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Department of Health (DOH) |
Adjusted Executive Legislative
Approp. Request Approp.
2000-01 2001-02 2001-02 Change
STATE OPERATIONS
General Fund 206,406,800 232,049,000 227,995,000 (4,054,000)
Special Rev.-Fed. 3,275,044,400 3,405,116,000 3,405,116,000 0
Special Rev.-Other 350,117,400 353,627,000 352,627,000 (1,000,000)
Fiduciary 2,725,000 2,965,000 2,965,000 0
Enterprise 10,000 10,000 10,000 0
Fiduciary Funds -
Miscellaneous New York
State Agencies 0 1,000,000 1,000,000 0
Total for Agency: 3,834,303,600 3,994,767,000 3,989,713,000 (5,054,000)
Total Contingency: 650,000,000 850,000,000 850,000,000 0
Total for
STATE OPERATIONS: 4,484,303,600 4,844,767,000 4,839,713,000 (5,054,000)
AID TO LOCALITIES
General Fund 6,320,167,893 6,839,080,000 6,809,664,750 (29,415,250)
Special Rev.-Fed. 16,559,793,500 18,118,904,000 18,513,434,456 394,530,456
Special Rev.-Other 1,673,981,100 1,801,469,000 1,908,469,000 107,000,000
Total for
AID TO LOCALITIES: 24,553,942,493 26,759,453,000 27,231,568,206 472,115,206
Capital Projects
Fund 120,077,000 115,259,000 120,259,000 5,000,000
Total for
CAPITAL PROJECTS: 120,077,000 115,259,000 120,259,000 5,000,000
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Agency Mission The Department of Health (DOH) is the designated State agency responsible for promoting and supervising public health activities, ensuring sound and cost-effective quality medical care, and reducing infectious diseases. Since State Fiscal Year (SFY) 1996-97, when the State's Medical Assistance Program (Medicaid) was transferred from the Department of Social Services, DOH has served as the principal State agency that interacts with the Federal and local governments, health care providers, and program participants for the Medicaid Program in New York State. Transfer of all Medicaid functions to the Department of Health pursuant to Chapter 436 of the Laws of 1997 consolidated operational and oversight responsibilities for the program for the first time within one agency, affording clear State accountability for Medicaid and greater efficiencies in the administration of health care programs. Year-to-Year Change Over 70 percent of the Department of Health's budget is funded with Federal Funds, of which the major portion relates to the federal share of Medicaid. The General Fund contributes approximately 25 percent to overall DOH program support, while Special Revenue-Other funds the remaining five percent. General Fund dollars are closely tied to Federal Funds: for every $1 in the General Fund the Agency generates nearly $3 in federal money. The Executive recommends a total All Funds appropriation of $31,719,479,000, a decrease of $2,561,155,907 or 8.78 percent. The Executive recommends General Fund/State Operations appropriations of $232,049,000, an increase of $25,642,200 or 12.42 percent. The Executive recommends General Fund/Aid to Localities appropriations of $6,839,080,000, a net increase of $518,912,107 or 8.21 percent. The Executive estimates General Fund spending in SFY 2000-01 for the Medicaid program will be $5,692,810,000. For SFY 2001-02, the Executive proposes that General Fund spending will be $6,065,400,000, an increase of $372,600,000 or 6.55 percent over SFY 2000-01 levels. This appropriation reflects the total General Fund benefit to the Medicaid program of the proposed new cost containment actions which the Executive estimates at $318,150,000. Of this amount, $138,900,000 is achieved through the previously mentioned cuts to providers while another $179,250,000 is effectuated through revenue and other Federal maximization efforts designed to offset Medicaid. MEDICAL ASSISTANCE PROGRAM Program Mission The Medical Assistance Program (Medicaid) is a national program, designed to provide health care for the elderly, the physically and mentally disabled, and children and families who do not have the resources to provide that care for themselves. In SFY 1996-97, responsibility for New York's Medical Assistance Program was transferred to the Department of Health from the Department of Social Services in an effort to establish clear State accountability for Medicaid policy and to promote efficiencies in the administration of health care programs. Legislative Changes
The Assembly's re-estimate of Medicaid spending is comprised of two components: Federal savings of ($24,350,000) in SFY 2000-01 and ($255,780,000) projected in SFY 2001-02.
The Assembly takes a reduction of ($198,410,000) in Medicaid General Fund spending related to: utilizing a more aggressive approach to calculating the Medicaid Upper Payment Limit (UPL) with respect to public hospitals other than the Health and Hospital Corporation (HHC) ($41,310,000) and expanding the authorization of hospital proportionate share Medicaid payments for certain non-State operated public facilities--HHC ($157,100,000).
The Assembly's re-estimate of Medicaid spending is comprised of two components: ($14,710,000) in General Fund savings in the current fiscal year and ($127,310,360) in projected savings in SFY 2001-02.
The Assembly recommends the previously authorized transfer of $82,000,000 from the Health Care Reform Act of 2000 (HCRA 2000) be used to offset Medicaid General Fund expenditures. The Assembly also recommends the previously authorized transfer of $25,000,000 from HCRA 2000 for the Supplementary Medical Insurance (SMI) program be used to further offset Medicaid General Fund expenditures. The Executive proposes eliminating these transfers in the SFY 2001-02 budget. The Assembly does not concur with this proposal and hence permits the transfers to proceed as authorized in HCRA 2000 and uses these funds to offset the General Fund Medicaid appropriation.
The Assembly takes a reduction of ($3,000,000) related to growth greater than inflation in nonpersonal services.
The Assembly takes a reduction of ($1,054,000) in personal services in the Office of Managed Care due to an inadequate explanation of the need for this 30-Day amendment.
The Assembly takes a reduction of ($1,000,000) for administration of the regional pilot project. The Assembly proposes to reprogram the $1,000,000 to help pay for operating costs for the plan.
The Assembly takes a reduction of ($500,000) associated with the establishment of the Pharmacy and Therapeutics Committee as the Assembly rejects the Executive's proposal to establish such a committee.
The Assembly allows $82,000,000 as authorized in the Health Care Reform Act of 2000 (HCRA 2000) to be transferred to the Medical Assistance Account-Special Revenue Other to be used as an offset to General Fund Medicaid expenditures. The Assembly also allows $25,000,000 as authorized in HCRA 2000 to be transferred to the Medical Assistance Account-Special Revenue Other to be used for the Supplementary Medical Insurance (SMI) program to further offset General Fund Medicaid expenditures. Legislative Proposals Medical Assistance In State Fiscal Year (SFY) 2000-01, the Ways and Means Committee staff estimates that General Fund Medicaid spending will be $5,678,100,000, approximately $14,710,000 or 0.26 percent below that estimated by the Executive. In SFY 2001-02, the Ways and Means Committee staff estimates that General Fund Medicaid spending will be $5,889,409,640, approximately $175,990,360 or 2.9 percent below that proposed by the Executive. As part of the Health Care Reform Act of 2000 agreement, the Medicaid cost containment measures, enacted as part of the SFY 1999-2000 budget, were extended for three years, until March 31, 2003, with the understanding that no new cuts would occur during this period of time. Despite this understanding, the Executive proposes new cuts to the State's Medicaid program. The Assembly proposes to restore $152,150,000 in Medicaid spending cut by the Executive, as well as adding $119,200,000 in new State Share Medicaid funding. Of the restoration amount, the Assembly proposes to restore $130,900,000 taken by the Executive as Medicaid cuts targeted at nursing homes. Specifically, the Assembly proposes to restore: the 2001-02 trend factor for nursing homes ($50,000,000); the supplemental payment to facilities that have more than 300 beds ($23,900,000); the return on equity incentives to proprietary homes ($11,000,000); and the nursing home reimbursement methodology to include the cost of Medicare and all other non-Medicaid patients in the Medicaid rate ($46,000,000). The Assembly also proposes to restore $2,000,000 in Medicaid cuts targeted at certified home health care agencies, as well as $6,000,000 in Medicaid cuts targeted at the pharmaceutical industry. These actions would restore over $350,000,000 in combined Federal, State and local reimbursement to certain Medicaid providers. The Assembly recognizes that increased prescription drug cost sharing for the poor and the elderly reduces their use of purchasing prescription drugs. Therefore, the Assembly restores $500,000 associated with the Executive's proposal to require managed care recipients to make a co-payment on prescription drugs similar to other Medicaid recipients. The Assembly also restores $4,000,000 associated with the Executive's proposal to increase co-payments from $2.00 to $3.00 for prescription drugs, ranging from $25.01 to $50.00. The Assembly further proposes statutory language to ensure that the Department of Health (DOH) would not be able to make this change administratively. The remaining $8,750,000 relates to restorations of Medicaid enhancements enacted in SFY 2000-01 but which are not continued by the Executive. Included is the Assembly's proposal to restore $7,000,000 and provide an additional $3,000,000 to support a transition fund to assist clinics in moving from a fee-for-service reimbursement system to a managed care environment. The Assembly also proposes to restore $250,000 and add $250,000 for uncompensated care payments to dental clinics sponsored by dental schools. Additionally, the Assembly provides for the restoration of $1,500,000 in funding to adjust the cap on reimbursement of administrative and fiscal costs of nursing homes to alleviate a disproportionate impact on certain homes without shifting costs to other nursing homes. The Assembly recognizes that a shortage of registered nurses and certified nurse aides poses a heavy burden for nursing home employees and adversely affects the quality of care they are able to give their patients. The Assembly proposes $125,000,000 in new funding, of which $100,000,000 would be provided in State Fiscal Year (SFY) 2001-02, to address nursing home quality of care and staffing issues. The new State funding will draw $100,000,000 in matching funds from the Federal Government. Under the Assembly proposal, the State would pick up the local share of the cost. As further protection to our vulnerable nursing home residents, the Assembly proposes to take steps to ensure that the provision of quality care is the top priority by enhancing staffing levels, improving accountability, and establishing a hotline to receive nursing home complaints. Additionally, the Assembly proposes increasing fines for nursing home facilities that do not take appropriate corrective actions and requiring the Department of Health to disclose to the public incidents of adverse patient care on an annual basis. The Assembly also proposes that the Department of Health be directed to hire additional nursing home inspection and surveillance staff and to provide for new training initiatives for all inspectors in order to better identify problems in residential health care facilities. The Assembly further recognizes that the need to recruit and to retain qualified nurses and nurses' aides is also of paramount importance to New York's hospitals. To address hospitals' operating and staffing needs, the Assembly proposes $50,000,000 in new funding to help hospitals to deliver quality health care services, as well as to recruit and to retain experienced health care workers. Additionally, the Assembly proposes $5,000,000 in new Medicaid funding for which the State would pick up the local share targeted to the home care industry to assist this sector in dealing with workforce recruitment and retention issues. The Assembly accepts the Executive's proposal to create 10 new positions in the Office of Continuing Care at a General Fund cost of $450,000 to conduct nursing home surveillance activities. The Assembly also accepts the Executive's proposal to establish the Quality of Care Improvement Account to receive all penalty and fine revenues collected by the Department of Health and the Federal Department of Health and Human Services from residential health care facilities and to reinvest these revenues in quality improvement programs for nursing homes. The Assembly recognizes that approximately 50 percent of the uninsured in New York State are eligible for either Child Health Plus (CHP) or Medicaid but are not enrolled. Additionally, many Medicaid and CHP recipients have become disenrolled during the recertification process due to complex administrative procedures. To address this problem, the Assembly proposes to eliminate certain barriers to enrollment and retention by simplifying the application process, and aligning recertification dates for family members, together with other proposals that would greatly enhance enrollment and retention in the Medicaid, Child Health Plus (CHP), and Family Health Plus (FHP) program. Additionally, the Assembly proposes to increase income eligibility for children in the Medicaid program from 100 percent to 133 percent of the net Federal Poverty Level (FPL) by repealing the previously enacted requirement that 50 percent of Medicaid eligibles must become enrolled in the Medicaid Managed Care program or that New York State must receive a federal waiver, which ever comes first, before this provision could become effective. The Assembly also proposes to extend the Child Health Insurance Program from March 31, 2001 through June 30, 2004. The Assembly proposes to expand CHP up to 300 percent of the Federal Poverty Level (FPL), which will make an additional 37,000 children eligible for the program. The Assembly also proposes to include emergency transport as a covered service under the Child Health Plus (CHP) benefit package. Additionally, the Assembly recognizes the importance of continuity within varying health insurance programs. In line with this objective, the Assembly proposes new funding for both the Prenatal Care Assistance Program (P-CAP) and Family Planning Services to expand such programs to up to 300 percent of the FPL, consistent with the proposed expansion of CHP. The Assembly would stipulate that a Federal waiver related to these eligibility increases could not be submitted to the Federal Health Care Financing Administration (HCFA) until federal approval has been received from the expansions enacted as part of the SFY 2000-01 budget. In addition, the Assembly proposes nearly $3,000,000 to provide full Medicaid and Family Health Plus (FHP) coverage to legal immigrants. The Assembly also proposes $1,000,000 in new funding to include legal immigrants in the Medicaid expansion up to 250 percent of the Federal Poverty Level (FPL) for low income women who are diagnosed with breast and/or cervical cancer through the national Centers for Disease Control's screening program, effective October 1, 2001. The Assembly recognizes that many persons with disabilities want to work but cannot take decent paying jobs without losing Medicaid coverage. Existing Medicaid income and resource limits prevent disabled individuals from earning enough to support themselves or their families. The Assembly proposes $4,850,000 in SFY 2001-02 in additional State share funding for a Medicaid Buy-In program for disabled workers under the Federal Ticket to Work and Work Incentives Improvement Act of 1999. The Assembly action proposes no local share. The Assembly's proposal, the Work and Wellness Act of 2001, would allow disabled workers to buy into the Medicaid program by paying premiums on a sliding scale based on income, effective April 1, 2001. When fully implemented, the Assembly estimates that approximately 17,000 persons would benefit from the expansion. Additionally, the Assembly would provide $1,000,000 to extend coverage under the Medicaid Presumptive Eligibility Program for a period of 90 days to uninsured persons discharged from psychiatric inpatient hospital care or released from a State or local correctional facility or jail for services and supplies related to the treatment of a mental illness. The Assembly also proposes $1,000,000 to provide Medicaid coverage for children leaving foster care, as authorized by the Foster Care Independence Act, up to the age of 21. The Assembly supports the Executive's proposal to continue additional Disproportionate Share Payments for the Health and Hospitals Corporation (HHC) hospitals. The Assembly also accepts the Executive's proposal to authorize Federal Financial Participation (FFP) for inpatient hospital and other services provided to inmates in State and local government facilities. The Assembly accepts the Executive's proposal to extend Prepaid Health Services Plans (PHSPs) through June 30, 2002. The Assembly accepts and expands upon the Executive's proposal to authorize hospital proportionate share Medicaid payments for certain non-State operated public facilities. The Assembly's proposal would authorize the Department of Health to make a specialty hospital adjustment to public general hospitals up to $900,000,000, an increase of $604,000,000 over the Executive's proposal. This action would result in a total net benefit to Health and Hospital Corporation hospitals of $149,800,000, an increase of $120,800,000 over the Executive's proposal. This action would additionally result in a net benefit to the State totaling $260,100,000, an increase of $157,100,000 over the Executive's proposal, even with a 10 percent reduction in State Share benefit as proposed by the Assembly for the incremental increase above the Governor's proposal. The Assembly further proposes to expand the Executive's proposal to authorize reductions in local share reimbursement to New York City for persons eligible for Medicaid as a result of a mental disability, consistent with the proposed expansion of the hospital proportionate share Medicaid payments. The Assembly also proposes for two years the utilization of a more aggressive approach to calculating the Medicaid Upper Payment Limit (UPL) for six public hospitals outside of New York City. This methodology, combined with a 10 percent increase in the local savings share will result in an additional net benefit of $27,540,000 to the public hospitals, as well as an additional benefit of $41,310,000 to the State for SFY 2001-02. In SFY 2002-03, the UPL benefit to the State and the public hospitals will be adjusted to reflect the anticipated loss to county nursing homes of a portion of the revenues generated through Inter-Governmental Transfers (IGT) due to federal actions. The Assembly rejects the Executive's proposal to eliminate the transfer of $82,000,000 from the Health Care Reform Act of 2000 (HCRA 2000) to offset General Fund Medical Assistance spending. The Assembly further rejects the Executive's proposal to decrease the Supplementary Medical Insurance (SMI) funding distributions in HCRA 2000 by $25,000,000 in SFY 2001-02. Additionally, the Assembly rejects the Executive's proposal to transfer an unspecified amount of monies generated from the Tobacco Control and Insurance Initiatives Pool into the Health Care Initiatives Pool, until June 30, 2003. The Assembly accepts the Executive's proposal to transfer $69,000,000 in residual Health Care Reform Act 1996 (HCRA 1996) funds into the Child Health Insurance Program Account to offset Child Health Insurance expenditures. Any unused or uncommitted funds remaining in HCRA 1996 after the $69,000,000 transfer would be used for the funding of other Health Care Initiative Pool programs in the Health Care Reform Act of 2000. The Assembly rejects the Governor's proposal to prohibit Medicaid capital reimbursement for any new residential health care facility beds that have not received final approval to commence construction as of January 1, 2001. Public Health The Assembly recognizes the importance of promoting good health, assuring quality of care, and continuing efforts to fight infectious diseases. With this in mind, the Assembly proposes to restore $60,287,000 and add $37,393,164 in public health funding for SFY 2001-02. This funding will afford local health providers and not-for-profit agencies the opportunity to carry on with their efforts to provide necessary services to children, the elderly, HIV/AIDS patients, victims of rape, those afflicted with cancer and other illnesses, and families in need of primary and preventive care. The Assembly recognizes that one of the most critical issues facing health care providers is the shortage of health care workers in New York State. In the current fiscal year, the Legislature provides well over $100,000,000 in combined funding in the Temporary Assistance to Needy Families (TANF) Block Grant and HCRA 2000 for worker recruitment and retention programs. To target even more funds to address healthcare workforce recruitment and retention issues, the Assembly proposes raising public awareness about federal monies currently available from other sources that could be utilized for this purpose. For example, under the Federal Workforce Investment Act of 1998, approximately $31,500,000 in federal funds are available for training initiatives to address the critical shortage of skilled workers in various occupational fields, including the health care industry. The Assembly proposes that the State Workforce Investment Board, in consultation with the Department of Labor (DOL) and the Department of Health, use these available federal funds to develop a program to provide skills training for entry level health care workers, to provide assistance to employers, as well as to provide skills upgrading to employed individuals already in the health care profession. In awareness of the fact that the needs of community providers are escalating as AIDS/HIV caseloads continue to grow, which is in part a result of longer life expectancy of HIV/AIDS patients due to improved drug therapies, the Assembly proposes $24,901,000 in additional funding for the AIDS Institute. The Assembly's proposal would restore $7,901,000 in AIDS funding eliminated by the Executive, as well as provide $17,000,000 in additional funding for AIDS programs. Of this amount, $5,000,000 would provide enhancements to existing services and harm reduction. The Assembly recognizes that the incidence of new AIDS cases are most prevalent in communities of color. Therefore, the Assembly proposes $12,000,000 in new funding targeted at prevention and services for these individuals, to be delivered by community-based providers in a geographically accessible, culturally sensitive, and linguistically appropriate manner. The Assembly proposes $300,000 to support maternity and early childhood services. The Assembly also proposes the restoration of $3,000,000 for family planning services, as well as $1,000,000 to support efforts to ensure access to family planning clinics. The Assembly also proposes the restoration of $1,000,000 and an additional $2,000,000 for school-based health programs, including mental health services. In addition, the Assembly proposes the restoration of $1,035,000 for clinics serving migrant workers. The Assembly proposes to restore $600,000 and add $700,000 for rape crisis center programs. The Assembly also proposes $4,000,000 to restore funding for the Adult Care Facility Quality Incentive Program (QUIP). The Assembly also proposes to restore $1,000,000 for Primary Care Development and proposes $5,000,000 in new capital funding for Community Health Centers through the Certificates of Participation (COPS) Program. The Assembly also proposes $1,000,000 in new funding for the Independence Care System, which helps serve physically disabled adults through a managed long-term care approach. The Assembly proposes to restore $500,000 and add $500,000 for breast cancer and other cancers, including ovarian, prostate, and testicular cancer, for additional detection and educational services, as well as supportive services for persons diagnosed with cancer. Additionally, the Assembly proposes $5,250,000 in new funding to provide for a 5 percent trend factor to the reimbursement rates for Early Intervention (EI) services. EI reimbursement rates have not been increased since 1994. Additionally, the Assembly proposes $3,000,000 in new funding for Diagnostic and Treatment Centers (D&TCs) sponsored by, and serving patients of, substance abuse facilities licensed under Article 19 of the Mental Hygiene Law, in order to help defray a portion of the indigent care costs incurred by these facilities. These clinics are ineligible for uncompensated care funding from HCRA 2000. The Assembly proposes to add $3,000,000 for the Women, Infants and Children (WIC) program and $500,000 for the New York State Donor Registry Awareness Campaign. The Assembly also proposes to restore $176,000 and add $200,000 for Alzeheimer's programs. The Assembly also proposes an add of $250,000 for Osteoporosis education and prevention, $250,000 for diabetes diagnosis and control programs, as well as a restoration of $200,000 for asthma management programs. The Assembly proposes additional funding of $6,600,000 to support various public health programs related to diagnosis, treatment, education, screening, research, consumer assistance, therapies, and other general health services. The Assembly rejects the Governor's proposal to lower pharmacy reimbursement from 95 percent of the Average Wholesale Price (AWP) to 90 percent of the Average Wholesale Price in the Elderly Pharmaceutical Insurance Coverage (EPIC) programs. The Assembly further rejects the Governor's proposal to apply the Consumer Price Index (CPI) methodology used in Medicaid to EPIC rebates to mirror the Medicaid program. The Assembly accepts, with modifications, the Governor's proposal to require private health insurers to match membership files with the EPIC program to facilitate a coordination of benefits. In addition, the Assembly proposes new language to amend the EPIC program to allow recipients to continue to be eligible for the program even if a Cost-of-Living Adjustment (COLA) in their pensions or social security benefits causes them to exceed eligibility limits. The Assembly also proposes new language in the Health Care Standards and Surveillance Program to stipulate that the $5,466,000 General Fund increase for the implementation of the Health Information Quality Improvement Act of 2000, commonly referred to as "Physician Profiling," and the reappropriation of $3,000,000 must be spent pursuant to Chapter 542 of the Laws of 2001.
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