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Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
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|---|---|
| Jan 05, 2022 |
referred to finance |
| Oct 22, 2021 |
referred to finance |
Senate Bill S7460
2021-2022 Legislative Session
Relates to medical assistance payments
download bill text pdfSponsored By
(R, C) 60th Senate District
Archive: Last Bill Status - In Senate Committee Finance Committee
- Introduced
-
- In Committee Assembly
- In Committee Senate
-
- On Floor Calendar Assembly
- On Floor Calendar Senate
-
- Passed Assembly
- Passed Senate
- Delivered to Governor
- Signed By Governor
Actions
co-Sponsors
(R, C) 57th Senate District
2021-S7460 (ACTIVE) - Details
- Current Committee:
- Senate Finance
- Law Section:
- Appropriations
- Laws Affected:
- Amd §1, Chap 53 of 2021; amd Part H §90, Chap 59 of 2011
2021-S7460 (ACTIVE) - Sponsor Memo
BILL NUMBER: S7460
SPONSOR: GALLIVAN
TITLE OF BILL:
An act to amend chapter 53 of the laws of 2021, enacting the aid to
localities budget, in relation to medical assistance administration; to
amend part H of chapter 59 of the laws of 2011 amending the public
health law relating to general hospital inpatient reimbursement for
annual rates, in relation to the across the board reduction of 2021
PURPOSE OR GENERAL IDEA OF BILL:
Restores Medicaid rate cuts enacted in SFY 2019-20, SFY 2020-21 and SFY
202122 budgets, retroactively. Increases such rates by 1.5 percent each
state fiscal year going forward.
SUMMARY OF PROVISIONS:
Section 1 amends chapter 53 of the laws of 2021, enacting the aid to
localities budget, by repealing the authority of the Division of the
Budget to implement a payment reduction plan to make across-the-board
reductions to Medicaid spending. Section two amends chapter 59 of the laws of 2011, to require all Medi- caid payments related to general hospital inpatient reimbursement for annual rates be restored to previous funding levels by retroactively increasing said Medicaid payments and increasing such rates by 1.5 percent in each future state fiscal year. Section three establishes the effective date. JUSTIFICATION: Those who work in the healthcare industry have been under enormous stress as result of the COVID-19 pandemic. Moreover, pandemic related mandates placed on our healthcare systems by government regulatory agen- cies have artificially inflated the costs to provide essential care. Policy decisions made by the State of New York to reduce Medicaid reimbursement rates to healthcare providers and entities that employ healthcare workers, during a period of extraordinary demand for health- care services, is troublesome. This bill aims to address such need by restoring the Medicaid cuts previously implemented, retroactively. PRIOR LEGISLATIVE HISTORY: New bill. FISCAL IMPLICATIONS: Would increase state Medicaid expenditures an estimated $450 million by retroactively restoring rates in the SFY 2019-20, SFY 2020-21 and SFY 2021-22 budgets. Ongoing costs to the financial plan are estimated to be $200 million annually. EFFECTIVE DATE: Immediately and shall be deemed to be in full force and effect on and after April 1, 2021; provided, however that section two of this act shall be deemed to have been in full force and effect on and after April 1, 2019.
2021-S7460 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K
________________________________________________________________________
7460
2021-2022 Regular Sessions
I N S E N A T E
October 22, 2021
___________
Introduced by Sen. GALLIVAN -- read twice and ordered printed, and when
printed to be committed to the Committee on Finance
AN ACT to amend chapter 53 of the laws of 2021, enacting the aid to
localities budget, in relation to medical assistance administration;
to amend part H of chapter 59 of the laws of 2011 amending the public
health law relating to general hospital inpatient reimbursement
for annual rates, in relation to the across the board reduction of
2021
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 1 of chapter 53 of the laws of 2021, enacting the
aid to localities budget, is amended by repealing the items hereinbelow
set forth in brackets and by adding to such section the other items
underscored in this section.
MEDICAL ASSISTANCE ADMINISTRATION PROGRAM ................ 2,868,800,000
--------------
General Fund
Local Assistance Account - 10000
For reimbursement of local administrative
expenses for medical assistance programs
and for state administration of medical
assistance programs, notwithstanding
section 153 of the social services law, to
include the performance of eligibility and
enrollment determinations by the state or
third-party entities designated by the
state to perform such services.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD13411-03-1
S. 7460 2
Notwithstanding any provision of law to the
contrary, subject to the approval of the
director of budget, up to $23,000,000 of
the amount appropriated herein shall be
available for the purpose of providing
payments to local social services
districts for medical assistance adminis-
tration claims that exceed an administra-
tive ceiling established by the commis-
sioner of health.
Notwithstanding any inconsistent provision
of law and subject to the approval of the
director of budget, moneys hereby appro-
priated may be increased or decreased by
transfer or interchange between these
appropriated amounts and appropriations of
the medical assistance administration
program, the medical assistance program,
and the office of health insurance
programs. Funding authority from this
account used for state administration of
the medical assistance program may be
transferred to state operations appropri-
ations within the aforementioned programs
at amounts agreed upon by the commissioner
of health, and the New York state division
of the budget.
Notwithstanding section 40 of the state
finance law or any other law to the
contrary, all medical assistance appropri-
ations made from this account shall remain
in full force and effect in accordance, in
the aggregate, with the following sched-
ule: not more than 50 percent for the
period April 1, 2021 to March 31, 2022 and
the remaining amount for the period April
1, 2022 to March 31, 2023.
Notwithstanding section 40 of the state
finance law or any provision of law to the
contrary, subject to federal approval,
department of health state funds medicaid
spending, excluding payments for medical
services provided at state facilities
operated by the office of mental health,
the office for people with developmental
disabilities and the office of addiction
services and supports and further exclud-
ing any payments which are not appropri-
ated within the department of health, in
the aggregate, for the period April 1,
2021 through March 31, 2022, shall not
exceed $23,531,327,000 except as provided
below and state share medicaid spending,
in the aggregate, for the period April 1,
2022 through March 31, 2023, shall not
exceed $25,587,116,000, but in no event
S. 7460 3
shall department of health state funds
medicaid spending for the period April 1,
2021 through March 31, 2023 exceed
$49,118,443,000 provided, however, such
aggregate limits may be adjusted by the
director of the budget to account for any
changes in the New York state federal
medical assistance percentage amount
established pursuant to the federal social
security act, increases in provider reven-
ues, reductions in local social services
district payments for medical assistance
administration, minimum wage increases,
and beginning April 1, 2012 the opera-
tional costs of the New York state medical
indemnity fund, pursuant to chapter 59 of
the laws of 2011, and state costs or
savings from the essential plan program.
Such projections may be adjusted by the
director of the budget to account for
increased or expedited department of
health state funds medicaid expenditures
as a result of a natural or other type of
disaster, including a governmental decla-
ration of emergency.
The director of the budget, in consultation
with the commissioner of health, shall
assess on a quarterly basis known and
projected medicaid expenditures by catego-
ry of service and by geographic region, as
determined by the commissioner of health,
incurred both prior to and subsequent to
such assessment for each such period, and
if the director of the budget determines
that such expenditures are expected to
cause medicaid spending for such period to
exceed the aggregate limit specified here-
in for such period, the state medicaid
director, in consultation with the direc-
tor of the budget and the commissioner of
health, shall develop a medicaid savings
allocation adjustment to limit such spend-
ing to the aggregate limit specified here-
in for such period.
Such medicaid savings allocation adjustment
shall be designed, to reduce the expendi-
tures authorized by the appropriations
herein in compliance with the following
guidelines: (1) reductions shall be made
in compliance with applicable federal law,
including the provisions of the Patient
Protection and Affordable Care Act, Public
Law No. 111-148, and the Health Care and
Education Reconciliation Act of 2010,
Public Law No. 111-152 (collectively
"Affordable Care Act") and any subsequent
S. 7460 4
amendments thereto or regulations promul-
gated thereunder; (2) reductions shall be
made in a manner that complies with the
state medicaid plan approved by the feder-
al centers for medicare and medicaid
services, provided, however, that the
commissioner of health is authorized to
submit any state plan amendment or seek
other federal approval, including waiver
authority, to implement the provisions of
the medicaid savings allocation adjustment
that meets the other criteria set forth
herein; (3) reductions shall be made in a
manner that maximizes federal financial
participation, to the extent practicable,
including any federal financial partic-
ipation that is available or is reasonably
expected to become available, in the
discretion of the commissioner, under the
Affordable Care Act; (4) reductions shall
be made uniformly among categories of
services and geographic regions of the
state, to the extent practicable, and
shall be made uniformly within a category
of service, to the extent practicable,
except where the commissioner determines
that there are sufficient grounds for
non-uniformity, including but not limited
to: the extent to which specific catego-
ries of services contributed to department
of health medicaid state funds spending in
excess of the limits specified herein; the
need to maintain safety net services in
underserved communities; or the potential
benefits of pursuing innovative payment
models contemplated by the Affordable Care
Act, in which case such grounds shall be
set forth in the medicaid savings allo-
cation adjustment; and (5) reductions
shall be made in a manner that does not
unnecessarily create administrative
burdens to medicaid applicants and recipi-
ents or providers.
The commissioner shall seek the input of the
legislature, as well as organizations
representing health care providers,
consumers, businesses, workers, health
insurers, and others with relevant exper-
tise, in developing such medicaid savings
allocation adjustment, to the extent that
all or part of such adjustment, in the
discretion of the commissioner, is likely
to have a material impact on the overall
medicaid program, particular categories of
service or particular geographic regions
of the state.
S. 7460 5
(a) The commissioner shall post the medicaid
savings allocation adjustment on the
department of health's website and shall
provide written copies of such adjustment
to the chairs of the senate finance and
the assembly ways and means committees at
least 30 days before the date on which
implementation is expected to begin.
(b) The commissioner may revise the medicaid
savings allocation adjustment subsequent
to the provisions of notice and prior to
implementation but needs to provide a new
notice pursuant to subparagraph (i) of
this paragraph only if the commissioner
determines, in his or her discretion, that
such revisions materially alter the
adjustment.
Notwithstanding the provisions of paragraphs
(a) and (b) of this subdivision, the
commissioner need not seek the input
described in paragraph (a) of this subdi-
vision or provide notice pursuant to para-
graph (b) of this subdivision if, in the
discretion of the commissioner, expedited
development and implementation of a medi-
caid savings allocation adjustment is
necessary due to a public health emergen-
cy.
For purposes of this section, a public
health emergency is defined as: (i) a
disaster, natural or otherwise, that
significantly increases the immediate need
for health care personnel in an area of
the state; (ii) an event or condition that
creates a widespread risk of exposure to a
serious communicable disease, or the
potential for such widespread risk of
exposure; or (iii) any other event or
condition determined by the commissioner
to constitute an imminent threat to public
health.
Nothing in this paragraph shall be deemed to
prevent all or part of such medicaid
savings allocation adjustment from taking
effect retroactively to the extent permit-
ted by the federal centers for medicare
and medicaid services.
In accordance with the medicaid savings
allocation adjustment, the commissioner of
the department of health shall reduce
department of health state funds medicaid
spending by the amount of the projected
overspending through, actions including,
but not limited to modifying or suspending
reimbursement methods, including but not
limited to all fees, premium levels and
S. 7460 6
rates of payment, notwithstanding any
provision of law that sets a specific
amount or methodology for any such
payments or rates of payment; modifying
medicaid program benefits; seeking all
necessary federal approvals, including,
but not limited to waivers, waiver amend-
ments; and suspending time frames for
notice, approval or certification of rate
requirements, notwithstanding any
provision of law, rule or regulation to
the contrary, including but not limited to
sections 2807 and 3614 of the public
health law, section 18 of chapter 2 of the
laws of 1988, and 18 NYCRR 505.14(h).
The department of health shall prepare a
quarterly report that sets forth: (a)
known and projected department of health
medicaid expenditures as described in
subdivision (1) of this section, and
factors that could result in medicaid
disbursements for the relevant state
fiscal year to exceed the projected
department of health state funds disburse-
ments in the enacted budget financial plan
pursuant to subdivision 3 of section 23 of
the state finance law, including spending
increases or decreases due to: enrollment
fluctuations, rate changes, utilization
changes, MRT investments, and shift of
beneficiaries to managed care; and vari-
ations in offline medicaid payments; and
(b) the actions taken to implement any
medicaid savings allocation adjustment
implemented pursuant to subdivision (4) of
this section, including information
concerning the impact of such actions on
each category of service and each
geographic region of the state. Each such
quarterly report shall be provided to the
chairs of the senate finance and the
assembly ways and means committees and
shall be posted on the department of
health's website in a timely manner.
The money hereby appropriated is available
for payment of liabilities heretofore and
hereafter accrued and shall be available
to the department net of disallowances,
refunds, reimbursements, and credits.
Notwithstanding any other provision of law,
the money hereby appropriated may be
increased or decreased by interchange or
transfer, with any appropriation of the
department of health, and may be increased
or decreased by transfer or suballocation
between these appropriated amounts and
S. 7460 7
appropriations of the office of mental
health, the office for people with devel-
opmental disabilities, the office of
addiction services and supports, the
department of family assistance office of
temporary and disability assistance, the
department of corrections and community
supervision, the office of information
technology services, the state university
of New York, the state office for the
aging, the office of the medicaid inspec-
tor general, and office of children and
family services with the approval of the
director of the budget, who shall file
such approval with the department of audit
and control and copies thereof with the
chairman of the senate finance committee
and the chairman of the assembly ways and
means committee.
[Notwithstanding any provision of law to the
contrary, the director of the budget, in
consultation with the commissioner of
health, may use a payment reduction plan
to make across-the-board reductions to the
department of health state funds medicaid
spending by $373,000,000 for state fiscal
year 2021-2022 and $373,000,000 in state
fiscal year 2022-2023 to limit such spend-
ing to the aggregate limit specified here-
in, or reduce the aggregate limit speci-
fied herein to provide a reduction to the
state's financial plan. Reductions shall
be made in a manner that complies with the
state medicaid plan approved by the feder-
al centers for medicare and medicaid
services, provided, however, that the
commissioner of health is authorized to
submit any state plan amendment or seek
other federal approval to implement the
provisions of the medicaid payment
reduction adjustment.]
Notwithstanding any inconsistent provision
of law, in lieu of payments authorized by
the social services law, or payments of
federal funds otherwise due to the local
social services districts for programs
provided under the federal social security
act or the federal food stamp act, funds
herein appropriated, in amounts certified
by the state commissioner of temporary and
disability assistance or the state commis-
sioner of health as due from local social
services districts each month as their
share of payments made pursuant to section
367-b of the social services law may be
set aside by the state comptroller in an
S. 7460 8
interest-bearing account in order to
ensure the orderly and prompt payment of
providers under section 367-b of the
social services law pursuant to an esti-
mate provided by the commissioner of
health of each local social services
district's share of payments made pursuant
to section 367-b of the social services
law.
Notwithstanding any provision of law to the
contrary, the portion of this appropri-
ation covering fiscal year 2021-22 shall
supersede and replace any duplicative (i)
reappropriation for this item covering
fiscal year 2021-22, and (ii) appropri-
ation for this item covering fiscal year
2021-22 set forth in chapter 53 of the
laws of 2020 (26963) ..................... 1,090,100,000
Special Revenue Funds - Federal
Federal Health and Human Services Fund
Medicaid Administration Transfer Account - 25107
For reimbursement of local administrative
expenses of medical assistance programs
and for state administration of medical
assistance programs provided pursuant to
title XIX of the federal social security
act or its successor program. Notwith-
standing section 153 of the social
services law, to include the performance
of eligibility and enrollment determi-
nations by the state or third-party enti-
ties designated by the state to perform
such services.
Notwithstanding any inconsistent provision
of law and subject to the approval of the
director of budget, moneys hereby appro-
priated may be increased or decreased by
transfer or interchange between these
appropriated amounts and appropriations of
the medical assistance administration
program, the medical assistance program,
and the office of health insurance
programs. Funding authority from this
account used for state administration of
the medical assistance program may be
transferred to state operations appropri-
ations within the aforementioned programs
at amounts agreed upon by the commissioner
of health, and the New York state division
of the budget.
Notwithstanding section 40 of the state
finance law or any other law to the
contrary, all medical assistance appropri-
ations made from this account shall remain
S. 7460 9
in full force and effect in accordance, in
the aggregate, with the following sched-
ule: not more than 50 percent for the
period April 1, 2021 to March 31, 2022;
and the remaining amount for the period
April 1, 2022 to March 31, 2023.
The money hereby appropriated is available
for payment of liabilities heretofore and
hereafter accrued and shall be available
to the department net of disallowances,
refunds, reimbursements, and credits.
The amounts appropriated herein may be
available for costs associated with a
common benefit identification card, and
subject to the approval of the director of
the budget, these funds may be transferred
to the credit of the state operations
account medicaid management information
systems program.
Notwithstanding any other provision of law,
the money hereby appropriated may be
increased or decreased by interchange,
with any appropriation of the department
of health, and may be increased or
decreased by transfer or suballocation
between these appropriated amounts and
appropriations of the office of mental
health, the office for people with devel-
opmental disabilities, the office of
addiction services and supports, the
department of family assistance, office of
temporary and disability assistance, the
department of corrections and community
supervision, the office of information
technology services, the state university
of New York, the state office for the
aging, the office of the medicaid inspec-
tor general, and office of children and
family services with the approval of the
director of the budget, who shall file
such approval with the department of audit
and control and copies thereof with the
chairman of the senate finance committee
and the chairman of the assembly ways and
means committee.
[Notwithstanding any provision of law to the
contrary, the director of the budget, in
consultation with the commissioner of
health, may use a payment reduction plan
to make across-the-board reductions to the
department of health state funds medicaid
spending by $373,000,000 for state fiscal
year 2021-2022 and $373,000,000 in state
fiscal year 2022-2023 to limit such spend-
ing to the aggregate limit specified here-
in, or reduce the aggregate limit speci-
S. 7460 10
fied herein to provide a reduction to the
state's financial plan. Reductions shall
be made in a manner that complies with the
state medicaid plan approved by the feder-
al centers for medicare and medicaid
services, provided, however, that the
commissioner of health is authorized to
submit any state plan amendment or seek
other federal approval to implement the
provisions of the medicaid payment
reduction plan.]
Notwithstanding any inconsistent provision
of law, in lieu of payments authorized by
the social services law, or payments of
federal funds otherwise due to the local
social services districts for programs
provided under the federal social security
act or the federal food stamp act, funds
herein appropriated, in amounts certified
by the state commissioner of temporary and
disability assistance or the state commis-
sioner of health as due from local social
services districts each month as their
share of payments made pursuant to section
367-b of the social services law may be
set aside by the state comptroller in an
interest-bearing account in order to
ensure the orderly and prompt payment of
providers under section 367-b of the
social services law pursuant to an esti-
mate provided by the commissioner of
health of each local social services
district's share of payments made pursuant
to section 367-b of the social services
law.
Notwithstanding any provision of law to the
contrary, the portion of this appropri-
ation covering fiscal year 2021-22 shall
supersede and replace any duplicative (i)
reappropriation for this item covering
fiscal year 2021-22, and (ii) appropri-
ation for this item covering fiscal year
2021-22 set forth in chapter 53 of the
laws of 2020 (26993) ..................... 1,261,300,000
MEDICAL ASSISTANCE PROGRAM ............................. 176,134,709,000
--------------
General Fund
Local Assistance Account - 10000
For the medical assistance program, includ-
ing administrative expenses, for local
social services districts, and for medical
care rates for authorized child care agen-
cies.
S. 7460 11
Notwithstanding section 40 of the state
finance law or any other law to the
contrary, all medical assistance appropri-
ations made from this account shall remain
in full force and effect in accordance, in
the aggregate, with the following sched-
ule: not more than 48 percent for the
period April 1, 2021 to March 31, 2022;
and the remaining amount for the period
April 1, 2022 to March 31, 2023.
Notwithstanding section 40 of the state
finance law or any provision of law to the
contrary, subject to federal approval,
department of health state funds medicaid
spending, excluding payments for medical
services provided at state facilities
operated by the office of mental health,
the office for people with developmental
disabilities and the office of addiction
services and supports and further exclud-
ing any payments which are not appropri-
ated within the department of health, in
the aggregate, for the period April 1,
2021 through March 31, 2022, shall not
exceed $23,531,327,000 except as provided
below and state share medicaid spending,
in the aggregate, for the period April 1,
2022 through March 31, 2023, shall not
exceed $25,587,116,000, but in no event
shall department of health state funds
medicaid spending for the period April 1,
2021 through March 31, 2023 exceed
$49,118,443,000. Provided, however, such
aggregate limits may be adjusted by the
director of the budget to account for any
changes in the New York state federal
medical assistance percentage amount
established pursuant to the federal social
security act, increases in provider reven-
ues, reductions in local social services
district payments for medical assistance
administration, minimum wage increases,
and beginning April 1, 2012 the opera-
tional costs of the New York state medical
indemnity fund, pursuant to chapter 59 of
the laws of 2011, and state costs or
savings from the essential plan program.
Such projections may be adjusted by the
director of the budget to account for
increased or expedited department of
health state funds medicaid expenditures
as a result of a natural or other type of
disaster, including a governmental decla-
ration of emergency.
The director of the budget, in consultation
with the commissioner of health, shall
S. 7460 12
assess on a quarterly basis known and
projected medicaid expenditures by catego-
ry of service and by geographic region, as
defined by the commissioner, incurred both
prior to and subsequent to such assessment
for each such period, and if the director
of the budget determines that such expend-
itures are expected to cause medicaid
spending for such period to exceed the
aggregate limit specified herein for such
period, the state medicaid director, in
consultation with the director of the
budget and the commissioner of health,
shall develop a medicaid savings allo-
cation adjustment to limit such spending
to the aggregate limit specified herein
for such period.
Such medicaid savings allocation adjustment
shall be designed, to reduce the expendi-
tures authorized by the appropriations
herein in compliance with the following
guidelines: (1) reductions shall be made
in compliance with applicable federal law,
including the provisions of the Patient
Protection and Affordable Care Act, Public
Law No. 111-148, and the Health Care and
Education Reconciliation Act of 2010,
Public Law No. 111-152 (collectively
"Affordable Care Act") and any subsequent
amendments thereto or regulations promul-
gated thereunder; (2) reductions shall be
made in a manner that complies with the
state medicaid plan approved by the feder-
al centers for medicare and medicaid
services, provided, however, that the
commissioner of health is authorized to
submit any state plan amendment or seek
other federal approval, including waiver
authority, to implement the provisions of
the medicaid savings allocation adjustment
that meets the other criteria set forth
herein; (3) reductions shall be made in a
manner that maximizes federal financial
participation, to the extent practicable,
including any federal financial partic-
ipation that is available or is reasonably
expected to become available, in the
discretion of the commissioner, under the
Affordable Care Act; (4) reductions shall
be made uniformly among categories of
services and geographic regions of the
state, to the extent practicable, and
shall be made uniformly within a category
of service, to the extent practicable,
except where the commissioner determines
that there are sufficient grounds for
S. 7460 13
non-uniformity, including but not limited
to: the extent to which specific catego-
ries of services contributed to department
of health medicaid state funds spending in
excess of the limits specified herein; the
need to maintain safety net services in
underserved communities; or the potential
benefits of pursuing innovative payment
models contemplated by the Affordable Care
Act, in which case such grounds shall be
set forth in the medicaid savings allo-
cation adjustment; and (5) reductions
shall be made in a manner that does not
unnecessarily create administrative
burdens to medicaid applicants and recipi-
ents or providers.
The commissioner shall seek the input of the
legislature, as well as organizations
representing health care providers,
consumers, businesses, workers, health
insurers, and others with relevant exper-
tise, in developing such medicaid savings
allocation adjustment, to the extent that
all or part of such adjustment, in the
discretion of the commissioner, is likely
to have a material impact on the overall
medicaid program, particular categories of
service or particular geographic regions
of the state.
(a) The commissioner shall post the medicaid
savings allocation adjustment on the
department of health's website and shall
provide written copies of such adjustment
to the chairs of the senate finance and
the assembly ways and means committees at
least 30 days before the date on which
implementation is expected to begin.
(b) The commissioner may revise the medicaid
savings allocation adjustment subsequent
to the provisions of notice and prior to
implementation but needs to provide a new
notice pursuant to subparagraph (i) of
this paragraph only if the commissioner
determines, in his or her discretion, that
such revisions materially alter the
adjustment.
Notwithstanding the provisions of paragraphs
(a) and (b) of this subdivision, the
commissioner need not seek the input
described in paragraph (a) of this subdi-
vision or provide notice pursuant to para-
graph (b) of this subdivision if, in the
discretion of the commissioner, expedited
development and implementation of a medi-
caid savings allocation adjustment is
S. 7460 14
necessary due to a public health emergen-
cy.
For purposes of this section, a public
health emergency is defined as: (i) a
disaster, natural or otherwise, that
significantly increases the immediate need
for health care personnel in an area of
the state; (ii) an event or condition that
creates a widespread risk of exposure to a
serious communicable disease, or the
potential for such widespread risk of
exposure; or (iii) any other event or
condition determined by the commissioner
to constitute an imminent threat to public
health.
Nothing in this paragraph shall be deemed to
prevent all or part of such medicaid
savings allocation adjustment from taking
effect retroactively to the extent permit-
ted by the federal centers for medicare
and medicaid services.
In accordance with the medicaid savings
allocation adjustment, the commissioner of
the department of health shall reduce
department of health state funds medicaid
spending by the amount of the projected
overspending through, actions including,
but not limited to modifying or suspending
reimbursement methods, including but not
limited to all fees, premium levels and
rates of payment, notwithstanding any
provision of law that sets a specific
amount or methodology for any such
payments or rates of payment; modifying or
discontinuing medicaid program benefits;
seeking all necessary federal approvals,
including, but not limited to waivers,
waiver amendments; and suspending time
frames for notice, approval or certif-
ication of rate requirements, notwith-
standing any provision of law, rule or
regulation to the contrary, including but
not limited to sections 2807 and 3614 of
the public health law, section 18 of chap-
ter 2 of the laws of 1988, and 18 NYCRR
505.14(h).
The department of health shall prepare a
quarterly report that sets forth: (a)
known and projected department of health
medicaid expenditures as described in
subdivision (1) of this section, and
factors that could result in medicaid
disbursements for the relevant state
fiscal year to exceed the projected
department of health state funds disburse-
ments in the enacted budget financial plan
S. 7460 15
pursuant to subdivision 3 of section 23 of
the state finance law, including spending
increases or decreases due to: enrollment
fluctuations, rate changes, utilization
changes, MRT investments, and shift of
beneficiaries to managed care; and vari-
ations in offline medicaid payments; and
(b) the actions taken to implement any
medicaid savings allocation adjustment
implemented pursuant to subdivision (4) of
this section, including information
concerning the impact of such actions on
each category of service and each
geographic region of the state. Each such
quarterly report shall be provided to the
chairs of the senate finance and the
assembly ways and means committees and
shall be posted on the department of
health's website in a timely manner.
The money hereby appropriated is to be
available for payment of aid heretofore
accrued or hereafter accrued to munici-
palities, and to providers of medical
services pursuant to section 367-b of the
social services law, and for payment of
state aid to municipalities and to provid-
ers of family care where payment systems
through the fiscal intermediaries are not
operational.
Notwithstanding any inconsistent provision
of law to the contrary, funds may be used
by the department for outside legal
assistance on issues involving the federal
government, the conduct of preadmission
screening and annual resident reviews
required by the state's medicaid program,
computer matching with insurance carriers
to insure that medicaid is the payer of
last resort and activities related to the
management of the pharmacy benefit avail-
able under the medicaid program.
Notwithstanding any inconsistent provision
of law, in lieu of payments authorized by
the social services law, or payments of
federal funds otherwise due to the local
social services districts for programs
provided under the federal social security
act or the federal food stamp act, funds
herein appropriated, in amounts certified
by the state commissioner of temporary and
disability assistance or the state commis-
sioner of health as due from local social
services districts each month as their
share of payments made pursuant to section
367-b of the social services law may be
set aside by the state comptroller in an
S. 7460 16
interest-bearing account in order to
ensure the orderly and prompt payment of
providers under section 367-b of the
social services law pursuant to an esti-
mate provided by the commissioner of
health of each local social services
district's share of payments made pursuant
to section 367-b of the social services
law.
Notwithstanding any inconsistent provision
of law, funding made available by these
appropriations shall support direct salary
costs and related fringe benefits within
the medical assistance program associated
with any minimum wage increase that takes
effect during the timeframe of these
appropriations, pursuant to section 652 of
the labor law. Each eligible organization
in receipt of funding made available by
these appropriations may be required to
submit written certification, in such form
and at such time the commissioner may
prescribe, attesting to the total amount
of funds used by the eligible organiza-
tion, how such funding will be or was used
for purposes eligible under these appro-
priations and any other reporting deemed
necessary by the commissioner. The amounts
appropriated herein may include advances
to organizations authorized to receive
such funds to accomplish this purpose.
Notwithstanding any other provision of law,
the money hereby appropriated may be
increased or decreased by interchange or
transfer, with any appropriation of the
department of health and the office of
medicaid inspector general and may be
increased or decreased by transfer or
suballocation between these appropriated
amounts and appropriations of the depart-
ment of health state purpose account, the
office of mental health, office for people
with developmental disabilities, the
office of addiction services and supports,
the department of family assistance office
of temporary and disability assistance,
the department of corrections and communi-
ty supervision, the office of information
technology services, the state university
of New York, and office of children and
family services, the office of medicaid
inspector general, and the state office
for the aging with the approval of the
director of the budget, who shall file
such approval with the department of audit
and control and copies thereof with the
S. 7460 17
chairman of the senate finance committee
and the chairman of the assembly ways and
means committee.
Notwithstanding any inconsistent provision
of law to the contrary, the moneys hereby
appropriated may be used for payments to
the centers for medicaid and medicare
services for obligations incurred related
to the pharmaceutical costs of dually
eligible medicare/medicaid beneficiaries
participating in the medicare drug benefit
authorized by P.L. 108-173.
Notwithstanding any inconsistent provision
of law, the moneys hereby appropriated
shall not be used for any existing rates,
fees, fee schedule, or procedures which
may affect the cost of care and services
provided by personal care providers, case
managers, health maintenance organiza-
tions, out of state medical facilities
which provide care and services to resi-
dents of the state, providers of transpor-
tation services, that are altered,
amended, adjusted or otherwise changed by
a local social services district unless
previously approved by the department of
health and the director of the budget.
Notwithstanding any inconsistent provision
of law to the contrary, funds shall be
made available to the commissioner of the
office of mental health or the commission-
er of the office of addiction services and
supports, in consultation with the commis-
sioner of health and approved by the
director of the budget, and consistent
with appropriations made therefor, to
implement allocation adjustment developed
by each such commissioner which shall
describe mental health or substance use
disorder services that should be developed
to meet service needs resulting from the
reduction of inpatient behavioral health
services provided under the medicaid
program, by programs licensed pursuant to
article 31 or 32 of the mental hygiene
law. Such programs may include programs
that are licensed pursuant to both article
31 of the mental hygiene law and article
28 of the public health law, or certified
under both article 32 of the mental
hygiene law and article 28 of the public
health law.
Notwithstanding any inconsistent provision
of law, the moneys hereby appropriated may
be available for payments associated with
the resolution by settlement agreement or
S. 7460 18
judgment of rate appeals and/or litigation
where the department of health is a party.
[Notwithstanding any provision of law to the
contrary, the director of the budget, in
consultation with the commissioner of
health, may use a payment reduction plan
to make across-the-board reductions to the
department of health state funds medicaid
spending by $373,000,000 for state fiscal
year 2021-2022 and $373,000,000 in state
fiscal year 2022-2023 and to limit such
spending to the aggregate limit specified
herein, or reduce the aggregate limit
specified herein to provide a reduction to
the state's financial plan. Reductions
shall be made in a manner that complies
with the state medicaid plan approved by
the federal centers for medicare and medi-
caid services, provided, however, that the
commissioner of health is authorized to
submit any state plan amendment or seek
other federal approval to implement the
provisions of the medicaid payment
reduction adjustment.]
For services and expenses of the medical
assistance program including hospital
inpatient services and general hospitals
that are safety-net providers that evince
severe financial distress, pursuant to
criteria determined by the commissioner,
shall be eligible for awards for amounts
appropriated herein, to enable such
providers to maintain operations and vital
services while establishing long term
solutions to achieve sustainable health
services.
Notwithstanding any provision of law to the
contrary, the portion of this appropri-
ation covering fiscal year 2021-22 shall
supersede and replace any duplicative (i)
reappropriation for this item covering
fiscal year 2021-22, and (ii) appropri-
ation for this item covering fiscal year
2021-22 set forth in chapter 53 of the
laws of 2020 (26947) ..................... 1,310,688,000
Special Revenue Funds - Other
HCRA Resources Fund
Medical Assistance Account - 20804
Notwithstanding section 40 of the state
finance law or any other law to the
contrary, all medical assistance appropri-
ations made from this account shall remain
in full force and effect in accordance, in
the aggregate, with the following sched-
S. 7460 19
ule: not more than 51 percent for the
period April 1, 2021 to March 31, 2022;
and the remaining amount for the period
April 1, 2022 to March 31, 2023.
Notwithstanding section 40 of the state
finance law or any provision of law to the
contrary, subject to federal approval,
department of health state funds medicaid
spending, excluding payments for medical
services provided at state facilities
operated by the office of mental health,
the office for people with developmental
disabilities and the office of addiction
services and supports and further exclud-
ing any payments which are not appropri-
ated within the department of health, in
the aggregate, for the period April 1,
2021 through March 31, 2022, shall not
exceed $23,531,327,000 except as provided
below and state share medicaid spending,
in the aggregate, for the period April 1,
2022 through March 31, 2023, shall not
exceed $25,587,116,000, but in no event
shall department of health state funds
medicaid spending for the period April 1,
2021 through March 31, 2023 exceed
$49,118,443,000 provided, however, such
aggregate limits may be adjusted by the
director of the budget to account for any
changes in the New York state federal
medical assistance percentage amount
established pursuant to the federal social
security act, increases in provider reven-
ues, reductions in local social services
district payments for medical assistance
administration, minimum wage increases and
beginning April 1, 2012 the operational
costs of the New York state medical indem-
nity fund, pursuant to chapter 59 of the
laws of 2011, and state costs or savings
from the essential plan. Such projections
may be adjusted by the director of the
budget to account for increased or expe-
dited department of health state funds
medicaid expenditures as a result of a
natural or other type of disaster, includ-
ing a governmental declaration of emergen-
cy.
The director of the budget, in consultation
with the commissioner of health, shall
assess on a quarterly basis known and
projected medicaid expenditures by catego-
ry of service and by geographic region, as
determined by the commissioner of health,
incurred both prior to and subsequent to
such assessment for each such period, and
S. 7460 20
if the director of the budget determines
that such expenditures are expected to
cause medicaid spending for such period to
exceed the aggregate limit specified here-
in for such period, the state medicaid
director, in consultation with the direc-
tor of the budget and the commissioner of
health, shall develop a medicaid savings
allocation adjustment to limit such spend-
ing to the aggregate limit specified here-
in for such period.
Such medicaid savings allocation adjustment
shall be designed, to reduce the expendi-
tures authorized by the appropriations
herein in compliance with the following
guidelines: (1) reductions shall be made
in compliance with applicable federal law,
including the provisions of the Patient
Protection and Affordable Care Act, Public
Law No. 111-148, and the Health Care and
Education Reconciliation Act of 2010,
Public Law No. 111-152 (collectively
"Affordable Care Act") and any subsequent
amendments thereto or regulations promul-
gated thereunder; (2) reductions shall be
made in a manner that complies with the
state medicaid plan approved by the feder-
al centers for medicare and medicaid
services, provided, however, that the
commissioner of health is authorized to
submit any state plan amendment or seek
other federal approval, including waiver
authority, to implement the provisions of
the medicaid savings allocation adjustment
that meets the other criteria set forth
herein; (3) reductions shall be made in a
manner that maximizes federal financial
participation, to the extent practicable,
including any federal financial partic-
ipation that is available or is reasonably
expected to become available, in the
discretion of the commissioner, under the
Affordable Care Act; (4) reductions shall
be made uniformly among categories of
services and geographic regions of the
state, to the extent practicable, and
shall be made uniformly within a category
of service, to the extent practicable,
except where the commissioner determines
that there are sufficient grounds for
non-uniformity, including but not limited
to: the extent to which specific catego-
ries of services contributed to department
of health medicaid state funds spending in
excess of the limits specified herein; the
need to maintain safety net services in
S. 7460 21
underserved communities; or the potential
benefits of pursuing innovative payment
models contemplated by the Affordable Care
Act, in which case such grounds shall be
set forth in the medicaid savings allo-
cation adjustment; and (5) reductions
shall be made in a manner that does not
unnecessarily create administrative
burdens to medicaid applicants and recipi-
ents or providers.
The commissioner shall seek the input of the
legislature, as well as organizations
representing health care providers,
consumers, businesses, workers, health
insurers, and others with relevant exper-
tise, in developing such medicaid savings
allocation adjustment, to the extent that
all or part of such adjustment, in the
discretion of the commissioner, is likely
to have a material impact on the overall
medicaid program, particular categories of
service or particular geographic regions
of the state.
(a) The commissioner shall post the medicaid
savings allocation adjustment on the
department of health's website and shall
provide written copies of such plan to the
chairs of the senate finance and the
assembly ways and means committees at
least 30 days before the date on which
implementation is expected to begin.
(b) The commissioner may revise the medicaid
savings allocation adjustment subsequent
to the provisions of notice and prior to
implementation but needs to provide a new
notice pursuant to subparagraph (i) of
this paragraph only if the commissioner
determines, in his or her discretion, that
such revisions materially alter the plan.
Notwithstanding the provisions of paragraphs
(a) and (b) of this subdivision, the
commissioner need not seek the input
described in paragraph (a) of this subdi-
vision or provide notice pursuant to para-
graph (b) of this subdivision if, in the
discretion of the commissioner, expedited
development and implementation of a medi-
caid savings allocation adjustment is
necessary due to a public health emergen-
cy.
For purposes of this section, a public
health emergency is defined as: (i) a
disaster, natural or otherwise, that
significantly increases the immediate need
for health care personnel in an area of
the state; (ii) an event or condition that
S. 7460 22
creates a widespread risk of exposure to a
serious communicable disease, or the
potential for such widespread risk of
exposure; or (iii) any other event or
condition determined by the commissioner
to constitute an imminent threat to public
health.
Nothing in this paragraph shall be deemed to
prevent all or part of such medicaid
savings allocation adjustment from taking
effect retroactively to the extent permit-
ted by the federal centers for medicare
and medicaid services.
In accordance with the medicaid savings
allocation adjustment, the commissioner of
the department of health shall reduce
department of health state funds medicaid
spending by the amount of the projected
overspending through, actions including,
but not limited to modifying or suspending
reimbursement methods, including but not
limited to all fees, premium levels and
rates of payment, notwithstanding any
provision of law that sets a specific
amount or methodology for any such
payments or rates of payment; modifying
medicaid program benefits; seeking all
necessary federal approvals, including,
but not limited to waivers, waiver amend-
ments; and suspending time frames for
notice, approval or certification of rate
requirements, notwithstanding any
provision of law, rule or regulation to
the contrary, including but not limited to
sections 2807 and 3614 of the public
health law, section 18 of chapter 2 of the
laws of 1988, and 18 NYCRR 505.14(h).
The department of health shall prepare a
quarterly report that sets forth: (a)
known and projected department of health
medicaid expenditures as described in
subdivision (1) of this section, and
factors that could result in medicaid
disbursements for the relevant state
fiscal year to exceed the projected
department of health state funds disburse-
ments in the enacted budget financial plan
pursuant to subdivision 3 of section 23 of
the state finance law, including spending
increases or decreases due to: enrollment
fluctuations, rate changes, utilization
changes, MRT investments, and shift of
beneficiaries to managed care; and vari-
ations in offline medicaid payments; and
(b) the actions taken to implement any
medicaid savings allocation adjustment
S. 7460 23
implemented pursuant to subdivision (4) of
this section, including information
concerning the impact of such actions on
each category of service and each
geographic region of the state. Each such
quarterly report shall be provided to the
chairs of the senate finance and the
assembly ways and means committees and
shall be posted on the department of
health's website in a timely manner.
For the purpose of making payments, the
money hereby appropriated is available for
payment of aid heretofore accrued or here-
after accrued, to providers of medical
care pursuant to section 367-b of the
social services law, and for payment of
state aid to municipalities and the feder-
al government where payment systems
through fiscal intermediaries are not
operational, to reimburse such providers
for costs attributable to the provision of
care to patients eligible for medical
assistance. Notwithstanding any inconsist-
ent provision of law, the moneys hereby
appropriated may be increased or decreased
by interchange or transfer with any appro-
priation of the department of health with
the approval of the director of the budg-
et, who shall file such approval with the
department of audit and control and copies
thereof with the chairman of the senate
finance committee and the chairman of the
assembly ways and means committee.
[Notwithstanding any provision of law to the
contrary, the director of the budget, in
consultation with the commissioner of
health, may use a payment reduction plan
to make across-the-board reductions to the
department of health state funds medicaid
spending by $373,000,000 for state fiscal
year 2021-2022 and $373,000,000 in state
fiscal year 2022-2023 to limit such spend-
ing to the aggregate limit specified here-
in, or reduce the aggregate limit speci-
fied herein to provide a reduction to the
state's financial plan. Reductions shall
be made in a manner that complies with the
state medicaid plan approved by the feder-
al centers for medicare and medicaid
services, provided, however, that the
commissioner of health is authorized to
submit any state plan amendment or seek
other federal approval to implement the
provisions of the medicaid payment
reduction plan. For services and expenses
of the medical assistance program.]
S. 7460 24
Notwithstanding any provision of law to the
contrary, the portion of this appropri-
ation covering fiscal year 2021-22 shall
supersede and replace any duplicative (i)
reappropriation for this item covering
fiscal year 2021-22, and (ii) appropri-
ation for this item covering fiscal year
2021-22 set forth in chapter 53 of the
laws of 2020 (29800) ..................... 7,930,179,000
MEDICAL ASSISTANCE ADMINISTRATION PROGRAM
General Fund
Local Assistance Account - 10000
The appropriation made by chapter 53, section 1, of the laws of 2020, as
amended by chapter 53, section 1, of the laws of 2021, is hereby
amended and reappropriated to read:
For reimbursement of local administrative expenses for medical assist-
ance programs and for state administration of medical assistance
programs, notwithstanding section 153 of the social services law, to
include the performance of eligibility and enrollment determinations
by the state or third-party entities designated by the state to
perform such services.
Notwithstanding any provision of law to the contrary, subject to the
approval of the director of budget, up to $23,000,000 of the amount
appropriated herein shall be available for the purpose of providing
payments to local social services districts for medical assistance
administration claims that exceed an administrative ceiling estab-
lished by the commissioner of health.
Notwithstanding any inconsistent provision of law and subject to the
approval of the director of budget, moneys hereby appropriated may
be increased or decreased by transfer or interchange between these
appropriated amounts and appropriations of the medical assistance
administration program, the medical assistance program, and the
office of health insurance programs. Funding authority from this
account used for state administration of the medical assistance
program may be transferred to state operations appropriations within
the aforementioned programs at amounts agreed upon by the commis-
sioner of health, and the New York state division of the budget.
Notwithstanding section 40 of the state finance law or any other law
to the contrary, all medical assistance appropriations made from
this account shall remain in full force and effect in accordance, in
the aggregate, with the following schedule: not more than 50 percent
for the period April 1, 2020 to March 31, 2021; and the remaining
amount for the period April 1, 2021 to September 15, 2022.
Notwithstanding section 40 of the state finance law or any provision
of law to the contrary, subject to federal approval, department of
health state funds medicaid spending, excluding payments for medical
services provided at state facilities operated by the office of
mental health, the office for people with developmental disabilities
and the office of addiction services and supports and further
excluding any payments which are not appropriated within the depart-
ment of health, in the aggregate, for the period April 1, 2020
through March 31, 2021, shall not exceed $23,606,772,000 except as
provided below and state share medicaid spending, in the aggregate,
S. 7460 25
for the period April 1, 2021 through September 15, 2022, shall not
exceed $23,531,327,000, but in no event shall department of health
state funds medicaid spending for the period April 1, 2020 through
September 15, 2022 exceed $47,138,099,000 provided, however, such
aggregate limits may be adjusted by the director of the budget to
account for any changes in the New York state federal medical
assistance percentage amount established pursuant to the federal
social security act, increases in provider revenues, reductions in
local social services district payments for medical assistance
administration, minimum wage increases, and beginning April 1, 2012
the operational costs of the New York state medical indemnity fund,
pursuant to chapter 59 of the laws of 2011, and state costs or
savings from the essential plan program. Such projections may be
adjusted by the director of the budget to account for increased or
expedited department of health state funds medicaid expenditures as
a result of a natural or other type of disaster, including a govern-
mental declaration of emergency.
The director of the budget, in consultation with the commissioner of
health, shall assess on a quarterly basis known and projected medi-
caid expenditures by category of service and by geographic region,
as determined by the commissioner of health, incurred both prior to
and subsequent to such assessment for each such period, and if the
director of the budget determines that such expenditures are
expected to cause medicaid spending for such period to exceed the
aggregate limit specified herein for such period, the state medicaid
director, in consultation with the director of the budget and the
commissioner of health, shall develop a medicaid savings allocation
adjustment to limit such spending to the aggregate limit specified
herein for such period.
Such medicaid savings allocation adjustment shall be designed, to
reduce the expenditures authorized by the appropriations herein in
compliance with the following guidelines: (1) reductions shall be
made in compliance with applicable federal law, including the
provisions of the Patient Protection and Affordable Care Act, Public
Law No. 111-148, and the Health Care and Education Reconciliation
Act of 2010, Public Law No. 111-152 (collectively "Affordable Care
Act") and any subsequent amendments thereto or regulations promul-
gated thereunder; (2) reductions shall be made in a manner that
complies with the state medicaid plan approved by the federal
centers for medicare and medicaid services, provided, however, that
the commissioner of health is authorized to submit any state plan
amendment or seek other federal approval, including waiver authori-
ty, to implement the provisions of the medicaid savings allocation
adjustment that meets the other criteria set forth herein; (3)
reductions shall be made in a manner that maximizes federal finan-
cial participation, to the extent practicable, including any federal
financial participation that is available or is reasonably expected
to become available, in the discretion of the commissioner, under
the Affordable Care Act; (4) reductions shall be made uniformly
among categories of services and geographic regions of the state, to
the extent practicable, and shall be made uniformly within a catego-
ry of service, to the extent practicable, except where the commis-
sioner determines that there are sufficient grounds for non-uniform-
ity, including but not limited to: the extent to which specific
categories of services contributed to department of health medicaid
state funds spending in excess of the limits specified herein; the
S. 7460 26
need to maintain safety net services in underserved communities; or
the potential benefits of pursuing innovative payment models contem-
plated by the Affordable Care Act, in which case such grounds shall
be set forth in the medicaid savings allocation adjustment; and (5)
reductions shall be made in a manner that does not unnecessarily
create administrative burdens to medicaid applicants and recipients
or providers.
The commissioner shall seek the input of the legislature, as well as
organizations representing health care providers, consumers, busi-
nesses, workers, health insurers, and others with relevant exper-
tise, in developing such medicaid savings allocation adjustment, to
the extent that all or part of such adjustment, in the discretion of
the commissioner, is likely to have a material impact on the overall
medicaid program, particular categories of service or particular
geographic regions of the state.
(a) The commissioner shall post the medicaid savings allocation
adjustment on the department of health's website and shall provide
written copies of such adjustment to the chairs of the senate
finance and the assembly ways and means committees at least 30 days
before the date on which implementation is expected to begin.
(b) The commissioner may revise the medicaid savings allocation
adjustment subsequent to the provisions of notice and prior to
implementation but needs to provide a new notice pursuant to subpar-
agraph (i) of this paragraph only if the commissioner determines, in
his or her discretion, that such revisions materially alter the
adjustment.
Notwithstanding the provisions of paragraphs (a) and (b) of this
subdivision, the commissioner need not seek the input described in
paragraph (a) of this subdivision or provide notice pursuant to
paragraph (b) of this subdivision if, in the discretion of the
commissioner, expedited development and implementation of a medicaid
savings allocation adjustment is necessary due to a public health
emergency.
For purposes of this section, a public health emergency is defined as:
(i) a disaster, natural or otherwise, that significantly increases
the immediate need for health care personnel in an area of the
state; (ii) an event or condition that creates a widespread risk of
exposure to a serious communicable disease, or the potential for
such widespread risk of exposure; or (iii) any other event or condi-
tion determined by the commissioner to constitute an imminent threat
to public health.
Nothing in this paragraph shall be deemed to prevent all or part of
such medicaid savings allocation adjustment from taking effect
retroactively to the extent permitted by the federal centers for
medicare and medicaid services.
In accordance with the medicaid savings allocation adjustment, the
commissioner of the department of health shall reduce department of
health state funds medicaid spending by the amount of the projected
overspending through, actions including, but not limited to modify-
ing or suspending reimbursement methods, including but not limited
to all fees, premium levels and rates of payment, notwithstanding
any provision of law that sets a specific amount or methodology for
any such payments or rates of payment; modifying medicaid program
benefits; seeking all necessary federal approvals, including, but
not limited to waivers, waiver amendments; and suspending time
frames for notice, approval or certification of rate requirements,
S. 7460 27
notwithstanding any provision of law, rule or regulation to the
contrary, including but not limited to sections 2807 and 3614 of the
public health law, section 18 of chapter 2 of the laws of 1988, and
18 NYCRR 505.14(h).
The department of health shall prepare a quarterly report that sets
forth: (a) known and projected department of health medicaid expend-
itures as described in subdivision (1) of this section, and factors
that could result in medicaid disbursements for the relevant state
fiscal year to exceed the projected department of health state funds
disbursements in the enacted budget financial plan pursuant to
subdivision 3 of section 23 of the state finance law, including
spending increases or decreases due to: enrollment fluctuations,
rate changes, utilization changes, MRT investments, and shift of
beneficiaries to managed care; and variations in offline medicaid
payments; and (b) the actions taken to implement any medicaid
savings allocation adjustment implemented pursuant to subdivision
(4) of this section, including information concerning the impact of
such actions on each category of service and each geographic region
of the state. Each such quarterly report shall be provided to the
chairs of the senate finance and the assembly ways and means commit-
tees and shall be posted on the department of health's website in a
timely manner.
The money hereby appropriated is available for payment of aid hereto-
fore accrued or hereafter accrued to municipalities, and to provid-
ers of medical services pursuant to section 367-b of the social
services law.
Notwithstanding any other provision of law, the money hereby appropri-
ated may be increased or decreased by interchange or transfer, with
any appropriation of the department of health, and may be increased
or decreased by transfer or suballocation between these appropriated
amounts and appropriations of the office of mental health, the
office for people with developmental disabilities, the office of
addiction services and supports, the department of family assistance
office of temporary and disability assistance, the department of
corrections and community supervision, the office of information
technology services, the state university of New York, the state
office for the aging, the office of the medicaid inspector general,
and office of children and family services with the approval of the
director of the budget, who shall file such approval with the
department of audit and control and copies thereof with the chairman
of the senate finance committee and the chairman of the assembly
ways and means committee.
[Notwithstanding any provision of law to the contrary, the director of
the budget, in consultation with the commissioner of health, may use
a payment reduction plan to make across-the-board reductions to the
department of health state funds medicaid spending by $373,000,000
for state fiscal year 2020-2021 and $373,000,000 in state fiscal
year 2021-2022 to limit such spending to the aggregate limit speci-
fied herein, or reduce the aggregate limit specified herein to
provide a reduction to the state's financial plan. Reductions shall
be made in a manner that complies with the state medicaid plan
approved by the federal centers for medicare and medicaid services,
provided, however, that the commissioner of health is authorized to
submit any state plan amendment or seek other federal approval to
implement the provisions of the medicaid payment reduction adjust-
ment.]
S. 7460 28
Notwithstanding any inconsistent provision of law, in lieu of payments
authorized by the social services law, or payments of federal funds
otherwise due to the local social services districts for programs
provided under the federal social security act or the federal food
stamp act, funds herein appropriated, in amounts certified by the
state commissioner of temporary and disability assistance or the
state commissioner of health as due from local social services
districts each month as their share of payments made pursuant to
section 367-b of the social services law may be set aside by the
state comptroller in an interest-bearing account in order to ensure
the orderly and prompt payment of providers under section 367-b of
the social services law pursuant to an estimate provided by the
commissioner of health of each local social services district's
share of payments made pursuant to section 367-b of the social
services law.
Notwithstanding any provision of law to the contrary, the portion of
this appropriation covering fiscal year 2020-21 shall supersede and
replace any duplicative (i) reappropriation for this item covering
fiscal year 2020-21, and (ii) appropriation for this item covering
fiscal year 2020-21 set forth in chapter 53 of the laws of 2019
(26963) ... 1,090,100,000 ..................... (re. $1,090,100,000)
Special Revenue Funds - Federal
Federal Health and Human Services Fund
Medicaid Administration Transfer Account - 25107
The appropriation made by chapter 53, section 1, of the laws of 2020, as
amended by chapter 53, section 1, of the laws of 2021, is hereby
amended and reappropriated to read:
For reimbursement of local administrative expenses of medical assist-
ance programs and for state administration of medical assistance
programs provided pursuant to title XIX of the federal social secu-
rity act or its successor program. Notwithstanding section 153 of
the social services law, to include the performance of eligibility
and enrollment determinations by the state or third-party entities
designated by the state to perform such services.
Notwithstanding any inconsistent provision of law and subject to the
approval of the director of budget, moneys hereby appropriated may
be increased or decreased by transfer or interchange between these
appropriated amounts and appropriations of the medical assistance
administration program, the medical assistance program, and the
office of health insurance programs. Funding authority from this
account used for state administration of the medical assistance
program may be transferred to state operations appropriations within
the aforementioned programs at amounts agreed upon by the commis-
sioner of health, and the New York state division of the budget.
Notwithstanding section 40 of the state finance law or any other law
to the contrary, all medical assistance appropriations made from
this account shall remain in full force and effect in accordance, in
the aggregate, with the following schedule: not more than 50 percent
for the period April 1, 2020 to March 31, 2021; and the remaining
amount for the period April 1, 2021 to September 15, 2022.
The moneys hereby appropriated are to be available for payment of aid
heretofore accrued or hereafter accrued to municipalities, and to
providers of medical services pursuant to section 367-b of the
social services law.
S. 7460 29
The amounts appropriated herein may be available for costs associated
with a common benefit identification card, and subject to the
approval of the director of the budget, these funds may be trans-
ferred to the credit of the state operations account medicaid
management information systems program.
Notwithstanding any other provision of law, the money hereby appropri-
ated may be increased or decreased by interchange, with any appro-
priation of the department of health, and may be increased or
decreased by transfer or suballocation between these appropriated
amounts and appropriations of the office of mental health, the
office for people with developmental disabilities, the office of
addiction services and supports, the department of family assist-
ance, office of temporary and disability assistance, the department
of corrections and community supervision, the office of information
technology services, the state university of New York, the state
office for the aging, the office of the medicaid inspector general,
and office of children and family services with the approval of the
director of the budget, who shall file such approval with the
department of audit and control and copies thereof with the chairman
of the senate finance committee and the chairman of the assembly
ways and means committee.
[Notwithstanding any provision of law to the contrary, the director of
the budget, in consultation with the commissioner of health, may use
a payment reduction plan to make across-the-board reductions to the
department of health state funds medicaid spending by $373,000,000
for state fiscal year 2020-2021 and $373,000,000 in state fiscal
year 2021-2022 to limit such spending to the aggregate limit speci-
fied herein, or reduce the aggregate limit specified herein to
provide a reduction to the state's financial plan. Reductions shall
be made in a manner that complies with the state medicaid plan
approved by the federal centers for medicare and medicaid services,
provided, however, that the commissioner of health is authorized to
submit any state plan amendment or seek other federal approval to
implement the provisions of the medicaid payment reduction plan.]
Notwithstanding any inconsistent provision of law, in lieu of payments
authorized by the social services law, or payments of federal funds
otherwise due to the local social services districts for programs
provided under the federal social security act or the federal food
stamp act, funds herein appropriated, in amounts certified by the
state commissioner of temporary and disability assistance or the
state commissioner of health as due from local social services
districts each month as their share of payments made pursuant to
section 367-b of the social services law may be set aside by the
state comptroller in an interest-bearing account in order to ensure
the orderly and prompt payment of providers under section 367-b of
the social services law pursuant to an estimate provided by the
commissioner of health of each local social services district's
share of payments made pursuant to section 367-b of the social
services law.
Notwithstanding any provision of law to the contrary, the portion of
this appropriation covering fiscal year 2020-21 shall supersede and
replace any duplicative (i) reappropriation for this item covering
fiscal year 2020-21, and (ii) appropriation for this item covering
fiscal year 2020-21 set forth in chapter 53 of the laws of 2019
(26993) ... 1,261,300,000 ..................... (re. $1,261,300,000)
S. 7460 30
MEDICAL ASSISTANCE PROGRAM
General Fund
Local Assistance Account - 10000
The appropriation made by chapter 53, section 1, of the laws of 2020, as
amended by chapter 53, section 1, of the laws of 2021, is hereby
amended and reappropriated to read:
For the medical assistance program, including administrative expenses,
for local social services districts, and for medical care rates for
authorized child care agencies.
Notwithstanding section 40 of the state finance law or any other law
to the contrary, all medical assistance appropriations made from
this account shall remain in full force and effect in accordance, in
the aggregate, with the following schedule: not more than 49 percent
for the period April 1, 2020 to March 31, 2021; and the remaining
amount for the period April 1, 2021 to September 15, 2022.
Notwithstanding section 40 of the state finance law or any provision
of law to the contrary, subject to federal approval, department of
health state funds medicaid spending, excluding payments for medical
services provided at state facilities operated by the office of
mental health, the office for people with developmental disabilities
and the office of addiction services and supports and further
excluding any payments which are not appropriated within the depart-
ment of health, in the aggregate, for the period April 1, 2020
through March 31, 2021, shall not exceed $23,606,772,000 except as
provided below and state share medicaid spending, in the aggregate,
for the period April 1, 2021 through September 15, 2022, shall not
exceed $23,531,327,000, but in no event shall department of health
state funds medicaid spending for the period April 1, 2020 through
September 15, 2022 exceed $47,138,099,000. Provided, however, such
aggregate limits may be adjusted by the director of the budget to
account for any changes in the New York state federal medical
assistance percentage amount established pursuant to the federal
social security act, increases in provider revenues, reductions in
local social services district payments for medical assistance
administration, minimum wage increases, and beginning April 1, 2012
the operational costs of the New York state medical indemnity fund,
pursuant to chapter 59 of the laws of 2011, and state costs or
savings from the essential plan program. Such projections may be
adjusted by the director of the budget to account for increased or
expedited department of health state funds medicaid expenditures as
a result of a natural or other type of disaster, including a govern-
mental declaration of emergency.
The director of the budget, in consultation with the commissioner of
health, shall assess on a quarterly basis known and projected medi-
caid expenditures by category of service and by geographic region,
as defined by the commissioner, incurred both prior to and subse-
quent to such assessment for each such period, and if the director
of the budget determines that such expenditures are expected to
cause medicaid spending for such period to exceed the aggregate
limit specified herein for such period, the state medicaid director,
in consultation with the director of the budget and the commissioner
of health, shall develop a medicaid savings allocation adjustment to
limit such spending to the aggregate limit specified herein for such
period.
S. 7460 31
Such medicaid savings allocation adjustment shall be designed, to
reduce the expenditures authorized by the appropriations herein in
compliance with the following guidelines: (1) reductions shall be
made in compliance with applicable federal law, including the
provisions of the Patient Protection and Affordable Care Act, Public
Law No. 111-148, and the Health Care and Education Reconciliation
Act of 2010, Public Law No. 111-152 (collectively "Affordable Care
Act") and any subsequent amendments thereto or regulations promul-
gated thereunder; (2) reductions shall be made in a manner that
complies with the state medicaid plan approved by the federal
centers for medicare and medicaid services, provided, however, that
the commissioner of health is authorized to submit any state plan
amendment or seek other federal approval, including waiver authori-
ty, to implement the provisions of the medicaid savings allocation
adjustment that meets the other criteria set forth herein; (3)
reductions shall be made in a manner that maximizes federal finan-
cial participation, to the extent practicable, including any federal
financial participation that is available or is reasonably expected
to become available, in the discretion of the commissioner, under
the Affordable Care Act; (4) reductions shall be made uniformly
among categories of services and geographic regions of the state, to
the extent practicable, and shall be made uniformly within a catego-
ry of service, to the extent practicable, except where the commis-
sioner determines that there are sufficient grounds for non-uniform-
ity, including but not limited to: the extent to which specific
categories of services contributed to department of health medicaid
state funds spending in excess of the limits specified herein; the
need to maintain safety net services in underserved communities; or
the potential benefits of pursuing innovative payment models contem-
plated by the Affordable Care Act, in which case such grounds shall
be set forth in the medicaid savings allocation adjustment; and (5)
reductions shall be made in a manner that does not unnecessarily
create administrative burdens to medicaid applicants and recipients
or providers.
The commissioner shall seek the input of the legislature, as well as
organizations representing health care providers, consumers, busi-
nesses, workers, health insurers, and others with relevant exper-
tise, in developing such medicaid savings allocation adjustment, to
the extent that all or part of such adjustment, in the discretion of
the commissioner, is likely to have a material impact on the overall
medicaid program, particular categories of service or particular
geographic regions of the state.
(a) The commissioner shall post the medicaid savings allocation
adjustment on the department of health's website and shall provide
written copies of such adjustment to the chairs of the senate
finance and the assembly ways and means committees at least 30 days
before the date on which implementation is expected to begin.
(b) The commissioner may revise the medicaid savings allocation
adjustment subsequent to the provisions of notice and prior to
implementation but needs to provide a new notice pursuant to subpar-
agraph (i) of this paragraph only if the commissioner determines, in
his or her discretion, that such revisions materially alter the
adjustment.
Notwithstanding the provisions of paragraphs (a) and (b) of this
subdivision, the commissioner need not seek the input described in
paragraph (a) of this subdivision or provide notice pursuant to
S. 7460 32
paragraph (b) of this subdivision if, in the discretion of the
commissioner, expedited development and implementation of a medicaid
savings allocation adjustment is necessary due to a public health
emergency.
For purposes of this section, a public health emergency is defined as:
(i) a disaster, natural or otherwise, that significantly increases
the immediate need for health care personnel in an area of the
state; (ii) an event or condition that creates a widespread risk of
exposure to a serious communicable disease, or the potential for
such widespread risk of exposure; or (iii) any other event or condi-
tion determined by the commissioner to constitute an imminent threat
to public health.
Nothing in this paragraph shall be deemed to prevent all or part of
such medicaid savings allocation adjustment from taking effect
retroactively to the extent permitted by the federal centers for
medicare and medicaid services.
In accordance with the medicaid savings allocation adjustment, the
commissioner of the department of health shall reduce department of
health state funds medicaid spending by the amount of the projected
overspending through, actions including, but not limited to modify-
ing or suspending reimbursement methods, including but not limited
to all fees, premium levels and rates of payment, notwithstanding
any provision of law that sets a specific amount or methodology for
any such payments or rates of payment; modifying or discontinuing
medicaid program benefits; seeking all necessary federal approvals,
including, but not limited to waivers, waiver amendments; and
suspending time frames for notice, approval or certification of rate
requirements, notwithstanding any provision of law, rule or regu-
lation to the contrary, including but not limited to sections 2807
and 3614 of the public health law, section 18 of chapter 2 of the
laws of 1988, and 18 NYCRR 505.14(h).
The department of health shall prepare a quarterly report that sets
forth: (a) known and projected department of health medicaid expend-
itures as described in subdivision (1) of this section, and factors
that could result in medicaid disbursements for the relevant state
fiscal year to exceed the projected department of health state funds
disbursements in the enacted budget financial plan pursuant to
subdivision 3 of section 23 of the state finance law, including
spending increases or decreases due to: enrollment fluctuations,
rate changes, utilization changes, MRT investments, and shift of
beneficiaries to managed care; and variations in offline medicaid
payments; and (b) the actions taken to implement any medicaid
savings allocation adjustment implemented pursuant to subdivision
(4) of this section, including information concerning the impact of
such actions on each category of service and each geographic region
of the state. Each such quarterly report shall be provided to the
chairs of the senate finance and the assembly ways and means commit-
tees and shall be posted on the department of health's website in a
timely manner.
The money hereby appropriated is to be available for payment of aid
heretofore accrued or hereafter accrued to municipalities, and to
providers of medical services pursuant to section 367-b of the
social services law, and for payment of state aid to municipalities
and to providers of family care where payment systems through the
fiscal intermediaries are not operational.
S. 7460 33
Notwithstanding any inconsistent provision of law to the contrary,
funds may be used by the department for outside legal assistance on
issues involving the federal government, the conduct of preadmission
screening and annual resident reviews required by the state's medi-
caid program, computer matching with insurance carriers to insure
that medicaid is the payer of last resort and activities related to
the management of the pharmacy benefit available under the medicaid
program.
Notwithstanding any inconsistent provision of law, in lieu of payments
authorized by the social services law, or payments of federal funds
otherwise due to the local social services districts for programs
provided under the federal social security act or the federal food
stamp act, funds herein appropriated, in amounts certified by the
state commissioner of temporary and disability assistance or the
state commissioner of health as due from local social services
districts each month as their share of payments made pursuant to
section 367-b of the social services law may be set aside by the
state comptroller in an interest-bearing account in order to ensure
the orderly and prompt payment of providers under section 367-b of
the social services law pursuant to an estimate provided by the
commissioner of health of each local social services district's
share of payments made pursuant to section 367-b of the social
services law.
Notwithstanding any inconsistent provision of law, funding made avail-
able by these appropriations shall support direct salary costs and
related fringe benefits within the medical assistance program asso-
ciated with any minimum wage increase that takes effect during the
timeframe of these appropriations, pursuant to section 652 of the
labor law. Each eligible organization in receipt of funding made
available by these appropriations may be required to submit written
certification, in such form and at such time the commissioner may
prescribe, attesting to the total amount of funds used by the eligi-
ble organization, how such funding will be or was used for purposes
eligible under these appropriations and any other reporting deemed
necessary by the commissioner. The amounts appropriated herein may
include advances to organizations authorized to receive such funds
to accomplish this purpose.
Notwithstanding any other provision of law, the money hereby appropri-
ated may be increased or decreased by interchange or transfer, with
any appropriation of the department of health and the office of
medicaid inspector general and may be increased or decreased by
transfer or suballocation between these appropriated amounts and
appropriations of the department of health state purpose account,
the office of mental health, office for people with developmental
disabilities, the office of addiction services and supports, the
department of family assistance office of temporary and disability
assistance, the department of corrections and community supervision,
the office of information technology services, the state university
of New York, and office of children and family services, the office
of medicaid inspector general, and the state office for the aging
with the approval of the director of the budget, who shall file such
approval with the department of audit and control and copies thereof
with the chairman of the senate finance committee and the chairman
of the assembly ways and means committee.
Notwithstanding any inconsistent provision of law to the contrary, the
moneys hereby appropriated may be used for payments to the centers
S. 7460 34
for medicaid and medicare services for obligations incurred related
to the pharmaceutical costs of dually eligible medicare/medicaid
beneficiaries participating in the medicare drug benefit authorized
by P.L. 108-173.
Notwithstanding any inconsistent provision of law, the moneys hereby
appropriated shall not be used for any existing rates, fees, fee
schedule, or procedures which may affect the cost of care and
services provided by personal care providers, case managers, health
maintenance organizations, out of state medical facilities which
provide care and services to residents of the state, providers of
transportation services, that are altered, amended, adjusted or
otherwise changed by a local social services district unless previ-
ously approved by the department of health and the director of the
budget.
Notwithstanding any inconsistent provision of law to the contrary,
funds shall be made available to the commissioner of the office of
mental health or the commissioner of the office of addiction
services and supports, in consultation with the commissioner of
health and approved by the director of the budget, and consistent
with appropriations made therefor, to implement allocation adjust-
ment developed by each such commissioner which shall describe mental
health or substance use disorder services that should be developed
to meet service needs resulting from the reduction of inpatient
behavioral health services provided under the medicaid program, by
programs licensed pursuant to article 31 or 32 of the mental hygiene
law. Such programs may include programs that are licensed pursuant
to both article 31 of the mental hygiene law and article 28 of the
public health law, or certified under both article 32 of the mental
hygiene law and article 28 of the public health law.
Notwithstanding any inconsistent provision of law, the moneys hereby
appropriated may be available for payments associated with the
resolution by settlement agreement or judgment of rate appeals
and/or litigation where the department of health is a party.
[Notwithstanding any provision of law to the contrary, the director of
the budget, in consultation with the commissioner of health, may use
a payment reduction plan to make across-the-board reductions to the
department of health state funds medicaid spending by $373,000,000
for state fiscal year 2020-2021 and $373,000,000 in state fiscal
year 2021-2022 and to limit such spending to the aggregate limit
specified herein, or reduce the aggregate limit specified herein to
provide a reduction to the state's financial plan. Reductions shall
be made in a manner that complies with the state medicaid plan
approved by the federal centers for medicare and medicaid services,
provided, however, that the commissioner of health is authorized to
submit any state plan amendment or seek other federal approval to
implement the provisions of the medicaid payment reduction adjust-
ment.]
For services and expenses of the medical assistance program including
hospital inpatient services and general hospitals that are safetynet
providers that evince severe financial distress, pursuant to crite-
ria determined by the commissioner, shall be eligible for awards for
amounts appropriated herein, to enable such providers to maintain
operations and vital services while establishing long term solutions
to achieve sustainable health services.
Notwithstanding any provision of law to the contrary, the portion of
this appropriation covering fiscal year 2020-21 shall supersede and
S. 7460 35
replace any duplicative (i) reappropriation for this item covering
fiscal year 2020-21, and (ii) appropriation for this item covering
fiscal year 2020-21 set forth in chapter 53 of the laws of 2019
(26947) ... 1,283,031,000 ..................... (re. $1,283,031,000)
Special Revenue Funds - Federal
Federal Health and Human Services Fund
Medicaid Direct Account - 25106
The appropriation made by chapter 53, section 1, of the laws of 2020, as
amended by chapter 53, section 1, of the laws of 2021, is hereby
amended and reappropriated to read:
For services and expenses for the medical assistance program, includ-
ing administrative expenses for local social services districts,
pursuant to title XIX of the federal social security act or its
successor program.
Notwithstanding section 40 of the state finance law or any other law
to the contrary, all medical assistance appropriations made from
this account shall remain in full force and effect in accordance, in
the aggregate, with the following schedule: not more than 51 percent
for the period April 1, 2020 to March 31, 2021; and the remaining
amount for the period April 1, 2021 to September 15, 2022.
The moneys hereby appropriated are to be available for payment of aid
heretofore accrued or hereafter accrued to municipalities, and to
providers of medical services pursuant to section 367-b of the
social services law, and for payment of state aid to municipalities
and to providers of family care where payment systems through the
fiscal intermediaries are not operational.
Notwithstanding any inconsistent provision of law, funding made avail-
able by these appropriations shall support direct salary costs and
related fringe benefits within the medical assistance program asso-
ciated with any minimum wage increase that takes effect during the
timeframe of these appropriations, pursuant to section 652 of the
labor law. Each eligible organization in receipt of funding made
available by these appropriations may be required to submit written
certification, in such form and at such time the commissioner may
prescribe, attesting to the total amount of funds used by the eligi-
ble organization, how such funding will be or was used for purposes
eligible under these appropriations and any other reporting deemed
necessary by the commissioner. The amounts appropriated herein may
include advances to organizations authorized to receive such funds
to accomplish this purpose.
Notwithstanding any other provision of law, the money hereby appropri-
ated may be increased or decreased by interchange or transfer, with
any appropriation of the department of health and the office of
medicaid inspector general and may be increased or decreased by
transfer or suballocation between these appropriated amounts and
appropriations of the office of mental health, office for people
with developmental disabilities, the office of addiction services
and supports, the department of family assistance office of tempo-
rary and disability assistance, office of children and family
services, the department of financial services, department of
corrections and community supervision, the office of information
technology services, the state university of New York, and the state
office for the aging with the approval of the director of the budg-
et, who shall file such approval with the department of audit and
S. 7460 36
control and copies thereof with the chairman of the senate finance
committee and the chairman of the assembly ways and means committee.
Notwithstanding any inconsistent provision of law, in lieu of payments
authorized by the social services law, or payments of federal funds
otherwise due to the local social services districts for programs
provided under the federal social security act or the federal food
stamp act, funds herein appropriated, in amounts certified by the
state commissioner of temporary and disability assistance or the
state commissioner of health as due from local social services
districts each month as their share of payments made pursuant to
section 367-b of the social services law may be set aside by the
state comptroller in an interest-bearing account in order to ensure
the orderly and prompt payment of providers under section 367-b of
the social services law pursuant to an estimate provided by the
commissioner of health of each local social services district's
share of payments made pursuant to section 367-b of the social
services law.
Notwithstanding any inconsistent provision of law to the contrary,
funds shall be made available to the commissioner of the office of
mental health or the commissioner of the office of addiction
services and supports, in consultation with the commissioner of
health and approved by the director of the budget, and consistent
with appropriations made therefor, to implement allocation adjust-
ment developed by each such commissioner which shall describe mental
health or substance use disorder services that should be developed
to meet service needs resulting from the reduction of inpatient
behavioral health services provided under the Medicaid program, by
programs licensed pursuant to article 31 or 32 of the mental hygiene
law. Such programs may include programs that are licensed pursuant
to both article 31 of the mental hygiene law and article 28 of the
public health law, or certified under both article 32 of the mental
hygiene law and article 28 of the public health law.
Notwithstanding any inconsistent provision of law, the moneys hereby
appropriated may be available for payments associated with the
resolution by settlement agreement or judgment of rate appeals
and/or litigation where the department of health is a party.
[Notwithstanding any provision of law to the contrary, the director of
the budget, in consultation with the commissioner of health, may use
a payment reduction plan to make across-the-board reductions to the
department of health state funds medicaid spending by $373,000,000
for state fiscal year 2020-2021 and $373,000,000 in state fiscal
year 2021-2022 and to limit such spending to the aggregate limit
specified herein, or reduce the aggregate limit specified herein to
provide a reduction to the state's financial plan. Reductions shall
be made in a manner that complies with the state medicaid plan
approved by the federal centers for medicare and medicaid services,
provided, however, that the commissioner of health is authorized to
submit any state plan amendment or seek other federal approval to
implement the provisions of the medicaid payment reduction adjust-
ment.]
For services and expenses of the medical assistance program including
hospital inpatient services.
Notwithstanding any provision of law to the contrary, the portion of
this appropriation covering fiscal year 2020-21 shall supersede and
replace any duplicative (i) reappropriation for this item covering
fiscal year 2020-21, and (ii) appropriation for this item covering
S. 7460 37
fiscal year 2020-21 set forth in chapter 53 of the laws of 2019
(26947) ... 13,628,958,000 ................... (re. $13,628,958,000)
Special Revenue Funds - Other
Miscellaneous Special Revenue Fund
Medical Assistance Account - 22187
The appropriation made by chapter 53, section 1, of the laws of 2020, as
amended by chapter 53, section 1, of the laws of 2021, is hereby
amended and reappropriated to read:
Notwithstanding section 40 of the state finance law or any other law
to the contrary, all medical assistance appropriations made from
this account shall remain in full force and effect in accordance, in
the aggregate, with the following schedule: not more than 49 percent
for the period April 1, 2020 to March 31, 2021; and the remaining
amount for the period April 1, 2021 to September 15, 2022.
Notwithstanding section 40 of the state finance law or any provision
of law to the contrary, subject to federal approval, department of
health state funds medicaid spending, excluding payments for medical
services provided at state facilities operated by the office of
mental health, the office for people with developmental disabilities
and the office of addiction services and supports and further
excluding any payments which are not appropriated within the depart-
ment of health, in the aggregate, for the period April 1, 2020
through March 31, 2021, shall not exceed $23,606,772,000 except as
provided below and state share medicaid spending, in the aggregate,
for the period April 1, 2021 through September 15, 2022, shall not
exceed $23,531,327,000, but in no event shall department of health
state funds medicaid spending for the period April 1, 2020 through
September 15, 2022 exceed $47,138,099,000 provided, however, such
aggregate limits may be adjusted by the director of the budget to
account for any changes in the New York state federal medical
assistance percentage amount established pursuant to the federal
social security act, increases in provider revenues, reductions in
local social services district payments for medical assistance
administration, minimum wage increases and beginning April 1, 2012
the operational costs of the New York state medical indemnity fund,
pursuant to chapter 59 of the laws of 2011, and state costs or
savings from the essential plan. Such projections may be adjusted by
the director of the budget to account for increased or expedited
department of health state funds medicaid expenditures as a result
of a natural or other type of disaster, including a governmental
declaration of emergency.
The director of the budget, in consultation with the commissioner of
health, shall assess on a quarterly basis known and projected medi-
caid expenditures by category of service and by geographic region,
as determined by the commissioner of health, incurred both prior to
and subsequent to such assessment for each such period, and if the
director of the budget determines that such expenditures are
expected to cause medicaid spending for such period to exceed the
aggregate limit specified herein for such period, the state medicaid
director, in consultation with the director of the budget and the
commissioner of health, shall develop a medicaid savings allocation
adjustment to limit such spending to the aggregate limit specified
herein for such period.
S. 7460 38
Such medicaid savings allocation adjustment shall be designed, to
reduce the expenditures authorized by the appropriations herein in
compliance with the following guidelines: (1) reductions shall be
made in compliance with applicable federal law, including the
provisions of the Patient Protection and Affordable Care Act, Public
Law No. 111-148, and the Health Care and Education Reconciliation
Act of 2010, Public Law No. 111-152 (collectively "Affordable Care
Act") and any subsequent amendments thereto or regulations promul-
gated thereunder; (2) reductions shall be made in a manner that
complies with the state medicaid plan approved by the federal
centers for medicare and medicaid services, provided, however, that
the commissioner of health is authorized to submit any state plan
amendment or seek other federal approval, including waiver authori-
ty, to implement the provisions of the medicaid savings allocation
adjustment that meets the other criteria set forth herein; (3)
reductions shall be made in a manner that maximizes federal finan-
cial participation, to the extent practicable, including any federal
financial participation that is available or is reasonably expected
to become available, in the discretion of the commissioner, under
the Affordable Care Act; (4) reductions shall be made uniformly
among categories of services and geographic regions of the state, to
the extent practicable, and shall be made uniformly within a catego-
ry of service, to the extent practicable, except where the commis-
sioner determines that there are sufficient grounds for non-uniform-
ity, including but not limited to: the extent to which specific
categories of services contributed to department of health medicaid
state funds spending in excess of the limits specified herein; the
need to maintain safety net services in underserved communities; or
the potential benefits of pursuing innovative payment models contem-
plated by the Affordable Care Act, in which case such grounds shall
be set forth in the medicaid savings allocation adjustment; and (5)
reductions shall be made in a manner that does not unnecessarily
create administrative burdens to medicaid applicants and recipients
or providers.
The commissioner shall seek the input of the legislature, as well as
organizations representing health care providers, consumers, busi-
nesses, workers, health insurers, and others with relevant exper-
tise, in developing such medicaid savings allocation adjustment, to
the extent that all or part of such adjustment, in the discretion of
the commissioner, is likely to have a material impact on the overall
medicaid program, particular categories of service or particular
geographic regions of the state.
(a) The commissioner shall post the medicaid savings allocation
adjustment on the department of health's website and shall provide
written copies of such plan to the chairs of the senate finance and
the assembly ways and means committees at least 30 days before the
date on which implementation is expected to begin.
(b) The commissioner may revise the medicaid savings allocation
adjustment subsequent to the provisions of notice and prior to
implementation but needs to provide a new notice pursuant to subpar-
agraph (i) of this paragraph only if the commissioner determines, in
his or her discretion, that such revisions materially alter the
plan.
Notwithstanding the provisions of paragraphs (a) and (b) of this
subdivision, the commissioner need not seek the input described in
paragraph (a) of this subdivision or provide notice pursuant to
S. 7460 39
para- graph (b) of this subdivision if, in the discretion of the
commissioner, expedited development and implementation of a medicaid
savings allocation adjustment is necessary due to a public health
emergency.
For purposes of this section, a public health emergency is defined as:
(i) a disaster, natural or otherwise, that significantly increases
the immediate need for health care personnel in an area of the
state; (ii) an event or condition that creates a widespread risk of
exposure to a serious communicable disease, or the potential for
such widespread risk of exposure; or (iii) any other event or condi-
tion determined by the commissioner to constitute an imminent threat
to public health.
Nothing in this paragraph shall be deemed to prevent all or part of
such medicaid savings allocation adjustment from taking effect
retroactively to the extent permitted by the federal centers for
medicare and medicaid services.
In accordance with the medicaid savings allocation adjustment, the
commissioner of the department of health shall reduce department of
health state funds medicaid spending by the amount of the projected
overspending through, actions including, but not limited to modify-
ing or suspending reimbursement methods, including but not limited
to all fees, premium levels and rates of payment, notwithstanding
any provision of law that sets a specific amount or methodology for
any such payments or rates of payment; modifying medicaid program
benefits; seeking all necessary federal approvals, including, but
not limited to waivers, waiver amendments; and suspending time
frames for notice, approval or certification of rate requirements,
notwithstanding any provision of law, rule or regulation to the
contrary, including but not limited to sections 2807 and 3614 of the
public health law, section 18 of chapter 2 of the laws of 1988, and
18 NYCRR 505.14(h).
The department of health shall prepare a quarterly report that sets
forth: (a) known and projected department of health medicaid expend-
itures as described in subdivision (1) of this section, and factors
that could result in medicaid disbursements for the relevant state
fiscal year to exceed the projected department of health state funds
disbursements in the enacted budget financial plan pursuant to
subdivision 3 of section 23 of the state finance law, including
spending increases or decreases due to: enrollment fluctuations,
rate changes, utilization changes, MRT investments, and shift of
beneficiaries to managed care; and variations in offline medicaid
payments; and (b) the actions taken to implement any medicaid
savings allocation adjustment implemented pursuant to subdivision
(4) of this section, including information concerning the impact of
such actions on each category of service and each geographic region
of the state. Each such quarterly report shall be provided to the
chairs of the senate finance and the assembly ways and means commit-
tees and shall be posted on the department of health's website in a
timely manner.
[Notwithstanding any provision of law to the contrary, the director of
the budget, in consultation with the commissioner of health, may use
a payment reduction plan to make across-the-board reductions to the
department of health state funds medicaid spending by $373,000,000
for state fiscal year 2020-2021 and $373,000,000 in state fiscal
year 2021-2022 and to limit such spending to the aggregate limit
specified herein, or reduce the aggregate limit specified herein to
S. 7460 40
provide a reduction to the state's financial plan. Reductions shall
be made in a manner that complies with the state medicaid plan
approved by the federal centers for medicare and medicaid services,
provided, however, that the commissioner of health is authorized to
submit any state plan amendment or seek other federal approval to
implement the provisions of the medicaid payment reduction adjust-
ment.]
For the purpose of making payments to providers of medical care pursu-
ant to section 367-b of the social services law, and for payment of
state aid to municipalities and the federal government where payment
systems through fiscal intermediaries are not operational, to reim-
burse the provision of care to patients eligible for medical assist-
ance.
For services and expenses of the medical assistance program including
nursing home, personal care, certified home health agency, long term
home health care program and hospital services.
Notwithstanding any provision of law to the contrary, the portion of
this appropriation covering fiscal year 2020-21 shall supersede and
replace any duplicative (i) reappropriation for this item covering
fiscal year 2020-21, and (ii) appropriation for this item covering
fiscal year 2020-21 set forth in chapter 53 of the laws of 2019
(29846) ... 1,898,000,000 ..................... (re. $1,898,000,000)
§ 2. Subdivision (a) of section 90 of part H of chapter 59 of the
laws of 2011, amending the public health law and other laws, relating to
general hospital inpatient reimbursement for annual rates, is amended
by adding a new paragraph 3 to read as follows:
(3) NOTWITHSTANDING ANY OTHER PROVISION OF LAW TO THE CONTRARY, FOR
THE STATE FISCAL YEAR BEGINNING APRIL 1, 2019 AND ENDING ON MARCH 31,
2020, ALL MEDICAID PAYMENTS MADE FOR SERVICES PROVIDED ON AND AFTER
JANUARY 1, 2020 THROUGH MARCH 31, 2020 SHALL BE INCREASED A UNIFORM ONE
PERCENT IN STATE FISCAL YEAR 2019-20. FOR THE STATE FISCAL YEARS BEGIN-
NING APRIL 1, 2020 AND ENDING ON MARCH 31, 2022, ALL MEDICAID PAYMENTS
MADE FOR SERVICES PROVIDED ON AND AFTER APRIL 1, 2020 THROUGH MARCH 31,
2022 SHALL BE INCREASED A UNIFORM ONE AND ONE-HALF PERCENT IN STATE
FISCAL YEARS 2020-21 AND 2021-22 AND EACH STATE FISCAL YEAR THEREAFTER.
§ 3. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2021; provided,
however that section two of this act shall be deemed to have been in
full force and effect on and after April 1, 2019.
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