New York State Medicaid Update - November 2020 Volume 39 - Number 16

In this issue …

Information in gray boxes in this issue indicates material abridged but linked from the succinct interactive Portable Document Format (PDF) version.

New York State All Health Care Provider Telehealth Survey

The New York State (NYS) Department of Health (The Department) is conducting a survey of All Health Care Providers to gain knowledge of providers' experiences using telehealth during the COVID-19 State of Emergency. The Department will use the results of this survey to inform post-pandemic telehealth policy development. The information gathered from this survey will be shared with, and help inform the work of, the Reimagine New York Commission. More information on the Reimagine New York Commission can be found at: https://forward.ny.gov/reimagine-new-york-commission.

The survey should take approximately 20 minutes to complete and can be found at the following link: https://www.surveymonkey.com/r/KQYXNHR. All clinicians are encouraged to respond; however, please limit to one survey response per individual clinician. The Department is interested in gathering perspectives from clinicians from the same organization, especially if clinicians have different perspectives. Clinicians must submit survey responses as soon as possible. The survey will close on December 15, 2020.

With the rapid transition to telehealth during the State of Emergency, providers may have received surveys from multiple state agencies. Surveys administered over the summer by the Department's Office of Quality and Patient Safety (OQPS) had a focus on provider well-being and the Office of Mental Health (OMH) survey had a focus on consumer experience with behavioral health services. For providers who are exclusively an OMH-licensed provider and who previously participated in the comprehensive OMH survey, the Department welcomes provider responses but understands if providers do not have the resources to complete another survey at this time.

Below are COVID-19 telehealth guidance resources issued by New York State and referenced in the survey:

Thank you for partnering with the Department to improve the use of telehealth across New York State.

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Payment Error Rate Measurement Upcoming Request for Medicaid Provider Documentation

The Centers for Medicare and Medicaid Services (CMS) will be measuring improper payments in the Medicaid and State Child Health Insurance programs under the Payment Error Rate Measurement (PERM) program. New York State will be participating for the fifth time, the last being federal fiscal year 2017. CMS, along with their contractor and the New York State Office of Medicaid Inspector General (OMIG), have the authority to collect information under sections 1902(a)(27) and 2107(b)(1) of the Social Security Act. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) statutes and regulations require the provision of such information upon request, and the information can be provided without patient consent.

NCI Inc., the new CMS review contractor, in partnership with OMIG, will be requesting documentation for randomly selected claims in order to perform a medical review. When claims submitted by providers are selected, NCI Inc. and OMIG will request documentation in writing to substantiate claims paid in the federal review period of July 1, 2019 through June 30, 2020. Provider cooperation and timely responses are required.

If providers receive letters in this regard from, the CMS contractor, please submit copies of the specific medical documents for selected patients directly to the CMS contractor and send second copies to OMIG at the following address:

Office of the Medicaid Inspector General
800 North Pearl Street First Floor
Albany, NY 12204
Attention: PERM

Requests for documentation will start in November 2020. The sampled claims will have been paid between July 1, 2019 and June 30, 2020. Requests and subsequent receipt or non-receipt of documentation will be tracked. Failure to provide requested records will result in a determination by CMS of erroneous payment and OMIG will pursue recovery.

Questions should be directed to the PERM Project Staff at (518) 474‑3499 or via email at PERMNY@omig.ny.gov.

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Help Stop the Spread of COVID 19 by Sharing the New COVID Alert NY App

New York State Department of Health's new COVID Alert NY app is gaining participation with more New Yorkers every day. Please keep sharing the COVID Alert NY app information with partners and consumers. Together everyone can help stop the spread of this virus.

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Medicaid Consumer Fact Sheets Now Available

New York State Department of Health (DOH) Office of Health Insurance Programs has created new Medicaid consumer fact sheets focused on chronic health conditions. Each fact sheet provides information regarding how a condition can be prevented and managed, as well as relevant Medicaid benefits that can be used to help enrollees stay healthy. Fact sheets are currently available on the topics of diabetes, high blood pressure and asthma control, in the following languages: English, Spanish, Traditional Chinese, Russian, Haitian Creole, Bengali and Korean. Fact sheets on additional health topics will be produced in the coming weeks and posted on the Medicaid Redesign Team (MRT) II Policies and Guidance web page.

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New York Medicaid EHR Incentive Program

Distribution to Eligible Professionals & Eligible Hospitals Since the Start of the Program in 2011*
Number of Payments:Distributed Funds:
45,236$1,024,921,785

*As of 11/9/2020

Through the New York (NY) Medicaid Electronic Health Record (EHR) Incentive Program, eligible professionals (EPs) and eligible hospitals (EHs) in New York who adopt, implement, or upgrade certified EHR technology (CEHRT) and subsequently become meaningful users of CEHRT, can qualify for financial incentives. The Centers for Medicare and Medicaid Services (CMS) is dedicated to improving interoperability and patient access to health information. The NY Medicaid EHR Incentive Program is a part of the CMS Promoting Interoperability Program but will continue to operate under the current name of NY Medicaid EHR Incentive Program.

Paymeny Year (PY) 2020 Events and Announcements

To view all upcoming deadlines, announcements, and events, visit the EHR web page.

Check Provider Participation

At minimum*, a provider must have completed and received an incentive payment for one PY in 2016 or earlier to participate for future years. Providers who wish to check their participation status should contact the support team at (877) 646‑5410 (Option 2) or via email at hit@health.ny.gov.

*Providers must also meet all other relevant program requirements and metrics to be eligible to participate in the NY Medicaid EHR Incentive Program.

LISTSERV Communications

The NY Medicaid EHR Incentive Program uses a LISTSERV messaging system to quickly communicate upcoming events, deadlines and any changes to the program as a whole. Information and instructions on how to subscribe can be found on the NY Medicaid EHR Incentive Program LISTSERV web page. Providers who experience any difficulty when attempting to subscribe should contact the support team for assistance.

Webinars

The NY Medicaid EHR Incentive Program hosts a variety of informational webinars covering problem areas identified by providers. Providers who would like to have a particular topic discussed should submit requests by completing the Program Satisfaction Survey. Schedule and registration information for all webinars can be found on the EHR Webinar calendar page.

Questions

The EHR Incentive Program has a dedicated support team ready to assist. Please contact the program at (877) 646‑5410 (Option 2) or via email at hit@health.ny.gov.

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NY State of Health Open Enrollment Period is Underway

During these challenging times, NY State of Health, remains committed to ensuring access to affordable, quality health insurance for all New Yorkers, so they can get the care they need. Open Enrollment in a Qualified Health Plan is underway now. NY State of Health expects to renew Qualified Health Plan coverage for nearly 200,000 households and enroll new consumers into coverage during the Open Enrollment Period. New and returning consumers must enroll or renew by December 15, 2020, for coverage starting January 1, 2021. All New Yorkers who are currently enrolled in a Qualified Health Plan through NY State of Health are encouraged to renew their coverage. Anyone without health insurance should also visit the NY State of Health website and take this opportunity to enroll. Due to the ongoing COVID-19 public health emergency, consumers already enrolled in NYS Medicaid, Child Health Plus, or the Essential Plan will have their coverage continued automatically and do not need to renew at this time.

NY State launched a Special Enrollment Period (SEP) in March 2020 and recently extended it through the end of the year, to ensure that people do not avoid seeking COVID-19-related testing or medical care due to a lack of health insurance coverage. The extended 2020 Special Enrollment Period coincides with the 2021 Open Enrollment Period. Eligible New Yorkers can enroll in a Qualified Health Plan for November and/or December 2020 and continue enrollment in the same plan for 2021 without a gap in coverage. Consumers will be instructed to call Customer Service for this SEP.

Additionally, NY State of Health has launched its 2021 advertising campaign – the message, "We're Here to Help," is a continuation of messaging used during the COVID-19 pandemic to promote NY State of Health as a safety net for New Yorkers who may have lost job-based coverage. Ads will run statewide across all digital media platforms: search, social and display as well as TV/radio and downstate ethnic print publications. The goal of the campaign is two-fold: reach those who remain uninsured and encourage and remind those who did enroll in 2020 to renew their coverage for 2021, if required.

Consumers can enroll in a health plan by:

Additional information on insurance options during the Coronavirus emergency can be found at the NY State of Health Coronavirus (COVID-19) Information Page.

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Attention Taxi/Livery Providers

The Enacted 2020-2021 State Budget and Medicaid Redesign Team II (MRTII) initiative will decrease Medicaid Taxi/Livery base and mileage fees by 7.5 percent effective December 1, 2020. The updated fees effective for dates of service on or after December 1, 2020 are posted at the link below.

https://www.emedny.org/ProviderManuals/Transportation/PDFS/Transportation_Fee_Schedule.xls

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New York State Incontinence Supply Program Requirements

Enrolled New York State (NYS) Medicaid providers dispensing incontinence products in accordance with the Incontinence Supply Program initiated in September 2016 are responsible for ensuring that all incontinence products meet the minimum product specifications established by the NYS Department of Health (DOH) and must verify the specifications through independent testing result documentation. Previously, products purchased from DOH's contracted preferred provider were exempt from this requirement; however, that contract has expired. Accordingly, the enrolled NYS Medicaid provider must comply with the program requirements and minimum product specifications. Documentation must be maintained on site and available for review upon request.

Documentation from an independent laboratory must show that the incontinence products dispensed meet the following the minimum standards:

  • No plastic (non-breathable) backed products;
  • Rewet rate of <2.0g;
  • Rate of Acquisition (ROA) of <60 seconds;
  • Retention capacity of >250 g;
  • Presence of breathable zones with a minimum value of >100 cubic feet per minute (cfm);
  • Presence of a closure system which allows for multiple fastening and unfastening occurrences. (Applicable for products that have closures).

These minimum standards apply to all adult and youth sized products dispensed to NYS Medicaid members residing in community settings by fee-for-service, managed care and managed long-term care NYS Medicaid providers.

DOH continues to incorporate the review of incontinence product minimum quality specifications into routine pre-payment and post-payment reviews as well as other audit processes. DOH will also investigate any complaints received from NYS Medicaid enrollees or other parties concerning NYS Medicaid enrolled providers dispensing incontinence products which do not meet the established minimum product specifications.

For questions about the Incontinence Supply Management Program, contact the Bureau of Medical Review at (800) 342‑3005 or by email at OHIPMEDPA@health.ny.gov.

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The Medicaid Update is a monthly publication of the New York State Department of Health.

Andrew M. Cuomo
Governor
State of New York

Howard A. Zucker, M.D., J.D.
Commissioner
New York State Department of Health

Donna Frescatore
Medicaid Director
Office of Health Insurance Programs