MRT Plan Current STCs - January 9, 2024

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CENTERS FOR MEDICARE & MEDICAID SERVICES

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1. See SMD #17-003 RE: Strategies to Address the Opioid Epidemic. 1
2 Medically needy refers to those who have the option of spousal impoverishment budgeting, including post eligibility when it is more beneficial. Medically needy is defined as an individual who is not eligible for, or in receipt of public assistance or SSI (or the state supplement), because his/her income and/or resources are in excess of cash assistance standards, but who has insufficient income and/or resources to meet the cost of his/her necessary medical and remedial care (42 CFR 435.320 (aged), 435.322 (blind) and 435.324 (disabled)). 2
3 All beneficiary protections apply to MMMC, MLTC and HARPs, unless otherwise noted in STC 5 3
4 Throughout these STCs, the term "Health Home," unless otherwise noted, only refers to Health Homes approved under section 1945 of the Act and consistent with approved NY Health Home state plan benefits for Health Homes SPA for IDD, Health Homes SPA for children, and/or Health Home SPA for Chronic Medical and SSI Health Home program. 4
5 Prescription drug monitoring programs (PDMP) are electronic databases that track controlled substance prescriptions in states. PDMPs can provide health authorities timely information about prescribing and patient behaviors that contribute to the "opioid" epidemic and facilitate a nimble and targeted response. 5
6 Ibid. 6
7 Demographic and HRSN data should include all of the following categories: race, ethnicity, primary language, disability status, sexual orientation, gender identity, and health-related social needs. 7
8 For a description of CMS's current policies related to budget neutrality for Medicaid demonstration projects authorized under section 1115(a) of the Act, see State Medicaid Director Letter #18-009. 8
9. 42 CFR §431.420(a)(2) provides that states must comply with the terms and conditions of the agreement between the Secretary (or designee) and the state to implement a demonstration project, and §431.420(b)(1) states that the terms and conditions will provide that the state will perform periodic reviews of the implementation of the demonstration. CMS's current approach is to include language in STCs requiring, as a condition of demonstration approval, that states provide, as part of their periodic reviews, regular reports of the actual costs which are subject to the budget neutrality limit. CMS has obtained Office of Management and Budget (OMB) approval of the monitoring tool under the Paperwork Reduction Act (OMB Control No. 0938 - 1148) and in states agree to use the tool as a condition of demonstration approval.  9
10 14 NYCRR 817.3(d)(1) and 14 NYCRR 800.4  10
11 New York State Public Health Law Article 33 Section 3331 (5).https://www.nysenate.gov/legislation/laws/PBH/3331 11
12 New York State Opioid Annual Report 2020. https://www.health.ny.gov/statistics/opioid/data/pdf/nys_opioid_annual_report_2020.pdf 12
13 CMS Informational Bulletin: https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/cib080519-1004_64.pdf 13
14 Good Samaritan Law was enacted as Chapter 154 of 2011; Publicly available brochure can be found at: https://www.health.ny.gov/publications/0139.pdf 14
15 Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1-49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1 15