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MRT Reviews Detailed Slate of Proposals for Consideration

The Medicaid Redesign Team (MRT) met today in New York City for a second time to review a consolidated list of proposals from among over 2,200 submissions by the public.

The dozens of proposed recommendations discussed today were wide ranging, such as: changes to the global cap methodology; program integrity provisions; health information technology reforms; new approaches to care management, social determinants of health, transportation, and workforce supports; revenue raisers (such as insurance and health care taxes); and program-specific structural, enrollment, procedural or payment recommendations for various sectors, including additional proposals advanced by a long term care advisory committee. 

Many of these areas would touch the home care, hospice and Managed Long Term Care (MLTC) provider and plan infrastructure in a variety of ways.

slide presentation with details is available here.

A number of the proposals on the MRT table synchronize either directly or conceptually with some of the program improvements and/or procedural efficiencies and program measures HCA submitted to the MRT for home care, hospice and MLTC. These include changes to allow practical cost efficiency in the system by providers and MLTCs, enhanced use of telehealth, Medicare home health and hospice use expansion, home visits for asthma management, direct-care worker training and support initiatives, and pursuit of non-Medicaid/private financing options for services, among others. Notably, slide 7 in the chairs’ introductory comments specifically mentions HCA and HCA’s sepsis program as offering “promising long-term care efficiencies.”

Many additional proposals, however, raise high-level concerns or require further detail as to their design and implications, especially items related to: MLTC restructuring, consolidation and movement toward fully integrated programs for duals; Medicaid and MLTC-specific eligibility changes; a proposed new pooling of wage parity funds for “unrepresented home care workers”; personal care services authorization changes (including through an as-of-yet undefined conflict-free evaluation and enrollment-type process); changes in Medicaid coverage of transportation services; changes to CDPAP; expanded audit and civil monetary penalties in program integrity cases; the revival of a proposal from last year’s budget to require aides to obtain a unique identifier for Medicaid claims; and the possibility of deeper “across-the-board” cuts.

These proposals are numerous, and the areas mentioned in this alert are by no means exhaustive. It remains to be seen which specific items on today’s massive slate of proposals will be chosen for the final MRT report, as the process now invites written comments from the public and feedback from MRT members to prioritize and further synthesize items for consideration in a final package.

HCA will be submitting comments and feedback. We will also be seeking further information on the items that require more details

The next MRT meeting is scheduled for March 19 in Albany. HCA will provide the membership with important updates as we learn more specifics about the MRT’s proposals and the direction of the overall MRT process leading up to its final recommendations.

Meanwhile, it is expected that the Senate and Assembly will be issuing their one-house budget proposals soon. These bills and/or resolutions may include additional health care provisions or impacts that HCA will analyze and respond to as the Legislature negotiates with the Governor on a final budget, including the still formative inclusion of MRT advisory recommendations in the process.  

Still unknown is the relationship between these one-house bills and the Legislature’s ultimate dealing with the MRT proposals. The Legislature will have very limited time to respond to the MRT proposals, and it is anticipated, based on the Executive’s past approaches, that the Executive will seek to maximize all that it can within its Administrative authority.

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