/privatize SUD/mental health services; reimburse provider case management; reduce complexity/duplication of regulatory & licensing processes; allow uncomplicated
                                               detox in non-hospital settings.



                                                                                                                                                                                                                                                                          19
 #                   Author                                                                                                                         Proposal
1031   NYSAC                                 Lower the Family Health Plus eligibility level for parents and 19&20 year olds to 133% of FPL.

1032   MRT Member (Jim Introne)              Allow nursing home eligibile individuals to receive a disregard of a portion of housing expenses if they join a Managed Long Term Care Plan.

1033   NYSAC

1034   NYSAC                                 Eliminate some Medicaid programs once coverage is available through the Exchange.

1035   Senate Medicaid Reform Task Force,    Reinstitute the Resource test for Medicaid applicants/renewals.
       Senate Republican Task Force on
1036   Senate Medicaid Reform Task Force

1037   Senate Medicaid Reform Task Force

1038   Senate Medicaid Reform Task Force

1039   Senate Republican Task Force on       Create a system to allow counties to learn of incarceration of their enrollees in other counties.
       Medicaid Fraud
1040   Senate Republican Task Force on       Require a credit report and a real property tax search at application.
       Medicaid Fraud
1041   William Kee 119SEIU                   Increase the utilization of generic drugs.

1042   Wendy Matson NYS Comptroller          Do not cover certain drugs because there are less expensive alternatives.
       Office
1043   Bob (bobsmailbag@gmail.com)           Contract directly with a Pharmacy Benefit Manager (PBM).

1044   Dr Anandavalli Menon                  This proposal establishes case management standards for beneficiaries eligible for the pharmacy benefit. Related to MRT# 540.

1045   Karen Korotzer NYSARC Oneida-         Ensure adequate funding for early intervention and screening of children with mental developemental and behavioral needs and for community supports.
       Lewis
1046   Advocates for New Yorkers wtih        The coalition strongly supports a specialty behavioral health ―carve-out‖ plan which will improve care and responsibly reduce costs by integrating mental health and substance use services.
       Behavioral Health Conditions
1047   Senate Medicaid Reform Task Force     Proposals include reducing the income/resource limits for a spouse of an institutionalized Medicaid recipient and requiring direct deposit of federal SSI payments to nursing home.

1048   Glenn Liebman, Mental Health          Allow for the complete carve-out of all mental health medications.
       Association in NYS
1049   New York Association of Psychiatric   Establish Regional Behavioral Health Plans
       Rehabilitation Services
1050   Georganne Chapin, Pres. & CEO,        This proposal will categorize Human Growth Hormone (HGH) as cosmetic treatment and prohibit Medicaid coverage.
       Hudson Health Plan
1051   Sally Miller, Housing Works, New      Do not cut out eye care, dental care, or foot care for Medicaid Beneficiaries
       York State Catholic Conference,
1052   North Country Behavioral Service      Integrate behavioral and primary care, develop regualtory models that are patient centered and outcome oriented, pursue PCMH and ACO projects.
       Network
1053   Anonymous                             Using volunteers in outpatient services would reduce costs and be more effective




                                                                                                                                                                                                                                            20
 #                      Author                                                                                                                           Proposal
1054   William Reilly                           Eliminate redundant medical checks on one's physical condition that will not change/improve.

1055   New York Association of Psychiatric      Implement mental health Recovery Homes for high-cost, high-need individuals, in keeping with ACA section 2703.
       Rehabilitation Services
1056   David Stachnick - PSSNY, NYSCHP          Provide Medication Therapy Management (MTM) services to improve adherence.

1057   Medicaid Reform Task Force -           Establish a "trial" period of 14 days for first time users of a long-term/maintenance medication. Related to MRT #527.
       December 2003 Report of the Senate
1058   New York Association of Psychiatric    Explore Medicaid reimbursement for peer services such as support, care coaches and recovery coaches.
       Rehabilitation Services,Long Island
1059   New York Association of Psychiatric    Direct State agencies and the Most Integrated Setting Coordinating Council (MISCC) to accelerate timelines for redirection to more integrated care settings.
       Rehabilitation Services
1060   New York State Psychiatric Association

1061   Steven Rutter, FEGS                      Streamline application process and have better coordination with SS and Medicare, transferability between counties so reapplication would not be necessary.

1062   Georganne Chapin, Pres. & CEO            Implement a process to assess new drugs and technologies for inclusion in the benefit package and provide coverage advice based on a cost-benefit analysis that can be managed by the health plans.
       Hudson Health Plan
1063   New York Association of Psychiatric      NYSPA endorses a prior authorization program for all psychiatric drugs including those subject to the statutory prohibition.
       Rehabilitation Services
1064   PSSNY, David Stachnick                   Reduce spending for brand name drugs by implementing step therapy - statutory authority exists. Contract amendment required for system functionality.

1065   Judy Schelle                             Adult daughter lives in group home; protect services and supports. Still afraid of Willowbrook...health and safety issues remain.

1066   Mental Health Association of Nassau      Support regional behavioral healthcare carve-outs similar to Pennsylvania.
       County
1067   Nicholas McCarthy                        Lives at home, attends day hab which makes "my future is so much more promising".

1068   New York Association of Alcoholism       Use SBIRT in primary care settings to identify and divert individuals with alcohol and substance use to care.
       and Substance Providers
1069   Kevin Christman; Meryl Jackelow;         Benefits of appropriate home health care with flexible hours increases independence, contributions. Works as TA for UCP, first job which was very hard to find. Make Medicaid more economically efficient, don't gut
       Howard Cohen; Charlie Fleisch; Nancy     good programs.
1070   GMHC                                     Maintain eligibility levels, and continue to streamline eligibility, enrollment and renrollment processses.

1071   Jackie Shenkman                          Adult daughter with intellectual disabilities benefits from self-determination, supported employment, individualized supports and services; pays taxes.

1072   GMHC                                     Ensure transparency and accountability in Medicaid spending, such as aligning charity care payments to hospitals with actual services to the uninsured.

1073   GMHC                                     Avoid across-the board cuts to safety-net providers so the medically underserved low-income communities do not lose access to health care services.

1074   Jane Gerken                              Annual medical check for all adult Medicaid beneficiaries to encourage preventive care; mandatory drug testing to identify recipients that need referral for treatment.

1075   Center for Independence of the Disabled Collaborate with housing agencies to develop permanent integrated housing for people with disabilities.

1076   Center for Independence of the Disabled Reduce Medicaid costs by rebalancing long term care to provide more community-based and personal care services.




                                                                                                                                                                                                                                                                       21
 #                    Author                                                                                                                           Proposal
1077   New York Association of Emerging and Generate cost savings through removing some of the regulatory requirements for evaluations.
       Multicultural Providers
1078   NACDS                                Improve generic dispensing rates.

1079   New York Association of Emerging and Identify spending on out-of-state placements and redesign New York State programs to serve these individuals.
       Multicultural Providers
1080   Roy Probeyahn                        Do not reduce OPWDD waiver program. Supporting individuals in the community is cost effective. Submitted by parents of 3 adults with autism who live at home.

1081   Saundra Gumerove, NYSARC               Changes made as part of Medicaid reform must not harm individuals with intellectual and developmental disabilities.

1082   Anonymous                              More people should be on generic medication - This is addressed through Proposal #15

1083   Kathleen Sebelius, Health and Human    Increase cost-sharing for certain prescription drugs,thereby steering individuals toward less costly generics or preferred brand-name drugs.
       Services, Laurie Kostrzewski, TEA
1084   Alliance of Long Island Agencies       OPWDD must be allowed to continue to revise its regulations and payment policies.

1085   Kathleen Sebelius, Health and Human    Use of the actual acquisition cost as the benchmark for drug reimbursement can save in pharmacy costs.
       Services
1086   PSSNY, David Stachnick                 This proposal would mandate the payment of copays for medications.

1087   Katie Kilkenny, LMSN                   Ensure funding for HIV prescription drugs.

1088   Katie Kilkenny, LMSN                   Ensure funding for HIV prescription drugs.

1089   Senate Republican Task Force on       Ensuring that generic drugs are properly dispensed when the physician does not specify a brand drug would save approximately $300 million statewide, according to research by one data mining company.
       Medicaid Fraud, Senator Hannon, Chair
1090   Tom Ayers, We Care Transportation     The Medicaid rate currently paid to OPWDD day habilitation programs includes the costs of transportation to and from the program. These costs should be removed from the program payment, and transportation
                                             providers paid fee-for-service.
1091   Ruth E. Kelleher, Pediatric NP        This proposal will eliminate payment for OTC medications.

1092   Isabella Geriatric Center              Propose to create a medical and mental health home to meet the needs of chronic medically ill clients with mental health co-morbidities.

1093   Kathleen Sebelius, Health and Human    Medicaid rules give states the ability to use cost-sharing to promote the most cost-effective use of prescription drugs. For people with incomes above 150 percent of the federal poverty level, cost sharing for non-
       Services                               preferred drugs may be as high as 20 percent of the cost of the drug. In addition, for beneficiaries above 100 percent FPL, states may deny services for nonpayment of cost sharing.
1094   Tom Ayers, We Care Transportation      Request bids on all dialysis trips in a region, and reward the lowest bidder with all trips. This will reduce the transportation fee from the single ride amount to a lower group ride fee.

1095   Leo Genn, Northside Center for Child   Recommend the MRT focus on Regional BHO's with a focus on county involvement similar to the Pennsyvania HealthChoice Model.
       Development
1096   PSSNY, David Stachnick                 Readjust the reimbursement allowance for generic drugs, strengthen co-payment policy, and differentiate pharmacy reimbursement between independent and chain pharmacies.

1097   County of Fulton Mental Health         Recommend the MRT focus on Regional BHO's with a focus on county involvement similar to the Pennsyvania HealthChoice Model.
       Services
1098   Tom Ayers, We Care Transportation      Provide non-emergency transportation to ensure access to non-emergency medical care, thereby reducing more expensive hospital or emergency room treatment.

1099   Rochester /Monroe County Homeless      Decrease Medicaid costs by reducing expenditures on high-need populations through expanding permanent supprotive housing.
       Continuum of Care



                                                                                                                                                                                                                                                                       22
 #                       Author                                                                                                                         Proposal
1100   Anonymous                                Allow pharmacies to accept and re-dispense sealed medications.

1101   National Alliance on Mental Illness      Carve out managed behavioral health care to better serve the specialized needs of those with mental and behavioral illness

1102   PSSNY, David Stachnick                   This proposal would deny prescription claims that are ordered by a disqualified prescriber. Current POS claim edits exist to deny claims ordered/prescribed by disqualified prescribers.

1103   Unknown                                  The Home and Community Based Services waiver for persons suffering from a traumatic brain injury allows for the reimbursement of transportation expenses incurred for travel within the community, to social events
                                                such as shopping, worship, and recreation.
1104   Glenn Martin, MD - New York State        Allow prior authorization (PA) for psychiatric medications on the preferred drug list when they are being prescribed for the first time.
       Psychiatric Association
1105   National Alliance on Mental Illness      Increasing access to school-based mental health services will provide early detection and better outcomes.

1106   National Alliance on Mental Illness-     Implement stricter rules and monitoring to prevent transfer of assets to qualify for Medicaid
       Queens/Nassau
1107   National Alliance on Mental Illness-     Cut costs for long term care thorugh shifting to a model of more community based and home care; models include Oregon and Massachusetts.
       Queens/Nassau
1108   Suzanne Maloney                          The Medicaid Program is required to assure transportation of a Medicaid enrollee is avialable when traveling to and from a Mediciad covered serivice. However, when the wrong mode of transportation is supplied, the
       (greatgreys2@aol.com)                    Program incurs unnecessary expense.
1109   Robert Ross, CEO, St. Joseph's Centers   Substance abuse service agencies should work with OMH and OASAS to implment a managed care approach for providing substance abuse services.

1110   Robert Ross, CEO, St. Joseph's Centers Significant savings to the substance abuse service system can be achieved by refocusing regulatory requirements and refocusing OMIG fraud and abuse efforts.

1111   NYS Council of Health-system             This proposal would institute a Medication Therapy Management (MTM) Program.
       Pharmacist (NYSCHP)
1112   NYSCHP                                   Allow pharmacists to make adjustments to prescriptions, in accordance with treatment protocols and in collaboration with a physician.

1113   Anandavalli Menon                        Payments for prepaid mental health services need to be adjusted to account for reductions in service delivery.

1114   Pfizer Inc, Anna Maria Maritato          Enhance the Medicaid Electronic Prescribing Incentive Program to improve care and reduce costs.

1115   Linda Pelletier                          Manage care for chemical dependency to eliminate duplication of services

1116   Senate Medicaid Reform Task Force        Apply the 60 month look back period for transfer of assets to non-institutional long-term care applicants with spousal impoverishment protections.

1117   Providers of Health Care for the         Address the needs of the homeless with chronic illness and co-occurring disorders through a health home model.
       Homeless
1118   K. Kilkenny, United Way of LI,           Continue to support funding of oral health care which is one of the most important areas of treatment for HIV/AIDs while knowing restrictions/funding opportunities through MNY and Ryan White.

1119   NYSCHP                                   This proposal would require that medical homes incorporate pharmacists as part of the multi-disciplinary team and require pharmacists provide MTM for patients enrolled in the home.

1120   NYSCHP                                   Require hospitals to include clinical pharmacists with physicians and nurses when making daily rounds.

1121   NYSAC                                    Every effort should be made to ensure veterans receive their care from the Veteran's Benefits Administration rather than Medicaid.

1122   Sharon E Hoffman                         Moving son from Congregate Care Level II to Consolidated Supports and Services cut his Medicaid service budget in half, saving almost $50,000. CSS model is still considered an innovation requiring "new" money
                                                instead of allowing shift of existing funds. Why?



                                                                                                                                                                                                                                                                        23
 #                      Author                                                                                                                        Proposal
1123   Medicaid Matters New York, Metro       With the expansion of managed care to additional populations, it is important that consumers, especially those with more chronic health issues (including HIV), are fully engaged in understanding managed care, the
       New York Health Care for All           benefits, and how to navigate the system. Fully informed consumers are less confused, and more apt to navigate the managed care system in a healthy way. It is crucial that materials be culturally and linguistically
1124   Island Nursing and Rehab Center        Expedite state takeover of Medicaid eligibility and service authorization roles. New York should accelerate the State takeover of the administration of Medicaid long term care programs. NY could accelerate
                                              involvement of complex patients in effective integrated care models, while also eliminating duplicative levels of program administration, by ensuring that the State takeover occur upon finalization of the uniform
1125   Dario M Castaldi                       Testimony of value of self-determination providing opportunity to have self-directed life, obtain necessary skills to have a career in photography.

1126   Richard Brennan

1127   NYSDA                                  A major obstacle to improving quality and reducing costs in the Medicaid program is the lack of real-time information on patient eligibility, program utilization and expenditures which would enable DOH to manage its
                                              resources, evaluate program effectiveness and account for actual costs. eMedNY is not fully compliant with current nationally recognized standard dental procedure coding, nomenclature and claims forms that simplify
1128   Joan Travan, Jack Mrozak, Ellie        Establish a minimum durational residency requirement before someone can be eligible for Medicaid.
       Corcoran, Michelle Schimel,
1129   NYSCHP                                 This proposal will allow pharmacists to administer all vaccines recommended by the CDC for patients ages 11 and above.

1130   Billy Freeman                          Medicaid services to amputee were fragmented, redundant. Prosthesis manufacturers made money on improper, unusable appliances without recourse. Medical services were uncoordinated,insufficient, damaging in
                                              some cases. Author has had significant help though peer advocacy organization (Baltic Street AEH Peer run program). To extrapolate
1131   Joan Travan                            Do not accept self-attestation of any eligibility requirement.

1132   Barry Brauth, Health Payment           Assign lead agencies for oversight of all behavioral health services carved out of Medicaid (case management,community services and rehabilitation)on a regional basis
       Alternatives
1133   Arnold Birenbaum, MD Rose F.           Medicaid should apply immediately for enhanced federal funding to support health homes for individuals with chronic health conditions.
       Kennedy Center, Albert Einstein
1134   Pfizer Inc, Anna Maria Maritato        Accelerate rebate collections through securitizing the receivables.

1135   Allison Covino

1136   Katie Kilkenny, LMSW                   Extend period for recertification for AIDS program. Increasing rates on Long Island, esp for over 40 - request increased funding for many services, continued support for oral health care; train private MDs about treating
                                              AIDS. Author will provide ideas for eliminating barriers to transportation and oral health care if requested
1137   Children's Defense Fund                Replace the antiquated and uncoordinated enrollment systems and move toward statewide electronic submission of applications and renewals.

1138   Senate Republican Task Force on       Require beneficiaries to choose one primary care physician and pharmacist. Related to Proposal # 97.
       Medicaid Fraud; Senator Hannon, Chair
1139   NYS Conference of Local Mental        Support a Behavioral Healthcare Organization model for SMI and SUD enrollees provided there is county involvement and authority in service delivery.
       Hygiene Directors
1140   Children's Defense Fund               Maintain funding for the Facilitated Enrollment Program.

1141   Therapeutic Communities Association    Uncomlicated detoxification could be offered for lower cost in non-hospital settings.
       of New York
1142   Therapeutic Communities Association    Private not-for-profit centers could offer better and more cost-effective services.
       of New York
1143   Therapeutic Communities Association    Allow CBO's to piggy-back on OGS negotiatied vendor contracts for commodities such as fuel, gasoline and to use State employee benefit packages.
       of New York
1144   Therapeutic Communities Association    Eliminate the numerous administrative cost redundancies that exist between State agencies and County/Municipal service providers.
       of New York
1145   Therapeutic Communities Association    Identify and eliminate costly regulatory requirements that are neither evidence or outcome based.
       of New York



                                                                                                                                                                                                                                                                             24
 #                    Author                                                                                                                            Proposal
1146   Therapeutic Communities Association     Make no more OASAS capitol or other awards to increase treatment capacity; due to Drug Law Reform and treatment in lieu of incarceration exsitign capacity is sufficient.
       of New York
1147   Therapeutic Communities Association     Create community-based treatment alternatives to State-operated programs including residential, day-service and out-patient treatment.
       of New York
1148   Empire Justice Center                   This proposal would allow for the enrollment of low birth-weight and disabled infants under six months of age into Medicaid managed care. This population is currently excluded from enrolling.

1149   C. Voltz, AIDS Community Services of Writer wishes to stress the importance of Medicaid-reimbursed COBRA case managment program
       Western NY
1150   Ruth Kelleher, NP                    Exclude Lifestyle Drugs from Coverage - already implemented.

1151   Diane Meier, Mount Sinai School of      This proposal would expand palliative care provided by hospitals.
       Medicine
1152   Housing Works                           Expand HIV SNP eligibility to HIV-negative persons with hepatitis C and for persons who are at risk for HIV due to homelessness; (NYC only)

1153   Housing Works, AmidaCare                Implement a demonstration project authorizing HIV SNPs to include such services as AIDS adult day health care and COBRA case management, outpatient substance abuse services, and services for people with
                                               extreme mental illness
1154   AmidaCare                               Implement a demonstration project authorizing HIV SNPs to include such services as AIDS adult health care and COBRA case management, outpatient substance abuse services, and services for people with extreme
                                               mental illness.
1155   HealthCare Chaplaincy

1156   Rochestre Regional Healthcare        Develop alternate models of care coordination particularly for behavorial health clients.
       Advocates
1157   New York State Association of County Core public funding for local emergency preparedness should be preserved.
       Health Officials
1158   Nassau-Suffolk Hospital Council      Behavioral/Mental Health patients would greatly benefit from better care coordination.

1159   Beacon Health Strategies                Carve all behavioral health services into managed care plans to promote total health care integration

1160   United Way of Long Island               Reduce the complexity of Medicaid Managed Care for people with HIV/AIDS.

1161   Julio Batista - Director, NY            Implement an infrastructure for care coordination which will improve care for catchment areas while minimizing cost.
       Presbyterian Hospital
1162   Julio Batisto - Director, NY            Take steps to address medical malpractice reform.
       Presbyterian Hospital
1163   Joanne M. Baccellato                    Reduce use of Emergency Rooms as medical care of first choice.

1164   AIDS Community Research Initiative of   Preserve New York's Regional Training Centers, supported by the DOH AIDS Institute, that provide training sessions throughout the state for HIV case management and other service providers working with people
       America (ACRIA)                         with HIV/AIDS. Also proposes to replicate RTCs to address training needs outside of the HIV/AIDS sphere.
1165   AIDS Community Research Initiative of   Develop a nursing home diversion demonstration project for people with HIV/AIDS to enable older adults with HIV/AIDS receive quality care in their homes, thus avoiding the high cost and negative impact of moving
       America (ACRIA)                         them to long-term care facilities.
1166   Keith Chambery, Executive Director,     Eliminate hospital observation days. Hospitals retain patients over a number of days without officially admitting them. These visits do not qualify as a hospital admission, regardless of the patient's physical location or
       Genesee Health Facilities Association   the procedures that are rendered; the hospital decides what the patient status is. As patients stabilize and are discharged to a lower level of care, they are blocked from using their Medicare benefit upon admission to the
1167   Senior Alliance of Greater Rochester    Seek access to the value of recipient real estate for long term care savings.

1168   Mary Kargbo, Sheehan Health Network Enhance patient-centered medical homes and evaluate the payment for these services as they are keeping patients out of hospitals. This will decrease also decrease duplication of services




                                                                                                                                                                                                                                                                                25
 #                    Author                                                                                                                         Proposal
1169   Ellie Corcoran, TEA New York            Explore the computer program used by Chemung County.

1170   Ellie Corcoran, TEA New York            Support Erie County Executive CHris Collins' plan to have counties opt out of non-mandated Medicaid services.

1171   Ellie Corcoran TEA New York             Eliminate luxury benefits such as cell phones.

1172   NYAHSA                                  The Federal Centers for Medicare and Medicaid Services (CMS) had mandated that by August 13, 2013 all nursing homes/long term care facilities be equipped with a supervised automatic sprinkler system. This
                                               proposal would assist nursing homes in obtaining financing (which would be reimbursed through the nursing home Medicaid capital rate) by combining the individual debt financings into one pooled financing.
1173   Metro New York Health Care for All      Provide special assistance upon enrollment, and ongoing assistance once enrolled, with navigation and assertion of rights to new populations enrolling in managed care.
       Campaign
1174   Lisa Sbrana - Legal Aid Society,      The adoption of comprehensive care coordination models, provides both the opportunity to receive increased federal matching funds and for realizing savings based on better health outcomes. We rcommend that any
                                             plans to adopt care cordination through medical homes and health homes include measures that requrie the Department have staffing necessary to enforce contract terms and monitor compliance, quality outcomes and
1175   Lisa Sbrano, Legal Aid Society        It is critical that NY enact legislation establishing a Health Insurance Exchange as required by the Affordable Coverage Act.Medicaid shoulb be the foundation to build on. Using the past four years of Medicad
                                             simplification and streamlining measures as a basis to build on.
1176   Greater New York Hospital Association Move behavioral health services for SSI Medicaid Managed Care enrollees into the benefit package. This would allow for better care management for those individuals and would be a step towards the integration of
       (GNYHA)                               behavioral and physical health services.
1177   Lisa Sbrano - Legal Aid Society       Under current system, computers running NYC's Medicaid program, the rest of the state's Medicaid program, the Medicaid program for children in NYC's foster care system and Child Health Plus do not communicate
                                             with one another. This patchwork system is beyond repair. The State should take advantage of increased federal administrative matching funds to ensure compliance with the Affordable Care Act requirements and
1178   Greater New York Health Association Medicaid enrollees with behavioral health conditions are one of the highest cost Medicaid populations. These patients commonly suffer from multiple chronic illnesses and are subject to frequent hospitalizations for
       (GNYHA)                               both medical and behavioral reasons. Patients with serious and persistent behavioral health conditions are among those most in need of comprehensive care management services yet New York’s Medicaid program is not
1179   New York State Association of         Expand the use of mandatory Medicaid Managed Care to higher cost populations. Currently, there are too many exclusions for individuals, resulting in a program that tends to put the lowest cost, healthiest people into
       Counties                              managed care.
1180   Anonymous                             Expand Community Health Workers to educate and help communities at risk to improve annual primary care visits, decrease late finding of chronic diseases/cancer, etc.

1181   New York State Association of           Include more services, such as pharmacy and supplies, personal care and others, under Medicaid Managed Care. Current Medicaid Managed Care models carve out too many services that ultimately reduce overall
       Counties                                savings potential.
1182   Anonymous                               Improve overall NYS health. Focus and incentives to improve health and fitness in order to decrease chronic disease, co-morbidities in patients, and Emergency Room visits.

1183   New York State Association of           Implement family premiums for Medicaid Managed Care plans. Specifically, in a household of more than one person, each person should not be covered by a single plan.
       Counties
1184   Paula Mathews,                          License naturopathic physicians, approve nutracueticals, alternative/complementary medicines and preventive medicine.

1185   New York State Association of           Redirect unused managed care premiums paid to insurers who do not provide coverage at all to their plan participants. Proposal would include contract provisions that provide an automatic redirection of these unused
       Counties                                premiums to uncompensated care pools.
1186   Glenn Liebman                           Reject having large health care plans manage mental health care: population needs are too complex.

1187   Kaleida Health and Great Lakes Health   Require that patients needing higher levels of care, as determined by a universal assessment tool to enroll in a program that includes care management and expand programs that provide care managment such as MLTC
       of Western New York                     and LTHHCP.
1188   Kaleida Health and Great Lakes Health   New York has attempted innovative programs toimprove care coordination and cost efficiency by integrating care and financing trhough PACE, Medicaid Advantage and Medicaid Advantge Plus. Several factors have
       of Western New York                     limited enrollment in these models. The State should take advantage of the opportunity afforded in federal health reform and the ACA to work with health plans and providers to more effectively care for the needs of
1189   New York Hospital Queens

1190   New York Hospital Queens

1191   Greater New York Hospital Association Medicaid enrollees with behavioral health conditions are one of the highest cost Medicaid populations. These patients commonly suffer from multiple chronic illnesses and are subject to frequent hospitalizations for
       (GNYHA)                               both medical and behavioral reasons. Patients with serious and persistent behavioral health conditions are among those most in need of comprehensive care management services yet New York’s Medicaid program is not



                                                                                                                                                                                                                                                                        26
 #                     Author                                                                                                                            Proposal
1192   Nassau Suffolk Hospital Council          Dual eligibles account for 14% of enrollees and more than 40% of Medicaid spending. Services and financing are difficult to coordinate and often subject to conflicting state and federal incentives and rules. Every 1%
                                                reduction in Medicaid spending resulting from coordination of care for dual eligibles saves the Medicaid program $175 million.
1193   Jeffrey Sachs                            Adopt an 85% Medical Loss Ratio (MLR) for Medicaid and Family Health Plus managed care plans.

1194   Jeffrey Sachs                            Eliminate the Medicaid Fee-for-Service Program (FFS0 in three years. The State should use multiple innovative models for providing coordinated care.

1195   Anonymous                                Ensure that Medicaid Managed Care Plan profits are appropriate.

1196   John M Imhof, Commissioner Nassau        restore asset test; reduce drug and psychiatric rehospitalizations through better QM and accountability and support for ambulatory care; eliminate duplicative services across agencies; address fraud in precription drug
       County DSS                               misuse; give OMIG and/or counties more enforcement power.
1197   Wheels of Progress                       Save over a billion dollars by changing current institutional bias in favor of care in the ocmmunity by developing affordable, accessible housing. Collaboration with housing authorities,statewide rental assistance
                                                pogram, state allocation of Section 8 vouchers.
1198   Long Island Coalition of Behavioral      Supports Health Home model for persons with SPMI
       Health Providers
1199   Kim Bank, RN                             Have prevention programs prior to illness. Stop selling cigarettes ni NYS; mandtory training of proper nutrition in school, how this relates to obesity/diabetes; mandatory physicaleducation daily in schools; health
       Kbank@rochester.rr.com                   coaching available at every clinic
1200   Kim Bank, RN                             Start over - build oover; take the government out. If the state cannot afford programs, then we should do without, i.e. ...nonmedial expenses

1201   Karen Ostrum, MS, RD, CDN, Niagara Medicaid will recognize and reimburse registered dietitions as independent practitioners.
       Falls Memorial Medical Center
1202   Michelle Schimel, NYS Assembly     Review criteria for transportation and is it need based. Review Transportation costs.

1203   VICKI WHITE, UNITED WAY OF          Physicians need additional training to be able to provide quality care for HIV/AIDS patients, especially those with a number of comorbidities.
       LONG ISLAND
1204   Vicki White, United Way of Long     Provide sufficient wages for below paid helath care workers.
       Island
1205   Suffolk Co. DSS Comm. Gregory Blass The state takeover creates fiscal and operational challenges. The plan accounts for only 2-3% of the state's annual $53 billion budget. The takeover will present a hidden fiscal vacuum that counties will have to fill. In
                                           Suffolk Co. it could mean an additional $5m in costs to the county. "In a state mired in its own administrative and legislative challenges, I don't see how this takeover will curb expenditures or help in the delivery of
1206   MRT Member Jeffrey Sachs            The State should reduce the costs of prescription drugs and increase price transparency.

1207   Suffolk Co. DSS Comm. Gregory Blass No detail was included with this proposal but dental services are optional for this group of recipients.

1208   Joseph B Stamm, New York County       Mandate precertification/concurrent review and case management for fee for service Medicaid recipients, e.g. special needs, rural areas, etc.
       Health Services Review Organization /
1209   Bob                                   Medicaid should directly contract with specialized disease management and utilizaiton management companies, especially in conjunctin with the medical home model. this will maximize care for those who hav
                                             ecomplex chronic illness.
1210   James R Kaskie, Kaleida Health        Improve care coordination for patients frequenting the ER to improve quality of care and reduce costs over time. Advance the use of electronic medical records to improve care coordination.

1211   David W. Fisher, President/CEO Oak       Invest in a robust, patient-centered primary care that reduces the need for more expensive interventions, partiuclarly for patients with multiple chronic illnesses. Significant resources can be found in the Affordable Care
       Orchard Community Health Center          Act (ACA), including a 90% federal match in some cases.
1212   David W. Fisher President/CEO Oak        Use Medicaid to drive change in the health care system as a whole. Use the Medicaid redesign opportunity to align all payers around the principles of the redesign, especially in support of primary care and patient-
       Orchard community Health Center          centered medical home (PCMH).
1213   Douglas Melzer, Long Beach Medical       Create medical homes and manage care at the local level rather than by insurance companies who are concerned with cost containment, not care. A Gain Sharing arrangement could be incorporated into such a program
       Center                                   to reward the local hospital and providers for effective performance.
1214   Suffolk Co. DSS Commr. Gregory           Currently there is no utilization threshold for inpatient detox. Estimated savings to Suffolk County is $1m.
       Blass



                                                                                                                                                                                                                                                                                 27
 #                    Author                                                                                                                            Proposal
1215   James R. Kaskie, Kaleida Health       The State shoudl establish a health home program for patients with multiple chronic conditions and/or serious mental illness. Each home would be reimbursed a monthly care coordination fee, the funding which is
                                             available at a 90% federal match under th Affordable Care Act (ACA).
1216   Greater New York Hospital Association Medicaid managed care plans currently provide mental health services for most enrollees. However, for these plans’ SSI enrollees, mental health services are provided through the FFS system and are generally
       (GNYHA), Kaleida Health and Great     unmanaged. Yet patients with behavioral health conditions are among those most in need of care management services. Furthermore, this separation of medical benefits from mental health benefits results in
1217   Ellie Corcoran, Tea New York          Erie county plan to have counties opt out of non-mandated Medicaid services.

1218   Kaleida Health & Great Lakes Health of   Move behavioral health services for SSI Medicaid Managed Care enrollees into the benefit package. A compromise suggestion is to have plans cover this benefit but require that they come together on at least a regional
       Western New York                         basis to contract with a single BHO that meets standards established by SDOH and OMH and provides care management services that are eligible fo the 90% Federal match.
1219   American Cancer Society- including       Expand coverage of smoking cessation counseling to all Medicaid beneficiaries, including coverage of all first line tobacco use cessation medications and to remove annual and lifetime limits on duration and frequency
       Hillary Clarke's Testimony               use.
1220   Laurie Kostrzewski, TEA New York         Every item should be scaled back to basic needs

1221   Laruie Kostrzewski, TEA New York         Deduct copays from benefit checks

1222   James R. Kaskie, President, CEO,         Facilitate quality and efficiency improvements through a new coordinated service strategy. The State should develop person client records to link utilization and State spending o health care, special education, welfare,
       Kaleida Health                           housing, corrections and any other ervice rendered to specific clients. This will facilitate the ability of health care providers to care for defined popultions in partnership with other public and community-based
1223   Jody L Lomeo, Erie County Medical        Manage and coordinate care of enrollees and fund providers appropriately to avoid ER abuse.
       Center
1224   Frances Burns                            Develop a monitoring plan to prevent providers from doubling and tripling monthly medication

1225   Joann Casado, The Bronx Health Link,     Safety net providers that serve low income communities must be protected
       Inc
1226   Joann Casado, The Bronx Health Link,     Increase accessible primary care and preventive care services in the Bronx.
       Inc
1227   NYS Conference of Local Mental           Sub-group made up of BH stakeholders: counties/cities, providers/ MC plans and consumer groups.
       Hygiene Directors
1228   Kevin Dahill, Nassau-Suffolk Hospital    Patient centered medical homes and other care models (accountable care organizations, bundled payment systems) strive to achive better medical management and care coordination through a team effort.
       Council
1229   James R Kaskie, Kaleida Health           Preserving access to and iproving efficiency of hospital servicees - Include initiatives to preserve essential hosp8talsin low-incoe communities. Medicaid rates should be decoupled from other payer rates such as
                                                Workers' Compensation, No Fault, and the FHP Employer buy-in program. Add a differential to the Medicaid inpatient/outpatient reimbursemtn rates for payers required to use the Medicaid rates or allowing providers
1230   James R. Kaskie, Kaleida Health          DOH should convene a workgroup charged with identifying regulatory reforms that will reduce the administrative burden for both itself and providers.

1231   Campaign for Tobacco Free Kids           Expand coverage of smoking cessation counseling to all Medicaid beneficiaries, including coverage of all first line tobacco use cessation medications and to remove annual and lifetime limits on duration and frequency
                                                use.
1232   Jim Mutton Project Renewal               MC cannot effectively serve homeless. Project Renewal provides healthcare, homes, jobs to those with mental illness, substance abuse, co-morbid. Receive federal health care for homeless granst and operate FQHC.
                                                Eager to discuss with MRT how.
1233   Kaleida Health, James R. Kaskie          the medical malpractice system diverts enormous resources from the health care system and from edicaid. This is due to the high cost of malpractice coverage and to the extraorinarily high cost of defensive medicine
                                                practiced to avoid potential liability. Almost half of malpractice costs relte to delivery of obstetrical services alone. NYS Medicaid covers nearly 50% of all deliveris in the State, 60% of deliveries in NYC and 7-% of
1234   Housing Works                            Expand primary and preventive care within a community based settings in communities of highest health morbidity.

1235   Optional Services must be maintained     Optional services must be maintained for people living with HIV/AIDS and for all Medicaid recipients.

1236   American Heart Association- Julianne     Expand coverage of smoking cessation counseling to all Medicaid beneficiaries, including coverage of all first line tobacco use cessation medications and to remove annual and lifetime limits on duration and frequency
       Hart, Director NYS Government            use.
1237   American Stroke Association              Expand coverage of smoking cessation counseling to all Medicaid beneficiaries, including coverage of all first line tobacco use cessation medications and to remove annual and lifetime limits on duration and frequency
                                                use.



                                                                                                                                                                                                                                                                              28
 #                    Author                                                                                                                          Proposal
1238   Medical Society of the State of New    Expand coverage of smoking cessation counseling to all Medicaid beneficiaries, including coverage of all first line tobacco use cessation medications and to remove annual and lifetime limits on duration and frequency
       York                                   use.
1239   New York State Nurses Association      Expand coverage of smoking cessation counseling to all Medicaid beneficiaries, including coverage of all first line tobacco use cessation medications and to remove annual and lifetime limits on duration and frequency
                                              use.
1240   Leslie Verghese         Lifespire      Carve out MH and LTC services , including transportation, access these through FFS, avoiding current billing and QA review systems

1241   American Lung Association in New       Proposing full coverage of tobacco cessation coverage for Medicaid recipients.
       York State
1242   DASH-NY                                Stem the incidence and associated costs of obesity, diabetes and heart disease through:

1243   Amila Dowd Neufeld Family              Many in large group homes get unnecessary generic services, stay there longer than necessary. Separate out behavioral supports for habilitation services from housing options to individualize services.
       Residence & Essential Enterprises
1244   New York State Association of          NYSALM promotes evidenced-based maternity care and reduced cesarean rates.
       Licensed Midwives - see #805
1245   Addiction Treatment Providers          Separate BHO is most cost effective, OASAS should pay for performance outcomes; implement the already developed APG system.Continue decreased use of hospitals for detox.Dual licensing of OMH and OASAS
       Association                            for co-occurring disorder patients. Include OASAS licensed facilities in HITECH Act funding.
1246   Planned Parenthood of Western New      Establishing a uniform credetnialing system that would be applicable to all commercial and public insurance managed care plans. As DOH already approves all of Medicaid managed care providers it may be possible
       York                                   for commercial managed care plans to access this approved provider list. This unifrom system would allow our clinics to focus their staff resources on providing quality cost effective care.
1247   Anonymous                              Proposer favors use of Alcoholics Anonymous for substance use disorders.

1248   New York County Health Services        Prohibit performance of utilization review by health care payers. Allow retrospective review validation of precertified cases. Mandate precertification/concurrent review and case management for FFS Medicaid
       Organization                           recipients. Intensify validation of coding assignments by independent agents, implement punitive meaures for potentially preventable conditions. Review ofr inappropriate readmissions. Establish commission to
1249   Planned Parenthood of Nassau County,   Establish a uniform credentialing system that would be applicable to all commercial and public insurance managed care plans. As DOH already approves all Medicaid managed care providers, it should be possible for
       Inc                                    commercial maanged care plans to access this approved provider list.
1250   Health Plan Association                Integrate care provided to the SSI population enrolled in managed care by carving the behavioral health benefit into the plans benefit package.

1251   PHSP Coalition                         Carve the behaivioral health benefit into the MMC plan for the SSI population and include additional BH benefits for all enrolled members.

1252   Excellus Health Plan                   Require Medicaid managed care and commercial plans to obtain NCQA accreditation to measure quality of plans and to be eligible for the quality incentive payments.

1253   Senior Alliance of Greater Rochester

1254   Senior Alliance of Greater Rochester

1255   Senior Alliance of Greater Rochester

1256   Senior Alliance of Greater Rochester

1257   Senior Alliance of Greater Rochester

1258   Senior Alliance of Greater Rochester

1259   Richard Herrick                        Not enough information to evaluate the proposal.

1260   Richard Herrick                        Allow withdrawals, without penalty, from existing IRAs, 401K plans, and other pension plan options in order to purchase long-term care insurance or to allow payment for long-term care services.




                                                                                                                                                                                                                                                                         29
 #                    Author                                                                                                                           Proposal
1261   Richard Herrick

1262   Keith Chambray, Genesee Health
       Facilities Association
1263   Ellie Corcoran - TEA NY

1264   Michelle Schimel

1265   Jewish Home Lifecare

1266   Donald Degni - AARP                     Ensure that Medicaid recipients are legal.

1267   Gary Tucker

1268   Charlotte Davis

1269   Laurie Kostrzewsri - TEA NY

1270   Laurie Kostrzewsri - TEA NY

1271   Patricia Zinke - Winthrop University
       Hospital
1272   Southern New York Association

1273   DOH                                     The creation of a workgroup to review the existing Assisted Living Program. The workgroup will be charged with reviewing and incoporating proposals made during the Medicaid Restructuring Team (MRT) process.
                                               The workgroup should identify areas of Medicaid savings while allowing for long term care in a less restrictive environment.
1274   P4P for Medicaid FFS Providers          Establish pay for performance mechanisms for Medicaid FFS providers

1275   Terri Seppala, American TeleCare        improve care by monitoring patient's clinical conditions and health status continuously through video-telehealth to prevent acute events and disease progression.

1276   Louis Kaplan, Kings Harbor Multicare PAs should be given the ability to refer/order hospice for those patients that meet the criteria for hospice.
       Ctr
1277   Assisted Living Federation of America Author states an increase in the number of licensed Assisted Living Residences will lower the number of senior citizens that prematurely enter more expensive nursing homes. In addition, the author states that: ALP
                                             residents should receive the benefits outlines in the Assisted Living Reform Act of 2004 (aging in place); communities should be allowed to accept both private pay and Medicaid residents; Medicaid reimbursement
1278   Philip Bennett, Disabled in Action    Request NYS to sign onto the Community 1st Choice Option contained in the federal healthcare bill; give individuals choice of receiving home care rather than being sent to an expensive nursing home; change
                                             regulations regarding the M(11)Q form and extend to 90+ days.
1279   Susan Sorrentino, Family Residences   Transfer operating costs out of traditionally funded day program centers to affirmative business opportunities.
       and Essential Enterprises
1280   Rochester MRT Hearing                 Revise payment system for home care - convert from FFS to prospective payment system, similar to Medicare.

1281   Reprot of the Senate Medicaid Reform    Improve the cost effectiveness and efficiency of the system in order to provide for the best use of resources. Establish disease management programs. The existing Medicaid program has evolved into what is mainly a
       Task Force, December 2003               payment system for health care providers. Generally, this system is not accountble for the quality or cost effectiveness of care provided to Medicaid recipients. While managed care has presumably introduced some
1282   Rochester MRT Hearing                   Adopt regional pricing system for nursing homes.

1283   Rochester MRT Hearing                   Examine negotiated rates as part of nursing home reimbursements to create a viable structure.




                                                                                                                                                                                                                                                                       30
 #                    Author                                                                                                                                  Proposal
1284   Carol Mahoney, CEO HomeCare &            The PACE model, "Program of All-Inclusive Care for the Elderly," provides a fully integrated solution for dual eligibles to benefit from coordinated care. A health care environment that requires review of options at the
       Hospice                                  time of enrollment and at the point of any assessment/reassessment. Increased efforts to de-institutionalize patients from inpatient settings. Also requires unbiased materials not associated with or vested in particular
1285   Katheryn P Bunce                         Provide supportive and respite services to families with disabled children so that they can remain in the family home.

1286   Hofstra University MRT Hearing           Do not implement regional pricing for nursing homes

1287   Hofstra University MRT Hearing           Facilitate the refinancing of higher interest rate mortgages taking advantage of record low interest rates.

1288   Island Nursing and Rehab Center          Do not implement regional pricing for nursing homes.

1289   Mark Hannay, Director, Metro NY        Establish reimbursement rates to support providers efforts to offer culturally competence and undertake measures to address health disparities based on race, ethnicity, gender, age, disability, sexual orientation, and
       Health Care for All Campaign           gender expression.
1290   Island Nursing and Rehab Center        Launch a statewide program to encourage nursing home mortgage refinancing. New York should develop and implement a program to facilitate the refinancing of capital debt of long term care facilities (to include
                                              potential assistance with refinancing fees and related costs), which will reduce the State's expenses over time related to pass-through payment of nursing home capital costs.
1291   Annette Choolfaian, Women's City       Examine and define the current Medicaid population; identify and prioritize the essential needs of the Medicaid population before the preferential needs. Decrease costs in long term care by funding home care;
       Club of NY                             maximizing use of technology and services (assistive technology; developing programs for naturally occurring retirement communities; expand certified home health aides' role to administer medication); examine the
1292   The Institute for Health Care          Nassau University Medical Center, while in an affluent county serves a significant portion of vulnerable populations whihc are typically communities of color and lower socio-economic status and is a rarity among
       Disparities: Nassau University Medical safety-net providers. It is not enough to protect safety-net providers and insure access, Medicaid redesign must be innovative to improve outcomes by improving wellnes and prevention to reduce long term costs.
1293   Eddy VNA                               Convert the current CHHA fee-for-service payment system to an episodic Prospective Payment System that is constructed using an appropriate base, case mix sensitivity, and allowance for appropriate capital costs
                                              beyond today's A&G cap (for example, EMRs).
1294   Claire Altman, HealthCare Chaplaincy Allow Assisted Living Programs (ALPs) to have the ability to have the Enhanced Assisted Living Residence (EALR) option

1295   Medicaid Matters; GMHC                 Accross the board cuts must be avoided and safety-net providers that serve consumers and the uninsured must be protected, so that medically underserved, low income communities do not continue to lose access to
                                              health care services.
1296   Eddy VNA                               Begin piloting new payment systems for LTHHCPs. A monthly case rate or similar alternative would be designed to allow agencies to balance the varying needs of patients as compared to today's fee-for-service, patient-
                                              specific budgeting process.
1297   Anne K. Nolan, President & CEO,        There is irrefutable evidence that there is a way to reduce health-care costs, a number of studies document that FQHC patients have 30% lower total cost per Medicaid beneficiary. This success stems from the highly
       Community Health                       efficient, primary care medical home model provided by comprehensive, multi-disciplinary health care teams at community health centers.
1298   Gregory J. Blass, Commissioner Suffolk This proposal would require the prescribing and dispensing of generic drugs, when available.
       County DSS
1299   Cynthia Dames Consulting LLC           Relocate the gateway for inpatient detox services to non-hospital settings that have a clear and uninhibited connection to outpatient or residential treatment, Execute a realistic more transparent Medicaid Revenue base
                                              for hospitals, revisit Medicaid reimbursement rates now available for CBO's. Also allow a carve-out for patients seeking detox in non-hospital settings by re-thinking rules and regulations for all stakeholders.
1300   Jewish Home Lifecare                   Do not implement regional pricing for nursing homes.

1301   Ellen Wagerman                           HMO's cannot provide effective/efficient coordination for consumers and their many complex needs regarding Behavioral Health Care.

1302   Morris Tenenbaum, CEO, Kings Harbor Three phase approach: intial purchase; retirement age; long term care & end of life needs. Consumer buys DPI for life and/or long term care. DPI addresses 2 major risks - income protection & LTC costs. Consumer
       Multicare Center, Foundation for    may also convert life insurance to DPI. For insurance companies, DPI attracts new customers & encourages current policyholders to purchase additional insurance. Employers purchase tax-qualified DPI in place of
1303   Carol Mahoney                       Move towards deinstitutionalization and facilitated enrollment with assessment and reassessment as necessary.

1304   Leah Farrell, Center for Disability      Allow persons with significant disabilities to bank authorized home care/personal care hours to use when they are in a situation that requires more assistance or for emergency situations.
       Rights
1305   Jewish Home Lifecare                     Implement statewide program to encourage nursing homes to refinance mortgages.

1306   CCLC                                     Do not implement regional pricing for nursing homes.




                                                                                                                                                                                                                                                                              31
 #                    Author                                                                                                                              Proposal
1307   CCLC                                    Create a system to facilitate refinancing of nursing homes capital debt in New York.

1308   Mike Godino, Director of Advocacy for   Medicaid is a benefit that most people with disabilities cannot live without. Medicaid provides the services that assist people in living their lives. Cutting Medicaid servcies will place many people with disabilities in
       the Brooklyn Center for Independence    nursing homes. Increase more community based services (i.e., 1619b and waiver programs).
1309   Kathleen Plum, Monroe County Office     Collaborate with county MH and Community BH providers for SPMI; assure SPMI can access physical health; maintain bh services for all.
       of Mental Health
1310   Maxim Healthcare Services;Parent to     Higher reimbursement rates for home care private duty nursing: This would allow nurses to receive a higher pay rate which in return would allow staff to be implemented at a faster timeline which would allow hospitals
       Parent of NYS                           to discharge in a timely manner.
1311   Diane H Ashley            Rochester     Care for dual eligible Medicare and Medicaid recipients needs to be better coordinated.
       Regional Healthcare Advocates
1312   Step-by-Step, Inc.                      43 individuals who receive mental health services through Step-by Step, Inc. in Ogdensburg submitted letters requesting that the MRT consider their needs.

1313   Maintain current BH services in         Maintain current community programs that increase member's access to services that promote recovery from mental health and address important quality of life issues. These programs coordinate services and provide
       community settings                      case management.
1314   Dolly Sanchez                           Support carve-out for behavioral and mental health services.

1315   Grace Otto, RN - Bellevue Hospital      Expand primary care in the community to avoid hospitalizations and re-hospitalizations.
       Center
1316   Carmeliyia Blake                        Monitor hospitals for better discharge eduction to minimize re-hospitalizations.

1317   Consumer Directed Personal Assistance Expand use of CDPAP for persons with significant disabilities
       Association of NYS
1318   Medicaid Matters New York             Implement evidence-based models of managed behavioral health care using models such as Pennsylvania's Behavioral Health Choices. These approaches take advantage of tools such as person centered care, peer
                                             support, wellness recovery action plans, etc.
1319   Adele Gorges NY Care Cordination      Identical with #792
       Program
1320   Gregory Bradley, Administrator of     The State should capture savings from reductions in hospitalizations of nursing home patients.
       Jamaica Hospital Nursing Home
1321   Angela M. Hebner                      In favor of Behavioral Health Carve out that preserves and appreciates the value of peer, rehabilitation and support services.

1322   NYS Association of Licensed             Want to implement evidence based maternity care to reduce the number of C-Sections, lacerations, artifical rupture of membranes and electronic fetal monitoring.
       Midwives(NYSALM)
1323   Pfizer, Inc.- Anna Maria Maritato       Improving access to smoking cessation services could help address NY's budget deficit and help improve health outcomes in the coming fiscal year. Massachusetts recently leveraged federal grant funding which
                                               improved health outcomes and showed a significant return on investment in the first two years.
1324   Kathryn Hoffman                         Provide daily basic, compassionate care to individuals once discharged from the hospital; streamline State programs & offices administering the Medicaid program to avoid duplicity; institute a comprehensive medical
                                               model with properly trained staff for those with TBIs; institute long term placements to provide continuity of care; reimburse families who provide home care services, as well as provide support servcies, therapies &
1325   Aging in America                        Do not implement regional pricing for nursing homes.

1326   Robin Chappelle Golston                 Supportive affordable housing with on-site services is the most effective and cost-efficient way to help the homeless population. Individuals with complex mental health, substance abuse, and medical conditons require
                                               specialty managed behavioral health organizations.
1327   Aging in America                        Implement statewide program to encourage nursing homes to refinance mortgages.

1328   Pfizer, Inc. - Anna Maria Maritato      Identify strategies for serving patients who can be served in community settings as an alternative to hospital admits or nursing facility care.

1329   United Way of Long Island               This proposal requests program changes that would reduce complexity of Medicaid Managed Care for persons living with HIV/AIDS.




                                                                                                                                                                                                                                                                              32
 #                    Author                                                                                                                               Proposal
1330   Long Island Autism Examiner             Eliminate funding for long-term residential programs and waiver programs and make self-determination/community choice the only for services not offered through Medicaid/MMC

1331   Alere Womans and Childrens Health       Proposal to provide better managed prenatal and newborn care to result in Medicaid savings.

1332   Julia Garver                            Medicaid is clearly at the root of the state of our State today and hugely impacts lcoal government's ability to address local issues. Why does NY offer all 30 of the federally-qpproved program aptions .....no other state
                                               does that, except California, and its fiscal crisis exceeds our own?
1333   NYS Association of Counties             This proposal is to expand enrollment of mandatory managed care to higher cost populations, by reducuing the number of exemptions and exclusions to the program.

1334   New York State Association of           This proposal would waive managed care plan choice in areas where two plans are not available or create a statewide plan that could provide managed care coverage. Apply for federal waivers if necessary.
       Counties
1335   Buffalo Psychiatric Center              Decrease the total cost for inpatient behavioral health care by utilizing peer-based respite care as an alternative to inpatient psychiatric care

1336   Buffalo Psychiatric Center

1337   Gus Birkhead                           Office of Public Health (OPH) is interested in working with office of Health Insurance Programs (OHIP)on an effort to create "Integrated Centers for HCV Care" as part of the State's Health Homes initiative. Under
                                              this initiative the State would be eligible to receive 90% federal matching funds for the first 2 years of operations.
1338   Parent to Parent of NYS - Michele Juda In response to the remarks of the President of Fox Hospital, "tight local network" providers to control costs in Medicaid will not meet the needs of children with complex health care needs.

1339   Unknown                                If managed long term care plans are to grow rapidly to serve the personal care population, particularly for the disabililty populations, the Department needs to assure the plans have adequate networks, are ADA
                                              compliant, include social services or linkage with diability organizations, emphasize community integration, incldue disability-literate outreach and engagement and are monitored for marketing and enrollment activities
1340   NYS Health Plan Association, Coalition This proposes implementation of the section of the report to the state legislature for takeover of the local county administration which includes the implementation of the Medicaid Managed Care and Family Health Plus
       of NYS Public Health Plans             Contract in all areas of the state. This proposal would streamline the contracting process for both the health plans as well as the SDOH contract staff. Currently, NYC holds the managed care health plan contracts for
1341   Health Plan Association                Encourage managed care programs to enroll dual eligibles, especially thorugh participation in the Medicaid Advantage Plus program.

1342   Steven Ruttter, FEGS

1343   Steven Rutter, FEGS

1344   Steven Rutter, FEGS

1345   Steven Rutter, FEGS

1346   Care for LIFE Foundation                Improve access to PACE and managed long term are by leveling the competive field to allow immediate enrollment and commencement of services.

1347   New York Health Plan Association       Integrating pharmaceuticals into the Medicaid managed care benefit package will allow health plans to manage care in a way that increases quality while reducing unnecessary or even harmful services.
       (HPA)
1348   Parent to Parent of NYS - Michele Juda Inefficient prior authorization processes mean money is being expended on bureaucracy, not on valued services.

1349   Kathy Benner, Administrator for All     --Waiver consolidation & streamlining for more consistency; exploration of federal financial incentive to more efficiently provide home & community based care.
       About You Home Care agency
1350   OMIG                                    Medicaid Trauma and Estate recovery programs are mandated by CMS as another means of recovering Medicaid expenditures from other liable parties. In New York State, these programs are currently administered at
                                               the county level, leading to disparities in effective administrative approaches and overall results from county-to-county. Efforts are underway to coordinate these recovery programs statewide; at this point, though,
1351   OMIG                                    Reduce OASAS group session rate from $75 per individual for each group session to a more appropriate amount. APGs already address this concern.

1352   CPHS                                    Revise the Voluntary Hospital Inpatient UPL payment to have the qualifying criteria for the safety-net allocation to be based on services provided to Medicaid and the uninsured.




                                                                                                                                                                                                                                                                               33
 #                      Author                                                                                                                           Proposal
1353   Nassau County                            Would provide the OMIG with law enforcement authority to more effectively combat Medicaid fraud, waste and abuse.

1354   OMIG                                   Whether a beneficiary is enrolled in one of the state's Medicaid Managed Care programs or participates in traditional Fee-for-Service (FFS) Medicaid, the state remains the payer of last resort. To make certain liable
                                              third parties fulfill their financial obligations for beneficiaries in a Medicaid Managed Care program, we recommend a centralized, coordinated, eligibility Reassignments and Disenrollments from Managed Care to FFS
1355   Parent to Parent of NYS - Michele Juda Enhanced nursing rates, without a cumbersome approval process, are needed to assist families in securing staffing for technologically-dependent adult children.

1356   Parent to Parent of NYS - Michele Juda NYS must fully support and develop comprehensive medical homes, including adequate physician reimbursement for care coordination. Adult care physicians must be trained to care for individuals with complex
                                              needs. Confidence in doing so will help them provide services more efficiently and cost effectively.
1357   Coalition of NYS Prepaid Public Health This proposal urges the state to expand the Medicaid managed care benefit
       Plans, NYS Health Plan Association
1358   Dr Anandavalli Menon                   Change PMHP to cost for service rates

1359   New York State Healthy Eating and        To follow Grade A or B proven preventive services from the USPSTF- recommend adding to Medicaid and any 'benchmark' plan with no cost sharing as soon as possible.
       Physical Activity Alliance
1360   Coalition of NYS Prepaid Public Health   Integrating pharmaceutical coverage into the health plan benefit package will allow the health plans to to manage care in a way that increases quality while reducing unnecessary or even harmful services. It allows a
       Plans, NYS Health Plan Association       robust, comprehensive MMC package, improving care quality, and bending the cost curve.
1361   CPHS                                     Increase Chairy Care pool funding for Diagnostic and Treatment Centers

1362   Coalition of NYS Prepaid Public Health In order to control spending growth and ensure that adequate services are provided to beneficiaries, the state should allow the Medicaid managed care plans to manage their members' personal care services. Managed
       Plans                                  care organizations have financial and quality incentives to control for service over-utilization and maximize health outcomes, ensuring cost-effective care delivery.
1363   Nassau County DSS - John Imhof         Stop permitting multiple/needless/repetitive drug detox. and psych.hospitalizations costing hundreds of millions of dollars, all provided without any quality management and cost effectiveness accountability.

1364   Center for Urban Community Services      Coordinate local efforts and target supportive housing to high-need, multi-diagnosed populations.

1365   William Reilly                           Save moeny and salaries, benefits and pensions by allowing voluntary agencies to operate state operated group homes.

1366   OMIG                                     Should New York choose not to change the status quo in terms of centralizing and shifting the responsibility for eligibility reassignments and disenrollments (MRT #837), the alternative path is a significant shift in the
                                                State's approach to Medicaid Managed Care. Allowing the status quo to continue creates a disparity in the treatment of beneficiaries on managed care with access to third party coverage; depending on the local district
1367   Center for Urban Community Services      If the State chooses to carve out BH services, they should be managed by a non-profit specialty BH organization and overseen by OMH and OASAS.

1368   Mary Ann Malack-Ragona, Coalition of Restore funding for Alzheimer's Coalition Chapters so they can continue to be a valuable resource for NYS residents in need.
       NYS Alzheimer's Association Chapters
1369   Center for Urban Community Services Reducing Medicaid expenditures for high-need, multi-diagnosed population is complicated and needs to be flexible and patient-centered.

1370   Nassau County DSS - John Imhof           Taxpayers have a right to know that the dollars removed from their paychecks are being used in effective programs, not revolving door Medicaid mills or state bureaucracies, esp. OMH, DOH, and OASAS.

1371   Laura Merritt                            Enhance family services and respite services in OPWDD and will eliminate need for Group Homes.

1372   Christine Fitzpatrick, Adult Day Health Some counties require re-authorization of Medicaid transportation to/from adult day health care every six months. Propose to re-authorize transportation every three years for individuals having chronic illnesses.
       Care Council
1373   Laura Merritt                           INcrease parent training and respite for children with mental health concerns to lower cost of counseling and out-of-home placments.

1374   Anna Maria Maritato, Pfizer              New York could elect "early implementation" of the ACA Medicaid expansion, increasing eligibility for childless adults from 100% up to 133% FPL, at a 50% match rate. ACA provides a higher federal matching rate
                                                (100% for this population), but it is not available until 2014.
1375   OMIG                                     For a hospital to be eligible to receive a fee-for-service/GME payment for a managed care enrollee, there must first be a paid encounter by a managed care organization (MCO) to the hospital. This proposal would
                                                change existing State (Department of Health) policy, which allows a hospital to receive a GME payment for managed care enrollees regardless of receipt of payment from the MCO.



                                                                                                                                                                                                                                                                               34
 #                     Author                                                                                                                             Proposal
1376   Joseph Vollaro, NYS Alliance of           --Improve the overall administrative & communication structure of TBI & NHTD waivers, perhaps instituting an official statewide communication system. It is imperative that providers understand from whom
       Waiver Providers                          directives about the programs will be coming, that they be in written form, and that a method where in providers can get questions answered in a timely manner be established. A clear chain of command for contacting
1377   Visiting Nurse Service of Rochester and   Develop standards for home health aide utilization supported by a standardized, commom assessment tool for identifying long-term care service needs.
       Monroe County, Inc.
1378   Medicaid Matters (MMNY)                   Aligning charity care payments to hospitals which provide actual services to the uninsured will help to ensure maximum transparency and accountability in Medicaid spending.

1379   Addiction Treatment Providers             This proposal supports OASAS in conjunction with DOI to create an RFP process for Behavioral Managed Care entities to bid on managing all Medicaid for the SUD population in NYS.
       Association
1380   Gay Men's Health Crisis (GMHC)            Aligning charity care payments to hospitals which provide actual services to the uninsured will help to ensure maximum transparency and accountability in Medicaid spending.

1381   OMIG                                      New York Medicaid currently employs a thorough and robust approach to identify liable third parties and to recover from those parties any expenditures where Medicaid did not bear primary liability for the health care
                                                 costs. OMIG recommends applying this same program to participants of New York's Childrens' Health Insurance Program (CHIP), or Child Health Plus, to achieve two primary outcomes: ensure enforcement of CHIP
1382   OMIG                                      New York Medicaid currently employs a thorough and robust approach to identify liable third parties and to recover from those parties any expenditures where Medicaid did not bear primary liability for the health care
                                                 costs. OMIG recommends applying this same program to participants of New York's Childrens' Health Insurance Program (CHIP), or Child Health Plus, to achieve two primary outcomes: ensure enforcement of CHIP
1383   NYS Psychiatric Assoc., Inc.- Glenn       The NYS Medicaid fee schedule for private practicing psychiatrists continues to be among the lowest in the country and much lower than for the same services provided in a clinic.
       Martin, M.D.
1384   AFSCME Local 1549                         Bad debt and charity care pool funds should be calculated and distributed to hospitals based strictly on services to the uninsured.

1385   Kathy A. McMahon, Hospice &        --Provide incentives for nursing homes to make hospice care available through contracts with their local hospices.
       Palliative Care Association of NYS
1386   Medicaid Matters New York (MMNY) Aligning charity care payments only to hospitals which provide actual services to the uninsured will help to ensure maximum transparency and accountability in Medicaid spending.

1387   Office of the Medicaid Inspector          Requires all managed care organizations (MCOs) to notify the OMIG when they terminate a network provider's contract or refuses to renew the contract with a network provider. The notification would include the
       General                                   basis for the termination or refusal to renew the contract. The OMIG would then consider if the circumstances are such that the provider should be excluded from the Medicaid Program.
1388   New York State Conference of Local        This proposal outlines strategies to utilize successful care coordination models statewide in managed care, including determining how current programs/services would be covered in a managed care structure, provider
       Mental Hygiene Directors                  risk arrangements, consumer protections and choice, etc.
1389   OMIG                                      A subset of the overall Medicaid population is classified as dual-eligibles; these are individuals eligible for both Medicare and Medicaid coverage of health care expenses. For these individuals, Medicaid's financial
                                                 liability is secondary to Medicare. However, New York Medicaid will pay a dual-eligible's full Medicare cost-sharing obligation (co-insurance and deductible), even if this leads a total reimbursement in excess of the
1390   Gina Koch                                 --Appoint a Redesign Team liaison assigned to the two waivers.

1391   OMIG                                      The Federal Deficit Reduction Act of 2005 mandated that each state pass legislation compelling carrier cooperation in Medicaid coordination of benefits. New York passed such legislation, found in the Social Services
                                                 Law, §367(a)(2) as well as in the Insurance Law, §3212(e)(3)-(4). The intent of this language is to facilitate Medicaid's coordination of benefits with private carriers, including the removal of administrative hurdles in
1392   Office of the Medicaid Inspector          Requires all MCOs to notify the OMIG when they discover that an employee or contractor of the MCO has engaged in any activities that result in fraudulent enrollment into the Medicaid Program.
       General
1393   DOH                                       Change the reimbursement methodology for clotting factor products to pay at the lesser of acquisition cost or the Medicaid established state maximum allowable cost (SMAC).

1394   Laura Merritt                             Indicates schools should not use Medicaid funds for reimbursement for therapy within school settings

1395   Office of the Medicaid Inspector          Allows the OMIG to conduct audits of the financial reports filed by MCOs, and if the audit determines that the report contains mis-statements or ommissions of facts -- resulting in the receipt of inappropriate payments
       General                                   by the MCO -- the OMIG can recover any and all overpayments.
1396   Commission on the Public's Health
       System (CPHS)
1397   Office of the Medicaid Inspector          Allows the OMIG to directly recover Medicaid payments made to managed care network providers when that provider submits a false claim and receives a payment from an MCO for services rendered to or on behalf of
       General                                   a medicaid managed care beneficiary. The OMIG would also be allowed to assess penalties in accordance with State rules and regulations.
1398   RES Company                               --Person centered (change 6 month service plans to annual; eliminate signature on Individual Service Report (ISR); annual treatment plan requirements; redefine RRDS role)




                                                                                                                                                                                                                                                                                35
 #                    Author                                                                                                                              Proposal
1399   NYSAC                                   Provide fiscal incentives to Medicaid recipients to encourage the appropriate use of emergency room care. Increase co-pays to maximum levels for unnecessary visits to emergency rooms.

1400   DOH                                     Reduction in pharmacy ingredient cost and dispensing fee reimbursement amounts to align with levels achieved in other State Medicaid Programs and commercial payers.

1401   Throgs Neck Medical Billing             This proposal seeks to better manage the costs associated with Medicaid managed care enrollees that have access to or are in receipt of Third Party Health Insurance.

1402   New York Care Coordination Program,     This proposal would implement specialty health homes for persons enrolled in Medicaid managed care, being a central component of the managed care ensuring true integration of physical health, behavioral health, and
       Monroe County Office of Mental          social services for people with serious mental illness. Proposal includes recommended requirements for the managed care organizations to work cooperatively with county mental health departments for planning,
1403   Pharmceutical Society of the State of   Immediately end eligibility upon death.
       NY
1404   Suffolk County Department of Social     The Suffolk County Department of Social Services is opposed to the state assuming the administration of Medicaid. Believes the State should focus on other costs.
       Services
1405   Suffolk County Department of Social
       Services
1406   Suffolk County Department of Social     Eliminate duplicate CINs and duplicate coverage between Suffolk and NYC.
       Services
1407   Onondaga County Department of Social
       Services
1408   Onondaga Department of Social
       Services
1409   Onondaga Department of Social
       Services
1410   Onondaga Department of Social
       Services
1411   Gus Birkhead                            Proposes adding the following services: Obnesity counseling/Diabetes Prevention services; tobacco cessation cousnseling for all (not just adolescents and pregnant women); and extend coverage of Medicaid coverage
                                               of Nicotine Replacement Treatment for Persons with Serious Mental Illness from 6 months to 12 months.
1412   Gus Birkhead                            Implement coverage of CDC-recognized diabetes programs.

1413   New York State Association of           Expand Medical homes:
       Counties
1414   New York State Association of           Provide fiscal incentives to Medicaid recipients and Medicaid managed care plans to encourage the appropriate use of emergency room care. Increase co-pays to maximize levels for unnecessary visits to emergency
       Counties                                rooms and require Medicaid managed care plans to pay similar fees when their plan participants use inappropriate settings of care.
1415   Nurse Practitioner Association          Provide enhanced Medicaid rates for high-volume Medicaid caseload practices demonstrating quality outcomes in the area of health education, prevention and wellness and management of chronic disease.

1416   Nurse Practitioner's Association        Discourage use of Emergency Room services for primary care needs. For Example:

1417   DOH                                     Accelerate the collection of rebates through immediate enforcement of a drug's non-preferred status.

1418   New York State Psychiatric              The proposal submission included the Center for Medicaid State Medicaid Director Letter (SMDL# 10-024, ACA # 12), dated November 16, 2010 which provides preliminary guidance to States on implementing
       Association, Inc.                       Health Homes for Enrollees with Chronic Illness as promoted by the Patient Protection and Affordable Care Act, Section 2703 which adds section 1945 to the Social Security Act. This provision is an opportunity for
1419   The Long Term Care Community            Remaining in place as one grows more dependent would allow an assisted living facility to allow people to stay in what is now their home for a longer period of time.
       Coalition
1420   Ruth Kelleher                           Use of emergency room services for non-emergent care should be discouraged by larger co-pays and the collection of these co-pays should be aggressive.

1421   Parent to Parent of NYS                 Vigilance must be taken in assuring that private insurance companies are not shifting costs to Medicaid.




                                                                                                                                                                                                                                                                        36
 #                    Author                                                                                                                            Proposal
1422   Kaleida Health & Great Lakes Health of   Develop systematic & rational approach to delivering long term care services.
       Western NY
1423   Anne Calvo, Winthrop University
       Hospital Home Health Care Agency
1424   Ann Calvo, Winthrop University           --Review the overutilization of personal care programs in NYC, and abuse of the system
       Hospital Home Health Agency
1425   Mary Rose McBride, VP of Marketing       --Increase availability and knowledge of New York State’s Nursing Home Transition and
       & Communication, Lifespan of Greater
1426   Scahilltandr@gmail.com                   Educate the public on end of life care decisions.

1427   DOH , Ms. Perrin                         Adds Consumer Directed Personal Assistance Program (CDPAP) services to managed long term care plan packages.

1428   Cynthia Dames Consulting LLC             Convert State-operated services for developmentally disabled to existing community-based nonprofit organizations that already provide community residences and day services.

1429   Brenda Ward, Erie County DSS

1430   Barry Palatas, Visiting Nurse Service of Consolidate programs aimed at meeting the needs of specific populations. An example is the Home and Community Support Program of the Nursing Home and Transition Diversion Waiver Program; it serves less than
       Rochester and Monroe County. Inc.        130 people in our region, yet requires a costly administrative structure to oversee and manage. Instead, expand the capacity and flexibility of the Long Term Home Health Care Program. These types of existing programs
1431   Center for Disability Rights             --Transition people from nursing facilities who have expressed a desire to return to the community

1432   CDR                                      Implement the Community First Choice Option (CFC) and shift people from the traditional

1433   CDR                                      Move long term care users from certified home health agencies to consumer directed programs & transition appropriate consumers from traditional personal care to consumer directed programs. We recommend the state
                                                initiate efforts targeting the CHHA population receiving long term services. Because CHHA services are notauthorized through the Local Departments of Social Services (LDSS), the Department of Health can identify
1434   DOH                                      Convert a portion of Family Planning grants from 80% state funds to Medicaid reimbursement that would be 90% federally funded.

1435   New York State Catholic Conference,  Maintain benefits: In seeking savings, it may be tempting to look at reducing or eliminating existing benefits that are not always considered "basic care," such as behavioral health, dental, and vision coverage. This
       Richard Barnes                       would be a short-sighted spproach because in reality, these services have a profound impact of the overall health status of the individual. Eliminating routine and preventive care in these areas likely will result in
1436   CDR                                  Better utilize assistive technology to reduce personal care spending, for a potential first year savings of $1.74 million in the non-federal share. While there are options for obtaining assistive technologies (AT) under the
                                            NHTD and TBI waivers and through vocational rehabilitation services, the Department of Health has generally overlooked
1437   New York State Association of County NYSACHO supports an immediate cap of county expenditures for the preschool special education program and subsequently phasing counties out of fiscal, administrative and programmatic responsibility.
       Health Officials (NYSACHO)
1438   GNYHA                                Establish a Health Home program for patients with multiple chronic conditions and/or serious and persistent mental illness. The program’s focus should be on the ground, integrated care coordination teams responsible
                                            for providing or coordinating all of their enrollees’ required health care services as well as connecting their enrollees to social support services. Teams would vary in makeup and the intensity of care coordination
1439   Cynthia Dames Consulting LLC         Remove Alcoholism Treatment Centers from OASAS oversight and transition clients to existing community-based models.

1440   Nurse Practitioner's Association         Develop a volunteer Medical Service Corp that is incentive based, and that can serve as anational model utilizing existing FQHC infrastructure to increase access and availability to primary care utilizing NPs. Tax
                                                incentives and NP loan forgiveness (similar to Docotor's Across NY) could be developed to recruit providers who volunteer two weeks of service per year to help staff FQHCs.
1441   GNYHA                                    In order for the recommended health home program to succeed, participating providers must have access to electronic health records that include all Medicaid-covered services for participating beneficiaries.

1442   New York Presbyterian Hospital (NYP) NYP suggests targeting populations receiving fractured care by improving and monitoring transitions of care through health homes. Interventions provided: Rapid Access Teams (stemming from Inpatient and
                                            Emergency Departments Admissions); home visits (nurse practitioner or community health worker dependent on the severity); home care; multidiscipli9nary transitions of care team.
1443   GNYHA                                New York State requires separate licensure and imposes separate regulations on providers of psychiatric and addiction treatment services. Neither the Medicare program nor other states follow this practice. Many
                                            hospitals have reported that the ability to treat a patient for mental illness and substance abuse in the same setting would much improve quality and efficiency. This proposal is to combine OMH and OASAS into a
1444   HANYS                                The state should strengthen and expand existing behavioral health care coordination programs by replicating statewide those models /pilots that have proven successful.




                                                                                                                                                                                                                                                                              37
 #                   Author                                                                                                                             Proposal
1445   Cynthia Dames Consulting LLC            NYS should increase the use of the non-profit clinic model as opposed to the county or State operated clinic model.

1446   HANYS                                   Starting immediately, all high-cost populations should be in a care-coordination program that strengthens the management of care.

1447   HANYS                                   The state should expand the current Statewide Patient-Centered Medical Home Program (SPCMHP) to more payers and broader patient participation.

1448   HANYS                                   Coverage for many optional Medicaid services needs to be an examined relative to beneficiary growth and cost controls.

1449   Cynthia Dames Consulting LLC            NYS should seek opportunities to move disabled clients from day habilitation programs to customized employment strategies such as training/mentoring programs.

1450   Nurse Practitioner Association of New   Global Signature Legislation clarifies that a Nurse Practitioner may perform all medical functions - including signing, verifying or certifying forms or documents –pertaining to any medical service that is authorized
       York State                              within the nurse practitioner’s scope of practice.
1451   DOH                                     The MRT will estalish various workgroups to focus discussion on major reform issues. The workgroups will include:

1452   HANYS                                   Expanding school-based health centers will enhance access to primary care and reduce inappropriate use of hospital emergency departments.

1453   HANYS                                   New York should coordinate the various efforts under way to promote use of telemedicine.

1454   LTCCC                                   Modify the case mix Medicaid nursing home system to encourage quality, access, efficiency.

1455   LTCCC                                   Create quality pool for nursing homes.

1456   Coalition to End Medicaid Enforced      Establish a Medicaid LTC Buy-In Program to encourage more private payment.
       Poverty
1457   Pfizer, Inc. - Anna Maria Maritato      State hospitals can bill Medicare Part D for prescription drugs provided to Medicare eligible patients who have exhausted Part A benefits but many don't.

1458   HANYs, DOH, Dr. Shah,NYS           Omnibus Managed Care initiatives which eliminates many excluded/exempt categories for non-duals,expands the benefit package, promotes access to services, and ensures consumer rights.
       Cathiolic Conference, CNYHSA,Amida
1459   Southern NY Association            Improve care for the most chronically ill and costliest patients.

1460   Medicaid Matters                        Provide comprehensive care coordination teams.

1461   Medicaid Matters                        Employ innovative service design such as Patient Centered Medical Home and Health Homes for those with chronic conditions.

1462   MRT Member (Steve Acquario              Various proposals to expand use of the Partnership for Long Term Care Insurance Program and other LTC insurance products.
       NYSAC; Eli Feldman, Metropolitan
1463   Excellus Health Plan                    Statewide, enrollment in Medicaid Managed Care of eligible Medicaid beneficiaries hovers between 78% and 89%. Due to the high penetration rate, plans are in a position that they must market to Medicaid
                                               beneficiaries already enrolled in other plans to continue to increase plan enrollment. Movement of enrollees between plans and policing marketing practices results in unnecessary administrative costs to the State and is
1464   Medicaid Matters                        The U.S.

1465   Medicaid Matters                        Many long-term care consumers are capable

1466   Medicaid Matters                        Current waiver programs

1467   Website Submission                      Continue to support in home care-in most but not all cases it is cheaper and far better for the person. Also,have the Developmental Centers turn most of their residences(not the center based, very specialzed,or forsenic
                                               ones)and day programs over to the nonprofit cerebral palsy and associations for retarded citizens and simular organizations.These agencies can do the job for less money. We know there are union issues here-perhaps



                                                                                                                                                                                                                                                                             38
 #                  Author                                                                                                              Proposal
1468   Website Submission    Weed out illegal aliens.

1469   Website Submission    Use finger print identification.

1470   Website Submission    My organization represents clients with hemophilia and other bleeding disorders. Many are enrolled in Medicaid. Factor (infused daily, every couple of days or on demand) can be very costly. CHIP and Family Health
                             Plus does not cover out patient use of factor - only when administered in patient. This is not a good option for those who can lead normal functioning lives with the administration of regular factor. There exists a Federal
1471   Website Submission    I am a family physician (immediate past president, current secretary of the Albany chapter of the NYS academy of the American Academy of family physicians). I do womb to tomb family medicine, inclusive of
                             obstetrics, gynecology and pediatrics.
1472   Website Submission    We know that many Medicaid Recipients deserve Medicaid. We also know that many abuse the system. I think a taskforce with MFCU and OMIG should be created with the investigators already in-house, and go after
                             those recipients. Then add press-releases. I know this will not generate revenue, but will make the 'underground' people that work out of payroll and take advantage of system a message. I think that many people have an
1473   Website Submission    Visit the OMIG and check how many management specialist just do nothing all day. Some people are over-worked and others dont deligate to maintain power.

1474   Website Submission    in my practice i see a lot of medicaid recipients. and one thing i have noticed is that some people seem to go to their doctor 4-5 times a week for various reasons/prescriptions as well as the ocassional emergency room
                             visit. i really see no need for multiple trips to the same doctors office per week. there's too much of the ""it's free"" attitude with recipeints. it's not free! NY and it's taxpayers are paying the price. we need to push for
1475   Website Submission    In moves to save at the local level, too many counties are playing the system of what they charge to programs that receive high reimbursements. However these costs then boil to medicaid costs...eg..county wants a new
                             car..let's have Social Services buy it since they get 70%+ reimbursement and the county then can take the previously purchased car and move it to a program that doesn't get any/low reimbursement! Charge higher price
1476   Website Submission    Eliminate all non medically necessary items, medicines and services.

1477   Website Submission    There should be at least a $10.00 co-pay for every qualified medically necessary medicines, items and services.

1478   Website Submission    Bring NYS Medicaid costs in line with the average of all other states excluding California and New York.

1479   Website Submission    People on medicaid should be under the same rules as those of us with paid insurance- unless it is an emergency, emergency room visits ambulance rides should be preauthorized with a penalty for abuse. Over the
                             counter medications and supplies should require a ""prescription"" from a physician or dentist and BUS FARE should be used for travel, not Taxis or sadly, ambulances. Medical and dental insurance should be limited
1480   Website Submission    One suggestion I have is putting a cap on people with substance abuse problems. I know of to many individuals that continue to go through substance abuse treatment programs time after time every year. They continue
                             to go to inpatient units, halfway houses,out patient treatment etc. There needs to be a limit on how many times these indiviuals are allowed to use those type programs. . Many people use it as a form of living year after
1481   Website Submission    New York State needs to completely redesign the program and closely moniter foolish spending. NY spends about $800 per resident which is over double what even the 10th highest state of Vermont pays. Medicare
                             patients can get name brand medicine. If generic is good enough then so be it. They cannot use public transportation free of charge. When you look at statistics from all states, most often New York State has been
1482   Website Submission    We have to reduce the number of medical services/procedures offered to recipients and approved by Medicaid. It is true that New York state has the ""Cadilac"" of Medicaid coverages. You should look at what other
                             States offer in their programs and reduce New York's coverages.
1483   Website Submission    We also have to reduce or eliminate the local County share of the Medicaid program Again, New York State is one of the very few State that charge their local governments for the cost of Medicaid.
                                Possibly, if the State of New York were to pay a greater share, then perhaps they might be more willing to cut the cost of the prograam !!
1484   Website Submission    I am the President of a large not for profit nursing home. I would gladly consider decertifying a considerable number of beds, however, lower expense options we've considered such as assisted living, ALP, Adult Day
                             Care, etc. do not generate the revenue necessary to cover our costs. As a result, the only way to honor our mortgage commitment is to continue on as an SNF. I'm not sure what the solution is, short of some type of
1485   Website Submission    The agency where I work recently eliminated the entire art therapy department including my job and two others, I know that it is not unexpected to hear of lay off with today?s economy, but I have to wonder about an
                             agency that prides itself on ?an individual's right to choose? and ?making personal dreams come true? would eliminate a department that is such an important part of peoples? lives. I was told that the agency was
1486   Website Submission    Studies performed in many different localities- both urban and rural- consistently demonstrate that appropriate funding and incentives for supportive services for elders are very effective at enabling independent and
                             semi-independent elders to remain in their own home, at a fraction of the cost and at an order of magnitude of greater dignity and quality of life versus institutional care.
1487   Website Submission    It starts at the top. Hire commissioners who are experienced with Welfare, know the constituents they serve.
                             don't hire tehm just because they have been in government so long and need a place to go. The commisioners need to be respectful, respected employers who treat their employees likewise. Presently we have
1488   Website Submission    Do not cover routine infant male circumcision. It's medically unnecessary. I don't think Medicaid should be covering procedures that are purely cosmetic.

1489   Website Submission    Not sure where all the money for operating state community homes for OPWDD comes from but these houses (individuals who live in them as well) should not be spending money simply because we need to make sure
                             we spend all we get. Buying unnecessary furniture, TVs and the likes just taxes all us little folks all the more.
1490   Website Submission    My suggestion is that to reduce administration costs all Hos[itals and Doctors offices need to become computerized sp patient information is enter ONCE into a medical database and can then be used by all in the
                             system. Example: my wife had knee surgery and was in the Hospital overmight. She came home and 3-4 hours later had to return to the emergency room in the same Hospital due to complications. She still had the



                                                                                                                                                                                                                                                                  39
 #                  Author                                                                                                            Proposal
1491   Website Submission    I think it is short sighted to not have representation from the Office of the Medicaid Inspector General's office on the Team (not Jim Sheehan, but someone who actually knows what could be done to reduce cost/improve
                             program integrity). After 2 years working at OMIG, 2 years working within OHIP/DOH, I have seen first hand instances of waste and abuse that cannot be addressed because the regulations are unclear. My unit is
1492   Website Submission    Another area of serious concern is reimbursement for the provision of personal care services to Medicaid recipients. Just last week, I identified a physician that ordered more than $500,000 in personal care services in a

1493   Website Submission    Streamline administration, slash paperwork to free up clinicians to meet with consumers and reward use of innovative approaches to mental health.

1494   Website Submission    Stop taxi transportation for Traumatic Brain Injured individuals to get cigarettes at Native American Reservations because this is included in their care plan. Stop payment for mentally ill for things like home repairs,
                             mortgage payments, etc because this is included in the individuals care plan. Care plans should only address health related activities. Extrapolation of "medicaid coverage" for care plan authorized services because they
1495   Website Submission    The individuals that live in state operated group homes should not be going to the hospital to have blood drawn, using taxpayers money to do something that staff should be doing. This would save on gas and staff time
                             as well.
1496   Website Submission    Look at the cost of operating day treatment programs and redesign to reduce the cost of them.

1497   Website Submission    I know several people that have taken advantage of the Medicaid program. Many of them needed the care but some really abused it. The abusers basically didn't care. Some were single older men that got Viagra
                             through Medicaid and then hired a hooker. This happened many times not just once. I have no problem with those in need getting help, but I really think that the Viagra is a little much.
1498   Website Submission    When treating Medicaid patients in the hospital dental dept. I noticed that they take little to no responsibility for their dental health, because as they said -""Medicaid will pay for my treatment anyway"". Some even
                             unnecessarily used ambulance services to bring them in at night to the emergency room -because Medicaid paid for it. Suggestion-Don't cover ambulance services unless they were deemed necessary by the treating
1499   Website Submission    Aggressively identify and prosecute medicaid fraud.

1500   Website Submission    NYS should cut all the non-mandated parts of the program. It should save millions and help reduce the property taxes and make NYS friendlier to everyone. Anyone violating the rules should be fined and doctors have
                             their licenses to practice anywhere in the US suspended. You have to get tough on violators. The fines should go back to the counties where these doctors practice--should encourage more convictions.
1501   Website Submission    The NYS DOH has failed to recover Personal Care Program funds that DOH data mining reports CLEARLY REVEAL OVERPAYMENTS/AND/OR FRAUD TO COUNTY MEDICAID PRORAMS in excess of a
                             billion dollars PER ANNUM.THE CAUSE IS POLITICS AND THE REFUSAL OF GOVERNMENT TO CORRECT THIS SYSTEMIC PROBLEM OVER A 30 YEAR PERIOD.
1502   Website Submission    Bar any administrator who promotes or participates in medicaid fraud from receiving retirement benefits.

1503   Website Submission    SEND THE ILLEGAL ALIENS HOME AND USE THE MONEIES FOR THOSE
                             PEOPLE THAT PAID INTO THE PROGRAMS!!!!!!!!!!!!!!!!!!!
1504   Website Submission    Change laws and loopholes to make it more difficult for people to hide assets in order to qualify for Medicaid. One such law/policy, Spousal refusal, should no longer be allowed. It is unfortunate that those who have
                             the financial means to pay for their care are able to turn to Medicaid which was created to help those in financial need.
1505   Website Submission    Put a copayment on Doctor visits so they do not run to the Doctors for a runny nose which they do because they pay nothing. I have to pay for office visits so I go only when I have to.

1506   Website Submission    Stop paying for a cab to Medical appointment. People use this to get around. They say they are going to medical appointment then get as close to where they want to go.

1507   Website Submission    Watch the substance abuse medicine. They go to the Doctor and get suboxone and then sell it on the street for $10.00-$15.00 per pill then go buy crack. This is fact because I know people who do this and it is
                             disgusting.
1508   Website Submission    Make them pay a copayment for some medicines. I have worked all my life and I have to pay a copayment so why should people on Medicaid not have to pay anything because they never worked?

1509   Website Submission    Why can't Medcaid patients living in Niagara Falls see a specialist in Niagara Falls we see them in Lockport the tax payers are paying for round trip transportation. Give a Medcaid specialist in N.F. an incentive to see
                             Medcaid patients
1510   Website Submission    Inform Medicaid Patients to go to Urgent Care Centers instead of the ER for sore throats,earaches,ect,costing millions of dollars a year.
                             Why are we accepting patients coming in from other states and the get wonderful benefits this needs to stop.
1511   Website Submission    mostly new york is giving social service people too many benefits cell phones money welfare people live better on welfare than if they worked. someone who really deserves welfar is ok but there r so many just plain
                             lazy people that dont wanna work and wont because it s too easy to get welfare. give people bare essentials to live and not all these benefits that people take advantage of. also drug test welfaare recipients and give em 1
1512   Website Submission    OVER THE COUNTER DRUGS--Example aspirin. Consider the cost of the pharmarcist filling the prescription. I pay out of
                             pocket--so why can't the Medicaid recepient?
1513   Website Submission    The Office for People with Developmental Disability esposes ""Putting People First"" however, the agency does not practice this as a true mission or vision. Over the past 4 yrs., this agencv has added positions to
                             Executuve Leadership which are unnecessary and add little to the provision of services. Most recently, with the redesign of the Medicaid Service Coordination program and the termination of 104 front line staff, who



                                                                                                                                                                                                                                                              40
 #                  Author                                                                                                             Proposal
1514   Website Submission    I have worked in the PCA/PDN/CAH/LTHHCP/NHTD/TBI/CHHA/NY Connects world for most of my career. There is so much to discuss I cannot figure out how to summarize my thoughts.Regulations cause us to
                             waste alot of money. I think there should be a fiscal assessment and cap on spending to keep someone home - like proposed many years ago. We do need group homes as the cost of salaries in keeping difficult people at
1515   Website Submission    I have heard that people on Medicaid are only dispensed brand name precriptions...is that true? If they are switched to generic when possible could save BILLIONS!

1516   Website Submission    Start by eliminating the waste - people taking ambulances to hospitals for a vitamin or a tiny cut on a finger are ridiculous.(Just a few examples) Giving viagra to men on medicaid is also ridiculous. Medicaid should be
                             given to those who absolutely need it, not those too lazy to work to buy their own health care through an employer.
1517   Website Submission    Also - isn't there a way to limit this only for a number of years (like Welfare) and then cut it off? This should be for people who can't help but be on it.

1518   Website Submission    I am employee in a psychiatric center, and I believe money could be saved by having the medical doctors care for the patients in our hospitals then always transporting them to an outside clinic or drs office. There are
                             Medical doc, dental, and psychiatric docs in the buildings so why are the patients transported out for the needs. I feel that outside services are needed in true medical emergencies. Not hang nails, teeth cleaning,
1519   Website Submission    I feel that the constant medical appointments that the clients @ Pilgrim Psych. Center go for needs to be re-examined. Many of these appts. are unnessesary and are wasting taxpayers dollars for the cabs that are called,
                             and the vitits themselves.Many of our clients just want to get out of going to their programs, so they invent reasons to go to the emergency room or the doctor's office. We as employees must aknowledge each and every
1520   Website Submission    I believe that New York's Medicaid program should be in line with the other States in the union,each State has its own model,ours should be comparable.Medicaid should not exceed the cost or benefits offered by
                             private insurance carriers here in New York.I also believe that a recipient should be a resident for a reasonable period of time before eligibility.People applying for benefits should apply in person and be a legal citizen.
1521   Website Submission    Having worked in a Dr's office I'v seen many bottles of Medication payed for by medicaid thrown into the trash.
                             Doctor Rx med patient can't tolerate after a couple doses.Doctor changes med.
1522   Website Submission    I ama person on medcaid. I am dependant for treatment for many condtions. Rather work and have a good medical coverage but alas its not possible. I do have an idea for you its simple,and nobody gets messed o ver
                             and takepayers get a break. In Buffalo/WNY where I live particpiants are pput on manafged care, they are offered three insurance companies to choose from and the coverage begins they have partnered up w/medicaid.
1523   Website Submission    I know for a fact that some Medicaid consumers are obtaining Narcotic pain medication from their Dr's,and then selling them on the street.Oxycotin sells for $80.00 per pill on the street,and some of the other Narcotic
                             pain killers are not far behind in price.These Medicaid consumers then Doctor shop to obtain more scripts for more pain killers for which they then pay cash for it,because a bottle of 30 Oxy tablets will bring in
1524   Website Submission    I did read the acrobate adobe booklet of Medicaid Reform and do see that your most interested in chronic care reformation. I am responding to the request for ideas on that reform and speaking from a somewhat
                             personal experience. I may be giving more information than what you need but it is based on an experience that you may not know of when all you see is numbers and statistics. If you want to fix the system you truly
1525   Website Submission    The other issue is acute care. My health insurance provider WILL NOT PAY THE BILL if I use the ER room for any reason which is not a life threatening illness or acute injury needing immediate medical attention
                             (such as a broken bone). I know many people in the medical community and they are disgusted at the amount of people who will use the ER for a sore throat, flu, hang nail, etc. There needs to be a place for people to
1526   Website Submission    Must be a ny resident for no less than one year before any kind of assistance can be applied for. Regular drug testing for those thought to be abusing system. Food stamp program overhauled, food stamps for particular
                             food groups such as fruits and veggies forcing some people to make healthier choices that affect ones health,which in turn raises health care costs. Absolutely no cosmetic improvements covered under programs with
1527   Website Submission    WHY ARE NEW YORk state employees exempt from taxes< holy crap< that would clear up you budET PROBLEMS IN A HYRRY !! Another UNION PERK. Bust THe UION!!!!!!

1528   Website Submission    We pay for everything!!! It has a revovling door policy. People who take this road should only be allowed to do it once!! I know first hand, with a family member at the outragious cost we pay as tax payers.
                             I am 59 and have raised 2 grandchildren for 9 years. I saw 1 bill fom patient and was horrifies at the cost for 1 month, before transfer to New Horizons Village for 3 months, then to supervised living, then to supported
1529   Website Submission    While the immediate challenge facing our state's Medicaid program may be spiraling costs, the underlying problem is structural: one level of government defining the benefits and compelling another level of government
                             to pay for them; a burden that escalates with poverty, unemployment and recession falling most heavily on those parts of our state that are in the weakest position to pay for them; financed by sales taxes and property
1530   Website Submission    Hello, I am a health care professional working at an Article 28 dental facility.I have been with the the company for 5 years.Some of the observations I have made:
                              Multiple patients having gastric by-pass surgery,and are still obese.
1531   Website Submission    Even though the regulatory environment has stiffened, the current Medicaid/FHP/CHP enrollment system is filled with waste and fraud. It is time to scrap the direct enrollment model and join the dozens of other states
                             that use a more cost-effective means of determining eligibility and ensuring the subsequent enrollment of those eligible for public health insurance programs.
1532   Website Submission    I work in the Forest Hills/Rego Park area of Queens, NY. As someone who stops many vehicles for traffic infractions, I can tell you, along with all of my colleagues, of those people driving brand new Mercedes, Lexus,
                             BMW, etc., and have a Medicaid card in their wallets that have thier names on it. It is the norm here, not the exception.
1533   Website Submission    One suggestion would be to eliminate any non-mandated programs such as dental and vision. Also you could eliminate the new cell phone program, Assurance, that provides recipients with a cell phone and a number
                             of minutes each month.
1534   Website Submission    We have got to stop being the ""giveaway state""! Some of our elderly population who have no other means of receiving good medical care deserve all of the help they can get--- but those who move in from other states,
                             or who are illegally in this country have NO right to these benefits! Also, some of our younger people who are all too willing to sit back and take medicaid since they seem to be too particular about the type of job they
1535   Website Submission    do not admit to inpatient mental health units people with borderline personality disorder. they thrive on the experience of the ip committment and basically do not participate in therapy. the process of admitting them
                             alone is enabling their behaviors. i believe, in some bordering state, maybe mass, they have a special unit that people with borderline diagnosis are diverted to when they show up in an er requesting admission. it not
1536   Website Submission    Stop paying for trips to the doctors for eye appointments and things that are not live threatening.
                             Stop allowing the ER to be a primary doctor



                                                                                                                                                                                                                                                               41
 #                  Author                                                                                                            Proposal
1537   Website Submission    Recommendation: Eliminate the Medicaid in Education program to schools for services provided to Medicaid eligible students.
                             Rationale: these are students whose services (occupational therapy, physical therapy, speech therapy, counseling, busing)are mandated by their Individual Education Plans (IEPs)as approved by the Committee on
1538   Website Submission    All prescription durgs shall be filled with less expensive generic drugs.

1539   Website Submission    Medicaid has gone from a wonderful basic needs program to help those who cannot help themselves due to unpreventable circumstances to a program that has become a continuing family lifestyle. There has to be a
                             way to control the abuse of the system. Why should we pay for a female who has four children with four different fathers and can't remember who they were! Check with the Child Support Departments across the state
1540   Website Submission    Maybe there should be clinics established for the sole use of those on assistance and staffed with qualified doctors and nurses paid by the State to manage these sites.

1541   Website Submission    All personnel of medical services, whether providing care at home, hospital / clinical, pharmaceutical, or other healthcare facility need to employ similar ethics as those defined in Ethics in Public Service. Public
                             employees have a duty to conserve public resources and funds against misuse and abuse. Easier said then done? Well, this spells out proper conduct and appropriate action that needs to be taken in order keep public
1542   Website Submission    North Carolina's Medicaid management program, known as Community Care of North Carolina (http://www.communitycarenc.com/) is a group of physician-led networks that rely on the medical home model to save
                             costs and improve health care quality. For a capitation of $5.50 per Medicaid patient per month, practices are required to use evidence based guidelines for at least 3 conditions, track tests and referrals, measure and
1543   Website Submission    Need to stop Fraud by getting people's authorization on what was done before the bill is paid. Also there are people that can work and are not disabled. Put them to work for the state.

1544   Website Submission    When I have to go to the hospital and there is a question about whether or not it is a true hospital emergency. I have to call my Dr to make sure I should go. If not, my health insurance carrier may deny my claim. Do
                             medicaid recipients have to do this? For example, if one has a toothache, can they get a $300 ambulance ride to the hospital and receive the $100 Emergency Department visit? I know that they can, since I work in an
1545   Website Submission    STOP IMAGING SELF-REFERRAL.

1546   Website Submission    bring back resource test

1547   Website Submission    limit the services that are provided when a person is receiving medicaid

1548   Website Submission    revisit why we need to give people out of prison automatic Medicaid?

1549   Website Submission    Transportation should be included in the redesign team. Transporting Medicaid clients is a huge amount of the cost of Medicaid, especially in rural areas. I would like to suggest that we also look at regionalizing the
                             Counties of Essex, Clinton and Frnaklin. We have a lack of doctors and services can be long distances. Our three Counties already connect through public transit and want to look at ways to cut cost. If we could move
1550   Website Submission    If California can cover twice as many people for 25% less money, perhaps we should take a look at their program and model New York State's program after theirs.

1551   Website Submission    After working temporarily in a Medicaid office, I wonder if having the state take over or have the insurance companies take over the application review, etc. Currently it is so detailed and time consuming with AIRs and
                             giving people chance after chance along with so much wasted time by high paid and some spoiled county employees that there has to be a less expensive way to provide the service! Privatization may be the best answer
1552   Website Submission    It should be easier to find out if you have restrictions or suspentions on your medicaid. Maybe a Medicaid ONLINE with a PIN number.
                             I work with mental health and subtance use populations and most have a lot of problems with their medicaid and are unable to explain them to others. It would be easier if there is something like Medicaid conference
1553   Website Submission    In the WNY area, many people are employed by collection agencies. These agencies provide a good income for many, but collector's salaries are divided into hourly rate and incentive. These companies also offer
                             employer sponsored health insurance programs.
1554   Website Submission    Quick suggestion - run an excel sheet by a time wise manner & look into those who have been using the system for a long term use - yrs - when the economy was in good standing. I know that sounds mean, but it does
                             hold some truth to abuse.
1555   Website Submission    I am a volunteer fireman and see first hand some of the abuse of the system. There is no accountability or self responsibility for using 911, ambulances or the hospitals. If I use any of the above, I?m charged with a co-
                             pay on my insurance. I think everyone should be made to pay a co-pay and if is not paid, it should be deducted from there benefit check. Yes this may hurt a few but it will cut back on the number of people that go to
1556   Website Submission    1. Encourage faith based free clinics which run efficiently and offer quality care for the indigent.

1557   Website Submission    Better gatekeeping of the use of medicaid......
                             i.e. limiting the number of inpatient treatment episodes allowed for substance abuse treatment
1558   Website Submission    Like the food stamp program, there should be a MANDATORY and enforcable requirement to REPORT an INCREASE IN INCOME within a short time period of the increase/change in circumstance. The change
                             must be for the foreseeable future, for example - a new job, a child support order. It should be that the increase in pay might change your level of care, ex. Medicaid to Family Health Plus, or free care to having to pay a
1559   Website Submission    My suggestion is to make people who transfer their homes to others, but retain a life tenancy, ineligible for the STAR exemption. I know many people who whose parents have transferred their homes to their children or
                             trusts in order to qualify for medicaid should they eventually need to go into a nursing home. Currently they can do this and still qualify for the STAR school tax exemption. Properties should only be eligible for the



                                                                                                                                                                                                                                                            42
 #                  Author                                                                                                              Proposal
1560   Website Submission    As a nurse working for the past 10 years in an out-pt psychiatric clinic for Rockland Psych Center in Mt Vernon NY I have observed a few things:
                             1- Go back to Regulated Medical Waste collection every 3 months. We have a separate closet area downstairs to store the sharps containers. Right now, the guy comes once a month and takes away ONE small 1-gallon
1561   Website Submission    As a family new to medicaid one of the hardest thing is being able to find medicaid doctors in my area. It would be helpful to have a list of available doctors and medical centers that accept straight medicaid. Also, as a
                             new family I received no information on how use medicaid coverage. Thank You.
1562   Website Submission    My suggestion has to do with getting rid of taxi cabs to drive medicaid recipients to appointments. Furthermore, I would love to know what we spend to put the so called homeless up in motels for months at a time. How
                             many dealers and hookers do you figure are working out of those rooms you pay for. You could probably build shelters with the money you give the local motels. GOOD LUCK.
1563   Website Submission    My wife works for a local Rite Aid and sees abuse of the system everyday. People are using to system to fuel their disires. They refuse to pay the co-pays on drugs and by law they can not be refused. Then when leaving
                             the store they buy cigerettes and beer. The system allows them to get top tier drugs at no cost. And to make them stop smoking we buy them nicorit gum at about 50 dollars a box. They go out sell them on the street and
1564   Website Submission    We really need to understand what types of patients incur the biggest Medicaid costs. I am an RN in a hospital and in the past year I have cared for many Medicaid patients who are either ""frequent flyers"" and/or have
                             very extended hospital stays (more than four months) whose health problems are caused by drug dealing and substance abuse. One patient had seven strokes from cocaine use, and he continues to use even though he is
1565   Website Submission    Good vision care is essential for students to learn and workers to be productive; however, it is not necessary to automatically allow individuals to obtain new eyeglasses/vision products on a regular, even annual basis. It
                             would be more reasonable to provide new products when needed, determined by a vision care specialist at times of significant changes and/or challenges for healthy eyesight. Scheduling eye exams every other year
1566   Website Submission    Care for the disabled is overseen by OWPDD---this is not an appropriate oversight agency, and they allow terrible abuse and neglect, and no one is willing to provide the necessary care.

1567   Website Submission    STOP FUNDING Abortions and Planned Parenthood!!
                             Stop paying for unneccessary plastic surgury.
1568   Website Submission    I believe the cost of medical taxis for Medicaid clients is extremely expensive. There are clients who leave who live more out in country part of Monroe County and take medical taxis for all their medical appointments.
                             It has to be extremely expensive to take a medical taxi all the way across Monroe County. Taxi cab companies, like Apple Taxi, take clients from one outer suburb to another outer suburb. I was surprised Medicaid
1569   Website Submission    Medicaid is a Federal program, like welfare. If the Federal Government created the system, the Federal Government needs to fund it with Federal Tax dollars... not State, not County, not City tax dollars.

1570   Website Submission    My 2'nd Recommendation is that Medicaid Assistance Limits need to be incorporated. We can't pay for everything. Funds are limited. My Health Care Insurance keeps going up and my employer expects me to pay
                             larger and larger deductibles. Medicaid needs similar treatment. Perhaps Medicaid should only cover Major Medical expenses and not routine care. Just like many private health care plans are evolving into. The
1571   Website Submission    Civil commitment for sex offenders is extremely costly, and no one ever ""graduates"" from the program. Perhaps the money could be better spent providing closer community monitoring of offenders coupled with
                             community-based treatment programs.
1572   Website Submission    Also, many inpatient psychiatric patients remain hospitalized far longer than necessary due to lack of sufficient community housing alternatives. (I worked for 30+ years in an inpatient facility and have seen this first
                             hand - the community agencies are extremely risk-averse).
1573   Website Submission    When I began working in NYS service in 1973, the NYS Office of Mental Health, OMRDD, and the state?s alcoholism treatment services were a single agency ? the Department of Mental Hygiene. The state could save
                             millions by once again combining these agencies under a single administrative structure. In Rochester, the Norris Clinic (the alcohol treatment center), the Rochester Psychiatric Center, and Finger Lakes Developmental
1574   Website Submission    FIRST AND FOREMOST, DEMAND PROOF OF CITIZENSHIP BEFORE GRANTING BENEFITS. THIS WILL SAVE MILLIONS IMMEDIATELY!

1575   Website Submission    I work for a commercial ambulance service in New York, and as a tax payer, I get frustrated seeing the abuse / misuse of the services we provide.

1576   Website Submission    It would be a good idea for the patient to receive confirmation of anything paid for him or her by Medicaid, including services rendeered and amounts paid. In speaking for my husband, who had a severe stroke two
                             years ago on Jan. 14,2009, I phoned Medicaid to have these figures sent to me, and they refused. He has ephasia and cannot speak, but understands anything asked of him. How can any fraud be recognized when we
1577   Website Submission    I recommend that Medicaid continue to offer a high quality medical program and adapt a progress co-payment system so that as people have increased income they pay progressively higher co-payments for service.

1578   Website Submission    Urge all doctors to prescribe generic drugs when avaiable.
                             My health insurance Co. does this for my meds when ever available. Does the same as name brand drugs, except much cheaper.
1579   Website Submission    5 year NYS residency requirement, as well as proof of U.S. citizenship, as eligibility criteria, will stop growth while a real plan is formed.

1580   Website Submission    My first suggestion for reforming Medicaid and in fact, all public welfare is that every recipient should be tested for illegal drugs. If he/she tests positive, then he/she should receive funds only if they enter rehab service
                             and come out clean and stay clean.
1581   Website Submission    I think that everyone 21 and older should be givin a drug and alcohol test. If you fail then try again in 30 days. Everyone on medicaid should be smoke, alcohol and drug free. Tobacco, drugs and alcohol related illness
                             cost the state alot of money.
1582   Website Submission    REDESIGN MEDICAID ELIGIBILTY SO THAT THERE IS A SUBSTANTIAL WAITING TIME FOR INDIVIDUALS WHO MOVE TO THIS STATE WITH THE PLAN THAT THEY BECOME
                             IMMEDIATELY MEDICAID ELIGIBLE AND THAT NY STATE HAS GREAT SERVICES FOR THE MEDICAID INDIVIDUAL IE: PCA, EA, LPN, CAH, NURSING HOME TRANSITION WAIVER, ETC;



                                                                                                                                                                                                                                                                  43
 #                  Author                                                                                                           Proposal
1583   Website Submission    There should be a mandatory residency limitation. Why do residents of canada or other foreign crountries come to NY to give birth. The feedback is because NY pays for it.

1584   Website Submission    Medicaid now reimburses school districts for nurses', occupational therapists, physical therapists, speech/language pathologists,etcetera, services. Insurance companies do not recognize these services within the school
                             setting and do not reimburse for them. Some states do not use medicaid money to pay for these services. New York would save millions of dollars in one cut, to quit reimbursing school districts for these services.
1585   Website Submission    As a social worked employed in the Admissions Department of one of the not-for-profit nursing homes in Rochester, I am frustrated by the frequent use of SPOUSAL REFUSAL for couples with generous financial
                             resources. By hiring a lawyer who is familiar with the Medicaid loopholes,individuals are misusing Medicaid which results in loss of substantial income to the nursing home and obviously increases the burden of
1586   Website Submission    Appoint a case worker to any patient seen in an emergency room more than 2 times a week. I am a nurse in an urban hospital who sees individuals misusing the system seeking narcotics. Case managers should be used
                             to identify these individuals and place them with a pain management physician. Benefits should be then made to be contingent on continuous care with that physician's plan of care. Adaequate reimbursement needs to
1587   Website Submission    I suggest that the poor and elderly not be the main focus of ways to save money in a state that has many rich people as residents. The poor and elderly need Medicaid. What would you suggest that poor elderly people be
                             put out on the streets when their Medicaid runs out or their lives be cut short to lessen the budget of the state of NY? Be fair and let those who have more than enough money help those who have very little.
1588   Website Submission    My ideas emanate from nearly 18 years of experience with my wife's treatments as a dialysis patient. Hemodialysis patients are treated three times a week for 3 to 4 hours each time to clean their blood of impurities and
                             removed fluid when their kidneys have failed. They are all covered by Medicare as their primary provider but many are also covered by private insurance or Medicaid. It is easy to tell at a dialysis center who is
1589   Website Submission    As both a taxpayer and a health care administrator, I would like to suggest that time be spent on the redesigning of medicaid comparing the MA benefit to the benefits of those of us that have private health insurance. I
                             know in my plan, I can't get a lot of name-brand prescriptions, I have to use the generic form. I think Medicaid should be the same. Also, in my plan, I can't get unlimited home care visits when I may need them, the
1590   Website Submission    Office of Mental Health enrolls patients receiving outpatient services in PMHP. Most of these clinics are not provide recovery services and are billing a patient's medicaid or medicare on top of receiving PMHP money.
                             Some may say that this is fraud. Someone needs to look into this. Some clinics are enrolling long term chronic patients in PMHP but billing each service under psychotherapy thus getting paid at both ends. Maybe
1591   Website Submission    IPRT programs are falling apart with PROS. First they are merging CDT and IPRT together which can attribute to lower functioning and higher functioning clients becoming symptomatic and thus resulting in more
                             hospitalizations. Since PROS has been implemented here in Monroe County NY,there has been change for the worse. Staff layoffs, less participation and A higher drop out rate from these necessary programs.Mundane
1592   Website Submission    Medicaid, like all other insurances, should pay mobile mass vaccinators not just DOH clinics or MD offices. In our county, we set up flu clinics where aging and disabled people live but Medicaid will not pay these
                             because of NY Medicaid regulation. This increases the cost of vaccination ( in transportation and MD office visits) and reduces access of Medicaid clients to preventative care, which could prevent more serious illness.
1593   Website Submission    Shame on private sector YAI for bilking 18 million dollars from Medicaid for services not provided. It seems as if closer monitoring and stricter accountability of the Medicaid funds in the private sector should be the
                             key to getting NY state back on its feet rather than laying off or freezing the salaries of state employees. $18,000,000 collected back from YAI would put a considerable dent in NY's budget deficit. Whose pocket did
1594   Website Submission    I was caregiver for my mom who passed away a year ago today. She had both Medicare and medicaid. I dealt with everything as a caregiver. I could write a book. Medicaid needs to reform first at the Administration
                             end. There is no connect there for patients and caregivers. This department needs to run like private insurance. Dealing with medicaid for her and dealing with my Health Insurer was day and night. Taking care of an
1595   Website Submission    Medicaid, just like all social welfare programs should have a maximum benefit or time limit. Once an individual has obtained a maximum dollar amount in benefits, or has been on government programs for a pre-
                             determined length of time - then cut their benefits off. The only exception should be those with disabilities that prevent them from working - as they should be permitted lifetime benefits. Eligibility guidelines need to
1596   Website Submission    I think the redesign committee should seriously consider the cost of using a middle-man to implement and regulate waiver services. Voluntary agencies are cheaper, and often more efficient than their state run
                             counterparts. The waiver system is bogged down with a lot of unnecessary waste spending, in the form of high-paid paper pushers. One area to consider is the OPWDD auditing system. I strongly feel that OPWDD
1597   Website Submission    . Focus on children.

1598   Website Submission    Simplify tracking of savings.

1599   Website Submission    Fund preventive activity.

1600   Website Submission    We must manage compliance more effectively. We should not be carrying out both federal and state audits, should not promulgate state regs that are in excess of federal regs, should provide compliance technical
                             assistance to providers instead allowing them to flounder in a bewildering array of regulation and interpretation, and should carefully measure the cost-benefit relationship of every new regulation. For example, the
1601   Website Submission    I currently work as a Medicaid Service Coordinator at a non-profit organization. I have been to three different Departments of Social Services and at each one there have been instances where I am waiting with a client
                             and have overheard conversations of people waiting for their public assistance or cash assistance and are talking about going to concerts, making drug deals, and going to the mall. I believe people on welfare should be
1602   Website Submission    One sure way to save is to make long term care insurance mandatory and have the state pay all are a portion of tne preimum to those who cannot afford to pay. The cost savings would easily offset the cost of the
                             program plus save because many seniors use Medicaid for nursing homes, home health, and other services.
1603   Website Submission    Two: Allow health insurance companies to sell a catastrophic health policy in group or individuals up to age 40 and have adult mediciad recipents switched to this policy with the sate paying their preimum. The policy
                             would cover routine doctor visits, non-life threating emergencies, and would allow a higher remibursement encouraging more doctor involvement.
1604   Website Submission    As is common knowledge, many persons present at the emergency room with concerns that are truly not emergent. My suggestion would be for each hospital ER to have an urgent care center either in the same building
                             or next to it so that a triage nurse could evaluate a patient and send them to the urgent care center if the nurse felt that was the appropriate level of care. This would save at minimum hundreds of dollars per patient
1605   Website Submission    ) Introduce a Community Health worker/patient advocate to the process at the beginning of hospitalization to those identified as "" frequent readmit"" or those who are deemed at risk ( chronic disease, multiple disease
                             states, h/o social isolation, etc.) This should be totally taken out of managed care remote administrative staff and placed in the hands of a community collaboratuve of community health workers ( networks exist in some



                                                                                                                                                                                                                                                            44
 #                  Author                                                                                                               Proposal
1606   Website Submission    ) consider tax breaks/incentives to family memebers willing to take a 2 week/month long hiatus for caring for an aging parent/family member as they transition to home..family supports and patient adviocates can work
                             to bridge gaps to keep people at home, and provide for the right care at home
1607   Website Submission    have managed care invest resources in ""naturally occurring retirement communities"" where people can stay at home with the right supports rather than in institutions which are more costly, and likely provide less
                             holistic health
1608   Website Submission    A significant expansion of the understanding of ""primary health care""...and networks...it cannot be done as we are doing now. A new workforce and diminished institutional dependancy will ultimately save
                             tremendous resources. Infrastructure that is built on community assets : human capital, rather than instututional capital, ie., build a network of workers in the community with the correct resources and training ( training
1609   Website Submission    Create a trauma informed state, as they did in Wisconsin, and allow communities to work collaboratively to reduce trauma and violence and the diseases associated with community trauma and violence.

1610   Website Submission    The Assisted Living Program (ALP) should be expanded in order to provide lower cost alternative to nursing care.

1611   Website Submission    1)Needs to be better coordination between medicaid and medicare--sharing of data.
                             2)Needs to be a community care approach for chronic conditions. Mental health needs to be managed so it does not affect other costs to our state--such as folks who do not take meds and committ crimes etc..,
1612   Website Submission    the aca expands medicaid eligibilty to cover all adults w/ incomes below 133 percent of fed povert level starts 2014

1613   Website Submission    In order to contain home care costs to Medicaid recipients that were over 2 billion dollars per year in 1991, Chapter 165,sections 20-26 of the Laws of 1991 were enacted. SSL section 367-j,367-k, and 367-1 defined
                             fiscal assessment. Basically, fiscal assessment was the comparison of the estimated average monthly cost of the home health services a recipient would require over 12 months to 90 percent of the average monthly cost of
1614   Website Submission    Eliminate transporation, require a copay for all practioner and emergency visits as well as a nominal charge for perscriptions

1615   Website Submission    If a person goes in for substance abuse or detox they have to agree to participate and they have to stay in the program for at least 1 week this signing in and out like its a hotel is ridiculous. It costs money in the tests that
                             need to be run through the Emergency room to clear them for the unit then to the Unit by the time they get there they go to sleep then, the next day sign out. What a waste of time and money.
1616   Website Submission    There are many New Yorkers who get Medicaid Housekeeping Services only. For example, NYC HRA Housekeeping Services.

1617   Website Submission    My suggestion is that non-invasive procedures be encouraged so that more expensive operating room room procedures that also result in a longer recovery time and, sometimes, permanent damage, can be avoided.

1618   Website Submission    I am an Ultrasound Technologist in a hospital. I believe you could cut Medicaid spending by managing Medicaid like other private insurances. I see so many abuses by these patients that it is ridiculous. They are the
                             only people, those on Medicaid, that do not require preauthorization for CAT scans and MRI's. They come for their Ultrasound exams because they want to know the gender of their 5th child. Then they're back a week
1619   Website Submission    Adding more regulations does not save money, it increases the documentation burden which increases costs. A small example is medicaid in education. Medicaid could pay for services or eliminate payment for
                             services. To set up a program where we have to keep track of make up visits (required by SED) but not bill to medicaid-just costs more time and money at the implementation end. The new requirement for annual face
1620   Website Submission    Make it mandatory that to receive Medicaid benefits, clients must submit to random drug testing. Make the clients show you proof where they have applied for jobs like you have to do for unemployment benefits.
                             People don't have money to buy food, etc. but they sure do have the money for their drugs, cable TV, booze, clothes, cigarettes, etc. And I, as a taxpayer, am subsidizing their habits. Wake up NY and start saving the
1621   Website Submission    I strongly recomendd that all agencies hospital/ MDs be computerized. All meds Rx listed and followed. This would stop misuse of the now established list and stop duplication of procedures and misuse of services.

1622   Website Submission    The program should be restricted to legal US citizens, or perhaps citizens and those visting legally with a Visa or such.
                             Further, examples abound of people collecting medicaid who are truly capable of working full time but simply don't because it's easier to take the caid coverage. This is costly fraud.
1623   Website Submission    We should give out tax breakes to anyone or any Agency in the health or medical fields Even at state local goverments & empolyees That come up with ways to reduce medicaid or medcare cost by alot they get a % in
                             tax reduction
1624   Website Submission    The continuation of funding OUTPATIENT MENTAL HEALTH CLINICS,operated by NY State and local county employees is paramount to providing quality care.
                             The most educated, experienced and regulated treatment providers are found in these settings.
1625   Website Submission    Incorporate the concept of Care Transition program developed by Dr. Eric Coleman and Dr. Mary Naylor. The coach could follow Medicaid patients that have had a hospitalization to help them to better manage
                             medications, Dr visits and knowing what can be done for medical issues other than always returning to the ER. The outcome would be to cut down on Medicaid costs fro hospitalization.
1626   Website Submission    The process used by the DOH for auditing the provider networks and directories of the Medicaid managed care companies is antiquated. The use of data analysis would not only save the DOH money, but would do a
                             much better job for consumers, possibly recognizing fraud and keeping MMCs accountable.
1627   Website Submission    Don't reimburse for treatment for sepsis or bed sores when part of the same admission dates at the same facility.

1628   Website Submission    Medicaid HMOs charge a monthly fee - sometimes even for months when there are no medicaid paid for services for the member. Consider paying only for results or services.




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 #                  Author                                                                                                             Proposal
1629   Website Submission    Prohibit CEOs/administrators of organizations that get Medicaid funding from receiving compensation over a certain percentage of the amount of the Medicaid funding

1630   Website Submission    Very often a medicaid recipient will come to the pharmacy counter and ask for their prescription co-pays to be ""waived"" because they cannot afford the .50, $1 or $3 copay. Legally I cannot force them to pay their co-
                             pay, so I waive it. (THIS NEEDS TO BE REFORMED) Then they go to the front of the store and purchase BEER! ARE YOU KIDDING ME! they can not afford to pay their extremely low co-pay but they can afford
1631   Website Submission    Another problem I see is the abuse of the cash/funds that are put on the medicaid card. This cash NEEDS to be monitored more closely. They should not be using this cash for candy and pop, they should use it for milk,
                             cheese and bread a system should be put in place in which only certain things can be purchased with the card.
1632   Website Submission    Please take time to look into the following agency: Continuing Developmental Services in Rochester NY. This organization falls under the OPWDD Medicaid Waiver programs. Services that have been used for
                             marketing and OPTS funding are not being provided. Positions that provide direct services to people with DD(music,art therapy , horticulture, media training etc.) are being eliminated while management positions
1633   Website Submission    Stop giving medicaid to non residents who come here just to get medicaid. NY has to stop being the sappy melting pot because of some antiquated ideals. We need to circle the wagons and start helping our residents
                             who have paid for everyone elses medicaid. Erie county recently reported that all thier homeowners tax dollars goes just to pay medicaid.
1634   Website Submission    I work for a health insurance company, and process claims. I see the monies paid out for care being rendered in emergency rooms which could very well be performed in either urgent care settings, or office visits. I
                             would like to see cases reviewed based on medical necessity. If the recipient of care does not obtain care for non-life threatening emergencies in the appropriate setting, I would like to see the that person be penalized in
1635   Website Submission    Thank you for the opportunity to provide information from a street-level provider's perspective on the Medicaid program and funding for early intervention, preschool, and school special education services.

1636   Website Submission    Improving the quality and timeliness of primary medical care for nursing home residents can produce immediate savings for both Medicaid and Medicare through reduced emergency room visits and hospital admissions.

1637   Website Submission    Eliminate state operated programs. This could be done over a series of years with out laying off state employees. This would be done through retirements and consolidations. As people retire state operated programs
                             could be transferred over to community based non-profit providers. The non profit providers could hire 2 direct care works for one state direct care worker. This would provide saving in Medicaid. Government should
1638   Website Submission    Eliminate burdensome and redundent regulations. Eliminate confusing and conflicting regulations between Mental Hygine, County and DOH.

1639   Website Submission    Medical/Ambulance Services need to be coordinated to prevent non medical transportion and to maximise transporation passangers. Coordinate medical appointments between patients/riders so that vans or taxis would
                             transport more than one passanger to a medical appointment.
1640   Website Submission    Redirect OMIG to persue fradulent activity or fradulent providers instead of going after providers that made simple documentation errors and classifing it as fraude. It is know that there are a lot of fraude in the home
                             health, medical equipment and pharmacy proviers. OMIG/DOH should be checking on these providers to certify that they are legitament before they are allowed to bill medicaid for services.
1641   Website Submission    Increase community based supports for familes who provide care to disabled or elderly family members. It is far cheaper to keep people in their home or with family instead of them being placed in a skilled nursing
                             facility, state operated developmental center or psyicatric center.
1642   Website Submission    Explore potential to fund enhanced Hospital Outpatient reimbursement through extension of Federally Qualified Health Center (FQHC) program (and federal dollars associated) to Hospital based clinics. There are a
                             few grandfathered in NYS, but most all are not allowed to participate in the program under current Federal rules. Many of these hign Medicaid/Medicaid Managed Care Hospital based clinics lie in Medically
1643   Website Submission    The number of benefit recepiants who choose the Mirena IUD for their birth control needs to have some sort of restrictions or controls applied to its use. Working in a GYN office in which we see numerous recepiants
                             have the device inserted only to have it removed a short time later simply because they do not like it. The IUD cost over $800 per unit. That is a tremendous cost to the State every time an individual simply decided they
1644   Website Submission    Tier One drugs should have an attached copayment. Dental & eye care coverage should be re-evaluated. Substance abuse treatment should be reviewed and on going payment should stop when the individual fails to
                             complete the program.
1645   Website Submission    Another option should be capped cost per person. Would it be possible to determine a set monitary amount and let the medicaid patient use the money to purchace health care benifits? Have a choice in what you want
                             the money spent on and what they can live without.
1646   Website Submission    I have been aware that anyone who receives medicaid can be transported by medicab to any medical appointment. It used to be that the primary physician would have to justify a need for medicaid transportation ie:
                             mental or physical disability. The justification would have to be sent to the local medicaid office and would be good for 6 months at a time. This process seemed to weed out people that could transport themselves are
1647   Website Submission    Break the union death grip on service providers! Annual cost increases are borne by taxpayers while the value of care is diluted by UNNECESSARY wage increases. Government intervention is required to correct the
                             existing power imbalance. We hear a lot about teacher accountability, but there is no comparable discourse for the life and death work of overpaid, underperforming nurses and allied health professionals. The days of
1648   Website Submission    Medicaid currently pays for penile implants and other non-critical devices to include ED medication. Why?

1649   Website Submission    Adult acility residents who do not have emergency ailments are transported by ambulance, often privates, charging $750 per trip.
                             How often do Adult facilities send residents to the ER needlessly, tying up resources?
1650   Website Submission    Medicaid does not pay for combination drugs even when they are more efficient and cost effective
                             Participants are entitled to and demand multiple wheelchairs, as encouraged by vendors
1651   Website Submission    Manage care instead of allowing managed care organizations to profit from Medicaid by underpaying claims.




                                                                                                                                                                                                                                                               46
 #                  Author                                                                                                            Proposal
1652   Website Submission    Eliminate Medicaid FFS carve outs, but force insurers to pay all claims and minimize overhead.

1653   Website Submission    Require enrollment with a primary care provider as a pre-condition for Medicaid coverage.

1654   Website Submission    Strictly ration access to specialists and ancillary services.

1655   Website Submission    Require pre-authorization by a care coordinator for all care.

1656   Website Submission    Penalize enrollees with time-limited co-payment increases for abusing the system with preventable admissions and nonurgent ER visits.

1657   Website Submission    Force enrollees to receive age/gender appropriate preventative services to remain Medicaid eligible. Impose penalties for non-complaince.

1658   Website Submission    Mandate smoking cessation, routinely test blood CO levels, and restrict benefits for enrollees who continue to smoke.

1659   Website Submission    Since NYS spends more on medicaid than Florida, Texas and North Carolina combined, it would make sense that the redesign team visit those states instead of having hearings in NYS. Vested interests will only via for
                             their own particular agenda. Doctors and hospitals lose money on medicaid now...the only alternative is to cut services- those not mandated by the federal government.
1660   Website Submission    Eliminate county and institution specific rates historically developed to compensate for differences in cost of providing care or cost of living. Set flat rates to achieve expected State-wide totals below past cumulative
                             spending rates. Allocate a portion of the difference to induce quality outcomes. Take back payments when efficiency targets are not satisfied.
1661   Website Submission    Merge DOH, OMH, OASAS, and OPWDD. Only in New York do we find bureucracy in quadruplicate at all levels below Governor. Retain a think tank of experts to tend to unique needs of special groups. Layoff
                             duplicated positions. Set everybody else loose on mission critical waste, fraud, and abuse initiatives.
1662   Website Submission    Based on the way we do business at the DDSO if an individual is seen by their primary physician or at the ER we must follow the recommendation on the consult for a follow up visit. Very often these follow up visits
                             are clearly unnecessary and evaluation could be provided by a DDSO RN or NP. For example the primary will ask for a repeat visit to assess if a rash has resolved, or if an abrasion that an antibiotic was prescribed has
1663   Website Submission    As a General Dentist and a Participating Provider in the Medicaid Program, there are areas of coverage that really do not make good sense from a policy and financial viewpoint. Consider the Orthodontic Coverage for
                             Medicaid recipients: It is written as a covered service only when there is a ""Medically Compromising Malocclusion"" and there is a laundry list of conditions that must be present to qualify. My personal definition of
1664   Website Submission    It would be much more useful for New York State to have an online list as other states do or to allow regional offices to publish their own lists of providers who accept Medicaid.

1665   Website Submission    Inform Medicaid redesign process with what makes sense for Medicaid recipients themselves- ASK THEM- host focus groups in partnership with CBOs and FBOs who serve a high Medicaid population and/or
                             communities who are experiencing health disparities.
1666   Website Submission    Allow for the use of generic drugs when they are available and the use of over the counter medications when available
                             * Cap the amount of Medicaid money available for Mental Health Substance ABuse especially when there is no demonstrated, measureable results. Stop the ""revolving door"" syndrome for those who are only seeking
1667   Website Submission    We need to decrease or eliminate the amount of spending on Medicaid including transportation to and from the health care facilities, OTC RX ( I have seen patients come in with pedicures and manicures just completed
                             and ask for a scrip for OTC Tylenol, Motrin, allergy medication) Dental is not included in any health care coverage why is it covered in Medicaid and Orthodontics should never be covered. We need to offer only the
1668   Website Submission    *Require at least a 2 year residency prior to receiving benefits. Sure it was nice when we were ""the Empire State"", but we simply cannot afford it anymore! Face it!!!

1669   Website Submission    The cost of group home care is extraordinary. The cost to build each group home can be up to a million dollars and the cost for annual care for these people can be 150-250,000 each. It is not a surprise that with the
                             increasing numbers of kids born with disabilities that the state cannot afford this cost of care.
1670   Website Submission    1) eliminate the spousal refusal option under eligibility for nursing homes,

1671   Website Submission    2) consolidate/collapse the various medicaid waiver programs under DOH, OMH, OMRDD and OCFS into one silo,

1672   Website Submission    )state takeover of Medicaid eligibility and authorization of care, to eliminate regional differences/bias/shortcomings in medicaid administration

1673   Website Submission    4)provide centralized case management of alcohol/drug rehab programs.

1674   Website Submission    *** Limits on Medicaid reimbursement for Nicotine replacement get in the way of adequate efforts to reduce smoking within the seriously mental ill population.
                                 1. Medicaid should not limit duration of tobacco cessation medication to this population who frequently need longer, more intensive treatment for success.



                                                                                                                                                                                                                                                            47
 #                  Author                                                                                                            Proposal
1675   Website Submission    Seniors with dementia are a large fraction of those receiving Medicaid assistance for nursing home care, and they need professional care 24x7. However many of them do not need nursing home care. A memory care
                             unit, which is usually in an assisted living facility and cheaper than a nursing home, is often sufficent until the dementia gets severe.
1676   Website Submission    think everyone should read Atul Gawande's article on health care hot spots in Camden and Atlantic City, NJ, in this week's (Jan. 17, 2011) New Yorker magazine. The only way we are going to control health care costs
                             is to change our system to provide excellent care with a team (especially in areas where there is great poverty) including a family physician, a social worker, and a nurse practitioner, as Dr. Brenner did in Camden, NJ.
1677   Website Submission    For an idea on how to cut costs, can Medicaid stop paying school districts for therapies? Recently, school based therapists have begun to bill Medicaid. It does not make sense to me that educationally relevant services
                             have a place collecting from a system based on MEDICAL NECESSITY, not educationally relevant services. It is my opinion that school districts are responsible for paying for services that are educationally relevent;
1678   Website Submission    Should look at how much is spent on ambulance transport for non- emergencies. People call 911 when they go into labor or their child has a cold. Police, fire dept & ambulance respond. There are cars in the driveway,
                             adults in the house but no one willing to drive to the doctors. Ambulance insist on transporting because they want to be paid. Prenatal care should include child care classes & planning who will bring you to the
1679   Website Submission    These are my general thoughts on the Redesign of Medicaid, with a focus on the integration of physical and mental health services. My first principle has to do with how integration is defined.
                             In such a case, the physical & mental health providers partner to manage treatment of behavioral health in a medical setting or physical health providers provide care in a mental health setting. All case records are
1680   Website Submission    Hello, My name is Leonette Trudeau and I am hoping this will be heard by someone. I have another area of Medicaid service that is not working appropiately. You see I have already gone to school for a new career.
                             However I had an emergency come about thta required me to see the Dentist. To my surprise I have 3 teeth missing on the side of my mouth and they are trying to tell me that unless I have teeth missing in the front they
1681   Website Submission    As a recently retired twenty-seven year veteran with the Greene County Probation Department, I applaud the efforts of Governor Cuomo and the Medicaid Redesign Team to examine and address the unsustainability of
                             the Medicaid program. While there are certainly many factors which have contributed to this problem, the one with which I am most familiar has arisen from the welfare system, and its resultant creation of a mentality
1682   Website Submission    People on Medicaid should use generic drugs. They should not be given Viagra. All services should require a small co-pay for drugs, doctor office visits, x-rays and labs. ER visits should require a higher co-pay.
                             Transportation and housekeeping services should be eliminated. Alcoholic should not be getting liver transplants.
1683   Website Submission    1. Mandatory drug testing for recipients
                             2. Work programs for recipients where possible (Ie. Mild house/office cleaning, child care could be provided for by recipients)
1684   Website Submission    Transportation is an issue. I work in a psychiatric hospital and find people are approved for transportation that do not need to be and others that truly are in need are not covered. I can recall an incident where a patient
                             had an appointment at a medical facility across the street and it was necessary to be cabbed by regulations at a cost of $50 one way ( due to an existing contract). Also many HMO's( Total Care ) require that medical
1685   Website Submission    After meeting with Edward Golden, Deputy Director Budget Studies, Minority Ways and Means Committee, and P. Langendorf, I was advised yesterday to forward my recommendations to you as well and to keep
                             meeting with top legislators including representatives of Senator Silver, Skelos, Sampson and the Governor's Budget Director.
1686   Website Submission    While the OMIG is doing an excellent job, more incentives for vendors and the community to report fraud most certainly has to be beneficial. We work with Medicaid managed care companies and receive and analyze
                             member and provider demographic data for them. There are many instances where anomolies exist; however we would need to expend resources to review this and submit to OMIG. Currently, aside from the False
1687   Website Submission    follow the money 1st Then an only then can we fix or even understand what we are dealing with someone or some company is getting rich. We must look at the pharmaceutical,hospitals,long term care sites ,mental
                             health site all have very high adminstration cost. Most hospital Have many layers of high payed levels of management 5 or 10 VP Aka doctors even more then that in some cases An be-side the goverment mandates &
1688   Website Submission    end spousal refusal provisions for chronic care budgeting.

1689   Website Submission    Having spent most of my professional career trying to reform the health care system in the Rochester, NY region, it is an understatement to say your Committe has been given an extremely difficult task.

1690   Website Submission    Simplify,streamline and automate Medicaid eligibility. Do away with the spend down program. It is very time consuming to administer. Not cost effective. Combine Medicaid and Child Health Plus into one program
                             with two different benefit packages.( one with medical transportation and one without)This will stop the constant loss of coverage for the children when they bounce between programs. I am a trainer of new Medicaid
1691   Website Submission    I have been involved in the Medicaid Program since 1968 and, in the past, have served as a Local, Regional as well as State Wide Mediciad Dental Director. I also, previously, participated as a private fee/service
                             provider in the program . I retired from State Service in 2003, however, am Currently, working pafrt time in the Dental Unit within the Office of the Medicaid Inspector General. I would be be glad to assist the
1692   Website Submission    I have worked for Social Services for nearly 33 years. I believe the very first step is to amend the New York State constitution and implement a RESIDENCY REQUIREMENT. Not only do we have many out of
                             country people coming here in need of emergency health care, we also have many from out of state coming here because of our generous plans.
1693   Website Submission    As an RN employed by NYS, I have very good health insurance, including medication coverage. However, I make a point of asking my doctors for, and using only generic prescribed and/or OTC meds. This not only
                             saves money for my insurance company, but it also lowers my co-pay. I feel that those on Medicaid should do the same.
1694   Website Submission    Obtaining Medicaid Prior Authorization for Brand named drugs is a joke. You AUTOMATICALLY ALWAYS get approval! You are never asked if the patient was tried on a(cheaper/ generic) drug. I have never been
                             refused!
1695   Website Submission    All patients should have co-pays. For example, a $.50 co-pay for generic meds vs a $1.00 for Brand name will remind all patients to ask for generic prescriptions. I'd much rather pay my $5.00 co-pay for generic than
                             $20.00 for Brand name!
1696   Website Submission    All patients should also have a co-pay for doctor visits and/ or using the Hospital Emergency Room. People will think twice about going to the hospital for a common cold and being billed a $20.00 co-pay vs waiting till
                             the morning to see their doctor and being billed a $5.00 co-pay.
1697   Website Submission    I have been dealing with the Medicaid Program for the last 26 years while working at a doctors office. My one and only advise is to make obtaining medicaid for able bodied people harder or make it impossible for
                             them to obtain it unless they are working somewhere. Too many people have medicaid who could be working. I see it every day. Medicaid receipients breed medicaid recepients and we have to stop the trend.



                                                                                                                                                                                                                                                               48
 #                  Author                                                                                                            Proposal
1698   Website Submission    Make people making over $150.000 a year pay more into health care system medicaid

1699   Website Submission    To no longer cover over-the-counter medications.

1700   Website Submission    First-drug test all recipients....no coverage if you are a user of illegal drugs.Or if you must cover drug users, require that they be in treatment and stay successfully off drugs.
                             Second-have an easy system in place for the reporting of fraud. And then follow up on those committing fraud.
1701   Website Submission    Except for preventative care, everyone should pay a co-pay for health services. It needs to be small, obviously, for the poor but it should be something. Co-pays should be geared to encourage appropriate medical
                             choices. For example, a doctor or clinic visit should cost less than an emergency room visit.
1702   Website Submission    I have worked in healthcare for over thirty years and at the present time 20% of my family income is spent on heathcare. I think that it is imporant for Medicaid recipients to take responsibility for the cost. They of
                             course cannot pay copays because they would not be getting Medicaid if they were not low income, however, they should not be allowed to abuse or over tax the system by frequent doctor appointments or unnecessary
1703   Website Submission    I believe that something must be done about Union benefits to make any real impact on health care spending. The current health care employer contributions to various funds is significantly higher than other industries,
                             and cannot be sustained.
1704   Website Submission    Require those that apply for medicaid benefits in this state shall be a resident that has paid taxes or rent in this state for a year before applying for benefits. Because our state is much more generous with benefits we
                             have many people moving here just for them. Hold Drs. more accountable for unnecessary billing and appts. My insurance has been improperly billed for something I did not receive. The insurance company caught it
1705   Website Submission    Get rid of all illegal immigrants on medicaid!! The answer is to easy..

1706   Website Submission    I would just like to make a couple of quick suggestions with regards redesigning our state's Medicaid program. I am a professional medical biller, with a specific background in Worker's Compensation. It seems as
                             though with W/C there is an adequate state-mandated fee schedule which helps curb mark-ups based on coding.
1707   Website Submission    New York State still provides a significant amount of direct services especially for the MR/DD population. These are provided at significantly higher costs that the same services provided by the not-for-profit sector. I
                             believe a significant savings can be accomplished by switching most direct services (day programs, residential and at home supports) to private provider agencies along with case management, with the state only
1708   Website Submission    Under the NY State Medicaid program, recipients are allowed a pair of glasses once evey 2 years. This rule is a joke since the glasses will be replaced in the event of lost or broken ones. Recipients are aware of these
                             exceptions and ""lose"" or ""accidently"" break them so that they can get a new pair. Perhaps they would take better care of them if they were allowed one pair every two years, period. No exceptions. Most insurances
1709   Website Submission    May I suggest that the members investigate who is receiving Medicaid and who is not and why. Four years ago, my very best friend's husband left her with no money and no heart medicine. The back of her heart was
                             dead, she had severe allergies, found walking any distance difficult. As she had been a full-time homemaker, she hadn't amassed enough work credits to be eligible for SSD. When she applied to Monroe County
1710   Website Submission    Strictly enforce the US Citizenship requirement to receive Medicaid.
                             Prevent ALL NYS benefits given to illegals except for life threatening emergency services.
1711   Website Submission    1) Make the State 100 percent responsible for Medicaid costs as part of the general budget. Eliminate the county 25 percent portion. People on fixed income, including senior citizens, pensioners, and low income
                             workers, simply cannot afford to live in their homes any more in NY because of the Medicaid portion of their property tax bills.
1712   Website Submission    Services for people with developmental disabilities are underdeveloped and underfunded, unlike those for other Medicaid services such as hospitals and nursing homes, which required a Berger Commission action to
                             reduce infrastructure. Find ways to support development for new disability services, to reduce huge wait lists.
1713   Website Submission    After perusing the Office of Medicaid Inspector General's website and randomly reading the audits, it appears the costs of audits of Medicaid service providers is more than the amounts they are recouping for NYS. For
                             example, spending one to two weeks at a hospital with staff and thwe amount owed for ianppropriate billing is $1,200 is inefficient.
1714   Website Submission    1) Restrict enrollment of people who have moved from other states to NYS by having them be NYS residents for one year. I know of people who have purposely moved here from other states because of the Medicaid
                             coverage.
1715   Website Submission    2) Consider geographic location of providers when allowing treatment. For example, I know of someone who lives in West Falls but their child (who is autistic) goes to school in Amherst. If a client chooses a provider
                             that is way out of a geographic area (i.e., 10 miles from home), the client should pay extra and not be allowed special transportation.
1716   Website Submission    with the imp.emendation of electronic medical records, everything is done except dan cataloging. simply put, dan printing will eliminate fraud when compared against the names database and the social security number
                             database. I personally know people with multiple social security numbers and multiple names and. citizens not of this country and rich that use us and new York Medicare to get services including heat bass surgery
1717   Website Submission    1) There should be a minimum residency requirement for anyone who can apply for NYS Medicaid, at a minimum 1 year. If the NYS Constitution must be changed, so be it. Only life-and-death emergencies could
                             qualify as exeptions.
1718   Website Submission    Emergency room service should be restricted for true emegencies, not routine health care. At Mercy Hopital in South Buffalo, several times I have seen the waiting room full of people that were not in emergency
                             situations. The recently built $25 million ER was not even available for a friend who had a heart attack so that he had to go to Millard Fillmore Gates to be treated.
1719   Website Submission    Payment for ambulance services to an ER or other medical facility for non life threatening or non-emergency situations as stipulated by ER doctors, shall be denied.

1720   Website Submission    NYS out patient mental health services accepting MA should be spread more evenly across the State to provide better accessibility to the mentally ill(there will obviously be more in areas concentrated closer to inpatient
                             facilities). Closer attention should then be paid to ensure those with severe mental illness have priority over consumers who are less ill and may be primarily seeking to receive local, State, or federal benefits for their



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 #                  Author                                                                                                              Proposal
1721   Website Submission    Receipients of MA who use drugs and/or alcohol should not be allowed to receive cash assistance if they test positive for substances.

1722   Website Submission    Evaluation of programming conducted by an external evaluator which will assess impact and effectiveness of programming and identify the critical data points for collection rather than the current "bean counting"
                             methodologies. This will allow the state to reduce costs through the elimination of redundant, ineffective paperwork and auditing required for most medicaid programs and will allow the state to reduce funding for
1723   Website Submission    I would also suggest that Medicaid recipients who receive care at the hospital when not medically necessary be liable for the difference in costs.

1724   Website Submission    I would also suggest better coordination of other federal services and which are coupled with requirements for receipt. In particular, recipients of federal dollars should be required to pass a drug test in order to receive
                             benefits - if they do not pass, they should receive substance abuse treatment/support. They should also be required to be engaged in efforts to become self-sufficient including employment, education, substance abuse
1725   Website Submission    I am the parent, sister and guardian of two individuals serviced by Opportunities Unlimited of Niagara and Heritage Christian Services in their group homes, pre-voc workshop and day hab programs. I know service
                             coordination has recently been streamlined for the number of visits, but I also think money may be saved by having one service coordinator for a residence rather than having several coordinators visit each residence. I
1726   Website Submission    Establish a data base that will check all claims at the time they are submitted to confirm that 1) the claimant is a real person - for instance has a Social Security number that can be verified, 2) that the claimant was alive
                             at the time of the claim, 3) that the claim was filed in the same geographic area that the claimant lived, or if not, some form of ID was presented to confirm the claimant was actually present at the location submitting the
1727   Website Submission    I am greatful for this opportunity to respond to a forum re:NYS medicaid. I write as a behaviorial health provider in Warren county.
                             I believe that a redesign of medicaid service for the outpatient BH population should include the following:
1728   Website Submission    Medicaid recipients should be required to pay co-pays the same as individuals who have medical insurance. I believe though, that there should be tiers of Medicaid which would be income based. If co-pays were
                             mandatory, this would deter Medicaid recipients from abusing emergency room visits and deter them from seeing numerous specialists.
1729   Website Submission    In regards to HCBS waiver programs, Medicaid should not be provided without some sort of co-pay; again, to be determined by income. I have seen unlimited number of parents who have children with disabilities that
                             earn three figure income who have Medicaid for their child. It is understandable that they want their child to have necessary services that they can only access if they receive Medicaid but this should be associated with a
1730   Website Submission    Is there any concern with the current vendors claim payment procedures in light of the recent audits which found fraud and incorrect payments?

1731   Website Submission    Eligibility changes:
                                 To be eligible for Medicaid, recipients of Medicaid should have been residents of NYS for at least 1 year. I know of a case where a 40 year old woman who grew up in Rochester, NY, but has not lived in Rochester
1732   Website Submission    Set up Medicaid Clinics:
                              Many Primary Care Physicians are NOT taking Medicaid Patients because of the very low reimbursements. Because we don't have many doctors to treat Medicaid Patients, Patients end up going to the Emergency
1733   Website Submission    Nursing Homes/Reimbursement

1734   Website Submission    Review the Medicaid Formulary and align it more closely with what is advailable in the private sector. Increase pior authorizations for more expensive drugs as well as step therapy usage. Review of medications for
                             poly pharmacy and institue a review process not only could this be cost effective it would improve patient care.
1735   Website Submission    Unlike the County Executive of Erie County, I do not favor letting counties determine the benefits available under Medicaid. Such a plan would pit counties against each other in balancing their budgets on the backs of
                             those most in need. However, a close look at benefits could bring in considerable savings. One benefit, for instance, that shouild be looked at as inconsistent is fertility treatments. Do we really want to assist women in
1736   Website Submission    1. Make primary care physicians mandatory.(alleviate costs and burden on Emergency Rooms.)
                             2. Put a cap on number of Drug rehabs and mandate users to day treatment in order to qualify for ongoing treatment.
1737   Website Submission    New York first needs to separate the people who will not work from the people who cannot work.

1738   Website Submission    The very first thing that comes to mind is generic; never namebrand unless generic isn't available. For any maintenance drug, they should have to use mailorder pharmacies such as Medco who offer a reduced rate.
                             Secondly, there should be a lifetime maximum of years that any person between the ages of 18-60 can receive benefits on the taxpayers dime. I would say 5 years max. This should include welfare and medicaid. As a
1739   Website Submission    We need a one year residence law so people don't come to New York just to get benefits without ever putting a dime into New York. They showcased a story in the Niagara Gazette about a man from Puerto Rico who
                             came to Niagara County to get his cancer treated to the tune of $500 to $600 thousand without ever putting a dime into New York's economy. As soon as his cancer was in remission he moved back to Puerto Rico.
1740   Website Submission    I believe that giving 100% compensation to "" injured "" shta staff is wrong, nurses and other clinical staff are expected to be more "" visible"" on the units and are providing individual care are only compensated at
                             60%. the overtime would be greatly reduced if so many staff were not out on comp
1741   Website Submission    I work in a forensic psych. hospital, the night shift staffing generally consists of 2 regular assigned staff and up to 7 or 8 overtime staff. these staff sleep all night. they are supposed to be watching dangerous pt's, some
                             pt's are on 2;1 supervision and both staff are sound asleep. being the nurse on the unit I have to bring a flashlight out to do rounds and hope that none of the aren't hiding in the bathroom. the units also have video
1742   Website Submission    There must be a co-pay (10-20 dollars). Patients MUST have some stake in their own health. A completely free service is NEVER valued and generally abused.

1743   Website Submission    Current payments to physicians is unrealistically low. I think it is about $6 for a follow-up visit (have honestly stopped looking). Medicaid patients usually end up seeing junior residents for their care, which is less
                             than ideal. Payments must be realistic. If it cannot be, then physicians treating medicaid patients should be provided other non-monetary benefits to compensate and acknowledge, such as prefered parking close to



                                                                                                                                                                                                                                                                 50
 #                  Author                                                                                                            Proposal
1744   Website Submission    There MUST be a reward for keeping good health; such as not smoking, regular doctor checkups etc. This could be an annual end-of-year "gain-sharing" program such that if Medicaid saves monies, a small bonus is
                             paid out to those who have done their best to keep healthy.
1745   Website Submission    Demand residency to receive medicaid!

1746   Website Submission    Medicaid should not cover
                              sex change operation
1747   Website Submission    instead of paying contract staff (numerous trainers)have state workers develop online training. seems like it would save travel expense etc. and districts would have the training available when they need it.

1748   Website Submission    Do not Allow people to move into NYS and get on Medicaid from other States that do not have the same Medicaid benefits.
                             In other words start putting restrictions on Medicaid, the same ones you have on Medicare.
1749   Website Submission    In pediatric home care (LTHHCP) many children recieve rehabilitation therapies both in school and at home (Speech therapy, physical therapy, and occupational therapy. The justification for home therapies is that they
                             need to learn to perform ADLs in their home environmnt which makes sense. However, learning ADLs should be time limited and not ongoing for years. Scrutinizing this practice, which costs Medicaid well over $100
1750   Website Submission    There would be huge savings (and a solution to the problem of storing/destroying controlled substances) if pharmacies were able to relabel controlled substances when the directions change. There are numerous
                             prescriptions for narcotics in LTC, especially in pediatric LTC due to many high antiseizure med use. If there are ninety 10 mg pills for a 30 day supply and the physician changes the order to 20mg, all remaining pills
1751   Website Submission    NYS regulations currently require that prenatal health education be delivered one-on-one, not in groups, by a medical professional, thus mandating the most expensive setting and the most expensive staffing. Allowing
                             appropriately qualified health educators to deliver education that supports a woman's likelihood of having a healthy pregnancy and a healthy baby in a group setting that has been demonstrated to be effective would save
1752   Website Submission    Ensure that Medicaid services for elderly care are focused on the right level of care. More re-imbursement for in-home care before moving elderly to nursing home where care costs more. It seems it would be less
                             expensive to keep elderly in their homes or in a lower level of care before transferring them to a high cost nursing home facility.
1753   Website Submission    As one who has been both a financially challenged working mother and has dealt with administering Medicaid benefits from an HMO, I've seen and understand both sides of the street.
                             One area which has always struck me as wasteful and with great potential for improvement relates to payment of transportation for Medicaid recipients. Many providers of services feel bullied into providing cab rides
1754   Website Submission    * require that those who sign up for Medicaid select a Primary Care Physician and intiate services w/ a PCP.
                             * require that users of Medicaid follow the same protocol for seeking services at an Emergency Room - same as those of us who purchase our own Health Care - all ER trips require approval from the PCP
1755   Website Submission    The first and most obvious is to require video cameras in all hallways in nursing homes and video cameras in rooms where the resident wants them. If anyone should know the value of video cameras in nursing homes, it
                             is Governor Cuomo. As Attorney General he was very successful in uncovering abuse in nursing homes through the use of video cameras. They would immediately improve the quality of care and reduce medical cost as
1756   Website Submission    Integration of Mental Health/Substance Abuse with Medical- I don't understand why their is a bifurcation between SSI and non-SSI recipients with the mental health and substance abuse benefit package is the same.
                             Further, I find it perplexing that a health plan would be asked to care coordinate services when the service may be carved out and the plan is often unaware where the consumer is getting care. I suspect that there may be
1757   Website Submission    1. Eastablish a residency requirement. Many come to NY because their homestate doesn't cover their immediate needs.
                             2. Limit number of ambulance uses to those who use it like
1758   Website Submission    In looking at other state requirements there was one requirement that stood out that New York State did not have listed, that is to be a RESIDENT of New York state. Anyone can come here and apply for and receive
                             Medicaid. It has been a long standing joke that if you need a operation and don't have insurance go to New York. I have also heard Florida pays for their residents to come to NY for medical procedures. This needs to
1759   Website Submission    The medicaid in education issue should be reviewed carefully. Related service therapies (OT,PT, ST) in schools follow a educational model, not a medical model. Students receiving services in schools are eligible for
                             them through their IEPs. Monies given to the schools for medicaid eligible students do not go toward services for these children but are put in the individual school districts' general pot. Special education and related
1760   Website Submission    put people on system to work after 6 months if they are not working by then - BURGER KING, MCDONALDS, WALMART, ETC ARE ALWAYS HIRING!!!! At least minimum wage if not better. MAKE IT
                             MADATORY!
1761   Website Submission    Make the prerequisite for obtaining medicaid longer - resident of the state 1 YEAR at least. Have to be a US CITIZEN! Take into account ALL possessions - use some of the savings from cutting down on who gets
                             medicaid to do spot inspecitons on peoles homes for possessions. Mandatory to workers to check dmv and assessors for cars and properties in persons name. DENY MEDICARE FOR LIFE AND PUT IN JAIL
1762   Website Submission    STOP ALLOWING PEOPLE TO MOVE INTO N.Y.S. WITH THE INTENT TO GET ON THE SUPER WELFARE AND MEDICARE PROGRAMS. THERE ARE THOUSANDS THAT COME FOR
                             FREEBEES AND THEN MOVE BACK HOME. RESIDENCY FOR ONE YEAR AND A JOB SHOULD BE REQUIRED BEFORE ANY HANDOUTS.
1763   Website Submission    limit the number of children covered under medicaid in each family to 2. people can have all the children they want but taxpayers should only be required to support a maximum of 2. birth control if free under
                             medicaid. every night in our local paper nearly half of the birth listings are to single parents or couples who are not married-most of which are welfare.
1764   Website Submission    Increase amt of money given to physicians to care for them in their offices. Mandatory co-pay (subtracted from their welfare funds) when the emergency room is used for non emergency conditions. Do not pay for over
                             the counter medications (or at the very least, make them pay for a portion). Make smokers pay a percentage of care until they quit smoking. Again, subtract these funds directly from welfare money received.
1765   Website Submission    Medicaid repipients should have to accept generic drugs , i just like a private insurances would demand.
                              there should be no ambulance trips unless it is a real emergency, not a frivolous ride to get medicine at a pharmacy or a trip to the doctor.
1766   Website Submission    All infants born of a medicaid recipient should NOT be automatically enrolled in medicaid. The state should determine if the father has adequate means to support the child first.




                                                                                                                                                                                                                                                        51
 #                  Author                                                                                                             Proposal
1767   Website Submission    Let each county of NY decide the options they want to support and fund under medicare. Remove the state mandates!

1768   Website Submission    einstate the process the requires an interview to determine whether an applicant is a viable candidate for medicaid.

1769   Website Submission    Medcaid coverage should not be better than the health coverage of a working tax payer of NYS

1770   Website Submission    Recipients of medicaid (over age 18) if physically capable should be required to perform community work to contribute to society. ( i.e. FDR's CCC)

1771   Website Submission    Look at administrative costs to programs esp executive salaries-place cap on how much medicaid can be used to support non-direct services (this should exclude quality assurance and billing/financial oversight as I
                             would consider this part of direct services). OCFS should be paying for children in custody who sit and rot in psychiatric programs becauase OCFS hasn't developed a program or community based supports to allow
1772   Website Submission    Medicaid should encourage the cheapest level of care. If reimbursement is capped for costly long term care, except under unusual circumstances, there will be little incentive for fraud and a natural progression into less
                             costly care. Cutting outpatient services which are less costly undermines the whole concept of reducing costs. There should be a greater emphasis on community based clinics in areas of mental health and substance
1773   Website Submission    Expand and Implement the Evidenced Based Program such as Transitional Care Model that uses community providers and other community social services agencies to keep individuals out of hospital/ED's and home in
                             the community.
1774   Website Submission    Medicaid should also consider a separate reimbursement for care managers and/or Geriatric Care Managers (historically Social Workers) implementing proven interventions and target groups. There are many existing
                             aging providers using Social Workers to provide excellent quality services much cheaper than government run programs.
1775   Website Submission    It is plain lunacy that an uneducated medicaid beneficiary who has no understanding of health, medicine, the human body or the role of doctors can make an appointment with any specialist (ie: Neurologist, Orthopedic
                             Surgeon, etc) without ever seeing a primary care physician.
1776   Website Submission    Stop promoting the idea that there is massive fraud and abuse in the provider system, and labeling recoupments based on clerical or normal human documentation errors as ""fraud & abuse"" in the media. Yes, there is
                             some fraud and abuse, but not on the scale promoted and it's not likely to be of sufficient magnitude to balance the budget.
1777   Website Submission    Incentivize outcomes, not volume, or cost savings at the expense of good care. Easier said than done, but worth the effort.

1778   Website Submission    Reduce Medicaid Base by 4% of 2010
                             o There is no other quick fix to stabilize the cost
1779   Website Submission    Redesign the charity care system to allocate resources based on the level of uninsured that a hospital sees and provide more charity care resources to D&TCs.

1780   Website Submission    Adopt and implement the following policy recommendations in the ""Proposals to reduce New York State spending and promote the independence and integration of seniors and people with disabilities"" from NYAIL-
                             New York Association on Independent Living.
1781   Website Submission    Adopt and implement the following policy recommendations in the ""Proposals to reduce New York State spending and promote the independence and integration of seniors and people with disabilities"" from NYAIL-
                             New York Association on Independent Living.
1782   Website Submission    MEDICAID FUNDED ORGAN TRANSPLANT PROGRAMS--need revision-- to MANDATE other neighboring states to accept NYS medicaid reimbursment-- potentially eliminating the need for LIVE LIVING
                             DONORS-- when there is an EXPLANT and TRANSPLANT from a LIVE donor to the person in need of the transplant-- NYS MEDICAID -- PAYS for the associated COSTS --can be in the MILLIONS-- for BOTH
1783   Website Submission    As the Governor said regarding institutions for ""youthful offenders"", institutions don't exist to provide jobs, and people should not be incarcerated in them in order to create jobs. This principle is just as applicable to
                             segregated residential facilities operated by OPWDD and OMH as it is to juvenile justice facilities. Currently OPWDD operates 10 very large institutions to house approximately 1500 people, nearly all of whom could
1784   Website Submission    The Medicaid Redesign team must bear in mind that closing institutions and segregated programs, and moving people from them into individualized integrated settings, is not just a good idea economically, and it is not
                             an option that can be rejected. This kind of transformation of the system is REQUIRED under the Americans with Disabilities Act (ADA), as elucidated in guidance provided to all state Medicaid authorities by the
1785   Website Submission    As also advised by CMS and the Justice Department, any change to the Medicaid program that reduces the availability of individual integrated long term care supports to people with disabilities, while the state
                             continues to operate segregated congregate long term care facilities, would be a violation of the ADA and the Olmstead decision. The Medicaid Redesign Team CANNOT legally make any decision that would have
1786   Website Submission    The Medicaid Redesign Team currently includes only one member that represents the interests of Medicaid consumers--the Medicaid Matters representative. The Team is top-heavy with representatives of hospitals and
                             other institutional providers, state agencies that operate institutional settings, and representatives of unions whose members work in institutional settings. It is difficult to understand how the Team can arrive at a plan
1787   Website Submission    Stop giving illegal immigrants emergency Medicaid. Have photo id on Medicaid cards. Fraud is rampant, Medicaid cards are passed from one individual to the next. Tighten up means testing. I personally know
                             someone paying $4,000.00
1788   Website Submission    Fire the people in state government especially Schenectady County. Worst county in NY. Way too many state workers get paid alot more then they should and do not deserve the salaries they do get for positions they
                             are burnt out from or just out and out lazy. Lawyers that hide assets of wealthy clients through revocable or irrevocable trusts so that their clients qualify for medicaid that should go to the people that truly need it.
1789   Website Submission    Please have some faith in the medical professionals that work for Health. Legislation ties the hands of those who have the clinical expertise to protect the health of fellow citizens in a safe and cost effective manner. I
                             was blown away to learn that Health cannot say no to any request for medications. Not allowing denials of off label medication use forces tax payers to pay for experimental therapy. Not only do I wonder if patients



                                                                                                                                                                                                                                                                52
 #                  Author                                                                                                           Proposal
1790   Website Submission    New York taxpayers already pay for some 35,000 abortions a year under Medicaid to the tune of $16.5 million annually, according to the Guttmacher Institute.

1791   Website Submission    You need to put more effort into verifying patients' financial qualifications for Medicaid. There is so much fraud, which #1, takes away from those truly in need of services, and #2, cheats the taxpayers of their hard
                             earned money, which is being wasted on those not in need. As a physician, I see patients who drive to my office in luxury cars, are dressed in very elegant clothes, chatting on their cell phones, but yet are on Medicaid.
1792   Website Submission    Several years ago, the Food and Drug Administration was supposed to have released the guidelines for generic insulin for diabetics, but they won't release those guidelines. There are companies that wish to make generic
                             insulin, but they can't until the FDA releases the guidelines.
1793   Website Submission    All Medicaid recipients should pay $20/month into Medicaid and also pay $5 per visit to the Dr.

1794   Website Submission    Having worked in a Pharmacy for the past 3 years, I have witnessed first hand how much the New York State Medicaid system is failing and how it is allowing many people to use and abuse the system.
                             First of all, I think the biggest mistake is allowing people to waive their copays at pharmacies for their prescriptions! It's basically an open door for anyone to waive their copay and then go and purchase unneccessary
1795   Website Submission    ) Stop paying for over the counter medications such as Tylenol, Motrin, Pedialyte. No primary insurance carriers cover these prescriptions. This would create a huge savings.
                             2)Elective sterilization should be permitted before the age of 21.
1796   Website Submission    Medicaid recipients should be drug tested in order to receive it. Random drug tests should be administered for those who pass the first drug test. Those who fail these should get medicaid revoked. There should be more
                             providers that accept medicaid. Those receiving treatment for mental health issues should be checked by a non-partisan medical professional.
1797   Website Submission    Pay attention to fraud detection; provide adequate staffing and computer resources to this effort.

1798   Website Submission    This is a much studied issue and much is know, hence I think the reasonable short time frame to identify the major issues and problems to resolve over the coming years.
                             It seems that the first major issue is identifying the system users with a clear and unambiguous ID. This is fairly simple. The triplet of name, birthday, address ID's 95% of users. The second issue is to accumulate the
1799   Website Submission    The FDA in October 2010 gave exclusive rights to URL Pharma in Philadelphia to manufacture colchicine, a drug to treat and prevent gout. This drug is safe and has been on the market since the 1800's. Now this
                             company will be selling colchicine as a brand name drug for $5.00 per pill, and companies that have produced this drug for decades are being forced to stop producing the generic version of the drug, which previously
1800   Website Submission    One child per US citizen Medicaid recipient paid for by the US taxpayer. There are so many agencies to help the improverished that the consumer should be made aware that although it is their right to have children
                             that the state government will only pay for one.
1801   Website Submission    Drug testing (blood) for drugs and alcohol on Medicaid recipients excluding children under the age of 10.

1802   Website Submission    Affadavits that CLEARLY explain someone else living in the household contributing to living expenses must be delineated
                             and that notification to the Medicaid Program must be made within two weeks. Follow-up visits by Medicaid Program should be made monthly.
1803   Website Submission    If you already have a child they cannot support, don't pay medicaid for additional children. Remoev the child from the household. Adoption? Foster system? Once they realize they won't get any financial gain from it
                             they might learn or move to a different state with a more generous plan
1804   Website Submission    Set up state projects and require that they work for their check. Set up work teams of meducaid recipients. Surely there are menial jobs they can do- clean up, basic mainenance, grass cutting. I work for my check, they
                             should too. No work, no check. Being poor is not a good enough excuse for doing nothing
1805   Website Submission    If you get caught cheating the system, they never qualify again for medicare in NY.

1806   Website Submission    Extend terms of enrollment in MMC/CHP/FHP from 1 yr. to 2 yrs.
                             End County-based administration and cost-sharing.
1807   Website Submission    I am not on the medicaid program myself however, I work with many consumers and families that are. Currently we have one consumer who currently is living in our local Developmental center and he is only still there
                             because he has a feeding tube. Our local Developmental center has had the habit of releasing people with no support services in place. They are ""cured"" all of the sudden. One of our consumers had been placed there
1808   Website Submission    Fraud. Put together a NEW task force of Certified Fraud Examiners to review current procedures. CFE's are a nationwide organization. There are some great minds out there. All aspects, from A to Z should be reviewed.

1809   Website Submission    Medicaid should continue to expand its Home and Community Based Waiver services for individuals with a Developmental Disabilities from age 4 through senior adult.

1810   Website Submission    Regarding Physicians - make them more accountable for the charges relating services provided to medicaid recipients (grey area) who is checking on whether the service was needed or provided, only the fact that
                             Medicaid will pay based on what the paperwork indicates.
1811   Website Submission    As a health care administrator I have some concerns about the current medicaid system and the services regarding HCBS WAIVER. I will begin with a question and then make some suggestions. Is it possible for
                             private insurance to pay for part of the services for individuals with intellectual disabilities (ID) who are receiving or would like to receive HCBS Waiver services? Children under 18 have to be enrolled in the waiver in
1812   Website Submission    Remove Telehealth from the requirement that it be part of Home Care. This will allow it to function at a Fraction of the cost because it can monitor and Triage patients without the cost of a Nurse to visit.
                             Communication with MDs can be done and patients can be MORE SAFELY cared for with VERY small cost relative to Home Care services



                                                                                                                                                                                                                                                             53
 #                  Author                                                                                                              Proposal
1813   Website Submission    As one example, Medicaid funds that support mental health counseling for youth might look expensive in the narrow context of Medicaid funding, but if those services were provided in an effective, results-oriented
                             program for youth in the juvenile justice system it would generate a net cost reduction for New York State as recidivism rates decreased. Currently, no such programs exist.
1814   Website Submission    One major reduction would be the automation and acceptance of an online submission and approval process. The use of so many staff to process a manual and paper oriented package is no longer necessary with the
                             large number of software tools available to handle documents, income and asset validation and more. In addition, the departments have never taken a universal methodology to complete the process which leaves many
1815   Website Submission    the cost of ambulettes to transport patients to and from providers of healthcare is a travesty. the transport companies receive an outrageously high fees. in new york city most patients who are presently are transported by
                             ambulette can be transported by taxis, using a voucher system or an additional card.
1816   Website Submission    Please consider limiting the diagnosis and treatment of medicaid recipients to a system of state certified public hospitals and clinics. Each center would be certified to deliver diagnostic testing and treatments based on
                             community standards. Each patient would be enrolled in an electronic medical record system (currently available through the VA system) in order to track the efficacy of each diagnostic test and treatment based on
1817   Website Submission    As an Administrator/professional working with and supporting adults with developmental disabilities, I am one who believes in the importance of being recognized regardless of how big or small one may contribute to
                             society. I strongly believe that the Office for People With Developmental Disabilities (OPWDD) should remain a seperate entity and not be combined with the Office of Mental Health or any other Medicaid funded
1818   Website Submission    stop the use of medicade for non emergency ER visits
                             2. make sure that the co-pays are paid
1819   Website Submission    Limit medicaid coverage to those services covered under EMPIRE PLAN BC/BS enrollees.

1820   Website Submission    I would like to suggest that the Medicaid Redesign Team strongly consider the importance of preventative treatment services for addiction, when considering the fiscal health of our state. Preventative treatment services
                             that work to stabilize citizens suffering from addiction, greatly reduce the cost to our state health system and improve the wellbeing of our communities. When individuals enter treatment they are often living in state
1821   Website Submission    More restrictions for patients who use inpatient mental health/substance abuse services. Many patients go from hospital to hospital and use the same services over and over again during the course of a year as a form of
                             housing.
1822   Website Submission    Facilitate OASAS 822 clinics implementing DOH Article 28 clinics, based upon addiction medicine, to increase preventive health services and decrease over utilization of emergency rooms and urgent care centers. This
                             should result both in lower costs and better health outcomes for high end Medicaid users
1823   Website Submission    Put ALL mental health services into managed care.

1824   Website Submission    I think one change that should be made is charging co-pays not only for Doctors visits, but also for ER visits and medications. 99% of people that have medical insurance through employers have co-pays for the above
                             mentioned. Time and again I have witnessed medicaid abuse by individuals who come to the ER for minor health issues because it doesnt cost them anything and they did not want to wait for an appointment with their
1825   Website Submission    Just a thought. I wonder how many young people are getting services from Medicaid that could be getting their health benefits from there parents insurance. I suspect that there are many citizens who are not aware of
                             the new age limitation.
1826   Website Submission    Make it easier for people to return home - for example - several years ago I cared for a client who needed assistance with a wheelchair ramp ($500)so they could safely exit the home in case of emergency with family
                             prepared to provide care - declined as a permanent addition to the house so the client spent 4 months in a nursing home at considerably more cost to the state
1827   Website Submission    Computer enhanced brain biofeedback can benefit many of our most seriously ill patients. It is not available in any OMH facility. An investment of 10K in equipment woulf allow dozens to be discharged and managed
                             on the outside. A portable QEEG machine that could move around the state would give valuable diagnostic findings. Some people could live outside the hospital, many would reduce medication, some would get off it
1828   Website Submission    Wheel chairs are currently rented by medical equipment rental companies to the recipient at $50/month. After 13 months the recipient owns the chair. Why are we tax payers paying $650 to rent a wheel chair that you
                             can buy for less than $200? Why doesn't the recipient own the chair after 4months or less? I assume there are many more cases of this type of rental ripoff to taxpayers. The whole area of medical equipment rental
1829   Website Submission    Look at the duplication of services, and how we, as society tend to want to overhelp people.
                             For example, I run a state run social club. I have a nice little room with a tread mill, two exercise stationary bikes, and free weights. It is a difficult job to motivate my club members to use this room- and I even bring free
1830   Website Submission    Person receiving medicaid benefits has to comply with the treatment suggested. If the person does not comply and complications occure,he/she should be held responsible.

1831   Website Submission    It has always been my belief that mental health state aid funding that has been rolled into Medicaid rates over the years to gain the benefit of the federal share, actually included deficits related to private insurance
                             reimbursing less than cost. Reduce the Medicaid payments to providers by the difference between the cost of services and what the private insurances pay for their patients.
1832   Website Submission    Just like unemployement in NY, individuals receiving Medicaid that are physically able to work should have to subject to interviews bi-weekly to ensure that they are trying to obtain employment to continue to receive
                             benefits.
1833   Website Submission    Why don't you make the medicaid program be like the unemployment program? Working people in NYS only get a certain amount of time to be on unemployment (now these are people that have worked almost all
                             their life) and then are taken off it. Why don't you make people on medicaid get off it after so long and work for a living? Also if people are on medicaid they should be doing some form of work to receive those
1834   Website Submission    Get rid of the retroactive eligibility that goes back further than the 3 months. Even this should be eliminiated. What other Insurance company would retoactivly insure someone.

1835   Website Submission    Cardiac Advisory Program / Database System was a gold star program in the beginning. It no longer serves as purpose and incredibly redundant with reporting requirements at the federal, payor, HAI reporting, AHA
                             Get With the Guidelines, and other reporting systems.



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 #                  Author                                                                                                               Proposal
1836   Website Submission    NY already has a public/private partnershp for long term care insurance. Now it's time to develop another type of public/private partnership to pay for nursing home care. Let families contribute to the costs of care for
                             their medicaid-eligible members who have moved into a nursing home.
1837   Website Submission    Consider integrating DOH, OMH, and OMRDD. There would be tremendous operational efficiency; as well as a potentially more integrated, streamlined, and effective approach to managing people with co-occurring
                             diseases.
1838   Website Submission    Streamline the paper work required for admission and discharge especially for patients in Psych Centers who are direct admits from community residences. This requires untold manpower hours and is often redundant

1839   Website Submission    1st, send someone to california to study and adopt their policies, and 2nd, almost every criminal brought into the erie county correctional facility has more than one medicaid card, many more than one in most cases, and
                             nothing is done about it, the sheriffs even give the cards back to them when they leave jail, take some of that stimulus money and investigate and punish the abusers of this necessary system we have.
1840   Website Submission    Eliminate the family contribution ""refusal option"" when applying for medicaid.

1841   Website Submission    Transfer Medicaid services for the developmentally disabled from state agencies to the private sector. It is a fact that the costs to provide virtually identical services are substantially greater in state-run facilities than in
                             private sector facilties, with no perceptible difference in quality. A quick look at the pay scales for for state vs. private sector employees serving people with developmental disabilities will confirm the difference in cost.
1842   Website Submission    Immediate reductions in Medicaid cost could be achieved by:
                             1. Requiring Spousal Refusal Medicaid recipients to agree & contract at time of application to reimburse Medicaid on an ongoing basis as a condition of continued eligibility rather than bringing lawsuits as is now
1843   Website Submission    Eliminate Medicaid. Turn the business over to private managed care.

1844   Website Submission    A much slimmer formulary, not including off-label uses, not including many abused diagnoses, without strict restrictions.
                             Perhaps protection from lawsuits for not prescribing such drugs as Viagra, Modafanil, etc, that are certainly easily deleted, but which are constantly being diverted.
1845   Website Submission    Refuse people medicaid coverage if they smoke or if they are over wieght Unless they attend programs to lose weight quit smokeing Then & only then they will recive full coverage

1846   Website Submission    The profits generated by the complex rehab equipment providers under medicaid are unbelievable. I have been in the business 25 years and the money I have made equal to the work is outrageous. My idea:

1847   Website Submission    Provide only Federaly mandated coverage. No more, No less

1848   Website Submission    Ifeel there should be a set time in a lifetime that u can receive Medicade. That being said, everyone should pay a co-pay. Maybe then ppl would not be so quick to the ER and go to their GP. This would also cut down
                             on ER visit times.
1849   Website Submission    am a social worker in a small town in upstate NY. I have an idea as to how to save money in the welfare/medicaid area. In order to encourage folks to get off welfare, we need to provide them with living arrangements
                             that are affordable (and not substandard, like so many HUD apartments). Small log cabins that can accommodate one or two people could be erected and be made energy efficient. These small cabins cost around
1850   Website Submission    Incentives should be provided to ENCOURAGE--NOT DISCOURAGE State auditors to find, expose, document and prosecute waste and fraud. Do NOT farm this out to outside, for pay contractors who can be easily
                             corrupted into manipulating their findings to perpetuate both their continued employment and the current bloated system. Stop letting junkies and alcoholics continue to game the system. Stick them in managed care
1851   Website Submission    Redesign of the OMRDD and OMH system is equally vital at this point. There appears to be significant waste and misaligned/non-value added services.

1852   Website Submission    In order to reduce the Medicaid cost, we need to implement a universal tracking system for billing purpose. A patient can obtain multiple prescriptions from different providers and the billing system in place does not
                             detect this. We also need to explore ways to use genetic drugs instead of the brand name drugs. Pharmaceuticals want doctors to prescribe brand name drugs to consumers. One last suggestion is investment in preventive
1853   Website Submission    I would encourage the Medicaid Redesign to due some very robust incentive programs to encourage rapid change into the redesign systems; as well as align basic payment systems with value added services for
                             sustainability.
1854   Website Submission    It would be a great advantage to revisit the concept of Nursing Home Without Walls. While Medicaid funding is complex and different for each program (Federal vs State vs County), the overall cost to the taxpayer
                             benifits from funding Home Care to the elderly as opposed to Nursing Homes. Please consider the following advantages;
1855   Website Submission    think it would greatly help the medicaid costs if there was a plan in place to educate people on what qualifies a visit to the walk-in or emergency departments. These are costly services and even a small reduction in the
                             costs could save a large amount of money. I truly believe that some people just don't understand the chain of services available and the proper way to use them. It could start out at the primary doctors office where
1856   Website Submission    Purchase Hospital reimbursement and HMO managed care policies for all medicaid insured. Utilize copays for outpatient Dr. visits and pharmacutical services. Charge a sliding scale premium for medicaid coverage.
                             Consider using PPO fee schedule for reduced cash payments to health providers for services without actually insuring beneficiaries and eliminate insurance intermediary and paperwork. Provide payments to family
1857   Website Submission    ith clinic restructuring we are now able to see the Medicaid costs associated with the care of our mental health clients as the spread sheets per provider are provided for the licensing staff. The medicaid costs could be
                             reduced I believe by taking a closer look at the patterns of each individual patient. I think you will find a system that does not work in a coordinated manner to ensure the individual recieves care and appropriate
1858   Website Submission    any years ago the state was determined to turn over mental hygiene responsibility for planning, developing and monitoring of the needs of their county to the county authorities. While in many case it has worked very
                             well, in many others, it has weakened the services and the service delivery system and lessoned accoutability and quality of services provided. Specifically with mental health, the Single Point of Accountability



                                                                                                                                                                                                                                                                    55
 #                  Author                                                                                                             Proposal
1859   Website Submission    Pharmacy: Most drug plans have formularies for preferred medication. Under the state employee pharmacy plan, Nexium is not covered by the policy requiring my husband to use an alternative medication. However
                             under (non HMO) Medicaid, it is allowed.
1860   Website Submission    Transportation services to the disabled are a very necessary service for inclusion. However it seems that private companies have been abusing this service, charging exorbinant fares (busing the disabled) with Medicaid
                             funds.
1861   Website Submission    As a new york state licensed psychologist working for the office of mental health, I feel that the amount of paperwork that is required reduces the amount of time that can be spent providing direct patient treatment. This
                             leads to high re-hospitalization recidivism rates and invariably costs more. I would suggest streamlining the paper requirements thus allowing clinicians to do clinical work. In addition, doctoral level clinicians are often
1862   Website Submission    Too much paperwork is required by clinicians - can't spend as much quality time with patients. Can't do nice things for patient's that they would enjoy. Much of paperwork is done for Clinic Recertification purposes -
                             does not help client AT ALL. Most of our clients (Chronic Mental Health conditions) have a progressively deterioriating condition and the Medicaid Paperwork regulations ask us to show how their condition is
1863   Website Submission    NYS OPWDD should get out of the business of direct service provision for individuals with developmental disabilities. Services can be provided by community based not for profit organizations such as UCPs and
                             ARCs at a 30% cost savings due to inflated state salaries and fringe benefits, most notably the NYS Retirement System.
1864   Website Submission    Also, there should be required consoldiations of those not for profits, similar to the outcomes recommended by the Berger Commission for Hospitals. This would reduce the duplication and overlap of services while
                             cutting administrative and overhead costs dramatically.
1865   Website Submission    Imagine that Supermarkets and convenience stores ( 7-11 0 are fully automated with bar code reader technology . Every time they sell a box of pasta, bag of potato chips, juice container, milk, etcc. they know the brand
                             sold, the size, the type of pasta, chips, juice, milk.. etc... Waste is reduced significantly because they know when their products are about to expire and conduct sales to accelerate sales.
1866   Website Submission    Develop peer specialist role in substance use disorder and mental health treatment.

1867   Website Submission    There needs to be some way to discourage medicaid recipients from using the hospital emergency rooms for routine medical problems, and community physicians need to be able to take medicaid recipients as patients.
                             We're in a rural area where there is a shortage of physicians and an even greater shortage of physicians willing to treat these people.
1868   Website Submission    I am a former employee of a COBRA Case Management organization in NYC. As a case manager I had a billing quota I was expected to meet daily. In order to make that quota, I often did things that I knew would be
                             pointless, just to get my billing. Nothing illegal...just what was expected of me. For example, traveling to a client's home to outreach when I knew they probably would not be there. Because we got to bill for travel
1869   Website Submission    Reduce the mandatory three month requirement for patients to meet with their psychiatrist if they are stable and doing well.

1870   Website Submission    Reduce the administrative staff at OMH and each state psychiatric facility, increase support staff.

1871   Website Submission    We need to pay the family members direct to stay at home & take care of ageing parents or mental handicaped kidds instaed of putting them in nursing home or state run mental site this would cut down cost alot (no
                             labor cost& bldg cost) An on lawsuits because the family members would the care giver and not the state. Family should take care of family it should not be the states job & My wife & i took care of two family
1872   Website Submission    Explore the Vermont model whereby the state requests a federal Medicaid (and perhaps Medicare) waiver for the purpose of establishing a single-payer approach to health care for its residents. This model would seem
                             to have the best chance of controlling costs while improving quality through a uniform system of billing and provider accountability. The federal government should have taken this approach to health care reform.
1873   Website Submission    some type of oversite so that expensive procedures are not repeated for patients who were not compliant with the directions for the initial procedure so it is repeated with the same results (for ex $30,000+ back surgeries)

1874   Website Submission    Medicaid transportation expenses for cabs when other more economical public transportation is available
                             providers are unwilling to take on fiscal responsibility for various expenses with their patients
1875   Website Submission    Promoting taxpayer fiscal responsibilities by somehow incorporating comments within the form that will remind providers to not blanketly order services, medications, etc. so they don't have to argue with patients- the
                             feeling of detachment from actual expenses makes this all to easy for folks
1876   Website Submission    onvert the present nursing home rate structure to flat per-patient rate payments
                               One way that Medicaid can save significant money is by changing the payment scheme for nursing homes from rate assessments to flat rate payments. Medicaid spends more on elderly enrollees than almost any state
1877   Website Submission    Eliminate bed reservation payments at nursing facilities
                               Bed reservation payments, when nursing homes are paid a full daily rate to hold a bed for a Medicaid recipient who is not at the nursing home, were put into place when nursing home bed availability was very low.
1878   Website Submission    Require all facilities that have DME items that are included in their rates to obtain these items from DME pharmacies without using patient names.
                             Facilities at times have pharmacies charge these items to Medicaid instead of paying for these items directly. Prohibiting the use of patient names for DME orders for facilities that have the items in their rates will ensure
1879   Website Submission    ake measures to stop prescription abuse.
                               Pharmacies are filling prescriptions that they receive by fax and never check with the prescriber to confirm the drug was prescribed. A fax can be sent from anywhere with any fax header the sender wants to put on
1880   Website Submission    Have a central registry for home health aides who are certified. Providers need to be able to check to see whether aides that they hire are really certified.

1881   Website Submission    As a provider of eyeglasses to nursing home residents I have a unique perspective to share.




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 #                  Author                                                                                                               Proposal
1882   Website Submission    Would you like to save an average of 18k dollars per year on each of your hemophilia patients? Based on prevalence there are approximately 1437 hemophilia patients in NY State. This places NY State Medicaid's
                             hemophilia population at 350-450 patients. Continue reading if you're interested in my idea of how to save over $6 million Medicaid dollars per year.
1883   Website Submission    STOP ALL BENEFITS NOW! Start reregistering each applicant. One name, One address ONLY!! Verify multiple names at same address. Reregistration upon residence change. Fraudulent claims are to be
                             prosecuted and person is removed PERMANENTLY from ANY PUBLIC ASSISTANCE OR ENTILTEMENT PROGRAM.
1884   Website Submission    Stop allowing elective c-sections.

1885   Website Submission    It is unbelievable how I have seen first hand the numerous promotions given to individuals in the "good ol boy" network at the Saint Lawrence Psychiatric Center during this fiscal crisis. This organization needs to be
                             investigated VERY closely as to why they are so top heavy with management for such a small facility in New York state.
1886   Website Submission    a. study other state's programs.
                             b. mandate generic drugs, and benchmark to lowest price nationally.
1887   Website Submission    People often criticize this idea, but requiring drug tests and tobacco tests would force these people to make the tough decision of living healthier or getting kicked off. I do not think this is unreasonable at all considering
                             we are paying for it, in more than one way actually. Since medicaid often undercuts what they pay to Drs. my medical expenses are increased. So to reduce the $1000 a month health care premium that my family has to
1888   Website Submission    I work in the mental health field with children and adolescents. I have worked in an outpatient clinic as a clinic supervisor in the past. Our clients used all different kinds of insurances, whether private or Medicaid. I am
                             no longer in that job but I learned a lot from it. When I began working in that job, I was given several cases that were open in the agency for a year-3 years. These particular cases were of children who attended therapy
1889   Website Submission    I'm not sure how to address the following issue. When I worked in the outpatient clinic, I often saw clients for a screening to see if they needed counseling services. There were many times I did not admit a child because
                             services were not necessary. Within a couple of months of me seeing them, I sometimes received a letter from SSI requesting their information. I took this as the parent of that client trying to get the child in counseling in
1890   Website Submission    Medicaid waiver HCBS under OPWDD now covers day camp for teens it used to cost families $895 for 6 wks now it is a waiver program only Medicaid teens can attend (most do not meet income requrements until
                             18)and the rate is $5000for exactly the same program. Parents have asked if they can pay but they cannot afford the $5000 and there are no waiver slots available. This has taken a valuable program away from middle
1891   Website Submission    The Medicaid Buy-In for Medicaid recipients with disabilities has theoretically made it possible for people to work and slowly climb out of poverty without losing their Medicaid eligibility. However, there is a
                             disincentive to save the money that is earned. The existing limits on assets make it impossible to save enough money to have an adequate cushion to cover private health insurance, medical expenses, medical
1892   Website Submission    Cutting costs in Mental Health medicaid dollars. In order to see a psychiatrist and receive medications, nearly all agencies require costly ongoing counseling for people who are stable and needing or desiring only
                             medications. Of course these agencies make more money doing this, but it is not the best practice for all. Also, opening up the credentials considered QHPs, to include lower cost, highly qualified certifications (LMHC,
1893   Website Submission    Drug and Alcohol abuse. Over the course of twenty five years in healthcare, I have seen many, many times when drug addicts and alcoholics request detox for the tenth, fifteenth time in a few years. The taxpayers
                             should not have to carry this burden. Stop the abuse of this and make is mandatory if after the second or third rehab that they either pay for it themselves or make them work for it.
1894   Website Submission    Children. Many, many people that are currently on Welfare have far more children than the working taxpayer. I am not saying we have a right to control their reproductive urgencies, I am saying if you are on Welfare
                             and already have five kids, getting pregnant for the sixth time is not necessary wise from a financial viewpoint. It is the individual and partner's responsibility to care for the child, not the taxpayers of New York.
1895   Website Submission    change the law that if your parents are illegal immigrants the child born here is a US citizen. stop letting people fly over here and give birth and the taxpayers have to pay the bills because they have no insurance.

1896   Website Submission    stop paying benefits out to people who are eligible because they have cash jobs,hide their income such as waitresses and lawn workers who collect medicaid benefits. make it harder to get medicaid benefits with a longer
                             waiting period more investigation into their life and assets like other states. why is it so easy in NY to get medicaid?
1897   Website Submission    Everyone who enrolls in Medicaid should be obliged to improve their health: stop smoking, lose weight, join the brisk-walk-a-day club, take nutrition courses, take cooking courses, take how-to-eat-right courses, take
                             how-to-shop-for-groceries right courses, take dental hygiene courses (didn't a young boy in Baltimore DIE several years ago from bad teeth?). Colleges used to do this sort of thing with their students. During your first
1898   Website Submission    Medicaid recipients should be able to use Urgent Care services when they are ill if they do not have a primary care practitioner or it is after office hours instead of the Emergency Depts of hospitals which is much more
                             costly.
1899   Website Submission    I would suggest that Medicaid be approved more quickly. Right now, many of my clients have to wait 6-8 weeks for approval. As a result, they have to go to city hospitals to get their care, or to get medication that
                             would cost significantly less if it were from a primary care doctor or other outpatient clinic.
1900   Website Submission    Inpatient Medicaid reimbursement is based on Diagnosis Related Groups (DRGs). The DRGs are calculated for claims based on diagnoses, procedures, demographics, etc. Complex cases are assigned to one of a
                             limited number (less than 1,000) groups, or DRGs. The reimbursement rates are then calculated for each DRG.
1901   Website Submission    Eliminate state hospitals and ATCs, except for 1 state pscyh facility. None of these facilities are full occupancy, staffing ratios are totally absurd (politics over patients)patients can all go to a regional facility. Local care
                             at this level is not needed as these psych patients are going to be inpatient for years. As for SUD patients in ATC there are enough OP and free standing IP facilities who can treat these patients more cost effectively as
1902   Website Submission    Provide for dual licensing for Inpatient and Outpatient facilities so that they can be reimbursed for treatment for patients that have co-occuring disorders more effectively.

1903   Website Submission    Decrease utilization/beds for detox in general hospitals. Inpatient free standing detox (Part 816)and outpatient detox (appropriately reimbursed) can meet the needs of most of these patients and do better job of linking
                             them to next level of care increasing outcome for sobriety and long term recovery. This issue has been studied and documented in OASAS and DOH for years.
1904   Website Submission    Encourage and reimburse the implementation of EMRs in behavioral health programs. Not to do so and only provide for this funding for medical care is discriminating.




                                                                                                                                                                                                                                                                     57
 #                  Author                                                                                                            Proposal
1905   Website Submission    Encourage the utilization of behavioral professionals to provide SBIRT and other short term services in medical clinis,ERs and health homes.

1906   Website Submission    Implement/ensure Parity by MCOs.

1907   Website Submission    Manage all Medicaid, no carve outs needed. SUD and MH patients are no more complex than many medical patients and they are all managed....effectively.

1908   Website Submission    Overall we need to re-look at current tx models and reassess their effectiveness, redesign the models to be more evidence based. State agencies should implement outcome tools for each level of service so that there is a
                             consistent methodology for us to "grade" our work as well as to insitute a Pay for performance model.
1909   Website Submission    You should focus on giving the counties more power when it comes to prosecuting fraud. The county I reside in had to let their fraud investigator go two years ago and has been functioning without one ever since. If
                             you seriously want to reduce costs you need to be proactive during the process. Getting the assistance from the State should be a temporary stage, not a way of life.
1910   Website Submission    Why does the state distribute transportation costs for OTP patients with hard copy checks? This is an inefficient means of distribution for these funds and many checks never get to the patients. Would it not be more
                             efficient to distribute the funds using the Medicaid cards in the same way that HRA does.
1911   Website Submission    I believe there are many clinicians who have very different ways of noting minutes of direct face-to-face contact on progress notes. I was trained to write 1.00 hour on MHARS for any clients I see more than a certain
                             amount of time (30 minutes or 45 minutes, etc). I believe there should be a classrrom-type training for all clinicians that would standardize the way we document time with clients and time spent writing notes. There
1912   Website Submission    I think the answer to medicaid is universal health care. Being able to see a doctor regularly, would be prevenitive and people would not be using emergency dapartments as an office visit. (Second) Let me work, with so
                             many lay offs and no money to hire. Let me use my skills and improve on them where help is needed, as part of recieving health care. Maybe this would lead to employment and benifits on my own less on the
1913   Website Submission    I run a 250 bed not-for-profit Nursing Home. Clearly there needs to be a reduction in medicaid dollars spent on Nursing Home care, however, reducing medicaid rate to Nursing Home providers escalates risk of inferior
                             services and litigation. Instead, the Gov. needs to develop and incentivize more programs that will allow seniors to age in place at home, like transitions of care pilot programs. I would add that there needs to be more
1914   Website Submission    Reduce reliance on expensive institutional models of long-term care which cost more than 3 times as much on average as compared to community-based approaches that most people on Medicaid prefer.

1915   Website Submission    Use the Office of Medicaid Inspector General (OMIG) to require service providers receiving Medicaid funding to show how ?least restrictive setting? requirements are being used in administering their services.

1916   Website Submission    Stop filling Adult Homes with individuals with mental illness. It?s time for community integration. New York State should immediately end its appeal in the DAI v. Paterson Adult Home Decision which directed New
                             York to move individuals with psychiatric illnesses out of institutional-style Adult residences into the community with necessary supports. It?s legal, cheaper and more humane.
1917   Website Submission    Automatic refill for a new medication (prescription) should not be given for more that 15 days. In this case if the patient is not responding to his/her treatment, medications and refills are not wasted. Often, medications
                             are prescribed for 30 days for 3 refills. After 15 days if there is no response, another medication can be prescribed or alternative care can be offered.
1918   Website Submission    Make more efficient transfer from the short term care to long term care in home care agencies. With short tem care, nurse has to see the patient at least once every 2 weeks, In case of long term care nurse should see the
                             patient once a month/3 months.
1919   Website Submission    shut down rochester psych center and all other non criminal facilities.thier a waste of money.we do no good whatsoever.patients spend a yr here then we discharge them and they come back 2 weeks later.at 300k a yr per
                             patient.also thiers far to much administration.thiers more administration than direct care staff.complete waste of money.shut all mental health places down.even the one i work at.
1920   Website Submission    Althought labor intensive, validating Third Party Health Insurance available to Medicaid recipients and, if appropriate, disenrolling them from Medicaid Managed Care (sometimes paying premiums) is a cost effective
                             measure. Staffing and work overload in Medicaid offices hinders efforts in this process, unfortunately, as this is one true cost avoidance method.
1921   Website Submission    I also believe there is a wide discrepancy in service delivery between Managed Care plans serving public insurance programs and fee for service Medicaid. The discrepancies include oversight; often providers ask
                             districts to place people back in fee for service as they feel it is easier to get services and payment than from managed care. Possibly if the fee for service side had more oversight on services delivered, mostly in the
1922   Website Submission    When determining eligibility for medicaid, income for those self employed should be based on their gross income amount not their net amount( which is a huge differance after all the loss that can be claimed on their
                             income taxes) or all those not self employed their income eligibility should be determined by their net also, they should each have the same income eligibility rules, I have seen those self employed with a six figure gross
1923   Website Submission    Another suggestion might be to try to make more individuals elligible with some sort of bonus points for being actively employed but just over the income eligible limit, I've seen people working hard but still not able to
                             provide healthcare for themselves and would quit their job so they can recieve healthcare -promoting them not to work so they can have health care, or maybe at least just a prescription drug coverage card - most of the
1924   Website Submission    I work with OPWDD and for years many staff have been complaining about the number of times our folks must be seen by doctors. Of course, when its necessary there is no problem with doing this, but many times
                             these appointments seem like a waste of a lot of money. Looking at the number of times and for what reasons people, being served by OPWDD, are seen by doctors/medical facilities & whether or not these
1925   Website Submission    I think NYS should go back to the original Medicaid setup from years ago. We had ONE Medicaid card for people of low income and Medicaid A or B. The Bush Administration confused everything with their so
                             called solution! It's ridiculous! None of it makes sense! You have all these stupid drug pharmacies and you don't understand any of it! We need something that ALL the American people can understand:
1926   Website Submission    OPWDD Waiver Services:
                             ""Family Education and Training"" Waiver service is designed to provide children of middle class families Medicaid. In this fiscal climate, can we continue to encourage this?
1927   Website Submission    I am a psychologist currently working in OPWDD. We are often pressed to use up a consumer's funds when they reach certain limit, and this results in the purchase of numerous recliners and flat screen televisions for
                             people whose needs are already met. I suggest that the extra be returned to the state. On the office side of things, we tend to spend what we are allotted in order to keep the same level of monies the next year. We could



                                                                                                                                                                                                                                                              58
 #                  Author                                                                                                            Proposal
1928   Website Submission    My suggestion would be to redesign the Medicaid Program in NYS to allow doctorate level (PhD & PsyD) clinicians to provide services and bill Medicaid upon completing their education and the national psychology
                             licensing exam. Other states have changed their laws so that upon completion of the doctorate degree as well as the national psychology licensing exam, PhD/PsyD level clinicians can be licensed and bill insurances. If
1929   Website Submission    The reglations related to psychotropic medications are extremely costly, absolutely unnecessary and may actually be discrimatory towards the developmentally disabled population.

1930   Website Submission    Currently it is illegal for any male staff to transport a female consumer. This law is in place b/c 70+ years ago, a male staff sexually assualted a female consumer. Now, a male staff is allowed to be alone in a group
                             home, or in the community with a female consumer but he just can't transport.
1931   Website Submission    Perhaps the establishment of standardized documentation would increase the consistancy, clarirt and ability to oversee the appropriate billing for Medicaid services. While a specialized form might be needed for
                             categories of service, all providers of Medicaid reinbursable services under the auspeces of OPWDD could use one form. This would allow for standardized training and simplify auditing throughout the state.
1932   Website Submission    Make an Assisted Living a real alternative to Nursing Homes (cost: $3,000-$4,000/month vs. $11,000/month).

1933   Website Submission    Don't allow them to to see 2 providers in the same day for the same health issues just because they don't like what they were told or were not given a antibiotic.

1934   Website Submission    Re: services through OPWDD
                             - bill for level of care in residences not for training programs
1935   Website Submission    Re: general public
                             - determine co-pays for all medical/pharmaceutical services
1936   Website Submission    The medicaid system would work more efficently if the private insurer's were held accountable for providing coverage to individuals in New York State. As a residential adolescent chemical dependency provider of
                             services I see an ever increasing amount of denials for coverage by the private insurance companies and more and more families applying for medicaid coverage to get the required services for their child. If New York
1937   Website Submission    Offer welfare and public assistance recipients a form of co-pay coverage so that doctor visits and prescription costs are not so impactful. For example, a small ($2-$8) monthly reduction can be taken from the recipients
                             monthly welfare or public assistance payment and be set aside in a separate, unaccessible account for these costs. My previous employer provided this option and it felt like a huge savings to me and encouraged instead
1938   Website Submission    Quite simple I deal with developmentally disabled individuals who by being institutionalized are allocating $5000 per day for this state. Of that, each individual can tap into that for such things as laser eye surgery,
                             dental implant surgery, to name a few. They buy stuff that the average working middle class tax paying person of the state could never afford. Yes they are inside a fence; I know some think this is all they have, unlike
1939   Website Submission    Medicaid Fraud is endemic and costs working tax payers millions; statistical techniques sampling cases in areas of ""treatments"", ""doctors"" and ""health care organizations"" and ""Clients"" offers a very inexpensive
                             way to quickly identify where and what kinds of fraud are being perpetrated.
1940   Website Submission    Make the first option for long-term care an in-home community based model, rather than the institutional bias where care is predominantly given in nursing homes. Institutional care is more expensive than community-
                             based care
1941   Website Submission    Make state agencies accountable to look to community based care in the least restrictive setting possible.

1942   Website Submission    Continue to focus on community integration - scale down residential group homes, and stop congregating persons with mental illness in residential facilities.

1943   Website Submission    Shift the design of medical care to competing over the long-term health outcomes of clients, per dollar spent on care. This would change the nature of competition from shifting costs and denying services to providing
                             the best care as efficiently as possible.
1944   Website Submission    The New York State DOH has an Invitro Fertilization Grant A sliding scale for Household Incomes of $0 dollar - $195,000 determines the amount the NYS state and the patient pays. Apparently, in order to be eligible
                             the participant must have insurance.
1945   Website Submission    Eductate data analysts and programmers alike formally with actual courses in ""eMedNY"". For too long, this has been the purview of a small number of employees with fiscal titles.

1946   Website Submission    As a Psychologist II with OPWDD I have attended many consultations with private Consultant Psychiatrists in the Albany area who are sometimes 50 miles away from the programs and residences of the DD people we
                             serve. In fact, all the psychiatrc consultations in my caseload are covered by privately practicing psychiatrists or those who work for private agencies and are contracted to conduct clinics in our program areas. Capital
1947   Website Submission    If NYS is serious about saving money in this severe financial climate, why is the OMH pharmacy I work at being asked to drastically increase our pharmacy inventory beyond normal means. It doesn't make sense to
                             spend all this money for surplus inventory when peoples jobs are at stake.
1948   Website Submission    The biggest problem that I feel needs corredting is the frequency that medicaid clients abuse the insurance system. Perhaps if they are actually required to have copayments for visits or if medicaid did not cover several
                             routine visits such as private insurances it might discourage those clients from making so many trips to the ER or their personal physicians. Many times I see medicad covering things that private insurances would not
1949   Website Submission    An oxygen concentrator such as the one I am paying $25/month copay for sells for approximately $1000 new, but probably much less to the private health care providers. The providers not only get my monthly copay,
                             but they get a whopping $500/week from Medicaid. How is this allowed to happen? The unit is really inferior and doesn't have a decent filter, so you get any pathogens along with the oxygen. Wonderful! Why does the
1950   Website Submission    Another thing that bothers me are the recipients of yearly eyeglasses whether they need them or not. A neighbor of mine has loads of them - collects them because they're free!




                                                                                                                                                                                                                                                            59
 #                  Author                                                                                                             Proposal
1951   Website Submission    First of all to do an audit of actual people who qualify....I know people who are scamming the system in various ways from hiding money to lying about paying rent, etc to get these benefits and I'm sick of it.

1952   Website Submission    The state mandates that all consumer meds be labeled with the persons name, etc. even the OTC calcium, vitamins, etc. If we did not have to do this the pharmacies would not be able to bill us horrific prices for these
                             OTC medications. (Some of which bill close to $12.00 for 30 tablets of a medication which only costs a couple dollars for over a 100 tablets. OPWDD needs to be cost effective and not mandate that the OTC
1953   Website Submission    Medication dosage reduction,and reducing the use of more than one drug for the same diagnosies(epileptic-psychiatric)Many health problems are seen as a result of over-medicating an aging population.

1954   Website Submission    Reduce some agency 'required' medical appointments/tests, according to age and health issues. (ex: many people don't need an ANNUAL physical,etc)

1955   Website Submission    Open more Urgent Care Facilities esp for after-hours care (and take the burden off ERs)

1956   Website Submission    Stop the bleeding in such areas as physical therapy and home health care, especially in NYC. Limit PT treatments and require a physican SIGNED order for same. Go after the ordering physician when fraud is detected.
                             Same for home health care. Shut down any program that allows the clients family to contract workers with no oversight. Limit respite care to maximum of 16 hours per week.
1957   Website Submission    Eliminate Ambulette transportation or require ordering physican to assume responsibility for the ordered service.

1958   Website Submission    Put all Medicaid clients in Managed Care.

1959   Website Submission    Do we really need to require medicaid recepients with life long disabilities go through an annual recertification process?? (This seems like a huge waste of staff and consumer time for someone who is unlikely to be
                             "cured".
1960   Website Submission    Is it possible to look into the possibility of allowing certain medications taken on a regular/monthly ongoing manner to be despensed via mail order vs. traditional pharmacy? If there were one state wide provider costs
                             might be lower. Also recepients would not have to take an expensive taxi ride to the pharmacy to pick up medications.
1961   Website Submission    Are there children receiving medicaid who are otherwise covered under parental/guardian health insurance? If so, which is the primary payer of services? (It would seem that the secondary should be the taxpayers, not
                             the first)
1962   Website Submission    NYS might want to encourage the development and use of primary clinics located in high need areas so that medicaid recipents don't utilize emergency rooms and hospitals for routine and non emergent health care
                             issues.
1963   Website Submission    All recipients of Medicaid should have to pass a regular drug test in order to recieve aid. Just like those that pay for medicaid have to be tested.

1964   Website Submission    Implment a premium schedule for the Mediciad Buy-In for Working People With Disabiities Program. This has been "in process" since 2003.

1965   Website Submission    Cut ALL Medicaid spending. Medicaid is unconstitutional.

1966   Website Submission    If, as Senator Maziarz indicated in his email, California spends 25% less and treats twice as many people, can't we adopt their program as is? Wouldn't that save some time, as well as money? I understand there would
                             be logistical issues, but isn't that a great place to start? Do we need to reinvent the wheel?
1967   Website Submission    Limit recipients to very basic coverage and force them to use public transportation to doctors/hospitals

1968   Website Submission    People on medicaid should not be allowed to buy OTC meds with their medicaid. They should always be held to the same standards as the majority of major insurance co. They also should have some co-pays

1969   Website Submission    Treating tobacco-caused illness is estimated to cost more than $8 billion each year in New York (CDC), with about $3.3 billion paid by Medicaid (2004 dollars). http://www.cdc.gov/pcd/issues/2009/jul/08_0153.htm

1970   Website Submission    Marry up the new EBT card to a State data control to thebad choices they take to become entitled more of the system. Food choices are unhealthy and The option to use as a debit card allows alcohol sales with cash.
                             Computer data base will tract correct healthy foods. They follow our Medicaid rules not theirs they throw in our face. They sell food
1971   Website Submission    People who repeatedly go through substance abuse treatment (especially inpatient) with out success should have their coverage, their cash benefits, and foodstamps reduced.

1972   Website Submission    Trips to the emergency department, for adults, for things that should be handled by a primary care provider should not be covered. The hospital should refer the patient to a clinic or other, less expensive service after a
                             brief exam to evaluate their condition.
1973   Website Submission    More preventive services should be encouraged and recipients made aware of their availability.




                                                                                                                                                                                                                                                             60
 #                  Author                                                                                                           Proposal
1974   Website Submission    There should be a drug list much like the health insurance company uses. For the 6 months that my mother was on Medicaid in a nursing home she was receiving brand name drugs that had good generic alternatives.
                             When I questioned this I was told it did not matter to Medicaid.
1975   Website Submission    The state should negotiate the price of drugs as health insurance companies do.

1976   Website Submission    Patients in the Rochester area on medicaid receive only as much home health aide service that they need-usually less than 2 hours daily and a few hours a week. My supervisor went to New York City a few years ago to
                             do visits with some of their home health visit staff and patients that were capable of doing their own personal care had 8 hours of aide service daily! This is a huge waste of money, especially with the number of patients
1977   Website Submission    determine how to get standard costing for items used by patients in the hospital - stop the ridiculous charges for simple items that we know are billed in excessive

1978   Website Submission    hold insurance companies liable for their part in the increased costs for insurance

1979   Website Submission    put spending caps on certain procedures that involve high cost surgery

1980   Website Submission    stop any fraud both by physicians and patients

1981   Website Submission    Cut state employees staffing by 50 % terrible respoinse and service all poiltical appointments.

1982   Website Submission    Privitize many functions

1983   Website Submission    Duplicate what what middle of road states do.

1984   Website Submission    A department and/or controls need to be put in place to constantly work to uncover fraud by providers and abuse by the people who use the Medicaid system. We need to stop expecting our doctors and hospitals to take
                             less money just because they are caring for people with less money. There would be more than enough money to pay providers what they deserve if all the waste of money could be stopped.
1985   Website Submission    Since 1988 I have worked for chemical/abrasive manufacturing companies and been subjected to mandatory alcohol and drug testing. It is my belief as a New York State tax payer that all recepients of Social Services
                             and Medical Services test drug free in order to receive any benefits. I take exception to children under the age of 18; they should have medical coverage. However, if adult parents are not capable of being drug free; the
1986   Website Submission    I do not know much about the residency rules/laws; however, I believe there should be one in place and adhered to.

1987   Website Submission    if a single mother has her first child and they are on medicaid and social services, any future children should not be allowed. Its wrong for these girls to have babies knowing NYS will take care of them.

1988   Website Submission    For HCBS Waiver environmental modifications/adaptive technologies - utilize a "means testing" approach in determining level of funding.

1989   Website Submission    For HCBS Waiver Day Habilitation services - pull transportation costs out of site based rates - have cost as add on ONLY when needed and not required cost (rolled up) associated with service.

1990   Website Submission    Make generic drugs and lowest cost medical/rehb items mandatory whenever available. There seems to be a lot of times when the lowest cost options is not covered, but pricier ones are.

1991   Website Submission    think that there should be a time limit for people to be on medicaid. I can't even afford my co pays to go visit the doctor, yet you have many people sitting on welfare and medicaid that are choosing not to find a job,
                             because they have it easier on welfare. I know someone that has been on it for quite some time, and she has many prescriptions filled every month that she doesn't even use.
1992   Website Submission    ADHT is an early-stage health-monitoring services company on the Buffalo Niagara Medical Campus that provides a complete telehealth program for people to electronically, effectively and efficiently manage their
                             own health, a patient?s health, an employee?s health or a family member?s health from home, the office or wherever. We strongly believe that we can assist in reducing Medicare and Medicaid fraud by:
1993   Website Submission    Medicaid users should only be only be supplied with generic
                             drugs unless is would be life threating.
1994   Website Submission    My solution is to adjust NY's benefits to be 10% less than the #2 state and watch what happens! The career recipiets will pick up and move so fast you're head will spin! Of course the only "risk" to this plan is that a
                             huge population of voters who support the entitlement minded politicians will have moved to greener pastures.
1995   Website Submission    No more aliens. Person must be a resident of the state for a year before getting any kind of aid.

1996   Website Submission    Increase the criteria for authorizing gastric by-pass surgery.




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 #                  Author                                                                                                               Proposal
1997   Website Submission    Limit number of free abortions to one. Anyone is entitled to a mistake but learn from it or pay for it

1998   Website Submission    Limit the number of births born to a medicaid family.

1999   Website Submission    Allow mental health billing of all autisim spectrum disorders across medicaid and medicaid managed care recipients.

2000   Website Submission    Allow folks that are border line eligible for Medicaid and/or Family Health Plus a threshold of 40 visits or lower to be maintained. For the chronically mentally ill, remove the threshold.

2001   Website Submission    I think there needs to be more accountability in the program. Three strikes and you're out...or something like that. Basically, if you continually abuse the system - and the taxpayers like YOU and I who are funding that
                             system - then you can no longer take part in it. Period. End of story.
2002   Website Submission    I think the funding for Medicaid should come at the State level, not the county level. I also believe that NYS has to dramatically cut the funding to Medicaid and bring it in line with the other states around the country.
                             I am to the point that if my property taxes do not drop significantly, I will move out of this state and I have lived here all my life (50 years). When the only people left in this state are the ones on Medicaid, it will be
2003   Website Submission    Please institute a minimum 1-year waiting period for new residents of NY in order to apply or receive Medicaid benefits. This cut down on abuse immediately and also discourage non-residents from moving to NY just
                             to take advantage of our liberal benefits. Let's take care of our own residents first !!!!!! We should also install safeguards that encourage Medicaid users to get off of the program also either through incentives or
2004   Website Submission    I recommend reducing Medicaid costs by 20% as a measure, providing the equivilent of the State with the lowest benefit for Medicaid and that none of the Medicaid charges are by law able to be imposed upon the
                             counties, cities and towns. The later requires NYS to be more fiscally responsible in establishing any laws that cascade costs to the local communities for each to absorb the responsibility and ultimately pass on to the
2005   Website Submission    Limit the amt of time children/adolescents are in RTF or RTC by using more respite workers in the home.

2006   Website Submission    Why not have 1 pharmacy provider like the VA to buy drugs at a greater discount.

2007   Website Submission    MH is getting crazy with respect to their regs; i.e. - 24hr onsite nursing. why not have an LPN at night when 100% of the kids are sleeping or at least exempt those agencies where there have been no problems after 11
                             pm - 7am for at least a yr.
2008   Website Submission    Health insurance should exhaust before Medicaid dollars are used.

2009   Website Submission    Establish Medicaid assisted-living funding for the subset of people in nursing homes receiving Medicaid reimbursement whose care needs can be met in less costly assisted-living facilities.

2010   Website Submission    Invistigate families that are living off of their parents or grand parents retirement and social security and not declairing the income on their taxes or filing taxes for these elderly people for fear of getting caught doing
                             something illegal.
2011   Website Submission    Investigate as to why the prison systems aren't forced to submit the social security numbers of the inmates to the state so their unemployment benefits and social service can be stopped. All to many are having either a
                             family member or friend call in their claims and withdrawing the funds via ATM machines.
2012   Website Submission    nvestigate as to why the bars are allowed to let their employees whom are collecting SSDI and medicaid work for tips only so they don't have to disrupt their social security or social service status.

2013   Website Submission    nvestigate as to why divorced parents are allowed to obtain health care benefits through social services for their child (children) so they can avoid the co-pays at the doctors office, when their spouses provide the health
                             care coverage already.
2014   Website Submission    Investigate as to why someone can be cleared to go back towork after claiming a mental illness can dictate to their employer how many days a month they can work as to not disrupt their medicaid benefits food stamps
                             or heap through social services.
2015   Website Submission    Investigate as to why people are allowed to own and run a bar when they are collecting SSDI and are also allowed to qualify for government funded small business grants.

2016   Website Submission    It would benefit all if Social Services through out the state would dictate as to what food stamps can buy. It should eliminate soda pop and junk foods. Most of the poeple who receive these benefits purchase more junk
                             food than anything else, which adds to the obesety and diabetes in this country and higher cost health care coverage.
2017   Website Submission    Investigate as to why people who work for social services are allowed to apply for heap and food stamp and medicaid programs when their husbands are fully capable of working but choose not to.

2018   Website Submission    There are some people that are offered health insurance by thier employer with a small co pay taken out of thier wages but refuse.
                             Why!because they say if they need medical help they can go to the ER and get it.
2019   Website Submission    If a client has two insurances say Medicare and a supplemental, they should not be able to obtain Medicaid as well. I have to pay for my health insurance along with any copays, co insurance etc. We need to stop
                             giving "full" medicaid coverage.



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 #                  Author                                                                                                               Proposal
2020   Website Submission    I believe elderly nursing home cost is a major portion of Medicaid. It's very expensive and most people can't afford it. The taxpayer is the last resort.

2021   Website Submission    Eliminate the extras when it comes to dental and vision. These recipients recieve better benefits than a person with normal health care from an employer. My mother-in-law is on Medicare with a supplemental insurance
                             and is considered poor, but receives $150 to $200 too much to receive Medicaid,and has to pay for these extra benefits. Also, we need a better way to combat fraud. This includes patients and doctors.
2022   Website Submission    Perhaps it is time to hire more workers so they can spend the time to be sure that the people who use Medicaid really need it, but also check the providers who bill for services not necessary or even not even given. If
                             you don't have enough workers to put the time in to be sure everyone is getting Medicaid that needs it, and that providers are billing for services actually rendered, then there is the danger of fraud that goes unchecked.
2023   Website Submission    there needs to be a way to motivate doctors to take on maedicaid patients

2024   Website Submission    Adults should only be coovered for a 1 year period.

2025   Website Submission    Consolidated Supports and Services - I have brokered over 110 plans for the existing 500+ plans that are in place in NY State. Please contact me for ideas on how we can improve this program, as well as all programs
                             under OPWDD.
2026   Website Submission    the state's Medicaid program should be modeled after Canada's socialized medicine for example(OHIP) my spouse is aFormer resident of the province of Ontario Canada & she has lost more members of her family
                             waiting for triage & medical treatment. During an emergency Room visit whilstshe was pregnant-the Dr. told us we would have to return to the HMO service in WNY if we wanted to receive treatment.we were even
2027   Website Submission    medications On numerous instances Medicaid has attempted to switch medications which work for lesser priced medications which don't work. I'm not talking about generics-I'm talking about switching real BenGay
                             with odorless BenGay!
2028   Website Submission    Medicaid Service Coordination through the NYS OPWDD/DDSO offices is a much needed service. Many Medicaid Service Coordinators were laid off during the cuts that were made by Paterson a few months ago. If
                             these State Workers were not providing this service there would be people going without services...
2029   Website Submission    There can be more shared services between OMH and OPWDD....there are many dually diagnosed individuals (both children and adults) who could receive some services from each HCBS Waiver system and it would
                             be a more appropriate and possibly cheaper way of providing support. I say this, since delivery could be tailored to their needs...too often we see placements occur because we can't be creative with the service delivery
2030   Website Submission    I think it is important to look at the Fee for Service Medicaid Recipients. FFS recipients include some of the high cost, high need population and it is a population that can best benefit from the work that has been done
                             by the Medicaid Managed Care Program. One idea is to consider looking at these populations closely and consider mandatory managed care. Another thought is to have the State develop a case management division
2031   Website Submission    Addiction Detoxification stays should be limited. While it may take more than one detoxification in an individuals journey to recovery, there are a small number of individuals that use detoxification stays excessively
                             (several time each year) and the cost of these stays is being funded by the taxpayers. Put a limitation on the number of stays permitted with a requirement that the individual move to another level of treament or they will
2032   Website Submission    My suggestion for medicaid redesign is take hmo's out of medicaid. A better choice than hmo's, are ppo's and p.o.s. Because hmo's, are restrictive and the recipient cannot go out of network. With ppo's and p.o.s, they
                             can. Another solution is to stop having medicaid paying for people in long-term care facilities who are in irreversible comas, from which they will never recover. A third solution, is those with the financial means to pay
2033   Website Submission    We need a new system to get non critical people to their doctor or the emergency room. It is to easy to call 911 for an ambulance ride. Being in the first responder role our call volume has went up over 300 percent in the
                             last five years. At least 50 percent are non critical. It is not cheap to ride in an ambulance these days.
2034   Website Submission    STOP such liberal policies! I know a single woman in her thirties, already on SSI,no boyfriend, who wanted a child. She said Medicaid paid to have her artificially inseminated! She bore a child who has medical
                             concerns, and since that time she became obese and developed diabetes. A year ago Medicaid paid for gastric bypass surgery! She has lost weight, found a boyfriend she would marry, but refuses because she would lose
2035   Website Submission    Take a more in depth review of those requesting Medicaid. I am sure there are some using this program that could afford to at least pay a portion of their care.

2036   Website Submission    Scrap the entire structure, and make Medicaid a simple voucher program. Let those nice people you serve buy their own coverage. DO NOT pay anyone/thing/entity with anything other than the vouchers.

2037   Website Submission    Could we possibly train a number of current recipients to become investigators (of sorts)...recipients that would prefer a job over welfare? Once we do away with the fraud, then take a look at cutting costs. But how can
                             we even possibly consider cutting costs to those who need it until we weed out the fraud? Many recipients can't survive without welfare, while others abuse the privilege.
2038   Website Submission    One example that comes to mind is the unlimited number of times an uninsured alcoholic or drug addict can re-enter a treatment facility, free of charge, while the taxpayer picks up the tab. Restrict it to once every
                             couple of years
2039   Website Submission    Illegal aliens have no right to free health care at America's expense. Hospitals should not have to treat anyone who isn't here legally. Life-threatening emergencies are another matter. Stabilize and deport.

2040   Website Submission    The state should consider drastically downsizing the Office of Mental Retardation and Developmental Disabilities. It has been proven that volunteer agencies/organizations can provide services much more effecient and
                             cost effective. The staffing; weather it be direct line service providers all the way up to the administrators; is far less costly in the volunteer sector. This is noticeable in any of the services provided weather it is Medicaid
2041   Website Submission    Costs could be trimmed dramatically if the Physcians would stop requiring consumers/clients to visit them for unecessary visits. Many times for something any normal tax paying citizen would not need. Dental and
                             Podiatry are the tip of the iceberg. If an individual requires these services due to real health concerns they should recieve services; however; nobody needs to go to a physcian to have their nails cut on a quarterly basis.
2042   Website Submission    Get NYS out of the group home business and give them to the non-profits, which are more cost effective.




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 #                  Author                                                                                                            Proposal
2043   Website Submission    Establish more clinics where people can go for minor health problems.

2044   Website Submission    Limit the amount of prescription pain medication. Provide payment for alternative therapies such as chiropractic and acupuncture to improve health, increase activity, and avoid habitual addiction of these drugs.

2045   Website Submission    Extend qualifying period to six months.

2046   Website Submission    Many consumers with developmental disabilities who have feeding tubes are in nursing homes, waiting for placement in a group home; however, because of the very limited number of beds in group homes currently
                             available for such consumers (mainly because of staffing issues), the Medicaid program winds up paying nursing homes to take care of these consumers for extended periods of time. The daily rates paid to these nursing
2047   Website Submission    The public health law requires ""flat rate"" fees for hospitals to charge for emergency room, clinic and in-patient services. Yet, the Dept. of Health frequently and routinely grants exemptions from this law, allowing
                             hospitals to double and triples their charges.
2048   Website Submission    We need to look at every person who is on and who signs up for benefits to verify they are truely eligible through (visual verification, proper ID, and legal citizen status). I believe there are many people on the program
                             that do not meet this criteria. We also need to see that each and every person is a legal resident of this state and not a transient.
2049   Website Submission    Give vouchers to Medicaid recipients (equal to the average Health Insurance Policy in the State) to purchase their own Health Insurance that include: RX,dental, eye coverage. With no other special privileges including
                             transportation, emergency room visits unless they pay a premium as other citizens do. In other words don?t give Medicaid recipients any services for health care that are not offered to the average citizen in New York
2050   Website Submission    Require that medicaid recipients be required to have a primary care physician to mangage their care and treatment and require them to be assigned to an HMO. I think some counties in NY have certan restrictions on the
                             number of visits, but it is not uniform across the state. I have this requirement for my employer health insurance so why should people that are receiving coverage from the government get to see whatever doctor they
2051   Website Submission    f people on medicaid go to the ER for obvious nonemegencies they should be penalized by being made to pay the State back for the ER charges or having their medicaid suspended for a month or more. There is no need
                             for this when they could go to a regular doctors office or after hours clinic much more cheaply like normally insured people.
2052   Website Submission    There needs to be a stronger fraud detection effort - even a "whistle blower" anonymous tip hotline.

2053   Website Submission    There needs to be a program where to stay on medicaid for longer than two years a patient would have to volunteer for community or hospital service.

2054   Website Submission    No tubal ligation reversals.

2055   Website Submission    I believe that it is necessary to form a group of law enforcement officers to go after Medicare fraud in a large scale investigation. News reports seem to indicate that fraud crime syndicates started in Florida and are
                             spreading throughout the country. It must become known that fraud will not be tolerated and perpatrators will be prosecuted.
2056   Website Submission    Let local elected leaders determine what benefits are provided to their constituents on a county by county basis. I'm am tired of downstate politicians that only care about the bribes they can get from the SEIU
                             determining what benefits are provided across the entire state.
2057   Website Submission    Alot a payment (voucher) for the amount of $300.00/month for each individual on medicaid. This would be used by the state to purchase health insurance through BC/BS, Independent Health, or whichever insurance
                             company would write the best and cheapest policy. This amount would be the maximum the state would spend on each individual, so the cost could actually be lower. The state would handle the money and payments,
2058   Website Submission    No more payment for cosmetic surgery or sex change operations.

2059   Website Submission    Prenatal and infant care should be fully covered when both parents are identified and take some responsibility for the child's care. A mother who refuses to identify the father of the child should get a reduced benefit

2060   Website Submission    Elder care should be switched to the European model with fewer procedures and high cost tests.

2061   Website Submission    First there should be a residentcy requirement for people coming in from other states. It should be 2 years, and verified. I can tell you people use their relatives addresses to get medicaid. There should be how people are
                             eligiable.
2062   Website Submission    People should be either physically incapble of working, to have medicaid pay for their illness, and also people that have a mental illness. People should be over the age of 21, so that they aren't young drop outs that
                             usually flood the system. Should have a requirement of only being on medicaid and public assistance for the duration of 2 to 3 years. If you want NYS to increase the employment rate this would help.
2063   Website Submission    To be eligiable the Dept. Of Social Services should be going out in the field to verify eligibility. It is so easy to fraud the system like we have now. So to verify that people aren't doulbe dipping from other states or
                             counties, there should be fingerprinting and cross reference the names and the real places they live at.
2064   Website Submission    Increase the cost of national brand medicine co-pays by $5 to entice more generic brand usage.

2065   Website Submission    your webpage says it all $53 billion for 4.7million. that is $10,000 per person. On that basis a family of 4 is $40,000 which is more than twice family health plans. need to remake it as a group insurance pool. Reduce
                             the cost by over 50% thereby reducing taxes (got my local tax bill). Driving people out of NYS. Illinois residents complaining of raising personal income tax from 3% to 5% while NYS is already at 6.875%. Medicaid



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 #                  Author                                                                                                            Proposal
2066   Website Submission    I see many vehicles transporting people to and from appointmets (medicle moters and arc). Often I notice only one or two patients being transported in a large vehicle. My suggestion would be to phase out many of the
                             larger vehicles and replace them with more fuel efficient ones.
2067   Website Submission    Facilitate the use of Electronic Health Records (EHR). Trying to keep track of immunizations and historical medical information is currently a nightmare. Accessing complete patient records is constantly being griped
                             about whenever i am in a waiting room. EHRs should help coordinate that and, i would imagine, allow for better targeted care. And giving all of our doctors access to test results without needing to fax copies
2068   Website Submission    Shift Medicaid costs away from the counties. Property taxes are not a sustainable funding source. Plus it contributes to the stigma against the use of Medicaid that keeps some people from applying for it.

2069   Website Submission    I am a pharmacist currently practicing in a community setting. I see many abuses/misuses of the drug benifit portion of NY Med coverage. For example there is a particular pain medication that is no longer covered in
                             the generic form unless a prior authorization is completed by the provider. For some unknown reason the Brand name version of this same medication is covered without prior authorizaton reqiured as long as the
2070   Website Submission    I have had experience with Job Development program participants who have medicaid as their health insurance. Job Development workers are required to work at a site for a set number of hours per week which I have
                             never seen a requirement of 40 hours. With completing their work schedule they learn and also receive assistance. It is part of their requirement in the program. When assigned to a job site they must contact their worker
2071   Website Submission    At a residential level should look at each individual and see there financial status as to what kind of funds they have of there own. Example inheritus, insurance policy from family members ect. ect. Some of the
                             residents have money that has to be spend periodically, whether they need things or not, staff have to find a way to spend the money or they lose it. Why can't some of this money be used to pay for there care and
2072   Website Submission    Eliminate or greatly limit use of special needs trusts. Further reduce loopholes and definitions of assets which allow for wealthy New Yorkers to access long term care funded through Medicaid.

2073   Website Submission    Review assets and income of parents with children in the Care at Home Program, environmental modifications and adaptive technologies. At least look at a sliding scale based co-pay formula.

2074   Website Submission    Medicaid is intended to provide health care for the poor, but there's an industry enabling the wealthy to bilk the system. While Chris Collins wants to eliminate dental care for the "unworthy" poor, he and his country
                             club cousins manage to shield their assets so they can access long term care through Medicaid and still leave huge inheritances to their "deserving" heirs.
2075   Website Submission    The other area where I saw an issue. My ex-husband is a drug addict. He is in and out of rehabs constantly. I believe that they should have more long term care, located upstate in a non-populated preferably old psych
                             facility, have them maintain their own food by growing it possibly in they summer months, canning for the winter, preparing in a kitchen with a professional, and maintaining their own facility by being taught the trades
2076   Website Submission    I believe we should (I am a Medicaide recipient) pay something , or more, for Doctor'ds office visit. When I was an early GM retiree on that health care plan (since removed), I had to pay significantly for office visits.
                             Now, it seems virtually free. Free will get abused with unnecessary visits.
2077   Website Submission    We need to find at least some ways to decrease the benefits associated with medicaid for the non-permanent disabled (TBI, CVA, Down's, Mentally deficient, SCI, etc) those patient populations need the assistiance,
                             someone out of work and collecting unemployment because it is easier than working is killing our State. Combining that group with the out of state residents that somehow qualify without so much as a waiting period
2078   Website Submission    Simple forms for service providers (like this one )are needed for accountability -not tedious, fill in time to the minute ,dates,signatures, and print your name a hundred times etc. This takes time away from direct care of
                             patients and means fewer patients can receive treatment from the same provider because of paperwork responsibilities. Keeping people accountable should not mean wasting their treatment time with redunant and costly
2079   Website Submission    Simply repeal the law in it's entirety to keep from endless debate on which components of the existling law to change or delete. Then pass a law that is in place in a state like Texas or Forida which has been proved to
                             work. I would also add Tort Reform as a part of the bill to keep future costs from getting out of control as we all know NY is the most litigious state in the nation.
2080   Website Submission    Consider financial assistance to parents of adult children, served by OPWDD. I am a 28 year employee of Capital District DDSO, I also have a daughter with devolopmental disabilities. Because I need to work full time
                             to support our family, she requires a sitter, due to medical and supervision needs. The sitter is paid just over $25,000 yearly. Because we do not have enough hours to cover the amount of time Laura requires she also
2081   Website Submission    I feel the doctors share the blame for the prescription drug epidemic in NY and should be held accountable. Investigating prescription writing, would hopefully limit the amount of narcotics prescribed needlessly. Let's
                             face it, some doctors just write prescriptions too easily and too much.
2082   Website Submission    Issue debit cards for specific services.........when it's gone it's gone!

2083   Website Submission    Limit the types of procedures that can be performed based on monetary limit or procedural limit or other determination. Care needs to be reasobnably pruden

2084   Website Submission    Limit the number of visits per person per diagnosis and anything above needs to be out of pocket for the medicaid recipient.

2085   Website Submission    Limit organ transplantation.

2086   Website Submission    All medical equipment must be limited to a monetary value that is reasonably prudent.

2087   Website Submission    If a person on public assistance uses medicaid for unnecessary visits to the doctor or hospital (non-emergency visits) there should be an automatic monetary deduction from their next month cash or food stamp benefits.
                             Holding them financially responsible for non-emergent visits would reduce their abuse of medicaid. The physician, also, in these cases should not be paid for such visists.
2088   Website Submission    Prescriptions should be limited to absolute necessary medication, thus cutting costs. I have worked in medical offices and hospitals and know that the amount of wasted prescriptions and unnecessary visits is part of the
                             medicaid problem.



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 #                  Author                                                                                                              Proposal
2089   Website Submission    Next, drug and alcohol rehabs are not very successful and are a waste of taxpayers money. Working in a hospital medical record dept. has shown me the lack of success these facilities have. In such cases whereas a
                             court order has put an abuser in rehab to the cost of thousands of dollars, is medicaid used for those without jobs? If so, it is a waste of money. These people keep coming back. I do not want my tax money being used
2090   Website Submission    Stop the pay and chase of inappropriate Medicaid payments: design and enforce better front end controls/edits in the Medicaid claims processing system. 2.Run the Medicaid program like the insurance plans we
                             taxpayers pay for ourselves: sell the "cadillac" - we cannot afford it! Buy a "civic" - affordable, basic health care without the luxuries but it gets the job done.
2091   Website Submission    Combine the horsepower and knowledge of the state agencies that play a role in identifying, deterring and reducing the fraud, waste and abuse in the Medicaid program - NYS OSC Medicaid Audit & NYS OMIG &
                             and NYS OAG-MFCU, etc. Together these agencies could have great impact in identifying, deterring and reducing the fraud, waste and abuse that affects quality of care and is so costly to taxpayers.
2092   Website Submission    .Empower the OMIG to be a credible enforcer of program integrity - the current agency structure (NYS OMIG being part of the Department of Health) limits OMIG's power and effectiveness as there is too much of a
                             blur between policy and program integrity.
2093   Website Submission    Advocate for and improve information sharing with federal, state, and private partners in the health care claims processing arena: CMS; Medicare fiscal intermediaries; third party insurance; other states' Medicaid
                             programs; FBI; USDOJ, etc.
2094   Website Submission    ny state should not offer waivered services

2095   Website Submission    Although it is but one small facet of the overall necessity to re-structure Medicaid, one of the steps which needs to be taken is oversight of what costs & procedures are covered. Medicaid should face the same
                             restrictions that an employed person's HMO would not cover.
2096   Website Submission    I am concerned that the costs involved for first responders and ambulance crews attending to minimal health related problems, are abusing the use of ambulance transportation, and emergency room visits. The workers
                             responding to such cases, could verify that in most cases the ambulance ride and hospital visit to the emergency room are not a true emergency. The costs involved to our present Medicaid program is enormous. The
2097   Website Submission    We also have WAY TOO MANY HOSPITALS in certain area's - while I understand everybody wants help minutes away we have how many hospitals that are 2/3 empty most of the time in the Buffalo Area. Cut out a
                             1/3 of them and that will cut medicade costs
2098   Website Submission    There is waste with prescription medications/ topical meds/enteral formulas. I've seen unused packages of meds disposed of because pharmacies won't take them and repackage for someone else.

2099   Website Submission    Do not limit Medicaid payments to just one provider per day. For some people, Medicaid pays for transportation to and from clinics. If a person could have multiple visits in the same day at the same clinic, then the
                             transportation cost to Medicaid would be reduced.
2100   Website Submission    prisoners should not receive it... I mean is that really the consequence for killing someone? free healthcare and meals for life??????? we need to be a bit crueler like other countries to felons....they should not get a free
                             ride yet have $ to pay for cigarettes, etc.
2101   Website Submission    edicaid should not cover victimes of violence such as gang members who get shot then treated at local hospitals for free....they need to use their drug money to pay their hospital bill..... That is one thing that I am so sick
                             of reading about in the Buffalo News....I know these 20 something year olds who get shot over drug deals do not have private insurance...let's get realistic....I am paying for their surgeries and for them to be released to
2102   Website Submission    Perhaps this could be done as part of the implementation of the health insurance exchange--here's my idea. Say you've paid premiums to your private insurer throughout your career, and that you've paid in a lot more
                             than you've claimed, so that you have a positive ""balance""--and then you're forced to give it up (e.g. because you lost your job) and you have to switch to another private insurance company or to gov't insurance like
2103   Website Submission    I work alongside B.O.C.E.S. school social workers and school psychologists. I have the impression that their counseling services for students are financially reimbursed by Medicaid. Yet, the school districts which pay
                             B.O.C.E.S. so that their students can be entered into these community educational sites pay the B.O.C.E.S. organization for such services as part of the package B.O.C.E.S. charges for their placement. As such is the
2104   Website Submission    Get rid of the overhead... 99% of the state medicaid employees are not needed. They are one of the principle reasons for our elevated costs. CAN EM

2105   Website Submission    OPWDD- Medicaid transportation to take kids to afterschool and respite programs, outrageous, have the parent get excused from work, without getting in trouble. Have the parent bring the child. We all bring our
                             children.
2106   Website Submission    OMH- Direct Care Staff (TA''S) Inpatient Units- Thesde folks need a wake up call for OT, they skkip lunch, reverse there 1:1 coverage, as to get more OT. Overtime needs to happen ONLY in the event of an
                             emergency. They Aides need to follow the role of the nurse and look at the budget around them.
2107   Website Submission    e need to make the penalties, for Medicaid abuse, very, very severe. Like drug dealers, a Doctor, convicted of Medicaid abuse, should forfeit everything he owns. Maybe that way, we could recoup, some of the losses.
                             Another way is to have Doctors use more of their diagnostic skills, instead of relying on expensive technical procedures. Example...if it's a sprained ankle, fine, do we really need a ""MRI""????? People need to be held
2108   Website Submission    One of my ideas for a Medicaid redesign would be to eliminate the mental retardation & mental health populations seeing/having an appointment with the primary care physician prior to having an appointment with a
                             specialist such as an eye doctor, dermatologist, etc.
2109   Website Submission    Eliminate wasteful use of taxpayer dollars like the purchase of bottled water

2110   Website Submission    elimination of paying for prescription drugs not deemed necessary to strengthening health (Viagra is a clear example of a drug that should not be paid for by taxpayers).

2111   Website Submission    reate short-term stay (one or two night) programs/facilities for patients with mental health problems who may require closer supervision/support than is available in the community, but do not meet the criteria for a
                             hospitalization. Often times I am left with no choice but to admit a patient to our psychiatric unit because no other option is available. This sometimes is the case for people who have run out of their medications but



                                                                                                                                                                                                                                                                 66
 #                  Author                                                                                                           Proposal
2112   Website Submission    dental should be removed except for cleaning of children.

2113   Website Submission    many do not have mental health coverage on their health insurance. why should medicaid. co-payment or use catholic charities which serves anyone anywhere.

2114   Website Submission    Enter patients more into clinics that have midlevel providers-NPs specifically. Need to examine what California does. Educate patients not to use EDs to go to their assigned clinic and make sure you have after hours
                             for them also after hours for OTC medications such as tylenol which we all take for granted. And please do not take money away from us as providers. You will not have any doctors that will take these patients.
2115   Website Submission    OPWDD Family Care (FC) Program is the least expensive residential program with the potential for the greatest quality of care. The FC Program also supports local economies keeping people off of unemployment.
                             There needs to be a Statewide effort to advance the number of Family Care Homes and individuals living in Family Care to reduce the cost to taxpayers and allow individuals with disabilities to have a great residential
2116   Website Submission    Restrict to one doctor or group and one pharmacy. There is too much abuse. People go to one doctor one week then to the emergency room the next week. Because it's covered by Medicaid they get several medications
                             and continue to show up at the hospital for a common cold. If they had to pay more for each visit they wouldn't abuse it. I see people get low cost if not no cost medications at the pharmacy as they walk over to the beer
2117   Website Submission    Take a survey of 50 states. Calculate the average cost of Medicade per covered person. Delete 40 states with the lowest cost. New York should spend the average of the top 10 states. This formula will provide
                             coverage at a rate that is in the top tier of the country and is bullet proof against any arguments that we are not committed to providing a quality of care that meets or exceeds the care enjoyed by the majority of
2118   Website Submission    Sick people cost money. Therefore, PREVENTATIVE MEASURES are most cost-effective. WE NEED TO HAVE A SODA TAX. Sugar in soft drinks leads to tooth decay,diabetes, obesity, and nutritional
                             inbalance. There is NO good nutrition in soda pop & yet people drink it counting it as food. Water would be better. Anyway, instead of filling up on good nutrition, there is a lack of good nutrition because of false
2119   Website Submission    PREVENTION ....PREVENTION....PREVENTION.....What to do with Soda Tax money....help neighborhoods build/repair sidewalks. People would like to walk but often there are no sidewalks or the sidewalks are in
                             disrepair. I suggest a partnering with the local municipalities. Offer 50+% to local municipalities to apply for sidewalk build/repair programs. This could be expanded to include walking paths, bike trails,
2120   Website Submission    Prescription utilization review is key. It is one of the biggest line items,and should require A LOT more criteria, and follow up. You will definately find HUGE $$$$ there.

2121   Website Submission    old physicians accountable for overprescribing medications for persons who have "tried" the medication and report "it didn't work" after only taking it a few days. As a community health nurse I have had patients show
                             me literally shoeboxes full of medications they have "tried" and are no longer using. What a waste of taxpayer dollars.
2122   Website Submission    Rescind dental and vision coverage except for children under 18 years of age. Today that type of coverage is almost non existent in the workforce industries and workers have to budget for these health issues, should
                             they arise, unlike those who use Medicaid as an limitless checkbook.
2123   Website Submission    Hold physicians, pharmacies and insurance companies to always prescribe generic brands whenever possible, which I believe can be the majority of the time.

2124   Website Submission    Persons over 18 should be working, albeit a minimal wage job, and given limited government health care assistance

2125   Website Submission    Was working on a project to see if Medicaid could be paid based upon a Regional Price like Medicare is done. From the Data, Hospitals in NY State are made up of about 94% operational costs and 6% is Capital Costs.
                             Rates paid should reflect Medicaid Usage or have incentives to Hospitals to cut operational cost/improve operations. However, you would need to make the incentives higher for Downstate NY because those Hospital
2126   Website Submission    An other idea would be to cap what is an allowable cost for Medicaid for example if you have adim. cost of CEO, CFO and other wages of $5 million and cap of $4 million, this would reduce the amount of Medicaid,
                             while allowing the hospital to run as they wanted, however they are going to have to made a choice of making it up from privite ins. or cut costs.
2127   Website Submission    I am an employee of OHIP and work in an area responsible for production and analysis of Medicaid statistics. Although a fairly new NYS employeee, I have been expsoed to Medicaid as an administrator in private
                             medical practices for ~25 years. From elementary research I have done since working in OHIP, I know NYS's Medicaid program is not only the most costly, but of the top 4 states, it is over twice as expensive as the
2128   Website Submission    If access to care is increased medicaid dollars will be decreased. One effective way to do this is through outreach events designed to increase awareness of the importance of having a primary care physician and the
                             easiest way to access a primary care physician. Has their been any thought to utilizing existing personnel and services within the DOH to accomplish this task?
2129   Website Submission    Please consider a NY-based start-up, SimplicityDB LLC, with an innovative new system for viewing costs and care patterns and responding to them in real-time. As an experienced hospitalist physician, I designed the
                             patientsDB system to integrate data from all legacy hospital systems. Its real-time performance and cost dashboard automatically identifies high-cost patterns at the level of the patient or the provider. We designed the
2130   Website Submission    Medicaid users are told by their caseworkers that they do not have to pay their co-pay. As a working New Yorker I am not privy to that option and in my opinion neither should the Medicaid receipients. How much
                             would we save if Medicaid receipients had to pay the co- pay before they got their medications. I also believe that these people should be means tested and drug tested to see if they are qualified to be receiving this
2131   Website Submission    Co-pay for all medical care except preventive care such as vaccines, mammograms, etc. Also higher co-pays for emergency room treatment to direct patients to their medical providers instead. Totally free care leads to
                             abuse of the health care system.
2132   Website Submission    Hire more investigators to investigate medicare fraud and over billing. The jobs will pay for themselves through savings in the program.

2133   Website Submission    Maybe an incentive program laden with incentives for good health care and preventative measures taken, and penalties for bad health care so people realize they have a share in their own personal health care. The
                             government is NOT totally responisble for a citizens bad behavior, habits or personal health choices.
2134   Website Submission    Eliminate Medicaid funding from the County/City/Town property taxes as Gov. Cuomo has suggested. Finance the Medicaid program as most other states do. Although this may shift from property taxes to the state
                             income taxes, it would provide property tax relief to all property owners and should reduce taxes to those on fixed incomes, i.e. retirees.



                                                                                                                                                                                                                                                           67
 #                  Author                                                                                                             Proposal
2135   Website Submission    Reduce physician liability insurance costs by limiting and controlling malpractice law suits. These are encouraged by lawyers and do nothing to help anybody but themselves.

2136   Website Submission    As a tax payer, it bothers me that through effective estate planning individuals (and in many cases by their children) can shield their assets so that they qualify for Medicaid either at the time of admission into a nursing
                             home or shortly thereafter. This puts the burden of paying for their care on the general population of the State. I have seen the level of Medicaid utilization increase in the Nursing Home industry and as a result the
2137   Website Submission    The State should review the current payment level for SSI qualified individuals who are looking into Adult Home/Assisted Living and/or Enriched Housing residency. The monthly allowance is insufficient to cover the
                             cost of such residency. As a result, I feel these individuals are not accepted into this lower level of care and instead forced to seek residency in a Nursing Home (many times a County run facility) at a higher cost since
2138   Website Submission    Reform must reduce the State?s reliance on expensive institutional models of long-term care which cost more than 3 times as much on average as compared to community-based approaches that most people on Medicaid
                             prefer.
2139   Website Submission    Governor Cuomo must assure that State Agencies are directed to come up with a timed plan to move individuals out of institutional settings back into their own homes and/or apartments in the community with supports.
                             Essential to this transition to the community, it is imperative that housing, transportation, personal care, and other necessary supports be part of those plans moving funding from institutions to community-based service
2140   Website Submission    Reform efforts should use the Office of Medicaid Inspector General (OMIG) to require service providers receiving Medicaid funding to show how ?least restrictive setting? requirements are being used in administering
                             their services.
2141   Website Submission    Medicaid Re-design in New York should be transparent and should allow regular citizens and consumers of services to have meaningful input that is included in reform results, not simply the ability to give comments
                             on the process. The state should provide multiple ways at multiple levels for consumer involvement and bring New York State into compliance with Title II of the ADA through all recommendations for service
2142   Website Submission    Stop filling Adult Homes with individuals with mental illness. It?s time for community integration. New York State should immediately end its appeal in the DAI v. Paterson Adult Home Decision which directed New
                             York to move individuals with psychiatric illnesses out of institutional-style Adult residences into the community with necessary supports. It?s time to end outdated models of service that segregate people simply
2143   Website Submission    Dedicate more staff resources to find fraud and abuse. State agencies are never given enough resources to do much beyond the core mission. Quality control and assurance is often sacrificed when there are budget cuts
                             or staff reductions. Finding or preventing fraud and abuse must be part of the core mission or it will never be done properly.
2144   Website Submission    Change the law to allow impostion of double or treble damages in cases of Medicaid fraud. This would allow the Gov't to recover more funds where fraudulent schemes require signficant prosecutorial resources to
                             recoup all the stolen funds involved. With double or treble damages only a portion of the fraud would have to be proven. Plus it would serve as a significant deterrent.
2145   Website Submission    Cut back the Federal aid for Medicaid to the Federal mandated level of 50%. NY is giving 50% more than the Federal limit,therefore passing the cost down to each county.

2146   Website Submission    Home care nurses should have the family sign off for hours worked to confirm they actually worked those hours. Confirmation could be sent to the signee via internet to keep it wireless. They could submit their hours
                             online at the house if there is access.This should not be a cumbersome process.
2147   Website Submission    The use it or lose it parts of the program encourage people to use things they may not need. There should be a provision/reward going forward if resources are not used

2148   Website Submission    My suggestions are as follows for the area of DME (durable Medical Equipment)

2149   Website Submission    I am a licensed Occupational Therapist working in a public school setting. This year we have been instructed to document our service delivery so the districts can begin Medicaid billing. Some of us have serious
                             reservations about whether Medicaid funds can be accessed by the schools, when Special Education laws stress our services are to be educationally-based, not medical. We question the ethics of this billing as well as
2150   Website Submission    If a person can't produce a tax return, for they have not contributed, they should not share in help that we tax payers support.

2151   Website Submission    Reduce expense by shifting resources towards preventive medicine and the patient centered medical home

2152   Website Submission    Eliminate the burden of regulation and fear of OMIG (whose expansive powers far outreaches due process) on primary care providers; reducing expenses that are then passed on as costs to the consumer and to the state
                             in the case of FQHCs
2153   Website Submission    Streamline payment and reduce third-party reward for holding the government contract. Providers are paid less systemically year over year for providing the same care under Managed Medicaid contracts but state pays
                             more.
2154   Website Submission    If a person is entitled to Medicaid, then they should be fingerprinted by electronic verification and everytime they visit a Physician,Hospital or Pharmacy, they must provide their fingerprint. A follow-up system should
                             thus be connected to these electronic fingerprints and if multiple visits on the same date,same code or perscription at a different facility or Pharmacy occur, this would be a red flag to investigate possible fraud. No cards
2155   Website Submission    OMIG in the Western Regional Office consists of 5 retired state employees that are ""double dipping"" salaries and pensions.
                              2) OMIG and OAG Medicaid Fraud Unit provide duplicative services
2156   Website Submission    The State needs better education on ""The least costly alternative"" to Case Managers, Discharge planners, and ordering clinicians. We see Case Managers telling families that can have equipment and Medicaid will pay
                             for it and they do do not understand the process or whether thet even quailify for the equipment.
2157   Website Submission    Medicaid Re-design in New York should be transparent and should allow regular citizens and consumers of services to have meaningful input that is included in reform results, not simply the ability to give comments
                             on the process. The state should provide multiple ways at multiple levels for consumer involvement and bring New York State into compliance with Title II of the ADA through all recommendations for service delivery



                                                                                                                                                                                                                                                                68
 #                  Author                                                                                                              Proposal
2158   Website Submission    PLEASE include wording, legislation and accountablity that follows up on persons claiming benefits who are employed. As an employer in health care, we hire to fill hours that are always open and available, but soon
                             after hire, claimants request to reduce their hours to Part-time status, so that their earnings for the immediate period before certification or renewal reflect low income. Shortly thereafter, they will accept work as FT or
2159   Website Submission    Choice of services is key. Individuals, as guaranteed under the federal Olmstead Decision, must be given clear and unvarnished information as to all community based services available.The ""pro-forma discharge""
                             from a hospital to a nursing home must end.
2160   Website Submission    One way to reduce costs is to reduce how much we spend on medicines and medical devices. There is a whole cottage industry formed around bilking medicaid and medicare of millions of dollars which under previous
                             administrations, has been legal and ramped. These are the same people who charged the government six hundred dollars for a toilet seat.
2161   Website Submission    The Home Care Association of New York State (HCA) has advanced an 11-point plan that offers concrete, practical and workable policies for reforming and yielding additional cost-savings in New York's home and
                             community based health care system.
2162   Website Submission    Many government programs add to the cost of providing care to New York State residents and thereby raise the reibursement rates for Medicaid patients. In looking to trim costs one needs to look at components that
                             make up those costs and assess whether the programs are effective and efficient in today's market. I am specifically thinking of the CON process which can often take years between concept and fruition and each year
2163   Website Submission    Private Duty Nursing should have a MAXIMUM cap of 16 hrs/day.

2164   Website Submission    Beneficiary's who remain living in a private home OUTSIDE NYS,should not be allowed to continue being NYS Medicaid eligible & receive benefits(ie.private duty nursing).

2165   Website Submission    An immediate family member who is an enrolled Medicaid provider(RN or LPN)should not be allowed to provide private duty nursing to the beneficiary & get paid by Medicaid for it.

2166   Website Submission    A Mediciad appointed physician should attend all Fair Hearings & assist the ALJ in making the FH decision.

2167   Website Submission    Beneficiary's should not be allowed to receive assistance from politicians in order to override a Medicaid decision.

2168   Website Submission    Look at OMIG and determine if it is necessary. Has it saved NY money since its creation or cost us more to maintain it? Why is it that the Attorney General's Office has a unit dedicated to investigating Medicaid fraud,
                             staffed with investigators holding police officer status, and OMIG has a unit staffed with other investigators that have no enforcement status? Why are there two State entities doing essentially the same work?
2169   Website Submission    Look to the 5 states in the union that lead the country in keeping Medicaid costs down and adapt their methods as are practicable. Why reinvent the wheel?

2170   Website Submission    OMIG's Counsel's Office spends time going after Medicaid authorized practitioners of all stripes for sloppy bookkeeping. While this may uncover more savings, is it worth the money to conduct hearings to sanction the
                             practitioners for keeping sloppy records? State auditors should be empowered to review and assess penalties where necessary and appropriate, not for pointless technicalities (ex., one doctor signing off on authorized
2171   Website Submission    5% Reduction in fees for drugs. The payout is nearly at 20O% in some cases.

2172   Website Submission    A stricter control on provider dispension of drugs. Most infection will clear up on their especially in children.

2173   Website Submission    Restrict caesarsean sections to only when absolutely necessary.

2174   Website Submission    Renegoiate the managed care maintenance organizations to freeze cost increases for fiscal year 2011

2175   Website Submission    Reduce adult dental services to clinic only visits.

2176   Website Submission    Allow 3% increase in 2012.

2177   Website Submission    Reduce provider benefits by 2% across the board.

2178   Website Submission    Psychiatric care should be a step process. string with initial care by an NP or CSW and then escalated to the more costly Clinical psychologist or psychiatrist for difficult cases.

2179   Website Submission    Streamline the enrollment process of providers.

2180   Website Submission    Separate Community Medicaid resource guidelines from Chronic Care Medicaid. There is no bigger drain on Medicaid than nursing home care. There is no reason for nursing home residents to be able to have
                             $13,800.00 in resources. Ten years ago $14,000.00 would have more than covered two full months of private pay in a nursing home. Since then we have raised the resource allowance from under $4,000.00 (still too



                                                                                                                                                                                                                                                               69
 #                  Author                                                                                                            Proposal
2181   Website Submission    Eliminate school nursing serviced

2182   Website Submission    Eliminate hostile svcs

2183   Website Submission    Track children for obesity and smokers. Penalize sm
                             okers with mandatory co- pays. Private carriers already
2184   Website Submission    Put the brakes on the ratio of administrators to patients.

2185   Website Submission    Delete "do nothing" positions.

2186   Website Submission    Get aggressive in stopping medicaid fraud.

2187   Website Submission    Medicaid should not pay for gastric bypass surgery.

2188   Website Submission    I know I might sound like a crusader, but my office also treats drug addicts from a halfway house. some of these people have fathers that are doctors!!! Why do the hard working taxpayes have to pay to rehab these drug
                             addicts that CHOOSE to use drugs, and ruin their health. This is just a handout, almost a reward for breaking the law.
2189   Website Submission    And I believe that if a person is arrested - for breaking the law- they SHOULD NOT RECEIVE MEDICAID BENEFITS!!!!!!
                             Why is NY state rewarding people who steal, rape, drink, and do drugs??????
2190   Website Submission    Perhaps a medical cap limit that could be flexible if seriously needed but for general care, so many visits per year or up to a certain $ level for each year per person, but not per family.

2191   Website Submission    There needs to be checks and balances on the amount of pain pills prescribed, reason for them and how many people will go to different Drs. to get the same pain pills. It might cost alittle more to set up a system but it
                             would create savings in the long run.
2192   Website Submission    I feel patients on medicaid should not be able to have elective cosmetic procedures such as breast implants unless they are medically necessary after mastectomy.

2193   Website Submission    I also feel the age change to 26 as a rider on parental Ins. plans will make a huge difference. 18-26 year olds throughout NYS were forced to seek Medicaid. My son was actually advised to work less (fewer hours) last
                             year so he could be eligable for Medicaid. That was against everything my husband and I taught him.
2194   Website Submission    Help family members who are willing, to keep loved ones at home by providing services such as aides, PT, OT, transportation, etc. instead of placing elderly people in nursing homes, Help the caregivers who do help
                             elderly loved ones with tax deductions and credits.
2195   Website Submission    The State of New York should publicize and recommend Consumer-Directed Personal Assistance Programs (CDPAPs) for self-directing individuals who require home care assistance.

2196   Website Submission    eliminate all the non-essentials that NY provides.

2197   Website Submission    Change the asset transfer process. Mirror the 15 states without the medically needy program. Or create a law that prevents an individual from transferring funds or specific types of funds past a certain age.

2198   Website Submission    Move all Medicaid recipients into a managed care Medicaid payer. Find a way to make it a benefit for an HMO to administer this benefit. Utilize a case manager to assure benefits are appropriately used.

2199   Website Submission    Assess the current PCA program services. What I observed for years was minimal or no personal care, many housekeeping services only, and a misuse of staff for personal reasons.

2200   Website Submission    End the unique interpretation of the federal abandonment law.

2201   Website Submission    Assure payment for services is the same for all payers for the same service. I worked for three Home Health Agencies one in MD and each one cherry picked case based on who paid more. I saw many times where
                             patients had no choice other than Nursing Home Placement because Medicaid paid less and the revenue margin was narrow
2202   Website Submission    The 2006 report reflects the NYS cost is more than the national figure. What is the breakdown and where are the excess costs? In the last few years national companies in health care show lower costs because overhead
                             costs are less-is that the reason and should state health care delivery systems because private companies nationwide can keep costs lower? For large metropolitan areas, Boston and NYC make sense due to cost of living
2203   Website Submission    Has there been any further development for the analysis and comparative cost benefit analysis for Assisted Living Facilities vs. Skilled Nursing. The population will continue to age with less acute and sub acute costs
                             (modern medicine, shorter length of stay, healthier living) and more custodial care needs. If we could find a way to cover the cost of an ALF currently it seems like only the higher income elderly of those with educated



                                                                                                                                                                                                                                                            70
 #                  Author                                                                                                           Proposal
2204   Website Submission    As stated on a previous point Medicaid PCA hours I personally have seen are excessive and not necessary. My suggestion would be to look at patient specific examples of the same medical and physical profile and
                             determine why the variation in hours. I have also seen where social service and community health personnel are often too busy or short staffed to actually take the time and reduce services-there is no incentive and no
2205   Website Submission    Develop a PPS payment based on clinical and functional indicators to contain costs with an attempt to reduce excessive service, inappropriate service for select patients.

2206   Website Submission    It has been my observation that far too little emphasis is placed on exercise that could make a dramatic change in our patients' lives and prognosis, as well as our state fiscal budget and the amount of money spent on
                             medication. If our patients were, by doctors order, prescribed to exercise 30 minutes a day, even if that meant walking on the lowest setting on a treadmill or around a track for 30 minutes, what a dramatic improvement
2207   Website Submission    If a person has chronic health condition and expensive prescription drugs that they must get on a monthly basis the cost of these drugs should be factored into the monthly qualifing income threshold for medicaid. Many
                             people with high cost prescription drugs and other medical needs would like to work but, because, finding a job with health benefits is hard they can't affored to risk losing their medicaid coverage in order to work at a
2208   Website Submission    The state of Washington has a more cost effective program where people pay low premiums based on their income levels. This allows more flexibility for people with slightly higher income rates to buy into the program
                             making the program reach more people while costing less money to the taxpayers because the reciepients pay at least some premiums. Please take a look at it.
2209   Website Submission    Individuals who receive Medicaid do not get an Explanation of Benefits (EOB) when services are provided. Medicare and private insurance companies provide EOB statements. With Medicaid, a service provider could
                             fraudulently bill for services and the beneficiary wouldn't know.
2210   Website Submission    Shift all costs to New York State to get this beast off the backs of property owners, then just cut it 25%, no exceptions.Also stop people from getting rid of their assets to qualify for nursing homes.

2211   Website Submission    Unleash the medicaid fraud squad.

2212   Website Submission    As former Chairman and member of the NYSDOH Medicaid DUR Board I have seen the system ripped off via fraud and abuse.

2213   Website Submission    My idea for Medicaid Re-Design is directly aimed at cutting fiscal spending. I feel that an increase in RN (Registered Nurse) staffing in N.Y. State agencies, specifically O.P.W.D.D, would be a great ally in regards to
                             cutting spending.
2214   Website Submission    As a medicaid eligibility reviewer for OMH I see a lot of Supplemental Needs Trusts that are established to artificially impoverish clients so that they can obtain both medicaid and SSI while have a trust of any size. I
                             think reform should start with eliminating Supplemental Needs Trusts. The clientele have a safety net, their needs are met through Medicaid and SSI. Why should their assets not be spent down first?
2215   Website Submission    OPWDD habilitation oriented programs have been designed in a highly idealistic way which is premised in the idea of continual training-up of all developmentally disabled persons in OPWDD programs. I suggest that
                             in many cases the effort and expense may be wasted. Perhaps ways could be found to decrease the expenses of constant evaluation, training and record keeping for those consumers who cannot significantly benefit from
2216   Website Submission    funding for fertility drugs. Most insurance plans do not! Why should the taxpayer support this when the person cannot even support themselves! This is crazy! Not only is it wasted spending in medicaid, it contributes
                             to generational dependence on all DSS benefits.
2217   Website Submission    A review of the services offered must be undertaken. If there are services that might be more then basic and necessary services offered these services should be dropped or offered with an enhanced version of medicaid
                             and an associated fee assessed or a deductable charged.
2218   Website Submission    The Social Services offices in each county should be investigated for fraud and corruption. (Orleans County for one)

2219   Website Submission    program where people making more than the Medicaid and Family Health Plus income levels should be implemented where there would be a reasonable monthly payment--let's say $50/month--similar to the Child
                             Health Plus program, but for adults.
2220   Website Submission    Also, having been privy to the dysfunction of the Medicaid system, particularly through the Westchester DSS office when I waited for months to access health insurance for my then newborn son, I think that the state
                             should completely overhaul the county implementation of the program and provide a framework for the county offices to do what their employees are paid decent money to do which is, of course, to assist in the access
2221   Website Submission    One area worth doing is to reauthorize the use of IDA financing for health facilities but WITHOUT requiring prevailing wages. The prevailing wage requirement would add cost to the projects which ultimately is
                             passed on to payors including Medicaid. Another area which while it does not necessarily reduce Medicaid costs would reduce provider costs. We have to have a separate cost report audit performed for our adult day
2222   Website Submission    One issue that was brought to my attention regarding medicaid is the placement of individuals in nursing homes by family members who live in another state. New York state is a dumbing ground for nursing home
                             placement by individuals who are protecting their personal assets.
2223   Website Submission    All medical providers should be required to accept Medicaid. The sooner anyone receives proper medical care the better. Waiting, being on a list, driving far, none of that promotes better health. And yes, there's the
                             cost. Medical providers that I know all have the same complaint, no repayment. They fill out endless forms and occasionally, if ever, receive reimbursement. Can't say I would work for free, either. So the gap is between
2224   Website Submission    perhaps each year a recipient is on Medicaid, their out of pocket cost should go up

2225   Website Submission    NYS should no longer support nonfunded and underfunded Federal mandates

2226   Website Submission    Medicaid Waiver programs for children with mental health needs have associated flexible spending funds available for each child up to $2500. This is too much money that often is used on non-essential items for the
                             child and family. Better to reduce amount per family to $1500 or less.



                                                                                                                                                                                                                                                           71
 #                  Author                                                                                                            Proposal
2227   Website Submission    Medicaid recipients should be offered free or low-cost preventive procedures such as gastric bypass and lap band surgery to manage obesity-related health issues, and tubal ligation and/or vasectomy to manage
                             unplanned pregnancies.
2228   Website Submission    The HCBS waiver administered by OPWDD enrolls many children under the age of 18, and as a result they receive Medicaid regardless of parental income. I believe traditional health insurance plans should take the
                             burden off of Medicaid and begin to cover therapies and supports for the children.
2229   Website Submission    Means testing is another option that is not used when approving services for individuals. If families have the ability to contribute to the cost the supports and services they should. It will also make them more
                             appreciative of the service system. I don't believe families served by OPWDD even know how much their services cost. If they knew how much MSC, home modifications, community habilitation, day and residential
2230   Website Submission    1st nys spents too much $ on managed care managed care should be used on those that are chronically ill receive mental health tx. Those that go to the drs just for physicals which is infrequent then regular medicaid
                             should suffice. Medicaid should pay drs prevailing rates that way it would be more widely accepted.
2231   Website Submission    Pay private duty nurses who work as medicaid direct and bill as independent contractors less than the rate agencies can bill. These nurses work without backup, supervision, or credentialing, all of which agencies do for
                             the same hourly rate. Pay these nurses at least 25% less and money will be saved and fraud will be substantially reduced.
2232   Website Submission    In the Claim / billing structure, please consider eliminating the Medicaid Rate Codes.
                             Other payers don't use these. Can't payment/billing be done without these?
2233   Website Submission    I would like to suggest the state to combine all clinic certification under one entity. Which means DOH article 28, OMH article 31, OASAS article 32, and OPWDD article 16 will have a universal CON or PAR process
                             and licensure. this will accomplish a number of savings as well as better oversight and better patient care and will help the state to move to the medical home model. for example a DOH article 28 under the current
2234   Website Submission    eliminate paid bed hold in nursing homes. Currently medicaid pays 95% of the daily rate to hold a bed while someone is in the hospital...so in essence, our tax dollars pay for an empty room.

2235   Website Submission    Since 2004, more than $840 million in Federal, State and private sector funding has been spent on health information technology and health information exchange to improve the effectiveness and efficiency of health
                             care delivery in New York State.
2236   Website Submission    You need to be more pro-active for those committing fraud. Hire more investigators, and go after those that are using the system illegally. When you have someone that is already collecting SSD, has a husband who is
                             collecting SS, and a pension, and can afford to buy two new cars, and whatever extra's they want for pleasure, and still get Medicaid, the system is definitely not working. There are people that really need the help from
2237   Website Submission    Medicaid should not pay for nursing home stays in which the individual refuses to pay their portion ( medicaid determines how much na individual should pay towards their nursing home stay...usually the pension and
                             social security)
2238   Website Submission    Examine each incremental liberalization step and reverse each. For instance now applicants are not required to personally apply. Return to require personal applications.

2239   Website Submission    The only way to redesign is to get rid of the Welfare management system (WMS)and start over with a system that is the same Statewide,no separate system for NYC. Make eligibility rules simpler. Managed Care
                             should not be a separate Bureau. It could either be joined with Medicaid or State Insurance. Managed care does not cover all services that Medicaid covers. It should,but special lobby interests have carved it all up.
2240   Website Submission    Simply stated, we need to keep people out of the hospital. We also need to keep people out of nursing homes. For vulnerable patients, like the folks I care for here in the Bronx -- patients with HIV/AIDS, substance
                             abuse, and mental health issues -- this means shifting resources to the outpatient arena. New York is #6 nationally per enrollee in hospital services and #6 nationally per enrollee in institutional long term care spending
2241   Website Submission    The Medicaid costs related to hospice services in hospitals and nursing homes are high and the service is redundant if proper palliative care planning is performed. This is an area that should be examined for cost
                             savings.
2242   Website Submission    Bundled payments especially in the long term space is the most effective way to go. For example, JAMA just cited that Programs such as the Program for All Inclusive Care for the Elderly (PACE) is the best method of
                             providing care and managing costs. Personal care services are being overutilized and abused. And I'm very disappointed no one from the largest PACE insurance provider in New York is sitting on this
2243   Website Submission    Add a look back for home care

2244   Website Submission    Increase the look back for nursing home care to five years

2245   Website Submission    I have been a registered nurse for 33 years. Stop paying for canes, crutches & walkers! Many people have them gathering dust in their homes. They're frequently thrown away & aren't resold ?because "you can just get a
                             brand new one." Nursing homes are full of them.?
2246   Website Submission    Use a "go green " approach. These are items that should be reused & recycled. Encourage donations to community loan closets, VA, orthopedic clinics or churches.?

2247   Website Submission    Having had a aged mother who was on Medicaid for a number of years it angered me that she would only uses brand name drugs & not the generic. Her reason. She & most of her aged friends used brand named drugs
                             They were ALWAYS the same color and/or shape. Generic are not. My mother & her friends with their poor eye sight were afraid they would mix their drugs if they were generic, besides it did not cost any more for the
2248   Website Submission    make medicaid benefits available o n their benefit cards on a weekly or bi monthly basis so that they cannot accesss their entire month's allowance on the first of the month and have it gone by the third of the month.
                             More closely control how it is spent. Cash spitting out of an ATM is just plain ridiculous for people who can't handle cash in the first place and are addicted to drugs and alcohol. Make them work in some way to earn
2249   Website Submission    I work in the Medicaid business. I believe that you should not allow spousal refusals. Allowing people to hide/protect thousands, millions of dollars is not appropriate. A lot of the rules hurt the poor and cater to the
                             rich. I think that if you have the money you should have to pay. I know that we refer the refusals to legal but most of them aren't dealt with. They say the legal costs are more than the monies but if you add it all up on



                                                                                                                                                                                                                                                             72
 #                  Author                                                                                                             Proposal
2250   Website Submission    Hold administrators accountable so nurses who are documented as being assigned to a ward are actually working on a ward.

2251   Website Submission    Your medicaid is being abused and ripped off. King Edward walked through his troops disguised as one of them to figure out what the moral of the troops were.
                             This is how we should do it. Anonymous scouts should be sent to all areas of the government and hospitols to obtain the ways in which waste and fraud can be address. If you go into emergency rooms most people can't
2252   Website Submission    one idea for medicaid redesign is to ELIMINATE the new attestation standard for recertification- proof of income should be mandatory

2253   Website Submission    the state must bring back resource standards to determine medicaid eligibility. there are MANY recipients who possess a lot of money- attest to very little; and maintain extremely large assets (which should be used to
                             purchase their own health insurance
2254   Website Submission    eliminate the recent nassau county medicaid standard of limiting recertification every 2 years (which provides free medical care regardless of an individual's change in income).

2255   Website Submission    andate that facilitated enrollers who knowingly misstate/misrepresent an applicant's income/earnings must face immediate dismissal. as long as fe's process applications on a 'commission' basis- they will greatly increase
                             the workload of medicaid workers- by submitting numerous applications for the same hh. adding one person at a time
2256   Website Submission    change the current budgeting standard which allows people to live as a family (with children in common); but have one adult state that they 'receive room/board' from the other- rather than have the income count for
                             ALL under the same roof.
2257   Website Submission    I am a medical social worker with 20+ yrs experience in hospitals, homecare, nursing homes and 2 HMO's (CDPHP/Senior Whole Health). For beginners, let's ask why we have so many Medicaid enrollees, dual
                             eligibles, enrolled in Medicare B and D but not Part A? Why is Medicaid stuck with the tab for Part A? Let's discuss family care homes, encourage people to open their homes to care for the infirm and disabled with
2258   Website Submission    As a licensed optician, I receive numerous phone calls per week looking for Medicaid eye care providers, both for examinations and theraputic eyewear. I believe an eye examination should be available to anyone age 5
                             and above every two years. I think that the ability of providers to opt out of providing puts a burden on those providers who do not opt out! I feel that making the provision of care mandatory to all providers is
2259   Website Submission    Transportation to physicians office has to be limited distance.

2260   Website Submission    Tort reform!

2261   Website Submission    Remove all the people selling Hydrocodone and other controlled meds at taxpayers expense and their profit.

2262   Website Submission    ave new recipients go through a back ground check-it poses a cost but surely will pay for itself in the long run.

2263   Website Submission    Remove the following from the residency requirement: ""except that during the first 12 months in the state, a person who is otherwise eligible, shall receive benefits which do not exceed the higher of 50% of the amount
                             otherwise payable or the standard of need applicable to the person under the laws of the state in which he or she resided immediately prior to arrival in New York""
2264   Website Submission    Services for the developmentally disabled in OPWDD should not cost approximately $200,000 per resident. Services should be bill on what is needed and not an agency funding stream. ICF's are converted to IRA's to
                             jack up funding for agencies. What are the benefits to individuals. This is completely ludicrous. I'm not entering identifying information, to protect myself from repercussions.
2265   Website Submission    There is an urgent need to do a complete audit of those receiving benefits from the state. If a person is no longer eligible, they should be removed from the system and more comprehensive measures should be taken to
                             investigate welfare recipiants who may not deserve funds.
2266   Website Submission    I think one of the quickest and meaningful ways to save Medicaid dollars would be by re-designing the pharmacy benefit. Currently, a Medicaid recipient has access to any drug that the physician prescribes. There is
                             currently a Preferred Drug List that has no ""teeth"". If a doctor simply calls and asks for a more expensive drug, that is likely identical to a cheaper generic drug, the patient can get that drug.
2267   Website Submission    I still don't understand why NYC HRA is the only Local DSS that does not submit cost reports. No matter what the payment mechanism is, cost reports do break down information about individual companies that
                             benefit analysis and may help identify issues that need to be addressed.
2268   Website Submission    Please fix the Office of the Medicaid Inspector General. Here are some questions you might ask that could help you make decisions about how to address some of the issues at OMIG

2269   Website Submission    ere are some thoughts about the Office of the Medicaid Inspector General to consider in your redesigning Medicaid.
                             * OMIG is required by law to issue compliance guidance to Medicaid providers to help the providers comply with their Medicaid obligations. How many compliance guidances has OMIG issued during Mr. Sheehan?s
2270   Website Submission    I think that actions against Medicaid fraud should be part of Medicaid redesign. I think we should consider requiring ""positive ID"" of all Medicaid recipients, for example requiring fingerprint ID in order to receive
                             benefits. However, I realize that might be politically unacceptable. At a minimum NYS should require photo ID, and auditors should include facial recognition software as one of the tools they use to uncover fraud.
2271   Website Submission    hank you for inviting New Yorkers to share ideas on helping New York thrive. I was inspired by The Center on Budget and Policy Priorities and the Reamer Reports (Putting America to Work ? 10/10) and would like
                             to share the following thoughts.
2272   Website Submission    Eliminate levels and levels and levels of management. Train supervisors to supervise and be no nonsense with employees who don't do their jobs. End the practice of sending poor employees to another location.
                             Eliminate retirement benefits for anyone who commits faud, embezzles or otherwise commmits a crime against the state.



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 #                  Author                                                                                                            Proposal
2273   Website Submission    I would like to make a clarification on my submission regarding Medicaid Service Coordination. My statement that people could be excluded was generic not specific to MSC. People are not having that experience in
                             that program. My statements regarding MSC are hoped to enhance the program for it's participants and providers. Thank you.
2274   Website Submission    The other thing is that by keeping our Son home and cared for by trained caregivers it keeps him healthier and happier. Therefore less Medicaid dollars wasted on health problems. It is also a known fact that it is cheaper
                             to keep our son home than putting him in a group home and putting the burden on the tax payer.
2275   Website Submission    We have seven young adults with varying disabilities who live in our Independence Houses. They are very happy living in an environment that is not otherwise available in this area. They use the medicaid funded
                             consumer directed aide program for their aide care. Currently under this program, they are required to have a meeting every 6 months with a case manager and a nurse. We suggest that if their medical condition is stable
2276   Website Submission    A specific case of medicaid dollars not being used wisely is this - a disabled individual who owns his own vehicle and wishes to take himself to a therapy appointment 3 times per week was told they could not have
                             consumer directed aide care for the transport to therapy. So rather than paying an aide $11.00 per hour for three hours a week - medicaid pays $150 per medicaid transport three times per week. $33 versus $450.
2277   Website Submission    DME - Durable Medical Equipment - there are literally hundreds of stories that I could tell you of how medicaid forces families to "trial" and purchase equipment that they don't want and isn't beneficial - only so that
                             they can rule out things on the medicaid list - families with special needs children and young adults have a hard enough time caring for their children each day - they don't need a battle each and every time they need
2278   Website Submission    irst I'd like to say... it's about time! I'm a mother of a child with cerebral palsy. He is part of the ""care-at-home"" program which has been great. One area that needs addressing is how the private duty nurses are paid.
                             I have two nurses who cover up to 55 hours per week (much less when he is in school) but the problem is, I have no way of knowing what these nurses submit for hours worked. I trust my nurses but I'm sure there are
2279   Website Submission    How about computerizing the medicaid renewal form... I understand that not everyone has a computer, but a lot of us do…

2280   Website Submission    re we unnecessarily providing Medicaid benefits to employees of companies, such as WalMart, who are not providing insurance benefits to their employees? In our area, I have heard that WalMart does not provide all
                             of its employees with benefits, and these employees are seeking Medicaid benefits. I believe that large companies should be held accountable to provide insurance for their employees, especially when these companies
2281   Website Submission    Send a letter to every Medicaid recipient, with a postage paid return envelope, asking them to re-affirm their (and dependents) enrollment. Medicaid enrollment is full of duplicates and enrollments that have been
                             perversely incentivized. This is especially important for recipients in managed care. Vulnerable population could be excluded from the mailing.
2282   Website Submission    Improve DSS website functionality to enable members to change their contact information directly. Incorrect address information seriously impairs ability of health plans to provide information, case management, assist
                             in maintaining membership status, etc. The "churn" negatively impacts continuity of care.
2283   Website Submission    nvestigate why NYS is not utilizing Section 1011 funds (TrailBlazer/High Mark) for Emergency Room services provided to undocumented aliens. Annually for several years, tens of millions of federal dollars have been
                             untapped.
2284   Website Submission    With the Berger Commission requiring closure of hospitals due in part to unused inpatient beds, investigate use of these closed wings/facilities as office space for primary care physicians. Investigate incentives or
                             subsidies for facilities to convert the space. This space could be leased (to generate revenue) at a lower rate than a stand-alone office, and could have access to computer server resources (secure shared areas) and
2285   Website Submission    Investigate having Western New York declared as a federally-designated medically-underserved area. Federal funds to provide PCP incentives might encourage general/family practice access growth to offset the
                             increase in specialists, who do not provide comprehensive member assessment or care.
2286   Website Submission    would suggest that all residents of a group home be under one medical umbrella and a nurse or doctor visit the home once a week to check on the residents. This doesn't mean they shouldn't be sent to the doctor if they
                             are sick just normal checkup on their health. Also a graet deal of cost savings could be realized if activities and programs be held at the group home instead of transporting the residents all over. I don't think this is a
2287   Website Submission    My concern is with long term care- There are those currently in nursing homes who do not need to be there on a long term basis or are able to come home much sooner. Such persons could return to their own homes
                             with the proper support services, such as Home Health Care, Case Management, Care Coordination and therapies such as Occupational, Physical and Speech therapy.
2288   Website Submission    the way the medicaid program is set up makes absolutely no sense. There are too many levels of eligiblity. There is an awful lot of money spent on determining eligiblity. Health insurance should be paid for by a tax
                             deduction that is taken equally as a flat percentage from all. I can't figure out how it all got so complicated
2289   Website Submission    It would be prudent for Medicaid to allow dually eligible patients to obtain 3 month supply of routine daily meds as most insurers allow participants to obtain a 3 month supply of meds by mail but only pay 2 monthly
                             co-pay instead of 3 this change would in itself safe a lot of money to Medicaid
2290   Website Submission    I think that ambulance companies should be mandated to do some triage, and take people with primary care needs to these hospital-based primary care clinics, or to off-site emergent care centers, or to telemed sites.

2291   Website Submission    rimary care providers might also be given a slightly higher rate for seeing Medicaid patients after 5:00 and on weekends, so that they start providing services at times when the working poor can receive them.

2292   Website Submission    Telemed sites providing links to primary care providers after 5:00 and on weekends should also be encouraged, as this seems a low-cost alternative, relative to the ED.

2293   Website Submission    I would like the medicaid program to stop funding the refugee resettlement program sponsored by the catholic family center. Why are refugees being brought to our region and we the community must pay for this. We
                             cannot take care of own people yet we are required to pay and house people from other countries that are taking our resources?? Catholic family center brings refugees from all over and marches them right down to the
2294   Website Submission    consider advising the FDA and NIH to move a focus to low-cost, high-value medical equipment, drugs, and methods, in place of ""gee whiz"" expensive solutions that push high cost health care. The FDA, largely
                             staffed by experts in the existing medical methods, may slow progress in higher value methods, equipment, and drugs due to numerous reasons (this can be seen by reading the FDA documents pertaining to equipment
2295   Website Submission    Please consider enacting any willing provider rules for all health insurance transactions, including managed care organizations. This will eliminate administrative expense caused by duplicated credential reviews. It will
                             increase choice by lowering barriers to small practices being formed, and simplify access in under served areas. It will also lower emergency room costs by eliminating primary care gatekeepers.



                                                                                                                                                                                                                                                              74
 #                  Author                                                                                                              Proposal
2296   Website Submission    Having worked as a Medicaid Service Coordinator for NY state since the inception of HCBS Waiver, I have two suggestions regarding the State Medicaid portion regarding services for persons who are developmentally
                             disabled:
2297   Website Submission    I suggest that there be more staff on the phones and in the office to make the process faster.

2298   Website Submission    Establish deemed status and streamlined survey process for high performers. Deploy Department of Health survey team members to focus on the low performing facilities.

2299   Website Submission    With multiple state and local agencies involved in administering senior living and services, a lack of coordination of efforts contributes to duplication, inconsistency of treatment and lack of responsiveness for service
                             recipients and providers. The state has created roadblocks to expanding existing creative models and developing new models and service combinations. For example, ALP providers must comply with three sets of laws
2300   Website Submission    The state should revisit the process by which regulations are developed and promulgated in the state.
                             Instrumentalism, unfunded mandates, conflict/duplication and requirements imposed outside of regulations often characterize the regulatory process. There needs to be more thorough assessments of benefits versus
2301   Website Submission    The state should seek federal approval to provide spousal impoverishment protections to community spouses of home- and community-based services recipients in concert with curbing the use of &#8213;spousal
                             refusal.
2302   Website Submission    The state should prioritize takeover of Medicaid eligibility determination and service authorization activities as part of its five-year plan to assume Medicaid administrative responsibilities from local governments.
                             Millions of dollars could be saved by eliminating duplicative Medicaid administrative bureaucracies among state and local governments.
2303   Website Submission    It appears that the OMIG's findings from clerical and administrative errors lead to extrapolation of 10% of an agency's annual Medicaid billing. Why not give agencies the option of just paying out 10% of their annual
                             income in a one-shot deal? You could reduce the work of the OMIG's staff significantly, and therefore the number of state workers under the wing of the OMIG. Further, you could mandate a 10% payback and
2304   Website Submission    Medication Theraphy Management program. These programs are designed to review a patients total medication therapy, make suggestions or if necessary intervene on the patients behalf with their doctors. MTM
                             programs are known to reduce emergency room visits and inpatient hospital admissions.All Medicaid recipients receiving a pharmacy benefit must be required to participate in the MTM program
2305   Website Submission    Initial fill edits. When processing a first time fill of a drug require that no more then 30 days of the drug be dispensed on the initial fill. This reduces the amount of drug disgarded if the patient has ill effects from the
                             drug.
2306   Website Submission    Set time parameter of 1 year from the date the prescription is written that would allow drugs to be dispensed under that prescription. This would require the patient to see their doctor so that the need for the prescription
                             can be validated by the doctor.
2307   Website Submission    Consider a separate, yet complementary point of entry for MA recipients. A site which would provide a lower level of care and convenient access for health guidance, assessment, referral, and triage as needed to a
                             higher level of patient care. This resource should be made easily accessible to the Medicaid population and in their own neighborhoods embedded within standing trusted non-medical community based organizations.
2308   Website Submission    Accessible housing and a well running waiver program which includes a statewide communication program is essential. Currently, the communications are not clear and consistent. The regs and are not being interpreted
                             consistently across thse state. A possible way to eleviate this problem would be to have DOH administer the programs rather than contract out the Regional Resource Development Centers. Our RRDC center currently
2309   Website Submission    Pay for results, not for volume, or location. New York State pays rates for services that are not reflective of results, but rather are reflective of geography and costs. Where is the profit motive, or efficiency driver in that
                             model?
2310   Website Submission    As IT Director I get to work with data and what I have found is that CDPAP (Consumer Directed) uses only about 70% of the services authorized by the county. (Monroe) This is probably an overlooked statistic. While
                             many might try to make you think that consumers will want to maximize their hours, in fact the opposite is true. Proof is in the data. If these same services were provided by an agency rather than by the consumer, I am
2311   Website Submission    e are my ideas for reducing Medicaid's nursing home costs:
                             1) We need to have nursing home facilities with a range of cost and benefit levels. At the lowest level of cost with a barebones level of amenities would be Medicaid facilities. These facilities would be free for
2312   Website Submission    2)with the above system, since more individuals will be paying for their own care, a) they will have an incentive to find lower cost providers, and b) providers will have an incentive to keep their costs down so that they
                             could compete to attract more residents.
2313   Website Submission    As a provider of Medicate services I have a grave concern about the amount of funding given out by medicate in an agency located in Utica NY. They bill hundreds and thousands of dollars more than they should for
                             service that are being utilized by a population that is difficult to serve but not as difficult as the developmentally delayed or handicapped.
2314   Website Submission    Another example is Kids Oneida Service Coordinators get between 35,000.00 and 50,000.00 a year to provide only 7-9 case at a time where OPWDD has each Service Coordinator serving over 35 cases for an average
                             pay of between 25 and 35 thousand a year. How is it we are laying service coordinators off in the state and we keep paying with the Medicaid dollars to Kids Oneida for services that are being overpaid.
2315   Website Submission    Individuals that reside in community DDSO homes have primary physicians? in the community. These physicians fill out a consultation form after each visit and we are mandated to follow the recommendations. Often
                             the recommendation is for a 3 month follow up with the physician, despite the fact that the patient does not have any active disease or medical issues that the team feels require such intensive recall. Additionally many
2316   Website Submission    Is there any reason the hospitals couldnt set up a program
                             > at the er , like a clinic . they could register as usual but
2317   Website Submission    Many churches sponsor immigrants mainly from African states and the newcomers have no money,jobs,training,education,means of subsistence. After 3-4 moths they are transferred to medicaid.Churches should be
                             forced to support any such people until they are independently capable of their own health care, food, shelter etc.Second comment: we allow unregulated illegal and legal immigration of people without means for health
2318   Website Submission    WHEN I BRING MY KIDS TO A MEDICAID DENTIST, CURRENTLY THEY CAN ONLY TAKE CARE OF ONE CAVITY PER APPOINTMENT. WHY CANT THEY HAVE ALL CAVITIES DONE IN
                             ONE APPOINTMENT?



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 #                  Author                                                                                                              Proposal
2319   Website Submission    One quick example regards equipment. I use a special boot to prevent contractures. Medicaid allows up to $710.00 per pair of these boots. I have ordered the very same pair of boots through both a medical vendor and a
                             drug store. The medical vendor knowing the maximum allowance charged $710.00. After the first pair of boots wore out the drugstore replaced that very same Invacare boot for $160.00 a pair. It sickens me that such
2320   Website Submission    Another quick example is Medicaid required mandatory nursing visits. I am a medically stable individual that lives at home. Just like anyone else if I feel ill I can call my Doctor, contact my case Nurse, or go to the
                             Hospital. Yet Medicaid REQUIRES that I have Monthly Nursing Visits and 3 Recertification Nursing Visits per Year. EACH Nursing Visits cost $160.00. That is $2,400.00 worth of nursing visits for no other reason
2321   Website Submission    The Medicaid Redesign Team should review the Washington Health Technology Assessment (HTA). HTA allows State governments to ensure health care programs are paying for drugs, medical devices, diagnostics,
                             and surgical procedures that are safe and effective, as shown by evidence-based reviews. Washington is conducting its own HTA reviews--using existing analyses--and using the results to make coverage and
2322   Website Submission    Hire more nurse-practioners to coordinate the care of consumers in State-operated houses for the developmentally disabled who have multiple medical conditions, particularly those who are elderly, and have multiple
                             chronic conditions such as diabetes, hypertension, and heart disease. For consumers who fit into this category, coordination of care by a nurse-practitioner will (in most cases) result in reduced Medicaid payouts for
2323   Website Submission    liminate the Medicaid program and all the thousands of positions within the current systems massive paper pushing agencies and instead .. build medical facilities \ campuses for use by only those without health
                             insurance & \ or persons with a yearly income below a certain amt. Proof of income & dependent info. could be easily obtainable online via NYS Dept. of Taxation & Finance. Create these campuses throughout NY
2324   Website Submission    Right sizing" means consolidating Medicaid fraud investigation units. One could combine OMIG, OSC Medicaid Fraud Unit, Attorney General s unit, Department of Health, SUNY Research, and SUNY Buffalo
                             consultants into one entity to eliminate the overlap. Has anyone done a study to see which organization has recouped the most money? What is the cost ratio for FTE's/dollar cost recouped by organization? What has
2325   Website Submission    AS co-chair of the OPWDD Task Force on Special Dentistry (all voluntary members) for the past two years, we have been dealing with a MA redesign called Ambulatory Patient Groups (APGs). This change greatly
                             endangered the provision of dental care for people with developmental disablities who need to go to the hospital operating rooom (OR) for regular dental care. Three hospitals stopped their OR programs and one
2326   Website Submission    It would be helpful to have periodic (perhaps every two years) reevaluation of patients (physical and mental health) to see if their situation has changed. If someone can not work, could they have some requirement to
                             volunteer a minimum amount of time to the community?
2327   Website Submission    If someone is in repeated substance abuse programs, should there be a limit to benefits if the person does not work or volunteer in the community?

2328   Website Submission    almost every criminal brought into the erie county correctional facility has more than one medicaid card, many more than one in most cases, and nothing is done about it, the sheriffs even give the cards back to them
                             when they leave jail, take some of that stimulus money and investigate and punish the abusers of this necessary system we have.
2329   Website Submission    Means testing for benefits. Everyone must contribute to and subsidize the benefits they receive -- regardless of income! Of course, those calculations should be on a sliding scale. This is a standard expectation in
                             numerous other states.
2330   Website Submission    ligibility must be consistent across states. NY is much too lenient and fails to pursue due diligence in assuring that only the truly eligible are enrolled. The inbound travelers passing the taxpayers leaving the state, are
                             people denied Medicaid in other states who know they can come here to enroll in 100% state supported benefits they could not receive anywhere else. You don't even have to be a citizen of the US to enroll. That's a
2331   Website Submission    All Fair Hearing decisions based merely on a history of service rather than an accurate assessment of current needs and measures of eligibility must be immediately vacated. Hearing Officers must be instructed to
                             dismiss past service history and only evaluate current status. Failed hearing decisions only result in lifelong funding commitment that deprives supports to those who genuinely need it.
2332   Website Submission    Provisional enrollments must be based on conditions and evidence that the individual will need long term supports. Today, provisional enrollments are a false mechanism for obtaining a Medicaid Card.

2333   Website Submission    Audit decisions must determine if a service was provided not calculate disallowances because a provider initialed a document when they should have signed their full name. Rational auditing rightfully penalizes
                             fraudulent claims. Irrational auditing needlessly punishes providers and depletes the resources needed to continue quality care.
2334   Website Submission    increase criteria the state and county pays for the purchase of hoverounds...every where you go you see young people riding around in them. if many of them did a little excercise they would be far better off. it's ironic
                             that these hoverounds are encouraged and i even received a post card letting me know that the government would pay for it. I understand that they cost about 12,000 each and a few weeks ago there must have been 8
2335   Website Submission    Reviews for chronic nursing changed from 6 mths to 1 year review and authorization.

2336   Website Submission    My name is Michelle and I am an OTR with 26 years experience in various settings including sub-acute care, acute care, rehab settings, early intervention, state and public settings serving the needs of individuals with
                             developmental disabilities. I currently work for an ARC as an OT for the agency?s article 16 clinic.
2337   Website Submission    Coverage Criteria
                             The beneficiary ?has not refused therapy.?- This is too abstract. Does this mean one time refusal then discharge? Can they refuse if they are sick? It needs to be more concrete- like the Medicare Three Strike Rule.
2338   Website Submission    ?Rehab Cycle:?
                             Again, using Medicare as a model for change in the right direction for the NY state Medicaid system our current therapy service delivery should evolve to a Rehab Cycle. The criterion has to be overhauled and it needs
2339   Website Submission    Day Hab Sites and other programs:
                             The criteria for activity in these programs have to be more ?active? in nature. Passive activities have to be discouraged and stopped as it is more of a babysitting service versus a place and structure to address needs and
2340   Website Submission    Wheelchairs
                             I work with individuals that I am constantly working on wheelchair justifications and wheelchair parts. I began working with wheelchairs 15 years ago and the quality of the goods being provided has gone down! The
2341   Website Submission    Early Intervention:
                             I also for a number of years was a provider for Early Intervention services. The provision of services at that level, and what I seen in the homes of these children tortured me to the point where I no longer work with this



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 #                  Author                                                                                                            Proposal
2342   Website Submission    With regard to Access A Ride. As a psychiatric social worker, I have come across several clients who have Access A Ride services but cannot afford the $5 round trip fee for transportation to mental health services-
                             sometimes 3-4 days/week. If they were able to use public transportation and had Medicaid, they would be eligible for Metro cards for transportation. Some then chose to use ambulette services, covered by Medicaid,
2343   Website Submission    Auditing of vendors that provide large quantitites of DME products. No oversight leads to incorrect charges.

2344   Website Submission    Require all vendors to use the same forms and utizlize invoice numbers.

2345   Website Submission    Require data submission from all state agencies requesting reimbursement.

2346   Website Submission    Require vendors to provide Explanation of Benefits paid by all parties to the final payer. (no exceptions)

2347   Website Submission    Provide auditing for all vendors, etc. on a yearly basis and not just when someone reports fraud, waste, etc.

2348   Website Submission    Improve your whistleblower law. Retaliation of any form is a deterrent to filing a complaint.

2349   Website Submission    Require all companies that are the medicaid provider to report ALL fraud complaints, in writing, to the state agency overseeing Medicaid benefits.

2350   Website Submission    Eliminate the outdated bed need methodology for nursing home beds.
                             - Set threshold levels for ""CURRENT"" occupancy levels (%) by county before allowing additional nursing home beds/units. For example, do not allow additional beds in a county if its occupancy rate is below 95%.
2351   Website Submission    Medicaid was originally intended to be a federal program, organized and funded by the federal government at the federal level. The best solution to the current problems of the program is to return to the original plan
                             proposed by the Kennedy Administration in the early 1960's, and fund the entire program at the federal level.
2352   Website Submission    I am in the Fmaily Care program in the Central New York DDSO. I have four individuals that are in my program that use taxi services to get to and from employment, which supports theie residential habilitation goals
                             as part of their Medicaid services. These individuals have worked for many years, and the State of NY pays for thier taxi service to and from work, while the individual;s pay nothing into their transporation. In one
2353   Website Submission    It has come to my attention that students that attend the public school school system in NYS who have an Individualed Education Plan (IEP)are required to have a counseling component in school as part of that plan.
                             The social workers in these shools are employees of these schools and furnish this service as part of the regulations that school districts are required to follow.
2354   Website Submission    Recommendation #1: Yearly cap on adult dental services at a specific dollar amount. This would be similar to specific benefits amounts allotted by private insurance carriers. This idea would allow eligible patients to
                             have needed services performed, keep patients out of pain and provide basic chewing function.
2355   Website Submission    Recommmendation #2: Limit services such as periodontal therapy (scaling/root planing), bicuspid endodontics, bicuspid crowns and metal-based partial dentures. Some of these services could be either limited or
                             removed entirely to help with fiscal woes. There are cheaper options to all services listed above.
2356   Website Submission    Redesign the Reimbursement system for inpatient care.
                             Potential savings are:
2357   Website Submission    I suggest we move community-based behavioral healthcare from a fee-for-service to a capitated model. Counties would receive a capitated payment for each Medicaid recipent, and in turn would manage their care.
                             Regulations would move from facility and costly documentation of care requirements, to measures of accessibility and outcome. Innovation and effectiveness would be rewarded.
2358   Website Submission    To increase efficiancy in enrollement and reduce cost linkgae within government agencies should be able to be done with a presentation of a social security number. Person comes in for medicaid application all they
                             would need to do is present social security number and confirmation of address. A network connected to the social with New York City tax, New York State, and federal Taxation. The person would not need to bring in
2359   Website Submission    I think that it is high time that OPWDD and OMH and possibly
                             OASAS are rejoined. Scant resources can be maximized,redundant administration can be consolidated and the agencies can discontinue the practice of attempting to push the needs of the consumers back and forth
2360   Website Submission    I've had a concern since my mother signed up for medicare/medicaid that, despite my attempts to resolve it at the time, was never cleared up to my satisfaction. I believe it is an abuse of the system, perhaps taking
                             advantage of a loophole, that increases the cost.
2361   Website Submission    Site-specific CFR reporting - OPWDD reports all sites for a single program type in a single column (except for IRAs , which use 2 columns to split IRA and Res Hab costs). This makes it impossible to look for
                             problems on a site-specific basis. It also makes it very difficult to create appropriate cost screens. All reporting should be site-specific, as it was formerly.
2362   Website Submission    Move OPWDD Waiver Programs to Cost Based Rates - OPWDD still, even after nearly 20 years, uses budget-based rates for waiver services. This allows many programs to be reimbursed above cost on a perpetual
                             basis.
2363   Website Submission    In-house architectural and engineering reviews of new OPWDD facilities - The current reviews are severely limited and do not address the scope of work or the cost. The limited number staff performing this function
                             should be expanded. Many inappropriate or inefficient building and projects have been approved.
2364   Website Submission    OPWDD should primarily do new construction, not acquisition/rehab - Acquisition renovation project end up being more costly for the final product. Homes costing several hundred thousand dollars are purchased
                             and then hundreds of thousands of dollars are poured into renovations.



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 #                  Author                                                                                                            Proposal
2365   Website Submission    OPWDD should increase bed size - 3 and 4 bed homes are inefficient to construct and staff and provide limited socialization opportunities.

2366   Website Submission    Mental hygiene clinic visit thresholds - There should be a lower annual per patient visit threshold (still well above average) over which reimbursement is reduced for visits by 25% and a higher threshold over which
                             reimbursement is reduced by 50%.
2367   Website Submission    Targeted investigations of high utilization providers - The OMIG should investigate all behavioral health providers that have utilization well above the norm.

2368   Website Submission    We have a program at our long term care facility, I believe it is called Family Choice, where these insureds have a Nurse Practioner that is assigned to them. When the resident has a non-life threatening medical problem,
                             the NP comes to see them in our facility. This has dramatically reduced hospital admissions, decreasing costs to the system as well as keeping our elders in a familiar environment. Expanding these types of programs
2369   Website Submission    Increase use of technology! Use NYC's electronic processing of medicaid applications statewide, for example. Even just converting the myriad of DOH forms into and Adobe form format that could be completed
                             electronically would save our caretakers time on paperwork. Time they could then spend caring for our residents.
2370   Website Submission    onsolidate decision-making. Consolidating the medicaid application and approval process at the state level will decrease costs at all levels, as well as provide a level of consistency in applying the medicaid rules that is
                             unseen in today's fractured environment. Each county has a different interpretation of the regulations, and the provider is left trying to fight for dollars. This is just one example. There must be many more examples of
2371   Website Submission    Reduce regulation. We spend an increasing amount of time and money trying to figure out how to comply with regulations that are sometimes at odds with each other. At times it trully feels like a no win situation. A
                             DOH regulation may not be in compliance with an OSHA regulation, so we are left trying to analyze which regulation would be less costly/risky to break. Is there a way to start over to figure out what really matters -
2372   Website Submission    Cost screens for OASAS inpatient rehabilitation programs - Strict cost screens should be implemented for these cost-based rates. There should be screens for administration, staffing, and employee compensation, as
                             well as screens for non-personal service and capital.
2373   Website Submission    Efficiency adjustments to capital reimbursement - Regional adjustments should be made on a site-specific basis to programs with high capital costs. This will require a law since these providers have DOB approvals for
                             their capital costs.
2374   Website Submission    Eliminate the capital thresholds over which DOB approval is not required. - A specific DOB capital approval should be required for all programs. Programs should be able to automatically spend up to a threshold.
                             DOB should do comparative analysis before granting approvals.
2375   Website Submission    I believe that people should NOT be allowed to transfer ownership of their property to a relative and then continue to live in that house. I think the current law should be rescinded and anyone receiving medicaid must
                             sign ownership into a trust that will allow medicaid to put a lien on the property.
2376   Website Submission    Adoptive parents receiving child support adoption subsidies through county DSS, should not be eligible for these monthly payments if their adoptive child moves to a residence for the developmentally disabled or
                             mentally challenged. OPWDD and Mental Health agencies cannot bill parents for cost of care charges against child support subsidies. Nor, in many cases, can an SSI application be made for the adoptive child if the
2377   Website Submission    Individuals receiving large tax refunds should not be able to keep the entire refund if they are receiving any type of Medicaid benefit. Part of the refund should be used to repay Medicaid.

2378   Website Submission    Medicaid pays for medications which are delivered by pharmacy to OMH and OMRDD group homes, SROS, Assisted Living Facilities and Nursing Homes.
                             These medications are packaged in blister cards and are untouched by human hands. When the patient has a medication change, dies or disappears the medications (still untouched by human hands) are flushed down
2379   Website Submission    When a person either runs out of money while residing in an AL community or can't afford to enter an Assisted Living community, he/she ends up in a nursing home (NH) because they accept medicaid. When in an
                             Assisted Living community (AL), they sometimes get sent to a hospital for some reason and then are refused admission back in the AL community. The hospital then sends them to a NH and they go on Medicaid. NH
2380   Website Submission    I feel that individuals should not quailify for Medicaid until they have exhausted all other funds (trust funds, "fun" monies, hidden monies e.t.c).

2381   Website Submission    This note is in follow-up to my comments at the Rochester forum, January 20, 2011 concerning enrolling Medicaid reciptients who are full time college students in student health programs. As I mentioned, such a
                             student at UR would get an extremely high quality low cost care for $2112/year, no co-pay, prescription coverage, very generous mental health,and all other coverage up to a $million/program year. Montana already
2382   Website Submission    I am a Long Term Care Registered Nurse, actively practicing as Supervisor/Nurse Manager of a skilled nursing care unit in NYS. There are Medicaid regulations that are mandated for our facility and our Medical
                             Director to follow in order to maintain an operating certificate in NYS. One of these requirements is that every Medicaid insured resident in our facility must be examined by the facility physician every 60 days.
2383   Website Submission    Nursing Homes (Rehab facilities) keeping Medicaid consumers beyond the time they should be discharged. Nursing homes are not required to submit medical documentation or get prior authorization for extended stays.
                             Home care providers don't have to get prior authorization to service a Medicaid consumer for 24/7 care. This can go on for years.
2384   Website Submission    Third Party Health Insurance should be researched for every Medicaid consumer. Currently there are consumers on Medicaid who have TPHI.

2385   Website Submission    The Welfare Management System should be one system. Upstate and downstate. If we had one system we could prevent duplicate Medicaid Client Identification numbers (CIN). Currently a consumer can apply in an
                             upstate county, be eligible and also apply in NYC and be eligible. SDOH could be paying a capitation payment to an MCO for each CIN. This happens all the time.
2386   Website Submission    Allow Medicaid consumers who are in the recipient restriction program to enroll in managed care.The managed care plan's PCP can be the gate keeper and the MCO can keep better track of the consumers utilization.
                             Take away the exemptions and enroll those consumers in managed care.
2387   Website Submission    Have one benefit package for managed care consumers instead of one for non SSI and SSI. Also include pharmacy in the benefit package. This would be easier for plans to managed their patients.Instead oftreating one
                             condition treat the whole person.



                                                                                                                                                                                                                                                              78
 #                  Author                                                                                                             Proposal
2388   Website Submission    n the commercial world there is a limit as to how many time an individual can enter inpatient and outpatient rehab for Substance abuse. Consider limitations. We have consumers that utilize this service 3,4 or more times
                             within a year.
2389   Website Submission    Combined the O agencies with SDOH.

2390   Website Submission    hy do we need three different agency's to oversee our compliance with Medicaid regulations and for submiting financial data? The system needs to be collapsed down into one state agency. If other types of Health
                             industries are required to submit the same types of data, maybe their is room for more collapsing than just in the mental health area.
2391   Website Submission    The Independence at Home Act (IAH) , a little noticed provision of the Obama Health Care Reform Act can dramatically cut the cost of Medicaid and address the budgetary woes of the States. IAH promotes
                             ""mainstreaming"", the care of the sickest people in their homes rather than in hospitals and nursing homes.
2392   Website Submission    Pay mass immunizers for flu vaccinations administered to Medicaid recipients. Medicaid recipients are being turned away at public clinics because their insurance does not pay. It is far more cost effective to pay for a
                             flu vaccination than a hospitalization for complications of the flu.
2393   Website Submission    Place more emphasis on providing home health care and personal care services for the elderly and disabled which will delay or prevent the need for more costly nursing homes and assisted living homes. Rural area
                             residents often do not recieve the amount of personal care they need to help them remain independent in their homes. Require that personal care and home care be provided by licensed agency providers in order to bill
2394   Website Submission    The reimbursement rates for substance abuse and mental health therapy continue to rise, while providers continue to be in greater need, often utilizing state and county funds to supplement medicaid payments.

2395   Website Submission    I have always felt that when someone signs up for any kind of public assistance they should be REQUIRED to do the following:

2396   Website Submission    1.Put a resource level back on Medicaid. Why should someone with $50,000 be allowed to reserve their money? We save money for rainy days and shouldn't be the cost of the tax payer.

2397   Website Submission    2. Remove spousal budgetting for chronic care cases and all of the legal loopholes that go along with it. This will again not make the state responsible for people who have the money.

2398   Website Submission    3. Remove correct when made however re-evaluate case from TA, FS and MA cases. Fair hearing Judges allow this to happen too often and also cost the State a decent amount.

2399   Website Submission    Comment:
                             - Evaluate Adult Day Health Care Programs (ADHCP).
2400   Website Submission    Besides program costs, another considerable cost to the taxpayer is staffing costs to support the multiple components of the Medicaid program.
                             - The Governor's Office should consider how to consolidate DOH staff without the unpalatable need for layoffs, which is often blocked by unions.
2401   Website Submission    (1) a new program, to be called Medicaid BRIDGE would be started. This program would be to cover former consumers who would otherwise be too afraid of losing their Medicaid benefits to try working part-time or
                             full-time for pay. (I have been working in the mental health field for over 20 years and the fear of losing Medicaid insurance coverage is the FIRST thing consumers state as the reason they could not consider working.
2402   Website Submission    (2) Tax incentives would be given to any employer that newly hired any consumer who had been previously receiving either public assistance, HRA assistance, or HASA assistance. Also, these consumers would
                             receive the lowest possible tax rate (regardless of their income) for at least the first three years of their being employed after being disabled. This would help them in the long run get on their feet.
2403   Website Submission    GET RID OF THE MANAGED HEALTH CARE PLANS (family health, metro plus,etc...) that are sucking the life out of Medicaid and instead work with the Medicaid program as a whole.

2404   Website Submission    We need to LIMIT the AMOUNT of Medicare per person. TELL the citizens of NYS they each have an allowance limit ($5,000 -- yes, her bills paid by NYS Medicaid have exceed this amount years ago) and when
                             that ALLOWANCE is gone, its GONE, NO EXCEPTIONS. People have to be held accountable for their actions, period. AT LEAST UNTIL WE CAN RESTRUCTURE THE SYSTEM.
2405   Website Submission    The State should go through all the federal options for eligibility and revisit the decisions made over time. Start with the home value limit - Why did NYS go to the maxi level of $750,000 - the lower limit available
                             would make make some families plan sooner for LTC
2406   Website Submission    I am a physician working in the VA system for the past eight years, so I don't have personal experience lately with Medicaid. Among others, one thing that the VA does extremely well is to control the costs on their
                             medications by having a rather restrictive formulary with strict criteria for non-formulary use. The main focus is on safety and efficacy, but it results in considerable reduction in expenses for medications. I recall ads
2407   Website Submission    This is about various services provided under Office for the people with development disabilities (OPWDD) programs.

2408   Website Submission    I am a Medicaid Service Coordinator with an agency that serves the intellectually disabled. My co-workers and I put in a tremendous amount of time and energy on paperwork, much of which we feel is redundant and
                             unnecessary.
2409   Website Submission    Allow EMS personnel to decide, in the field and onsite whether ambulance transport is medically necessary. (Example, there are 2 or 3 patients with Medicaid in any given Hospital service area that use ambulance
                             services for transport on a daily or greater then once per week basis.) Other states, such as Pennsylvania allow EMS personnel to make a field decision as to medical necessity.
2410   Website Submission    Disallow narcotic medications as a first prescription for any condition, other than LARGE BONE fracture or cancer. I hear all too often, the number of people who "fake back pain to get Oxy's or Hydro'S" on a regular
                             basis so that they can sell them to supplement their unemployment benefits or welfare payments.



                                                                                                                                                                                                                                                             79
 #                  Author                                                                                                             Proposal
2411   Website Submission    Limit the number of paid NON-EMERGENT visits to emergency rooms and urgent care centers. (Example, I've had a sore throat for an hour and I go to the ER or Urgent Care instead of calling my primary doctor or
                             trying something over the counter.
2412   Website Submission    Eliminate the term "BENEFIT" from all literature, property and other material regarding Medicaid. It is NOT beneficial to be poor and in need. A lot of the people seen in the system see this as a sense of entitlement
                             and therefore no need to try to get out of it.
2413   Website Submission    Limit the number of over-the counter prescriptions that can be filled in any given fiscal year.

2414   Website Submission    Increase effort to provide for smoking cessation. Part of the problem seen in our realm of care is that they "Can't afford meds or co-pays" but they can afford smokes.

2415   Website Submission    Establish a method for healthcare providers to report abusers of the system without violating privacy.

2416   Website Submission    I have worked in OPWDD for 23 years and something that has made absolutely no sense to me is the consumers that get new orthopedic shoes every six months. It further boggles my mind, when many of these
                             consumers are non-ambulatory and do not weight bear. Perhaps, every two years would be more appropriate for these consumers. I am not against consumers having good shoes, just not every six months when their
2417   Website Submission    Medicaid recipients should NOT be permitted to be seen in the emergency department for ongoing chronic issues UNLESS there has been an acute change. For example, I have had numerous patients with complaints
                             of this sort: Patient signs in the triage area with a complaint of back pain. Back pain started 6 months ago and there has been no recent re-injury or trauma. The patient did not attempt to contact their PMD in the past 6
2418   Website Submission    The state should look into the Ithaca Health Alliance Model for the Medicaid Program. From the Ithaca Health Alliance websitehttp://www.ithacahealth.org/ ""The Ithaca Health Alliance was created on a cooperative
                             model, and from the beginning we have been shaped by our members. Through the power of community building, our members help other members in need with health expenses ? financially, through the organization
2419   Website Submission    In order to find enormous Medicaid savings, I would suggest looking at alternatives to the Certified Home Health Agencies (CHHA) services within Adult Care Facilities (ACF). As per a 2005 NYS Department of
                             Health report, CHHA?s have utilized Medicaid to the tune of over $35 Million providing services to ACF residents. Tremendous cost savings to the State can be realized, if the State were to switch the Home Care
2420   Website Submission    as an rn and a part of the mental system in ny i find that the limited mh svcs available are being used and abused by criminals. a common practice is when a person gets arrested and they are in the back of the police car
                             they tell the officers that they are suicidal and the policy for the police is to take them directly to the hosp for a mh evaluation. this is not only needlessly wasting our resources but ofttimes results in an admission
2421   Website Submission    We need to model the NY Medicaid drug formulary to the VA formulary. The VA has a mandatory formulary that is based off of being cost effective. Every medication has to be "cut in half" to cut costs and it is a
                             mandatory generic only plan. I am a Pharmacist and see far too much waste from the system. I have heard that in Florida medicaid beneficiaries are only allowed 5 prescriptions per month. anything more they must pay
2422   Website Submission    ACT teams (assertive community treatment) would be a huge cost saver if used more widely

2423   Website Submission    Reconsider the IMD exclusion for people aged 19 to 65 with mental illness in state hospitals and other institutions of more than 16 patients devoted to treating mental disorders. Medicaid would pay half the cost to the
                             state for such patients. Limits could be placed on new admissions to the state hospitals to keep costs down
2424   Website Submission    create set-asides in all state funded housing programs to provide more units for mentally ill people. This should apply to any housing developments that get state or federal money, to assign some housing with affordable
                             rents and for disabled people
2425   Website Submission    creation of more crisis residences to keep people out of hospitals would save money. regulations need to be softened to allow them to have less professional staffing than a full time nurse and doctor. they cant afford that.

2426   Website Submission    have hospitals manage patients better who have co-occurring mental illness and complex medical problems when admitted. they are sometimes discharged once or twice and readmitted right after, to handle ongoing
                             problems of high blood pressure or diabetes or congestive lung disease, for example, while their mental disorder becomes worse and needs treatment because these conditions are interrelated
2427   Website Submission    Call off state OMIG--Office of Medicaid Inspector General, who is riding too hard on the housing providers in mental health. this has sown seeds of great distrust between the state and the housing agencies and great
                             dislike for state high handedness that need not exist.
2428   Website Submission    We do 100% of our detoxifications outpatient. Psychiatrists prescribe medications for detox as a routine part of practice.
                             * All patients coming in must arrive with a sober support person (SSP). This requires asking for help BEFORE patients arrive for treatment. The SSP hears the entire psychaitric evaluation and participates in early
2429   Website Submission    Make stronger and far more accessible CDPA. This is a consumer directed program that my son participates in every day of every week. It allows him to live at home, work, pay taxes and be a functioning member of
                             society. He is happy contributing and working like most other folks.His personal care aides save the state hundreds of thousands of dollars each year by his living at home. Nursing homes and their high price tags are not
2430   Website Submission    #1 Nursing Homes-They are very expensive yet in general their care is not of high quality. When I worked in Nursing Homes, even with good workers we were very minimally staffed. We were within guidelines, but
                             to provide good care you need to have a smaller ratio of Aides to Clients. The standard in the facilities I worked in was 8 clients to one aide on day shift. That's not bad after lunch, but for morning care it is horrendous.
2431   Website Submission    #2 Personal care Program - Why is House hold chores given to individuals who are out of their homes most days and do not need assist with personal washing/ dressing? Medicare provides household chores as
                             incidental to personal care. If you don't need personal care, you don't receive household chores.
2432   Website Submission    #3 Why did the CAH program change its focus from the none finacial qualifing family to accepting already Medicaid clts. It seems it would be more cost effective to offer some of the services available in the CAH to
                             the regular 0-18 years old clients. Most of the Medicaid clients could benefit from case management. Why are we allowing the CAH clients to not have to pay co payments. Some in our program do not receive nursing
2433   Website Submission    #4 It would seem that it would be beneficial to tighten the guidlines before we remove benefits. Obviously to discontinue present benefits would be a fight between the Government and MD's,Home Care agencies,
                             Nursing homes, families, hospitals, drug companies, Opticians, Optomologists etc. The Lawyers would have a field day.



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 #                  Author                                                                                                           Proposal
2434   Website Submission    MA patients should lose something if an appointment is missed. Withhold money from welfare checks. Too many appointments are skipped which wastes resources. MA patients call in the morning for emergent
                             visits and often are no-shows only to call the next day for another appointment.
2435   Website Submission    All MA patients should be required to take some type of Nutrition Course to help prevent unhealthy habits. Nutrition education could help reduce smoking and overweight---diabetes is costing us a fortune!!

2436   Website Submission    tudy audit findings and audit reports. Bigger fines are necessary for providers who cheat or game the system. Providers often see audit findings as ?a cost of doing business? because the auditors settle for less than
                             100% of findings. Providers bring in high paid lawyers to fight findings. NYS needs lawyers with MA expertise and administrative law judges who understand MA and are sympathetic to taxpayers, not providers.
2437   Website Submission    Study an audit done 20 years ago---Southern Tier Pediatrics (STP). The doctors had a monopoly in Elmira. We had $6 million in legitimate audit findings (billing errors). Rather than repay the money, the doctors
                             stopped seeing MA patients. Consequently, MA patients went to the Emergency Room at local hospitals, and that cost MA a fortune. DOH went in and declared STP a clinic and wrote them a big check (the difference
2438   Website Submission    Tort reform??speaks for itself. This would cut down on unnecessary tests.

2439   Website Submission    A major project in NYC identified a significant source of potential recoupment. Politicians shut us down because doctors were refusing to accept MA patients. We found fraud and abuse. Audit teams consisted of an
                             auditor, an RN (medical professional) and an investigator. Medical records were screened and follow-up tests, prescriptions, lab work, etc. were compared against the patient symptoms. Why x-ray someone?s arm if
2440   Website Submission    Nurture primary care practices and training. When family physicians are allowed to practice using their full scope of training, providing continuous, longitudinal, coordinated, first-contact care, the health of the
                             population is optimized. Family physicians practicing patient-centered care leads to improved chronic disease management and less preventable hospitalizations.
2441   Website Submission    Providing rational end of life care. Hospice care provides pain control, autonomy, a holistic approach and less aggressive treatment for the dying patient. These attributes are very important to most people. A recent
                             study in the New England Journal of Medicine showed that patients with terminal lung cancer who received palliative care early on had less pain, were happier, more mobile and in fact lived 3 months longer.
2442   Website Submission    Scrutinize overused procedures (e.g. stents, back surgery, MRI's, etc.) and right size screening. The Less is More feature of the Annals of Internal Medicine gives few examples: unnecessary CT scans causing cancer;
                             feeding tubes and antipsychotics in nursing homes with no demonstrable benefit. Unnecessary C-sections - the examples go on and on.
2443   Website Submission    Good medical could be provided if doctors stopped prescribing any new drugs and relied on the Target $4 list exclusively (the only significant exception is the need for inexpensive insulin and steroid inhalers). I was
                             sickened to learn how much medicaid spends on some medicines (Nexium, Singulair, Lipitor [Provachol 40 mgs is $4/month], Actos [may cause heart attacks]).
2444   Website Submission    I would like to recommend that recreation therapy services provided by Certified Therapeutic Recreation Specialists (CTRS) be a covered service under future plans. Recreation therapy is cost effective and has been
                             shown to have a plethora of benefits and outcomes for the health and well being of patients and clients in all settings. For more information see www.NCTRC.org, www.ATRA.org. I have been a CTRS since 2004 and
2445   Website Submission    The YMCAs of New York State in partnership with the New York State Department of Health (DOH) and the New York State Health Foundation has implemented the New York State YMCA Diabetes Prevention
                             Program (NYS Y-DPP). This program utilizes a proven model developed by Indiana University researchers and the CDC to implement group-based diabetes prevention programs in YMCAs for people with pre-
2446   Website Submission    MUCH OF MEDICAID FUNDED TRANSPORTATION TO PHYSICIAN OFFICES AND CLINICS IS EXPENSIVE AMBULETTE TRANSPORTATION WHEN MUCH LESS EXPENSIVE CAR SERVICE
                             TRANSPORTATION COULD BE USED. HOW ABOUT USING CAR SERVICE FOR MOST NON-EMERGENCY PATIENT TRANSPORTATION? THEY'RE ALSO USUALLY PROMPTER THAN
2447   Website Submission    Everyone on medicaid should have a co-pay, howevber small, same as the rest of us. As for the wealthy, they should pay for their own parents in nursing homes or they don't get care.

2448   Website Submission    when looking at medicaid redesign, please also consider changing the way it is funded. nys is the only state that requires a 25% local cost share, rather than the state picking up the total 50% cost. the 25% is picked up
                             by the local property taxpayer, which is a regressive tax. Shifting the total cost to the state, would then spread the cost as an income tax, which is based on income, where costs are borne by everyone in a fairer wayand
2449   Website Submission    Sliding scale of payment for families in the medicaid waiver (OPWDD). There are families who can afford to share in the costs of their child's care. This can relieve some of the burden on the system and ensure that the
                             funds will be there to provide essential needed services for those who can not afford to pay.
2450   Website Submission    The provisions of the 2010/2011 State budget instituted a cap on the administrative component of the Managed Long Term Care Plans which has been phased in over a three year period. This administrative cap bears
                             no relation to the administrative costs of MLTC plans. Unlike any other program in the State, and even the other components of the rate for MLTC plans, it is not based on the average costs in the region.
2451   Website Submission    Redesign should build on the distinct strengths of the existing home and community-based service system. The system does a good job of helping people live independently and remain at home. Its major weakness is
                             that it is not designed to help people avoid potential medical complications. It particularly does not have much capacity to deal with behavioral health and substance abuse issues.
2452   Website Submission    Reducing care for consumers receiving 12 or more hours of care who need intensive daily assistance will only cause harm to those consumers, while achieving limited or no financial benefit. Medicaid home care costs
                             will be cut, but those costs will only be transferred to the nursing home sector. This kind of cutback will result in a protracted legislative battle and a likely court case under the Supreme Court?s Olmstead decision
2453   Website Submission    Home care aides represent about 70?80% of the paid hands-on care in the home setting. New York City?s home care aide workforce is divided, about equally, into two segments:
                             1) Home health aides are employed by licensed home health service agencies which contract with Certified Home Health Agencies, LTHHCP?s and MLTC plans; and
2454   Website Submission    Care management is a valuable resource and should be targeted to consumers with complex care needs. Care management is defined here as a person-centered, interdisciplinary process designed to integrate health care
                             and social support services. It includes a health assessment of functional strengths and limitations, medical problems or issues, and service needs; a social assessment of support needs, including housing, benefit issues
2455   Website Submission    Long-Term Home Health Care Programs (LTHHCP) and Managed Long-Term Care (MLTC) Plans should be consolidated into one program for the long-term care of chronically ill and disabled Medicaid consumers.
                             The LTHHCP and MLTC plans serve largely similar populations and have a similar set of covered services. However, the critical driver of a LTHHCP operationally is the individual budget cap of 75% of average
2456   Website Submission    Home care aides are an underutilized resource in the home and community-based service system. Creation of an Advanced Aide position would provide substantial added value to consumers and providers while
                             offering genuine cost efficiencies to the service system. A fundamental redesign of the aide role would provide a real rung in a career ladder, midpoint between an aide and a Licensed Practical Nurse (LPN).



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 #                  Author                                                                                                             Proposal
2457   Website Submission    New York, like many states, has struggled to implement federal nursing home transition and diversion grants. Reducing nursing home utilization at scale will require dedicated staff, access to housing subsidies and the
                             ability to provide sufficient hours of personal care, especially at the outset of home care. Specific CMOs should be designated to specialize in nursing home/long-stay hospitalization transitions and offered financial
2458   Website Submission    Develope a stong, intelligent team to investigate fraud - people who won't be intimidated by attorneys.

2459   Website Submission    It is my suggestion that Medicaid dollars can be saved in NYS in a few areas. I often see in our agency alone that benifactors of Medicaid must quickly spend down monies in order to keep receiving this benefit. That
                             requires staff to think of Large items or several items to purchase for individual to accomplish this spend down. I think its wasteful, rather than to simply surrender the unused funds back to Medicaid.
2460   Website Submission    Another area and I don't know how plausible this is, but families that are financially able to do so, I feel should support their mentally deficient child in some way..just as any parent is responsible for the support and
                             care of their child. Perhaps a tax levied on such a parent. Or a percentage identified just like it is through the family court systems on parents who rear a child separate from the parental care giver.
2461   Website Submission    NY is moving towards going "Green" Is is possible NYS could take some of their land in trust and put it to use that would also preserve the Land. Such as establishing "Green Burial grounds". Millions of medicaid
                             dollars are spent on Irrevocable burials trusts for individuals without families. Wouldn't pressing the "Green initiative" be the path to take. Green burials are not harming to the environment, it would save millions of tax
2462   Website Submission    Teen Age Services Act (TASA) would not be missed.
                             This is case mgt. services for pregnant and parenting teens.
2463   Website Submission    Adults with physical disabilities and chronic illnesses who are over 18 years of age, are eligible for Medicare and Medicaid, and qualify for a nursing home level of care, are a population that lives with severe constraints
                             in terms of available health and social services and access to them. Their needs often go both unrecognized and unmet in a service system that is not designed to serve consumers with multiple conditions and disabilities,
2464   Website Submission    We must tie the Medicaid and Medicare programs together for participation in either as the doc dont want to give up Medicare.

2465   Website Submission    Mental health screenings should be manditory as part of health care. Those MDs who dont want to provide screenings should not be allow to participate in Medicaid or Medicare. Depression is a major cause of
                             disability and of poverty stricken and working poor mothers not being able to monitor their children. In the long run this cost us in teen age pregnancy, drug adition and prison programs.
2466   Website Submission    Whole sale and retail pharmacies should have a better tracking/reporting system for all narcotics. A simple excell program will sort all those doc writting more than a reasonable amount of narcotics rx. Addicts shop
                             around with both public and private insurance and self pay for thier drugs. If the whole salers also had to report these pipe lines could be closed and Medicaid could track which local pharmacies are jacking up their
2467   Website Submission    Those who will not facilitate in cutting the cost of needless repeated testing through the use of electronic medical records should not be allowed to participate in Medicaid or Medicare.

2468   Website Submission    Monitoring of pharmacies must improve. Pharmacies are charging out ragious mark ups. I review one chart where the prices on one medication charged to Medicaid went up a few hundred every few months. Who is
                             watching the store? Why are we allowing these outragious mark ups? There are computer programs to monitor this too. Why is it not being done? If they dont want to facilitate monitoring they should not be permitted
2469   Website Submission    Doc's should face the same penalties as other drug dealers. In a recent article in Newsday reported an MD put 15 million dollars worth of oxicodin on the street. He was charged with "10 felonies and faces 5.5 years".
                             Anyone else facing 10 felonises would face 10 years. They did not "stack" his charges. He was not charged with conspiracy" as any other drug dealer would be. Crack addicts/dealers are getting 45 years or AKA:life as
2470   Website Submission    If you try to get patients into speciality treatment they are put on the "Medicaid waiting list" because they dont want the general public expose to these lowly people so they go on the list specific to Medicaid patients
                             which is highly structured:the third Thursday of every other month for two hours either before or after the buses stop running. They say it is because they no/show so much.
2471   Website Submission    The Regional Resource Development Center is located in 9 regions across New York State. This division of the Department of Health is currently contracting with the Nursing Home Transition and Diversion Waiver
                             Program and is responsible for NHTD referrals and pending Aid to the Disabled cases. The area hospitals refer a high volume of these cases and the delay time is extensive due to the fact that they are processed by one
2472   Website Submission    Treatment of mental health issues would greatly reduce our costs. Those with untreated depression return repeatedly with depression caused numerous aches and pains. It is also the largest cause of disability. It also
                             prevents poverty stricken and working poor mothers from being able to monitor and guide thier children. This costs us in courts and prisons. Of course sending the number of people we send to prison also feed poverty
2473   Website Submission    We urge the Redesign Team to recommend customized employment as a full or part-time alternative to day habilitation. A small, results-oriented investment, diverted from existing training efforts, would build capacity
                             among OPWDD providers and significantly increase job placements. Job Path would be pleased to partner with OPWDD on a pilot effort, which would document savings and placement results.
2474   Website Submission    I think one cost saving measure for prescriptions would be to have prescriptions filled for 90 day refills. If this is a new medicaton the first month would be a 30 day fill, this would allow time to see if the medication
                             and dosage is effective. After the first fill all refills would be for 90 days. Medication in bulk is cheaper for both the state and the patient. State employees have this option because of savings. Medicaid patients should
2475   Website Submission    Bring back the resource test for all applicants. I've actually seen cases that have resources valued at half a million to close to a million. The interest income was counted, but no other income in household, so hh
                             remained eligible.
2476   Website Submission    DSS should be able to recover Medicaid incorrectly paid from clients if agency error, and not only on a voluntary basis.

2477   Website Submission    Do we still need facillated enrollers if Medicaid applicants can now mail in?

2478   Website Submission    If we are to have mandatory enrollment into HMO programs, make more available to the clients.

2479   Website Submission    Why have CHPA + CHPB? Have cases handled in one agency by, again, adjusting income levels.




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 #                  Author                                                                                                             Proposal
2480   Website Submission    Contracting out Medicaid is not a good idea. I think it should be run by government and government employees. I think we'll have a mess if we have some of our cases being handled by Maximus and some by the local
                             DSS. Although I know the goal is to eventually transition the whole MA program to Maximus, but we have so many clients that need that interface with a local agency, even if only by phone.
2481   Website Submission    Bring back employment requirements and drug/alcohol requirements to the Medicaid program.

2482   Website Submission    Streamline the income eligibility guidelines (which should be a little higher to make more clients income eligible)and allow those over income to ""Spenddown"" or buy into Medicaid.

2483   Website Submission    The call center may be a good idea for clients to ask general questions, but put the cases back into the hands of the local DSS employees.

2484   Website Submission    If a person has Medicaid, eldercare (nursing home care, in home nursing care, etc.) is often covered, when people with private insurance are not. So those with private insurance have to wait until they have no insurance
                             and are eligible for Medicaid to get the coverage they need for care.
2485   Website Submission    send an EOB (electronically when available)for every single patient visit paid by Medicaid to the patient, and ask that the charges be verified by the patient via return email (if available) or via letter and SASE for return.
                             Getting an EOB for each visit would deter providers from the temptation of charging Medicaid for services not provided.
2486   Website Submission    reating a "Medicaid facility" network throughout NY would allow "one stop shopping" for Medicaid patients . . . Primary Care physicians, Pharmacy, X-ray/Ultrasound/CT/MRI services, Phlebotomy services, Mental
                             Health Services, Alcohol & Substance Abuse Services, even dental services all in one building . . . even a cafeteria - would allow patients the opportunity to get more than one visit for well care and/or follow-up care
2487   Website Submission    Currently, a large portion of medicaid expenditures are due to intentional fraud/abuse, overbillings, or improper billings. We then spend a great deal of time, money, and energy to recoup this misspent medicaid money.
                             An ounce of prevention is worth a pound of cure.
2488   Website Submission    let medicaid pay for a stair lift this way a patient can be discharged from a nursing home back to their family, a chair lift cost $4,500 as opposed to 1000 a day for SNF

2489   Website Submission    Local district social services need consistency and program integrity reviews. All counties bear the burden of paying but do not realize the effects of the decisions.

2490   Website Submission    Best practice and enforcement of current rules need to be reviewed.

2491   Website Submission    Approval on care plans, PRI, and other rate and eligibility issues should have an actual review document that illustrated input and review by the office along with assistance in decision making or dollar authorization
                             implications.
2492   Website Submission    if the person isn't participating in leading a healthy life and is not self responsible remove from rolls

2493   Website Submission    require a 10 year residency before eligible
                             or
2494   Website Submission    foreigners are eligible for catostrophic care only - anyways, they all should be covered through their employers

2495   Website Submission    llegals should be sent back to their home country, not released back into the street

2496   Website Submission    have commuters work several facilities
                             there is a person in Bflo who stays there then goes home to Rochester on the weekend - is there someone doing the reverse?
2497   Website Submission    Fee for service is not working. It is not working for patients and it is not working for Primary Care. We need to think differently and start looking at re-imbursement for patient care and not for office visits. For 2-4$ a
                             day (depending on the complexity of the patients medical condition)most medicaid patients could be cared for in a way that would prevent further costs. I am talking about care that is meaningful. telephone coaching,
2498   Website Submission    Re-examine eligibility requirements; perhaps consider work for Medicaid (for those that can work) or certain aspects of Medicaid benefits could be loaned out and thus curtail some of the handouts. Handouts in general
                             do not motivate or work
2499   Website Submission    I think that the Willowbrook decision/compensation should be revisited

2500   Website Submission    I understand that some of the OMRDD homes are getting their patient medications from local pharmacies. I would expect this should be at a bulk rate.

2501   Website Submission    If the American Indian tribes are not paying New York State taxes on the cigarettes they sell, than can we assume that no tribe members are using Medicaid?

2502   Website Submission    The OPWDD currently provides Western New York DDSO programming services through Day Habilitation facilities that are leased. Costs to operate these facilities include transportation, utilities, maintenance, and
                             limited staffing that is already spread as thin as it can get, posing potential risks to the safety and well-being of participants. Large groups of individuals from multiple homes attend programming activities in classrooms



                                                                                                                                                                                                                                                               83
 #                  Author                                                                                                            Proposal
2503   Website Submission    My biggest complaint with Medicaid is the amount of medical supplies they give people. Instead of giving a small amount and then having the client reorder them, these big boxes appear with supplies they can simply
                             not use up.
2504   Website Submission    One of the current certificate of need criteria is ""financial feasibility."" A proposed project must stand on its own. However, this is not applied or not consistently and effectively applied to public facilities. Local
                             governments, primarily counties propose projects and even new facilities that even their own documentation shows will lose money.
2505   Website Submission    From my perspective the Medicaid system became out of control when family health plus and child health plus was attached to it. It created a unsustainable burden to the program and created an image of Medicaid
                             growth being out of control. Family Health Plus and Child Health Plus should be seperated from Medicaid. The public will then see the true costs of what Medicaid was designed for and allow for a better identification
2506   Website Submission    I was recently told by a Neonatal Intensive Care nurse working at a large New York City hospital that Medeicaid is now paying for In Vitro Fertilization (IVF) procedures. These are very expensive and are not covered
                             by most private insurance. These procedures often result in multiple births that can require extensive neonatal intensive care. Why is Medicaid covering this when private medical insurance does not cover it? How much
2507   Website Submission    Allow clients in the supervised community service devision outpatient State Operated Community residences to utilize the medical clinic at Pilgrim Psychiatric Center

2508   Website Submission    Medicaid should be designed as an insurance program, not an intitlement. If I pay for my insurance and am denied certain things, Medcaid should not pay for this .

2509   Website Submission    ong term care-you should look at the number of beds actually needed in NYS. More people are staying in the community, the average age of a nursing home resident is now around 85. More community services should
                             be provided. These are less costly than a nursing home stay.
2510   Website Submission    Drugs-in a nursing home, drugs, particularly narcotics are destroyed if the resident no longer takes the drug, has died or is discharged home. These medications should be albe to be sent back to the pharmacy for credit.

2511   Website Submission    We also need to look at the strigent regulations in NYS that govern long term care. Most other states follow the Medicare guidelines, which are less restrictive and let the provider have more options in care delivery.

2512   Website Submission    There should be serious thought given to parollees. currently, they are often mandated to an alcohol and drug center as part of their parole. These monies are designed for the addict, not the parollee. The parollee gets
                             housing as a result of this.
2513   Website Submission    All Medicaid participants should be mandated to have a primary physician.

2514   Website Submission    Mandate that all Medicaid participants schedule and keep routine wellcare visits with primary physician (i.e physical, dental exams,

2515   Website Submission    When medical care is required participants first choice of treatment should be a urgent care type facility rather than the emergency room. (will need to set guidelines as to when real emergency room care is required (i.e.
                             significant emergencies).
2516   Website Submission    Mandate that all Medicaid participants schedule and keep routine wellcare visits with primary physician (i.e physical, dental exams, mammograms,GYN, pediatrics care, routine care for any chronic diseases (diabetes,
                             hypertentsion,etc.
2517   Website Submission    Set up some type of method for tracking the above and set consequneces for failure to follow these standards.

2518   Website Submission    Set standard as much as possible that generic medication is precribed adn used as the first choice over other medications.

2519   Website Submission    Patients receiving Medicaid benefits with chronic diseases often tell me that they can not go back to work because if they lose their Medicaid they will not be able to afford their medications. Often they have a GED and
                             no other educational backround. Living in New York City and taking a minimum wage job does not allow them to pay rent, food, clothing, transportation, and health insurance. A few of my patients are on the waiting
2520   Website Submission    Second, we need a faster way to regulate patients who recieve Medicaid benefits due to their HIV positive status, see multiple providers and fill multiple HIV prescriptions at different pharmacies and then sell these
                             prescriptions. There is one Medicaid Investigator, Robert Mooney, investigating this fraud, but it is too much for one investigator. The pharmacies involved in buying back these HIV prescriptions must be shut down.
2521   Website Submission    Finally, as we know, receiving primary care in teh emergency room is not cost effective. We need more patients receiving preventative care at clinics and primary care facilities. In order to do so, we need more clinics.
                             The Physicians, Physician Assistants, and Nurse Practitioners are available. There is space available, especially in areas where hospitals have shut down, to open small clinics. These clinics must out number the
2522   Website Submission    In each area /city /town a specific hospital or fecility should be designated as medicaid provider.Then the medicare recipients are alloted to each fecility . The hospitals/fecilities are given a lump sum /year to manage
                             their health without regard for what they need to do.
2523   Website Submission    Childrens medicaid program (Child health plus) should be more closely looked at for excessive services in the downstate area compared to upstate NY. For example hearing and vision services beyond the normal well
                             visit. In the Albany area for example if a child does not pass a hearing evaluation they would be referred to an audiologist who would perform appropriate testing. It has been my observation that there is a remarked
2524   Website Submission    Why don't we reduce coverage to be comparable to what the average coverage is in other States?

2525   Website Submission    OASAS Program has no limits on the amount of visits a patient receives. This should be changed.




                                                                                                                                                                                                                                                             84
 #                  Author                                                                                                            Proposal
2526   Website Submission    OMIG should be performing internal audits on other State Agencies to ensure that they are in compliance with the Regulations when it comes to coverage of service.

2527   Website Submission    For all programs where Aides are contracted out. PCA's HHA's
                             LTHHC, etc. Instead of paying the agencies an Hourly rate. which has to be passed down toeach level and then trickling down to the aide. Pay a management fee depending on the hours spent in administering the case.
2528   Website Submission    My first proposal is Medicaid cost share by the recipients; I mean by that, in frequent Medicaid services such as, physicians? visits, rehabilitations services, eye exams, all kinds of pharmacy services and all similar
                             services that can be incorporated.
2529   Website Submission    Years ago OMH intiated a program called Intensive Case management. It 's role was to assertively outreach and engage high users or high need seriously mentally ill individuals who were not effectively served in the
                             existing mental health system. The premise was to provide whatever was needed to assist individuals to better engage and participate in services and reduce misuse or overuse of costly emergency services and inpatient
2530   Website Submission    Reduce the amount of paid State/Federal Holidays to government workers i.e. Presidents' Day, Martin Luther King
                             Day, Veterans' Day, etc.. This money can then be used for the deficits.
2531   Website Submission    Revision of rate setting methodology for voluntary foster care agencies. Current methods require the agency to pay for many services that Medicaid generally covers for youth not placed in our care. When this occurs,
                             the agency is billed at the customary fee schedule, not the Medicaid rate, resulting in use of Medicaid dollars at a higher cost. This difference can be significant, i.e. ambulance services.
2532   Website Submission    Providing edits in the Medicaid billing system that would prevent a provider from billing Medicaid for a service that is the responsibility of the foster care agency. If youth access service from a provider who already has
                             the Medicaid number, and we are not aware, billing will go to Medicaid.
2533   Website Submission    Consider permitting all services to be billed to Medicaid for youth placed in voluntary foster care agencies. This would guarantee billing at Medicaid rates, the agency could be provided with a small administrative rate
                             to cover nurses, first aid supplies, etc.
2534   Website Submission    Stop issuing Medicaid cards to youth placed in voluntary foster care agency programs, simply include them on the monthly roster we receive. When youth or families have the card, they access services without our
                             knowledg
2535   Website Submission    When people use medicaid to enter drug treatment and do not comply with rules, they usually get discharged from treatment. Many of these people do this only to return a month later and it becomes a cycle. If people
                             are not going to take their recovery seriously and continuously go into treatment and do not complete or comply with rules, medicaid should not continue to pay for it. Hard working people with private insurance usually
2536   Website Submission    We have a NYSDOH Patient Safety Center Best Practice that IPRO has awarded as the best program for a reduction in readmissions by 33%. Happy to share.

2537   Website Submission    Close all State operated ATC's. It is a duplication of services available in the community.

2538   Website Submission    We need to strengthen and increase our outpatient Mental Health and Substance Abuse services. More specific, programs like Partial Hospitalization Programs need to be expanded reducing the amount of
                             hospitalizations and the significant costs associated with them. In summary we need to focus on reducing the most costly of the services which is the hospitalization and enhance the outpatient system for prevention and
2539   Website Submission    My recommendation is that public health care clinics open up in hospitals since that is where the majority of Medicaid recipients go when there is a health care need. Even the police take indigent people to the hospital
                             emergency department. The services in those clinics could be structured in the framework of Medicaid finance. People are going to go to the hospital when they are ill so that's where the services should be. Since it's
2540   Website Submission    I think the Peer Bridger Program that helps people with mental illness re-integrate into the community from inpatient settings is an excellent program. It helps with sustainability, positive outcomes, and support when
                             change is hard. many individuals coming off inpatient units need the most support so they do not return to the hospital.
2541   Website Submission    In this economic time when cutting costs and trying to save jobs seems prudent, why are we being asked to expand our pharmacy inventory well beyond needs. We had to have an extra refrigerator brought to the
                             pharmacy just to store extra risperdal consta, a very expensive med. We had to do this last March and still have medication sitting on the shelves and not used. In fact we have 10 boxes of Invega Sustena 234mg ordered
2542   Website Submission    There are particular groups of persons (the Hassidic community as an example) who deplete the system of millions of dollars of resources while they contribute nothing. This is completely unfair to the tax payers who
                             have to support these communities who are in reality perfectly capable of supporting themselves and who have no wish to do so.
2543   Website Submission    Programs that provide day treatment services to mental health/mentally challenged individuals should provide transportation to and from instead of paying taxi services. This would lower the cost (coach rate vs. taxi
                             rate) and would employ othe
2544   Website Submission    Small premium for medicaid should be considered..to be taken directly from those receiving SSI, SSD, VA benefits, welfare benefits, ect. Receiving everything for nothing reinforces that mentality and does not
                             encourage independence, pride, and self worth. At least community service should be required... in lieu of premiums...would give unemployed (not special needs population) medicaid recipients some sense of
2545   Website Submission    Consider consolidation of counseling services that are reimbursed by Medicaid. For example, schools often provide medicaid-reimbursed counseling services to students in special education programs. These same
                             students also often receive medicaid-reimbursed counseling services from the local mental health system or other community providers. Perhaps a concerted effort to have mental health clincians available to the schools
2546   Website Submission    Evaluate number of members that are in case management with no encounters (or a cap level) over the last year and move them to fee for service. Could run matrix to determine the demographic of this group. If no
                             encounters, NYS could save perhaps as much as $6,000 per member. Perhaps mandating case management in a county for a relatively healthy member is not cost effective
2547   Website Submission    Look at Vermont's model for SNF cost containment.

2548   Website Submission    NYS is 11th in Pharmacy Claims Rebates. Should be one or two. Evaluate retro program to ensure that NYS is capturing all the rebate funding. According to federal government in the 90's, NYS lost out in over 300
                             million; still recoupable in part.



                                                                                                                                                                                                                                                              85
 #                  Author                                                                                                               Proposal
2549   Website Submission    mplement Payor Initiated Eligibility (PIE) file into eMedNY to avoid paying members with TPL sources

2550   Website Submission    Eliminate duplicate eligibility files (especially in managed care situations) and eliminate duplication (NYC).

2551   Website Submission    Evaluate Medicare laws and determine if a "reverse rebilling" of Medicare for Medicaid services could recoup money. Example: paid Medicaid claims the same month as a member qualifies for Medicare (Medicare
                             provides eligibility retro to the first of the month). SNF billing for when a Medicare/Medicaid member goes back to the hospital, potentially starting a new spell of illness.
2552   Website Submission    Move Medicaid patients from hospitals into beds already being reserved for another member that has to be readmitted to the hospital.

2553   Website Submission    Set up a procedure to allow discharges from hospitals to "assisted living facilities" for those that do not need SNF care.

2554   Website Submission    Allow for electronic signatures for eMedNY; currently wet signatures are required.

2555   Website Submission    People on Medicaid should have a $5 co-pay for emergency room visits that would be have been more appropriately dealt with at a physician's office or urgent care. Many of our folks will go to the emergency room so
                             they do not have to wait as long.
2556   Website Submission    A service between medicaid transport and case management should be developed to accompany some folks to medical appointments. There are many folks who need some assistance in understanding what the doctor
                             tells them and help in relaying information to the doctor, but it would not have to be as expensive as a case manager, it could be potentially a waiver service.
2557   Website Submission    Community Day Habilitation through the OPWDD Waiver should also be looked at. Often times this is just staff driving folks to the mall, or completing recreational activities. These are nice things to do, but are more
                             recreational than educational. Those type of outings could be done less expensively in a group setting. Day Habilitation should be more focussed on learning how to complete activities of daily living in the community
2558   Website Submission    Site based day habilitation programs could be looked at as well. For many residential folks, this is a way to avoid staffing the residence during the 8-3 time period. Rather than bus people to a site to take them out in the
                             community, would it not make more sense to staff the residence during the day and take them into the community directly from the house.
2559   Website Submission    Increase reimbursement to Psychiatric Nurse Practitioners with incentives to open up & manage clinics. This would be much more cost effective & increase the accessability of mental health services. I have done this
                             in other states & also set up outpatient clinics that are managed by psychiatric nurse practitioners. It is a model that really works & provides excellent care that is cost effective. It is not just psychiatrists who can deliver
2560   Website Submission    I feel money could be saved when renting equipment, such as hospital beds, or CPAP machines, if Medicaid stopped ?renting? when the rental fees equal the cost of the equipment. To me it is wasteful to rent an item in
                             EXCESS of the purchase price. I feel this could make a significant reduction in Medicaid expenses.
2561   Website Submission    Reduce or eliminate the amount paid to a nursing home to hold a bed while a recipient in is the hospital. It is ridiculous to pay a nursing home thousands of dollars to hold a bed. Set up a standard rate that is paid to all
                             nursing homes to hold a bed.
2562   Website Submission    Medicaid coverage should start on the date of application once a recipient is determined eligible.

2563   Website Submission    Only cover services that are mandated by the Federal Government.

2564   Website Submission    Limit the time a provider can bill for services, claims should be submitted and paid in a reasonable period of time, not years.

2565   Website Submission    ook into the School Based Health Center costs. These are full clinics within a school that meets certain poverty criteria. There is a medicaid cutout to pay for care of children with medicaid and Medicaid Managed Care.
                             Much care is duplicative: PEs done by PCPs and clinic staff within the same year, ""sick visits"" that are initiated by the child, many of which are Mommy care issues. I'm certain there is a large pot of money that could
2566   Website Submission    Currently the OWPPD requires consumers to be placed on head injury protocol and obtain an x-ray of their heads if a bruise or cut of an unknown etiology is noticed. The americans with disabilities act requires that the
                             disabled are given the same opportunities and treatment as the general population. The taking mentally retarded to the ER every time an injury of unknown origin occurs is a drain not only on Medicad but on the
2567   Website Submission    Medicaid dollars are being spent on Wii gaming units for DSSO houses. Also parents caring for their developmentally delayed children are requesting funds for gaming units, heated pools, etc when the families are
                             financialy solvent and have the funds to pay for the items they are requesting.
2568   Website Submission    Office for people with developmental disabilities (OPWDD) programs:

2569   Website Submission    I feel that eliminating clinical staff (PT, PTA, OT, dieticians, SLP's, audiology) within CNYDSO and obtaining serves on a prn basis would prove cost effective in this time of fiscal crisis. Historically these sevices
                             were thought to be essential when this population resided in the developmental center and now theses services are readily available simply by requesting a doctor's order. In doing so, monies would be saved in salary,
2570   Website Submission    TO LOWER UNNECESSARY/UNWANTED & EXPENSIVE ICU/END-OF-LIFE COSTS by:
                             1)getting advanced directives (minimal criteria should be health care proxy & resuscitation status) from patients, making them available for MDs to view online (see State of CA: http://www.sos.ca.gov/ahcdr/), and
2571   Website Submission    TO LOWER COSTS OF EMERGENCY ROOM CARE: prevent use of the ER as a primary care office by -




                                                                                                                                                                                                                                                                    86
 #                  Author                                                                                                            Proposal
2572   Website Submission

2573   Website Submission    TO LOWER OUTPATIENT COSTS: attempt to minimize the use of unnecessary tests/studies (lab/imaging/etc) - compile copies of clinical guidelines to participating physicians, and threaten to fine or deny
                             reimbursement for a procedure -OR- threaten to make the ordering MD pay for a test/study that is NOT indicated by the guidelines (for example, echocardiograms for surgical clearance for low-risk surgeries or
2574   Website Submission    TO LOWER OUTPATIENT COSTS: end fee-for-service for primary care providers, as it just motivates a provider to bill for as many things as possible, and most primary care MDs are happy to receive a salary; you
                             should salary the primary care MDs by the number of patients that they are assigned, and they should be given a slightly higher pay for very complicated patients (medically/socially complicated); require patients to find
2575   Website Submission    TO LOWER COSTS OF HOME HEALTH CARE: prevent overuse/abuse of unnecessary ""home attendant"" hours by clinicians that fill out the paperwork at the request/pressure of the patients by:

2576   Website Submission    Medicaid recipients should receive a statement showing any activity on their account. They can check for errors. If you don't get a statement, how do you know if things are correct.

2577   Website Submission    Better managed outpatient support programs to reduce the re-admission rate to health care facilities. Lessen the threat of lay-offs throughout the state and create meaningful jobs. Reward employees who better
                             themselves via higher education so that they can use their education to facilitate therapeutic progress with their patients.
2578   Website Submission    Medicaid is often a secondary plan, but after the primary claims are paid, the medicaid claims have to be modified to supply information that Medicaid requires a different paper form than other insurances and a
                             different electronic format as well. When medicare changes a CPT code, most other insurances follow medicare's lead immediately or shortly thereafter. Medicaid may take months and months to follow suit--that
2579   Website Submission    Our latest dilemma is that we have to supply Medicaid with a NDC code for drugs we use in procedures PLUS one of 4 units of measure (MG is not one of them although gram is), PLUS the amount of the drug in a
                             dose PLUS a single dose cost. No other insurance requires this. That means that any claim paid by Medicare and sent onward to Medicaid has to have a manual intervention to make sure that information is on the form.
2580   Website Submission    Must stop paying for young girls to have babies. I know - no lawmaker has the guts to follow through on this - but it is an immense drain and not only adds to the cost of Medicaid now, but also in the future as these
                             children grow up. These girls have to take no responsibility, nor do the fathers - and they all know it. Everything is paid for, over and over. There's no incentive to not have more children. There should at least be a
2581   Website Submission    One of the problems is that it is too easy to obtain Medicaid. I have seen able bodied individuals claim disability just to obtain benefits. I have seen someone deliberately lie on a birth certificate to obtain benefits for
                             herself and her child. This specific abuse was reported to the authorities, but I do not know if there were any consequences to the individual and she collected benefits fraudulently. However, it would save a great deal of
2582   Website Submission    The agency that does evaluations for disability, Industrial Medicine Associates, does not use best practice in conducting IQ tests. Many of the individuals tested in this way are deemed to have mental retardation and are
                             obtaining disability, and thus, Medicaid, when a more thorough evaluation, conducted under proper standardized conditions, may yield very different results. This practice should be investigated. If this agency is doing
2583   Website Submission    Also, there are individuals receiving benefits from state agencies who may not meet eligibility criteria. In the past people may have been accepted for services in agencies like OPWDD or OMH who did not actually
                             meet the criteria set forth by Mental Hygiene law, as things were not as stringent in the past. However, once in the system, they continue to receive very expensive benefits. State dollars pay some of these coss, Medicaid
2584   Website Submission    Another idea is to have a spendown system for families who have a disabled child, but who have the financial ability to contribute to their child's csre. For example, in the OPWDD system, Medicaid waiver can pay
                             many thousands of dollars for a person's care over a lifetime, even if the parents are wealthy. The waiver "waives" income and finances. Why? In this budget climate it is time to develop a spendown system so that those
2585   Website Submission    There are currently hundreds of millions of dollars in potential federal Medicaid recoveries by the OIG against NY for mental health restorative services which were not appropriately authorized by a physician and a
                             similar allegation in a federal whistleblower case against NYC for inappropriate authorization of personal care services. CMS has recently emphasized its concern with physicians ordering un-needed services and goods
2586   Website Submission    DRUG TESTING for ALL MEDICAID RECIPIANTS.

2587   Website Submission    There is a significant opportunity to reduce Medicaid pharmacy cost. NYS is significantly behind other states that have working on this for decades and NYS should be more aggressive on implementing a Pharmacy
                             Formulary and in providing data to prescribers which has never been made available. If these measures are done appropriately the saving should be dramatic!
2588   Website Submission    I believe one of the biggest savings can be found in the area of Medicaid fraud. I personally have known about people who work as sole proprietors in the construction trades - carpenters, painters, etc. - whose services
                             are paid for in cash, a portion of which is unreported to keep yearly income low enough to qualify the person and his family for Medicaid benefits and who pay little or no state taxes. Yet the person's real income allows
2589   Website Submission    As we wrote to the OMIG and SDOH, there is a requirement now that all Medicaid managed care plans have a ""secret shop"" program for their Facilitated Enrollers. The program has been in place for 4+ years and
                             was essentially implemented to appease CMS and renew the waiver. The results of each of the ""secret shops"" are reported back to the MMCs with the only accountability at the annual audit. The secret shop program
2590   Website Submission    Suggestion #1:Do away with the institutional bias in hospitals. Right now most hospitals automatically send patients with long-term disabilities to expensive nursing homes rather than arrange much cheaper and better
                             quality care in their own homes. Most people with disabilities prefer home care. If Christopher Reeve was able to receive homecare, so could almost anyone. Billions in savings right there! The state of New York must
2591   Website Submission    Suggestion #2: the M(11)q form, which must be submitted by the person with a disability in NYC in order to receive homecare, must be made less burdensome. Right now the M(11)q expires only 30 days after the last
                             medical examination & must be filled out by a doctor. Frequently bureaucratic screwups or mistakes by the doctor slow the completion of the process beyond 30 days. Then a new form must be submitted. As a result
2592   Website Submission    NYS MEDICAID REDESIGN
                             DECENTRALIZED INTEGRATED CARE
2593   Website Submission    I feel that the greatest means of reducing Medicaid costs is to eliminate the Spousal Refusal provision. I work on a grant that trains local district Medicaid staff and repeatedly hear that individuals with millions of
                             dollars in assets utilize this provision to refuse to make their assets available to their institutionalized spouse. These couples have the means to pay for their own nursing home care but choose to utilize this loophole to
2594   Website Submission    Take a look at Special Education/Medicare/SSI




                                                                                                                                                                                                                                                            87
 #                  Author                                                                                                            Proposal
2595   Website Submission    Look@ $ being spent on OMH PMHP. $10 mill+ on those already in NHs. Easy$ 2 save.

2596   Website Submission    We need to put Medicaid on the road to better quality services at lower costs. New York State Medicaid should consider applying immediately for enhanced federal funding (90% federal) for support for health homes to
                             create linkages to other community and social supports for individuals with 2 chronic conditions, l chronic condition and at risk for another or one serious and persistent mental illness. Support is available for 2 years
2597   Website Submission    1.Ask patients to describe recent experiences/procedures and suggest what could have been done differently to reduce costs.
                             2. Test out different methods of communication (ex: patient initiates on line; dept sends surveys; ask MDs to distribute, etc.)
2598   Website Submission    Perhaps mental health services would be used more efficiently if mental health patients were given vouchers for services they could use during the year to prevent inpatient stays, and rewarded with cash bonuses if they
                             have no inpatient hospitalizations for the entire year. The vouchers could be used for extra case management services, psychiatric treatment, individual or group therapy, outpatient substance abuse services, peer
2599   Website Submission    Institute the Buy In on the Medicaid Buy In Program for Working People with Disabilities (MBI-WPD

2600   Website Submission    Stop paying for Medicaid Cabs/ make this expense be justified in most cases public transportation is available.

2601   Website Submission    My suggestions are instead of allowing hospitals expand their ER's; have them co-locate urgent care centers next to their ER's. I would guess that a very high perecntage of ER visits could be just as well handled in the
                             urgent care center. This would also put more urgent care centers closer to the poor. We should also reimburse taxi cab companies for providing transportation to the urgent care centers which would be far less costly
2602   Website Submission    Regarding drug treatment programs: Our feeling is that the entire approach should be re-designed. There should be incentives given for decreasing methadone doses, frequent drug testing for assessment of continued
                             illicit use while in treatment and eviction from program if illicit use continues. We would also support less frequent admissions for detox as these are frequently abused by patients who have no real intention or
2603   Website Submission    Stop paying for over-the-counter medicines such as ibuprofen, acetaminophen.

2604   Website Submission    require annual primary care visits for continuation of benefits

2605   Website Submission    increased education of chronic illness management, educators assigned to high-utilization patients.

2606   Website Submission    diabetic, hypertensive, obese patients have to have some accountability in their own healthcare,and MUST change their way of life.I would rather subsidize a health club membership that more drugs. At least that would
                             be beneficial. We can't just keep thowing more drugs at them. That is not making the any healthier and just costing the system more and more money.
2607   Website Submission    cutting back the Over the Counter meds covered. Vitamins should be covered for children up to a certain age only( say 16),and for adults over 65 yrs old. Everyone should be able to afford $3.00 for #100 vitamin
                             tablets. Most time they only refill a 30 day supply every 2-3 months anyway,so they are not taking them everyday anyway. Also laxatives like docusate, senna and metamucil are inexpensive enough to be paid for by the
2608   Website Submission    here has to be a cap on all the programs. Other states do it

2609   Website Submission    other states require the patient pay their copyas for their drugs. $3.00 copay for a $800 atypical antipsycotic is pretty cheap. They just spend the $3.00 on lottery tickets. I see it every day. Why should the pharmacy have
                             to write off hundreds of dollars a week in non-paid copays,that they are entitled to.
2610   Website Submission    For years I have thought that the Prior Approval of Non covered drugs was a joke. Everything not covered gets approved,just with a phone call from a doctor's office. Any other insurance company would want proof of
                             therapeutic failure of a non-formulary drug,or particularly a generic vs brand. My insurance would not approve PROTONIX (for stomach acid suppresion) over the generic equivalent. There is no reason for it. Yet
2611   Website Submission    I don't see why medicaid could not be a primarily generic medication based program. When dealing with patients with private health insurance, MD's need to be very aware of the restrictive formularies imposed by each
                             insurance company, considering cost-effectiveness of the meds that are prescribed. This is not as much the case when dealing with medicaid patients. Medicaid should mandate use of generic meds for first line
2612   Website Submission    Additionally, as a health care provider, I've noticed that many patients, when prescribed a new medication, take one or two pills, decide that they don't like it and stop, returning to their MD for a new script or stopping
                             treatment completely, wasting often hundreds of dollars of unused meds. Perhaps, when starting new meds, a one week supply should be filled initially with the bulk of the script filled should the patient choose to stay
2613   Website Submission    Recipients of Medical Assistance, when able, should be required to complete community service and or assist selected companies to increase consumer education, conduct mailings, etc. Physicians should determine if
                             the consumer is able to work. There should be a list of companies/ government agencies/ community offices along with a list of the type of 'work' that is available. The Medical Assistance should be viewed as a 'dollar'
2614   Website Submission    Vendors often charge exorbitent prices for medicaid services, especially for durable medical equipment. Why not put a cap on what Medical Supply locations can charge?

2615   Website Submission    f a Medicaid provider (say, a dentist) is not available in a given area, a person has to travel a distance to receive dental care. That travel adds additional medicaid cost. Why not require every medical or dental provider
                             to provide Medicaid? or, at least, a specific percentage of providers to make services available in each community. Those providing services could do so, say, for a three year cycle, after which, other providers in each
2616   Website Submission    Fixed rates for some medicaid services are unjustly low and the paperwork for reimbursement is difficult. These are the main reasons many practitioners or resources refuse to accept Medicaid consumers. Why not
                             establish a specific just reimbursement amount to be paid to providers every six months (much like grant payments) instead of reimbursing for each individual service?
2617   Website Submission    I worked for a Medicaid agency in another state, and I spent quite a bit of time analyzing dental claims. That state managed its own claims system and had no HMOs, so this idea may or may not be useful to New York.
                             I found problems with the way dental claims were billed. For example, the first tooth to be filled in an appointment was paid at a higher rate than the subsequent teeth filled during the same appointment. Yet because of



                                                                                                                                                                                                                                                              88
 #                  Author                                                                                                           Proposal
2618   Website Submission    Eliminate NYS nursing home minimum standards and follow the federal guidelines. Much of the content is redundant and duplicative. Nuances between the two are insignificant. There may be a few state specific items
                             that may want to be kept. These can be condensed and distributed in a much more efficient manner. Many state regs are "upsized" and not necessary to meet the desired outcome.
2619   Website Submission    Eliminate local town code required inspections of SNF,EH, ALP,etc.. Currently we must pay a fee for these inspections which have already been by DOH survey.

2620   Website Submission    Proposal: Use Medicaid and/or State Children?s Health Insurance Program (SCHIP) funds to pay for university sponsored student health insurance plan ( SHIP) under an alternative coverage program (when it is
                             determined that the alternative coverage of the University meets Medicaid standards and results in cost savings to the state).The federal law allows for Medicaid and State Children?s Health Insurance Program (SCHIP)
2621   Website Submission    Long-term care financing should be overhauled to require additional private pay contributions which would provide incentives for long-term care insurance and lower cost alternatives to institutional placements.
                             Medicaid was designed for low income/poor, however, it is widely used to finance nursing home and long-term care as many individuals shield their assets and refuse to pay for the cost of their care. NYS should find
2622   Website Submission    The high users of Medicaid often have co-occuring pysical and mental health issues and also substancee abuse. Many of these people also have vocational and stable housing challenges. Maybe try more innovative
                             bundling rather than just traditional managed care but try to wrap in the things that are social determinants of health as well. Find ever economy of scale, e.g., bulk purchasing and then incorporate pay-for-performance.
2623   Website Submission    In response to the request from the MRT for input from stakeholders regarding specific regulatory or administrative changes to improve quality of care while reducing Medicaid costs, the following recommendations are
                             submitted for consideration: revise OASAS Part 822 regs and DOH Article 31 regs to allow for a ""chronic care"" category for clients who suffer from multiple problems negatively affecting their abilities to function
2624   Website Submission    Right now, we are reimbursing people for private insurance when they are not even a part of the Medicaid case, and their income is not used in determining the eligibility of the person who is on Medicaid - common
                             example: a child eligible for Medicaid based on a waiver program - and mom, dad and other children have health insurance thru one parent's employer - we reimburse the parents everything they pay for the insurance,
2625   Website Submission    Another issue - reimbursing people in the MBI-WPD program for their Medicare premium, or other insurance - when technically they are supposed to be paying us a premium for their coverage, if they are eligible
                             between 150% and 250% -of the FPL -
2626   Website Submission    I have worked in a home care agency and now a TBI waiver provider for the past 3 years and have gained alot of insight on the TBI manual as well as the NHTD manual.

2627   Website Submission    Prescription drug advertising in the general media encourages the ordering of more expensive medicines. I believe there should be a $1 surcharge levied on each ad for prescription medications in general interest
                             publications. Advertising in medical/clinical/other trade publications would be exempt. Similar to the public goods pools, surcharges collected could help pay for indigent and other shortfalls for Medicaid payments to
2628   Website Submission    In a nursing home, a resident on managed medicaid, in for rehab, completes rehab when the insuance coverage ends....YET, nursing home regulation requires that the facility issue a notice of discharge which the
                             resident can appeal if they do not want to leave....they get to stay at the nursing home for FREE...insurance ends, will not pay, resident has no means to pay...sometimes the appeal takes up to 6 weeks- a free stay...no
2629   Website Submission    The Medicaid Redesign Team has a unique opportunity to include Medicaid reimbursement for language assistance services as part of redesigning Medicaid. By doing so, it will achieve the Medicaid Redesign Team?s
                             stated goals to reduce costs and increase quality and efficiency by (1) increasing patient safety, (2) eliminating health disparities, (3) improving patient outcomes, and (4) achieving Medicaid savings. We offer the
2630   Website Submission    New York State must reform the regulatory and administrative CON systems that govern the medical facility review process. The current system is not conducive to nimble expansions in a cost-saving manner. The
                             most effective model would be to establish a discrete, limited menu of services such as HIV or STI testing, pregnancy testing and counseling and contraception at different locations targeted to particular health needs of
2631   Website Submission    Expansion can take the form of either part-time clinics or extension clinics, where we partner with particular agencies to provide services they are unable to deliver. PPNYC has, via our Mobile Medical Unit (MMU),
                             brought discrete services to community colleges as well as to other underserved locations. Our experience has shown that college health centers, as but one example, often do not have the capacity to address the multiple
2632   Website Submission    We urge New York State to explore ways to reform regulations in order to expedite the review process and allow family planning providers to expand their services into other community-based settings. It would not
                             only increase access to reproductive health care, but also allow these providers to receive Medicaid reimbursement. Equally important, this model would be less costly and less time consuming than building and
2633   Website Submission    imilarly, New York State should revise the system of credentialing providers for managed care contracting, including Medicaid managed care plans. Currently, each Medicaid provider is required to credential each of
                             its clinicians with every managed care plan. We urge New York State to develop a uniform, universal credentialing process that would apply to all commercial and public health insurance managed care plans. This
2634   Website Submission    Family planning providers like PPNYC have long played a critical role in screening their patients for Medicaid eligibility through our on-site entitlement model. We have successfully enrolled thousands of clients every
                             year into Medicaid programs. We follow up with the local departments of social services (or the Human Resources Administration in New York City) to track our patients? Medicaid applications and make sure that they
2635   Website Submission    We urge the Medicaid Redesign Team to consider Medicaid reimbursement for family planning providers and other health care providers that screen their patients for public health insurance eligibility. Increasing
                             patients? Medicaid coverage would result in more cost-effective care in the long term: insured individuals are less likely to delay care and more likely to seek primary and preventive health services. Reimbursing
2636   Website Submission    In addition, the Medicaid Redesign Team must work with the State legislature to facilitate passage of a bill (BILL NO. A00661; reintroduced by Assembly member Richard Gottfried earlier this year) that would
                             implement Medicaid reimbursement for language assistance services. As mentioned earlier, family planning providers are often the only source of health care for underserved communities, many of whom are limited in
2637   Website Submission    1. What specific reform proposals should be enacted that will improve quality and/or reduce costs in the Medicaid program?

2638   Website Submission    2. What specific regulatory or administrative changes should be implemented to lower costs and/or improve quality in the Medicaid program?
                             A. Apply for State Plan Amendments to
2639   Website Submission    3. What current elements of the Medicaid program truly work to control costs and enhance quality and should be preserved?
                             A. DOH Chronic Illness Demonstration Program with peer initiatives (see appendix 13)
2640   Website Submission    You need to first cut the drug coverage- people should not be on 25 meds/month. Other states mandate a max of 6 drugs/month. The drug formulary also needs to be changed- 1-2 drugs from each class (generics
                             ONLY) should only be covered; our medicaid patients get the best drug coverage ever!



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 #                  Author                                                                                                            Proposal
2641   Website Submission    Peer services: There are a number of innovative approaches to help engage people with chronic illnesses in self care, to coordinate primary care, to improve services and help this population find community alternatives
                             to costly avoidable inpatient stays and ER visits. Peer services are playing a key role in reducing these costs by providing a personal, active, consistent and persistent relationship with each person?s recovery.
2642   Website Submission    Engagement Services: Assertive engagement services need to be available to all as an integral part of the managed delivery system. While our mental health system has developed the tools to engage even the most ?hard
                             to serve hard to find? individual in their own wellness and recovery plans, our current system designs make those models the exception rather than the rule.
2643   Website Submission    Contract and Monitoring Safeguards: Absent strong contractual and monitoring safeguards, turning over full care responsibility to the health plans will weaken many of the most exemplary members of our community
                             mental health system. There is no evidence across the country that on their own health plans and the medical system have the experience, skills, and ?feet on the street? style necessary to engage our ?high cost high
2644   Website Submission    Recovery Homes: We support mental health ?recovery homes? for the majority of these ?high cost high needs? individuals. These recovery homes should be a requirements for all managed care contracts (MCOs
                             and/or BHOs), regardless of the carve-in or carve-out strategy chosen. They should meet all CMS requirements for health homes, achieve these standards by hiring peers and using self-help strategies and be based in
2645   Website Submission    Regional Managed Behavioral Carve-Out: We strongly support a regional managed behavioral health carve out that either focuses care on people with serious mental illness and addictions (the current definition is more
                             than 20 outpatient MH visits or 30 inpatient days) or that carves-out all mental health services (similar to what has been done successfully in Pennsylvania?s county based system), This should be implemented over the
2646   Website Submission    We urge the state to apply for a state plan amendment that establishes Medicaid reimbursement for peer services, services operated by people with psychiatric treatment histories who bring critically needed and unique
                             engagement, support, health coaching and crisis relapse prevention skills to our systems of care.
2647   Website Submission    Implement additional state plan amendments to reconfigure our mental health clinic and case management services to apply for the flexibility afforded in the 1915.i Home and Community based Services option (see
                             attachments), We understand the concerns about such a sweeping state plan amendment but would suggest that it may be possible to combine it with a 1915b waiver, gaining the advantages of both.
2648   Website Submission    During years of working with families whose children receive SSI benefits for mental health issues, I have noted that the money that they are receiving is often not used in the manner in which it is intended. I have seen
                             many families using the money "for the children" to purchase big screen tvs for bedrooms, multiple gaming systems, family vacations, mortgage payments, expensive electronics, etc. This is also a huge motivation for
2649   Website Submission    Should be a citizen of United States.

2650   Website Submission    Should be a resident of the State for at least 6 months

2651   Website Submission    As you know many many of the 25% of NY State residents who have Medicaid are not really poor. THey just "work out" their life to fit into the requirements to be eligible for Medicaid. It's totally free to them. THey
                             have no clue that other people work hard and pay taxes to pay for their socialized medicine. I suggest that with the exception of old people and disabled people almost every body on medicaid will have to pay a very
2652   Website Submission    Merge Child Health Plus B into Medicaid. At this time they are two separate programs administered by two separate agencies. There are hundreds of families in NY that part of the family is on a Medicaid/Family
                             Health Plus case and another part on ChpB. This is one family with two different people handling their yearly recertifications, combine the programs which would take a small change in wms and you now have one
2653   Website Submission    Facilitated Enrollers, they should not be allowed to recieve commissions for enrolling clients into a system paid for by the taxpayers. If facilitated enrollers are necessary then they should only be allowed to recieve a
                             regular weekly paycheck with no commission or bonuses. It will help to keep them a little more honest as some do have the tendancy to keep out certain information from an application to help the client become eligible
2654   Website Submission    Resource Test for clients. I don't know who came up with the great idea that resources for all but SSI related clients is exempt but in my opinion that had to be the not the brightest person in the State. Without access to
                             peoples bank accounts examiners have lost a huge fraud tracking tool. In addition many clients figure that since the resources are exempt the income coming in from them such as interest and dividends don't count
2655   Website Submission    Attestation to income, another bright idea. Because we know no fraud exists in Medicaid lets just make the examiners take the word of the client how much they make. It's not working.

2656   Website Submission    More investigative tools for the examiners. We can check in our own county if someone owns rental property or has a dba. We have no access to other county's information so a client could own multiple businesses or
                             rental units and we have no way of finding out.
2657   Website Submission    Residency, at least a year for community Medicaid, longer for nursing home care. I understand that this can't be done with refugees but dental students from Idaho bringing their spouses and children who all sit on NYS
                             Medicaid has to end. Shipping Grandma up from South Carolina for nursing home care has to end.
2658   Website Submission    Nursing Home care, try a program where you pay family members a small amount to stay home and care for their parent or grandparent. Many people who have just slight dementia or alzheimers could stay home if
                             family members could afford to stay with them. You don't have to pay them alot, there are plenty of people out there with parents in nursing homes because they can't afford to quit their minimum wage job to care for
2659   Website Submission    I don't understand why there is such fragmentation in the Department of Health. In particular, why is their a Department of Health Insurance Programs and a Department of Insurance for the CHP Program and
                             Facilitated Enrollments. Aren't they working with the same health plans and should have more coordination and integration. It seems to me that to work more efficiently the Department of Health to take a hard look at
2660   Website Submission    The "5-year look back" period for Medicaid eligibility has inspired a very lucrative "Medicaid Planning" cottage industry within the legal and financial professions. Elder Law attorneys can now specialize in moving
                             assets out of a client's name in order to prepare for a Medicaid application in 5 years. I think this loophole MUST be addressed in the redesign of the system. I recently heard an attorney boast that "Some of the richest
2661   Website Submission    I direct an OMH licensed outpatient mental health clinic. To address a no-show rate of 25%, we instituted a policy that any patient, regardless of insurance carrier, who is a no-show for an appointment or cancels with
                             less than 24-hours notice, is charged $10. This has resulted in a 25% increase in visits AND a much higher percentage of case closings. Patients who are not serious about their treatment and attend occasionally are not
2662   Website Submission    The current requirement for annual recertification of mothers with children is
                             unnecessarily disruptive and can more rationally and economically be done every two years.
2663   Website Submission    Hire an independent group of investigators to uncover fraud. Have their pay based on how much they save the state. Even at 50% the state would make out well and so would they.




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 #                  Author                                                                                                               Proposal
2664   Website Submission    Seek a waiver from Civil Service to fill positions without using Civil Service titles/lists. Oversight of the Medicaid Progam requires, in-depth knowledge of state and federal law/reg., advanced technical skills, clinical
                             background etc. Being restricted to top scoring test takers limits the ability of the Medicaid program to obtain the people with the most relevant skill sets. For example, we've applied for federal funding to plan for a dual
2665   Website Submission    One of my concerns has to do with the amount of medications that are waisted on a continuum. For example when a medication is decreased, let's say from 60 mg to 20 mg at times, clients may have a 30 day supplies of
                             unopened package when the change is made and the medication has to go to waste even when the pack or bottle has not been opened. Pharmacist has told me that Medicaid will not accept medication to be returned to
2666   Website Submission    we have providers that are always changing either the types of meds or titrating upward or downward after a short time and of course once a package is opened the rest has to go to waste. Private insurance has a system
                             in place that if you ordered a med and no longer needs it it can be returned if it is unopened.
2667   Website Submission    Before deciding to cut reimbursements to providers and facilities (which is always the first thing done), there needs to be better screening of who is actually eligible. Many people come to NYS/NYC specifically because
                             it is easy to get benefits and quick to get benefits. In other states you have to be a resident for a year before being eligible and to maintain your benefits you have to continue to live there. Not so in NY. So you can come
2668   Website Submission    Don't make mothers of children recertify every year. It interferes terribly with children's medical care. Every other year would be quite enough.

2669   Website Submission    Aggregate all medical imaging and laboratory results in New York State on a common state wide HIPPA compliant web portal for access by patients and their treating providers across care settings (practices, clinics,
                             hospitals, etc.) and for integration into the Statewide Health Information Network for New York (SHIN-NY).
2670   Website Submission    Reducing the all six-month approval paper to annual: The NHTD waiver recently changed the service plan requirement to annual and has issues annual Notices of Decisions (NODs). Doing the same in the TBI waiver
                             is strongly suggested. This reduces the amount of paperwork service coordinators and the local Regional Resource Development Centers (RRDCs) almost in half. It is also suggested that the Individualized Service
2671   Website Submission    Eliminate the signature on the Individual Service Report (ISR): In the most recent version of the programmatic manual, a change was made requiring the signature of the participant on the ISR. Up until this point, the
                             participant signed their service plan requesting specific service hours whereas individual service providers reported on the participant?s progress or lack of progress through ISRs that were only signed by the service
2672   Website Submission    Have annual detailed plan (aka treatment plan) requirements: If the detailed plans for services were also required annually with the changes mentioned above, all annual paperwork would be due and completed at the
                             same time. This would save service providers resources they expend into tracking all requirements of the program.
2673   Website Submission    Reconsidering the role of the RRDS: Currently the RRDSs have the impossible job of monitoring hundreds of participants in their regions, reading all of their service plans, individual service reports, plans of
                             protective oversight, etc. The RRDSs could accomplish more and handle other issues in need of their attention such as crises, developing resources, evaluating level of care ongoing, etc. if this arduous task of
2674   Website Submission    1. Reduce supervision requirements for clinical services (ILST, PBIS) from biweekly to monthly. It is important to note that this supervision is non-reimbursed. There are many unfunded activities associated with
                             supporting a billed service hour for community-based programs. Some of these costs include: travel time, gas, wear and tear on car, documenting sessions, completing related paperwork, interviewing new clients,
2675   Website Submission    Add a part of the manual/some specific training that specifically addresses billing: Billing and overall Medicaid Provider Compliance has been a major concern since the increase in OMIG audits. As a service provider,
                             we learned more about how, when, and what to bill based on the program?s manual during our OMIG audit than in the years we spent attempting to remain compliance with the program?s manual from a quality
2676   Website Submission    Allow an increased caseload for Service Coordination (aka case management): If the program is more person-centered and not paper-centered and paperwork is reduced as mentioned earlier, workers would be able to
                             effectively work with more people and have larger caseloads. They would spend more time working with participants. If paperwork is reduced, they could handle a caseload of approximately 23. Although 17 is the
2677   Website Submission    Allow Electronic submission of paperwork: At some point, it would be important to consider the cost-savings that can be generated in transitioning to a ?paperless? administration of the program. This would certainly
                             eliminate hidden costs and risks associated with lost records, filing, etc. If done correctly, it can also enhance care and efficiency.
2678   Website Submission    Change Staff Qualifications and Training Requirements: It is important to obtain service provider input about all changes but especially this suggestion. Many current requirements for personnel are meaningless or
                             restrict service providers from hiring individuals who have more experience or a degree that provided them with greater knowledge but do not qualify while allowing service providers to hire someone else who
2679   Website Submission    It would be beneficial to evaluate the current structure of these waiver programs and assess its effectiveness. Individuals holding various positions in DOH management and within RRDCs have changed throughout the
                             years yet the same issues despite two program manual revisions remain. From our point of view it is clear that problems will continue to arise if the programs structure does not change. Roles may need to be redefined,
2680   Website Submission    Shared cost for participants requiring higher level care: There are a number of participants whom are served by this program who require higher level care (i.e. high amounts of oversight/supervision/1-1 care).
                             Implementing a system to explore what unique services or arrangements are needed to support individuals with higher care needs would help the program support those with higher needs in a more cost effective way.
2681   Website Submission    Partner with participants and families: In the past, there have been some family members and participants whom were willing to provide private funding towards housing solutions for these participants with higher care
                             needs. Many issues emerged related to what was mentioned in the above paragraph but if a model can be developed, it is likely additional savings can come from family members whom would be willing to contribute
2682   Website Submission    Shift towards a more managed care administration of the program: Right now, enormous resources are put into managing day-to-day cases of participants. A dramatic change in administration would most likely result in
                             a significant decrease in cost. While I am sure the details would need careful consideration, one suggestion would be to have the RRDC be responsible for approving the total cost of the plan and have the provider and
2683   Website Submission    There is a huge gap in services for people with brain injuries who may not need nursing home level of care yet require help to avoid costing the state money as they enter crisis (i.e. jail, hospitals, institutions). It is likely
                             such individuals can be sustained with limited support and it might make sense to create an intermediate level of support for these individuals.
2684   Website Submission    If the programmatic manuals and regulations can be integrated into one, this would allow the state to have one administrative structure instead of two for these programs. In addition, it would reduce administrative costs
                             for providers whom must try and keep track of the trivial differences between the programs. I would like to emphasize to proceed with such a step carefully as in the past changes have so disrupted the programs and
2685   Website Submission    Managed care companies providing medicaid to SSI clients do not pay for in patient hospitalizations. Payment for inpatient hosptialization comes from a different medicaid source. Managed medicaid health plans
                             therefore have no incentive and in fact have a deincentive to prevent a client from hosptialization!
2686   Website Submission    Transportaion to treatment services is vital! Medicaid transportation for the SSI population is crucial to their continued stabiltiy to the community.




                                                                                                                                                                                                                                                                    91
 #                  Author                                                                                                             Proposal
2687   Website Submission    1. Utilize the FE (Facilitated Enrollment) Program more.
                             Since the end of face to face people are sending in applications wrong to DHS, therefore backing up caseworkers making months behind because they are required to reach out to each and every applicant, every month
2688   Website Submission    2. FE's could educate the people that come to them about finding Doctor's, better continuity, communication and keeping them out of ER's unnecessarily. communication = better use of resources. While working at a
                             Hospital saw people using ER?s unnecessarily, ex. Pregnancy tests, sore throats, coughs, ear infections, these visits should go right to the Dr. first, not an expensive ER visit. Better educate on Managed Care Plans
2689   Website Submission    3. Redesign the application, with input from FE's, Quality Assurance, and DHS workers, not people that sit in Albany and do not use the application on a regular basis.

2690   Website Submission    4. Use FE?s for enrollment in other commercial health insurance programs as well.

2691   Website Submission    If Resource test is to come back have Retirement plans exempt from resource test, look at other assets.

2692   Website Submission    We know from many studies that when people have insufficient access to necessary mental health care ? they needlessly suffer and, in desperation, often overuse other medical services. This is not only potentially
                             harmful but actually increases medical and other costs. We can be effective, humane and cost-saving without putting our most vulnerable and needy citizens at disastrous risk
2693   Website Submission    Devise plan for DOH and OMIG to work together along with the Social Security Administration to combat fraud, concerning SSI cash recipients, mainly in counties in Southern New York. With the cost of living so
                             high in these area's, it would be hard for anyone to live there with only SSI cash.
2694   Website Submission    Please redesign the Medicaid coverage offered to low-income residents to coinside more closely with the coverage that the average private sector residents have i.e. drop the cadillac coverage that is currently offered and
                             stick to basics only. Also let's have a 1 year residency requirement before coverage begins. New York needs to follow more closely what other states are doing.
2695   Website Submission    I would suggest Medicaid be modeled after a managed care organization.

2696   Website Submission    Edits should be set to defer duplicate claims and payments.

2697   Website Submission    Procedure codes should be carefully monitored by trained staff.

2698   Website Submission    Medical necessity should also be a priority for authorization of treatment.

2699   Website Submission    Excessive services should be immediately flagged by the system. -

2700   Website Submission    More should be looked at prior to a service being performed rather than retrospectively.
                             -The way Medicaid is set up now, surgeries performed are retrospectively reviewed. Unless a surgery is considered cosmetic, there is no prior approval required. For example, any female could have a hysterectomy
2701   Website Submission    There are too many overrides by pharmacies for medications and this is extremely important when looking for fraud. It makes it too easy for recipient to continue on narcotics for extended lengths of time.

2702   Website Submission    There needs to be a way to identify when a recipient is using transportation for something other than Medicaid services. I know I used to work in Workers' Compensation and I know there were recipients who used
                             Medicaid to pay for office visits to doctor's for a Medicaid related service. It is easier for them to do that than send Workers' Compensation a record of dates of service and mileage in order to get compensated.
2703   Website Submission    Long term care is only going to continue to grow. I know the nursing home my mom is in now using one pharmacy to fill 30 day prescriptions only. Why not use mail order pharmacies and do 90 day prescriptions. I
                             know that currently my mother is private pay, but the nursing home will only fill her medications from her pharmacy at 30 days. We are spending down much faster because of this. The pharmacies appear to benefit.
2704   Website Submission    In this incredibly challenging economic environment, it is very important to develop innovative and effective ways to maximize state resources. In that regard, the Council on Accreditation (COA) can assist the State of
                             New York by relieving it of some of its regulatory oversight by using accreditation as an indicator of a quality human service provider.
2705   Website Submission    ATPA supports the ""carve-out"" of OASAS and OMH Medicaid to the respective ""0"" agencies. This ""carve-out"" is the Medicaid monies which pay for SUD treatment services. We do not support DOH having
                             responsibility for managing behavioral Medicaid monies. In order to accomplish the greatest savings in Medicaid while continuing to deliver the most cost effective services to this population, OASAS and OMH must
2706   Website Submission    I think that you will find significant waste around pharmaceutical use in LTC and other residential programs. First, the pharmacy suppliers for these organizations provide renewals whether or not they are needed
                             (discharges, changes, deaths, etc.) leaving excesses that cannot be returned because they have been repackaged and/or arcane pharamacy rules. Second, particularly in psychiatry, medication changes are rapid and often
2707   Website Submission    SNTs- Supplemental Needs Trusts allow individuals to shelter hundreds of thousnads of dollars and still get FULL MEDICAID coverage. Something has to be done to change the rules that allow this sheltering of large
                             resources without any effect on ones's eligibility for government benefits.
2708   Website Submission    Transfer of Resources: people (disabled) are allowed to transfer their assets without due compensation and still qualify for FULL MEDICAID coverage, except for Nursing Home care.

2709   Website Submission    Third Party Health Insurance Plans are denying coverage for services renedered in a State or governmental facility, such as the Buffalo Psych Center, just because we are a government facility and we do not have a
                             contract with them.



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 #                  Author                                                                                                            Proposal
2710   Website Submission    There are not enough workers to pursue Outpatient billing to all TPHI sources, such as Workers Compensation, a very long, time consuming process, once handled exclusively by some OMH attorneys in Albany, and
                             there is potential for sizable reimbursement if pursued.
2711   Website Submission    In its new RULE thinking about CDPAP (Addition of section 505.8 to part 505 of Title 18 NYCRR) the state is proposing to include daughters, daughters-in-law, sons, and sons-in-laws as paid providers. This is a
                             good first step away from the antiquated set of rules that have governed thus far.
2712   Website Submission    Our firm was the Medicare Recovery Audit Contractor (RAC) in New York during the Demonstration program and now serve as a National Expansion RAC in the South. With the expansion of the RAC program to
                             Medicaid as mandated by the Afffordable Care Act (Section 6411), New York would stand to recover millions of dollars from overpayments very quickly by employing an experienced RAC such as our firm on an
2713   Website Submission    People with developmental disabilities should be seen by a dentist specializing in this area. An experienced dentist can quickly examine, clean & assess a person in one visit saving money on multiple visits. The patient
                             is less traumatized & receives better care. Proper dental care can prevent other medical conditions saving money in the long run.
2714   Website Submission    Over the years the misguided use of managed care plans has only resulted in reduced payments, less care for patients and stagnation. Fees from managed care plans start at the 2002 Medicaid fee schedule and are
                             reduced up to 50 percent from that. The net effect will be that in ten years the number of dentists providing care for the Medicaid population will be much decreased as practitioners retire without replacement. The
2715   Website Submission    FLHSA?s request is that Medicaid Redesign do more than increase quality and decrease cost: it must also aim for health equity and that means it must result in systems of:
                             ? Patient navigation - FLHSA believes that patient navigation and coaching programs should be supported and expanded to achieve better chronic disease management.
2716   Website Submission    NYS should accept federal criteria for qualifying medicaid recipients. For example, if some one is already on SSI or Medicaid, then they have already been deemed to have a qualifying disability and state eligibility
                             through a Level of Care Determination is unnecessary, wasteful and redundant. A diagnosis of a developmental disability is a permanent diagnosis, not subject to change.
2717   Website Submission    I am orignally from NJ & in the early 90's they redesigned their Medicaid program and it entailed something on the lines of: If you go on Medicaid & have 1 child they will pay & if you have a 2nd they will pay BUT
                             don't have a 3rd!!!! They will not cover it!
2718   Website Submission    to sit home and not be forced to loook for work. The economy may be bad now but it hasn't been for the past 18 years! I work in a local Nursing Home and have people here who can't get coverage because they can't
                             supply bank statements for the past 6 yrs due to their spouse passing away who handled all of the bills - come on now!!!!!!!! These are the people who realy need it - some of these people have no one to help them but us
2719   Website Submission    There should be a residency requirement minimum before an individual can become eligible for the benefits of Medicaid. People from as far away as Puerto Rico come to New York in the summer (only) and are
                             immediately given benefits of Medicaid and Welfare.
2720   Website Submission    Regional Task Force Auditors (one or two per county) to make personal visits to providers for compliance audits on the level of charges billed to the program. Documentation lacks by the providers and bills are
                             inappropriately submitted. This would be similar to the RAC and CERT audits by Medicare and may result in recoupment and penalty paid to the state.
2721   Website Submission    NYS Medicaid recipients should be required to receive care in NYS unless the care is unavailable within the state. I live in a county where Medicaid recipients receive travel vouchers for trips to another state (including
                             ferry passes) because the private medical providers in our community refuse to treat Medicaid patients.
2722   Website Submission    Epidemiologic studies have not demonstrated the efficacy of chiropractic with the exception of treating low back pain in which case it was no more and no less effective than standard medical care practiced by a
                             physician. Reimbursement for chiropractic care should be eliminated except for those treatments for which there is proven benefit. Public advertisement by chiropractors claim to have effective treatment strategies for
2723   Website Submission    Most private insurances have a deductable and a co-pay. Is it possible to do something simular thing with Medicaid. Even if it is a dollar per medical visit or medication. The exception would be well child visits and
                             immunizations. It could be based on income. This gives the medicaid patient a sence of self-worth and that NYS is there to help but the patient also needs to contribute. Nothing is free in life.
2724   Website Submission    Please note that the spend down policy noted below from the November 2010 Medicaid Aministration Report does nothing but drive up the cost of healthcare. If a beneficiary has a spend down they should be required
                             to pay the spend down amount to the state or pay their spend down amount toward their medical bills.
2725   Website Submission    As a Third Party Specialist for a Regional Drug Store chain, it is frustrating that when we call the NYS Medicaid Helpdesk, for quite some time they are not able to reverse paid claims over the phone. They have not
                             been allowed to do this for at least a few years now.
2726   Website Submission    I have seen many cases where a child is eligible for insurance benefits through a parent, but the custodial parent/primary placement parent, applies for medicaid and it is received with no investigation to the insurability
                             of the child through the non-primary placement parent. All avenues for insurability should be investigated before a child is placed into the program.
2727   Website Submission    Children are placed on full FHP or CHP benefits when the parent is capable of being fully insured through an employer. Rather than taking on the burden of full coverage and benefits, it would be better for the state to
                             suplement the additional cost of the employer-sponsored coverage for the child and allow the benefits to be administered through the employer sponsered plan.
2728   Website Submission    As someone who works in healthcare finance I am deeply concerned about the state of the Medicaid program. I think that the way the county offices are run in both Nassau and Suffolk are ineffecient. When I submit a
                             Medicaid Application/Recertification/Conversion to either county the cases are constantly being shuffled around to different workers. Also documents are lost on a regular basis. There has to be a more efficient way for
2729   Website Submission    Also I do not understand how people who have hundreds of thousands of dollars are able to have Medicaid pay for their long term care. These people should have long term care policies. Isn't that what they are for?

2730   Website Submission    The single best improvement in Medicaid was Medicaid managed care; a success. As the physician director of a large federally designated hemophilia center several issues remain:patients are sometimes assigned to
                             plans where important speciality services can't be coordinated by our hemophilia center. An example is dentistry. If the patient is in a plan that our dental department doesn't accept the patient's oral health may be
2731   Website Submission    Provide free birth control to everyone on medicaid.
                             These people need to stop having children they can not afford. I work but have a huge deductible i need to pay and then my coverage is only 80%. We need to find a way for people to stop thinking its easier, cheaper
2732   Website Submission    Any adult living independently in the community and receiving public aid in the form of Medicaid, food stamps or cash assistance should be required to be drug free as a condition of participation.




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 #                  Author                                                                                                           Proposal
2733   Website Submission    The system needs to be redesigned with the patient at the center. Support services should be appropriate and warranted not only by physicians but by decision makers for patients. The abuse in the system needs to be
                             targeted appropriately. Redesign should include systems to reduce the continual redundancy and lack of consistent of services across agencies that support the patient. For example in my case, nurses assess the same
2734   Website Submission    We are AHRCNYC (NYSARC, INC. New York City Chapter. We are a large Developmental Disability treatment agency in New York City. All our billing is through eMedNY, and it is Rate Based Instititional. We
                             operate under OPWDD guidelines.
2735   Website Submission    if you have not lived in NYS for more than 5 years and paid taxes in NYS you should not be able to receive benefits. To many people look at our MCD system as the cadilac of health care coverage. If something
                             happens to them and they need health care they come to NYS and we provide them what ever they need yet some people (elderly especially) have lived in NYS all their lives and they can not get coverage!
2736   Website Submission    If you are on MCD and have a baby the baby should be covered but the mother should not continue to have health coverage and continue to have babies while obviously they can not afford them. Unless the recipient is
                             suffering with a life long disability (ie: cerebal palsy, multiple sclerosis, mental impairment...) there should be a time limit to how long they can recieve benefits.
2737   Website Submission    From my experience, a unified Medicaid Systme for NYS would be beneficial as there would be uniform rules and regulations without the slight district to district differences. This would also assist in the need for Fair
                             Hearing Trials where Districts are forced to continue covereage for individuals who have transferred physically from the District. I also believe that proper education and training in necessary for the complicated rules
2738   Website Submission    am a Sr. Acct. Clerk with local government in NY, and simply question the NYS DOH institution of APG's to begin for OASAS clinics this year (OMH clinics already in force?). Per the APG calculator, our small
                             clinic would be in line to receive an annual increase of approximately 37% in Medicaid revenue. Not sure how this would help alleviate tax payers in any way since outpatient substance abuse treatment is very costly
2739   Website Submission    One area that needs MAJOR redesign is the fact that as medical providers, we are forced to bill Medicaid for patients that have settled their WC claim for a monetary amount due to a Section 32 settlement with the NYS
                             WCB. Settlement funds are designed to pay for on going medical treatment to the work related injury. As providers we are forced to bill the patients Medicaid product. Medicaid patients are continue to treat for their
2740   Website Submission    Please consider creating only one Medicaid program with one name and "one set of rules" rather than the cluster of programs Fidelis, Americhoice etc.

2741   Website Submission    Please consider a tiered out-of-pocket/co-pay fee schedule based on income/assets.

2742   Website Submission    OMH

2743   Website Submission    OASAS

2744   Website Submission    THERAPY VISITS

2745   Website Submission    NYSDOH

2746   Website Submission    ER / INPATIENT STAYS

2747   Website Submission    NOT FOR PROFIT MEDICAL INSTITUTIONS

2748   Website Submission    DIAGNOSTIC & TREATMENT CENTERS (D&TC)

2749   Website Submission

2750   Website Submission    MA AMBULETTE

2751   Website Submission    LONG TERM HOME HEALTH CARE (LTHHC)

2752   Website Submission    PHYSICIAN FEES

2753   Website Submission    RATES

2754   Website Submission    HMO

2755   Website Submission    ENFORCEMENT AGENCIES




                                                                                                                                                                                                                                                           94
 #                  Author                                                                                                             Proposal
2756   Website Submission    Privatize Medicaid with strict budgetary controls and rewarding the private companies a certain percentage more for doing a good job on MA saving dollars. Share the rewards.

2757   Website Submission    perhaps 20 someodd different hmos is unproductive and redundant and confusing and dentists would be more apt to participate if the patients were on the same plan for more than 10 days and then switched and history
                             could be checked and we could get paid a decent fee for services rendered. and perhaps if the omig would go after those providers that are BLATANTLY committing fraud instead of wasting time on doctors that hardly
2758   Website Submission    When dealing with forensic and civilly confined patients cost needs to be looked at much more closely then it is, I understand that medical care needs to be provided but it should not include elective things. The persons
                             that are civilly confined also have jobs and are being paid minimum wage, they should have co pays..I do. There is a lot of waste going on. elective procedures, unneccasary testing, labs being sent out STAT that don't
2759   Website Submission    Limit complete pairs of glasses to 2 per year for adults. Replacement of broken frames should still be unlimited, but adults shouldn't be losing their glasses so often. Make them show some responsibility.

2760   Website Submission    Be more strict with eligibility. I have too many patients in a rush for their glasses because they are going back to "their country" for 3-6 months.

2761   Website Submission    Make e-filing more user friendly. I tried it once a couple of years ago, but found the form much too confusing. It was hard to tell what spcifically pertained to me. Why can't it be based on the current paper form?

2762   Website Submission    No Lap Band Surgery

2763   Website Submission    1 Abortion Only-counseling on getting tubal ligation-strongly suggest

2764   Website Submission    Decreased/limited funding for large families. Economic need cannot be made because someone chooses to have children they cannot afford to raise independently-like many of the residents of Kiryas Joel in Orange
                             County
2765   Website Submission    Decrease transportation to schools for transportation for special education services. Should be provided "in house.

2766   Website Submission    please support the regional managed behavioral health carve out.

2767   Website Submission    Moving programs and services provided through OPWDD from state operated to voluntary providers will result in significant cost savings. I am currently invilved in such a project right now working with the
                             WNYDDSO to change a 13 person ICF from state operated to a voluntary provider, The Resource Center.
2768   Website Submission    Regulatory reform for OPWDD programs if done right will provide substantial cost savings. Look at reducing or eliminating regulations that do not impact on health, safety, or the promotion of independence,
                             integration, and productivity. Eliminating regulations that are duplicative.
2769   Website Submission    Allowing individuals on medicaid to have higher resource limits if they are using the money to stay in the community in place of moving to a certified residence. The money could be used to fill in gaps in services that
                             will allow someone to live in the family home as opposed to a OPWDD residence.
2770   Website Submission    Allow multiple treatment modalities in a single day other than what is allowable now. Seeing a client for group therapy and a medication visit in a single day is easier on the aged population, NOT TO MENTION
                             saving the State money on reimbursement for public transportation AND ambulette.
2771   Website Submission    Require Medicaid Managed Care insurers obtain MetroCards from the Managed Care Carrier

2772   Website Submission    ighten up medicaid eligibility. It is far too easy in NY State to shelter personal funds/resources. Attorneys make a living on advising the rich how to get on Medicaid so as not to have to spend their own money. Also,
                             families that steal their parents NAMI money which should go to Long Term Care payments should be prosecuted for misappropriating (stealing) their parents resources, making nursing homes into collection agencies.
2773   Website Submission    I believe that a major Medicaid savings can be obtained without impacting the homecare of recipients can be implemented by a major redesign of the NYC home attendant program. I believe that all the CASA offices
                             should be eliminated as well as most of the regulations governing home attendant services. All the Medicaid home care services and regulations in NYC should be folded into existing home care services provided by
2774   Website Submission    a checks and balance system needs to be in place so that Medicaid doesn't pay more than one provider for the same service rendered on the same day. An example of this is a lab bills Medicaid for a pap smear on the
                             same day that a provider bills for this same procedure (provider accidentally billed). Medicaid paid both providers and shouldn't have.
2775   Website Submission    Another suggestion would be that if a claim has an invalid procedure code on it, it would deny instead of $0 pay. They deny claims if the ICD-9/diagnosis code is invalid, but not if a cpt code is invalid. Of course, this
                             issue really doesn't have much to do with the task of the redesign team because it doesn't involve Medicaid loosing money, but it wouldn't hurt to add it.
2776   Website Submission    The medicaid card should have a picture of the medicaid recipient on the card to prevent unauthorized use of the card by another individual.

2777   Website Submission    Medicaid recipient who has a non-life threatening illness should be triaged and redirected from a hospital emergency room to an ambulatory or urgent walk-in facility. Perhaps an urgent care facility can be located in
                             the hospital.
2778   Website Submission    The Consumer Directed Home Care Program can be eliminated. It is duplicative of other, more effective programs and is prone to misuse. Particularly trouble is the provision that allows a person to get paid Medicaid
                             dollars to care for a sibling. Am I my brother?s keeper, indeed.



                                                                                                                                                                                                                                                            95
 #                  Author                                                                                                             Proposal
2779   Website Submission    Please support the Regional managed behavioral health carve out to continue the absolutely essential care needed by our citizens with serious mental illness. This is indeed a special population, one which benefits from
                             a flexible yet intensive menu of interventions. I have worked with people with schizophrenia for my entire career and seen the tremendous improvements that are possible when appropriate care is available. Any
2780   Website Submission    Community Health Workers (CHW) understand the complex realities of people living in vulnerable circumstances, such as Medicaid recipients. There is extensive evidence proving that ?high users? of health care who
                             are living in poverty and have various complicating issues will use health care services less and have better outcomes when their emotional, mental, and social needs are met. CHWs are uniquely positioned to approach
2781   Website Submission    To save Medicaid dollars and eliminate abuse, the ?Self-Attestation of Income? must be eliminated. During the time of application, a Medicaid applicant is allowed to self attest to her income if she claims to work off
                             the books, not file a tax return and is unable to get a letter from her employer.
2782   Website Submission    Seek to overturn the New York State Court of Appeals&#146; June 2001 decision in Aliessa v. Novello. This can be done via a State Constitutional amendment or further appeals of the decision. The state's finances
                             are going off a cliff and its taxpayers can no longer be asked to provide full health insurance to newly arriving immigrants. How is this not a public charge?????
2783   Website Submission    Medicaid should offer participants, and providers the right to place patients in the hospital for Observation services, mirroring the CMS guidelines for criteria to determine if they need further treatment as an inpatient or
                             if they can be safely discharged home.Observation services are necessary for diagnosis such as chest pain. Please consider this recommendation in the Medicaid Redesign. Thank you.
2784   Website Submission    Someone needs to look at the payment structure for diagnostic and tretment centers vs. out patient departments. Because out patient departments have always been paid far more than a DTC for the same service, they
                             receive reimbursements even under APG that can be more than $100 more for the same service as a DTC
2785   Website Submission    I am writing to absolutely urge you to reject carving behavioral health and substance use treatment services into general HMO plans, and instead to carve out such services into regional behavioral health carve outs such
                             as the New York Care Coordination Project proposal that also incorporates a rapid health home deployment. There is no evidence to support anywhere in the nation that traditional HMOs can both bend the cost curve
2786   Website Submission    Vera Institute of Justice, in collaboration with the New York State Office of Court Administration, established The Guardianship Project, a new? and we believe, promising? model of institutional guardianship that
                             returns clients from institutions to their homes and communities when possible, while generating significant Medicaid cost-savings. The Project?s team design, which includes attorneys, licensed social workers, property
2787   Website Submission    Why does MA pay for sex change operations for inmates?
                             - Why does MA pay for sex change operations at all?
2788   Website Submission    If a person is employed and has private health insurance and needs fertility medications many insurances do not pay for it, why does MA cover fertility meds?

2789   Website Submission    With managed care, if a client does not use their benefit, why are we continuing to pay the MC fees? There should be a way to tell whether it would be more cost effective for a client to be on managed care or fee for
                             service.
2790   Website Submission    whay does MA continue to pay for substance abuse/rehab for the same people for years and years. If the client does not want to be helped why are we forcing them and paying for the rehab. for nothing. It is like
                             throwing the money away.
2791   Website Submission    Limit personal services to 15 hours per week max

2792   Website Submission    The solution is simple. The managed care ban on reimbursing students in established programs must be lifted. NYS must make it a condition of any managed Medicaid contract that qualified students be allowed to
                             provide reimbursable service, just as they are now able to do under current NYS Office of Mental Health regulations. NYS must negotiate a fee schedule with any managed care company wishing to participate in its
2793   Website Submission    Straight Medicaid has no annual limit on outpatient mental health visits. This is far and above what a typical commerical insurance provides for coverage which is often 30 visits per calendar year. It is too easy for
                             providers and patients to fall into the pattern of weekly mental health visits without oversight as to goals accomplished. Indeed with unlimited visits there is less motivation to reach goals. The trend in mental health is
2794   Website Submission    Pursue "neighborhood policing" model : http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande?currentPage=all

2795   Website Submission    Stop paying for psychological services that have already been paid by Medicare
                             NY allows Medicaid to pay a supplement or copay when psychological services are offered to patients who have both medicare and medicaid. If a pt has just Medicare the provider is satisfied w that payment but if the
2796   Website Submission    Thesis:

2797   Website Submission    It is encouraging to see that New York State recognizes the need to address the diabetes epidemic by funding new programs such as Diabetes Self-Management Training (DSMT) starting this year. However, more still
                             needs to be done if we are to truly to tackle this growing health care challenge. More specifically, there needs to be a greater involvement in the health care of the quarter-million people with undiagnosed diabetes and
2798   Website Submission    The resource level for applicants in a skilled nursing facility should be brought back down to $5000.00 maximum. Raising that level to $13,800.00 was ridiculous.

2799   Website Submission    We have a large cohort of ""baby boomer"" consumers in our State-operated group homes for the developmentally disabled who are now in their fifties and sixties. Many of them are already on at least one
                             psychotropic medication, and as they get older, they will require additional medications for chronic problems such as diabetes, heart disease, and hypertension. As the number of medications each consumer takes
2800   Website Submission    More than one procedure code per facility in a day. I am a psychologist at Upstate Hospital outpatient and several of my clients also see psychiatrists at our facility. Some of them take Medicaid cabs. That means that
                             the state spends twice as much to get them to their appointments because I cannot see them on the same day as their psychiatrist at our facility. This is not only inconvenient for our clients, it is wasteful.
2801   Website Submission    Medicaid requires Prior Authorization for many drugs. I have never seen a Prior Authorization denied. A Medicaid represenative told me that is because NYS law does not allow a Prior Authorization to be denied.
                             NYS Medicaid should follow the example of other Insurance programs including Medicare D. Those programs require generics, require the physcian to prove that the patient needs a non-covered drug or require that a



                                                                                                                                                                                                                                                                96
 #                  Author                                                                                                           Proposal
2802   Website Submission    First,it is a bad idea for the funding of recovery oriented practices to be supplied by HMOs as opposed to funders who support recovery. Second, it would be a good idea to have a certification for peer services so that
                             there is a standard and their services will be reimbursable by Medicaid.
2803   Website Submission    please consider why the medicaid program is paying for the rx item VUSION ointment

2804   Website Submission    Drug and Alcohol treatment is another area that we see repeated use with high cost. As the Managed Care plans will usually not pay for this treatment it usually falls back on Medicaid to pay - so medicaid pays the
                             premium for the managed care and then also pays for the many carved out services.
2805   Website Submission    Clients leave the county, state, and sometimes country or get private health insurance but the managed care premiums continue to to out to the plan because the county office was unaware of the move. The money paid
                             out for these premiums are not refunded as the plan is at risk of being billed. The plans seem to have more power than the state as they determine what they will pay and what they will not. Suggestion would be some
2806   Website Submission    Non-essential, non-life threatening OTC items should NOT be covered under the Medicaid program for all Medicaid recipients. Examples of these include Vitamin B, Vitamin C, Acetaminophen, Ibuprofen, Lice
                             treatment, etc. There must be a way to eliminate these non-prescription items which the recipient should purchase on their own.
2807   Website Submission    Medicaid recipients, between the ages of 21 and 65, should be forced to pay their pharmacy co-pays. Making an individual financially responsible for part of their healthcare costs makes a person think twice about
                             abusing such programs. Currently all Medicaid recipients have the right to waive their co-pays and the pharmacy never sees that payment. Believe me when I say many, many recipients waive their co-pay because its
2808   Website Submission    tort reform.
                             As a resident physician, I witness thousands of dollars wasted every day on unnecessary tests (CT scans, X-rays, daily ""surveillance"" lab studies) obtained because providers aren't permitted to trust their clinical
2809   Website Submission    Reward individual providers for good, cost effective practice.

2810   Website Submission    Contract out payroll services to an automated system.

2811   Website Submission    Rededicate funds to outpatient/group home services since most OMH patients only require support rather than acute inpatient care.

2812   Website Submission    Any OMH facility that has more employees than patients? Bring in an outside efficiency expert to find out why so much money is being spent to support the work force rather than the patient population.

2813   Website Submission    Antiquated notions of access need to be re-examined. Facilities are being kept open to make them more accessible to a local community because of a PR back lash. All the facilities I know of are certainly accessible if a
                             person wants to drive for an hour or take public transport. The idea to consolidate services at Mohawk valley and Hutchings was not a bad one, and is obviously still in the long term plan. There was a small but vocal
2814   Website Submission    Lastly, you might want to go on record by explicitly stating you are trying to reduce pension payments when the media catches you in the act of working your current workforce to death through overtime, rather than
                             reacting like overtime is some unknown expense that you are unaware of...the public needs needs to have "downsizing the work force" and "attrition" explained to them, and your current workforce needs to have the
2815   Website Submission    Please change the program requirements so that insurance pays first and parents who are able at least contribute to the cost of caring for their children.

2816   Website Submission    Do not go through with medicaid paying for the pharmacy directly, there will no incentive for facilities to reduce pharmacy costs.

2817   Website Submission    Reimbursement for electricity is dollar for dollar, There should be a one time opportunity for facilities to invest in energey saving equipment like windows, operational equipment, cogeneration, solar panels or windmils;
                             allowing the facilities to get reimbursed for these projects in only one year as opposed to the current 30 years, this will provie long term savings.
2818   Website Submission    Force the union to reduce their operating costs (thousands of jobs were lost due to the closing of hospitals) which can then be passed onto the employees reducing the facilities expenses to the union.

2819   Website Submission    Allow the use of "med -techs" instead of LPN's for dispensing medication.

2820   Website Submission    Limit homecare to only 8 hours a day, otherwise commit to an institution.

2821   Website Submission    Open up more ALP licenses, but allow other operators not just existing ALP's or adult home or long term care operators an opportunity to enter the industry

2822   Website Submission    LIMIT MALPRACTICE AWARDS, many profesionals practice defensive medicine because they are afraid of a malpractice lawsuit to the piont of ridiculous. The ordering of tests is wasteful, a typical example is
                             ordering a colonoscopy in a 93 year old women in a nursing home, even if they found something 999 people out of 1000 would not do any surgery why spend the money and make the resident suffer
2823   Website Submission    Consider lower payments to therapists, psychiatrists, and psychologists who deal with the MI/MR populations.

2824   Website Submission    Please do not "reinvent the wheel". Please look at what Vermont is now doing to solve their similar cost escalation issue in their Medicaid health care program. Please read Dr. William Hsiao's recent statements before
                             the Vermont State Legislature. We all know what is the right thing to do for the New York people, but we are also aware of the very wealthy Insurance Lobby that will fight progress with every dollar they have.



                                                                                                                                                                                                                                                            97
 #                  Author                                                                                                             Proposal
2825   Website Submission    college students should not all be eligible

2826   Website Submission    participants need to volunteer as a payment for medicaid if they are unemployed-there may be exceptions based on medical needs

2827   Website Submission    hy not let a private company administer the programs which is overseen and verified by a smaller government body. One that speedily, efficiently and competently follows the rules yet has no direct interest in the
                             program other than the efficient administration. Then use some of the savings to root out fraudulent clients and claims of which there are plenty.
2828   Website Submission    Expand the use of nurses, social workers, and unlicensed community workers for care coordination for people with chronic illnesses.

2829   Website Submission    Support transitional care (from hospital to home, rehab to home, etc.) by nurses for people who are at high risk for re-hospitalization.

2830   Website Submission    Expand Childbirthing centers operated by nurse midwives. The potential savings to Medicaid through reduced complications, lower cost of care, etc. have been documented by several studies including a recent one
                             (publication in progress) of the Family Health and Childbirthing Center of DC by the Urban Institute. The birthing centers in NYC have closed because they are viewed by hospitals as an additional service, even though
2831   Website Submission    Talk with Peter Orszag about his idea for changing the standards for malpractice cases in ways that would encourage prvoiders to use evidence-based guidelines rather than practice defensive medicine.

2832   Website Submission    Get rid of the mandate for MD collaboration in the state practice act for nurses. Nurses already collaborate with MDs and this requirement adds to the cost of care and delays access to services. See the IOM report on the
                             Future of Nursing.
2833   Website Submission    Assign each family that has used a certain level of Medicaid a care manager (nurse would be good but perhaps a community worker who is trained for this role and works with a nurse) who can be available to answer
                             questions, proactively contact the family periodically to assess the family's level of health, etc.).
2834   Website Submission    reate "health homes" for people with chronic mental illness and put social workers in charge of them.

2835   Website Submission    Support school-based health centers that can serve families, as well. And focus on healthy policies and procedures in schools, particularly those serving poor communities that are most likely to have large proportions of
                             children on Medicaid/SCHIP. This is a long-term strategy, but we have to focus on how to change our nation's, our city's, our state's beliefs and behaviors in ways that promote health. Start with children in schools and
2836   Website Submission    NYS Medicaid needs to stop offering every available option and benefit.

2837   Website Submission    NYS must become better at policing the NYS Medicaid program and weeding out fraud and abuse by participants, as well as providers. Require picture ID's and fingerprinting and/or finger scans when presenting for
                             services.
2838   Website Submission    NYS Medicaid should NOT be granted to people who are already covered by other commercial insurance(s), except for specialized, life threatening services not covered by their commercial insurances. There should
                             also be a ""waiting period"" of 6-12 months for people who had commercial insurance available but voluntarily dropped it in order to get Medicaid. There should also be penalties for recipients who fail to report other
2839   Website Submission    NYS should develop and offer some type of "catastrophic" Medicaid coverage for people who are severely disabled or injured and need help, in addition, to what their commercial insurance may offer. An example
                             would be someone who may need nursing home care or extensive, 24 hour care at home that is not covered by commercial or Medicare insurance.
2840   Website Submission    Participants in the NYS Medicaid program need to be held accountable for any required copays and rules they must follow. If they refuse to follow the guidelines or regulations they should be given one warning and
                             then dropped, if they persist. (As an example: CT Medicaid has a program where some participants, with a high enough income, pay a monthly fee to be part of the program. If they're late with the fee or forget to pay it,
2841   Website Submission    NYS also needs to stop rewarding Medicaid participants financially for having more children while on Medicaid. If you can't afford to care for,and financially support, the children you already have, you should not be
                             rewarded with a higher Medicaid allowance for having additional children while on NYS Medicaid. A regulation should be put into place stating that whatever the size of the family is, when they apply for and are
2842   Website Submission    NYS should start some sort of "Work for Welfare" program. Medicaid and Public assistance recipients who have been in the programs longer than 6-9 months should be required to document that they have been
                             looking for employment (like people on unemployment) and be REQUIRED to take training to help them with skills and/or language barriers to allow them to become productive residents of NYS. Day care centers
2843   Website Submission    Eliminate or severely restrict coverage for conditions that are not truely life threatening or a serious medical condition. For example: Erectile Disfunction & Viagra, Cialis, etc.

2844   Website Submission    Medicaid/Managed Long Term Care-55 yrs plus and Medicare/Medicaid Long Term care
                             1.Evaluate 3-5 days (patient option)of social day care centers-providing transportation to a center,and a home health asst. to assist in AM or PM care at home.Social day care includes current events, day trips,meals,
2845   Website Submission    2.Evaluate what is provided in ""medical day care""-available 2-3 days per week. What are the medical services provided?
                             Does Dept.of Health evaluate utilization of Physical, Occupational and Speech Therapy for the seniors in programs?
2846   Website Submission    Offer the assertive engagement, care coordination and accountability needed to reduce costs and improve care for high need individuals with chronic conditions.

2847   Website Submission    There needs to be a mechanism where health providers can report no shows for appointments. We want to provide care, but if there are no consequences for not showing for appointments there is little incentive to keep
                             them. In our case it is the children who suffer. It also wastes our time and gives other medicaid recipients a bad reputation and diminishes providers willingness to participate in the medicaid programs.



                                                                                                                                                                                                                                                            98
 #                  Author                                                                                                               Proposal
2848   Website Submission    ARTICLE 28 RE IMBURSMENT FOSTERS WASTE AND FRAUD. I PREVIOUSLY WORKED FOR A NURSING HOME ARTICLE 28 DENTAL FACILITY. ,,,,, WE WERE INSTRUCTED TO TAKE ONE
                             FULL VISIT FOR EXAMINATIONS...... AND SEPERATE VISITS FOR X-RAYS ..... AS WELL AS ONLY BEING ALLOWED TO COMPLETE ONE RESTORATION PER VISIT .... THIS IS AN
2849   Website Submission    Without taking concrete steps towards significant reductions of Medical Fraud in our State,
                             all other initiatives will fail, because close to 30% of all Medicaid expenditures are being wasted
2850   Website Submission    You must protect access to quality mental health care now and into the future. Part of this effort is lifting the ban on managed care reimbursement for professionals in established training programs. NYS must make it a
                             condition of any managed Medicaid contract that qualified trainees (doctoral-level externs, interns and post-docs in psychology) be allowed to provide reimbursable service, just as they do now under current NYS
2851   Website Submission    Also, NYS covers so many more MEDICAID services than other states, I am forever hearing of people who located or re-located to NYS because they get more Medicaid services here. THIS state has to stop giving
                             everything away FREE, and look at even a nominal fee for service.Medicaid recipients will go to the emergency room for minor things because they do not have to pay the bill.
2852   Website Submission    the system should be designed to help people who are in need for a specific time period.

2853   Website Submission    it should limit the number of children it will support in a family. people can have as many children as the desire, the system will support 2.

2854   Website Submission    it should pay for tubal ligations and vasecetomy but not rehersals.

2855   Website Submission    people using the systems should have to earn their checks, if they are not disabled, clean up parks, clean up grafetti, litter along roadsides, etc

2856   Website Submission    parents(fathers) should be named at birth and required to support their children. if father unknown funds limited until determined.

2857   Website Submission    Support the "Regional managed behavorial health carve out". Recovery homes, peer services and COMMUNITY FIRST.

2858   Website Submission    As an employee in a physician's office I would like to tell you a few issues that we still have with medicaid patients.

2859   Website Submission    Dental billing should follow the private insurance model of time values per procedures. For example a cleaning has a time value of 25 min and a two surface filling/restoration may have a value of 45 min. Then this
                             should be the maximum alowable billed services for the time. As it is now I find it amazing that some practitioners do so much work.
2860   Website Submission    Send patients statements of services rendered similar to EOB statements that private insurance companies do.

2861   Website Submission    There is a lot of overtreatment and abuse in the current system and needs to be addressed or eliminate all dental services entirely since it is the state's option to provide.

2862   Website Submission    You must protect access to quality mental health care now and into the future. Part of this effort is lifting the ban on managed care reimbursement for professionals in established training programs. NYS must make it a
                             condition of any managed Medicaid contract that qualified trainees (doctoral-level externs, interns and post-docs in psychology) be allowed to provide reimbursable service, just as they do now under current NYS
2863   Website Submission    Presently there is no resource limit for Community Medicaid. Perhaps it is time to revisit our present regulations and policy in this area.

2864   Website Submission    Is there a way to make people pay their co-pays, for instance reduce their monthly amount that they get on Social Services by $1-5 dollars monthly. It may not make that big a difference immediately but, it will in long
                             run also give 10 visits yearly anything over that they need to pay a co-pay. (Something along that line) It's wasteful that use the Emergency room like its a primary care physicians office. Not like an Emergency Room.
2865   Website Submission    Certified Peer Support services should be provided by people with psychiatric treatment histories who bring unique engagement, support, health coaching and crisis relapse prevention skills to our systems of care.

2866   Website Submission    Assure strong consumer choice and rights protections and incentivize the provision of recovery, rehabilitative and peer support services.

2867   Website Submission    Offer the assertive engagement, care coordination and accountability needed to reduce costs and improve care for high need individuals with chronic conditions.

2868   Website Submission    Ensure strong contract provisions including limits on administrative costs and savings reinvestment funds.

2869   Website Submission    Carve-out all mental health services from the health plans (similar to Pennsylvania?s successful county-based system and to begin implementation immediately using a phased in regional approach.

2870   Website Submission    Establish Recovery Homes in Community Mental Health Centers, PROS or other specialized and comprehensive providers who meet state requirements for mental and physical health capabilities, as well as information
                             technology support. Providers should have a history of effective services for people with psychiatric disabilities. To be a recovery home they must employ peers in key care coordination roles and ascribe to self-help



                                                                                                                                                                                                                                                          99
 #                  Author                                                                                                             Proposal
2871   Website Submission    eer services:
                             The Governor should establish Medicaid reimbursement for peer services by applying for a state plan amendment that creates a certification process for peers as support, care coordinators and recovery coaches.
2872   Website Submission    I attended the meeting held last Friday at Hofstra University. As a Nursing Home Administrator I am certainly interested in changes to the Medicaid system. As I listened to the public comment I realized that no one
                             was going to mention the 800 pound gorilla in the room. RATIONING! My health insurance plan does not allow me full coverage, with nothing out of pocket, for all dental, medical and other allied services. Medicaid
2873   Website Submission    For individuals who receive services from OPWDD and are over the age of 21years they should not have to keep going every year for an updated psycholocical evauluation.There is no cure for developmental
                             disabilities. Only if there is a major change in the individual then an evauluation should be done. This would be a major cost savings.
2874   Website Submission    Any large agency that serves individuals with developmental disabilities should see that most of the money goes to the personal that acually cares for the individuals not the top adminstrators.
                             Check the salaries of all directors of large agencies example YAI, Heartshare ,ETC. It seems that the directors of these agencies collect a very large salary and the persons like the direct workers get a salary that is to low
2875   Website Submission    Give the family support services advisory councils more teeth so that when they see coruption they can do something about it.Give the stateworkers that power to fix an agency that does not do their job.

2876   Website Submission    Reinstitute Sanctions for Medicaid Recipents Not attending necessary Drug or Alcohol treatment.

2877   Website Submission    Consolidation of State Agencies - Persons in New York State with both substance abuse issues and mental health issues are regulated by two agencies - OASAS and OMH. Their rules are often in conflict and their
                             reporting systems duplicate costs for the provider. A person with such a "Dual" diagnosis essentially is left with no Agency ultimately responsible for their overall treatment. Neither Agency is accountable since the
2878   Website Submission    nnecessary Use of Emergency hospital services (NYS is ranked #50)- Require the growing number of ""urgent care centers"" to accept MA recipients and promote their use via educational programs for those applying
                             for or receiving public assistance and Medicaid. Use of these services, even if granted a ""medicaid premium"" of some sort would be far less costly that an emergency room visit.
2879   Website Submission    Detox reform MUST continue to be a priority for the Medicaid Redesign Team. Medically Managed Withdrawal Services in article 28 hospitals continue to be over-utilized. At least 90-95% of patients admitted to this
                             level of care do NOT require that intense level of service and should be referred to Medically Supervised Programs. In addition, patients in Medically Managed Services almost never access the next level of care while in
2880   Website Submission    New York State should administer medicaid eligibilty in every county across the State. Uniform processing, data collection and audit methods should result in efficiencies unrealized by the current system. This would
                             afford the State better controls over the rest of the "MA Redsign" effort as it is implemented.
2881   Website Submission    When contracting a service for an individual, create a review timeframe, so that the contracted service and the outcomes it produces are reviewed in an appropriate timeframe and either continued due to continued need
                             and effectiveness or terminated due to change in condition (No continuation of need) or lack of achieveing the desired/expected outcome.Many private insurers have already established the appropriate timeframes and
2882   Website Submission    Implement some participation requirements for Mental Health treatment. Public Assistance recipients are required to go to chemical dependency treatment if it presents a barrier to their employment. They are required to
                             go to treatment and the Providers are required to report their regular attendance and progress in treatment to the County. The same requirements should exist for those with mental health issues. The purpose of this
2883   Website Submission    In conjunction with DOH transitioning toward State assumption of costs and administration through the local DSS offices, eliminate the concept of a separate Medicaid ?district? (currently 58) to centralize the
                             eligibility processes. It would then no longer be necessary to open and close cases when people move or are institutionalized. County fiscal responsibilities may be identified within the case by county code.
2884   Website Submission    Extend attestation of resources (Renewal Simplification) to all Medicaid applicants/recipients, including those in chronic care and lengthen the certification periods to between 2 and 5 years, depending on an
                             individual?s living situation and other eligibility criteria.
2885   Website Submission    Focus on better marketing for Medicaid programs that are not currently well-publicized, such as the premium assistance program and Medicaid Buy-In Program for Working People with Disabilities (MBI-WPD).

2886   Website Submission    Improve system capabilities to cross-reference with other benefit eligibility systems to identify the existence of other insurance coverage and potential entitlements to programs such as Social Security disability and
                             Medicare.
2887   Website Submission    Continue to minimize the necessity of face-to-face visits to local DSS offices by offering online and telephone applications, recertifications, etc. These methods are currently in use by the Social Security Administration
                             and could be done in conjunction with the development of the State Exchange.
2888   Website Submission    Eliminate the resource test for disabled individuals (SSI-related category), except for those seeking a Nursing Home level of care.

2889   Website Submission    Disregard retirement assets such as 401(k) plans and pensions in determining eligibility for individuals enrolled in or applying for MBI-WPD. This is a roadblock for working individuals and presents an inherent
                             contradiction ? we want people to be able to go to work, but by doing so, individuals cannot plan for their own retirement without potentially losing their Medicaid coverage. This forces some individuals into lower-
2890   Website Submission    Streamline the disability determination process for developmentally disabled individuals. Currently, individuals must have a Developmental Disability (DD) determination performed when seeking OPWDD services
                             but may also be required to prove disability when applying for Medicaid. Allow Medicaid eligibility workers to accept a DD determination by OPWDD as proof of disability for Medicaid eligibility.
2891   Website Submission    The developmentally disabled population has unique circumstances related to eligibility and program enrollment, therefore allow all developmentally disabled individuals to have Medicaid cases administered by
                             OPWDD?s Revenue Support Field Offices rather than local county DSS offices.
2892   Website Submission    The Medicaid program should pay for evidence-based care only. This is being considered in Wisconsin, specifically with regard to things such as unnecessary Cesarean sections and male circumcision.

2893   Website Submission    Limit the use of pooled trusts that have no remainder to the state.




                                                                                                                                                                                                                                                            100
 #                  Author                                                                                                             Proposal
2894   Website Submission    Develop and require some standard of demonstration of need in order for individuals to shield income and assets in Medicaid exception trusts and cap the amount that an individual can place in a Medicaid exception
                             trust (SNT).
2895   Website Submission    The Medicaid program should be more rigorous about claiming against the estates of Medicaid recipients to recover Medicaid expenses paid on behalf of the individuals.

2896   Website Submission    Consider pooling drug/supply purchase contracts for all individuals under state (or, potentially state-sponsored) custodial care to reduce costs.

2897   Website Submission    The ""spend down"" system does not work. The majority of the time I see providers bill the patient for reimbursement during this period, but the patients DO NOT pay for the services and a provider is forced to send to
                             collection. Then the patient will complain they had Medicaid and the provider is forced to recall the account from further collection activity. What an administrative nightmare!
2898   Website Submission    There is enourmous waste in Medicaid around mental health drugs. Drugs are routinely prescribed and are then not taken. Some drugs are regularly traded on the street (seroquel, klonopin, vicodin, adderall...). Then
                             they are often replaced with a new RX, which then is billed to Medicaid again.
2899   Website Submission    New York State can best improve care and reduce runaway costs for Medicaid beneficiaries with chronic behavioral and physical health conditions through the implementation of regionally managed behavioral health
                             care coordination systems. These systems can provide the most effective outreach, engagement and linkages to medical care, housing and local support and social services that will produce savings immediately through
2900   Website Submission    Make the system truly accountable. Publish rates (my area is behavioral health) for every facility across the state. This will reveal the huge and unconscionable cost differentials in place currently. Variances for
                             example exist across state operated vs county-run vs private provider run services; huge regional differences rural- urban upstate-downstate; and across individual providers as well. Most of these variances are not
2901   Website Submission    It is a mistake to shift all the costs to the state. Counties and local taxpayers need to have some ?skin in the game? while the state needs to assure that certain basic standards of care, quality and access exist state-wide.
                             In Iowa the counties had to pay in part for their residents to use state level services, and guess what, they found community based alternatives as good or better than state operated programs for a fraction of the cost. If
2902   Website Submission    Combine OMH and OASAS at state and field operations levels.

2903   Website Submission    Use local successful programs such as NY Care Coordination Program to model integrated Managed Systems of Care. We are in Erie, Genesee, Chautauqua, Monroe, and Wyoming Counties in the west, and your (our)
                             members have benefitted tremendously. This could be expanded to chemical dependency as well.
2904   Website Submission    Watch out for the carve-in. While tempting on many levels, this approach does not appear to safeguard the kind of community-based services that lead to good results with behavioral health populations. If we do a
                             BH carve-out like the Pennsylvania model, we can build better integration of care into the original model and develop as we go along. Insurance companies are seeing dollar signs and should not be the major power
2905   Website Submission    Please consider restructuring the Medicaid Waivers in NYS. Many of the people we serve are eligible for more than one waiver. It would be more cost effective to de-regulate so you could be enrolled in more than one
                             waiver at a time which would allow for better service provision.
2906   Website Submission    Allow for Outpatient Mental Health clinic's to operate Mental Health Urgent Care Centers that would bill at outpaitent clinic rates and could operate "after-hours" (and be able to remain open 24 hours a day). Such
                             models are used in California and have cut down on mental health ED visits.
2907   Website Submission    Establish a network of Urgent Care Centers that accept mediciad.

2908   Website Submission    Emergency Dept Care- Require that hospitals establish urgent care centers within/attached to each of their ED's. After initial triage, all patients deemed not in need of emergency care (i.e. ear infections etc.) would be
                             "transferred" to the on-site urgent care center for treatment (the ED could only bill for a triage service), and this treatment would be billed at an urgent care center rate, NOT at the ED rate.
2909   Website Submission    Currently Medicaid rates for programs licensed by OPWDD, OMH and OASAS do not have to be approved by DOH (the single state medicaid agency). Each agency sets their own rates and ""lobbies"" the DOB to get
                             approval. This means that the cost for similar programs for the ""special populations"" vary widely. Specifically the cost for individuals with developmental disabilities living in OPWDD Developmental Centers are
2910   Website Submission    Opening service provider eligibility to NYS Licensed Mental Health Counselors (If desirable, screened according to experience and/or speciality) would provide significantly improved access to many who need mental
                             health services but are unable to access them through existing providers.
2911   Website Submission    Reincorporate carved out outpatient substance abuse services for Medicaid managed care and all behavioral health services of managed care SSI enrollees to streamline services, better coordinate care, and control the
                             costs of these services under fee for service Medicaid.
2912   Website Submission    Reincorporate pharmacy services into Medicaid managed care allowing for pharmacy benefits management. This also requires NYSDOH to explicitly endorse the use of generic drugs and step therapy processes,
                             including psychotherapeutic medications
2913   Website Submission    Institute malpractice tort reform to discourage unfounded suits and extravagant judgments against practitioners. This would markedly decrease overhead for practitioners and also make NY more attractive for
                             recruitment of practitioners from other states, thus increasing access to care.
2914   Website Submission    Require mandatory enrollment of Medicaid enrollees who are severely mentally ill into Medicaid managed care. This will provide for better care coordination between behavioral health and physical health services.

2915   Website Submission    Consolidate/merge Office of Mental Health (OMH) and Office of Alcohol and Substance Abuse Services (OASAS). There are too many regulations, licensing requirements, and overall administrative burdens for
                             behavioral health providers that make little sense and at times might conflict with each other to the detriment of consumers and with increased costs.
2916   Website Submission    My suggestion revolves around the idea of required telephonic nursing triage to help Medicaid members determine if their physical and/or mental symptoms are emergent or can be seen by a primary care provider.
                             Telephonic triage does not equate to forbidding a person to seek treatment, but helps a person determine what is and is not considered an emergency. Telephonic triage can also be utilized for medication management,



                                                                                                                                                                                                                                                            101
 #                  Author                                                                                                             Proposal
2917   Website Submission    Establish Urgent Care facilities for Medicaid users. An Urgent Care facility that people would have to go to before going to the emergency room for minor injuries and illness. I see alot people in the Emergency room
                             that have the flu, and illnesses that people who have to pay for the service and/or huge co-pays would go to their doctor or an after hours clinic or urgent care. Of course if the illness or injury was bad the emergency
2918   Website Submission    Decrease NYSDOH staffing by requiring all health plans in NYS (commercial, Medicare, Medicaid) to be NCQA (National Committee for Quality Assurance) accredited. Through this ""deeming,"" it would
                             significantly decrease the need to have extensive annual NYSDOH site visits. CMS uses NCQA for deeming Medicare Advantage Plans. Several other states deem health plans in this way. Pennsylvania has done this
2919   Website Submission    Put in place explicit criteria for medical review and step approaches for DME approvals. There are too many requests for "cadillac" items when "chevy" items have not been previously attempted/tried (e.g., wheel chairs
                             manual/motorized; voice assisted devices). The costs for some of the "cadillac" items are several-fold greater than lesser cost functioonal items.
2920   Website Submission    Eliminate universal transportation benefit foe all Medicaid enrollees. This benefit should be covered based on explicit and clear statewide criteria. Simply allowing physicians to prescribe it leads to significant abuse
                             when physicians do not want to argue with their patients.
2921   Website Submission    Require in-state use of services unless the requested service is unavailable within NY State or the quality/outcomes for the requested service available in-state is significantly poorer than provided elsewhere (e.g.,
                             transplants, treatment of rare diseases). The current reinsurance program makes the health plans the ""heavy."" If a patient does receive a service unavailable in NY State, reinsurance by the state should recognize this.
2922   Website Submission    NY State needs explicit statewide criteria for coverage and payment of Personal Care Attendants. The current approach fails to provide appropriate use of such resources.

2923   Website Submission    NY State must change its eligibility requirements for Medicaid coverage of long term care. There are too many loop holes that allow "millionaires" and well-off individuals circumvent spend downs at the expense of the
                             State
2924   Website Submission    Please include private practice physicians from the inner cities that lie within ""hot spots."" Hot spots are a concentration of disease states, which we have known for many years depict health disparities. We must spend
                             the dollars in ways that community organizations and physicians can coordinate.
2925   Website Submission    Improve program delivery by requiring the county social services offices provide the eligibility requirements and entitlements in clear simple language that include citation to the applicable statutes (transparency). The
                             county case managers should be well versed with the services the consumer is eligible to receive and provide all options to prevent disruption in medical coverage, e.g. enhanced salary rates to find and retain providers.
2926   Website Submission    With regard to saving the county's money: Consider as stated above, paying a fair market salary to private provider nurses (RN & LPN) which would draw a higher quality nurse to the system. At the same time, take a
                             closer look at the method by which the nurses are paid. They have to go through hoops and fill out a complicated form, but they are not required ever to have their hours worked verified by the people for whom they
2927   Website Submission    I believe a detailed look at inpatient laboratory testing should be evaluated for a source of revenue savings. I have recently begun an evaluation of daily testing of inpatients and note that a majority of patients get daily
                             blood testing thruout their hospital stay even though the day to day results do not vary much. I understand that some patients are quite ill and require frequent evaluation but in my review (which I would be willing to
2928   Website Submission    These patients due to their economic/social/education levels tend to be very complex and demanding of physician's time and attention, yet the reimbursement is terrible. I am aware this is improving some, but this
                             discrepancy severely limits patients access to quality care including prevention and education which typically doesn't pay well to begin with. When quality care and education/prevention are hard to get, the patient's
2929   Website Submission    Commercial patients because of deductibles and high copays,although not ideal, use this as a way to prioritize and manage their health needs. Medicaid patients have no such restrictions and also tend to be among those
                             that frequent care the most because of it.
2930   Website Submission    The patients on medicaid are not held accountable for their medical decision making or lack of responsibility the same way that commercial patients are. For example, when I trained in Pennsylvania, the primary
                             physician received a copy of the ER encounter and signed off as to whether the visit was appropriate/approved for the patient using the high cost of ER care or denied. If denied, the patient is held accountable for the
2931   Website Submission    Please look at OMH PROS it is a huge waste of money. I am a senior staff person running a PROS, but when I put on my taxpayer hat..it is a huge scam. The quality of the program is poor because the paperwork
                             demands are so steep that they consume the staff time.
2932   Website Submission    Build in thresholds/checks on over-use of services in E-MedNY data/billing system that rejects claims before payments [based on managed care/approved treatment plans].

2933   Website Submission    Recommendation: Service delivery should be redesigned as outlined in the Joint Task Force on the Continuum of Care for Alcoholism and Substance Abuse Services? 2008 report. Central to our redesign proposal is the
                             fact that persons experiencing an uncomplicated opioid withdrawal, which is rarely life threatening, can be treated safely and effectively in a community-based clinic. We propose a redesign of service delivery that
2934   Website Submission    Recommendation: Utilize case management and expand the Managed Addiction Treatment Services (MATS) program to every county in NYS and increase the MATS caseload in NYC. ASAP recommends that the
                             MATS case management caseload in NYC should be tripled to 2250 of the 4500 persons who utilize more than $30,000 annually in SUD related services alone. We also recommend that an equal number of persons
2935   Website Submission    ecommendation: Make screening, brief intervention, and referral to treatment (SBIRT) for alcohol and drug problems a routine part of every primary care and emergency room visit. (In a recent University of Texas
                             Southwestern study, Larry Gentilello, Professor of Surgery, estimated that hospitals save $3.81 for every dollar spent on brief counseling of ER patients.)
2936   Website Submission    Recommendation: Ensure that a comprehensive continuum of chemical dependence services closely linked with primary health and mental health care is in NYS?s Medicaid base benefit to improve the health status of
                             addicted persons and to ensure reductions in Medicaid expenditures. (Washington State?s study of the cost offsets resulting from the provision of chemical dependence treatment found that, for families that received
2937   Website Submission    Let's make Community Health Workers an integral part of Medicaid Redesign. CHWs cut costs at the same time they address our crisis-level disparities, lack of access, and lack of holistic and preventive measures. To
                             be truly effective, they need steady funding, such as Medicaid reimbursement, along with greater recognition and organization. CHWs bring cultural competence and an integrated approach that addresses the social
2938   Website Submission    The programs providing life line cell phone service need to be looked into a little. Because you can either have a cell phone or land line at the life line rate some of our folks are opting to go with the cell phone. The
                             problem with this is they use their minutes well before the month is up which results in them not having a working phone. It makes it more difficult to provide services as we must go out to resolve issues, which often
2939   Website Submission    Eliminate 'optional' benefits.




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 #                  Author                                                                                                             Proposal
2940   Website Submission    Set as a goal an expendature per capita that equals the median of all States. I don't believe that anyone wants NY to go from the highest per capita cost to the lowest, but being #1 in cost is not a distiction we should
                             strive for.
2941   Website Submission    Eliminate the IMD exclusion and provide Medicaid funding of Intensive Residential Drug treatment to reduce the costs of untreated chemical dependency and repeated unsuccessful outpatient treatment. Approximately
                             1 in 8 individuals has a substance use disorder. Untreated substance use disorders are costly to communities and to the overall health care system. Medicaid covers the cost of outpatient treatment, medication assisted
2942   Website Submission    State and County governments should discontinue directly providing SUD and mental health services. As illustrated in the example below, we estimate by doing so $24,133,582 could be saved annually. Private not-for-
                             profits can deliver these services as effectively and at much lower cost. Note the illogic in the recently promulgated mental health reimbursement restructure that set the base rate of $193.35 for WNY Counties versus
2943   Website Submission    Revise the OASAS and OMH licensing/reimbursement structure to encourage the
                             delivery of ""off-site"" services. The federal Patient Protection and Affordable Care Act promises money and increased federal participation in the Medicaid expense. This was activated as of 1/1/11, but the fixed site
2944   Website Submission    Mental health services should be audited/surveyed by clinicians -- not lawyers and ex-police officers. There is no clinical judgment involved in the current process of medicaid audits and there is no lee-way for simple
                             errors that are considered human errors -- for example: a clinician who works on a Saturday putting in Friday's date in a progress note -- clearly if there is evidence of a client coming to see their therapist on a Saturday,
2945   Website Submission    If MCO is the way NYS will be going, there should be a reciprocal authority to allow those providing Mental Health care to audit/survey or supply information on how the insurance company is doing on behalf of their
                             clients -- as we are talking about how tax dollars are spent -- they should be evaluated as well by both the individual and the facility providing Mental Health care.
2946   Website Submission    Equalize the Upstate and NYC personal care program service authorizations. Rarely do patients receive 24 hour 7 day coverage in our county.

2947   Website Submission    The rate setting mechanism for personal care service is based on statistical information that is 2 years old. Without trend factors, doing business with medicaid becomes a losing business.

2948   Website Submission    When rates are approved pay them in a timely fashion. Dont announce rates in December for the upcoming year and pay at last years rates due to some complex federal reporting mandate that was not approved. Not
                             only are rates late but often the rate is reduced before it is ever paid. This creates an accounting nightmare.
2949   Website Submission    There is abundant research to demonstrate that keeping individuals in their own homes is a cost effective alternative to nursing home placement. Pay home care reasonable rates to support this option to recieve home
                             care services.
2950   Website Submission    Regional assessment groups will result in even more errors in care planning for personal care clients. The staff at agencies providing the services must be included in the care planning process. Its my experience that
                             staff that specialize in Personal care services develop the best care plans.
2951   Website Submission    The consumer directed personal care aide program invites abuse. Relatives may be paid by medicaid to care for family members, staff recieves no supervision or formal training. Many consumer directed staff are
                             expected to work without adequate Personal protective equipment for infection control.
2952   Website Submission    Unwed women should only be covered by medicaid for one (1) pregnancy. Any further pregnancies should not be paid for by the taxpayers. Also any unwed women should not receive additional public funds for any
                             additional children.
2953   Website Submission    Anyone found to be using illegal drugs should be denied coverage by medicaid or any other public aid for at least one year and to then submit to drug testing prior to being allowed to participate in the program again.

2954   Website Submission    RE: Mental health care for New Yorkers.
                             Any new plan must be Recovery Focused, not illness focused and include real alternatives and peer recovery support. Peer based recovery support services help people to move out of the role of mental patient and back
2955   Website Submission    Given the incredibly high rates of prescription drug abuse, there should be some way to identify Medicaid recipients who are exhibiting drug-seeking behaviors by visiting multiple doctors, emergency rooms and
                             pharmacies. Over a year ago, when I spoke to someone in the Medicaid fraud unit about a young woman who was clearly doing those behaviors, I was told that there was so much fraud in the NYC area, that fraud
2956   Website Submission    New York State can best improve care and reduce runaway costs for Medicaid beneficiaries with chronic behavioral and physical health conditions through the implementation of regionally managed behavioral health
                             care coordination systems. These systems can provide the most effective outreach, engagement and linkages to medical care, housing and local support and social services that will produce savings immediately through
2957   Website Submission    Assure strong consumer choice and rights protections and incentivize the provision of recovery, rehabilitative and peer support services.

2958   Website Submission    Offer the assertive engagement, care coordination and accountability needed to reduce costs and improve care for high need individuals with chronic conditions.

2959   Website Submission    Eliminate Spousal Refusal. This "Medicaid Estate Planning" tool is used to "just say no" when the non-applying spouse is asked to contribute to the cost of services provided to the applying spouse. The children
                             inherit the money and the tax payer pays the bills. People in the know don't buy Long Term Care Insurance because that's for fools who don't know how to work the system. We have hundreds of millionaires on
2960   Website Submission    The state is encouraging fraud by allowing individuals to attest to their resources, attest to their income, prove their residence with an address sticker from a magazine, etc. Require appropriate documentation for this
                             expensive program.
2961   Website Submission    welfare recipients should not be eligible to accept a check from NYS tax payers IF they have pets or are smokers!!
                             tax payers should not have to provide services to those NYS recipients who can't make their dental apts because they will be "" In Florida for two weeks"" or ""Florida for the winter""!
2962   Website Submission    Focus on growing the Family Care Program as an alternative to group home housing for men and women who have developmental disabilities. The men and women living in Family Care receive overall better care than
                             a person does living in a group home.



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 #                  Author                                                                                                            Proposal
2963   Website Submission    Investigate KIryas JOel and you'll save billions of dollars.

2964   Website Submission    Enrollment bonds should be increased to cover Medicaid's potential liability to provider fraud.

2965   Website Submission    In the pharmacy field, third party payors and wholesalers should be required as a condition of licensure to build a computer system to track all pharmacy billings against acqusition of medications. Overbilling and
                             diversion will be automatically identified.
2966   Website Submission    Exclude Management personnel at Hospitals and Managed Care entities found to have permitted or tolerated abuses. Larger providers simply buy their way out of trouble without consequence.

2967   Website Submission    Disproportionate funds are spent on a relativly small number of patiets. Identify the sickest and most expensive patients and compel participation in wellness programs to stop them from engaging in lifestyle choices
                             such as smoking, drinking, unhealthy eating and not not visiting drs or taking meds to reduce costs. Program savings will be enormous.
2968   Website Submission    Medicaid Case Management is an extremely efficient way to assist recipients to access the services they need to avoid overuse of the medical system which is much more expensive. Case managers working out of
                             human services agencies, are paid far less than doctors, nurses, etc. But through programs like AIDS Case Management, TASA, etc., they are able to visit clients at home, assess their needs and refer them to appropriate
2969   Website Submission    NECESSARY PERSONAL CARE CHANGES:

2970   Website Submission    NECESSARY TRANSPORTATION CHANGES

2971   Website Submission    New York State can best improve care and reduce runaway costs for Medicaid beneficiaries with chronic behavioral and physical health conditions through the implementation of regionally managed behavioral health
                             care coordination systems. These systems can provide the most effective outreach, engagement and linkages to medical care, housing and local support and social services that will produce savings immediately through
2972   Website Submission    ? Strengthen and fully fund the NY Connects program as part of any reforms to the State?s long term care service delivery system

2973   Website Submission    Expand the availability of home and community based long germ care services provided by the aging network, particularly Expanded In Home Services for the Elderly Program, Community Services to the Elderly
                             Program and Supplemental Nutrition and Assistance Program
2974   Website Submission    Our NYS Medicaid Regulations need to be mirror the Medicare coverage guidelines for the Certified HOME HEALTH Agency services - like they have in the Commonweath of Massachusetts. Even when providers do
                             bill Medicare for the PPS episode (60 day period), they are cost shifting to Medicaid and causing an increase in the Federal share as they then pay more in matching funds. A PPS Medicare payment, a fee for service
2975   Website Submission    Remove regulatory barriers that restrict the practice of advanced practice registered nurses so that they are able to practice to the full extent of their education.

2976   Website Submission    Assure that Medicaid payment extends to advanced practice registered nurses who are providing primary and specialty services to the Medicaid population including behavioral health.

2977   Website Submission    Expand the Healthcare Reform Law's CLASS ACT, now CLASS LAW as of 1/1/11, in New York State by doubling the contribution for a double of the payment benefits, i.e., NYS CLASS LAW ENHANCED. The
                             Federal D of HHS is doing all of the acturarial calculations and payment determinations, build in NYS on their work by doubling the results.
2978   Website Submission    Share on 50/50 bases with the RHCF all savings by having RHCF's refinance their existing mortgage loans at today's lower interest rates. Thee is no financial benefit to an existing RHCF to refinance under existing
                             reimbursement regulations.
2979   Website Submission    Every person should be eligible to spend down to the Medicaid level and the MA level should be raised. As opposed to putting people on FHP and the state/federal government paying the monthly premium. There are
                             some people that have to be put on FHP b/c they are over the MA level by a couple of dollars. So we are paying around $300/mo for someone to be on FHP when they may never or hardly ever use the FHP.
2980   Website Submission    I would also like to know how cost effective it is for everyone to be put on Medicaid Managed care. Again, we are paying $300-$500/mo for them to have Fidelis, Americhoice, etc~ when they may never even need to
                             use their MA.
2981   Website Submission    Also, what needs to be looked into...is the fact that people who are applying for nursing home coverage that have hundreds of thousands of dollars in the bank are able to put it into a trust and it is not looked at as a
                             resource. I feel that if you have the money...you should be paying for your own bills, not safeguarding your money so your children can get a big inheritance.
2982   Website Submission    Suggest carving the dental portion out of Medicaid and administering dental Medicaid benefits independently from the medical portion. This reform would result in savings to the State on administration, improved
                             access and quality of care.Many state Medicaid agencies have begun to see the value in managing and administering dental Medicaid benefits independently from the medical portion, because dental benefits pose such a
2983   Website Submission    I believe resh hab services, specifically in IRA's, that are run by the NYS OPWDD ( formerly OMRDD )could be done in a much less costly way. People living in IRA's- get resh hab services. Medicaid pays $600.00
                             per day per consumer for these services. Resh hab is suppose to be a program which TEACHES or MAINTAINS skills. While some consumers benefit from this, others don't. Some are very low functioning
2984   Website Submission    I would also suggest that the family care program be looked into. This is one of the best ways to care for a developmentally disabled person if they are able to live in a family setting , and for whatever reason their own
                             family cannot care for them. There are some wonderful homes out there who care for consumers living in their home, and enrich the lives of these people involving them in the everyday activities of life. Room and
2985   Website Submission    Fund mobile truck-sized ""offices"" including salaried primary care physician/nurse, CLIA-waived lab tests, blood draw capability (for testing at the mobile office's home base), chronic medication delivery, and
                             telemedicine room for subspecialty consultation. Each truck should have a predictable schedule, preferably on a 1-2 week cycle, to apartment complexes, grocery store lots, and other locations within easy walking



                                                                                                                                                                                                                                                        104
 #                  Author                                                                                                             Proposal
2986   Website Submission    Assuming a nursing home bed costs Medicaid $100,000. A potential rebalancing model would bundle 10 Medicaid beds totaling one million dollars. New York State could allocate $750, 000 for moving people into the
                             community and $250,000 to establish a reserve/investment fund, which the state will manage to establish the sustainability of this Community First Options alternative as a model that other states can replicate
2987   Website Submission    My recommendation would be to make families more accountable
                             for the skilled care of their loved one in their homes and allow certified home health agency RNs to assess and monitor medicaid beneficiaries a few times weekly in the home care setting rather than allow a 1:1
2988   Website Submission    Carve-out all mental health services from the health plans (similar to Pennsylvania?s successful county-based system and to begin implementation immediately using a phased in regional approach.

2989   Website Submission    Ensure strong contract provisions including limits on administrative costs and savings reinvestment funds.

2990   Website Submission    Offer the assertive engagement, care coordination and accountability needed to reduce costs and improve care for high need individuals with chronic conditions.

2991   Website Submission    Assure strong consumer choice and rights protections and incentivize the provision of recovery, rehabilitative and peer support services.

2992   Website Submission    Convert behavioral health programs into Health Homes for people with behavioral disorders. NYS?s comprehensive behavioral health system, with its robust case management capacity, can be the foundation of a care
                             coordination initiative supported by the new federal Health Home model. Programs now supported by 50% state/local Medicaid match can be converting them into Health Homes with 90% of the calculated premium
2993   Website Submission    Utilize NYS?s community residence and supportive housing beds as alternatives and preventive strategies to costly inpatient psychiatric and substance abuse care.

2994   Website Submission    Integrate health and behavioral health services for people with SMI and substance abuse disorders in New Yorks? licensed behavioral treatment programs. New state regulations awaiting federal approval will permit
                             basic primary care delivery in licensed behavioral settings. A physician or nurse practitioner providing health assessment, health monitoring and coordinated referrals for specialty care would create a ?friendly front
2995   Website Submission    NYS can save at least 5% on Medicaid expenditures for preventable hospitalizations and ER visits in FY 2012 for people with chronic behavioral disorders and children with serious emotional disturbances (SED) by
                             creating capitated regional behavioral health plans that manage Medicaid-reimbursed mental health and substance abuse services, and help coordinate health care delivery. The regional behavioral plans would creatively
2996   Website Submission    Medical services for the poor should be sliding scale not free, not completely free. Lets all work and walk that extra mile

2997   Website Submission    search Finance Dept for anyone getting medicaid, who bought million dollar mansions or apartment buildings, basically anything other than rental or single family residence should raise a big red flag

2998   Website Submission    search DMV for those owning luxury cars, or if in New York City, anyone owning a car at all

2999   Website Submission    Combine OPWDD and OMH into one agency. Those covered by the two have much in common and should be able to be handled by one agency.

3000   Website Submission    Using a model much like Medicare uses, requirements for coverage of services such as Physical Therapy, Occupational Therapy and Speech Language Pathology can be made uniform. Even when payment types (ie
                             bundled into a rate or fee for service) are different the need for such services should be the same across the board to include being ordered by a physician, requiring routine reevaluation to determine effectiveness, etc.
3001   Website Submission    Clarify and Simplify Policy and Regulations - Policies are often vague and unclear leaving providers of services withoutg clear direction. Calling or writing the state on specific issues leads to different answers from
                             different sources and individuals. In my personal experience, I have become so frustrated with information provided by the state that I have reverted to Medicare policy on coverage which is very clear, specific and
3002   Website Submission    Implement Medicaid claims processing system with more front end edits and use of nationally recognized modifiers and coding guidelines in order to flag claims prior to payment rather than waiting several years for
                             labor intensive and expensive OMIG audits to discover simple billing errors and possible fraud.
3003   Website Submission    Require Medicaid to be kept current with coverage for services on an annual basis. Each year codes for billing services are updated with deletions, additions and changes. While all other payors, in my experience,
                             update on an annual basis, NY Medicaid might not address these changes for several years, leaving providers unsure as to coverage for these services.
3004   Website Submission    drop Managed care and institute a better system of review of cases by NYC HRA.

3005   Website Submission    Eligibility-entering client information on E-Paces is easy-deciphering the actual codes are a nightmare at best. The patient is coming in for dental work-we don't care if they are eligible for Long Term Care (LTC).
                             Dentaquest and Healthplex both - either eligible or not eligible.
3006   Website Submission    Inpatient substance abuse care is too liberal. I see inpatient clients sign out against medical advice at the end of the month so they can get their checks. They use the check to purchase drugs. When the money is gone,
                             they check back in and are housed and fed indefinitely or until they decide to get the next check and sign out. Private insurance might give 5 days inpatient if the case worker is very persuasive. The inpatient facility
3007   Website Submission    Medicaid will pay for just about any medication I prescribe. I know from colleagues that other states are not nearly as generous. I prescribe in the mental health field so I will give an example. I can prescribe any one of
                             the expensive atypical antipsychotics and the government will pay. Although it is nice to have that freedom because you can tailor the need to the patient, I know that some states requires generics only. See Arizona's
3008   Website Submission    I am the supervising pharmacist of a small retail pharmacy in Oneonta New York, and I am upset over the recent decision made by Medicaid to prefer brand Duragesic patches over the generic products. It doesn't make
                             sense to me to ask providers to do a prior authorization to prove that a patient has failed Brand therapy in order to get the lesser expensive generic product covered by Medicaid. (Where does that fit in with the



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 #                  Author                                                                                                                Proposal
3009   Website Submission    Make it illegal for law firms to offer "counsel, services, or plans" to shift assets to avoid payment of long term care.

3010   Website Submission    Change asset transfer rules to "the previous 10 years" including all assets (real estate, financial assets, trusts, gifts, etc.) to insure transfer of financial capability to pay for LTC has not been impaired.

3011   Website Submission    Consider a "family responsibility and financial capability rule". If the sons or daughters of a potential LTC medicaid recipient are substantial - the family has the responsibility for payment of care or they can provide the
                             care themselves.
3012   Website Submission    Require all medicine providers to offer Rx at rates less than or equal to the lowest price they offer customers or dealers worldwide.

3013   Website Submission    shift some people currently receiving long term services through Certified Home Health Agency to the less costly Consumer Directed Program would mean a potential first-year savings of $4.5 million in the state share.
                             Compared to CHHA care, CDPAP reduces Medicaid spending by $9.52 for every hour of service.
3014   Website Submission    shift some people currently receiving Personal Care Services through Licensed Home Health Care Agencies for a potential annual savings of $1.9 million in the state share. CDPAP is less costly than traditional PCA
                             services for the same reasons applied to the CHHAs. Additionally, the process necessary to realize these savings requires no additional staff or infrastructure and dovetails into existing work done by the LDSSs. On
3015   Website Submission    As part of the Managed Care Medicaid Integrity Program, insurers are required to follow up with applicants in selected categories (or at random) to confirm income, family size and/or income documentation. This is a
                             self-monitored program. It is very unlikely any fraud has been identified through the current program since there are no guidelines around how the follow up takes place, aside from it be a recorded phone call. "Results"
3016   Website Submission    I would like to draw the committee?s attention to the federal Aging and Disability Resource Center Program, or ADRC, which has served as the cornerstone for long term care reform in many states. It is a collaboration
                             on the federal level between CMS and the Administration on Aging. ADRC?s are designed to streamline access to long term care, integrating the full range of long-term supports and services into a single, coordinated
3017   Website Submission    Review and adopt, as appropriate, the California Medicaid (Medi-Cal) model for hospital contracting.

3018   Website Submission    Review the reasons for the differences in long term care per person expenditures between NY and one or two similar size states (e.g., California) and adopt changes that can be applied to NY from those other venues.

3019   Website Submission    when a client is receiving Medicaid home care, s/he is often receiving other entitlements like PA, FS or HEAP. Again if this person is living with one or more, why is an entire household receiving entitlements? Why
                             when a person goes on vacation, is hopsitlaized, goes into a NH or rehab facility do other entitlements continue? As I've mentioned to my Commissioner, Dr. Imhof, NYS needs a mechanism to trigger the cessation of
3020   Website Submission    First: Physicians. Our investigators tell us that it is impossible to ""go after"" physicians when no other MD will testify against a ""colleague"". Over and over again, I receive medical forms with diagnoses of ""hip
                             pain""; ""back pain""; ""weakness""; ""fatigue"", etc. '
3021   Website Submission    Universal Coverage: As noted earlier, New York has been a leader in extending health care coverage to children. Yet, there are still uninsured children who need coverage. In New York State, of the children who
                             remain uninsured more than 90% of them are income-eligible for health insurance. This translates into 280,435 children ages 0-17 years of age who were uninsured despite eligibility (in 2008). The State must
3022   Website Submission    Waiver Programs: When redesigning how Medicaid pays for long-term care, it is important to remember that there is a small population of children with intensive needs. New York has implemented initiatives that have
                             ensured that children who have severe mental health, medical issues and/or developmental disabilities can reside with their parents and not be institutionalized. The services provided through waiver programs are not
3023   Website Submission    Primary Care and Prevention: From the standpoint of positive outcomes and cost-benefits, the earlier a child?s mental health issues are identified and treated, the better the outcomes for the child and the more money
                             that can be saved down the road. Similarly, access to primary care and prevention for health needs ensures avoidance of more expensive care later on such as hospitalization. Medicaid Redesign presents an opportunity
3024   Website Submission    The New York State Department of Health (DOH) and the Office of the Medicaid Inspector General (OMIG) have stated that providers are obligated to perform monthly checks of their board members, staff and
                             vendors against Medicaid Exclusionary files (f),(g). There are three different government data sets that must be evaluated:
3025   Website Submission    Compliance or lack thereof with Medicaid billing rules has become an immense administrative burden for providers and state authorities. Audits and program reviews seemingly apply compliance criteria inconsistently;
                             good results from one assessment are no assurance of similar findings from others vested with these authorities. It is well known that the Medicaid eligibility and enrollment software is obsolete (h); simply, it is beyond
3026   Website Submission    Through the HEAL NY grant process, New York State has underwritten $440 million to improve health-related technology, particularly electronic health records (EHR?s), networks and health information exchanges
                             (HIE?s) (i) to date. Issues about the long-term sustainability of these efforts remain unanswered. The self-imposed limitations imposed by the grant terms and conditions have the effect of not fully leveraging the
3027   Website Submission    I am a state employee in the health department. I have spent the last 15 years working with patients (in public health and community based roles) on Medicaid and the providers who care for them.
                             What I see as a problem is that there aren't many requirements outside of income level and a formal address to receive this coverage. The majority of Medicaid recipients use the ER as their PCP resulting in greater cost
3028   Website Submission    please consider looking into how medication money is wasted.
                             i worked in an adult home/ assisted living program. 92 pysch residents that were on multiple meds.
3029   Website Submission    For cost-savings to be realized while maintaining quality care the redesign team must focus on efficient and coordinated delivery of care. Existing managed care programs do not adequately do this for people with
                             disabilities. The redesign team should look for places to remove barriers and increase accessibility. Access to social services and heath behaviors must be key components. Coordination of care teams need to be
3030   Website Submission    Emphasis must also be placed on proper training of Medicaid staff to accurately and quickly refer clients to appropriate care. In addition, Medicaid staff should have at their disposal an easily accessible helpline or
                             specialist staff to assist when complicated situations arise. Our experience suggests that excessive costs are incurred when clients are forced to make repeated visits to Medicaid staff to provide information that was
3031   Website Submission    Let nys contract with preferred naufactureres of generic pharmaceutical as it does with manufacturers of brand name drugs, let us especially consider those made in nys, distrubuted by a nys company, or at a minimum
                             by a company from the usa. Can keep people working in these domestic companies. We at Matthews Pharmacy in Ellenville NY have been seeking generics that are domestic and are proud of it.



                                                                                                                                                                                                                                                           106
 #                  Author                                                                                                              Proposal
3032   Website Submission    Please consider tighter regulations and check-ups on patients that have home health care aids. Is a system that we see being abused. And have reported so.

3033   Website Submission    Reward providers who whistel blow and report abuses of patients that are taking advantage of their benefits.

3034   Website Submission    Do more desk audits to reduce fraud.

3035   Website Submission    Get a handle on narcotic abuse and overuse. Leads to increased office visits and office charges becouse a legitimate doctor treating a legitimate patient with narcotic will now see a patient every month when this might
                             not be necessary in every case.
3036   Website Submission    Those that are physically able and are on public assistance should assist the public, for example, peform functions at a library, public school or in goverment instituion. If we require this then the individuals who must
                             receive public assistance will feel better about themselves becouse they participating in a area of importance.
3037   Website Submission    Use Pharmaceutical Company Patient Assistance programs to obtain free medications first. Only pay for medications when patients are not approved to use this resource.

3038   Website Submission    Promote wellness. Provide classes for individuals to reduce unhealthy behaviors (e.g. smoking, poor diet, etc.). Make Medicaid benefits contingent upon participation.

3039   Website Submission    Insist that each Medicaid recipient have a primary medical doctor and/or psychiatrist and that they are consulted prior to an ER visit.

3040   Website Submission    Identify frequent users/abusers of services (e.g. ambulance transport without need for hospital admission, daily ER visits, etc.) and place restrictions on their use.

3041   Website Submission    Review/revise income eligibility limits and establish small copays for those that are at the upper income limit.

3042   Website Submission    Establish residency requirements, so that people don't move to NY just for Medicaid benefits.

3043   Website Submission    We urge you to consider the role of the public system and the severe impact that budget reductions will have on its ability to continue its safety-net mission and serve those who no other nursing homes will accept.

3044   Website Submission    We encourage the task force to focus on achieving cost savings by providing regulatory relief and eliminating unnecessary system impediments. For example, working collaboratively with hospitals, nursing facilities
                             have demonstrated that they can reduce unnecessary readmissions to and from hospitals through more effective clinical management and coordination of care. Nursing homes, given the opportunity, can also be a
3045   Website Submission    Expanding capacity of suitable and affordable supported housing and alternative placement options would expedite discharges and reduce the average length of stays in public nursing facilities.

3046   Website Submission    I would strongly suggest no longer paying for cab rides home from any hospital in New York state after an emergency department visit.

3047   Website Submission    Select 4 to 8 regionally representative psychiatric centers to absorb the work of all the other centers. Other states manage with only a handful of centers despite larger populations and/or being much larger
                             geographically. Most of the state psychiatric centers provide little value for their cost.
3048   Website Submission    Recognize, and educate the public and politicians that many 100% state funded services were ?Medicaided?. The State?s huge savings from cost shifting to the federal government is forgotten when politicians are
                             looking for a scapegoat and whine that Medicaid is out of control.
3049   Website Submission    Stop the insanity of the OMIG audits looking for fraud, of which 99% amounts to ?i?s? not dotted and ?t?s? not crossed. This is not the way the public or most people understand fraud. It results in the demonization of
                             government officials, Medicaid and the providers. More importantly it focuses the providers? efforts away from care issues and prioritizes bureaucracy and office functions. OMIG should be focusing on REAL fraud
3050   Website Submission    Change the drug laws thereby reducing tremendous costs in the criminal justice system. Use 25% of the savings for treatment programs.

3051   Website Submission    State coordination of implementation of initiatives. Providers are beset with multiple state initiatives from a variety of offices, often from within the same department. For example, in MH outpatient; Attempting to
                             train staff and recreate programing to implement evidence based practices, meeting new credentialing standards, QI initiatives, PSYCHES initiatives, clinic restructuring, Consumer involvement, PROS conversion, and
3052   Website Submission    Convert some of the Psychiatric center campuses into SUNY branches i.e. Elmira could be a SUNY Binghamton outreach campus; Buffalo can be merged into Buffalo State campus etc.

3053   Website Submission    Require state psychiatrists/nurses etc. to carry caseloads similar to those in the private sector.

3054   Website Submission    Reduce the bureaucracy in Home care delivery. State and county bureaucracy eats the majority of the home care dollar. Only a very small percentage gets to the service provider. Services could be multiplied several
                             fold, allowing reduction in nursing home costs if the county/state component could be dramatically reduced.



                                                                                                                                                                                                                                                            107
 #                  Author                                                                                                            Proposal
3055   Website Submission    Negotiate statewide Medicaid rates for medications, for example: atypical antipsychotics. Create a regional state buying cooperative (NY, MA, PA, NH, etc.) to negotiate Medicaid purchase rates with pharmaceutical
                             companies.
3056   Website Submission    Merge regional offices of OMH, OPWDD and OASIS.

3057   Website Submission    Regarding OMH policies, rules & regs, recognize that a growing amount of outpatient services are delivered by the not for profit sector and not the Counties. Rules especially around funding cause not-for-profit
                             agencies to behave in fiscally irresponsible manners, which can put these organizations, and therefore their staff and clients at risk.
3058   Website Submission    Convert the current Certified Home Health Agency fee-for-service payment system to an episodic prospective payment system (modeled after the CHHA Medicare PPS but adjusted to reflect CHHA Medicaid patients
                             served). It is important that this is constructed using an appropriate base year, that the case mix methodology reflects the Medicaid population, and that capital costs (for example, electronic medical records, etc.) which
3059   Website Submission    Do not carve out mental health. There are better ways to improve care coordination, to integrate mental health and physical health care, to reduce inpatient stays and emergency room use and save money. In fact, the
                             work of a state funded demonstration project for managing the care of high cost Medicaid enrollees being conducted by HHC facilities – Bellevue, Woodhull and Queens Hospitals – is showing real promise in these
3060   Website Submission    Develop and implement a standardized assessment and assignment of aide hours of care across the Personal Care Program, CHHAs, LTHHCPs and other programs. Such an instrument has already been developed,
                             validated and tested across programs by a large provider in NYS (and similar tools are being used by other agencies across the State). This would reduce the extremely wide variation in aide services between providers
3061   Website Submission    Consolidate programs aimed at meeting the needs of similar patient populations. For example, the Nursing Home Transition Diversion Waiver Program serves the same population as the LTHHCP yet created an
                             entirely new and costly administrative structure to implement, manage and oversee. Instead, the Long Term Home Health Care Program should be modified to allow all of the same program elements. Likewise, if
3062   Website Submission    reduce all new beneficiaries to Fed minimum 15 option /basic medicaid health benefit.

3063   Website Submission    Restrict spousal refusal/impoverishment practice for long term care eligibilty for Medicaid

3064   Website Submission    utilize Salient type modeling /tracking of medicaid expenses by all Counties at NYS expense to help further control fraud, waste and abuse.

3065   Website Submission    I would recommend focusing on closing institutions, nursing homes and residences that cost far more than having people live in their own homes in the community. The Medicaid Waiver programs have shown that
                             they are much more cost effective and provide a higher quality of life for people.
3066   Website Submission    I also recommend looking at how people are determined eligible for medicaid and public assistance. I am aware of two young men, 21 years of age who are able bodied but who were able to receive medicaid and public
                             assistance but yet, an older couple who are hard working don't qualify for any assistance when he loses his job and she has a stroke and had to stop working. They were told they made too much in unemployment
3067   Website Submission    Many patients with Medicaid frequently change providers and institutions. As an Ob/Gyn (recently retired), I noticed many patients presenting for prenatal care who started prenatal care elsewhere. Records were not
                             easily accessible and labs and sonograms were repeated.
3068   Website Submission    Discontinue Prior Authorization procedures, streamline formulary to only basic, generic medications.

3069   Website Submission    Discontinue paying for any brand medications as the only medication allowed! For instance Adderall XR and Valtrex both have generics that NYS MEDICAID WILL NOT PAY FOR! NYS MEDICAID will only
                             pay for the Brand!
3070   Website Submission    Discontinue service for clients with IPHONES and fancy new cars. This is a regular occurance. Perhaps there needs to be a tougher enrollment procedure. There should also be more followup and followthru on clients
                             for eligibility
3071   Website Submission    I would suggest that Medicaid cover the basics only. Well child care, emergency care. I know they used to cover tubal ligation reversals, that is absolutely ridiculous.

3072   Website Submission    First,pick the poison:is the high cost of healthcare (A)patient or (B)profit driven?
                             (A) if costs of services are driven by patients than providers need to have options that are just as feasible and can work well towards healthy outcomes. A needs assessment by provider's should indicate a host of
3073   Website Submission    Psychiatric urgent care visits will replace more costly trips to the emergency departments (ED). There is expected to be a significant savings through reduced admissions and shorter lengths of stay for those consumers
                             who are admitted to inpatient units. Based upon discussions with public and private hospitals regarding their needs from the community-based system, PSCH has developed the concept of a psychiatric urgent care
3074   Website Submission    The Project

3075   Website Submission    Spend the medicaid dollars where it pays off - in direct care. Revist the reimburseable treatments. Therapy is not always indicated - even when someone benefits from medication. Group therapy is often more effective
                             than individual therapy.
3076   Website Submission    Most private insurance plans do not offer dental coverage, or if they do, there is a significant cost sharing component. Could you require a minimum co-pay (like $5 or $10) for dental services (cleanings, x-rays, etc)?
                             This co-pay could be waived for services directly related to an underlying medical cause (for example exams or cleanings when osteoporosis has been diagnosed). In addition, teeth extractions for children have to be
3077   Website Submission    New York State can best improve care and reduce runaway costs for Medicaid beneficiaries with chronic behavioral and physical health conditions through the implementation of regionally managed behavioral health
                             care coordination systems. These systems can provide the most effective outreach, engagement and linkages to medical care, housing and local support and social services that will produce savings immediately through



                                                                                                                                                                                                                                                          108
 #                  Author                                                                                                              Proposal
3078   Website Submission    Include mental health and substance abuse services in the benefit package for all Medicaid managed care enrollees.

3079   Website Submission    Expand the benefit package to include pharmacy services for all Medicaid managed care beneficiaries;

3080   Website Submission    Expand the benefit package to include personal care services for all Medicaid managed care beneficiaries;

3081   Website Submission    Reduce waste, duplication and health plan and state administrative costs by centralizing New York City MMC plan contracting oversight to the state

3082   Website Submission    Require a $1 or $2 replacement fee for NYS Benefit cards.

3083   Website Submission    Discontinue managed care 6-month guarantees, and the one-year guaranteed coverage for children.

3084   Website Submission    Require actual proof of income at Medicaid renewals, attestation of income invites fraud.

3085   Website Submission    Implement pay for performance

3086   Website Submission    Health Information & Telehealth Technologie: full utilization of these technologies in the following areas:
                             1. Medicaid application processing and case reviews, including supplemental assessments, e.g. multi-axial assessments team (MAAT) and managed addiction treatment services (MATS). This would require redefining
3087   Website Submission    2. Improved access to care, improved monitoring of the physical and mental status of individuals, health teaching, screening (physical, mental health, addiction) and more can be facilitated with fuller utilization of health
                             information and telehealth technologies.
3088   Website Submission    3. Critical to utilize an integrated care approach (integrated addiction, mental health, and primary care) as well as whole-person focus (separate suggestion to improve care, particularly for long term benefits).

3089   Website Submission    Limit the amount of medication a paitent can receive (# of refills - they could be selling them on the street)

3090   Website Submission    Re-evaluate the waivers for OMH. Are they really needed?

3091   Website Submission    For LTC - admissions an upfront cost or a annual fee amy be needed. Siblings are pushing their parnets into the nursing homes because they don't want to deal with them.

3092   Website Submission    People who have an addiction problem should be required to attend AA meetings and/or be enrolled in a treatment program. They are never going to beat the addiction without treatment.

3093   Website Submission    I recommend educating people about the benefits of using a regular doctor vs. emergency room services. This will save the state money in providing preventative care and decreasing the expense spent by medicaid on
                             emergency room services.
3094   Website Submission    Primary care and especially behavioral health care for American Indians often cannot be managed within one county, especially when seeking American Indian sensitive/specific care. Too often the county-based
                             Medicaid process presented major roadblocks to patients getting adequate, appropriate, and culturally proficient care. Service provision and case management for this population ought to be statewide (versus county)
3095   Website Submission    Addiction services provide an opportunity for prevention, not only of next generation addiction, but fetal alcohol spectrum disorders and health issues related to pre-natal exposure. The cost savings related to preventing
                             FASDs is large and few addiction services provide for this type of prevention work. Integrate these services as well.
3096   Website Submission    Develop methods to measure how integrated a service provider is in the community(s) they claim to provide specialized services to. Make a commitment to fully utilize culturally proficient care. The investment will
                             produce more effective and efficient work environments and better patient care. Surveys, monitoring instruments, competency standards, and on-site reviews would be essential.
3097   Website Submission    Reduce dependence on hospital emergency rooms by creating a network of community-based, family care clinics for colds, minor injuries, routine exams, mental health assessment/referrals, etc. Rather than having to
                             create NEW clinics, utilize existing public and private sites, e.g., substance abuse treatment Article 32 clinics during currently non-operational times (evenings, weekends); pharmacy chains (Duane-Reade, CVS, Rite-
3098   Website Submission    An area that we may be able to improve efficiencies on and thus save medicaid dollars would be medications. Specifically there are 2 components with potential cost savings that should be addressed: 1. the automatic
                             renewal of prescriptions from pharmacies which results in the delivering of prescriptions that are no longer being prescribed/need to come up with a better system for communicating to pharmacies when prescriptions
3099   Website Submission    I believe we could save a lot of money AND provide well for our seniors in ways they would prefer, if the program were expanded to include caregiving services covered by Medicaid within the many varieties of
                             residence that are developing to meet today's needs: senior apartment living, senior independent living, assisted living, and nursing homes. I also believe that we need to encourage municipalities to loosen their zoning
3100   Website Submission    You could eliminate the Utilization Threshold program. I don't know that it really is beneficial to containing MA costs, since the providers can complete an override form to get more visits. Some people (usually the
                             elderly) will follow the limits, & then won't go to the dr. when they need to. It is also a difficult system to work with for the providers (drs & pharmacies)between the limits & overrides. It would save money in



                                                                                                                                                                                                                                                          109
 #                  Author                                                                                                            Proposal
3101   Website Submission    This is an addition to a comment I posted yesterday. I was thinking that educational workshops could be set up to Medicaid recipients informing them of how to use Medicaid card, when is it appropriate to go to the ER
                             and when should your PCP be consulted.
3102   Website Submission    Expedite the assisted living residence application review process;

3103   Website Submission    Fold a reformed assisted living program with feasible rates and full aging in place into the Assisted Living Reform Act of 2004.

3104   Website Submission    intensive programs to prevent, or shorten psychiatric hospital stays exist in the private sector, but not in New York State Medicaid. Partial hospitalization (PHP)is an acute level of care(LOC)outpatient equivalent of
                             inpatient treatment. Continuing day treatment (CDT) is for chronic patients. Many community based support programs exist.
3105   Website Submission    Enough background, prior to starting ALTUS I worked as a Senior Manager at Arthur Andersen Consulting. Our main program was to go into failing hospitals and find savings opportunities. One of the largest savings
                             ideas was to recover a hospitals drug expense for indigent patients back from the pharmaceutical companies. We would save millions of dollars per hospital per year. When I moved back to New York and tried to
3106   Website Submission    Also, If you lifted the ban on For-Profit Hospitals in New York competition and improved cost efficiency would be a natural bi-product. The Berger Commission was an abysmal failure at the tax payers expense and
                             did not accomplish its mission. New York is the only State forbidding For-Profit health care and we are one of the most expensive Medicaid program in the US. I think we have to get over ourselves and come to the
3107   Website Submission    Permit Long Term Home Health Care Program (LTHHCP) agencies to become certified as Home Health Agencies for the sole/express purpose of serving clients in need of home care over a given length of time (perhaps
                             90 days). This could give them the ability to provide long term home care services to Medicaid consumers outside of the LTHHCP waiver (including, for example, consumers in other 1915(c) waivers or in need of State
3108   Website Submission    Require LTHHCP agencies providing services to LTHHCP waiver participants to provide or arrange for the full range of waiver services to enable the consumer to benefit from waiver participation, not merely to
                             receive basic home care.
3109   Website Submission    Limit CHHAs which do not have the long term designation to 60 days of Medicaid reimbursed care unless prior approval is obtained.

3110   Website Submission    HOSPITALS WHICH HAVE ASSOCIATED NURSING HOMES ARE RECEIVING BED HOLD PAYMENTS WHEN THE PATIENTS LEAVES THE NURSING HOME AND IS ADMITTED IN THE
                             HOSPITAL. THIS TYPE OF MEDICAID REIMBURSEMENT IS A DOUBLE PAYMENT FOR THE SAME RESIDENT WITHIN THE SAME ORGANIZATION. TWO PAYMENTS ARE RECEIVED ONE
3111   Website Submission    The current OASAS method and instrument used to review programs should be changed. Currently the instruments simply evaluate programs as to whether a form is in a patient record and whether that form is signed
                             and dated appropriately. The content is immaterial. This process of ?auditing? needs to change to assess the quality and clinical appropriateness of treatment being provided. Specifically with respect to Outpatient
3112   Website Submission    OASAS recently requested and was approved to have the ability to certify programs for five years. Given the information in the above item, a five year certification without changing the way programs are reviewed is
                             absolutely unthinkable. OASAS is using their ?Gold Standard? to identify programs which would quality for five year Operating Certificates, however, many of the elements of the Gold Standard are self reported by
3113   Website Submission    Currently, OASAS Field Offices monitor funded programs with extremely little oversight of non-funded programs and providers. Of the top 50 programs on OASAS? high Medicaid utilization list mentioned above,
                             68% are non-funded. Given that number, OASAS Field Offices definitely need to start monitoring non-funded programs as well as those that are funded.
3114   Website Submission    Utilization Review by OASAS needs to be monitored more closely. Long term outpatient treatment is not beneficial to patients. Patients attending outpatient treatment daily or near daily for 8 ? 13 years is outrageous,
                             but it exists in the OASAS system. Set yearly limits on the amount of visits for outpatient services.
3115   Website Submission    Chemical dependency treatment is just that TREATMENT for a medical illness! Currently OASAS permits drug courts and other criminal justice entities to dictate the frequency of treatment without consideration of
                             the clinical need or appropriateness. It is NOT a babysitting mechanism for probation and parole, DSS, drug courts and the like. Treatment should be based on clinical need, not mandated by outside entities whose
3116   Website Submission    Outpatient treatment should not be seven days per week. Currently OASAS regulations and Medicaid reimbursement rules allow for this excessive abuse of the treatment system. Proposed new OASAS regulations
                             which include APGs also allow for seven day treatment billing. In fact, billing with APGs allows for more than one service to be billed in a day. No other medical condition allows for seven day per week treatment
3117   Website Submission    Eliminate the costly State run Addiction Treatment Centers and allow them to be privatized to provide a huge cost savings to the State.

3118   Website Submission    During the last administration, a ?no wrong door? policy was adopted, however no standards were ever followed through with in regards to this policy. To actually follow through and provide standards for staffing and
                             overall policies would prevent double billing from OASAS and OMH programs.
3119   Website Submission    OMH regulations ? 599.13 provide for a 25% reduction in fees for providers with an operating certificate of less than six months due to having been determined to be deficient in meeting applicable standards and
                             requirements. OASAS and other agencies should have these same fee reductions. Governor Cuomo has been speaking about incentivizing with the education system; why not incentivize within OASAS, OMH and
3120   Website Submission    To continue access to community based care while providing improved over sight and fiscal control, limit the amount of State Plan community based home care services that can be obtained outside of a managed
                             environment (either through a waiver, managed care or case management).
3121   Website Submission    Medicaid Pediatric LTC Priority Recommendations:

3122   Website Submission    ong term: November 2011

3123   Website Submission    I strongly urge the Medicaid Redesign Team to follow the lead of the Surgeon General and affirm that ?you cannot be healthy without oral health.? To continue to approach oral health/dental services as ?optional?
                             defies scientific reality; oral health/dental services are an essential component of primary care. To provide adult primary care medical services without the oral health component will result in needless systemic disease



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 #                  Author                                                                                                            Proposal
3124   Website Submission    Recovery happens in every community in our state. Increasing the potential for recovery by situating counselors in each community hospital to conduct a Screening, Brief Intervention and Referral to Recovery Support
                             Services will connect people with substance use disorders and their families to local community based services. Efforts that involve caring peers that connect individuals to care and other support recovery efforts will
3125   Website Submission    Case Management services that include Recovery Support via Recovery Coach Mentors would assist those in early recovery to stay connected via a person centered approach that individualizes a response to a person?s
                             needs and thereby increases the potential for sustained recovery.
3126   Website Submission    By empowering Consumers, the Medicaid program can yield savings in two ways. First the traditional CDPAP model relied upon half the staff of a conventional home care program because all Quality Assurance and
                             Personal Assistance employment functions were vested exclusively with the Consumer. Second, the exception built into the Nurse Practice Act, enables Consumers with high level service needs to be served by lower
3127   Website Submission    I think that Medicaid should not pay for infertility treatment. I have been undergoing this through my own insurance through my employer and there are many things it does not pay for (medication, invitro fertilization,
                             etc.). I do not think that people that are receiving health benefits paid for by the taxpayers should be allowed to receive such services as this would further burden the taxpayers (i.e. a possible conceived child would be
3128   Website Submission    Eliminate the loopholes that continue to allow New Yorkers to creatively "estate plan" by such games as transferring their assets or refusing to support their spouses. Such mechanisms allow those with access to funds
                             and counsel to, in effect, transfer responsibility for their long term care to their neighbors. Granted, it's a great employment program for many in the elder bar and is even accepted by many legislators (including those
3129   Website Submission    In assessing which federal Medicaid reform options to pursue for long term care, include an analysis of the costs to New York State once any enhanced FFP is no longer available. Once a service option is made
                             available, it is effectively impossible to take that service away-it most likely supplements rather than replaces existing services,consumers become used to it, providers rely on it for income, and workers rely on it for a
3130   Website Submission    Utilizing the new DOH data warehouse solutions across agencies.
                             It is my contention that instead of having a cold backup site for disaster recovery but to identify the agencies that utilize the data on a daily basis. Then have these agencies house a hot backup of the DOH Medicaid
3131   Website Submission    Eliminate the need for requiring CPA sign off on Consolidated Fiscal Reports filed with OMH which represents a 25% of the audit costs. CPA certification of Financial Statements should be sufficient.

3132   Website Submission    Medicaid should implement a faster turnarount time for reimbursing/paying providers. Providing services for a complete month (OPWDD's Supervised IRA or Service Coordination) and waiting for another month to
                             collect threatens financial viability, quality of services and increases financial costs.
3133   Website Submission    I feel that if someone needs food stamps or allowances for heat or food should be given a blood test for nicotine. I know of several individuals who apply and receive food stamps and heap, and smoke 2 packs of
                             cigarettes a day. How can anyone afford to smoke? I know I can't afford it with grocery prices thru the roof! Please know that I'm an ex smoker of 20 years and I've been quit for 5 years. I did what needed to be done. I
3134   Website Submission    Require enrollment of dual-eligible patients in a managed care program as a pre-requisite to accessing personal care services.

3135   Website Submission    Eliminate duplicate regulatory and oversight activities. This is especially true in the area of behavioral and mental health services. As part of this, return rate setting for these services to the Department of Health, and
                             eliminate the fiscal management bureaucracy and redundancy of OMH, OASAS, and OPDD.
3136   Website Submission    Restructure disproportionate share funding (DSH) to support safety net providers. Traditional DSH funding has focused on hospitals with high levels of service to Medicaid and the uninsured. While these measures
                             should continue to be considered, funding should support safety net providers who are clearly essential to a community?s fundamental access to healthcare. Such is the case at our hospital and for many hospitals
3137   Website Submission    Establish a Center for Provider Innovation, similar to the federal Center for Medicare and Medicaid Innovation (CMMI) established in last year?s Health Reform Act. Healthcare providers have built over the decades
                             systems designed to produce units of care. In today?s environment, we as providers must change our systems and mindsets to manage processes of care . . . and not solely produce units of care. A state-sponsored Center
3138   Website Submission    Eliminate inappropriate use of Emergency Department services by directing patients with non-emergent needs to appropriate care settings. Our hospital, for example, operates 13 primary care centers and practices that
                             could support this initiative. Changes might include incentives for outpatient clinics and primary care sites for extended office hours to allow Medicaid recipients greater access to routine care. In addition, continue
3139   Website Submission    Alcohol and other substance abuse are directly related to more than one third of healthcare costs. As a researcher in the field for the past 40 years I have seen the effectiveness of substance abuse treatment and
                             intervention. Current regulations and funding limits are a serious impediment to providing treatment, especially to young clients who have the greatest potential for recovery or for a lifetime of healthcare and other
3140   Website Submission    For example, earlier this year, the Foundation released a report, conducted by The Lewin Group, ?Bending the Health Care Cost Curve: Options for Saving Money and Improving Care.? The report, available at
                             http://www.nyshealthfoundation.org/content/document/detail/12450/, examined 10 policy options?from expanding palliative care to improving coordination of services for New Yorkers who are eligible for both
3141   Website Submission    1. Establishing community health workers (CHWs) as part of the health care team. Community health workers can play an important role in improving the integration and coordination of care for people with chronic
                             illnesses and lowering the use of costly services like avoidable hospitalizations. NYSHealth is working with the Mailman School of Public Health at Columbia University and the CHW Network of New York City on a
3142   Website Submission    2. Implementing care transition programs to reduce hospital readmissions. Care transitions programs have been shown to improve patient satisfaction with the hospital discharge process and to reduce medication
                             problems, overuse of the emergency department, and hospital readmissions. An NYSHealth-funded pilot program in the Bronx provides patients with enhanced education on discharge instructions (medications, signs
3143   Website Submission    3. Maximizing the potential of the Chronic Illness Demonstration Projects (CIDP). Twenty percent of New York State?s Medicaid beneficiaries drive almost 80% of total Medicaid spending. These patients often have
                             multiple chronic conditions or disabilities and do not receive the coordinated care they require. As a result, patients are often forced to cope with costly and poor quality care. New York State responded to the need to
3144   Website Submission    4. Focusing on diabetes prevention and management. Our Foundation?in partnership with the New York State YMCA Foundation, and the New York State Department of Health?s Diabetes Prevention and Control
                             Program?is supporting YMCAs in 10 regions across New York State to implement community-based programs to prevent diabetes among those at highest risk. The initiative is based on the highly successful Diabetes
3145   Website Submission    Adminstrative overhead and executive salaries for non-profit agencies should be capped based on the size of the agency. Non profit administrators should not be making high six figure salaries given it is paid for by
                             Medicaid and tapayer monies. Additionally the direct support staff get paid next to nothing and they are the ones actually delivering the serices.
3146   Website Submission    Acknowledge that housing stability is a primary factor in achieving good health outcomes and reducing wasteful Medicaid spending. Supportive housing has been proven to be a determining factor in successful health
                             outcomes. Supportive housing is an established model with existing infrastructure in place, already serving high users of public services in a cost-effective way.



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 #                  Author                                                                                                                Proposal
3147   Website Submission    Coordinate Care in Supportive Housing ? Though supportive housing?s mission has focused on ending homelessness, increasing independence and maintaining housing stability, it has also achieved significant positive
                             health outcomes. If coordination of behavioral and medical healthcare were made more central to the mission of supportive housing, even more gains could be achieved. Many supportive housing providers are ideally
3148   Website Submission    MH Primacy Over Behavioral Health Care ? While OMH and DOH must work closely together, OMH should be primarily responsible for overseeing the analysis, design and implementation of any changes to the way
                             Medicaid funds behavioral healthcare. OMH has the expertise in this area, as well as a strong record in understanding the important role housing plays in recovery. If service coordination or care management entities
3149   Website Submission    Behavioral Health Carve-Out ? While service coordination must be improved within the behavioral health population, it is essential that this cohort continue to remain outside of
                             mainstream Medicaid physical health managed care. It may be that behavioral health may need to move to a managed care model. But this should be done in a thoughtful way that identifies the true reasons for high
3150   Website Submission    There Should Be a Nonprofit Option for Managed Care ? If it is decided that some portion or the entire behavioral health cohort becomes subject to managed care, the State should make it possible for nonprofit MCOs
                             and nonprofit providers to compete for the behavioral health managed care contract. Similar to the Pennsylvania model of managed care, or New York?s Special Needs Plans for people with HIV/AIDS (as well as SNP
3151   Website Submission    Legislate that 90% of all Behavioral Health Managed Care Medicaid payments must go to patient care ? This provision is included in the Pennsylvania model to ensure that care is adequately funded. It provides the
                             foundation for the success of the model in that state, and should be an essential element in any behavioral health managed care plan moving forward. There is no need for the taxpayers of New York State to pay an
3152   Website Submission    Explore the development of new strategies for early interventions in first breaks. These may build on approaches that emphasize family counseling, and use of benzodiazepines before turning to neuroleptics.
                             Experiences in Sweden and other European countries indicate that many individuals may be spared a life time of psychiatric disability if the most powerful anti-psychotics are used more cautiously. Solid research
3153   Website Submission    Develop a new crisis residence as an alternative to hospitalization. Psychiatric hospitalization is extraordinarily expensive. It should only be used when absolutely necessary. Again, intervention strategies in Europe
                             have progressed far beyond those in the United States, and should be emulated. Some existing OMH Community Residences can be converted to crisis residences to serve as a respite alternative to hospitalizations.
3154   Website Submission    ? Develop a multi-agency, coordinated identification and placement effort prioritizing high users of Medicaid services.
                             o Identification: Sharing and comparing data across agencies can identify high users of a multitude of public services, from Medicaid, to shelter to incarceration. In addition, the supportive housing community has
3155   Website Submission    Reduce institutional care capacity.
                             o Adult Homes: While there are many nonprofit and even some proprietary adult homes that provide decent levels of care, many for-profit adult homes continue to provide outdated, inappropriate, quasi-institutional
3156   Website Submission    evelop strategies that reduce Medicaid recipients? ability to ?shop around.? Some Medicaid overspending is driven by individuals who utilize multiple clinics, pharmacies and hospitals as a result of behavioral
                             challenges. Limiting people who overuse these services in this way in some manner could reduce costs.
3157   Website Submission    Establishing a definition of ―safety net hospital‖ that includes only those facilities
                             having a payor mix of 70% or more Medicaid and uninsured combined.
3158   Website Submission    Creating preferential reimbursement structures for safety net providers through
                             use of the Upper Payment Limit (UPL) or other mechanisms.
3159   Website Submission    Enforcing existing federal and state laws requiring hospitals to serve Medicaid and
                             uninsured patients without discrimination and to provide financial assistance.
3160   Website Submission    Guaranteeing transparency and accountability in the distribution of charity care
                             funds as well as physician compensation.
3161   Website Submission    Ensure that Medicaid dollars are spent on high-quality care that will prevent repeat
                             hospitalizations and physician visits and reduce overall utilization by:
3162   Website Submission    Medicaid employees should be better trained and better informed when speaking to parents over the phone, especially those designated ""help lines"". Each time you call you can get a different person with different
                             information. When you are dealing with a sick child, you don't have time to navigate the system and deal with the discrepancies in advice and information given by these employees. It would help for each family to have
3163   Website Submission    Access to Coverage
                             It is critical that New York act quickly this session to enact legislation establishing a
3164   Website Submission    Many of you have read or heard the buzz around the January 24th article in the
                             New Yorker by Atul Gawande. The article excited many who advocate on health
3165   Website Submission    Make any rx's issued only valid for 48-72 hours, like in other states. This may limit Dr shopping & therapeutic duplication; If they truly need the med, they'll have to get it or lose the opportunity.

3166   Website Submission    MANDATE the use of the PMP( national database for controlled substances issued) for pharmacies & prescribers alike, it's a no-brainer

3167   Website Submission    Go to one, statewide electronic rx program that would serve as "Official NYERx"...have them bid like the formulary process. It would be the only format for 5 years...then option for rebid/other company.

3168   Website Submission    Stop paying for diapers,formula,humidifiers, etc. If it doesn't pertain to a disease or disability, perhaps people will "learn" to find the means...or prevent the needs in the first place.

3169   Website Submission    Stop the swiping game at pharmacies,either your computers at the state have the online info or hire more people to get it done all the time.Healthcare doesn't close at 5, nor should your offices, or get out of healthcare. If
                             it adjudicates online at the pharmacy, its good.



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 #                  Author                                                                                                           Proposal
3170   Website Submission    For those disabled clients receiving private duty nursing care at home: currently, the family / care givers must re-certify every 6 months to obtain new providers for Medicaid case / care. This 6 month renewal requires
                             visit to physician to review medical orders, a head-to-toe nursing assessment either by agency or public-health nurse, letters of denial from medical insurance providers (in the cases whereby the disabled person is
3171   Website Submission    Medicaid Service Coordinators: This is another area of significant financial cost ? and waste. MSCs / agencies (for example, New Horizons in Dutchess County, NY) charge $253.91 an hour ? yet provide no tangible
                             service to the families of the disabled. The MSC will update the ISP Plan and minimal coordination of services for the disabled, but requires the monthly visit to the home despite providing no concrete assistance to the
3172   Website Submission    As part of Medicaid reform I strongly urge you to reduce group home and residential facilities for developmentally disabled and those with mental health issues. As a person who administered these programs for over 20
                             years, I saw first hand the many people who are currently living in these facilites that could live in the community. They could receive much less costly services in their own home and have a significantly improved
3173   Website Submission    When representatives from the OMIG are reviewing programs for medicaid fraud they should be evaluating if people are in fact receiving services in the least restrictive setting that could provide them with the supports
                             they require. Shifting people to less restrictive settings could save significantly more medicaid dollars than those that are being recouped through fraud detection activities.
3174   Website Submission    OASAS licensed outpatient detox with linkage to apprpriate level of car as determined by professionals

3175   Website Submission    appropriate reimbursement for all services to providers with professionals who are QHPs who can diagnosis,assess and treat

3176   Website Submission    case management should be offered to coordinate care

3177   Website Submission    Between 2008-2010- UMass Medical School?s Clinical Pharmacy Services program provided retrospective drug utilization review for NY Medicaid. During that time we identified several areas in which cost could be
                             avoided and quality of care improved, those areas include:
3178   Website Submission    Stop insurance companies from canceling insurance policies such as Durable Medical equipment and nursing care. The insurance companies are forcing patients to go to Medicaid , such as Guardian Insurance is doing .
                             They are not going to sell health insurance anymore in N.Y. or any other state. The Federal government should not allow them to forego their responsibilities to existing policy holders. If they did it all other insurance
3179   Website Submission    Grow the idea of service programs to develop a LTC workforce for both direct care and administration:

3180   Website Submission    COST SAVINGS IN CONNECTION WITH DUAL ELIGIBLES

3181   Website Submission    The following conditions make savings possible:
                             * There is a robust regulatory structure in place for these programs requiring certification, oversight of solvency, consumer protections, quality measurement, etc. Both the Department of Health and the Department of
3182   Website Submission    RETURN PHARMACY TO THE MEDICAID MANAGED CARE BENEFIT PACKAGE

3183   Website Submission    Consider reducing EPIC back to the prior income limits for the indigent population, and increase the copayments. When times were good, and the State was in the black the politicians gave away the piggy bank on this
                             program by increasing the income limits and lowering copayments. Costs went out of control on this program, and seniors in Country Clubs were allowed to join EPIC. As a result tax payers paid their share of local
3184   Website Submission    I have a few of suggestions for Medicaid Redesigning.
                             1. NY state Medicaid pays providers that are contracted with the Indian health Services that provide service to (native Americans and native Alaskans) a flat rate of $268.00 per visit no matter what the services are that
3185   Website Submission    In NYC have state run pharmacies- that way beneficiaries will have a legitimate pharmacy to use. The pharmacy should have staff to properly counsel patients and have access to the patient's complete medication
                             profile.
3186   Website Submission    The governor is right about the amount of time and money spent on administrative costs in home health care. It is absurd, but please consider the incredible number of unfunded mandates that have caused this
                             imbalance.
3187   Website Submission    MLTC and PACE Offer Proven Care Coordination Models that Improve Outcomes and Control Medicaid Spending.

3188   Website Submission    Recommendation #1: Reform Personal Care

3189   Website Submission    Recommendation #2: Streamline Enrollment for MLTC and PACE

3190   Website Submission    Recommendation #3: Embrace Manage Care for Dual Eligibles

3191   Website Submission    While the MAP program, implemented now for a few years, has had low enrollment for a variety of reasons, plans remain committed to making this product successful and are willing to work with the State to do so.
                             Without mandatory enrollment though, it will be difficult to drive beneficiaries to either of these integrated products. A change in federal law, a Medicaid waiver or the dual-eligible demonstration program under federal
3192   Website Submission    INCLUDE BEHAVIORAL HEALTH SERVICES IN THE EXISTING MEDICAID MANAGED CARE PROGRAM




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 #                  Author                                                                                                            Proposal
3193   Website Submission    Following the example of our neighboring state of Vermont, New York State should fund a detailed study of the alternatives available for achieving universal coverage, including alternative plans embodying single
                             payer principles. (Everyone recognizes that the ""Analysis of Reform Options"" conducted under a legislative mandate and published in July, 2009, failed to look in sufficient depth at the alternatives for achieving
3194   Website Submission    STREAMLINE MEDICAID ADMINISTRATION
                             HPA and its member health plans support the State?s takeover of county Medicaid administration functions, as outlined in the Department of Health?s November 30, 2010 report. HPA agrees that state takeover will
3195   Website Submission    Prior approval system needs to be adjusted. How about before giving a patient a brand name drug if a generic is available the patient needs to have a 30 day trial of a generic. No ifs ands or buts.

3196   Website Submission    Create a Medical and Mental Health ?medical home? that is able to meet the needs of chronic medically ill clients with mental health co-morbidities in a single integrated system. This would also provide a continuum
                             that includes collaboration with supportive community programs such as social and medical day care programs and Meals On Wheels.an integrated medical/mental health model that incorporate the participation of an
3197   Website Submission    We recommend that Provide flexibility that would enable the long-term home health care program (LTHHCP) to support the needs across the continuum of care. This will afford a more coordinated type of care,
                             increase operational efficiency and save costs. LTHHCP Programs be allowed to act as Certified Home Health Agencies (CHHA?s) for seamless care delivery for those who are otherwise eligible for Medicare/Medicaid
3198   Website Submission    Expand the scope of practice for certified home health aides and create a needed career ladder to fill the gaps in care management needs of our community residents. Home health aides can be trained to provide
                             medication assistance, look for mental health changes? and develop other competencies that would enrich our health care delivery system. This would also create new jobs and provide career ladders for those interested
3199   Website Submission    Nursing homes will always be a vital part of the continuum of care. We recommend maintaining adequate reimbursement, investing in capital improvements and acquiring new technologies so that nursing homes can
                             keep pace in a cost effective manner with the growing demands for quality skilled care
3200   Website Submission    1. RECOVER the $262.9 million annual healthcare expenditures in NY from secondhand smoke exposure and the appropriate amount of the $5.4 billion State Medicaid Program's total health expenditures caused by
                             tobacco use FROM HUD SUBSIDIZED LANDLORDS that intentionally inflict unnecessary and preventable adverse health effects on their tenants. DEDUCT these healthcare costs FROM THE NEGLIGENT
3201   Website Submission    INITIATE the following 2 penalties to pay for the administrative costs that may be needed (in addition to the above healthcare costs).

3202   Website Submission    I am a pediatrician and see many m'caid patients. Years ago, all the insurers went to a common ""billing code"" system. M'caid went along, except for some of the codes it chose not to. For example, office procedures
                             such as Strep Screen or Urine analysis use a diff code for M'caid than all the other insurers. This is wasteful of time for the physician and just down right annoying. It would be easy and simple, and nice, for you to fix
3203   Website Submission    DDSO community homes and m'caid. M'caid supports many handicapped patients in community homes or with special transportation needs from independent living. The transportation system is redundant. For
                             example, for children living in a community home, there is a special handicapped bus owned by the DDSO, one created and owned by the school, and public transportation also adapted for these clients (who are all in
3204   Website Submission    Efforts to simplify and streamline enrollment will reduce administrative costs. Antiquated and uncoordinated electronic systems, complicated applications, and duplicative paperwork place a financial burden on the
                             Medicaid program. Furthermore, the implementation of the Affordable Care Act requires the state to transform its health insurance and health care systems, including vastly simplifying access and enrollment. In order
3205   Website Submission    As a health care professional working in the home care environment I'd like to make some suggestions that most likely would decrease costs.
                             1. residency law
3206   Website Submission    As difficult as it was, I would recommend re-instating the Medicaid Fiscal Assessment Program for home health care. This program was sunset in the early 2000s, I believe. Under this program, providers had to keep
                             track of spending on Medicaid cases. Cases that exceeded a certain dollar amount required follow-up.
3207   Website Submission    The Medicaid team should do a audit of all consumer receipts and purchases and look at the cognative level of that individual. As a care giver for people with developmental disabilities you are made to go out and spend
                             money on BIG TICKET items such as flat screen tv sets and imported leather furnature cd players etc. just to spend their money, or they dont get Medicaid funding. most of these people dont have the level of
3208   Website Submission    The Medicaid Redesign Team and budget officials should carefully analyze the Nursing Home Rightsizing program before proceeding or authorizing any more projects. Proposed savings to Medicaid and to other
                             government funding sources have not been realized, and it is highly questionable whether savings will even be achieved in future years. Thus far costs to the taxpayer have far surpassed any savings, and it is difficult to
3209   Website Submission    s a rural family doctor in upstate N.Y. for the past 27 years i would like to submit my policy reform ideas to help reform our medicaid program into a cost effective system, that results in better care and saves
                             new york taxpayers billions. First , i believe we need to get the county governments out of the medicaid business . The state would take over all of medicaid delivery and costs. In exchange all sales tax collected
3210   Website Submission    With many physicians not accepting medicaid due to its very low reimbursement, many medicaid patients also use er,s( often delaying care), thus resulting in much more expensive hospital care. There is also a
                             substantial difference with reimbursements for primary care mds (about $30) vs title 28 clinics ,( receiving $100) for the exact same level of care. A uniform state run system can entice more primary care
3211   Website Submission    PROPOSAL FOR IMMEDIATE ACTION
                             NO LEGISLATIVE ACTION NEEDED
3212   Website Submission    Set up clinics in areas throughout the state that are run exclusively by the Medicaid program. These facilities could handle urgent care, physician, dental, lab, and counseling services. With this type of clinic there would
                             be no reason for providers to over-inflate services, and order frivolous tests, etc. Make participation of recipients mandatory in these clinics. Allow non-insured persons to utilize the services at these clinics at reduced
3213   Website Submission    Require recipients to purchase generic drugs (at their expense) through programs that pharmacies offer (such as Wegmans/ Walmart $4.00/$10.00 programs.) It is my understanding that recipients do not currently pay
                             any fee for perscription drugs. If a non-generic is the only option, then it should be covered by Medicaid.
3214   Website Submission    Intercept tax refunds of Medicaid recipients. If a Medicaid recipient is getting a tax refund then they should contribute to their own medical care.

3215   Website Submission    Right now, there are ""secure services"" individuals around the state being cared for by OPWDD. These individuals are criminals and could be in a regular prison system. While not in the general population in the
                             prison is a given, they should be under the care of Dept. of Corrections....by having felons imprisoned in OPWDD's care, they then fall under the care and finances of the Medicaid system. There is no need for this, as



                                                                                                                                                                                                                                                          114
 #                  Author                                                                                                           Proposal
3216   Website Submission    Six percent of Downtown Hospital?s revenue base goes to paying medical malpractice insurance premiums. Of the 3,000 women who have their babies at our Hospital, a little over two-thirds of them are Medicaid
                             recipients. I am urging you to consider creating either a No-Fault Fund or a Fault-Based Medical Indemnity Fund, which will reduce malpractice costs to hospitals like ours, with a large number of obstetrical deliveries.
3217   Website Submission    1. Reform the Hospital Bad Debt and Charity Care Pool
                             New York?s hospitals provide an important safety net for uninsured and underinsured New Yorkers. The Hospital Bad Debt and Charity Care (BDCC) pool (or the Hospital Indigent Care Pool) helps hospitals cover the
3218   Website Submission    2. Simplify and Streamline Enrollment & Renewal.
                             A significant step to improving quality in the Medicaid program is to ensure that those who are currently eligible for coverage are enrolled and, once enrolled, able to retain coverage through successful completion of the
3219   Website Submission

3220   Website Submission    3. Rebalance Long-term Care
                             Many states have been able to lower costs in recent years by rebalancing their Medicaid programs away from institutional care in favor of care provided within the community. New York also has an opportunity to
3221   Website Submission    4. Address Language Barriers
                             2.3 million New Yorkers are limited English proficient (LEP), which compromises their ability to communicate effectively with their health care providers. Lack of language assistance services in Medicaid undermines
3222   Website Submission    5. Incorporate Data Collection and Incentives to Reduce Disparities
                             New York has a well-established quality improvement program, the Quality Assurance Reporting Requirement (QARR), which feeds into its pay-for-performance program, the Quality Incentive (QI), for its Medicaid
3223   Website Submission    OPWDD is redesigning it's Medicaid Service Coordination Program and Plan of Care Support Services.

3224   Website Submission    For Licensed Home Health CAre employees are finger printed once and entered into a data base. Employers then claim their employees from the data base. Should an employee committee a crime the employer is then
                             notified. The cost for finger printing is done once. THe OPWDD system is not nearly as efficent and the cost is paid by the state. In OPWDD an employee is finger printed by each employer. There are two differnt
3225   Website Submission    OPWDD - DDP 1 and DDP 2 forms. Allow provides to complete these forms and submit them electronically. We currently complete the forms and mail them in. Then OPWDD pays data entry employees to enter the
                             information into an electronic version ofthe form. For DDP 2 forms if there is a question they then mail the form back to the provide who answers the quesitons and mails it back to the data entry person.
3226   Website Submission    OPWDD should be able to bill private insurances for their services like OMH does.

3227   Website Submission    New york should require all persons submitting tax returns must include a signed affadavit from a physician( one with NPI and state license) that the person(s) represented on the form have had an annual physical..No
                             health care information is provided therefore eliminating any violation of HIPAA..Either you provide a credit to those who submit or a penality for those who don't..If we can identify illnesses earlier we could reduce the
3228   Website Submission    OPWDD needs to be careful of ""reinventing the wheel"" and making Medicaid foot the bill for duplicative services that aren't needed.

3229   Website Submission    There needs to be a way for the individual to report their address change and have that information directed with centainty , possibly automatically to all active cases that the person gets benefits from. The address
                             change issue described above is one of the big reasons families lose their MA coverage when they are otherwise eligible. If this could be resolved, there would be a noticible decrease in reapplications for those who lost
3230   Website Submission    HCBS Waiver services are a cost effective use of Medicaid dollars. Recipients only use services that are justifiable as needed, using natural supports and community supports like family, friends, church members, etc.
                             to help provide supports that don't need to be purchased. This is a win-win for both individuals with disabilities and the community as taxpayers. Costs are reduced with these type of services and people are much more
3231   Website Submission    Use the positive outcomes from the NY Care Coordination Project and replicate this complex care management program across the state to improve client outcomes and reduce healthcare (Medicaid) expenditures

3232   Website Submission    The use of individual budgets, based on an assessment of need, provides a rational basis for funding services for individuals with Intellectual and Developmental Disabilities. Such a system will allow individuals to
                             receive the services they need as well as the services they want. Individual control can result in reducing costs as flexibility will likely result in people needing and choosing less than rigid program models offer.
3233   Website Submission    Perhaps a medicaid system with a limited number of acute visits and participant copay if those visits are exceeded could be instituted.

3234   Website Submission    Every time a recipient swipes their card, assess a charge of $1, which would then be subtracted from their monthly welfare check. If they use it 5 times, $5 dollars comes off their check for that month. The recipient
                             would then be contributing to their health care just like the rest of the country. For example; In Syracuse NY there are 80,000 medicaid recipients, 5 swipes a month X 80,000 = $400,000 X 12 months = 4.8 million
3235   Website Submission    Telehealthcare - develop screening criteria for use with individuals diagnosed with high cost chronic healthcare conditions (DM; COPD; HF; hypertension; obesity) to monitor and manage data, make appropriate
                             referral on continuum of care in advance of costly deterioration -->
3236   Website Submission    Medication Management: Med. dispenser technology for primary use elderly individuals who require some level of support to effectively manage medications at home. Enrollment in program to receive one month
                             prefill of medications (v. current practice RN to home one time per week to prefill - an expense not necessary if patient stabilized on med!)
3237   Website Submission    Rural regions: collapse multiple community-based home health programs to CHHA - long term programs with limited, if any, access; CHHA - MCare max "ease"; duplication administrative cost; decrease competition
                             for same pool of employees, where a workforce shortage already exist; develop shared staffing strategies / incentives across the continuum of care to address regional shortages ... and, reglatory flexibility to decrease
3238   Website Submission    Congregate Housing, or shared living environment designed to integrate the housing and services needs of elders and younger disabled individuals - as a condition for MCaid covered services - especially in rural NY.
                             - consider the MA plan:



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 #                  Author                                                                                                              Proposal
3239   Website Submission    Partnerships with consumers, health plans and providers to incentivize healthy behaviours --
                             a.) Managed Health Plan - to participate / offer products in NY, capped profits - and, excess to a pool that will:
3240   Website Submission    Many non-profit OMH housing agencies charge the state / medicaid for restorative services, which may not be needed. These services can lead to over three thousand dollars per month per client in addition to the
                             housing costs that are reimburst. 28 day rehabilitation services paid for by Medicaid can be used multiple times in a year with little benefit to the client. New York State mandated regulations of OMRDD and OMH does
3241   Website Submission    Reduce reliance on expensive institutional models of long-term care which cost more than 3 times as much on average as compared to community-based approaches that most people on Medicaid prefer.

3242   Website Submission    OPWDD is extremely overbilling for every person with a disability living in state institutional facilities (see series of investigative reports written by Mary Beth Pheiffer of the Poughkeepsie Journal). These facilities
                             were all slated to be closed by the year 2000, since 1991. OPWDD is currently charging over $4,500. per day/per person (1400 individuals), the Medicaid rate is over 4 times more than the next state. The majority of the
3243   Website Submission    We believe that endorsement of a Medicaid reimbursement methodology similar to the federal Medicare Critical Access Hospital reimbursement methodology will preserve the financial stability of the Critical Access
                             Hospitals in New York, ensure the ability of these safety net institutions to serve all of the patients in their communities, and enable these institutions to support the health care initiatives necessary for true Medicaid
3244   Website Submission    There is a big gap in the Medicaid rates paid to providers of skilled nursing facilities in New York State. Yet the quality of care remains consistently the same. Sure, some facilities receive more deficiencies than others
                             but they, none-the-less, are licensed, and open for business. And the old adage ―…you can’t please all of the people all of the time‖ applies to our industry. For every resident complaining about one aspect of care, there
3245   Website Submission    Nearly half of individuals receiving long-term care have a mental disorder other than dementia, but which frequently co-occurs with dementia and/or physical disabilities. Unfortunately, what is rarely understood is the
                             vital impact these disorders have on health care costs and placement in expensive institutional settings. Mental disorders significantly increase overall physical health care costs. Older adults with depression and co-
3246   Website Submission    FHP/PAP-As a result of Health Care Reform allowing parents to put their adult children on their health insurance up to age 26 we have seen adult children who are FHP eligible go to FHP-PAP.The parent does not
                             have to pay additional monies to add the adult child to their insurance but the local district is required to do a cost-effective re: the insurance as part of the eligibility.The insurance is cost effective so MA now is
3247   Website Submission    Our county has a significant # of clients on Saboxin and we are required to transport clients great distances to access this treatment.If there could be an incentive for local clinics to provide this service it could save alot
                             in Ma Transportation costs.
3248   Website Submission    A/R should have never been allowed to attest to income and resources.Many clients are found to be ineligible from hits the county receives after the fact and the monies expended are never recovered

3249   Website Submission    The fiscal assessment for personal care should have continued as it gave the districts parameters to focus on cost effectiveness in delivery of services and in many instances ""forced the hand"" of the A/R's family to
                             participate in order to keep their family member home versus another setting
3250   Website Submission    In an effort to control pharmacy costs I suggest putting pharmacy back in the managed care rates versus having it carved out.The plans will casemanage individuals they identify as problematic in their pharmacy use and
                             aid in controlling the escalating costs of pharmacy
3251   Website Submission    Develop several one-two MD practice access points (FQHC's) lookalike integrating primary health care and behavioral health services. Include family systems wrap-around services.

3252   Website Submission    There should be a cap on home care rates. Large corporations increase rates substantially because their higher overhead helps determine their rates. This can be misused because they can attribute large expense
                             accounts, cars and trips - to the cost of doing business.
3253   Website Submission    Spend-downs should be made to a dedicated division, not to eligibility workers.

3254   Website Submission    Each county should have an independent medical doctor over fair hearings.

3255   Website Submission    The challenge in redesigning any health care program is to successfully address the parallel requirements for improving quality and reducing cost. Health IT, and more specifically, health information exchange offers
                             the clear opportunity to accomplish both of these challenging objectives. By leveraging the substantial investments already made in New York State and supporting those RHIOs that are successfully operational and
3256   Website Submission    Pay private doctors at the same level as Medicare - 100%, not 80%.

3257   Website Submission    Protect physicians from lawsuits if they follow protocols, including pre-natal and in emergency room visits.

3258   Website Submission    Don't cover OTC drugs.

3259   Website Submission    Certify Medicaid benefits for 1 year at a time.

3260   Website Submission    Return benefit levels to federally required services only.

3261   Website Submission    As a Public Benefit Corporation, Westchester Medical Center?s employees are mandatorily covered by the New York State Employee Retirement System, which means that our pension costs are three times higher than
                             those of the academic medical centers in New York City with which we compete. Our total fringe benefit costs now exceed 40% of payroll, and will reach 50% within two years based on projections from the NYS



                                                                                                                                                                                                                                                             116
 #                  Author                                                                                                           Proposal
3262   Website Submission    a real time, online chat function to communicate with someone in the medicaid office who can answer questions regarding clients and their medicaid status. i did this once with my bank (bank of america), and it was
                             HUGELY efficient. it lets you multi task better. i tried calling the medicaid office to help a patient in my office, and couldn't reach anyone by phone.
3263   Website Submission    similarly, this chat function could be done for the medication authorization line that physicians use.
                             - we are often dealing with clients whose medicaid has been shut off for reasons that the client is unable to explain. easier access to look up clients via web to see what the problem is, would be great.
3264   Website Submission    There are a number of Medicaid waiver programs that require fairly extensive training, and more often than not the training from one program is sufficient for another. For example, respite and skillbuilding training is
                             required for both HCBS waiver programs and B2H, and it is common for the same staff to work in each of these, and other similar programs. We could cut some redundancy by simply allowing completion of one type
3265   Website Submission    Likewise, a centralized clearinghouse of data that would indicate who has cleared State Central Registry and other background checks would eliminate duplication as each time a worker wants to change (or add) jobs he
                             or she must undergo a new and expensive check.
3266   Website Submission    New York State can best improve care and reduce runaway costs for Medicaid beneficiaries with chronic behavioral and physical health conditions through the implementation of regionally managed behavioral health
                             care coordination systems. These systems can provide the most effective outreach, engagement and linkages to medical care, housing and local support and social services that will produce savings immediately through
3267   Website Submission    The State should eliminate the Medicaid Fee-for-Service Program (FFS) within three years. Instead of FFS, the State should use multiple innovative models for providing coordinated care, including managed care,
                             patient-centered medical homes, accountable care organizations, or other arrangements that offer incentives for offering high-value over high-volume care. Special emphasis will be placed on the dual eligible and
3268   Website Submission    The State should immediately pursue a gainsharing arrangement with Medicare, targeting dual eligible individuals in nursing homes. All dual eligibles residing in a nursing home should be enrolled in a managed care
                             program. The State should share in savings to the Medicare program that result from decreased hospitalizations and Medicare-financed rehabilitation in nursing homes. The State should be able to recover any increased
3269   Website Submission    3. In order to achieve improved efficiency, voluntary agencies receiving more than 20 percent of their revenues from Medicaid should be required to join a joint purchasing organization. The State will provide a list of
                             approved joint purchasing organizations. Failure to do so will result in a reimbursement penalty.
3270   Website Submission    In the case of program agencies that contract out, the combined administrative overhead of the contractor and any contractee should not exceed 20%.

3271   Website Submission    The State should immediately assume administrative responsibility for the Medicaid program, including eligibility determination, from the counties. Last year, the State enacted legislation that directs the Department of
                             Health to develop a plan for a state takeover of local Medicaid administration included recovery related to illegal transfer of assets to meet eligibility requirements for the Medicaid program.
3272   Website Submission    he State should seek to mandate a Medical Loss Ratio (MLR) to 85% for Medicaid managed care providers. The Patient Protection and Affordable Care Act (ACA) instituted MLR requirements for commercial plans
                             across the country. Under the ACA, beginning in 2011, health insurance issuers must meet a minimum MLR of 85% in the large group market and 80% in the small group and individual markets. The State should
3273   Website Submission    The State should require the universal adoption of best practices by providers to reduce avoidable hospital readmissions and health care acquired infections and sepsis, consistent with the federal Patient Protection and
                             Affordable Care Act (ACA). The State should offer technical assistance to providers who measure poorly on readmission and infection indicators. Providers who cannot achieve adequate quality measures should not
3274   Website Submission    The State should reform the home health care system. This will include:

3275   Website Submission    The State should reduce the costs of prescription drugs and increase price transparency. This will be done by:

3276   Website Submission    The State should seek to reduce the number of medically unnecessary cesarean sections and premature births. The increase in the number of births by cesarean section is a contributor to premature births. As Medicaid
                             pays for approximately 41% of all births in New York, the potential to increase the quality of maternity care and reduce costs to the Medicaid program is substantial. The State should examine new models and protocols
3277   Website Submission    The Medicaid spend down rules for LTC should be eliminated. Taxpayers should pay into the Medicaid program to receive future benefits. The earlier on someone pays in, the less expensive the buy-in, based on
                             income. In this system money would be coming into the program much like Social Security or Medicaid.
3278   Website Submission    Hospitals need assistance from Medicaid to expand medical homes in our region.

3279   Website Submission    Malpractice reform needs to go hand-in-hand with Medicaid reform. Tort reform is also critical.

3280   Website Submission    As the only 939 designated hospital in St. Lawrence County, Claxton-Hepburn Medical Center provides a much needed resource to the community. We evaluate over 2,000 patients in our ED each year, with
                             approximately 1,100 admitted to our inpatient unit. 40% of these inpatients are Medicaid. There are not enough outpatient resources in the community, resulting in a multiple admissions.
3281   Website Submission    Claxton-Hepburn Medical Center has the only maternal care center for Medicaid moms in St. Lawrence County. We struggle to support this service due to reimbursement and physician coverage.

3282   Website Submission    Sole Community and Critical Access Hospitals, as designated by CMS, provide a special safety net role in remote communities and deserve recognition.

3283   Website Submission    Most primary care physicians cannot survive in rural communities surrounding SCHs and CAHs; consequently, physicians see employment by hospitals. Claxton-Hepburn Medical Center employs physicians out of
                             necessity to recruit and retain primary care physicians and loses approximately $100,000 per physician per year. Most new physicians experience a wealth of Medicaid patients, which contributes significantly to their
3284   Website Submission    Include Medicaid formulary online to allow providers to access for e-prescribing.




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 #                  Author                                                                                                           Proposal
3285   Website Submission    Proposal
                             The State should require all SNF providers to make available to the long term care residents they serve the option to enroll in an I-SNP if I-SNP services are offered in the service area or county. If a SNF provider does
3286   Website Submission    Community Health Workers (CHWs) provide an opportunity to reduce costs, increase access, and improve health outcomes in New York State?s Medicaid program. The ability of the CHW to bridge social service and
                             health sectors to address preventable disability and disease by building community health and empowerment one family, one neighborhood, and one community at a time will translate into improved health measures for
3287   Website Submission    Make primary care expansion an Administration priority, and create a Primary Care Office at the Department of Health, with direct attention, oversight and implementation of policies affecting funding and primary care.
                             Having a centralized point of contact would facilitate primary care expansion efforts by helping Centers such as Ryan more efficiently navigate amongst the various State regulatory agencies and departments.
3288   Website Submission    Rapidly train and deploy primary care providers to underserved communities, enabling the ?Affordable Care Act? (ACA) to bring significant funding for scholarships, loan repayment and training programs, and rapidly
                             recruit/grow a primary care provider corps;
3289   Website Submission    Medicaid cost containment is possible through the provision of care at patient-centered medical homes;

3290   Website Submission    Provide funding for operational support of FQHCs. While Health Care Reform invests substantial funding to build new FQHCs, and expand existing facilities to meet the growing demands, many FQHC?s are facing
                             serious deficits because of the lack of operational resources and funds to sustain them, while at the same time, more and more uninsured are presenting at their doors.
3291   Website Submission    Do not cut reimbursement for pharmacies filling Medicaid prescriptions. These will ease the pressure on pharmacies to fill more prescriptions in order to simply stay in business, and allow pharmacists to have more
                             time to provide proper counseling and cognitive services to patients. Thorough counseling will improve patient compliance and health outcomes with an overall cost savings to the Medicaid program as there will be a
3292   Website Submission    An issue that increases the cost of health care is the non-compliance by patients to take their medications..There are studies that say the rate runs around 60%..As a result people develop more serious illnesses which
                             raises the cost of health care..
3293   Website Submission    Place strict limits on the duration that citizens can remain on Medicaid, similar to those in other states. The Medicaid system should exist to help those in need as a result of disability or a TEMPORARY loss of
                             employment, not as a hand-out for those who are able to find employment and work and willingly choose not to or those who work ""under the table"" and hide their income and assets.
3294   Website Submission    Eliminate social transportation as a covered benefit. Social transportation is permitted for participants in various waiver programs, including the Traumatic Brain Injury Waiver.

3295   Website Submission    RECOMMENDATIONS

3296   Website Submission    Enforce collection of co-payments on Medicaid funded prescriptions. Many patients are aware of their option to waive co-payments and do so regardless of their ability to pay for them or not. Often patients will waive
                             their co-pay while purchasing other products, including cigarettes, so the issue in waiving it is not a lack of funds to cover the cost.
3297   Website Submission    1. Deemed Certification

3298   Website Submission    2. Review and amend OASAS requirements pertaining to Community-based Detoxification Services

3299   Website Submission    3. Review the need for, cost and outcome performance of OASAS-operated treatment centers (ATCs)

3300   Website Submission    4. Fast track the NYS Health Information Technology Incentives Program for Physicians and Licensed NPs

3301   Website Submission    Expand the scope of practice for pharmacists. One option would be to provide increased incentives/reimbursements for services such as counseling and medication therapy management (MTM) which have been shown
                             to produce an overall cost savings in other states.
3302   Website Submission    Stop giving medicaid to babies born with qualifying conditions WITHOUT a complete case review to see if the family actually NEEDS the assistance. Case in point...babies born with lymphodema are automatically
                             funded with SSD and Medicaid to cover all their life's expenses, whether or not the baby exibits an inability to work or live a normal life. Why do taxpayers get dumped with the responsibilities of the parents. And
3303   Website Submission    Any OBESE recipients should be required to LOSE WEIGHT or lose benefits. Did you see all the MORBIDLY OBESE PEOPLE in the photos after Katrina. These are our foodstamps at work. Obviously too much
                             money goes into these mouths. And they will cost Medicaid billions in knee replacements alone...so they can sit in front of their flatscreen tv and eat eat eat.
3304   Website Submission    If long term care Medicaid used the same resource limits for eligibility as found in Medicaid coverage to cover the cost of nursing home care to provide care in assisted living it would be a savings to Medicaid in the
                             long run. It would offer more care to individuals who are truly in need and fall through the cracks of they system. More care available at a lower cost would reduce or in some cases eliminate the need for more
3305   Website Submission    We currently operate an ALP program. We also operate a SNF with a short term rehab unit, both in and outpatient. The outpatient is also licensed as a CORF. We offer PT, OT, Speech and audiology services. We have
                             approximately 25 FTE's in therapy. Our ALP requires that we contract with a CHHA or LTHHCP to provide these services, as we were denied approval to become a LTHHCP. Our therapists, through outpatient, can
3306   Website Submission    Replicate throughout the state the New York Care Coordination model that builds on existing resources and has had success at reducing costs.

3307   Website Submission    Expand the Single Point of Access (SPOA) to include addiction specific clients and either institute MATS (Mangaged Addiction Treatment Services) to all counties or enlarge (combine funding) the OMH case
                             mangement system to include the addiction specific clients.



                                                                                                                                                                                                                                                         118
 #                  Author                                                                                                             Proposal
3308   Website Submission    Attach outcome based expectations and planned interventions for the SPOA process that would provide oversight of high end users in terms of length of stay, ER visits, re-hospitalization, and arrests.

3309   Website Submission    Faciliate the integration/collaboration of behavioral health in primary care settings by establishing OMH/OASAS satellite sites or better yet initiate the ability to provide off-site behavioral health services that would
                             allow maximum flexibility to meet the needs of the client within the medical practice in a cost effective manner.
3310   Website Submission    Develop short term respite services in the existing community residence system that could offset ER visits and hospitalization in many instances.

3311   Website Submission    Provide behavioral health services that are recovery based and time limited. As with other chronic illness provide episodes of care versus continuous treatment.

3312   Website Submission    1. We recommend an expansion and scale up of comprehensive, integrated community-based healthcare models such as Adult Day Health Centers and Medical Homes to chronically-ill and homeless populations (HIV-
                             as well as HIV+).
3313   Website Submission    1a. We recommend the state do more to address chronic conditions through COBRA case management. We must shore-up COBRA case management including assessment, intensive case management, advocacy and
                             crisis intervention as a cost-effective, Medicaid-saving means of managing individuals? chronic conditions, promoting health and preventing further disease. Increasing support will increase universal access to HIV-
3314   Website Submission    2. We support Medicaid reimbursement policies that emphasize community-based primary and preventive care.
                             Safety net providers should be protected over better resourced, less accessible providers and we must avoid across-the-board-cuts to Medicaid providers. Community health centers are true medical homes offering a
3315   Website Submission    3. We recommend the state address homelessness as a medical cost driver
                             3a. Advance ?HASA for All? which that would extends housing benefits to asymptomatic people living with HIV. Increases in housing expenditures would be off-set by the cost savings to Medicaid, which result from
3316   Website Submission    Reimbursement is the same for either an agency or an individual nurse in Private Duty Nursing. Reduce the payment to the nurse to about 70% of the rate paid to an agency, which provides credentialing, supervision,
                             liability insurances, workers compensation, and substitution. Eliminate the individual medicaid direct nurse provider, who often keeps inadequate records, defrauds the program, and picks the pocket of taxpayers. It is
3317   Website Submission    Existing New York State laws and regulations require parental approval prior to transferring a family member (child or adult) living in an OPWDD certified facility to an alternate residential setting. This practice
                             inhibits productive utilization of facilities when a client is ready and capable of living in a less restrictive/less costly residential setting. Parental resistance to any change is not unusual yet they remain empowered to
3318   Website Submission    We are united in our firm conviction that an effective strategy to improve care outcomes and costs for ?high cost high needs? New Yorkers with complex mental health, substance use and medical conditions is through a
                             ?carved out? regional behavioral care coordination model. In 2004, we proposed this model to SAMHSA, and at this time we are well positioned to implement such a model. This model will build on current provider?s
3319   Website Submission    I work in a Pharmacy and I see many issues when it comes to Medicaid. One suggestion I would like to make is consolidating Medicaid and EBT cards. The State should then mandate that every transaction a Medicaid
                             or EBT recipient makes, they have to scan that card, even if they are not paying with it. This way the State can also track what these assistance receivers are buying. This will help "weed out" people who are buying say,
3320   Website Submission    he State could also "do away" with Medicaid co-pay waiving and instead, have recipients slide their hypothetical consolidated EBT/Medicaid card and use their allotted EBT money toward their co-pays. Or if nothing
                             else, the State could better monitor how many Medicaid co-pays are being waived by having them scan their card when they waive the co-pay. Under the current system, I'd wager that less than 5% of Medicaid co-pays
3321   Website Submission    New York State is a multi-racial, multi-cultural state. Health care services must be culturally competent and linguistically competent to serve this diverse population. If care is not competent, there can be mis-
                             communication, errors in follow-through, and unwillingness to go for care, and many other serious consequences. In addition, as we know, there are already serious racial and ethnic disparities in the delivery of care
3322   Website Submission    Require that providers that are receiving capital reimbursement in their Medicaid rates refinance their mortgages at more favorable interest rates. The current reimbursement system does not provide an incentive for
                             providers to refinance.
3323   Website Submission    Use expensive hospital-based drug/alcohol detoxification for only life-threatening or medically complicated detox.

3324   Website Submission    Convert the nursing home Medicaid reimbursement system to a prospective payment system similar to the way that Medicare rates are determined. This would eliminate a great deal of time and effort that goes into the
                             determination of rates and the auditing of provider costs.
3325   Website Submission    Non-profit agencies need to make some annual profit to ensure cash flow, develop new programs and save for tough times (like the ones we are currently in) but I think there could be a limit on that profit (example: 2%
                             of revenue) and anything over that could be returned to the Medicaid System
3326   Website Submission    It would save millions, if not billions, of dollars if the state got out of the business of providing Medicaid-funded services and turned all services funded by Medicaid over to the non-profit sector, which we all know
                             does the same work for lower costs.
3327   Website Submission    The distinction between Certified Home Health and Licensed Home Health should disappear and each should be entitled to direct bill and let the market decide who should survive the savings to the system would be at
                             least $3.00 per hour on labor costs.
3328   Website Submission    The department of health should be obligated to use long term planning on CON's and the planning areas should be redesigned to take into account the differences in Urban and Rural etc.

3329   Website Submission    Federally Qualified Clinics should be excluded from Medicaid Managed Care. At present the managed care company makes a profit and the clinic bills the wraparound so the system pays twice.

3330   Website Submission    Establish a medical loss ratio for CHHAs. Reduce or restrict the profit in this sector.




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 #                  Author                                                                                                              Proposal
3331   Website Submission    Using shared technology, any health care provider seeing a patient (for example in hospital or an Emergency Room, or in another setting; another doctor, a long term care provider, or a behavioral services provider)
                             regardless of location can immediately know the patient?s medical history, most recent tests, diagnoses and treatments. And this provider then adds their new medical services data into the regional network of linked
3332   Website Submission    Please consider revamping the base rates that were established many years ago and which now are simply adjusted upward by some factor rather than providers being encourage to provide more effective and efficient
                             care.
3333   Website Submission    Take a long look at the OPWDD Home and Community Based Services (HCBS) waiver Medicaid program. Social recreational programs are now considered medically necessary and are reimbursed by Medicaid.
                             Weekly dances that families used to pay $8-10 now are reimbursed at $23 per hour. Weekly bowling is at no cost to those on Medicaid - it is reimbursable by Medicaid. Day camps for teens -families used to pay $800
3334   Website Submission    My name is Abraham Jelin, MD and I am writing on behalf of District II of the American Academy of Pediatrics which represents more than 5000 physicians caring for and dedicated to the health and well being of all
                             infants, children, adolescents and young adults in New York. The pediatric community recognizes the role of Medicaid and Child Health Plus in assuring that all children in the state can access preventive services in
3335   Website Submission    Develop a better way to keep demographic information of Medicaid receipients updated - give each recipient an account and require them to verify/update their deomographic information. Develop easy system to
                             enable the managed care plans to notify the state of members with bad addresses and phone numbers.
3336   Website Submission    Use photo id on Benefit Cards, and/or require photo id or other way to confirm the person seeking care is truly the person to minimize sharing of benefit cards.

3337   Website Submission    Physicians and Hospitals who are non par with Managed Care plans often charge high private pay fees for services. Limit the non par payments to Medicaid rates or a percentage of UCR.

3338   Website Submission    language councilors should be available that represent the indigenous population of the area.Also there has been no mention of the Staten Island safety net. Let me remind you that the latest population survey indicated
                             that Staten Island had the greatest concentration of low income residents, it is not practical to assume that they can go to Brooklyn for their medical care, nor is it practical to assume that clinics are an adequate solution
3339   Website Submission    Currently there is no residency requirement for Medicaid eligibility. Individuals and families move to NYS to access our Medicaid services which are the broadest in the country. We should look at the benefit package
                             (as compared to other States) and eligibility requirements for such benefits rather than cutting payments to providers across the board. Additionally, emergency Medicaid benefits are extended to illegal aliens way after
3340   Website Submission    I am a member of the Family Advisory Council at MSCHONY and the parent of medically fragile child covered through the Care at Home Medicaid waiver. I have been working with a physician at the Morgan Stanley
                             Childrens Hospital (MSCHONY/NYP) to develop a pilot program to create a medical home program for better, more efficient management of medically fragile kids.
3341   Website Submission    There are serious racial and ethnic disparities in the delivery of care and in the outcomes of health care services. By expanding commnity health clinics in underserved communities, we can reduce these disparities,
                             reduce the need and costs of expensive Emergency Room visits, and improve the existing racial and ethnic disparities in health care.
3342   Website Submission    Reduce payments for Medicaid managed care organizations which have higher than average rates of preventable hospitalizations, similar to the idea of Medicare not paying for readmissions. Depending on how this is
                             implemented, could save up to $30 million annually.
3343   Website Submission    I support the regional managed behavioral carve out. i want to carve out all behavioral health services from health plans. i do not support managed care organizations because they don't understand mental health, peer
                             support. we support the managed behavioral health organizations because they have a good track record, they keep day day programs like PROS, and saved 4 billion in Pennsylvania.
3344   Website Submission    The State should create regional ACOs (as has Colorado) to take advantage of the upcoming potential shared savings that will be driven by federal Medicaid reform. This will ensure that all providers can participate in
                             an ACO and reduce the potentially overlapping ACOs that may confuse providers and patients and reduce their effectiveness. Potential shared savings on a statewide level could be up to $100 million annually.
3345   Website Submission    The OMRDD Taconic DDSO's use of "unearned" medicaid funds to underwrite other OMRDD costs is an abomination. It must be stopped. OMRDD must figure out how to fund needed programs without pillaging
                             Medicaid, just because "it can".
3346   Website Submission    he OMIG must be given police-level authority to investigate (and assist NYSAG in prosecuting) criminal Medicaid fraud. OMIG's practice of auditing for uncrossed T's and undotted i's in order to extrapolate fund
                             recovery in satisfaction of their federal mandate corrupts the very reason for their existence and is an insult to every NYS taxpaying citizen. It appears Mr. Sheehan is fiddling while Rome burns.
3347   Website Submission    II. Medicaid Savings through Modest Investment of Medicaid Funds

3348   Website Submission    The Medicaid Obstetrical and Maternal Services (MOMS) Program
                             Continued and increased investment in this Medicaid program, currently available in 37 counties in New York State through local health departments and nonprofits such as the Visiting Nurses, Planned Parenthood, is
3349   Website Submission    I. Investment of Existing State and Federal Non-Medicaid Funding in Prevention Yields Medicaid Savings
                             The suggestions below entail actions that can be carried out with support from federal and local funding, and in partnership with private actors to stem the incidence and associated costs of obesity, diabetes, and heart
3350   Website Submission    Incorporate Medication Therapy Management (MTM) in the state?s Medicaid program.

3351   Website Submission    Require pharmacists in health or medical homes.

3352   Website Submission    Start using HCFA 1500 forms instead of having a seperate form just for Medicaid. It would save money because the physicians are purchasing the 1500 forms instead of the government paying for them to be printed
                             and shipped.
3353   Website Submission    A significant source of inefficiency (waste) in the OPWDD service system is: There are currently more not-for-profit providers than are needed to deliver quality services.




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 #                  Author                                                                                                             Proposal
3354   Website Submission    I had a meeting on February 4, 2011 with Senator George Maziarz to discuss the ongoing problems with the WNYDDSO. Along with his assistance on these matters, he also recommended that I go on to this website
                             ?Redesigning the Medicaid Program? and submit a suggestion with regard to changing how the Medicaid Waiver program funds vehicle modifications through the OMRDD (now the OPWDD), and New York State
3355   Website Submission    1. OPINION: If any Medicaid Provider for any reason gets referred to Medicaid Fraud Control Unit (MFCU), Attorney General's Office and a successful prosecution case is conducted, then, that Provider should be
                             delisted as a NYS Medicaid Provider. While doing so, it should be noted that any subsidiary and related companies along with the parent company should be barred for permanently or for a minimum of five years from
3356   Website Submission    PHARMACY: Sometimes over the counter medications are sold at a fraction of the cost by the pharmacies when you pay cash.
                             SUGGESTION: Add in a clause to the pharmacy contract that they should charge the lesser of the price - the price contracted with the MA or the price they charge to customers who pay cash.
3357   Website Submission    Behavioral health services should be protected under Medicaid Managed Care through the management and coordination of these services by a Behavioral Health Organization (BHO) managed care carve-out as
                             opposed to a medical Managed Care Organization (MCO).
3358   Website Submission    The County Department of Community Services must continue to have authority over behavioral health services and contracts under a managed behavioral health care environment.
                             The County Mental Health Department, through its Director, is charged under Mental Hygiene Law with planning and oversight for the behavioral health service needs of the entire county population; the Department
3359   Website Submission    Reorganization of NYS Office For People with Developmental Disabilities

3360   Website Submission    I strongly recommend the adoption of a regional carved out behavioral managed care system as demonstrated by the New York Care Coordination Project.....this consortium of seven counties has effectively engaged
                             counties, providers, peers and a managed care demonstration for people with complex health, mental health and substance use disorder issues. The demonstration has effectively proven the power of collaborative and
3361   Website Submission    Telephone/oral orders for prescription (non-controlled) drugs and Over-the-counter drugs (except supplies) DO NOT require a follow-up hard-copy prescription sent from the Prescriber to the Pharmacy. This policy
                             needs to be Rescinded and reverted back to the pre-2005 policy.
3362   Website Submission    Council on Accreditation
                             Deemed Status for Medicaid in New York
3363   Website Submission    This idea was already submitted but for some reason has not made it onto your list of 274. I am resubmitting only the second half of the ""Decentralized Integrated Care"" proposal.

3364   Website Submission    Approve the use of a Behavioral Health Organization to manage the behavioral health care benefits offered Medicaid recipients

3365   Website Submission    Authorize a pilot that offers single licensure to cross-systems child and adolescent residential providers and test case payment approaches that will strengthen BHO management in the long-term by utilizing the most
                             expensive levels of care with stringent fiscal incentives to produce outcomes and reduce length of stay
3366   Website Submission    Reduce regulatory requirements for OMH licensed Residential Treatment Facilities (RTFs) and childrens community residences (CRs)that do not enhance quality of care and remove the flexibility necessary to negotiate
                             realistic rates for these very important levels of care
3367   Website Submission    Consider establishing a sub-committee of the MRT for behavioral health to determine the service needs of communities if the safety net of state operated hospitals is affected by closures and what the BHO design and
                             service package should look like
3368   Website Submission    Review the existing exemption categories for children exempt from Managed Care enrollment and determine whether to phase out or eliminate those exemptions

3369   Website Submission    Allow Article 31 licensed clinics and other licensed OMH providers to receive Medical Home status in New York to quickly establish the required models that meet the supplemental funding reuqirements for
                             establishing Health Homes for people with serious mental illnesses
3370   Website Submission    Revise utilization review criteria for inpt. psych hosp. (last revision 1985?). We have pt.'s that do not have an approved Axis I dx on our roles for months & years that could be care for at an alternate (and less
                             expensive) level of care.
3371   Website Submission    Relocating people from other states or countries to access New York benefits should be supported by those States, Countries and Medicare.

3372   Website Submission    Have all State employees punch in and out on a time clock. Too many, at all grade levels including professionals and administration are not accountable for their time.

3373   Website Submission    RECOMMENDATION I -- Therefore, we strongly suggest that, while cuts may be inevitable, the across-the-board practice be abandoned in favor of a more deliberate and, ultimately, effective, process of prioritizing
                             reductions.
3374   Website Submission    At the present time community services to developmental disabled adults is provided by both the State of NY and by the private not-for-profit organizations. The not-for-profit sector provides approximately 75% of
                             these services. Thus, to find savings I ask you to look at privatizing services-moving people from the more costly state-operated services to the more efficient community service sector. These services may include Day
3375   Website Submission    MA Managed Care for Behavioral Health Services

3376   Website Submission    MH Clinic Payment Restructuring




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 #                  Author                                                                                                             Proposal
3377   Website Submission    Community Based Care

3378   Website Submission    If we are serious about redesigning the Medicaid Program to be more cost effective great effort should be targeted to the doctors, Local Pharmacies and the consumers who are exploting the program with fradulent
                             claims.
3379   Website Submission    Sources of funding: Similar to the social Security and
                               Medicare funding, to fund the State sahre of the
3380   Website Submission    Shorten the length of stay in residential treatment facilities by enhancing outpatient services where needed. When you look at residential treatment it is plain to see that no where in the community are there look a like
                             services, so often these people return to care because they have not been provided with skills to manage in the real world.
3381   Website Submission    Encourage treatment of routine infections, such as UTIs, at Nursing Homes and Rehab. facilities, rather than waiting for advanced symptoms, such as high fever, and then sending the patient to the Emergency Room.

3382   Website Submission    1. New York State needs to modify credentialing for school psychologists that would ensure that these highly trained and qualified mental health professionals meet the qualification standards for Medicaid providers
                             when providing school supportive health services, as well as services in the community. The current credentialing regulations in New York prevent 75% - 80% of the school psychologists in New York State from
3383   Website Submission    Under Medicare rules,state governors can opt out of federal requirements that that a physician must supervise a Certified Registered Nurse Anesthesist (CRNA) when they administer anesthesia to federally reimbursed
                             patients.Sixteen states have chosen to opt out.NYS should also opt out of this requirement and allow CRNA's to practice independently and be reimbursed by Medicaid for services provided.This action would be
3384   Website Submission    Proposal: New York State Medicaid should make a time-limited and targeted investment to expand New York City?s electronic health record (EHR) extension program to help approximately 3,800 providers adopt and
                             use an EHR
3385   Website Submission    Proposal Title: Adult Day Health Care as a Medicare Covered Service

3386   Website Submission    We are asking that there be better regulation, accountability through integration and coordination in the delivery of Medicaid services through involvement and contracting with special organizations that have the
                             experience and specialized expertise to work with the special needs group of people in the mental health system. These include such organizations as OptimHealth, Value Options, Beacon. And New York Care
3387   Website Submission    Proposal: Expand the Managed Addiction Treatment Services(MATS) Program

3388   Website Submission    Proposal (Short Title): Extend Prior Authorization Period for ADHC Transportation.

3389   Website Submission    STATE SPENDING
                             1. 2008 SPARCS Data shows $161,722.319 spent on babies with very low birth weight
3390   Website Submission    Dis-enroll all clients in congregate residential programs from outside, free-standing case management because residential providers already provide services that would be allowed under both targeted and rehab option
                             case management. Residential providers are primarily responsible for coordinating the care of the clients in our congregate programs. Medicaid could use some savings from changing case management to the rehab
3391   Website Submission    Turn all community based State Operated Community Residences, many which bill Medicaid, over to not for profits that already provide these services because there would be tremendous cost savings if they were run
                             by not for profits.
3392   Website Submission    Reduce the reimbursement of Medical Model Adult Day Programs and fund Social Model Adult Day Programs, which cost far less. And fund the BLENDED MODEL.

3393   Website Submission    For nursing home care, many people will shield assets so that nursing home care can be provided by medicaid. Make more stringent rules to guard against asset ""Medicaid Asset Protection"" plans. Increase the 5 year
                             ""look back"" period to 10 years. Find other ways to close loop holes that shield assets from being used for care at nursing homes. People that can afford to pay for the care at nursing homes should pay their fair share
3394   Website Submission    Dual Diagnosis services (mental illness and substance abuse) need to be integrated to be effective. There are too few clinics and agencies offering this integrated treatment.
                             Early screening for mental illness for children.
3395   Website Submission    Reimbursement from insurance co.'s and those overseeing Medicare authorization for psychiatric inpt. stays is unacceptable. OMH is usually 'out of network', non-acute, or some other unfair and unwarranted design of
                             an excuse.
3396   Website Submission    I made a suggestion (and gave testimony), but do not see my idea on the list. I have attached it here. Please let me know if you have questions about this idea.Job Path recommends the implementation of an approach
                             that can reduce the cost of services for people with developmental disabilities by up to $23,000 per person annually. The use of customized employment strategies as a full or part-time alternative to habilitation programs
3397   Website Submission    Cap all Adminstrative & Overhead costs of all providers of Medicaid to 20%.

3398   Website Submission    OPWDD provides MSC/Medicaid Service Coordination, residential and other direct services to persons with DD. The cost for NYS OPWDD to directly provide service is much higher than that of provider agencies:
                             benefits, pensions, etc., not to mention low productivity. Regrettably, from my experience, the quality of MSC service from OPWDD is very poor. I can't specifically comment on residential. I suspect that when and if
3399   Website Submission    If a person has access to employer insurance, they should be required to take it with Medicaid paying for any insurance premium instead of having Medicaid Buy In for Working People with Disabilities as primary
                             coverage. This program (MBI-WPD) is great but abused if an individual can access private insurance but doesn't take it because they have easy to obtain public insurance as primary coverage.



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 #                  Author                                                                                                              Proposal
3400   Website Submission    Transfer services to Not For profit Private Sector DD Agencies and close the State Operations. The quality of service is just as good but the cost is half what the State does.

3401   Website Submission    *OPWDD has changed regulations on tuberculosis testing be given when an individual is employed as a direct care worker. Direct care workers were required to get a TB test at the beginning of employment and
                             annually thereafter. Direct care workers no longer have to have a TB test annually. Now regulations have been changed so that a direct care worker would receive a TB test at the beginning of employment only and
3402   Website Submission    *Recipients receiving home care services are required under regulations to be reassessed for home care every six months. Before the assessment can be completed, the recipient is required to get a physical (two
                             physicals per year). Physicians do not feel that recipients should be required to have two physicals that are dictated by regulation if the physician is satisfied with one.
3403   Website Submission    *Often a registered nurse is required to visit the recipient in their home for the purpose of checking vital signs or dressing wound. If the nurse only has to check vital signs, the visit usually doesn't take more than a 20
                             minutes to a half hour and yet the agency can bill for three hours.
3404   Website Submission    *While nursing homes will always be needed, there are a number of people with disabilities and the elderly who do not wish to be in a nursing home and their level of care is not at the level of needing nursing home
                             placement. In many cases, individuals are only given only a couple (1 or 2) home care hours a day, forcing them to be institutionalized at a very HUGE costs to the state.
3405   Website Submission    Medicaid can be reduced significantly by eliminating case
                             managers for those who already reside in a residential program that provides case managment services.
3406   Website Submission    Re-align the reimbursement tables for medical transportation to/from all areas of concerns to the federal mileage rates (plus a 10% coverage fee max).

3407   Website Submission    Decrease or eliminate the prescription handling fee for pharmacies.

3408   Website Submission    I would suggest mandating physicians to accept a certain percentage of Medicaid patients to their practice. Some of the savings from decreased emergency room visits could be diverted into higher reimbursement rates
                             for primary care physicians (thereby decreasing their reluctance to accept these patients).
3409   Website Submission    There is a duplication of services for individuals with a disability who reside in a community residence while also attending a day program...the duplication is Case Management Services under both OMH and OPWDD.
                             These type services could very easily be provided by the residence and day program for a quarter of the cost and more effective results. In the current climate many of these services are being provided by the residence
3410   Website Submission    Medical Homes. The state should expand the current Statewide Patient-Centered Medical Home Program (SPCMHP) to more payers and broader patient participation. Expanding the program could save the state as
                             much as $33.66 billion from 2011 to 2020 (Lewin, July 2010). In expanding SPCMHP the State should also consider the following:
3411   Website Submission    State Employees working in Medicaid need to be educated about the whole billing process so that they can be helpful to providers when calls are received. In more than one case NCCC staff had to call seven times to
                             get someone who could answer a question.
3412   Website Submission    Follow up on cap on A & OH. Executive Compensation is not the issue. The issue is what percentage of each dollar goes to patient care not how much the CEO makes. If a provider pays its CEO $500,000 but runs
                             at 10% A & OH - isn't that better than the organization that runs at 30% A & OH but pays its CEO $100,000?
3413   Website Submission    Many developmentally disabled people are required to go to a health care provider for regularly scheduled "medication reviews," at which the consumer and staff meet with the physician assistant to review medications.
                             As I see it, medications should be reviewed at any and every medical appointment and not a specially scheduled one, which certainly would be billed to Medicaid. In addition to the medical group billing for an
3414   Website Submission    Expanding school-based health centers will enhance access to primary care and reduce inappropriate use of hospital emergency departments. Recommendations include:
                             ? Fund the expansion of School-Based Health Centers (SBHCs) and increase their care capacity. Specific options include:
3415   Website Submission    Employment and performance should highlight any reform plan

3416   Website Submission    Proposal to Create a Tax Credit Program to Encourage
                             Private Investment in Supportive Services for the Elderly
3417   Website Submission    To help achieve more immediate cost savings, the state should strengthen existing programs with a proven record of care management, including managed long-term care, the Long Term Home Health Care Program, and
                             the Program for All Inclusive Care for the Elderly (PACE). All these programs serve the needs of a high-cost population, in need of care management for multiple, complex health conditions.
3418   Website Submission    ur cost savings suggestion is to keep people needing long term care services OFF Medicaid for as long as possible, using the following strategies:

3419   Website Submission    Eliminate ""double-dipping"" cycle participants:
                             -diagnosed as an alcoholic, obesity, crack addict, etc
3420   Website Submission    Eliminate, cap or reduce monies supplied to the enrollment of Medicaid participants children, spouses, etc... based on
                             needs and qualifying factors
3421   Website Submission    I work with developmentally disabled individuals, and I know that some of my high functioning consumers check themselves into hospitals when they have problems with the staff in their home and they don't want to
                             go back to the house. Medical staff should be checking these individuals out before shipping them off to the hospital for expensive stays.
3422   Website Submission    We formulated our recommendations based on your impressive efforts to frame the problem with sound, objective information available in a public process. Of special note to us is Slide 32 from the meeting material
                             for the Team?s January 13, 2011 meeting, entitled State of Medicaid Spending ? LTC. Overall, the slide displays the six year trend of a 26 percent increase in spending while recipient population remains basically



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 #                  Author                                                                                                            Proposal
3423   Website Submission    Simple steps and incentives can reduce the use of hospital emergency departments by non-emergent patients, reducing overall health care costs. Recommendations include:

3424   Website Submission    When developing and implementing the details of the five-year Medicaid administration takeover plan, the state should consider the following:
                             ? Identify ways to improve eligibility determinations and ensure greater consistency.
3425   Website Submission    Modify qualifying factors and extend Child/Well-Baby and WIC programs until ages 14 to promote optimal health in children thus reducing potential health concerns later in life.

3426   Website Submission    An analysis should be done that compares annual increases among different provider groups - cuts/increases on a go forward basis should take the past into account. For example, OPWDD residential programs are
                             approximately 20 - 30% above inflation. OMH residential programs are 14% behind inflation as tracked over the last 20 years.
3427   Website Submission    State Operated Community Residences should be turn keyed over to Non-for-Profits. Savings = $33 million minimum.
                             ALl state and local government operated programs should be reviewed with privatization in mind. A review of clinics showed some county run clinics to be the most expensive and least productive in the state. OMH is
3428   Website Submission    The state should implement state and federal initiatives to better manage and coordinate care delivery and reimbursement for services provided to dually-eligible beneficiaries (individuals enrolled in both Medicaid and
                             Medicare). High-cost Medicaid populations include 682,000 dual-eligibles, representing 14% of Medicaid enrollees and accounting for more than 40% of Medicaid spending, with much of that spending for long-term
3429   Website Submission    Outside case managers are not necessary for residents who reside in congregate residential programs. Residential staff already coordinate the care of our clients in our program.

3430   Website Submission    The state should address persistent workforce-related challenges in health care by:
                             ? Modifying or eliminating barriers to retention and recruitment of needed health care workers, including physicians, nurses, and allied health care professionals.
3431   Website Submission    I understand that about $800 million dollars is spent for physician education in NYS. Yet many of the individuals who are educated here leave. That is a hugh amount to target.

3432   Website Submission    Improve Patient-Centered Palliative Care

3433   Website Submission    Some of the highest users of Medicaid services are stretched across two totally different systems. For example, some individuals with DD are getting DOH Home Health Care for 24 hours, while simultaneously pulling
                             down OPWDD Waiver and non-Waiver dollars for simultaneous services. This seems duplicative at times? A cross check of ALL systems for the same Medicaid number may shed light on this possible high cost.
3434   Website Submission    I don't understand why we have outside agency nurses come in to give shots to people when we have RNs and LPNs who could be utilized for this. Also, taking people who have Medicaid or Medicare in to the doctor
                             to have their ears lavaged which is something a nurse can do. If there are guidelines surrounding this, they should be looked at.
3435   Website Submission    The state should redesign the certificate of need (CON) process, which could save the health care system millions of dollars. Because the state CON process prevents providers from reacting quickly, CON acts as a
                             barrier to needed change that is increasing the costs for health care delivery.
3436   Website Submission    To achieve savings, examine state policies regarding generic drugs and their interchangeability with other therapeutic drugs in the same class.

3437   Website Submission    Adopt Guiding Principles for Developing Quality-Related Payment Policies

3438   Website Submission    The State Legislature must maintain, and preferably enhance, its oversight of Medicaid reimbursement and rate-setting. The legislative branch provides important checks and balances on funding decisions that have
                             economic, geopolitical, and health policy consequences.
3439   Website Submission    Instead of having a cap that is the maximum amount of money that clients may own, allow them to invest any overage into a retirement account that they cannot touch until they are 65. A low rate of return (1-2%)
                             would not allow them to make more money then someone who invested it into your average long term savings account.
3440   Website Submission    Support and Expand Accountable Care Organizations

3441   Website Submission    The state must cease conducting facility surveillance activities that are duplicative of national oversight or that are not funded through federal contractual obligation, and must develop broader collaborations with
                             recognized accrediting bodies.
3442   Website Submission    RDS v. EGWP - Proposals submitted to Sen Duane, Sen Hannon, Sen McDonald, Assemblymember Gottfried, James Introne, & Michael Dowling. Approx. $655Million in reduced annual required contribution.

3443   Website Submission    One suggestion I would have is to re-define ""disability"", or ""work"", or both! There are just too many people who live off of SSI/Medicaid insurance who are able to drive cars, go shopping, plow snow, climb
                             ladders, (I think you get the picture), but for whom a doctor has signed off saying they cannot work. This seems to be a blanket statement! My understanding is that even severe allergies can keep you from working - so
3444   Website Submission    Another thought is that with Medicaid, any hypocondriac can walk into a specialist's office without a referral! It also seems as if the Medicaid patients get more done. In my field, I've seen people we serve get gall
                             bladders removed right away (while my husband, with insurance, can't get anyone to remove his - even though he's in tremendous pain), knees and shoulders replaced, medications prescribed - all very quickly. If the
3445   Website Submission    Community Health Workers (CHWs) are a natural fit to manage the cost, quality and access issues of the Medicaid population. CHWs are frontline workers who usually share common qualities such as race, ethnicity,
                             language, socioeconomic status, and life experience with the community members they serve. CHWs understand the complex realities of people living in vulnerable circumstances, such as Medicaid recipients. There is



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 #                  Author                                                                                                             Proposal
3446   Website Submission    When developing and implementing the details of the five-year Medicaid administration takeover plan, the state should consider the following:
                             ? The Medicaid claims processing system (eMedNY) must have flexibility to adapt to changes in payment, ensure that third-party insurance is billed properly, and detect payments that do not conform to state
3447   Website Submission    New York State can best improve care and reduce runaway costs for Medicaid beneficiaries with chronic behavioral and physical health conditions through the implementation of regionally managed behavioral health
                             care coordination systems. These systems can provide the most effective outreach, engagement and linkages to medical care, housing and local support and social services that will produce savings immediately through
3448   Website Submission    The state should reassess its prescription drug purchasing, and fully implement provisions authorized in the 2009-2010 enacted budget for DOH to negotiate directly with prescription drug manufacturers to achieve
                             additional savings through better rebates on drug purchases. The savings from this program have yet to be realized, but were estimated by the state to be at least $167 million.
3449   Website Submission    Alternative ways of responding to mental health related crises are urgently needed and likely to provide better quality services at lower costs. Currently, the vast majority of individuals experiencing a serious psychiatric
                             crisis in New York State are likely to find their way to hospital-based emergency rooms, where a good proportion of them are deemed in need of inpatient care, frequently under involuntary status. Such admission, aside
3450   Website Submission    Effective use of health information technology (HIT) systems has the potential to improve the quality and efficiency of care delivery across settings while advancing public health and medical research.

3451   Website Submission    Cobleskill Regional Hospital believes it is essential that the Medicaid Redesign Team?s proposed reforms include Medicare-dependent hospitals in a specifically defined category known as ?safety net hospitals? and
                             devise Medicaid reimbursement methodologies similar to those used for federal funding for this designation. We believe that critical access and sole community hospitals, as well as appropriately defined urban
3452   Website Submission    roviding primary and preventive care via mobile clinics will provide the medically vulnerable access to care, reducing the use of emergency departments for non-emergent care. Recommendations include:
                             ? Introduce legislation to provide financial and logistical support for a fleet of mobile health clinics to service vulnerable populations.
3453   Website Submission    Movement of patients from the OMH facilities to private hospitals ( article 28s) is not likely to save any money, rather it is likely to be very costly. I ran such a program in the past and it was a significant moneymaker
                             for the hospital. While it is true that patients did get better, the reason for this had little to do with any specific clinical or diagnostic expertise and more to do with meeting the active treatment demands of Medicaid.
3454   Website Submission    The use of care coordination to improve outcomes, control costs, and augment the prevention and management of pressure ulcers can result in significant Medicaid savings.

3455   Website Submission    Reforming the Emergency Medical Treatment And Labor Act (EMTALA) will decrease unnecessary emergency department care for patients whose conditions are not emergent, increasing efficiency and reducing costs.

3456   Website Submission    Psychaitery lacks tests to establish diagnose but relies oh n history and mental status exams. Hospitalizations are unnecessarily prolonged because it has become inordinately difficult, if not impossible to obtain records
                             of patients from previous admissions. Thus, patients are treated with no clear capability of being certain about the diagnoses and the past response, good and bad to prior treatments.
3457   Website Submission    BEHAVIORAL HEALTH BENEFITS MUST BE CARVED OUT OF MEDICAL MODEL MANAGED CARE- New York State can best improve care and reduce runaway costs for Medicaid beneficiaries with
                             chronic behavioral and physical health conditions through the implementation of regionally managed behavioral health care coordination systems. These systems can provide the most effective outreach, engagement and
3458   Website Submission    Quality reporting brings associated costs to the state and hospitals. In order to allow the state to focus on collecting data for the most critical quality and patient safety issues, the state should:
                             ? Ensure that data collection is standardized, efficient, and measures are based on scientific evidence or accepted standards of care that are under the control of providers and promote patients as partners in care.
3459   Website Submission    Mandate Medicaid to honored the annual gift tax exclusion

3460   Website Submission    Increase the Medicaid beneficiaries co-payment for medical services.
                             Eliminate the following Medicaid benefit of paying premiums:
3461   Website Submission    Expand upon the Medicaid bundled payment demonstration authorized by the Patient Protection and Affordable Care Act (ACA) of 2010, by introducing legislation to authorize such a demonstration and establish a
                             multi-stakeholder task force to design a state-sponsored Medicaid bundled payment demonstration project (the task force must establish conditions including a methodology for calculating the bundle, and expenses
3462   Website Submission    When developing and implementing the details of the five-year Medicaid administration takeover plan, the state should consider the following:
                             ? The state should continue pursuing the use of transportation managers on a regional and statewide basis.
3463   Website Submission    ? Triage emergency care starting from home for dd people: Have doctors (or nurse practitioners or PAs) set up to do emergency assessments starting from the home (or certified sites) either by phone or using technology,
                             or, in some cases, by going to their home. Vulnerable people (dd) are often sent to emergency rooms to get ""checked out"" in part for due diligence reasons but also because often the extent of their illness or injury is
3464   Website Submission    ? DD services need tools to assess need as a basis for rational pricing standards. Outcomes need to be more general and should include incentives for less impaired people to maximize their independence. Unlike health
                             care, cost savings in dd services are not with the high cost outliers with the greatest need ( as their is little way around their on-going supervision and personal service needs) but with people with less need.
3465   Website Submission    Starting immediately, all high-cost populations should be in a care-coordination program that strengthens the management of care.

3466   Website Submission    Inform medicaid clients of the duration of time their psychiatrist is billing for, as to make sure that the billing is accuate. The client themselves are the frontline, that way, in addressing fraud. Provide a simple way to
                             report and incentives to clients who let you know of discrepancies.
3467   Website Submission    The state should strengthen and expand existing behavioral health care coordination programs by replicating statewide those models /pilots that have proven successful. For example, the New York Care Coordination
                             Program (NYCCP - formerly known as the Western New York Care Coordination Program) is a collaboration of the county mental health departments, service providers and consumers in Chautauqua, Erie, Genesee,
3468   Website Submission    Recent pilot projects and studies show that redirecting non-emergent Medicaid emergency department (ED) patients, particularly ?frequent flyers,? to more appropriate settings or to earlier treatment in less intensive
                             settings results in dramatically improved outcomes, better use of ED resources, and significant savings. Recommendations include:



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 #                  Author                                                                                                           Proposal
3469   Website Submission    Health care services must be culturally competent and linguistically competent to serve a multi-lingual, multicultural population

3470   Website Submission    There is an excellent and very successful model for serving people with developmental disabilities in Syracuse through Onondaga Community Living. It is a program that assists people to be in their own homes or
                             apartments, alone or with friends and to have the supports necessary to succeed. Community Integration is foremost in the model, something that cannot be said for the OPWDD Waiver as a whole. And OCL serves
3471   Website Submission    onsumer Directed Personal Assistance (CDPA) saves money. It is the least expensive form of personal care in every county in the state. The final regulations should be issued and the program should be expanded.

3472   Website Submission    Embrace Managed Care, especially for Dual Eligibles, through mandatory enrollment.

3473   Website Submission    eform Personal Care

3474   Website Submission    The following proposals were developed by a coalition of major health provider organizations.

3475   Website Submission    Streamline Enrollment into MLTC

3476   Website Submission    1. Do away with the proposed ancillary component of APGs. We (small article 28 clinics and private doctor's offices) do not have the time, energy, resources, EMRs, software, or staffing to do what you want us to do.
                             This has been put on hold and should be eliminated, otherwise, you are going to loose even more providers that are willing to accept medicaid.
3477   Website Submission    Fair Hearings

3478   Website Submission    The malpractice reform HANYS recommends would eliminate tens of millions of dollars in expenses from the health system. Medicaid would experience significant savings, particularly from reducing defensive
                             medicine and establishing a fund to support care for neurologically-impaired infants.
3479   Website Submission    1) Utilizing Pharmacist Immunizers: Extend and expand the existing law before it sunsets in 2012 to allow pharmacists to administer flu/pneumococcal immunizations. As nearly 5,000 NY registered pharmacists
                             delivered nearly 750,000 immunizations in 2010, the State has seen a 2.9% increase in all resident immunizations.
3480   Website Submission    (2) Increasing Generic Utilization: For every 1% increase in the Medicaid generic spending, the State can see $78.8 million in savings. The state can achieve this by adding new generics to the Medicaid formulary
                             upon release similar to the private market to avert the existing 4-6 week process and use Step Therapy to encourage their use. State Medicaid lags behind others in generic substitution rates by 4%, generic substitution
3481   Website Submission    (3) Improving the Prior Authorization Process: Currently, the Medicaid prior authorization system does not appear to reduce utilization of high cost brands. Although prior authorization procedures are currently in
                             place, these procedures rarely result in a rejection of the prior authorization request.
3482   Website Submission    4) Expanding the Preferred Drug List (PDL): The state should follow in the footsteps of private insurance and expand its PDL to include mental health and other high cost drugs not currently covered which would result
                             in significant cost savings.
3483   Website Submission    (5) Implementing Medication Therapy Management (MTM): The State should broadly implement MTM and disease management programs to address the problem of poor medication adherence among patients and
                             reduce costs by improving the management of chronic diseases and decreasing overall health care costs associated with avoidable hospitalizations, emergency room visits and physician visits.
3484   Website Submission    (6) Extending E-Prescribing: Through the expanded use of e-prescribing and e-technology the State could realize cost savings and greater efficiencies. E-prescribing provides healthcare providers secure low-cost,
                             electronic access to prescription and health information. Real-time access to prescription and health information at the time the prescription is written can save patients? lives, improve efficiency and reduce the cost of
3485   Website Submission    New York?s Medicaid program supports certain uses of telemedicine, such as the state?s ?telestroke? initiative, which provides specialty care via video linkages to patients in underserved areas who may be experiencing
                             a stroke and whose treatment requires immediate consultation with a neurologist. It also partially supports the costs of remote monitoring of patients served by home care, and is encouraging use of telemedicine to
3486   Website Submission    The following are covered Medicaid items along with a suggested adjustment table-

3487   Website Submission    Reimbursement innovation will reduce costs by changing incentives to increase the efficiency of care delivery and the cost-effectiveness of the health care workforce. Recommendations include:
                             ? The state should design and implement innovative payment reform to reward cost-effective care models.
3488   Website Submission    New York State provides coverage for many optional Medicaid services. While these services are a vital part of the safety net, there needs to be an examination of the growth of these services relative to beneficiary
                             growth and cost controls. Care management and utilization controls should be put in place to ensure appropriate limits on usage of the fastest growing optional services, such as personal care, prescription drugs, dental,
3489   Website Submission    The state should aggressively implement a proposal from the 2008-2009 enacted budget that authorized DOH to enter into a contract with Adult Protective Services (APS) Healthcare to conduct retrospective reviews of
                             fee-for-service Medicaid claims to ensure clinical standards are met. This effort has not been fully implemented or expanded to generate savings that are possible through utilization review in the fee-for-service sector.
3490   Website Submission    If you utilize the programs already in place such as Facilitated Enrollment, it would eliminate the overtime hours MA examiners are putting in to keep up with the high volume of applications. The FE's are already
                             trained to assist applicants with enrolling in Government Programs and the application that are processed through the FE's are complete. These applicants obtain coverage in a more timely manor.
3491   Website Submission    When the state initiated the no face to face interview and allowed applicants to mail in applications it created a tremdous amount of back log and more hours required to process those applications because they are in our
                             district 100% incomplete.



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 #                  Author                                                                                                             Proposal
3492   Website Submission    Consolidate the two training programs for home health aides and personal care aides, which are currently operated separately by the Department of Education and Department of Health. Establish a single curriculum for
                             these paraprofessional staff.
3493   Website Submission    Eliminate the multiple categories of paraprofessional home care workers, and provide a single level certification that reflects training to the highest level of care.

3494   Website Submission    Modify Readmissions Law

3495   Website Submission    Proposal: Control Fraud by stopping third party billing companies from submitting claims to Medicaid.

3496   Website Submission    Expand the scope of authority and responsibilities for services that home health aides can perform. Examples might include basic medication administration, tests of blood glucose level, and assistance with
                             telemonitoring ? all activities which currently require a registered nurse, whose time is more expensive.
3497   Website Submission    I read through the Medicaid redesign suggestions and did not see all of these that were recommended previously by NYS ASAP.

3498   Website Submission    Reject Regional Pricing for Nursing Homes
                             Scheduled to go into effect on July 1, 2011, Regional Pricing would base payment to nursing homes on a ?one-size-fits-all? model that would cut most deeply from those that provide the highest quality of care,
3499   Website Submission    State Takeover of Collection of Medicaid Estate Recovery Process
                             The counties to which this responsibility is currently delegated have not pursued estate recoveries aggressively. New York is ranked 32nd nationally in estate collections as a percentage of total nursing home Medicaid
3500   Website Submission    Expedite Payment of Nursing Home Reimbursement Appeals
                             Process nursing home reimbursement appeals within six months of receipt, based upon a certified auditor?s report, and return a two percent credit to the State, when the appeal is paid.
3501   Website Submission    Post Provider Cost Reports to a Web Site within Three Months of Submission
                             This will allow all providers to learn about operating costs and operate more effectively.
3502   Website Submission    Reform Spousal Refusal/Spousal Impoverishment
                             Meaningful steps should be taken to curtail spousal refusal, while simultaneously seeking federal approval to provide enhanced spousal impoverishment protections.
3503   Website Submission    Expedite State Takeover of Medicaid Eligibility from County Offices
                             New York could accelerate involvement of complex patients in effective integrated care models, while eliminating duplicative and costly levels of administration.
3504   Website Submission    rovide Reimbursement and Incentives for Cost-Saving Technologies for Nursing Homes, Home Care, and Medical Model Adult Day Health Care
                             Technologies related to improving patient care, electronic medical records, electronic transfer forms, telemedicine and the like should be reimbursable through the capital cost reimbursement system and financial
3505   Website Submission    Electronic Submission of All State Forms
                             Allow all state forms to be submitted electronically, with no paper hard copies necessary for submission. Saves money and time, and is environmentally friendly.
3506   Website Submission    Utilize the State?s Buying Power to Reduce Costs for All Providers
                             Providers would benefit from reduced rates for utilities, technology, telecommunications, medical equipment, fuel, and drugs, among many other purchases that might be made from state-negotiated contracts that could
3507   Website Submission    Extend the recertification period to 24 months instead of the current 12.

3508   Website Submission    Discontinue requiring health plans to mail a printed provider directory to all new enrollees. Enrollees have already chosen a provider before they receive a directory, the directory is out of date as soon as it is printed, it
                             wastes an incredible amount of financial resources to print and mail, not to mention natural resources. Times have changed, everything is available to enrollees via health plans websites or by telephone to Customer Care
3509   Website Submission    Streamline recertification and enrollment for the recipients. Evaluate the Mediciad process to ensure recipients have coverage within 30 days.

3510   Website Submission    Proposal: Revise MMC Quality Incentive Program (QIP) to Improve Quality of Care and Reduce Costs

3511   Website Submission    Keeping older adults and other people who need long term care services Medicaid for as long as possible provides proven cost savings, and can be done using the following strategies:

3512   Website Submission    Proposal: Consolidate Medicaid Managed Care (MMC) plans in NYC to 2-5 plans

3513   Website Submission    Hospitals use therapeutic substitution of medications as a way to effectively control costs. This process would work effectively in nursing homes (they have the same structure) and save significant dollars.
                             Education Law needs to change to permit this
3514   Website Submission    The Dept. of Health should create an initiative focused on the collection of health disparities data and use that data to inform contracting, provider education, quality assurance activities, and evaluation of innovative
                             models



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 #                  Author                                                                                                            Proposal
3515   Website Submission    People with mental health disabilities face health disparities that need to be addressed by integrating primary care and mental health care. Initiating a patient navigator program for people with mental health diagnoses
                             and a chronic health condition can significantly improve health outcomes while (not coincindentally) lowering costs of providing care. Chronic conditions that are well managed achieve increased life years at lower
3516   Website Submission    lack of language assistance services undermines quality of care, and Medicaid patients needlessly suffer physically, emotionally, and economically. Consequences include: avoidance of and delays to care; unnecessary
                             over-treatment and mistreatment that add unnecessary costs; and lower health outcomes, poor quality of care, and low patient satisfaction.? Therefore, we agree with NYIC?s call for NYS to:
3517   Website Submission    Expand and Support Primary Care: Community-based primary care services have been proven to provide better care and be more cost effective because good primary care prevents the need for hospitalizations.
                             Currently, New York State ranks 50th (last) with the highest percentage of Ambulatory Care Sensitive hospitalizations in the nation for conditions which could be treated as an outpatient basis. By expanding primary
3518   Website Submission    Bolster Safety Net Providers: Health care facilities that are located in low-income, medically underserved, immigrant and communities of color provide needed services. Some of the facilities, and other larger
                             institutions, are inefficient and thus not cost-effective. The State Department of Health can, and must, manage the finances of these facilities so that they can be viable and remain in operation. We would also
3519   Website Submission    De-Institutionalization: In 5 years, over $1 billion can be saved via federal reform initiatives by moving people from institutions like nursing homes into community-based settings, where they can live with
                             independence and dignity
3520   Website Submission    Transparency & Accountability in Charity Care Spending and other public spending: Medicaid reform cannot be disconnected from the issue of charity care spending, which includes Medicaid dollars. We need full
                             transparency and accountability in the spending of any and all public funds. 100% of the Charity Care pool dollars should be distributed to hospitals based on their accurate reporting of the numbers of uninsured
3521   Website Submission    Share the Pain: The Albany mantra for reducing the budget deficit has been ?shared sacrifice?. Yet many hospital officials continue to earn millions of dollars a year while health care for New Yorkers worsens. The
                             head of NY Presbyterian, for example, takes home over $9 million and there are four top employees at Montefiore who earn over $4 million. Limits must be set on pricing/costs of personnel and other than personnel
3522   Website Submission    In January 24?s New Yorker magazine, there is an article that discusses a very convincing, impressive and encouraging approach to lowering health insurance costs. It reports on efforts made in NJ to address the long-
                             term health issues of the state?s most expensive patients in order to avoid their going for frequent and expensive ER visits. The article makes a strong case for putting more funds into monitoring the health of
3523   Website Submission    Effective coordination of care for health services is critical to cost-savings for Medicaid. Care coordination optimizes the impact of preventive care for children and families, leading to better health outcomes and,
                             ultimately, lowering the cost of care - reducing visits to the emergency room and costs involved to treat advanced illness. Care coordination needs to be part of the primary care process and infrastructure needs to be set
3524   Website Submission    Efforts to simplify and streamline enrollment will reduce administrative costs. Antiquated and uncoordinated electronic systems, complicated applications, and duplicative paperwork place a financial burden on the
                             Medicaid program. In order to move towards the requirements of the Affordable Care Act (the deadlines of which are quickly approaching) healthcare and healthcare systems must be easily accessible, seamless and
3525   Website Submission    1. Phase out state-run ?Addiction Treatment Centers?
                             The state should phase-out the OASAS operated ""Addiction Treatment Centers"". ATCs provide negligible capacity to the treatment system as a whole, are unconscionably expensive, and are entirely financed by taxes
3526   Website Submission    2. Shift from costly hospital-based to cost-effective residential treatment programs
                             NYS currently supports a hospital-based detoxification system that was abandoned by other more cost-effective conscious states decades ago. Currently treadmill, hospital detoxifications consume a large portion of the
3527   Website Submission    3. Licensing Reform
                             ? Empower OASAS to redo their licensing/ Medicaid structure to not only allow for ""off-site"" service delivery by their Qualified Health Professional personnel, but to encourage the provision of such services. The
3528   Website Submission    4. Relief from Costly Rules and Regulations
                             OASAS must review its Rules and Regulations with an ""evidence based"" eye toward unnecessary costs. For example, the agency's space regulations, in addition to numerous procedural documentation requirements,
3529   Website Submission    1. Right-size County Nursing Facilities and Diversify Local Services
                             There are 42 public nursing facilities operated by New York counties (n=38) and NYC?s Health and Hospitals Corporation (n=4). These public nursing facilities have played a vital role in delivering long-term care
3530   Website Submission    2. Fully Fund and Invest in NY Connects
                             NY Connects is a statewide, locally-based program that provides the public with one stop access to free, objective, and comprehensive information and assistance on long-term services and supports. Local offices
3531   Website Submission    3. Support Family Caregivers and Organized Volunteer Programs
                             Over 80% of all long-term care services and supports (LTSS) in New York State are provided informally by family members, friends and neighbors.9 AARP calculated that in 2007 3.3 million New Yorkers provided
3532   Website Submission    New Federal Funds Available to Support these Recommendations
                             New York State should seize the opportunity to utilize the significant grant opportunities under the Affordable Care Act of 2010 (ACA) to improve its LTSS system and infrastructure and provide needed services to
3533   Website Submission    1) A major reform in nursing home reimbursement was the enactment of nursing home ""rebased"" rates based on 2002 costs as prior to this most nursing homes received rates based on antiquated 1983 costs. These
                             ""rebased"" rates, which were to be effective April 1, 2009, need to be implemented and paid. Nursing homes have based their budgets and expenditures on receipt of these funds.
3534   Website Submission    Proposal: New York/New York III Supportive Housing Medicaid Prioritization

3535   Website Submission    Enable collaborative planning and partnering with Medicare FFS and MA plan administrators to establish improved eligibility/enrollment screening for all providers/institutions/IDTF etc to shut down fraudulent claims
                             activity based on non-existent and/or nefarious service providers. Utilize a divide and conquer approach and maintain some type of central registry for providers operating in NYS. California has taken measures like
3536   Website Submission    Transfer risk and liability for dual eligibles to special needs plans operating within NYS. SWH has demonstrated success in MA particulary in the urban setting (IE NYC) with improved quality of care and reduced
                             confinements. This is a win win - reduced liability and better care for an at risk population.
3537   Website Submission    I continue to see Medicaid (and many pts under other payers) being prescribed expensive BRAND NAME drugs rather than equally effective generic drugs. For example, I see patients receiving the brand name
                             antidepressant, Pristiq rather than a generic drug in the SSRI or SNRI category (such as fluoxetine, citalopram, etc. ) Other examples is the use of Lipitor or Crestor rather than generic drugs that cost 1/10th as much as



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 #                  Author                                                                                                           Proposal
3538   Website Submission    Piggyback on the Federal program HEAT (Health Care Fraud Protection & Enforcement Action team) successes and lessons learned, collaborate to advance combined success in eliminating program costs due to Fraud,
                             Waste and Abuse. Enable hand-off of cases that might be small on a federal level but could be beneficial to NYS.
3539   Website Submission    Dual eligibles in Medicaid should participate in Medicare's Independence at Home pilot, slated to begin January, 2011. The Veterans Administration Home-Based Primary Care Project has been operating a similar
                             program for a decade across the country serving 100,000 people. They cut nursing home utilization by 82%, hospitals by 50% and total costs by 24%.
3540   Website Submission    HHC proposes an expansion of its CIDP program as part of the State?s Health Homes Demonstration.

3541   Website Submission    Increase the HCRA opt in assesment to the plans to raise State income.

3542   Website Submission    To Make the insurers who have opted out of the HCRA tax easier to identify, by assigning a number to insurers that have opted in. This number would be more easily identified by providers, than the current listing, and
                             could be plan code specific.
3543   Website Submission    Insurers that offer Medigap policies must be forced ot "opt in". Since Medicare and Medicare HMO cases are excluded from the tax, when a patients benefits expire from Medicare, the case is taxed from that point on
                             based upon the self pay HCRA assessment. this is not easy for hospital systems to administer and needs to be reviewed and rebilled by providers on a case by case basis.
3544   Website Submission    The Medicaid Redesign Team?s (MRT) omission of the issue of Language Assistance Services during the hearings as a part of the Medicaid Redesign is quite alarming. Taking into consideration that 2.3 million New
                             Yorkers, the majority of whom are in lower-income communities of color, are limited English proficient (LEP), the Team would be remiss in not incorporating linguistic and cultural competency within their redesign.
3545   Website Submission    Develop an incentive based payment program for OBGYNS. Wherein an OB with an excessive c-section rate would be reimbursed less than an OB or midwife with a reasonable c-section rate. This would save a lot of
                             money because it would reduce the number of c-section thus saving money as well reduce the number of complications that can cost the system a lot of money.
3546   Website Submission    redesign computer systems - ex: current eligibility system (WMS) established in 70's. separate systems for NYC and rest of state - creates problems with cross matches which allows duplicate payments. Update could
                             also eliminate the need for some outside contractors. ex: Maximus contacts applicants regarding requirement to belong to HMO. This could be done by a mailing for most applicants and centralized assistance for the
3547   Website Submission    eliminate or limit the current policy of providing non-medical transportation to TBI waiver participants.

3548   Website Submission    review/eliminate current policy regarding disregard of supplemental needs trusts when determining eligibility for most Medicaid eligibility. This creates inequity in eligibity because persons with higher incomes and
                             assets can obtain legal help to assure their complete medicaid eligibility -sheltering their funds. Those with more limited means (many struggling to make ends meet) need to "spenddown" their excess income and
3549   Website Submission    Cost savings could be realized by reducing the redundancy in PAP smears laboratory screening tests. Currently women who receive Prenatal Medicaid receive a PAP smear at the 6 weeks post partum visit with the
                             prenatal provider. Women frequently are no longer eligible for Medicaid following the 6 weeks post partum visit and transfer to the NYS Family Planning Benefits Program where they have to have a second PAP with
3550   Website Submission    Smoking is a significant risk factor for preterm birth. Research demonstrates that women who are encouraged to quit and supported with a plan to quit are more likely to quit smoking. Quitting smoking significantly
                             reduces the risk of preterm birth. Preserving and expanding provider eligibility to provide smoking cessation counseling to prenatal women will potentially reduce Medicaid costs related to preterm births. For example,
3551   Website Submission    Currently, prenatal health education is reimbursed only if it is provided by a medical professional one-to-one, not in groups. Group health education conducted by a trained Health Educator has been demonstrated to be
                             even more effective and at greatly reduced cost.
3552   Website Submission    OASAS should phase out its state operated ATC system which is staffed by state employees and shift the beds to Article 28 providers statewide. This will save significant funds and allow hospitals to fill beds and
                             strengthen their position in the communities they serve.
3553   Website Submission    Please be advised that the current Managed Care contract could be in the process of being signed in the very near future (maybe even in early March 2011) and often the contract terms span a 5 year period. If so it may
                             be more difficult to implement idea # 1 if the contract is already signed.
3554   Website Submission    1. responsibility for preventing avoidable admissions belongs to the provider responsible for primary care
                             2. It is necessary to admit certain patients like someone who is homeless or unable to take care of themselves or a patient without a medical home
3555   Website Submission    Please include community health workers and funding for interpreters in the redesigned medicaid program . Deaf community members have tremendous difficulty accessing health care and health information due to
                             language barriers. Community Health Workers for the Deaf wil ensure that Deaf patients can interact meaningfully with providers, adhere to preventinve measures and achieve health equity.
3556   Website Submission    Inpatient hospital detoxification went through significant reform measures that began in 2008 and that providers are still adjusting to. Reimbursement rates were decreased and bed levels were changed. Hospitals need
                             to be supported through this transition since they offer the necessary services that cannot be duplicated in community based organizations. NYS ASAP continues to attack hospital based detox while making
3557   Website Submission    Medicaid Reform Proposal
                             Overhaul of the Medicaid organization, the Office of Health Insurance Programs (OHIP), is overdue.
3558   Website Submission    audit the incentives paid to long term care providers for recruitment and incentive of staff to determine if such incentives have been appropriately applied for that purpose and, since the incentives have become a yearly
                             expectations evaluate whether such incentives have had an actual positive impact on worker recruitment and incentive and whether there is a more cost effective way to compensate providers for legitimate costs
3559   Website Submission    audit the Traumatic Brain Injury and Nursing Home Transition And Diversion Waiver rental subsidy programs to determine whether funds have been expended in accordance with program rules and/or whether clients
                             receiving the subsidies have been qualified waiver participants
3560   Website Submission    audit the Regional Resource Development Centers under both the above waivers to determine both the appropriate expenditure of funds and proper delivery of services under the contracts




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 #                  Author                                                                                                                Proposal
3561   Website Submission    since the model is to be further expanded under the State's efforts to "right size" nursing homes, audit Assisted Living Programs to determine what problems exist in current programs, whether rates reflect reasonable
                             costs for appropriately qualified individuals based on their true level of need and what changes are needed as the model goes forward
3562   Website Submission    Large hospitals are not better hospitals. The hospitals in NYC tend to be identified by their size and scope of services, rather than the expertise that they have as well as their outcomes.
                             The continuing identification of the use of these large hospitals as teaching facilities tends to create a conflict in the quality and the cost of the care of patients. That is, it is often the case that patients could have been
3563   Website Submission    Increase Supply of Private Duty Nursing Services to care for medically fragile persons. Currently in many upstate communities there is a severe shortage of private duty nursing. Private duty nursing services can help
                             lower the cost of health care services by preventing emergency and hospital admissions, reducing the number of physician visits, reducing unnecessary pharmacy costs and improve the overall quality of patients'
3564   Website Submission    The Medicaid dental program is severely compromised by the lack of communication and coordination between the several factions which are responsible for the oversight and regulation of services. This causes
                             needless duplication of services, gaps in coverage for beneficiaries, severe administrative barriers, frustration for all stakeholders and an incredible waste of taxpayer money.
3565   Website Submission    Thank you, Governor Cuomo, for making this effort to redesign Medicaid a public process.

3566   Website Submission    I am writing as a parent of a young man with down syndrome. He is among more than 1,000 people in WNY on a waiting list for residential services. We are hopeful that he will be able to live independently in a group
                             home where he will be safe and secure. With the moratorium on new homes since 2008, we are concerned that he will not be able to make a planned move out of our home according to his needs and desires. Instead,
3567   Website Submission    Fully scaled CIDP?s should be designed to meet new federal ?health home? criteria, which are eligible for a 90% FMAP match.

3568   Website Submission    End the pharmacy carve-out from managed care plans

3569   Website Submission    top paying for medical services that were initially denied by private insurance coverage.

3570   Website Submission    As the developmentally disabled population continues to age, more consumers seem to be going to the hospital and then to nursing homes for skilled nursing care since that is not provided in the homes. More Level 3
                             homes should be added - homes with increase in nursing services, that could provide better care for consumers in a familiar setting. Hundreds of consumers are sitting in skilled facilities and are ot able to go to work,
3571   Website Submission    Eliminate the School Based Clinic carve out from Medicaid Managed Care. Students who have managed care medicaid should obtain their health care from their primary care provider. This will provide better
                             continuity of care for the patient and avoid the duplicate medical services often provided at a School Based Clinic. Further, School Based Clinics often do not communicate with the patients primary care provider
3572   Website Submission    At Sunmount DDSO, there are doctors on duty or on call at all times. But they refuse to come in or to see some of the consumers. They instead send them to the hospital. If they were seen at the DDSO, then Medicaid
                             would not be charged. These doctors are already being paid - we should not be billing Medicaid for their services.
3573   Website Submission    Proposals:

3574   Website Submission    Theme: Recalibrate Medicaid Benefits and Reimbursement Rates

3575   Website Submission    3. Short Title: OMIG Reporting by Medicaid Managed Care Plans

3576   Website Submission    4. Short Title: Standardization of Specialized Drugs/Devices and Payments for New Technology

3577   Website Submission    Short Title: Eliminate Medicaid Coverage of Human Growth Hormone

3578   Website Submission    Short Title: Reserve Requirements for MMCOs

3579   Website Submission    Short Title: Integrated Care/Managed Care for High-Utilizing, High-Acuity Populations

3580   Website Submission    As a very large portion of Medicaid fraud is conducted by Providers who bill for services they did not provide (and often falsify medical records to hide the fraud from auditors) Medicaid should start issueing
                             Explanations Of Benefits (EOBs) to patients everytime their Medicaid insurance is billed, just as private insurance companies do. This will allow patients to identify when their insurance is being billed for services they
3581   Website Submission    Successful re-design of the Medicaid Program resulting in access for all its diverse populations will require both first order and second order change. Cost (right price for the right product), efficiency (right place, time),
                             quality(desired health outcomes with current professional knowledge), and impact are clearly intertwined.
3582   Website Submission    As a nurse working in a State facility, it is frowned upon to use medication that is not expressly prescribed for the individual specified on the label. As a result,perfectly fine medication is discarded if it is discontinued
                             by the individual's physician. This means that medication that is individually blister packed and which has only been handled by the pharmacy is never used again. A directive from NYS to 24 hour facilities and the
3583   Website Submission    You should look at the semi-annual med orders whcih need to be done by the MD. Some MDs require a visit before they will rewrite orders. If the orders could be written for a year, a healthy consumer would only need
                             one visit instead of two for the year.



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 #                  Author                                                                                                            Proposal
3584   Website Submission    Behavioral Pharmacy Management (BPM) addresses quality prescribing. When a physician?s prescribing patterns deviate from current best-practice guidelines, we generate a consultative communication to facilitate
                             improved treatment. We also initiate peer-to-peer consultations with a board-certified psychiatrist when required.
3585   Website Submission    Prescription Adherence Improvement (PAI) addresses patient adherence. Pharmacy records are screened for evidence of patient non-compliance (failure to refill prescriptions, for example), and alerts are sent to
                             physicians and other clinicians for timely intervention.
3586   Website Submission    Care Management Integration (CMI) addresses care coordination. When multiple clinicians are treating a patient or when a patient has multiple co-morbidities, CMT?s technology systematically analyzes all pharmacy,
                             diagnostic and medical service data to establish a patient-centric medical home and compile an Integrated Health Profile (IHP), which is made available to all clinicians treating that patient.
3587   Website Submission    Opioid Prescribing Intervention (OPI) identifies inappropriate prescribing patterns for opioid analgesics, which can result in abuse and diversion of this dangerous class of medications.

3588   Website Submission    New York should further encourage residents to take responsibility for their long-term care needs through long-term care insurance ownership. One way of doing this would be to expand the New York State
                             Partnership for Long-Term Care program by allowing policies with inflation protection of less than the currently required 5%. The cost of a 5% inflation option in long-term care insurance policies has risen
3589   Website Submission    An avenue for controlling Medicaid expenditures in the long-term care area is to tie reimbursement to quality, which is already being done in the acute-care arena. Quality measurement data in long-term care is currently
                             self-reported with very little monitoring or oversight - stricter review or verification of submitted data may reveal less than ideal outcomes that, if tied to reimbursement, could represent savings to the Medicaid program.
3590   Website Submission    Risperdal Consta, Invega Sustenna and Zyprexa Relprevv

3591   Website Submission    Stakeholder Group:Families coping with a diagnosis of Alzheimer's Disease
                             Proposals to Redesign Medicaid
3592   Website Submission    Last year, the Governor proposed as part of the budget a long-term care financing demonstration project. The Legislature enacted the proposed change to section 366-i of the Social Services Law as part of Chapter 58 of
                             the Laws of 2010. The demonstration project recognizes the importance of changing the current ?all-or-nothing? approach that requires individuals to be impoverished in order to qualify for Medicaid. This law was
3593   Website Submission    Eliminate optional services unless enrolled in a managed care plan and eliminate fee for service carve-outs from managed care.

3594   Website Submission    Medicaid Redesign Savings Proposals

3595   Website Submission    1. New York should maximize access to and use of federally-subsidized benefits for people with Medicare, including those that are dual-eligible, in order to preserve precious state funding for the Medicaid program.

3596   Website Submission    2. New York should explore ways to streamline and simplify enrollment and recertification processes for Medicare-related public benefits to maximize federal dollars to the state, ensure seamless coverage for New
                             Yorkers, and reduce state and county administrative costs.
3597   Website Submission    3. New York should pursue a multi-faceted approach for improving coverage and care coordination for dual-eligibles—thereby ensuring that quality care is provided and costs are contained for this high-need and
                             vulnerable population.
3598   Website Submission    4. New York should align the eligibility rules and enrollment systems for the non-Medicare population with the rules and systems used for the Medicare population—thereby ensuring seamless coverage for individuals
                             newly eligible for Medicare owing to age or disability.
3599   Website Submission    Create and enforce a requirement for enrolled providers to re-attest to, or amend, all information gathered as a result of initial enrollment and only allow enrolled providers to order Medicaid services.

3600   Website Submission    Encourage enrollment in Long Term Care insurance by the following:
                             1)Create competition between insurers by utilizing a mechanism allowing policyholders to change LTC insurers and migrate reserves with no additional underwriting requirements. Currently, once a LTC insurer is
3601   Website Submission    Currently there is no control agency that fully oversees program integrity for pharmacies. E.g, BNE only looks at controlled substances, OMIG only looks at Medicaid, Education only looks at licensing, etc. There
                             should be an agency with the authority and duty to do comprehensive audits of pharmacies to ensure that their claims do not exceed their paid inventories.
3602   Website Submission    New York State is facing a crisis in delivery of healthcare. New York State must act now to achieve substantial health care cost savings and efficiencies and stem the loss of hundreds of physician-run surgical offices
                             providing critical access to quality patient care. On behalf of the Society of New York Office Based Surgery Facilities (NYOBS) and the thousands of medical professionals and patients we serve, we stand ready to
3603   Website Submission    Proposal
                             HHC would partner with supportive housing providers to place 100 - 500 Coler-Goldwater residents in scatter-site housing augmented by care coordination/case management support services for special needs (for
3604   Website Submission    RECOMMENDATIONS:
                             1. Establish a Community-Based Long Term Care Reinvestment Program to invest in services that prevent nursing home and hospital admissions. Community-based care must be forward funded to divert individuals
3605   Website Submission    2. Provide adequate nutrition and resources for a healthy diet to prevent and treat chronic illnesses

3606   Website Submission    3. Run a program utilizing the Expanded In-Home Services for the Elderly Program (EISEP) model to maintain impaired elders in the community




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 #                  Author                                                                                                         Proposal
3607   Website Submission    4. Utilize the community-based continuum of services to provide a broader and more cost-effective Medicaid funded long term home and community based care system

3608   Website Submission    5. Caregiver Supportive Services

3609   Website Submission    6. Transitional care: The community-based service delivery system already in place which includes senior centers and case management agencies among other services is well positioned to provide appropriate
                             transitional care as an older adult is discharged from a hospital or nursing home rehabilitation.
3610   Website Submission    7. Develop a continuum of adult day care for frail elderly receiving these services to maximize ability to remain at home, support family caregivers and prevent costly institutionalization.

3611   Website Submission    8. Affordable and supportive senior housing

3612   Website Submission    Clear communication is a key component of high quality health care, adequate funding for sign language interpretive services remains an issue for Deaf and Hard of Hearing patients within the New York State Health
                             system. In 2000, the Centers for Medicare and Medicaid services (CMS) advised state Medicaid directors that language services could be included as an optional covered service in their Medicaid and SCHIP programs
3613   Website Submission    Provide adequate reimbursement for facilities in all sites of service for medical devices

3614   Website Submission    Please look at the consumer directed pesonal assistance program. This program not only saves the state money, it employees people, empowers people, crosses barriers such as geographic locations,cultural and language
                             differences.
3615   Website Submission    Re-design of Medicaid Pharmacy program to an Access Based Network Design. This new approach has been proven to significantly reduce pharmacy spend while meeting access standards and reducing member co-
                             pays.
3616   Website Submission    Idea/recommendation: severely curtail nursing home medicaid planning

3617   Website Submission    Facility Formulary Therapeutic Interchange in Nursing Homes (RHCF?s)
                             &#61656; Clinical evidence on the relative effectiveness, safety or pricing of comparable drugs is provided in the Nursing Home Formulary
3618   Website Submission    Keep behavioral healthcare for SPMI and SED carved out of generic medicaid managed care plans

3619   Website Submission    The roles of the OMIG and MFCU have become muddled. The MFCU's operating budget should be fixed or based on convictions, they currently have a perverse incentive to settle cases rather than to prosecute and
                             remove bad providers from the system. MFCU - Fraud and Convictions, OMIG - Waste/Abuse and Recoveries
3620   Website Submission    Idea/recommendation: Changing title to joint bank accounts & life insurance beneficiaries during eligibility
                              When a NH Medicaid recipient dies substantial reimbursement is lost from both joint bank accounts and life insurance policies. Title to the joint bank accounts should be changed to the NH resident & the local DSS
3621   Website Submission    Idea/recommendation: Ending the promissory note scheme
                              Every dollar lost to Medicaid planning is paid by the taxpayers.
3622   Website Submission    Community-based long term care services are the most cost effective alternative to nursing home care. In Onondaga County, the Long Term Care Resource Center served more than 1700 residents, of all ages, in their
                             homes. In 2010, our records indicate that home care services, in all programs, saved Medicaid approximately $30,301,340 in what may have been spent on nursing home costs.
3623   Website Submission    1. Change some of the eligibility requirements since NY State is more generous than
                             other states. There are times when non-residents have received benefits.
3624   Website Submission    2. Consider use of the Medicaid or Medicare grouper vs. contracting with 3M keeping funds within the system instead of outsourcing this process.

3625   Website Submission    3. Improve basic Medicaid benefits/reimbursement and eliminate Medicaid
                             Managed Care products whereby 3rd party HMOs receive higher fees
3626   Website Submission    4. Improve claims processing through E PACES. The system is cumbersome, complex and does not follow the UB04 billing form. Providers use alternate private sources to assist with claims processing. E PACES
                             does work well for checking eligibility and verification of coverage.
3627   Website Submission    5. A decision for Long term Care coverage, once an application has been submitted,

3628   Website Submission    6. can take up to 6 to 12 months. In the mean time patients are told not to pay the provider. Perhaps a partial payment could be allowed and providers would provide refunds if appropriate. Often local county
                             Department of Social Services (DSS) staff is behind slowing the process. The Medicaid program must reexamine the relationships with the State and county DSS programs to improve the turnaround for eligibility
3629   Website Submission    7. Assure providers that the 1% tax on Medicaid payments will end this March 2011.




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 #                  Author                                                                                                            Proposal
3630   Website Submission    8. The timeliness of issuing new rates is a major concern. Hospitals, a few months ago, just received general Medicaid rates for 2009 that are due to be reissued shortly. There have been no rates promulgated for
                             mental health for 2009 (2008 rates are being used). There have been no definitive rates for skilled nursing facilities since January 2009.
3631   Website Submission    9. The constant retroactive reprocessing, issuing rates for the same time period many times with different components updated at different stages, and a lack of a summarized reconciliation when the rates are
                             reprocessed makes it rather time consuming to keep the receivables and liabilities up to date. There are other states that simply roll any adjustments forward into future rates (prospective only) and issue rates in advance
3632   Website Submission    10. Long Term Care ? there is lack of concrete information available on whether or not rebasing will occur, and what the impact will be. We do not know what the SNF rates will be changing to or when they may
                             change. This being ?up in the air? on what payments will be makes it difficult for us to plan as a facility for the financial changes ahead. We cannot budget effectively. Again, we have not had definitive rates for SNF
3633   Website Submission    11. Malpractice reform would reduce/prevent the unnecessary provisions of services.

3634   Website Submission    12. Currently, Medicaid has a tracking system in place that will restrict access, i.e. sanction, a beneficiary if there is suspected/confirmed abuse of the system. However, if the person is dually-enrolled in Medicare and
                             Medicaid, there is no oversight into potential abuses of the system. The ability to sanction the dually-enrolled could potentially save money.
3635   Website Submission    Health care disparities

3636   Website Submission    The chronically ill are responsible for a much larger amount of health care funding, including Medicaid expenses, than others. These are clients who seem to ""fall through the cracks"" and repeatedly utilize the same
                             servcies - the chronically ill. Other states, labor unions, and privately and self-insured plans (among others)have proven that a concentration of efforts that identify, closely manage, monitor, and concentrate services on
3637   Website Submission    Casualty and Estate Recovery Reform: Medicaid Trauma and Estate recovery programs are mandated by CMS as another means of recovering Medicaid expenditures from other liable parties. In New York State, these
                             programs are currently administered at the county level, leading to disparities in effective administrative approaches and overall results from county-to-county. Efforts are underway to coordinate these recovery
3638   Website Submission    Unit-Dose Drug distribution System reduces the waste of increasingly expensive medications and reduces medication distribution error.Community based Mental Health programs cost could be greatly reduced using
                             this system in Community Residences.
3639   Website Submission    I am the insurance manager in a pediatric practice. Much of the correspondence I receive from Medicaid has an unnecessary cover sheet. Often just the name and address and no other info. Today I received 3 notices
                             for electronic billing certification statements for 3 providers. The address is in the exact same spot so the window would fit, only diffence is the cover had a confidential statement on it.
3640   Website Submission    Prevention is an unreimbursed service under medicaid. We know that there are specific markers that indicate serious emotional problems in later life yet we cannot treat children who are at risk under the current model. I
                             reccomend that for every $10 cut in direct services $1 be applied to a preventive pool for at risk children. This would result in enormous long term savings.
3641   Website Submission    Broaden the benefits included in the HIV Special Needs Plans to include ALL services--including carve-outs--with a related increase in PMPM. The increase must then be mandated to be passed onto eligible
                             community-based providers, via a sub-capitation. ""Eligible"" providers are either those with a COBRA Case Management program or an OMH Assertive Community Treatment (ACT) program, with evidence of
3642   Website Submission    Transition Services from the State to the Voluntary Providers
                             The Office for People with Developmental Disabilities (OPWDD) has spent thirty years building the capacity of hundreds of not-for-profit agencies that are staffed with qualified, well-trained people and run by
3643   Website Submission    Support Olmstead/Most Integrated Setting
                             Many people with disabilities are housed in congregate care such as institutions, nursing homes and group homes with service levels that exceed the people?s needs. Institutionalization perpetuates NYS investment in
3644   Website Submission    1. All funds from the Charity Care hospital pool should be distributed to hospitals that provide services for the uninsured in a fully transparent and accountable manner.

3645   Website Submission    Willowbrook Community Advisory Board
                             The Willowbrook Consent Decree drives up costs for NYS by requiring redundant administrative processes that delay service delivery.
3646   Website Submission    Over the years, the State has made accommodations for the three or four organizations, including St. Mary?s, that provide post-acute care for children with special needs. A prime example of the accommodations has
                             been exempting pediatric nursing homes from Medicaid reductions including the elimination of the trend factor. During the redesign process, pediatric post-acute care must be recognized separately from the geriatric
3647   Website Submission    Medical Home/Health Home/Dual Eligibility
                             Managed care for people with chronic health conditions is a good idea. Many people with disabilities are high users of health care services. The majority of adults with disabilities are ?dually eligible? and enrolled in
3648   Website Submission    Enforce co-pays and create increasing copay based on means.

3649   Website Submission    Proposal for a Medicaid Buy-In for people who need Long-Term Care

3650   Website Submission    The CON requirement for the diagnostic and treatment center element of the PACE program extension sites should be eliminated as part of the Medicaid Redesign and managed LTC initiatives.

3651   Website Submission    Criminal Background Checks
                             Background screenings via fingerprint checks are managed independently by each state department. If a person is screened to work in a day care center (OCFS rules) and then wants to work in a group home (OPWDD
3652   Website Submission    Identify High Cost-Per-Person Medicaid Service Providers
                             Across-the-board funding reductions hurt cost-efficient and programmatically effective programs more than wasteful and ineffective providers. Funding reductions should be targeted toward agencies and practices with



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 #                  Author                                                                                                             Proposal
3653   Website Submission    Eligibility Determinations
                             Examination by and recommendation from a physician is required prior to enrollment and re-authorization to participate in Medicaid funded services. Sometimes, the Medicaid authorization system requires enrollees
3654   Website Submission    Office of Medicaid Inspector General
                             The two previous administrations sought to reign in Medicaid expenses by seeking incidents of ?fraud, waste and abuse?. The OMIG was charged with collecting huge amounts of money with very few controls.
3655   Website Submission    If the State is to ramp up managed LTC this year as quickly as possible, it seems that the LTHHCP can and will play a key role across the state. There are 25,000+ LTHHCP enrollees, and I expect most of them are
                             dual-eligibles by age alone. There is good dispersion of programs throughout the state, unlike other alternatives to date and could provide a backbone for new policy initiatives. To the extent that these enrollees move
3656   Website Submission    Make OPWDD day program funding more flexible, especially regarding transportation. Support services which combine center-based and community-based services.

3657   Website Submission    an enormous amount of money would be saved if there was a tool developed which would standardize the hours of service needed in a patient's home. NYC is out of control with the services that are provided for
                             patients. Statistically, their population receive 2-3 times the aide hours that the folks in upstate NY receive. The folks upstate are often living isolated in the countryside and far from the conveniences offered in NYC
3658   Website Submission    Maximizing Generic Rebates:

3659   Website Submission    Chronic Care Management/Primary Care Case Management (PCCM):

3660   Website Submission    E-Prescribing Technology to Improve Decision-Making:

3661   Website Submission    Electronic Health Record Incentive Program:

3662   Website Submission    Utilize Lock-In:

3663   Website Submission    Modified Dispensing Quantity Definitions:

3664   Website Submission    Comprehensive Review of Claims Edits, Operational Procedures:

3665   Website Submission    Restructure NYSDOH Division of INstitutional Services:
                             1. acquisition of Roswell Park Mem Cancer Institute by NFP designated cancer center; this activity is not core to NYSDOH mission, avoids future long term capital and pension commitments while offering better
3666   Website Submission    Medicaid Redesign
                             Substance Use Disorders
3667   Website Submission    Convert all the various home-based service programs (LTHHC, NHTD, Personal Care, etc.) into Managed Long Term Care Plans to streamline administrative costs and burdens. However, we recommend two key
                             features:
3668   Website Submission    HEALTHCARE FOR THE HOMELESS PROGRAMS ARE UNIQUELY POSITIONED
                             TO SERVE AS THE ?MEDICAL HOME? FOR HOMELESS INDIVIDUALS AND FAMILIES
3669   Website Submission    To address the Department of Health data highlighting that a small number of CHHAs have been responsible for the significant growth in Medicaid expenditures for home care, the Visiting Nurse Service of New York
                             (VNSNY)recommends utilizing CHHA cost report data to establish a Utilization Corridor (UC) based on the statewide average Medicaid hours per case; create a safety zone from 80% - 120% of this statewide average,
3670   Website Submission    Eligibility Integrity: Supplemental Asset Verification Services: The Centers for Medicare and Medicaid Services (CMS) has indicated that this program, often referred to AVS, will eventually become mandatory when
                             enrolling aged, blind, and disabled recipients into all Medicaid programs. AVS is a structured approach to asset verification at the time of application to a Medicaid program to ensure an individual has utilized, to a
3671   Website Submission    Reduce reliance on inpatient detoxification

3672   Website Submission    CON moratorium on establishment of new LTC single level of care projects, eg SNF, HHA etc. Redesign operating certificate to provide for establishment of integrated LTC providers offering multiple services, eg
                             expect that each new established entity will either provide or directly arrange thru contract for PACE, SNF, Assisted Living, CHHA, Personal Care, Hospice. No reason to keep adding new providers without creating
3673   Website Submission    Home visiting programs - Healthy Families NY and Nurse Family Partnership - for at risk pregnant women and families with a newborn/young child save money for the Medicaid program in the current year; for
                             example, these programs reduce low birth weight and hence NICU use. These programs are cut in the Governor's proposed budget. Instead, they should be expanded with the new Federal home visiting funding which
3674   Website Submission    Permanently delay or repeal nursing home regional pricing.

3675   Website Submission    if you have medicaid and are admitted to a hospital and also receive public assistance your public assistance ck should be decreased for that month by how ever many days you are admitted on a day to day pro rata basis.
                             the reason is the hospital is feeding you and housing you. there are people who feel enititled on medicaid that see no urgency to be d/c'd from the hospital for whatever reason and the answer is there is nothing you can



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 #                  Author                                                                                                             Proposal
3676   Website Submission    Eliminate civil confinement in NYS. Years of expensive mental health services are provided with no medical/clinical proof this treatment actually rehabilitates these individuals. The only success of this program is that
                             it keeps these individuals off the streets by default....something that could easily be accomplished at MUCH lower cost through the shrinking prison system...where capacity exists. This model has been adopted by the
3677   Website Submission    Remove existing regulatory barriers limiting an individual to a single federal home and community-based waiver, under section 1915(c) of the Social Security Act, to improve services to individuals with co-morbidities.
                             This flexibility would help eliminate barriers to cross-systems collaboration and service delivery currently encountered and facilitate a more needs-based service system. Savings would be yielded from administrative
3678   Website Submission    I strongly advocate for a transition of services from the public sector to the significantly less costly private nonprofit agencies. It costs up to 3x the amount to fund state operated residential homes than what the same set
                             of services would cost agency residential homes. Currently there is a waitlist, although it is often referred to as a registry list, which includes 1,100 people (who have been determined eligible), for residential placement
3679   Website Submission    There is a recent push to focus on the supports of new ""at home"" services. Our son is not able to be cared for in our home, as much as that would be our wish. He is challenged severe self-injurious, aggressive
                             behavior. Our son needs 24 hour supervision. Due to his autism, he is in need of an environment which supports his severe sensory abnormalities. This environment is not the cookie cutter group home. It needs to
3680   Website Submission    We propose that New York State partner with the Arthritis Foundation to provide New Yorkers with Medicaid access to the Arthritis Foundation evidence-based disease management programs through hospital
                             networks.
3681   Website Submission    Medicaid should pay for the purchase of overhead, track mounted hoyer lifts for patients who need to be lifted from bed to wheelchair and/or toilet to wheelchair, especially in cases where the rooms in the patient's
                             home are too small to accommodate the use of a standing hoyer for such transfers. Evaluation of the patient's home should be done by a person who has used a hoyer to transfer patients.
3682   Website Submission    Analysis: Office for Aging Services Saves $64,000/person in Medicaid $

3683   Website Submission    Maximize use of your best redesign resource pool - your existing rank and file Medicaid policy staff. They understand the FFP issues, the Federal mandates, and all the restrictions that apply while knowing where the
                             leeway is and which "sacred cows" can be tapped if the political will is there to do so (which it seems to be.) I am from another large Medicaid state with personal knowledge of how valuable this resource (your own
3684   Website Submission    eform of Fair Hearing Process
                             This proposal is two-prong: 1) Change state process of issuing final fair hearings decisions based on procedural defects and, 2) Allow for local option to submit fair hearing documentation electronically.
3685   Website Submission    Restore the Ability to Recover Medicaid Claims through 3rd Party Liability

3686   Website Submission    Our request to Governor Cuomo, to Jason Helgerson, Director of NYS Medicaid Services, and to members of the Medicaid Redesign Team, is that they undertake this challenge by taking into consideration the impact
                             of the decisions on people of color, who make up a disproportionate number of Medicaid recipients. http://www.antiracistalliance.com/EquityImpactStatement.html
3687   Website Submission    Trusts: Supplemental Needs Trusts/Pooled Trusts

3688   Website Submission    Require Notification of Local Social Service Districts of Deceased Individuals in Guardianship

3689   Website Submission    INTRODUCTION

3690   Website Submission    Reduce Unnecessary Hospital Readmissions with Intensive Home Based Services could achieve $165 million in gross Medicaid Savings.

3691   Website Submission    Enhanced e-prescribing technology to improve decision making can potentially save New York State $39.5 million gross when fully implemented. New York has an opportunity to enhance its curent New New York
                             Medicaid Electronic Incentive Program. Mississipi, Louisiana, and the State of Florida have provided high prescribing Medicaid providers with new technology that gratly reduced medical errors and produced
3692   Website Submission    Managed care is not a panacea, either for regular Medicaid managed care or for managed long term care programs.

3693   Website Submission    Consumer directed person centered services provided to people in their own homes is more cost affective than congregate segregated programs. Models such as the TBI and NHTD Medicaid waivers are proven
                             successful models. Services promote integration of people with disabilities, not segregation. Using an aggregate cost analysis these waiver programs save Medicaid dollars. The Consumer Directed Personal Assistance
3694   Website Submission    Improving access to smoking cessation services for Medicaid recipients (including expanding coverage of smoking cessation counseling during a medical population) could help address New York's budget deficit and
                             improve health outcomes. Massachussetts recently leveeraged federal grant funding to implement a smoking cessation initiative for Medicaid recipients which improved health outcomes and showed significant
3695   Website Submission    Enroll more Medicaid-only Aged and Disabled Patients into Medicare for $88.7 million savings in drug spending.

3696   Website Submission    This is a suggestion for regulatory reform.

3697   Website Submission    Better care could be provided to fee-for-service Medicaid patients at substantially lower cost if regional groups of providers contracted directly with DOH for fee-for-service members. Providers in some regions already
                             possess extensive expertise coordinating care and accepting risk in their separate dealings with managed care plans and insurers. In those regions (such as Brooklyn, the Bronx and some upstate communities) there are
3698   Website Submission    The New York Care Coordination Program (NYCCP) proposes a specialty health home program for adults with serious mental illness and children with serious emotional disturbance that is a flexible, functionally
                             oriented, replicable system and can be implemented quickly to realize enhanced Federal reimbursement and near term savings in health care costs. The structure proposed for specialty health homes is based on the



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 #                  Author                                                                                                           Proposal
3699   Website Submission    While there is urgency to reduce State expenditures for the forthcoming fiscal year, it is imperative not to lose sight of delivery system quality and cost improvements that all stakeholders seek over the longer term. To
                             the fullest extent possible, the MRT and the State should seek to limit the conflict between these two essential priorities. Provider payment reductions should, where possible, not be permanent, allowing providers to
3700   Website Submission    Secure Federal Matching Funds through Early Coverage of Eligible Medicaid Populations. The American Hospital Association estimates that $36 billion of uncompensated care was provided nationally for all hospitals
                             in 2008. If just 10% of this were attached to a local funding stream, for example, a large public hospital system, the opportunity to obtain a matching funds(pre2104) at the state's standard FMPA could provide up to
3701   Website Submission    Managed care is not a panacea, either for regular Medicaid managed care or for managed long term care programs.

3702   Website Submission    We recommend the following:

3703   Website Submission    Remove the requirements for the existence of the Community Advisory Board (CAB) to oversee Willowbrook Class members. What made sense 40 years ago no longer has purpose. Instead, the CAB has worked to
                             create a two-tiered system where Willowbrook Class members receive preferential treatment and services above what the rest of the disability community receives. The developmental disability services system has
3704   Website Submission    1. The New York Association on Independent Living and Center for Disability Rights presented a proposal to reduce NYS spending and promote the independence and integration of seniors and people with disabilities.
                             I strongly endorse their proposals as they would save the state, conservatively, over one billion dollars over the next five years. I have a dear friend who has ALS and lives at home with the support of his family and
3705   Website Submission    2. We have over ten years experience with the TBI waiver and it has proven to be very effective at providing person-centered, consumer-controlled, integrated services for people who were institutionalized or in danger
                             of being institutionalized. It has been my experience that over time, costs for individuals in this waiver have been reduced as people mastered independent living skills and created natural supports in their communities.
3706   Website Submission    Consider the whole person! So many providers have created their own specific eligibility requirements (under the rules promulgated by state agencies)and if a person doesn't meet them, he or she can't be served. People
                             are packaged by diagnosis instead of by actual needs. A person needs a roof over his head, food, clothing, and companionship. We have made the way we take care of our
3707   Website Submission    Medicaid Managed Care Coordination of Benefits

3708   Website Submission    Secure Federal Funds Related to State Psychiatric Hospital Billing Medicare Part D

3709   Website Submission    1) Medical malpractice reforms. Any serious Medicaid cost control effort requires reform of the State?s expensive and inequitable medical malpractice system, which exerts tremendous cost pressure on the program.
                             New York State, which led the country in the number of medical malpractice claims filed for the decade ending in 2009, has one of the highest medical malpractice premium rates among the states. Hospitals in New
3710   Website Submission    ) Close eligibility loopholes and overly generous provisions for certain services. Even when they have the economic means to do so, enrollees, spouses and parents are not always required to contribute toward the cost
                             of care. Medicaid can no longer afford to pick-up the tab in these instances.
3711   Website Submission    3) Utilize competitive bidding for contracts. Currently the Medicaid program acts as a payer but doesn?t leverage its critical role as a purchaser. Maximizing the competitive bidding process will allow the Medicaid
                             program to use its tremendous purchasing power to select cost effective providers and ensure that high quality services are being provided.
3712   Website Submission    Reinstate the Asset and Resource Test for Medicaid determinations and include the local department of Social Services (DSS) Fraud Unit as part of the application process. In 2009, the Legislature and Governor
                             enacted a measure (Chapter 58, Laws of 2009) that eliminated the resource review when determining eligibility for Medicaid. Several district attorneys around the State have discovered instances in their districts
3713   Website Submission    Expand estate recovery initiatives. Federal law requires all states to recover all property and assets that pass from a deceased Medicaid beneficiary under state probate law. Notwithstanding this requirement, New York
                             counties have not pursued these recoveries aggressively. As a result, New York ranks 32nd nationally in estate collections as a percentage of total nursing home Medicaid spending ? collecting amounts from estates
3714   Website Submission    Reduce excessive hospitalization of the elderly. As of 2008, New York's Medicaid spending of $22,159 per elderly enrollee was the highest in the nation. One reason for this was New York's extraordinarily high rate of
                             inpatient hospital treatment of elderly patients (nearly 650,000 recipients in 2008). By placing these recipients into managed care we can reduce unnecessary hospital admissions.
3715   Website Submission    Cap personal care hours. The most costly of the optional Medicaid services financed by New York's state and local taxpayers is ""personal care,"" a category of in-home assistance including personal hygiene, dressing
                             and feeding. At $24,762 per recipient, personal care expenditures in New York were 234% of the national average in 2008. New York could generate cost-savings by imposing a cap on personal care hours (phased in
3716   Website Submission    ncentivize managed care among dual-eligibles. Current statutes limit the state?s ability to mandate managed care for the high-cost dual-eligible population. However, the state could implement incentives that will
                             strongly encourage dual-eligibles to receive both Medicaid and Medicare services from an integrated entity, perhaps by only providing coverage for certain Medicaid-optional services to those who select to enroll in this
3717   Website Submission    Incentivize family involvement in long-term care which brings down personal care hours. Beneficiaries with family help available require fewer home attendant services. Tax credits or other incentives for this type of
                             family support could reduce the number of hours needed per client at an incremental cost to the state.
3718   Website Submission    Observation status should be made available to all hospitals for pediatric patients with asthma or other acute but episodic conditions.

3719   Website Submission    Child Health Plus Coordination Of Benefits:

3720   Website Submission    The first two years have been completed of a demonstration project on introducing consumer directed care into county aging office programs. The demonstration funded by the U.S. Administration on Aging targeted
                             adults at objective risk for nursing home placement and Medicaid spend-down. For the 93 individuals served at least three months there was a total monthly reduction in costs of $410,781 (as compared to nursing home
3721   Website Submission    Stakeholder Group: Coalition for the Homeless
                             Proposals to Redesign Medicaid



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 #                  Author                                                                                                               Proposal
3722   Website Submission    Stakeholder Group: Coalition for the Homeless
                             Proposals to Redesign Medicaid
3723   Website Submission    Stakeholder Group: Coalition for the Homeless
                             Proposals to Redesign Medicaid
3724   Website Submission    Stakeholder Group: Coalition for the Homeless
                             Proposals to Redesign Medicaid
3725   Website Submission    As I understand the role of the committee, it is to generate new ideas on how to lower costs and improve quality in New York?s Medicaid Program, and to evaluate the ideas generated through the Stakeholder
                             engagement process and by State staff members.
3726   Website Submission    Medicaid eligible need to reform their look back period to at least 15 years.

3727   Website Submission    As a provider of 24/7 OMH and OASAS community residence programs for the past 2 decades, I recognize the medicaid savings that will be gained by 'internalizing' the 'external' costs of 'intensive outpatient treatment'
                             that is currently provided in the 'fee for service' medicaid clinics. Provding these 'intensive outpatient services"" within the residential setting will eliminate the costly 'fee for service' that is currently contibuting to the
3728   Website Submission    Under 18 NYCRR 505.14 Personal Care nurses who perform the assess/reassess of the patient and the MD hired by DSS for independent medical review of the cases should be SUBJECT TO THE NEW YORK
                             STATE DEPARTMENT OF HEALTH REGULATIONS AT PARTS 515, 516, 517 AND 518 OF TITLE 18 NYCRR, WHICH PERMIT THE DEPARTMENT TO IMPOSE MONETARY PENALTIES ON, OR
3729   Website Submission    1. The 2009 skilled nursing facility reimbursement rates should be continued, and supplemented by the following modifications:
                             a. 10-year rolling average of the medical care component of the Consumer Price Index.
3730   Website Submission    2. Create incentives for lower vendor fees and allow operators to share in savings through:
                             a. Reverse auctions for DME and other supplies and services
3731   Website Submission    3. Reduce facilities? ever-escalating insurance costs by allowing and incentivizing homes to engage in group purchasing of:
                             a. Health insurance
3732   Website Submission    4. Systematic restructuring of care providers:
                             a. Allow nursing homes to expand ?step-up care? services within their facilities, thus reducing the need to discharge residents to the more expensive hospital setting.
3733   Website Submission    5. Reduce ambulance and ambulette reimbursement rates
                             a. State should cut from profitable programs first, as every nursing home already loses money on every Medicaid resident. Ambulance and ambulette rates have not experienced any meaningful cuts during the time in
3734   Website Submission    6. Eligibility Rule Changes
                             a. Adopt a look-back period and other eligibility criteria for home care that are consistent with those applicable to nursing home care.
3735   Website Submission    7. Increase Alternative Funding Sources
                             a. Implement the Klein-Morelle law
3736   Website Submission    8. Eliminate Office of Medicaid Inspector General
                             a. OMIG serves the same function as the Attorney General?s office and thus is redundant. OMIG?s recoupments barely cover its staff costs.
3737   Website Submission    9. Create incentives for nursing homes to implement information technology that will reduce Part D nursing home pharmacy costs: increase the nursing home assessment by .025 and use those incremental dollars to
                             purchase electronic medical records and computerized physician order entry systems to expand use of electronic health information technology to maximize intensive reviews and management of medications.
3738   Website Submission    10. Create incentives for nursing homes to implement information technology that will reduce operational costs

3739   Website Submission    11. Permit publicly-traded companies to operate nursing homes in New York State
                             a. Charge a transfer tax on each transaction; would be a windfall for the State.
3740   Website Submission    12. Allow for rapid negotiations wherein nursing homes would simultaneously settle all outstanding rate appeals and audit claims

3741   Website Submission    13. Maximize federal portion of any Medicaid cuts.

3742   Website Submission    14. Increase the number of Assisted Living Program beds without requiring nursing homes to give up SNF beds.

3743   Website Submission    15. Relieve facilities from going after family members for stealing resident NAMI funds. The state will assume responsibility for the collection. They in turn can bundle the debt and sell it to collections agencies and
                             get cash upfront
3744   Website Submission    Offer high-quality therapeutic nutritional supplements supported by published peer-reviewed data on the New York Medicaid formulary for a cost-effective intervention to prevent and treat the SAEs and co-morbidities
                             highly prevalent in HIV and cancer patients.



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 #                  Author                                                                                                            Proposal
3745   Website Submission    Approximately ten percent of the nursing home beds in New York State are in county owned and operated facilities. All but perhaps one or two of these 44 county-owned facilities lose money each year despite
                             receiving significant subsidies from the federal, state and local governments. Despite benefiting from these intergovernmental transfers and county subsidies, county nursing home have cost allocations that do not reflect
3746   Website Submission    1. Pay Certified Home Health Agencies by episode using the risk-adjusted payment methodology developed by NYS DOH.
                             2. Adopt the Inter-RAI universal assessment tool for long-term care.
3747   Website Submission    A transportation network manager, or broker, is an outsourcing solution for the administration and management of transportation benefits for covered populations. A Broker centralizes the transportation process to
                             ensure that the appropriate level of service is provided in the most efficient manner, eliminating the need for eligible persons to interact with a fragmented system of multiple transportation providers offering varying
3748   Website Submission    My focus is on the the question of how financial and human resources can be conserved through effective reduction in the number of Medicaid Potentially Preventable Admissions (PPA)and Potentially Preventable
                             Readmissions (PPR). I am a physician wihh more than thirty-five years of clinical and executive experience in both voluntart and public hospitals in New York City.
3749   Website Submission    For many years, the Medicaid program paid an extra factor (in the Medicaid inpatient rates) to 20 N.Y. trauma centers which voluntarily participated in a quality improvement process for traumatic brain injury cases
                             using the one and only national set of evidence-based practice standards for TBI cases. Medicaid ceased those payments with the introduction of APR-DRGs. Unfortunately, in the absence of the extra payments, and
3750   Website Submission    New York State should consider the New York City Primary Care Information Project (PCIP) as a model for public private collaboration to help meet the New York State's public health goals.

3751   Website Submission    Medicare Cost Sharing Reform:
                             A subset of the overall Medicaid population is classified as dual-eligibles; these are individuals eligible for both Medicare and Medicaid coverage of health care expenses. For these individuals, Medicaid's financial
3752   Website Submission    Enhanced Carrier Cooperation:
                             The Federal Deficit Reduction Act of 2005 mandated that each state pass legislation compelling carrier cooperation in Medicaid coordination of benefits. New York passed such legislation, found in the Social Services
3753   Website Submission    Eliminate coverage of growth hormone for children diagnosed with idiopathic short stature and save
                             $5- 10 million/year;also eliminate coverage of growth hormone for children with growth hormone deficiency and save $20-50 million/year. Projected savings are based on extrapolation of the experience of one NY
3754   Website Submission    ACFs SHOULD BE AUTHORIZED TO OPERATE ADULT DAY HEALTH PROGRAMS.

3755   Website Submission    As the foremost authority representing physicians who provide women?s health care in New York State, the American Congress of Obstetricians and Gynecologists (ACOG) District II would like to thank you and
                             Governor Cuomo?s Medicaid Redesign Team for the opportunity to provide our insight into how a viable and sustainable solution to the task of Medicaid reform can best be achieved. ACOG District II has reviewed
3756   Website Submission    For New York to ensure the most cost effective approach to managing long-term care, it should only consider a model that minimizes State risk
                             For example, Medicaid Advantage Plus provides an opportunity to control Medicaid expenses through the use of broad benefit design ? acute and long-term care, at risk
3757   Website Submission    NURSING HOMES SEEKING TO CONVERT NURSING HOME BEDS TO ALP BEDS MUST CONTINUE TO BE REQUIRED TO OBTAIN AN ACF/ALR LICENSE FOR ANY NEW ALP BEDS.

3758   Website Submission    Regardless of whether a BH managed model is carve in, carve out, or some hybrid, it will be necessary to (1) align incentives across inpatient/intensive levels of care and community-based care, using innovative
                             payment methodologies where appropriate; (2) Re-design delivery system: reduce hospital and long-term residential capacity, increase crisis alternatives and outpatient capacity, strengthen recovery- and resilience-
3759   Website Submission    Expand the Scope of Benefits in Medicaid Managed Care (MRT Proposal #11, 91, 93)
                             &#61607; Include behavioral health. Health plans successfully manage the benefit now for a vast majority of their members with high marks in quality, access, and outcomes. In order to achieve these same outcomes
3760   Website Submission    Support FQHCs Expansion to Achieve Medicaid Cost Savings and Quality Improvements

3761   Website Submission    Currently article 28 clinics that provide dental treatment are expected to " self-police" themselves and follow medicaid guidelines. Perhaps more so than in medicine generally, there can be alternate ways to achieve a
                             functional end result in dentistry. This may put the facility dentists at odds with either recommending what they feel would be the best treatment for their patient ( their primary duty) versus attempting to adhere to
3762   Website Submission    A. Re-evaluate all current construction projects involving Medicaid funds for:
                             1. Financial sustainability in light of the new Medicaid funding realities, and
3763   Website Submission    Continuous Enrollment-The State should enact continuous enrollment for adults in the Medicaid program by providing 12 months of continuous coverage to Medicaid recipients. The continuous coverage will allow for
                             the provision of continuous and high quality care including preventive care and improved management of chronic and complex diseases, thereby avoiding more costly services such as emergency department and
3764   Website Submission    Adopt InterQual-Like Criteria-The State should adopt prior authorization for non-urgent spine surgeries and cardiac procedures and utilize criteria similar to InterQual criteria for determining the medical necessity of the
                             requested procedures. The use of such criteria will ensure that all covered services are consistent with practice of evidence-based medicine, reducing costs to the Medicaid program for unnecessary care. Savings TBD
3765   Website Submission    Require NCQA (National Committee for Quality Assurance) Accreditation-The State should require NCQA accreditation for commercial managed care plans and MMC plans to measure the quality of plans and to be
                             eligible for quality incentive payments. Adopting NCQA accreditation requirements will eliminate the need for the State to maintain a separate program and will off load the costs of such a program on to the managed
3766   Website Submission    Behavioral Health Services for SSI-The State should move behavioral health services for SSI MMC enrollees into the benefit package. Doing so would allow for better care management for those individuals, and would
                             be a step towards the integration of behavioral and physical health services. Carving-in this benefit would off-load the risk associated with providing coverage for these services onto MMC plans allowing for the State
3767   Website Submission    Durable Medical Equipment-The State should adopt a preferred program for durable medical equipment similar to the preferred drug program and require a step approach for approving high cost equipment by requiring
                             ordering providers to order the least costly device or concretely demonstrate that the less costly devices would not meet the needs of the beneficiaries. This would ensure a more efficient, more cost effective environment



                                                                                                                                                                                                                                                         138
 #                  Author                                                                                                            Proposal
3768   Website Submission    Personal Care Services-The State should adopt uniform criteria for determining the need for and amount of personal care services. Currently, each county determines when to approve personal care services and in what
                             amount. This leads to large disparities across the state and significant over utilization in some regions. Savings TBD
3769   Website Submission    Transportation-Building on the authority granted to the Department of Health in the 2010-2011 NYS Budget, the State should enact specific management criteria that requires the most efficient use of transportation to
                             medical services for Medicaid beneficiaries. Criteria could include requiring all recurring appointments to occur on the same day, limiting the number of allowable trips each month, and requiring providers to document
3770   Website Submission    Marketing-Statewide, enrollment in MMC of eligible Medicaid beneficiaries hovers between 78% and 89%. Due to the high penetration rate, MMC plans are in a position that they must market to Medicaid
                             beneficiaries already enrolled in other MMC Plans to continue to increase plan enrollment. Movement of enrollees between plans and policing marketing practices results in unnecessary administrative costs to the State
3771   Website Submission    Tort Reform-The State should enact medical malpractice reform. Rather than focusing on evidence-based care, providers are forced to order and provide unnecessary services to avoid baseless malpractice allegations.
                             The cost of medical malpractice insurance continues to climb and places increasing financial pressures on hospitals and physicians. Enacting reform will ensure that providers can stop practicing defensive medicine
3772   Website Submission    Consolidate OMH and OASAS-Consistent with the Governor?s goal to streamline NYS Government, consolidating the Office of Mental Health and the Office of Alcoholism and Substance Abuse Services would
                             ensure more integrated approaches to treatment of substance abuse and mental health, two inextricably linked conditions, and eliminate the burden on providers of obtaining dual licensure and complying with dual
3773   Website Submission    These comments are in response to proposal # 6 -- ""Reduce Medicaid Managed Care an Family Health Plus ?profit? from 3% to 1%""

3774   Website Submission    Add Edits to the State?s eMedNY System to Suspend Questionable Provider Claims until Reviewed

3775   Website Submission    Providers such as those that are part of St. Peter's Health Care Services should be allowed to join interstate Obligated Groups (particularly those of thier Systems; e.g.: Catholic Helath East). For us we demonstrated that
                             financing as part of teh Catholic Health Obligated Group would reduce interst expense by $15M-$30M ove the life of our bonds. In 2006 a CON was filed to establish the Obligated Group that remains outstanding.
3776   Website Submission    I propose that Medicaid save money by covering doula care for pregnant women. Doulas (trained birth assistants) have been shown to provide several money-saving benefits, including fewer Cesarean sections and
                             fewer admissions to the neonatal intensive care unit (NICU). Doula care also leads to shorter labors, less need for anesthesia, increased initiation of breastfeeding, and increased bonding between mother and baby.
3777   Website Submission    establish medical necesity criteria for nursing homes in coordination with payment system based on resident specific RUG score similar to that used in other case-mix state and the Medicare program. Reward facilities at
                             the point of care who care for heavier residents. Have the system pay for costs per patient rather than costs per facility.
3778   Website Submission    1) Streamlining and improving utilization of restricted scope Medicaid for emergencies. Confusion about the program and a complex application process has led to an under-utilization of the program which adversely
                             affects patients, providers and the State. Low-income patients, billed as self-pay, avoid necessary treatment or follow-up care. Providers forfeit Medicaid reimbursement and accrue unnecessary billing costs. The State
3779   Website Submission    Enabling Medicaid reimbursement for language assistance services, as proposed by Assembly Bill A00661 (Gottfried). Language barriers cause patients to avoid and delay health care until it becomes more serious, and
                             more costly; providers practice defensive medicine?over-testing, over-treating, over-medicating?or simply mistreating?sometimes with tragic results. Reimbursing would provide an incentive to providers to
3780   Website Submission    The exemption from Medicaid managed care for homeless people is integral in providing patients with the quality and continuity of care they need and deserve. The exemption: (1) is COST EFFECTIVE; (2)
                             EXPANDS ACCESS TO CARE; (3) and ENHANCES QUALITY OF CARE.
3781   Website Submission    1. Averting high annual costs of hospitalization and institutionalization by assisting families to provide at-home care for children who are medically fragile and developmentally disabled: NAC serves some of the most
                             medically fragile and developmentally disabled children in New York City. Many of our clients would need to be in long-term hospitalization or institutionalization without Preventive and Foster Care and Adoption
3782   Website Submission    2. Saving Medicaid Costs through Preventive Medical Approaches: The Case of Asthma: Every child enrolled in NAC services receives treatment from our Comprehensive Health Clinic, which houses an Article 28
                             medical clinic and Article 31 mental health services. The medical clinic is directed by a developmental pediatrician whom every child sees, and the clinic is staffed by a full cadre of pediatric nurses and administrative
3783   Website Submission    Reducing Hospital Facility Energy Costs with Renewables.

3784   Website Submission    Potentially Preventable Admissions and Potentially Preventable Readmissions have been identified are very large areas for Medicaid savings, however to use them as a target, they need to be broken down into more
                             details to assess how much of the ?Potential? can reasonably be realized in a short time frame, by who, and how.
3785   Website Submission    I. PROPOSAL FOR RIGHTSIZING PERSONAL CARE
                             Background
3786   Website Submission    Medicare recognizes two duration units of a psychotherapy service. The 20 - 30 minute face to face session 90804 (outpatient)/90816 (inpatient); and 90806/90818 the 45 to 50 minute face to face therapy session
                             (outpatient and inpatient respectively). They also differentiate between codes for the diagnostic interview (90801), and other specific services. New York State Medicaid makes similar distinctions in the Psychiatrists’
3787   Website Submission    While we keep fighting for the day when everyone will have equal access to health care, New York State could establish an Medicaid Buy-In, with premiums on a sliding scale, for those who need LTC, and whose