Source: https://www.health.ny.gov/health_care/medicaid/program/update/2019/2019-03.htm
Timestamp: 2020-07-12 07:27:05
Document Index: 224502353

Matched Legal Cases: ['§3331', '§ 281', '§ 6810', '§ 281', '§ 281', 'art 455']

New York State Medicaid Update - March 2019 Volume 35 - Number 4
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C-Yes: The State's Designated Independent Entity for Children's HCBS
New Cycle of the Prevention Agenda Launched
Opioid Treatment Plan
Updated: Credentialed Alcoholism and Substance Abuse Counselor Now Approved for Billing Within an Article 28 Setting for DSRIP Project 3.a.i and Integrated Outpatient Services
Reminder: Reporting of the National Drug Code is Required for all Fee-for-Service Physician Administered Drugs
Electronic Prescribing: Blanket Waiver for Exceptional Circumstances
Reminder: Revalidation of Medicaid Providers is Required
National Healthcare Decisions Day (NHDD) is April 16, 2019.
NHDD was created to "inspire, educate, and empower the public and providers about the importance of advance care planning." NHDD in New York is a day dedicated to helping people understand that advance care planning includes much more than filling out forms; it is a process focused first on conversations about your wishes with your loved ones. Everyone has a role to play; families talking with each other about their care preferences and wishes as well as health care providers helping patients to understand how to make sure their wishes are followed in a clinical setting.
Advance care planning is the process of communicating and documenting your wishes for medical treatment in the event you are no longer able to speak for yourself. Through the advance care planning process, you may fill out advance directives or appoint a health care proxy to document your wishes. According to a national survey, ninety percent of people say that talking to their loved ones about end-of-life care is important, yet only twenty-seven percent have actually done so (The Conversation Project National Survey, 2013).
Here are some simple steps to can take to start your advance care planning process:
Think about what matters to you. It can be helpful to prepare yourself before talking to others about advance care planning. Think about what matters most to you and what you value.
Start the conversation. Make time to talk with your loved ones, doctors, or other healthcare professionals about what matters to you and what type of medical treatment you would like if you were unable to speak for yourself. It may take one conversation, or it may take many, but starting the conversation about your wishes is often the hardest part.
Fill out the forms. New York State advance directives include a Health Care Proxy and Medical Orders for Life Sustaining Treatment (MOLST). While everyone over the age of 18 should have a Health Care Proxy, a MOLST may not be appropriate for everyone. Typically, a MOLST is completed for someone with a serious health condition and who:
wants to receive or avoid any or all life-sustaining treatment;
may die within the next year.
Review and revise. Advance care planning is a process. You can always update your advance care directives if your preferences have changed. Review the decisions you made periodically and discuss them with your health care proxy and doctors to make sure everyone still understands your wishes.
For more information on advance care planning visit the New York State Department of Health web site at: https://www.health.ny.gov/professionals/patients/health_care_proxy/.
Research shows that five-year survival increases for women who have their breast cancer surgery performed at high-volume facilities and by high-volume surgeons. Therefore, it is the policy of New York State Department of Health (the Department) that Medicaid members receive mastectomy and lumpectomy procedures associated with a breast cancer diagnosis, at high-volume facilities defined as averaging 30 or more all-payer surgeries annually over a three-year period. Low-volume facilities will not be reimbursed for breast cancer surgeries provided to Medicaid members.
Each year, the Department reviews the list of low-volume facilities and releases an updated list effective April 1st. The Department has completed its annual review of all-payer breast cancer surgical volumes for 2015 through 2017 using the Statewide Planning and Research Cooperative System (SPARCS) database. Eighty-four low-volume hospitals and ambulatory surgery centers throughout New York State were identified. These facilities have been notified of the restriction effective April 1, 2019. The policy does not restrict a facility's ability to provide diagnostic or excisional biopsies and post-surgical care (chemotherapy, radiation, reconstruction, etc.) for Medicaid members. For mastectomy and lumpectomy procedures related to breast cancer, Medicaid members should be directed to high-volume providers in their area.
The Department will re-examine all-payer SPARCS surgical volumes annually to revise the list of low-volume hospitals and ambulatory surgery centers. The annual review will also allow previously restricted providers meeting the minimum three-year average all-payer volume threshold to provide breast cancer surgery services for Medicaid members.
For more information and to view the list of restricted low-volume facilities, please visit: http://www.health.ny.gov/health_care/medicaid/quality/surgery/cancer/breast/. All questions related to this policy should be directed to the Department at (518) 486–9012.
C-YES: New York State's Designated Independent Entity for Children's HCBS
Children and Youth Evaluation Service (C-YES) was designated by New York State (NYS) to act as the Independent Entity for children's Home and Community Based Services (HCBS). C-YES is responsible for conducting HCBS eligibility determinations of children prior to their enrollment in Medicaid and serves as the HCBS care coordination alternative to Medicaid-enrolled children/youth who decline Health Home (HH) care management. MAXIMUS Health Services, Inc., is the organization operating C-YES.
Referring a Child who is not Enrolled in Medicaid for HCBS Eligibility Determination
To obtain a Referral Packet, which is used to collect information about the child's medical history and includes consent forms, instructions, and general information about children's HCBS, providers and individuals should call C-YES at: 1-833-333-CYES (1-833-333-2937) or toll-free at 1-888-329-1541.
Upon receipt of a complete Referral Packet, C-YES will:
send a Registered Nurse to the child's home or other agreed-upon location to conduct an HCBS eligibility determination;
provide Medicaid application assistance to children who are determined eligible for HCBS*;
submit Medicaid applications, HCBS eligibility determination outcome and support documents, and capacity updates directly to the Local Department of Social Service (LDSS);
develop a person-centered HCBS Plan of Care (POC); and
provide education about Health Home care management.
*To access HCBS, NYS must also determine that there is capacity to serve the child and the child must be enrolled in Medicaid.
New York State's Prevention Agenda, which began in 2008, has started its third implementation cycle for the period 2019 to 2024. Partnerships between local health departments, health care providers, and community-based organizations are now occurring in every county. Each partnership is addressing health issues selected from the five statewide priority areas:
More information about the Prevention Agenda can be found at: https://www.health.ny.gov/prevention/prevention_agenda/2019-2024/. These partnerships welcome new opportunities to engage Medicaid providers in population health efforts. Visitors to the web site can find action plans for each priority along with recommended, evidence-based interventions. The site also links to the award-winning "Prevention Agenda Dashboard" which displays the most current data at the state and local level to track progress in improving health.
New York has made a commitment to be the first age-friendly state in the nation by encouraging interventions that promote healthy aging in people of all ages. The new Prevention Agenda cycle also has a special focus on promoting the Governor's "Health-Across-All-Policies" approach. State agencies are asked to include health considerations in their policies and programs so that New York will become the healthiest state in the nation.
Effective April 1, 2018, legislation signed by Governor Cuomo with the 2018-2019 State Fiscal Year Budget amends Public Health Law §3331 by adding subparagraph (8), as follows:
In short, a written treatment plan in the patient's medical record is required if a practitioner prescribes opioids for pain that has lasted for more than three months or past the time of normal tissue healing. There are exceptions for patients who are being treated for:
Such documentation and discussion of the above clinical criteria shall be done, at a minimum, on an annual basis. For an example of a generally accepted national governmental guideline for prescribing opioids for chronic pain from the Centers for Disease Control and Prevention (CDC), visit https://www.cdc.gov/media/modules/dpk/2016/dpk-pod/rr6501e1er-ebook.pdf. More information on opioid prescribing in New York State can be found on the Bureau of Narcotic Enforcement web page at: https://www.health.ny.gov/professionals/narcotic/docs/opioid_treatment_plan_letter.pdf.
39,127 $956,533,790
Now Accepting Payment Year 2018 Pre-Validations
Individual and group EPs who have already determined their Medicaid Patient Volume (MPV) may utilize the Pre-Validation services offered by the NY Medicaid EHR Incentive Program. Submitting Pre-Validation enables EPs to submit their data prior to attesting for preliminary review which may subsequently reduce the time of State review.
NY Medicaid EHR Incentive Program Support cannot review data until 90 days have passed from the end date of the 90-day MPV Reporting Period. This period is required to allow Medicaid claims to be processed and finalized. Therefore, providers initiating Pre-Validation with an MPV Reporting Period that ended within the last 90 days will receive notice from NY Medicaid EHR Incentive Program support about the inability to review the data. It is recommended to select an MPV Reporting Period using the prior calendar year method. This prevents the possibility of timing out of the twelve months prior to attestation method. Necessary forms for completion can be found as follows:
Individual EPs – Pre-Validation:
https://www.health.ny.gov/health_care/medicaid/redesign/ehr/repository/docs/ind_ep_pre_val.xlsx
Group EPs – Pre-Validation:
https://www.health.ny.gov/health_care/medicaid/redesign/ehr/repository/docs/grp_ep_pre_val.xlsx
Webinar: Preparing for Payment Year 2019
The Meaningful Use Stage 3 Webinar has been updated to focus on what providers can do now to prepare for Payment Year (PY) 2019. Centers for Medicare and Medicaid Services (CMS) has established eight objectives, each with its own required activity to demonstrate that the EP is meaningfully using Certified Electronic Health Record Technology (CEHRT). CMS calls these activities measures and EPs must either meet the measure(s) for each objective or show that they qualify for an exclusion to the measure. The objectives for Stage 3 are the same as they were for PY 2018, however, some of the measures will change. This webinar will be used as a resource to ensure all providers are prepared for this change. The eight objectives and their measures can be found under the "Meaningful Use Measures" tab on the EHR web site at: https://www.health.ny.gov/health_care/medicaid/redesign/ehr/2019_opt_stage3.htm.
Live Webinar Event: Patient Engagement for Eligible Professionals
Based on feedback received, the NY Medicaid EHR Incentive Program hosted a one-time webinar event on March 12, 2019. This webinar was designed for EPs new to MU. Topics covered included: benefits of the patient portal, strategies and considerations for setting up a portal, and a breakdown of Stage 3 measures involving patient engagement.
The Audit Report Card is a new feature of the Meaningful Use Registration for Public Health (MURPH) System. This is an additional application feature that provides new self-service utility functionality to the MURPH system that provides direct access to MU Public Health On-boarding Statuses for EPs, Eligible Hospitals (EHs) and their representatives. This new feature allows EPs and their representatives quick and easy access to a report of their public health status history for all of the Public Health registries with which they have registered intent to submit data.
For more information visit the MU Public Health Reporting page of the EHR web site at: https://www.health.ny.gov/health_care/medicaid/redesign/ehr/publichealth/. Questions should be directed to the MU Public Health Reporting Objective Support Team at: 1-877-646-5410, Option 3 (Mon-Fri, 8:30am - 5:00pm) or via e-mail at: MUPublicHealthHELP@health.ny.gov.
New York State (NYS) Regional Extension Centers (RECs) offer support to help providers meet their objectives. Answers to questions regarding the program and requirements, assistance on selecting and using CEHRT, or assistance to providers on meeting program objectives is available. NYS RECs offer free assistance for all practices and providers located within New York.
NYC REACH offers support services to providers located inside the five boroughs of NYC. For more information please visit the NYC REACH web site at:https://www.nycreach.org. For questions related to NYC REACH please call 1-347-396-4888 or email pcip@health.nyc.gov.
NYeC offers support services to providers located outside the five boroughs of NYC. For more information please visit the NYeC web site at:https://www.nyehealth.org. For questions related to NYeC please call 1-646-619-6400 or email hapsinfo@nyehealth.org.
NY Medicaid EHR Incentive Program has produced a series of Post-Payment Audit Educational tutorials to help providers to be prepared in the event of a post-payment audit. Links to each of the below tutorials can also be found at: https://www.health.ny.gov/health_care/medicaid/redesign/ehr/audit/.
Due to an acronym definition error in the February 2019 Medicaid Update, the "PPS" acronym has been corrected to be "Prospective Payment System." All other information herein is the same.
Effective January 1, 2019, an Article 28 facility that has been granted Integrated Outpatient Services (IOS) or Delivery System Reform Incentive Payment (DSRIP) Project 3.a.i authority may bill for services rendered by a Credentialed Alcoholism and Substance Abuse Counselor (CASAC). The CASAC must be properly supervised and medically directed. Clinics may bill for screening, individual and/or group counseling and other services, as applicable. For detailed guidance on permitted CASAC functions, please see the following link:https://www.oasas.ny.gov/workgroup/tm/documents/SOP.pdf.
Medicaid Managed Care (MMC) general coverage questions may be directed to OHIP Division of Healthcare Planning Contracting and Oversight at(518) 473–1134 or at covques@health.ny.gov.
The Commissioner of Health has approved a blanket waiver with respect to the electronic prescribing requirements, pursuant to Public Health Law (PHL) § 281 and Education Law § 6810, that go into effect on March 25, 2019, for exceptional circumstances in which electronic prescribing cannot be performed due to limitations in software functionality. The exceptional circumstances for which this waiver applies are set forth below (excerpt of waiver):
The Department recognizes that the standards developed by the National Council for Prescription Drug Programs (NCPDP), as adopted by the Centers for Medicare and Medicaid Services (CMS), still do not address every prescribing scenario. The current standards allow only a limited number of characters in the prescription directions to the patient, including, but not limited to, taper doses, insulin sliding scales, and alternating drug doses.
Similarly, for compound drugs, no unique identifier is available for the entire formulation. Typing the entire compound on one text line may lead to prescribing or dispensing errors, potentially compromising patient safety.
Further, the Department is mindful that practitioners must issue non-patient specific prescriptions in certain instances, and that such prescriptions cannot be properly entered into the electronic prescription software.
For these reasons, pursuant to my authority in PHL § 281(3), I waive the requirements for electronic prescribing in the following exceptional circumstances:
any practitioner prescribing a controlled or non-controlled substance under approved protocols for expedited partner therapy, collaborative drug therapy management or comprehensive medication management, or in response to a public health emergency that would allow a non-patient specific prescription;
any practitioner issuing a non-patient specific prescription for an opioid antagonist;
This waiver is hereby issued for the ten (10) above-listed exceptional circumstances and shall be effective from March 25, 2019 through March 24, 2020. Before March 25, 2020, I will determine whether the software available for electronic prescribing has sufficient functionality to accommodate each of these exceptional circumstances.
The above blanket waiver shall not affect other general waivers issued to practitioners pursuant to PHL § 281.
The full letter as well as additional information regarding e-prescribing can be found on the Bureau of Narcotic Enforcement web page at: https://www.health.ny.gov/professionals/narcotic/electronic_prescribing/.
Federal regulation 42 CFR (Code of Federal Regulations), Part 455.415, requires that all New York State Medicaid providers must revalidate every five years. Revalidation includes providing information on the provider's ownership, managing employees, agents, persons with a control interest, group affiliations, supervising/collaborating arrangements, as well as providing current addresses, specialties, etc. Providers will be notified by letter when they need to revalidate.
Providers, including prescribers, pharmacies, supervising pharmacists and any other enrolled provider, who do not revalidate will receive a termination letter and will be terminated. Terminated providers will not be able to participate in Medicaid Managed Care (MMC) networks and Children's Health Insurance Program (CHIP), in addition to being unable to bill for fee-for-service (FFS) Medicaid.
Pharmacies will not be able to process claims written by terminated, unenrolled providers. There is no override or exception process available. Information regarding the revalidation process can be found at: https://www.emedny.org/info/ProviderEnrollment/revalidation/index.aspx
Providers are encouraged to maintain their correspondence address to ensure the letters are sent to the correct address. For questions about the revalidation process or how to maintain ones provider file please visit www.eMedNY.org, contact the eMedNY Call Center at 1-800-343-9000, or email providerenrollment@health.ny.gov.