2020-2021 Enacted Budget Scorecard

FY 2021 MRT II Scorecard

  • Scorecard is available in Portable Document Format (PDF)
FY 2021 FY 2022
(State Share -- $ millions) Effective Date Article VII/Admin Enacted Enacted
Total Spending Reductions       ($2,201)   ($2,737)
Continuation of FY 20 Medicaid Savings Plan Reductions       ($739)   ($682)
          Reduce Mainstream Managed Care (MMC) Quality Pool Payments by 50%   Admin   ($60.00)   ($60.00)
          MMC Rate Range Reduction   Admin   ($96.07)   ($96.07)
          Discontinue Value Based Payment (VBP) Stimulus   Admin   ($42.50)   ($42.50)
          Discontinue the Hospital Enhanced Safety Net Program   Admin   ($66.00)   ($66.00)
          Discontinue Delivery System Reform Incentive Program (DSRIP) Equity Pools   Admin   ($190.00)   ($190.00)
          Additional Hospital Actions   Admin   $63.40   $121.00
          Reduce Managed Long-Term Care (MLTC) Quality Pool Payments by 25%   Admin   ($17.25)   ($17.25)
          MLTC Rate Range Reduction (MLTC)   Admin   ($20.93)   ($20.93)
          Discontinue Future Supportive Housing Resources Associated with Federal Waiver   Admin   ($18.00)   ($18.00)
          Discontinue Future Social Determinants of Health Investments   Admin   ($44.00)   ($44.00)
          ATB Rate Reduction (1.0% Annually; Effective 1/1/20)   Admin   ($248.00)   ($248.00)
Budget Year Spending Reductions       ($1,462)   ($2,056)
          Mainstream Managed Care Actions       ($145.07)   ($133.75)
          Encounter Data Accountability Penalty/Withhold (2.0% on MMC Plans) 4/1/2020 Article VII   ($142.50)   ($114.50)
          Managed Care Reforms N/A Article VII   $0.00   $0.00
          Tiered VBP Quality Incentive Penalty 1/1/2021 Admin   $0.00   ($3.50)
          Advance VBP Models (Maternity; BH/SUD, Data sharing Global Budget, Member Incentives) 4/1/2021 Admin   $0.00   ($5.00)
          Authorize Electronic Notifications 10/1/2020 Article VII   ($2.40)   ($5.26)
          VBP Global Budgeting Demonstrations 4/1/2021 Article VII   $0.00   ($4.80)
          Standardized Medicaid Managed Care Prior Authorization Data Set 1/1/2021 Admin   ($0.17)   ($0.69)
Hospital Actions       ($297.20)   ($304.20)
          Reduce Excess Medical Malpractice Liability Coverage Funding 4/1/2020 Article VII   $0.00   $0.00
          Reduce Indigent Care Pool for Voluntary Hospitals 4/1/2020 Article VII   ($87.50)   ($87.50)
          Discontinue the Public Indigent Care Pool N/A Article VII   $0.00   $0.00
          Establish Enhanced Safety Net Transition Collar Pool 4/1/2020 Article VII   $32.30   $32.30
          Reduce Hospital Capital Rate Add-on (5%) 4/1/2020 Article VII   ($17.00)   ($17.00)
          Reduce Hospital Capital Reconciliation Payment (10%) 4/1/2020 Article VII   ($4.00)   ($4.00)
          Discontinue Hospital Quality and Sole Community Pools 4/1/2020 Article VII   ($35.00)   ($35.00)
          Strengthen H+H 4/1/2020 Article VII   ($186.00)   ($193.00)
Long Term Care Actions       ($668.60)   ($1055.11)
          Institute an Eligibility Lookback Period of 30 Months for Home and Community-Based Services (HCBS) 10/1/2020 Article VII   ($5.05)   ($11.75)
          Eliminate Spousal Refusal N/A Article VII   $0.00   $0.00
Modify Benefit Eligibility Criteria for Personal Care Services (PCS) and the Consumer Directed Personal Assistance Program (CDPAS) Benefit

- For all Medicaid programs, require that individuals are assessed to need more than limited or greater assistance with more than 2 ADLs in order to receive PCS and CDPAS – with an exception for individuals with Alzheimer´s or Dementia who would need to require supervision or greater assistance with more than 1 ADL to access PCS and CDPAS

- To be eligible for enrollment in an MLTC plan, require that individuals are assessed to need more 120 Days of continuous community based long-term care services and limited or greater assistance with more than 2 ADLs - with an exception for individuals with Alzheimer´s or Dementia who would need to require supervision or greater assistance with more than 1 ADL to access PCS and CDPAS		 10/1/2020 - 4/1/2021 Article VII   ($119.25)   ($277.47)
Administrative Reforms to the PCS and CDPAS Benefit

- Require the Community Health Assessments (CHAs) annually, rather than semi-annually

- Eliminate requirement for monthly care management visits by MLTCs

- Require the CHA and Tasking Tool to consider telehealth as a substitute to care hours

- Permit CHAs to be conducted via synchronous telehealth modalities

- Require a Uniform Tasking Tool that plans/LDSSs use to Determine the Individual´s care plan including the number of hours of care that will be approved - Centralize and make independent the physician order authorization process - Require an additional level of utilization review for PCS and CDPAS when the requested hours exceed 12 hours per day to ensure the individual can remain safely in the community		 10/1/2020 - 4/1/2021 Article VII   ($82.00)   ($263.00)
Implement Comprehensive CDPAP Program Reforms and Efficiencies

- Complete Request for Offers (RFO)

- Impose moratorium on Fiscal Intermediary (FI) Advertising

- Implement conflict of interest rules for FIs

- Implement protocols, roles and standards for CDPAP consumers and designated representation

- Eliminate requirements on plans and LDSSs to notify consumers of CDPAP benefit availability

- Require that Consumers may only have one FI

- Permit personal assistants to provide non-emergent transportation to consumers during approved care hours		 6/1/2020 Article VII   ($33.00)   ($41.00)
          Duals Integration, including moratorium on, and phase out of, partial capitation MLTCs 4/1/2020-1/1/2022 Article VII   ($5.30)   ($41.80)
          Streamline and Enhance Fair Hearing Process 1/1/2021 Article VII   ($0.20)   ($0.93)
          Delay Community First Choice Option (CFCO) Services 4/1/2020 Admin   ($46.90)   ($46.90)
          Cap Statewide MLTC Enrollment Growth at a Target Percentage and Implement a 3% Withhold 10/1/2020 Article VII   ($215.00)   ($215.00)
          Reduce Workforce Recruitment and Retention Funding by 25% 4/1/2020 Article VII   ($22.50)   ($22.50)
          Statewide Independent Assessor 10/1/2020 Article VII   ($7.60)   ($15.56)
          Encounter Data Accountability Penalty/Withhold (1.5% on MLTC Plans) 4/1/2020 Article VII   ($101.90)   ($89.30)
          Offer Non-Medicaid Long-Term Care Programs to Encourage Delayed Enrollment in Medicaid with a private pay option for consumers to purchase on NYSoH 10/1/2020 Admin   $0.00   $0.00
          Community Spouse Resource Amount N/A Article VII   $0.00   $0.00
          Issue a Request for Offer for LCHSA´s 7/1/2020 Article VII   $0.00   $0.00
          Enhance Wage Parity Enforcement 10/1/2020 Article VII   $0.00   $0.00
          Discontinue Return on Equity for For-Profit Nursing Homes 4/1/2020 Article VII   ($13.90)   ($13.90)
          Reduce NH Capital (5%) 4/1/2020 Article VII   ($16.00)   ($16.00)
Care Management Actions       ($42.73)   ($69.50)
          Reform Patient Center Medical Homes (PCMH) 4/1/2020 Admin   ($6.00)   ($18.10)
          Achieve Health Home Rate Efficiencies (HH Admission/Step Down Criteria Revisions) 7/1/2020 Admin   ($11.63)   ($15.50)
          Discontinue Health Home Outreach 7/1/2020 Admin   ($16.00)   ($16.00)
          Establish Plan of Care Incentive/Penalty Payments 7/1/2020 Admin   ($5.00)   ($5.00)
          Comprehensive Prevention and Management of Chronic Disease 4/1/2020 Article VII   ($16.80)   ($37.10)
          Children´s Preventive Care and Care Transitions 4/1/2020 Admin   ($0.10)   ($0.20)
          Managed Care Process Optimization for Higher Risk Behavioral Health Patients (HARP/BH HCBS) 10/1/2020 Admin   ($0.40)   ($0.50)
          Children´s Behavioral Health Services 4/1/2020 Admin   $1.70   $1.70
          Invest In Medically Fragile Children 10/1/2020 Article VII   $12.80   $25.70
          Promote Evidence-based Preventative Dentistry 4/1/2020 Admin   ($1.60)   ($3.60)
          Emergency Room Avoidance and Cost Reductions 1/1/2021 Admin   ($0.20)   ($1.80)
          Addressing Barriers to Opioid Care 7/1/2020 Article VII   $0.00   $1.60
          Promote Maternal Health to Reduce Maternal Mortality 4/1/2020 Article VII   $0.50   ($0.70)
Pharmacy Actions       ($34.60)   ($130.20)
          Transition Pharmacy Benefit to FFS 4/1/2021 Article VII   $10.90   ($87.20)
          Reduce Coverage for Over-the-Counter Drugs (OTCs) N/A Article VII   $0.00   $0.00
          Discontinue Prescriber Prevails N/A Article VII   $0.00   $0.00
          Reduce Drug Cap Growth by Enhancing Purchasing Power 4/1/2020 Article VII   ($45.50)   ($43.00)
Transportation Actions       ($74.72)   ($216.66)
          Discontinue Supplemental Ambulance Rebate Payments N/A Article VII   $0.00   $0.00
          Reduce Taxi/Livery Rates 4/1/2020 Article VII   ($35.10)   ($51.37)
          Transition to a Medicaid Transportation Broker Program 4/1/2020 Article VII   $0.00   ($35.40)
          Carveout Medicaid Transportation from MLTC 4/1/2021 Article VII   $0.00   ($13.67)
          Carveout Medicaid Transportation from Adult Day Health Care N/A Article VII   $0.00   $0.00
          Maximize Public Transit in NYC 10/1/2020 Admin   ($1.76)   ($26.05)
          Public Emergency CPE 10/1/2020 Article VII/Admin   ($37.75)   ($89.95)
          ER Ambulance Diversion/Emergency Triage, Treat and Transport Program 10/1/2020 Admin   ($0.11)   ($0.22)
          Community Paramedicine N/A Article VII   $0.00   $0.00
Program Integrity       ($60.40)   ($73.60)
          Modernize Regulations Relating to Program Integrity 9/1/2020 Article VII   ($60.40)   ($67.20)
          Modernize Medicaid Third Party Health Insurance 9/1/2020 Article VII   $0.00   ($6.40)
Health Information Technology / Social Determinants of Health       ($8.80)   ($17.65)
          Medicaid System Information Technology & Data Access Modernization 4/1/2020 Admin   ($5.00)   ($2.50)
          Telehealth Network 4/1/2020 Article VII   ($2.60)   ($10.20)
          Pilot Social Determinants of Health (SDH) Interventions with Proven Return on Investment (ROI) 9/1/2020 Article VII   ($1.20)   ($4.95)
General Savings       ($130.00)   ($55.00)
          Additional ATB Rate Reduction (0.5% Annually; Effective 4/1/20) 4/1/2020 Admin   ($125.00)   ($50.00)
          Shift Water Fluoridation funding to Capital 4/1/2020 Admin   ($5.00)   ($5.00)