Summary of one-house budget priorities
Summary of changes reflected in the Assembly and Senate One-House Budget Bills
Global cap: The Senate adds language requiring: (1) DOH to adjust the cap to account for disaster related spending and any state Medicaid funding required under the proposed $10 billion MRT waiver; (2) legislative notification/approval of any plan to cut spending if the cap is breached; and (3) a report by 12/31/13 on whether the cap should be modified, continued or discontinued.
Trend Factors and 2% ATB cuts: The Assembly and Senate reject the proposed permanent elimination of trend factor adjustments, instead simply providing no trend through 2015. The Senate discontinues the 2% across the board cuts at the end of 2013 while the Assembly extends the 2% across the board cuts through 2014, rather than 2015 as proposed by the executive.
Spousal Refusal: The Assembly and Senate reject the executive’s proposal to eliminate spousal refusal. The Assembly and Senate both agree to extend spousal impoverishment protections and include spouses of MLTC enrollees.
Expanded enrollment in MLTC: The Assembly rejects the executive’s proposal to “carve-in” new populations into MLTC: (1) Native Americans; (2) people expected to be eligible for less than 6 months; (3) persons eligible for TB related services only; (4) persons receiving hospice care; (5) persons enrolled in TPHI; (6) persons receiving family planning services only, and (7) persons eligible pursuant to the Breast and Cervical Cancer Treatment Act. The Senate concurs with the executive’s proposal.
Consolidated funding for public health programs: The Assembly and Senate reject the proposed elimination of 89 discrete programs by DOH and the creation of outcome based block grants. The Assembly and Senate further restore the programs, including funding for EQUAL and Enriched Housing.
Capital investment pilot: The Assembly rejects the proposal to allow for private investment in health care facilities. The Senate accepts the proposal and expands it to 10 demonstrations.
Medicaid Recoupments and Reductions: The Senate includes language exempting Medicaid recoupments and reductions, from April 1, 2009 and forward, from interest and penalties.
Nursing Homes
Standard Wages in nursing homes: The Assembly largely accepts, with modifications, the executive’s proposal requiring standard rates of compensation for nursing home employees in contracts between MLTC and nursing homes. The amendments clarify that standard wages set by the department shall not supersede or diminish those established by a collective bargaining agreement; this essentially sets the union rate as the floor for wages. The Senate rejects the proposal.
Capital Reimbursement for nursing homes: The Assembly and Senate reject the proposal giving DOH sole regulatory authority to establish capital reimbursement methodologies for nursing homes. The state has a federal waiver request to authorize fee-for-service capital reimbursement to continue under managed care.
Financially disadvantaged payments for nursing homes: The Assembly and Senate restore the financially disadvantaged program and reject the executive’s proposal to transfer the associated funding to the Vital Access Provider program.
Specialty nursing home rates: The Assembly rejects the governor’s proposal to unilaterally develop a pricing methodology for specialty nursing homes. Instead, the Assembly creates a workgroup to help establish such rates. The Senate concurs with the executive’s proposal.
Home Care
Home health aide scope of practice: The Assembly and Senate reject the proposal to expand the scope of practice for home health aides to include administration of medications under the supervision of a nurse. The Assembly and Senate also reject the proposal authorizing advanced aides to provide nursing services to self-directing individuals.
CHHA & LTHHCP streamlining: The Assembly includes comprehensive provisions in their one-house budget bill related to CHHA and Lombardi programs, including:
- Prompt payment of clean claims by managed care plans,
- elimination of cap related to number of enrollees,
- adequate payment by MLTC for wage parity provisions,
- waiving federal conditions of participation for purposes of contracting with managed long term care plans, and
- adequacy of rates to MLTCs to cover costs of providers
The Senate also includes similar language related to:
- prompt payment of clean claims by managed care plans, and
- adequacy of rates to cover costs of providers
Home and Community Based Services Workgroup: The Senate budget includes language creating a HCBS Workgroup within DOH to make recommendations related to continuity of care, quality assurance, care delivery, etc. related to the transition to managed care. The Workgroup must convene by May 2013 and make final recommendations by October 2013.
Managed Long Term Care
Expansion of MLTC plans: The Assembly and Senate reject the proposal to eliminate the cap on the maximum number of MLTC plans that can be authorized.
Hospice coverage under MLTC: The Assembly includes provisions clarifying that individuals enrolled in managed long term care do not need to disenroll in order to access hospice care.
Standard Wage Mandate: The Assembly modifies the executive’s proposal related to nursing home wage standards (see nursing home section above). The Assembly also provides similar language to cover payment to home care agencies for wage parity provisions. The Assembly includes language instructing the Commissioner of Health to consider these costs when setting reimbursement rates to plans. The Senate rejects the proposed wage mandate.
Adult Care Facility/ Assisted Living
Quality funding: The Assembly and Senate restores the EQUAL program and restores funding to 2012-1013 level ($6.9 million).
SSI enriched housing subsidy: The Assembly and Senate restores the Enriched Housing Subsidy to 2012-2013 level ($502,900).
ALP Expansion: The Assembly and Senate accept the executive’s proposal to expand the ALP and provide capital reimbursement, and agree to limit it to transitional homes.