2011-12 Health/Medicaid, MMNY budget positions (as of 3/31/11)
This is a working document and it is subject to revision.
Governor Senate Assembly MMNY Enacted
MEDICAID MANAGED CARE
EXPANSION
Expand Medicaid managed Accept Accept Proposed language: Accepted, with requirement
care - exemptions for homeless, to consult with OCFS (from
kids in foster care, MMNY proposed language)
geographic proximity
- eliminate 60-day
treatment limit
- expand scope &
membership of MMCARP
Move pharmacy benefit Reject Accept, with modification Support Senate Accepted
into managed care to require MCOs to use the
PDL, CDRP, step therapy,
etc.
Expand services in Medicaid Accept Accept Oppose Accepted
managed care benefit
package to include personal
care
Mandatory Managed Long Accept Accept, with modification Oppose Accepted, but eliminates
Term Care enrollment cap on certificates
Managed Care Enrollment - Accept Accept Oppose Accepted
auto-assigned after 30 days
instead of 60 days
BENEFITS & ELIGIBILITY
REDUCTIONS
Eliminate carve-out for Accept Accept Oppose Accepted
currently exempt classes of
prescription drugs
Eliminate “prescriber Reject Accept Support Senate Rejected, for fee-for-service
prevails”
Eliminate Part D Medicaid Accept Reject Support Assembly Accepted
wrap for exempt classes
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2011-12 Health/Medicaid, MMNY budget positions (as of 3/31/11)
This is a working document and it is subject to revision.
Governor Senate Assembly MMNY Enacted
Limit Level I personal care Accept Accept Oppose both houses Accepted
from 12 to 8 hours per
week; authorize COH to
adopt standards
Impose management and Accept Accept, with modification Support Assembly Accepted, with requirement
utilization in personal care to require standards to be that standards are issued in
for split-shift & other high- adopted by regulation, not regulation but allowing use
intensity cases to be done on emergency of emergency basis
basis
Limit PT, OT, and speech to Accept Accept, with modification Oppose both houses, but Accepted, without
20 visits per year; except to allow people with support Assembly as Assembly modification
DD and kids physical disabilities to get compromise
overrides (as with other
utilizations limits in statute)
Increase co-pays and Accept Reject Support Assembly Rejected
impose new co-pays;
increase co-pay annual cap
from $200 to $300
Eliminate spousal refusal Reject Reject, propose new Support Assembly Rejected completely
language
Limit opioids to 4 fills per 30 Accept, with technical Accept Support Assembly Accepted
days modifications
Enteral nutrition limits, w/ Accept Accept Oppose Accepted
medical necessity
Reduction of EPIC Reject Accept, with slight Advocates proposed MSP Accepted, but restores part
modification alternative that would of the premium assistance
extend MSP coverage to cut
EPIC enrollees; would also
expand access for people
with disabilities who are
under 65 who have
Medicare
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2011-12 Health/Medicaid, MMNY budget positions (as of 3/31/11)
This is a working document and it is subject to revision.
Governor Senate Assembly MMNY Enacted
Orthopedic shoes and Accept Accept Oppose Accepted
orthotics - coverage limited
to growth and development
problems in children,
diabetics and when a shoe
is attached to a lower-limb
orthotic brace
Compression stockings - Accept Accept Oppose Accepted
limit to Medicare criteria
(treatment of open wounds
only) and during pregnancy;
no longer cover poor
circulation, varicose veins
and discomfort except In
pregnancy
TRANSPARENCY AND
ACCOUNTABILITY
Implement a global Accept, but require review Accept, provided a Oppose, support notice and Accepted, with modification
spending cap & consideration by the Medicaid savings allocation transparency requirements - DOB & DOH shall review
Legislature, 60 days notice, plan is made available to spending on monthly basis;
approval by Public Health the Legislature prior to DOH shall seek Legislative &
and Health Planning Council implementation stakeholder input in
developing allocation plan,
shall distribute to Finance
and Ways & Means 30 days
prior to implementing
N/A N/A N/A Increase from 10% to 100% N/A
the amount of hospital
charity care funding
allocated based on services
to the uninsured
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2011-12 Health/Medicaid, MMNY budget positions (as of 3/31/11)
This is a working document and it is subject to revision.
Governor Senate Assembly MMNY Enacted
N/A Allow counties to N/A Oppose Rejected
determine which, if any,
optional services they will
offer in their Medicaid
programs
N/A N/A Propose new language to Support Accepted
require DOH to make
Medicaid waiver and plan
amendments public,
including drafts
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