Need/forgot a password?

September 21, 2010 News Headlines

Lt. Governor Calls for Medicaid Overhaul; HANYS Opposes Shift in Rate-Setting Authority

Lt. Governor Richard Ravitch yesterday called for significant changes in New York's Medicaid system, including shifting control of the Medicaid rate-setting process from the State Legislature to the Department of Health (DOH). HANYS continues to review the report and recognizes the need to restructure and make improvements in the Medicaid program. However, HANYS fundamentally disagrees with the proposal to remove Medicaid rate setting from the legislative process. "Rate setting has a profound impact on the lives and health of nearly a quarter of the state's population, millions of the state's most vulnerable citizens. It is therefore essential that rate setting remains subject to the legislative process where it can be fully considered and debated," said HANYS' President Daniel Sisto. In the past, the Legislature has wrestled with the economic, geopolitical, and health policy complexities of health care reimbursement and funding issues. These issues have significant implications for patients and individual communities across the state. The legislative branch provides important checks and balances.

The Lt. Governor's other recommendations include:

  • Reform medical malpractice with legislative measures such as a cap on non-economic damages, a neurologically impaired infant fund, and specialized courts. Reduce the primary medical malpractice coverage required to make doctors eligible for the "free layer" of excess. Establish programs to increase obstetric patient safety and give doctors greater premium discounts and credits for participation.
  • Establish an independent commission to advise the Governor and Legislature (modeled after the federal Medicare Payment Advisory Commission).
  • Consolidate administrative authority over Medicaid in the state rather than the counties.
  • Create new Center on Medicaid Innovation.
  • Expand disease prevention efforts.
  • Modify Medicaid spend-down and spousal refusal rules.
  • Change Medicare's "freedom of choice" provisions so that dual-eligibles can be required to participate in managed care.

Recognizing the challenges associated with rising Medicaid costs and state budget deficits, HANYS' Board of Trustees earlier this year established a Task Force on Improving New York State's Medicaid Program, to develop sound health care policy alternatives to repeated cycles of health care funding cuts that do nothing to reform health care and continuously weaken the health care system. Immediate and longer-term proposals will show that Medicaid and various government processes can be re-designed to make the delivery of health care more efficient and effective, ultimately resulting in lower costs and better outcomes. In broad categories, the Task Force is addressing:

  • Medicaid redesign and overall government cost savings that will reduce pressure to cut Medicaid;
  • efficiencies that will "bend the cost curve" of health care spending;
  • efficiencies in the content, operation, and administration of New York State's health and insurance budgets, agencies, and programs that will reduce calls for Medicaid cuts; and
  • revenue generation.

Contact: Robin Frank


HANYS Comments on New Preventive Services Regulations

HANYS submitted comments to the U.S. Department of Health and Human Services (HHS) regarding Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act.

The Interim Final Rules implement Section 2713 of the Public Health Service Act, which generally prohibits group health plans and health insurance issuers from imposing cost-sharing requirements on plan members for preventive services. HANYS applauded HHS for including a broad array of preventive services and certain items and services recommended by the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices, and the Health Resources and Services Administration. However, HANYS noted the following shortcomings with the Interim Final Rules:

  • The Rules do not require health plans to cover preventive services when delivered out of network and allow cost-sharing to be imposed if preventive services are delivered by out-of-network providers. HANYS urged HHS to take further action to ensure that preventive services are covered without cost-sharing requirements, regardless of the network status of the provider.
  • The Rules instruct plans to use “reasonable medical management” to determine the frequency, method, treatment, and setting for items or services for which coverage is mandated but the controlling recommendation does not specify the appropriate standard of care, without defining “reasonable medical management.” HANYS asked for additional guidance on this point and suggested that “reasonable medical management” be defined in relation to evidence-informed medicine.

In addition, HANYS requested that HHS develop guidelines for value-based insurance designs so that health plans are not tempted to steer patients and providers to choose lower-cost care options, without sufficient regard to quality outcomes. HANYS believes that precise guidelines are necessary to ensure that providers are able to exercise unbiased and transparent clinical judgment when helping patients to choose appropriate health care services. Contact: Danielle Drayer