January 14, 2009 News Headlines

HANYS was part of an historic coalition of health care provider and patient advocacy organizations that held a press conference at the state Capitol yesterday to call on the State Legislature to ensure that any increase in federal Medicaid funding is used solely for Medicaid health care services.

The federal government is expected to pass a stimulus package shortly that is anticipated to include up to $5 billion in increased federal Medicaid funding for New York State. Twelve statewide health care provider and patient advocacy organizations have joined together to protect these health care dollars from being used for non-health care purposes.

“Our message is simple and reasonable: Medicaid dollars should be used for Medicaid services,” said HANYS’ President Daniel Sisto. “These anticipated federal funds will be a literal lifeline for patients, residents, and providers across the state. Medicaid has already been cut twice this fiscal year by more than $1 billion, and now we are staring down the barrel of the Governor’s latest budget proposal that includes another $5 billion in health care cuts and taxes over the next two years.

“We need the Legislature to take concrete steps to ensure that the anticipated federal dollars are used to offset these enormous state cuts, and that they are not raided for non-health care purposes,” Mr. Sisto said.

Sue Ellen Wagner, Executive Director of Healthcare Trustees of New York State, said, “The trustees of our hospitals and health systems understand the intense fiscal pressures facing health care providers and the very real danger that the Governor’s cuts and taxes will result in layoffs and the curtailment of health care services. That is why it is imperative that any additional federal Medicaid dollars be used to offset these cuts and taxes and to ensure that New Yorkers will continue to receive the health care they need.”

The boards of HANYS and HTNYS have passed resolutions calling on the Governor and State Legislature to use any new federal Medicaid funds for Medicaid purposes only, and are encouraging the governing boards of member organizations to do likewise.

HANYS is leading efforts at the state and federal levels for an increase in the Federal Medical Assistance Percentage (FMAP) as part of the economic stimulus package currently being developed. This would result in billions of Medicaid dollars coming into New York at a time when this funding is needed most. When this increase occurs, HANYS is advocating that FMAP resources must be dedicated to Medicaid as intended, and used to mitigate the Governor’s proposed Medicaid cuts. The Governor’s 2009-2010 Executive Budget proposal would eliminate more than $2.5 billion in health care funding, with more than $1 billion in hospital cuts alone.

Other members of the coalition calling for “Medicaid for Medicaid” include:

• Center for Medical Consumers, a leading statewide health care consumer advocacy organization.
• New York Organization of Nurse Executives, the professional organization for nurses who design, facilitate, influence, and manage health care services in New York State.
• Medical Society of the State of New York, an organization of approximately 30,000 licensed physicians, medical residents, and medical students in New York State.
• Home Care Association of New York State, representing home care providers, individuals, and associate members who collectively serve thousands of New Yorkers.
• New York State Association of Health Care Providers, Inc., representing more than 500 offices of licensed home care service agencies, certified home health agencies, long-term home health care programs, hospices, and health related organizations.
• New York Association of Homes and Services for the Aging, representing non-profit and public nursing homes, senior housing, adult care facilities, continuing care retirement communities, assisted living, and community service providers.
• New York State Health Facilities Association, Inc., representing skilled nursing facilities, adult homes, assisted living residences, and individual and multi-facility operations of proprietary, voluntary, and government sponsorship.
• New York State Public Health Association, a broad-based statewide organization devoted to promoting and protecting the public’s health.
• American Cancer Society of New York and New Jersey, dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer through research, education, advocacy, and service.
• American Heart Association, a national voluntary health agency whose mission is to build healthier lives, free of cardiovascular diseases and stroke.

Contact: William Van Slyke

Yesterday, Attorney General Andrew Cuomo announced a settlement with UnitedHealth Group after a year-long investigation into allegations that its subsidiary, Ingenix, was improperly calculating “usual, customary, and reasonable” (UCR) rates or charges for medical procedures. Health insurers use these UCR rates in setting out-of-network payments.

The settlement calls for United to pay $50 million to finance the creation of an independent database of UCR rates, which will ultimately replace Ingenix. Attorney General Cuomo has set a six-month timetable for the creation and implementation of this new database, which is planned to be run by a yet-to-be-named university.

According to an interview with The New York Times, Attorney General Cuomo stated that the Ingenix database has been used as “a scheme to defraud customers” and consistently understated the usual, customary, and reasonable rate used to reimburse health care consumers. The Attorney General described the data provided by Ingenix as “unreliable, inadequate, and wrong,” noting that it understated market rates by up to 28%.

In a meeting last year with the Attorney General before the announcement of the Ingenix investigation, HANYS discussed the core allegations against Ingenix that were the subject of a pending federal court litigation against UnitedHealth Group and Ingenix, which several HANYS’ members had joined. HANYS is gratified that the Attorney General chose to investigate these allegations about the database raised by consumers and providers.

In addition to the creation of a new, more reliable database, the Attorney General’s office is overseeing the creation of a Web site where consumers can look up reimbursement rates before receiving treatment. Contact: Jeffrey Gold

Today, the U.S. House of Representatives approved legislation to reauthorize and expand the State Children’s Health Insurance Program (SCHIP).

The legislation, similar to SCHIP legislation vetoed twice last year by President Bush, is expected to expand health care coverage to an additional four million children and adults, bringing the total number of those covered under the program to 11 million. Funded by an increase to the tobacco tax and a ban on physician self-referral to hospitals in which they have an ownership interest, the program would be reauthorized for four-and-a-half years.

An important provision included in the House bill is a measure that would eliminate the state option of imposing a five-year waiting period for coverage for legal immigrant children and pregnant women. New York State currently covers these individuals with state-only funds. This provision would bring an estimated additional $60 million in federal Medicaid funding to New York State.

The U.S. Senate Finance Committee is set to markup its own version of an SCHIP reauthorization bill tomorrow. While SCHIP reauthorization is expected to pass the Senate, it is unclear if the controversial provision to expand coverage to legal immigrant children and pregnant women will be included in a final version of the bill expected to be approved by Congress and signed into law by President-elect Obama shortly after his inauguration. Contact: Kevin Krawiecki

The New York State Health Foundation (NYSHealth) announced the award of a grant to fund the first statewide Center of Excellence for the Integration of Care (CEIC) to transform the system of care for 1.4 million New Yorkers suffering from both mental health and substance use conditions. The $3.2 million grant, awarded to National Development and Research Institutes, Inc. (NDRI), will directly benefit patients and work to address the enormous costs in lost productivity, re-hospitalization, and related health care costs.

NYSHealth has identified co-occurring mental health and substance use conditions as a major health problem at a time when state agencies are working to eliminate barriers to mental health and substance use treatment services. NYSHealth’s initiative aims to achieve the integration of mental health and substance use services throughout all phases of the recovery process for patients at all of New York’s 1,223 licensed mental health and substance use outpatient treatment centers. Contact: Cindy Levernois