2004 Yellow Book
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DEPARTMENT OF HEALTH (Summary) View Details

		Adjusted Appropriation 2003-04	Executive Request 2004-05	Change	Percent Change

AGENCY SUMMARY
	General Fund	6,902,820,100	7,210,845,600	308,025,500	4.5%
	Special Revenue-Other	4,718,503,000	4,721,080,000	2,577,000	0.1%
	Special Revenue-Federal	27,666,633,000	27,850,970,000	184,337,000	0.7%
	Capital Projects Fund	76,600,000	97,600,000	21,000,000	27.4%
	Enterprise	10,000	10,000	0	0.0%
	Total for Agency:	39,364,566,100	39,880,505,600	515,939,500	1.3%
	Total Contingency:	1,230,000,000	1,476,000,000	246,000,000	20.0%
Total for AGENCY SUMMARY:		40,594,566,100	41,356,505,600	761,939,500	1.9%

* 2000-01 through 2002-03 reflect enacted appropriations. * 2003-04 and 2004-05 reflect Executive recommended appropriations.

ALL FUNDS PERSONNEL BUDGETED FILL LEVELS
Fund	Current 2003-04	Requested 2004-05	Change

General Fund:	2,084	2,034	(50)
All Other Funds:	3,835	3,827	(8)
TOTAL:	5,919	5,861	(58)

Budget Highlights

As the designated State agency responsible for promoting and supervising public health activities, ensuring sound and cost-effective quality medical care, and reducing infectious diseases, the Department of Health (DOH) works toward its goal of ensuring the highest quality, most appropriate and cost-effective health care for all New Yorkers. Since State Fiscal Year (SFY) 1996-97, when authority for the State’s Medical Assistance (Medicaid) Program was transferred from the former Department of Social Services, the Department of Health has served as the principal State agency responsible for interacting with Federal and local governments, health care providers, and program participants on behalf of the Medicaid Program in New York. Transfer of all Medicaid functions to the Department of Health consolidated for the first time in one agency the operational and oversight responsibilities for the Medicaid Program, thereby clarifying State accountability for Medicaid policy and allowing for greater efficiencies in the administration of health care programs.

This agency is included in the Health and Mental Hygiene appropriation bill.

The Governor recommends All Funds appropriations for the Department of Health (DOH) totaling $41,356,505,600, an increase of $761,939,500, or 1.9 percent over State Fiscal Year (SFY) 2003-04, primarily attributable to an increase in both General Fund and Special Revenue Fund-Federal appropriations. The Governor recommends General Fund appropriations for the Agency totaling $7,210,845,600, an increase of $308,025,500, or 4.5 percent above the current fiscal year. Additionally, the Governor recommends Special Revenue Funds-Federal appropriations for the Agency totaling $27,850,970,000, an increase of $184,337,000, or 0.7 percent over SFY 2003-04. The Executive further recommends a Special Revenue Fund – Other appropriation totaling $4,721,080,000, an increase of $2,577,000, or 0.1 percent over SFY 2003-04.

The adjusted appropriations for the Department of Health (DOH) include recommended deficiency appropriations for General Fund and Special Revenue Funds – Other in Aid to Localities totaling $40,000,000. The proposed allocation of those funds is as follows: the Indigent Care Fund in the Medical Assistance Program, $10,000,000, and the Elderly Pharmaceutical Insurance Coverage (EPIC) Program, $30,000,000. The proposed deficiency appropriations are needed to fund unexpected program growth in both EPIC and Medicaid in the current fiscal year.

The Executive proposes to sweep $56,400,000 from the Quality of Care account to offset General Fund spending in SFY 2004-05.

State Operations

The Executive recommends a total All Funds appropriation for State Operations of $4,646,664,000, which reflects an increase of $96,203,400, or 2.11 percent over SFY 2003-04. This increase is primarily due to an anticipated increase in Federal funds. The Executive proposes General Fund State Operations appropriations totaling $170,066,000, an increase of $4,174,400, or 2.52 percent. The Executive also recommends Special Revenue Funds – Federal totaling $4,049,572,000, an increase of $87,852,000 or 2.22 percent.

In the SFY 2004-05 budget, the Governor proposes a net decrease of 58 full-time equivalent (FTE) positions agency- wide. This action would result in $1,700,000 cash savings to the General Fund and $200,000 cash savings to Special Revenue Funds in SFY 2004-05.

The Governor proposes to make permanent the authority of the Office of Professional Medical Conduct (OPMC) to fund the Physician Profiling Act (Patient Health Information and Quality Improvement Act). This action would result in State savings totaling $3,800,000 in SFY 2004-05.

The Governor further proposes to eliminate various public health programs that were enacted during the 2001 and 2002 legislative sessions. These programs include: the Alzheimer’s Tax Check-off General Fund Match (Chapter 359 of the Laws of 2002); the Endoscopy Study (Chapter 438 of the Laws of 2002); the Reflex Sympathetic Dystrophy Syndrome Prevention and Education Program (Chapter 429 of the Laws of 2002); the Obesity Prevention Program (Chapter 538 of the Laws of 2002); the Tattooing and Body Piercing License and Regulation Program (Chapter 562 of the Laws of 2001); and the Durable Medical Equipment (DME) Regulatory Program (Chapter 618 of the Laws of 2002). The Governor purports that the elimination of these programs would save the State $1,000,000 in SFY 2004-05.

The Governor also proposes to shift $6,245,800 in various administrative costs to the State Insurance Department, including: $3,500,000 in new costs associated with the proposed “forge proof” prescription program; $1,221,200 in fringe benefit costs from the Newborn Genetic Screening Program; and $1,524,600 in fringe benefit costs from the Center for Community Health.

Institutional Management

The Governor proposes to reduce the scheduled allocation amount for the Roswell Park Cancer Institute in the Health Care Reform Act (HCRA) from $83,000,000 to $78,000,000, resulting in a decrease of $5,000,000 in SFY 2004-05.

The Department of Health currently maintains five direct care institutions: Helen Hayes Hospital in West Haverstraw and four nursing homes for the care of veterans and their dependents -- Oxford, New York City, Montrose, and Western New York. The Executive proposes new capital funding of $60,000,000 to finance the reconstruction of the Veterans Nursing Home at Oxford, a 242-bed facility located in Oxford in Chenango County. Of this amount, the State contribution would total $21,000,000, and the remaining balance of $39,000,000 would be financed with federal dollars.

Aid To Localities

The Executive recommends All Funds Aid to Localities appropriations totaling $35,136,241,600, an increase of $398,736,100, or 1.15 percent over SFY 2003-04. This increase is primarily attributable to an increase in Special Revenue Funds—Federal.

The Executive proposes General Fund appropriations totaling $7,040,779,600, an increase of $303,851,100, or 4.51 percent over the SFY 2003-04 funding level. The Executive also recommends Special Revenue Fund-Federal appropriations totaling $23,801,398,000, an increase of $96,485,000 or 0.41 percent.

For the Early Intervention (EI) Program, the Executive recommends cash spending of $277,000,000 for SFY 2004- 05, a net cash increase of $36,000,000 over SFY 2003-04, due to both enrollment growth and increased utilization of services. The Executive also proposes significant changes to the EI program in SFY 2004-05. The Executive proposes to institute a sliding-scale parental fee schedule, ranging from $300 to $2,580 annually per family, depending upon income. Families under 250 percent of the Federal Poverty Level (FPL) would not be required to pay parental fees. The Executive also proposes to improve private health insurance coverage of EI medical services and to eliminate the enhanced rate for EI home and community-based visits. In addition, the Executive proposes a provider registration fee of $275 for individual providers and $900 for licensed agencies every three years. The Governor also proposes to maximize Medicaid reimbursement for EI services, and to implement a prior approval process for frequent EI services (county prior approval if a child receives five or more services and State prior approval if a child receives seven or more services per week). The Executive also proposes to allow counties to re-evaluate children at the time of the six-month review to determine continued eligibility for EI services, as well as to allow counties to negotiate EI rates with providers. The Executive estimates that localities would save $53,100,000 in SFY 2004- 05 from the proposed initiatives. The Executive does not estimate any State savings resulting from the proposed measures until SFY 2005-06 because of the payment lag in the Early Intervention Program. When fully implemented in SFY 2006-07, the Executive estimates that the EI proposal would save both the State and local governments $75,000,000.

The Executive proposes a $30,000,000 deficiency appropriation in the Elderly Pharmaceutical Insurance Coverage (EPIC) Program in SFY 2003-04, primarily due to increased price and utilization. For SFY 2004-05, the Executive recommends $704,500,000 for the EPIC Program, an increase of $66,500,000 in cash spending over SFY 2003- 04, reflecting an increase at a level consistent with program growth offset by proposed spending reductions of $60,000,000. Specifically, the Governor proposes to reduce the drug reimbursement rate for all pharmacies participating in the EPIC program from the Average Wholesale Price (AWP) minus 12 percent to the Average Wholesale Price minus 15 percent for brand name drugs, $22,600,000; to reduce the drug reimbursement rate for all pharmacies participating in the EPIC program from the Average Wholesale Price (AWP) minus 12 percent to the Average Wholesale Price minus 30 percent for generic drugs, $7,400,000; and to authorize the Department of Health to waive existing participant fees for low-income EPIC enrollees under 135 percent of the Federal Poverty Level (FPL) to encourage these enrollees to obtain the new Medicare Interim Discount Drug Card, $30,000,000. In addition, the Executive proposes to implement a Preferred Drug Program in EPIC in SFY 2006-07. While the Governor provides Article VII legislation to authorize such a program, the legislation itself does not specify the SFY 2006-07 implementation date; at this time it is merely Executive intent.

The Executive recommends cash spending of $229,300,000 in SFY 2004-05 in the General Public Health Works Program (Article 6) to support local public health activities, a cash increase of $13,300,000 over SFY 2003-04. The Executive also proposes to lower State aid reimbursement to localities from 30 percent to 20 percent for “optional” services in the General Public Health Works Program. This action would result in State savings of $10,800,000 in SFY 2004-05.

In the proposed SFY 2004-05 budget, the Governor eliminates $4,000,000 for the Adult Care Facility Quality Incentive Payment (QUIP) Program, but recommends transfer of a $75,000 suballocation from that appropriation to the Commission on Quality of Care for the Mentally Disabled. The Executive recommends a new $10,000,000 for adult home initiatives, of which $4,000,000 would be funded with General Fund dollars and $6,000,000 would be funded with Health Care Reform Act (HCRA) dollars. The proposed allocations would provide funding for case management activities, medication assistance, social and recreational services, and advocacy and legal support that the Department of Health would implement cooperatively with the Office of Mental Health (OMH), the State Office for the Aging (SOFA), and the Commission on Quality Care (CQC) for the Mentally Disabled. These proposed changes are not outlined in Article VII legislation.

In the AIDS Institute, the Executive continues funding of $393,800 for permanency planning and $393,800 for treatment adherence and compliance programs, as added by the Legislature in SFY 2003-04.

Other notable changes proposed by the Executive in Aid to Localities include:

a $3,500,000 increase in the Indian Health program;

the elimination of $2,100,000 in funding for family planning services, related to legislative restorations provided in SFY 2003-04; and

the elimination of $8,391,400 in funding in the AIDS Institute, related to legislative restorations provided in SFY 2003-04.

Medical Assistance (Medicaid) Program

The Executive recommends an All Funds Medicaid appropriation in Aid to Localities of $30,982,411,000, which is a net increase of $265,903,000, or 0.87 percent over SFY 2003-04.

For SFY 2004-05, the Governor proposes a total General Fund Medicaid appropriation of $6,325,009,000, a net increase of $256,888,000, or 4.23 percent over the SFY 2003- 04 appropriation. This estimate is predicated on the enactment of proposed cost containment actions and new health care provider assessments.

In the proposed budget, the Governor recommends a State share savings of approximately $776,700,000 to the Medicaid Program in SFY 2004-05. Specifically, the Governor proposes: new Medicaid provider cuts of $419,000,000; new Medicaid recipient cuts of $111,900,000; and other Medicaid actions saving $245,800,000. These cuts would generate a revenue loss to the health care industry of $1,450,900,000 in combined Federal, State, and local reimbursement.

New Medicaid Provider Cuts and Assessments

The Governor proposes new cuts and assessments on providers, totaling $419,000,000 in State share savings in SFY 2004-05, that affect every sector of the health care industry.

In the pharmacy sector, the Governor proposes new cuts totaling $81,600,000 in State share savings in SFY 2004-05. Specifically, the Governor proposes: lowering pharmacy reimbursement to the Average Wholesale Price (AWP) minus 15 percent for brand name drugs -- $29,000,000 savings; lowering pharmacy reimbursement to the Average Wholesale Price (AWP) minus 30 percent for generic drugs -- $13,500,000 savings; creating a Preferred Drug Program -- $37,100,000 savings; and authorizing prior approval for drugs excluded from the nursing home rate -- $2,000,000 savings.

In the hospital sector, the Governor recommends re- imposing the 0.7 percent assessment on hospital revenues, which would generate State share revenues of $183,300,000 in SFY 2004-05.

In the nursing home sector, the Governor proposes new cuts totaling $127,500,000 in State share savings in SFY 2004-05. Specifically, the Governor proposes: increasing the assessment from five percent to six percent on nursing home revenues and eliminating the scheduled phase-out of the assessment -- $124,900,000 savings; and mandating that AIDS nursing homes refinance their mortgages -- $2,600,000 savings. In addition, the Governor proposes to increase the wage equalization factor (WEF) to reflect 2001 data. This action would result in a State cost of $19,200,000 in SFY 2004-05, but would be contingent upon the enactment of two to nursing home cost containment measures: elimination of the Medicaid rate add-on for the hospital-based nursing homes -- $12,200,000 savings; and implementation of a four-year phase-out of the Medicaid rate add-on for nursing homes that have 300 beds or more -- $7,000,000 savings.

In the home care sector, the Governor proposes actions that would result in a State savings of $26,000,000 in SFY 2004-05. Specifically, the Governor proposes: re- establishing the 0.7 percent on home care revenues -- $15,000,000 savings; and increasing the home care savings target from $33,000,000 to $44,000,000 -- $11,000,000 savings to the State.

The Governor also proposes to eliminate podiatry services from the capitated clinic rate, for a total savings of $600,000 in SFY 2004-05.

New Medicaid Recipient Cuts

In addition to the direct cuts to providers, the Governor also proposes a total of $111,900,000 in cuts that would indirectly impact these providers, but are targeted specifically at Medicaid recipients.

The Governor proposes to eliminate several “optional” services from the Medicaid Program, totaling $31,700,000 in SFY 2004-05. Specifically, the Governor proposes to: eliminate private practitioner adult dental services -- $20,200,000 savings; and eliminate other practitioner services for adults -- $11,500,000 savings.

The Governor also proposes to increase pharmacy co- payments in Medicaid, as well as to impose co-payments in both the Medicaid Managed Care and Family Health Plus (FHP) Programs, totaling $17,500,000 in SFY 2004-05. Specifically, the Governor proposes: to increase pharmacy co-payments from 50 cents to $1 for generic drugs and from $2 to $3 for brand name drugs for Medicaid recipients -- $1,600,000 savings; to impose pharmacy co-payments for Medicaid Managed Care recipients at the same proposed schedule as in the regular fee-for-service Medicaid Program -- $2,600,000 savings; and to impose co-payments on various services for individuals enrolled in the Family Health Plus (FHP) Program -- $13,300,000 savings.

The Governor also proposes various changes to the Family Health Plus (FHP) Program. Specifically, the Governor proposes to impose an asset test similar to what is required in the Medicaid Program. The Governor also proposes to increase the waiting period from six months to one year for those individuals who previously had group health coverage, and to eliminate eligibility for individuals employed by a governmental entity or a business with more than 50 employees. The savings from these proposed changes, totaling $5,000,000 in SFY 2004-05, would offset spending in the Health Care Reform Act Program (HCRA). In addition, the Governor proposes to eliminate vision and dental services from the Family Health Plus (FHP) program benefit package. This action would produce a General Fund savings of $17,800,000 in SFY 2004-05.

The Governor also proposes to shift low-income children (family incomes between 100 percent to 133 percent of the Federal Poverty Level) between the ages of 6 to 19 years from the Medicaid Program to the Child Health Plus (CHP) Program. The Governor estimates that this action, which would shift approximately 77,000 children, would produce General Fund savings totaling $13,800,000 in SFY 2004-05.

In addition, the Governor proposes to:

limit Medicaid reimbursement for enteral (food supplement) products -- $5,200,000 savings. The Governor proposes to provide Medicaid reimbursement for eternal nutrition therapy (feeding tubes and other food supplement products) only if such enteral nutrition therapy is an integral component of a documented medical treatment plan, is ordered in writing by an authorized prescriber, and is provided for tube feeding or oral liquid administration for infants who can not absorb or metabolize caloric and dietary nutrients from food;

make various changes affecting eligibility for long- term care services, including: eliminating spousal refusal, extending the look-back period from 36 months to 60 months, imposing an asset transfer penalty on home care services, and requiring the penalty period for asset transfers to begin on the date services are received, instead of on the date the transfer was made -- $25,000,000 savings;

enroll on a voluntary basis Supplemental Security Income (SSI) individuals from the Medicaid Program to the Medicaid Managed Care Program -- $800,000 savings; and

enroll on a voluntary basis dually eligible recipients from the Medicaid Program to a new enhanced Medicaid Managed Care package that would include long-term care and pharmacy services -- $100,000 savings.

Other Medicaid Actions

The Governor further proposes various other Medicaid actions totaling $245,800,000 in State share savings in SFY 2004-05.

The Governor proposes that the State takeover the local share of long-term care costs over a ten-year period, effective January 1, 2005. The benefit to localities would total $24,200,000 in SFY 2004-05. This proposal is contingent upon the approval of various Medicaid cuts to the long- term care system, including: re-establishing the 0.7 percent assessment on hospitals and home care agencies and increasing the assessment to six percent on nursing homes; mandating that AIDS nursing homes refinance their mortgages; increasing the home care savings target by $11,000,000; eliminating spousal refusal, imposing an asset transfer penalty on home care services, changing the start date of the asset transfer penalty period, and extending look-back provisions in relation to eligibility for long-term care services; and allowing the Medicaid program to pay the Medicare Part A premium for dually eligibles.

Other actions proposed by the Governor that provide General Fund Medicaid savings in SFY 2004-05 include:

delaying the 53rd Medicaid cycle by two days -- $190,000,000 savings;

capping Overburden payments to localities -- $19,500,000 savings. This action reflects a cost shift to localities totaling $19,500,000 in SFY 2004-05;

implementing a new “forge proof” prescription program to require the use of non-reproducible prescription forms -- $6,900,000 savings;

paying the Medicare Part A premium for dually eligibles -- $46,100,000 savings; and

managing utilization patterns of high-cost specialty populations -- $7,500,000 savings.

Health Care Reform Act (HCRA)

The Executive proposes various changes to the Health Care Reform Act (HCRA) in SFY 2004-05.

New Spending

In SFY 2004-05, new spending initiatives proposed by the Governor include:

$6,000,000 to fund various adult home initiatives, including case management activities, medication assistance, social and recreational services and advocacy and legal support;

$10,000,000 to create one or more demonstration programs to promote the purchase of long-term care insurance policies, including the creation of a stop-loss fund which would reimburse insurers for claims paid;

$5,000,000 to fund public education and marketing associated with the long-term care insurance coverage demonstration programs; and

$5,000,000 to support various health care technology initiatives.

New Revenue

The Governor proposes to maximize Federal Medicaid reimbursement for Graduate Medical Education (GME). The Governor proposes to increase the GME Medicaid rate add-on to reflect 2001 data. This action contains a “hold harmless” provision and would produce a net benefit totaling $35,000,000 to teaching hospitals in SFY 2004-05. The net benefit to HCRA would total $63,000,000 in SFY 2004-05.

The Executive proposes legislation to allow any non-profit health plan organized under Article 43 of the Insurance Law to convert to a for-profit corporation under the same process, terms, and conditions as applied to the Empire Plan conversion, with two exceptions. First, prior to June 30, 2005, any proceeds of a conversion which are part of the 95 percent share to be distributed to the Public Asset Fund, but are in excess of $400,000,000, would require the enactment of legislation before being spent; proceeds up to $400,000,000 would be transferred to the Tobacco Control and Insurance Initiatives Pool in HCRA. After that date, legislation would be required to spend any of the proceeds earmarked for the Public Asset Fund. Second, no conversion proceeds of any future conversion which are part of the five percent share earmarked for the charitable foundation could be spent without the enactment of new legislation. The Governor estimates that this action would generate additional revenue to HCRA, totaling $400,000,000 in SFY 2005-06.

Reductions

In SFY 2004-05, the Governor proposes various reductions in HCRA, including:

a $5,000,000 reduction in the allocation to the Roswell Park Cancer Institute;

a $4,800,000 reduction associated with the elimination of the catastrophic program; and

a $2,000,000 reduction associated with the elimination of the individual subsidy program.

Article VII

The Governor proposes:

Part A:

Public Health Programs

eliminating the Alzheimer’s Tax Check-off General Fund Match (Chapter 359 of the Laws of 2002); the Endoscopy Study (Chapter 438 of the Laws of 2002); the Reflex Sympathetic Dystrophy Syndrome Prevention and Education Program (Chapter 429 of the Laws of 2002); the Obesity Prevention Program (Chapter 538 of the Laws of 2002); the Tattooing and Body Piercing License and Regulation Program (Chapter 562 of the Laws of 2001); and the Durable Medical Equipment (DME) Regulatory Program (Chapter 618 of the Laws of 2002).

making permanent financing of the Physician Profiling Program from the Professional Medical Conduct (OPMC) account;

establishing a Forge-Proof Prescription Program;

reducing State reimbursement to counties for “optional” services in the General Public Health Works Program from 30 percent to 20 percent. Counties would be given the flexibility to prioritize spending in the optional services category;

establishing the Quality of Care Improvement Account to receive the Federal portion of civil penalties collected for violations related to the operation of residential health care facilities; and

assessing clinical laboratories for the DOH laboratory certification program, based on the prior year of the enacted appropriation and a laboratory’s gross receipts, rather than the current method of assessing the laboratories for the prior year’s actual regulatory program costs.

Elderly Pharmaceutical Insurance Coverage (EPIC) Program

reducing pharmacy reimbursement from the Average Wholesale Price minus 12 percent to the Average Wholesale Price minus 15 percent for brand name drugs;

reducing pharmacy reimbursement from the Average Wholesale Price minus 12 percent to the Average Wholesale Price minus 30 percent for generic drugs;

authorizing a Preferred Drug Program; and

providing an incentive for EPIC enrollees with incomes below 135 percent of the Federal Poverty Level to participate in the new Medicare Interim Discount Drug Program by waiving EPIC fees for those individuals who choose to participate.

Early Intervention (EI) Program

imposing a sliding scale parental fee schedule for families with incomes above 250 percent of the Federal Poverty Level;

clarifying that insurers cannot deny coverage for medical services that are normally covered under the terms of the policy for the following reasons: the provider is out of network, the services are provided at the child’s home, or the child suffers from a chronic condition. Also, insurers are required to accept the child’s service plan, certified by the EI Official, as proof of medical necessity without requiring prior approval or recertification;

authorizing county EI officials to require that a child be re-evaluated at the time of the six month review to determine continued eligibility for EI services;

requiring State approval if the number of services recommended for a child exceeds 7 services per week and county approval for more than 5 services per week;

eliminating the enhanced rate (more than 59 minutes) for home and community-based visits;

implementing a provider registration fee of $275 per certified individual and $900 per licensed agency; and

establishing standards for provider advertising.

Part D: Health Care Reform Act

implementing various changes to the Family Health Plus (FHP) program, including: requiring co- payments on pharmaceuticals and other services, imposing an asset test (similar to the one used by Medicaid), requiring a 12 month waiting period for those who had group health coverage previously, prohibiting coverage for individuals employed by a government entity or a business with more than 50 employees, eliminating facilitated enrollment funding, and eliminating dental and vision services;

transferring an estimated 77,000 low-income children between the ages of 6 to 19 years from the Medicaid Program to Child Health Plus;

maximizing Federal Medicaid reimbursement for Graduate Medical Education (GME); and

allowing any non-profit health plan organized under Article 43 of the Insurance Law to convert to a for-profit corporation.

Part G: The Medical Assistance (Medicaid) Program

reducing pharmacy reimbursement from the Average Wholesale Price minus 12 percent to the Average Wholesale Price minus 15 percent for brand name drugs;

reducing pharmacy reimbursement from the Average Wholesale Price minus 12 percent to the Average Wholesale Price minus 30 percent for generic drugs;

establishing a Preferred Drug Program;

re-establishing a 0.7 percent assessment on hospitals;

increasing the assessment from 5 percent to 6 percent on nursing homes and eliminating the phase-out schedule of such assessment that was enacted in SFY 2003-04;

requiring AIDS nursing homes to refinance their mortgages;

re-establishing the 0.7 percent assessment on home care agencies;

increasing the home care savings target from $33,000,000 to $44,000,000;

eliminating spousal refusal, extending the look-back period from 36 months to 60 months, imposing an asset transfer penalty on home care services, and requiring the penalty period for asset transfers to begin on the date services are received, instead of on the date the transfer was made;

authorizing the State to assume the local share of long term care costs over a ten-year period;

increasing pharmacy co-payments, and increasing the limit on the maximum co-payments that can be made annually;

eliminating adult dental and other practitioner services;

limiting Medicaid reimbursement for enteral (food supplement) products;

implementing a four-year phase-out of the supplemental Medicaid rate add-on for nursing homes that have 300 beds or more;

reducing the supplemental payment to hospital- based nursing homes; and

updating the wage equalization factor (WEF) to a 2001 base year, contingent upon the elimination of both the 300 plus bed and hospital–based rate add-ons.

Medicaid Managed Care

requiring Medicaid managed care recipients to make co-payments on prescription drugs similar to Medicaid fee-for-service recipients;

creating a temporary receivership program to maintain services for Medicaid managed care participants similar to that established for nursing homes experiencing ineffective or inappropriate management; and

repealing the Medicaid Managed Care Advisory Panel and providing for the expanded membership of the Medical Advisory Committee.

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