2% Across The Board Medicaid Payment Reductions

April 2013 - March 2015 2% Extension

The final 2013-14 state budget (Chapter 56 of the Laws of 2013) requires an extension of the 2% across the board reduction on most Medicaid payments. Such payment reductions will apply for dates of service on and after April 1, 2013. The reduction will remain in effect for dates of service through March 31, 2015.

The following services are exempt from the 2% reduction:

1. Payments whereby Federal law precludes such reduction, including:
   • Federally Qualified Health Center services;
   • Health services provided to Native Americans who reside on reservations and receive services at one of four tribal clinics affiliated with the federal Indian Health Program;
   • Supplemental Medical Insurance - Part A and Part B;
   • State Contribution for Prescription Drug Benefit (aka Medicare Part D payments);
   • Any local share cap payment required by the Federal medical assistance percentages (FMAP) increase legislation;
   • Required payments related to the School Supportive Health Services Program and Preschool Supportive Health Services Program;
   • Hospice services;
   • Services provided to American citizen repatriates; and
   • Court orders and judgments.
2. Payments that are funded exclusively with federal and/or local funds, including:
   • Upper payment limit payments to non-state owned or operated governmental providers certified under Article 28 of the NYS Public Health Law;
   • Certified public expenditure payments to the NYC Health and Hospital Corporation;
   • Certain disproportionate share payments to non-state operated or owned governmental hospitals; and
   • Services provided to inmates of local correctional facilities.
3. Other Payments Excluded:
   • Any payments pursuant to Article 32, Article 31 and Article 16 of the mental hygiene law are exempt from the 2% reduction; with the exception of:
     • Hospital based and Freestanding Methadone Maintenance Treatment Programs (MMTP) - 2% Reduction applies as of December 2011.
     • All services provided in an Article 28 hospital (including mental health and substance abuse) - 2% Reduction applies.
     • However, Outpatient and CPEP programs operated by Art 28 hospitals are Exempt.
   • Early Intervention
   • DOH TBI Waiver
   • Care at HOME (CAH) I, II
   • Nursing Home Transition and Diversion Waiver (NHTD)

Services subject to the 2% payment reduction include:

Category	Program or Service Area
Medicaid Administration Costs	Medicaid Administration Costs paid to local governments, contractors, and other such entities 2% reduction applies
Inpatient Services	Hospital Inpatient Reimbursement 2% reduction applies Indigent Care Pool Payments 2% reduction applies Graduate Medical Education - Medicaid for Managed Care patients 2% reduction applies Hospital Disproportionate Share payments made to governmental general hospitals operated by the State of New York or the State University of New York 2% reduction applies Indigent Care Adjustments to hospitals operated by the State of New York or the State University of New York 2% reduction applies Supplemental Medicaid payments to voluntary hospitals 2% reduction applies Additional Disproportionate Share Payments to voluntary non-profit hospitals 2% reduction applies
Nursing Home	In State Nursing Homes - Alternative proposal accepted to generate commensurate savings through a non reimbursable increase of the cash assessment Out of State Nursing Homes - 2% reduction applies
Non-Institutional Services	Assisted Living Programs Alternative proposal accepted to generate commensurate savings through a reduction of the State only funding of 'EQUAL' Foster care 2% reduction applies Freestanding Clinic Alternative proposal accepted to generate commensurate savings through a reduction to the APG base rates Home Health CHHA - 2% reduction applies LTHHCP- Alternative proposal accepted to generate commensurate savings through an increase of the cash assessment Home Nursing 2% reduction applies Hospital Based Outpatient 2% reduction applies Managed Long Term Care Alternative proposal to generate commensurate savings through reducing premium levels Managed Care/ FHP/HMO Alternative proposal to generate commensurate savings through reducing premium levels Methadone Maintenance Treatment Programs-MMTP (hospital based and freestanding) 2% reduction applies Personal Care 2% reduction applies Pharmacy Alternative proposal- interactions amongst existing proposals and other pharmacy programs will generate commensurate savings , resulting in 1% or less in payment reductions Physicians Office place of service - Alternative proposal accepted to generate commensurate savings for office based physicians through an reduction in radiology fees All other places of service 2% reduction applies Other Services (Dental, Eye/X-ray, etc.) Office place of service - Alternative proposal accepted to generate commensurate savings for office based physicians through an reduction in radiology fees All other places of service 2% reduction applies to all others; except for Dental fee schedule billing