November 7, 2008 News Headlines

A final regulation was published today that clarifies the outpatient hospital services for which states will receive federal Medicaid funding by aligning the Medicaid definition of these hospital services more closely with the Medicare definitions. The rule contains significant improvements from the original proposal.

In the final rule, the Centers for Medicare and Medicaid Services (CMS) does not move forward, for now, with provisions to modify the methods for demonstrating compliance with and calculating the upper payment limits (UPLs) for outpatient hospitals and clinics. The UPL determines the maximum amount that Medicaid may pay for outpatient department and clinic services on an aggregate basis for states when constructing their Medicaid state plans.

The New York State Governor’s office had estimated that the state could suffer a loss of more than $450 million in federal Medicaid funding if CMS moved forward with this proposed modification. CMS cited one of six Medicaid regulations currently under a congressional moratorium until April 2009 as the reason for not making final this proposal and stated that the agency could move forward with this modification at a later date. The potential for this issue to resurface is HANYS’ primary concern.

Another favorable change for New York State is that the final rule dropped a provision that would have changed the treatment of “flat rate” hospital services in the state’s calculation of the UPL.

HANYS has long worked with members of the New York State Congressional Delegation on a two-pronged strategy, pushing CMS to change the rule and seeking a moratorium on it. HANYS is grateful for the support of the Delegation, including Senators Charles Schumer (D-NY) and Hillary Rodham Clinton (D-NY), and Representatives Charles Rangel (D-Manhattan), Eliot Engel (D-Bronx), and John McHugh (R-Pierrepont Manor), who have been leaders in Congress in working with CMS to modify the regulation.

HANYS is working with the Governor’s office and state partners to analyze how the final rule will affect federal Medicaid funding to the state, hospital outpatient departments, and freestanding clinics. HANYS continues to work closely with the Delegation as the state’s analysis of the rule is finalized. Implementation of the rule is set for December 8. Contact: Susan Van Meter

Governor David Paterson has launched a new Web site, http://www.reducenyspending.gov, which speaks to the fiscal challenges that New York State is facing and outlines the Governor’s plan to address the crisis.

One link on the site directs the public to a series of documents on the Division of Budget site, which provide insight on the “Core Mission” of each state agency. At the request of Governor Paterson, each agency provided detailed information on each individual state program and indicated its level of priority within the agency’s overall mission. The Governor indicated that the information would inform policymakers of the Administration’s state spending priorities.

The Governor will hold a town hall meeting in Syracuse on November 11 to speak about the current fiscal crisis. Contact: Robin Frank

Carmela “Deb” Laino has been named Deputy Director of the State Office of Health Emergency Preparedness Program (OHEPP) for hospitals and long-term care facilities, reporting to Robert L. Burhans, Director, OHEPP.

Most recently, Ms. Laino was the Chief Disaster Planning Leader and Corporate Director of Environmental Health, Safety, and Security for Unity Health System in Rochester. In her 12-year tenure there, she managed a staff of 50 to maintain safety and security initiatives for the 620-bed health system and 50 urban and suburban medical offices, clinics, assisted living, nursing homes, and extended care facilities. In addition to her work at Unity, Ms. Laino chaired the Monroe County Hospital Disaster Planning Committee, where she led area hospital collaboration with the Rochester Regional Health Care Association, fire, police, and emergency medical services to develop region-wide emergency preparedness plans for bioterrorism and other public safety threats.

HANYS and its members have worked with OHEPP in developing health care providers’ individual emergency response systems and plans, and in shaping the collaborative role of health care in the broader community emergency response plans. HANYS welcomes Ms. Laino and looks forward to continuing that work with her in her new position at OHEPP.

Contact: Christopher Smith

This week, HANYS held an educational program on clinical and reimbursement reform to hospital-based detoxification services enacted in the state fiscal year (SFY) 2008-2009 budget. The enacted reform initiatives reflect the work of the Task Force on the Continuum of Care for Alcoholism and Substance Abuse Services convened by the Department of Health (DOH) and Office of Alcohol and Substance Abuse Services (OASAS) with representatives from hospitals and community-based providers.

The SFY 2008-2009 budget reform included the clinical and regulatory flexibility to facilitate medically necessary services through the development of three inpatient levels of care: inpatient medically managed withdrawal beds, inpatient medically supervised withdrawal beds, and observation beds for up to 48 hours. The three inpatient levels of care will transition out of the current Diagnosis Related Group reimbursement methodology to a new per diem reimbursement methodology. The new per diem reimbursement methodology for the three inpatient levels of care is effective December 1, and is still pending federal approval.

Handout materials and presentations given by representatives from DOH, OASAS, and IPRO are available online. There is still opportunity to review and provide comments on the proposed regulations and guidelines for implementation of the reform initiatives. Members may forward comments to OASAS directly or send them to Cindy Levernois, HANYS’ Director of Behavioral Health, who will compile and submit them to OASAS. Ms. Levernois can be reached at (518) 431-7744 or at cleverno@hanys.org.

Contact: Cindy Levernois

The Department of Health (DOH) has announced the 2008 award recipients under the Empire Clinical Research Investigator Program (ECRIP). More than $8 million has been awarded to teaching hospitals across New York State. ECRIP supports the efforts of teaching hospitals and Graduate Medical Education (GME) consortia to train physicians as clinical researchers to advance biomedical research in New York’s academic health centers. The funding is drawn from the GME Reform Incentive Pool to support clinical research positions in each region.

HANYS supported the continuation of ECRIP funding within the 2008-2009 state budget agreement, which has allowed a number of New York’s medical institutions to remain at the helm of important clinical research.

Research project awards were announced at:

• Bellevue Hospital Center
• Beth Israel Medical Center
• Brookdale Hospital Medical Center
• Brooklyn Hospital Center
• Coney Island Hospital
• Erie County Medical Center
• Forest Hills Hospital
• Glen Cove Hospital
• Interfaith Medical Center
• Jacobi Medical Center
• Kaleida Health System
• Kings County Hospital Center
• The Kingston Hospital
• Lenox Hill Hospital
• Maimonides Medical Center
• Mary Imogene Bassett Hospital
• Memorial Sloan-Kettering Cancer Center
• Metropolitan Hospital Center
• Montefiore Medical Center
• Mount Sinai Hospital
• New York Hospital Medical Center of Queens
• New York Methodist Hospital of Brooklyn
• New York-Presbyterian Hospital
• North Shore University Hospital
• North Shore-Long Island Jewish Health System/Hillside Medical Center
• NYU Medical Center
• Our Lady of Mercy Medical Center
• Roswell Park Cancer Institute
• St. Luke’s-Roosevelt Hospital Center
• Staten Island University Hospital
• St. Vincent’s Hospital Manhattan
• St. Vincent’s Hospital Staten Island
• Strong Memorial Hospital
• United Health Services
• University Hospital of Brooklyn
• Westchester Medical Center
• Winthrop-University Hospital
• Wyckoff Heights Medical Center

Contact: Robin Frank