1-16-13 CP NEWS
1/16/2013 11:03:47 AM
An HTML version of the 1-16-13 CP NEWS can be found HERE.
1/15/13 Affiliate Update
(Volume #19 – Issue #2)
GOVERNOR DELIVERS THIRD STATE OF THE STATE ADDRESS
Governor Andrew Cuomo delivered his third State of the State address on January 9, 2013. The State of the State had a number of preceding speakers and the Governor’s speech lasted over an hour and was accompanied by a PowerPoint presentation of dozens of slides.
The speech was as notable for what it didn’t mention as what it did mention. There was no discussion of Medicaid, health care, mandate relief, special education, individuals with disabilities or any of the programs or services that are provided by the CP of NYS Affiliates.
The Governor did talk about:
Governor Cuomo said that: Government needs to focus on “tech-transfer,” where innovations from laboratories are translated into manufacturing; he would start coordinating the state’s marketing funding among counties; three casinos should be located “upstate” and he proposed a system of “hot spots,” which would be business incubators in which companies would be freed from business, property and sales taxes.
Cuomo proposed: merit pay for teachers; a tougher “bar exam” for teachers before they could enter a classroom; lengthening the school year, either by adding more classroom hours or days, and the state would pay 100 percent of the additional cost.
The Governor proposed: “ending the unnecessary risk of high capacity assault rifles;” ending “private sales” of guns that allow people to sell guns without background checks; criminalizing high-capacity ammunition magazines; and tweaking the definition of banned assault weapons to be the “toughest in the nation.”
Campaign Finance Reform
Cuomo said that: all political and lobbying contributions over $500 should be disclosed electronically within 48 hours and that the state should implement a system of taxpayer support for campaigns, similar to New York City’s matching program.
Cuomo proposed a “Women’s equality act” that would mandate equal pay for equal work and includes a version of the reproductive health act, which would codify abortion rights in state law should federal court decisions like the Roe v. Wade decision be abridged or overturned.
Climate Change & Superstorm Sandy
Cuomo recommended: abolishing the Long Island Power Authority; that we must “accept the fact that climate change is real;” lowering the cap on greenhouse gasses; state funding to reconstruct homes on pylons and buy out distressed property owners in order to protect coastal areas; the installation of submersible pumps, flood gates and vent covers for New York City’s subway system and airports to prevent flooding; gas stations should be required to have back-up generators; and the state should develop a “fuel reserve.”
The text version of “NY Rising,” Governor Andrew Cuomo’s 2013 State of the State address, can be found at: http://blog.timesunion.com/capitol/archives/175433/document-drop-ny-rising-or-sos-the-book/ or http://www.governor.ny.gov/NY/2013-State-of-the-State. The full address can be seen at: http://blog.timesunion.com/capitol/archives/175614/video-watch-complete-sos-via-new-york-now/.
The Governor’s gun control bill passed in both the Senate and Assembly earlier this week.
UPSTATE CEREBRAL PALSY ESTABLISHES HEALTH HOME
CP of NYS Affiliate Upstate Cerebral Palsy in Utica has recently established a Phase III Health Home approved by the New York State Department of Health. Upstate Cerebral Palsy will form a new entity “Central New York Health Home Network LLC” to operate as the lead health home in the counties of Oneida, Herkimer, Madison, Lewis, Cayuga, Jefferson and St. Lawrence. Central New York Health Home Network, LLC (CNYHHN) will provide administration and governance over the network of 94+ providers in seven counties which continues to expand.
CNYHHN is one of New York State’s initial health homes, an innovative model of care that provides personalized clinical and social support and service coordination aimed at improving the health and well-being of the community. More specifically, the Health Home is a care management service model where all of the professionals involved in an individual’s care communicate with one another so that all of a patient’s needs (medical, behavioral health and social services) are addressed in a comprehensive manner. Coordination is achieved primarily through the care manager who oversees and coordinates a patient’s access to needed services. Long term goals include reduction of avoidable hospital admissions and readmissions, reduction of avoidable emergency room service, provision of timely follow up care, reduction in health care costs, less reliance on long term care facilities and improved experience of care and quality of care outcomes for the individuals.
For more information, please contact Laura Eannace, Executive Director of the Central New York Health Home Network, LLC, at (315) 735-6736. The website www.cnyhealthhome.net is under construction and will contain a portal for providers and clients to access services.
CLASS ACTION LAWSUIT REGARDING MEDICAID COVERAGE OF ORTHOPEDIC FOOTWEAR AND COMPRESSION STOCKINGS
Davis et al. v. Shah is a lawsuit filed in federal district court in the Western District of New York. The case was filed on March 14, 2012 (case number: 12-CV-6134-CJS). On January 7, 2013, Judge Charles J. Siragusa certified this case as a class action lawsuit on behalf of "All current and future New York State Medicaid recipients for whom Defendant has directly or indirectly failed to provide coverage for medically necessary orthopedic footwear and compression stockings as a result of New York Soc. Serv. Law § 365-a(2)(g)(iii) and (iv) and regulations and policies promulgated thereto." Judge Siragusa appointed the Empire Justice Center and the National Health Law Program as legal counsel for the class.
The case alleges that the New York State Department of Health is violating the Medicaid Act when it denies coverage of orthopedic footwear and compression stockings to Medicaid recipients whose doctors have prescribed these services as medically necessary for their health conditions. The lawsuit also alleges that the Department of Health has violated the Medicaid Act and United States Constitution by denying these services without giving you notice of the denial and an opportunity to contest the denial.
If you are a Medicaid recipient and you have been unable to get Medicaid to cover your doctor-prescribed orthopedic footwear or compression stockings, contact the Health Law Unit at the Empire Justice Center at (800) 724-0490.
MANAGEMENT SERVICES SOLUTIONS SELECTS GROUP PURCHASING PARTNER
Management Services Solutions, LLC (MSS), a services organization formed to create administrative efficiencies for disability and other social service organizations, has announced a group purchasing partnership with United Iroquois Shared Services (UISS).
“This partnership will allow MSS to provide efficiencies, supply chain savings, products and programs that meet the needs of our customers. The selection of UISS brings an improved access to customer service professionals, a keen awareness of our market and the needs of our customers on a statewide, regional and individual basis,” said Fredrick Sears, Executive Director of MSS.
“United Iroquois Shared Services is excited to be selected as the group purchasing organization for Management Services Solutions, LLC,” said J. Edward (Jed) Potocar, Executive Vice President at UISS http://www.iroquois.org/Default.aspx. “We at UISS are pleased to bring cost savings initiatives, educational programs and opportunities for operational efficiencies to MSS,” added Mr. Potocar.
Management Services Solutions, LLC is a recently formed for-profit management services organization (MSO) that creates opportunities for improving the quality of services offered by member agencies by providing participants an opportunity to decrease expenses for goods, services and administrative processes so that funding can be targeted to more efficiently provide services for people supported by participating organizations. The corporation is an independent entity controlled by a nine-member board of directors. For more information about the organization, please visit their website at http://www.mssolutionsllc.com/.
JOSEPH MINEO RETIRES AS HEAD OF NIAGARA CEREBRAL PALSY
COO John Reardon Appointed Interim Executive Director
After over 47 years at Niagara Cerebral Palsy (NCP), Executive Director/CEO Joseph Mineo retired from the agency, effective January 2, 2013. Mr. Mineo has guided NCP’s growth from a small agency to the diverse, multi-faceted organization that today is a leader in the Niagara community, providing vital services to children, adults and their families. His leadership and vision has led to the creation of high quality programs that have supported thousands of people over the years.
The organization’s Board of Directors has named NCP’s Chief Operating Officer, John Reardon, Interim Executive Director. Mr. Reardon has served for 12 years in his current role and has been directly involved with and overseen every aspect of the organization. Mr. Reardon is also extremely active in many community organizations, including serving as a member and Past President of the Niagara County Board of Health, Chairman of the Zoning Board of Appeals in his township and President of Sertoma.
OPWDD ANNOUNCES NEW ADDITIONS
NYS Office for People With Developmental Disabilities (OPWDD) Commissioner Courtney Burke recently announced the appointment of several people.
Sally Berry has been named deputy director of the Division of Service Delivery. Ms. Berry has worked closely with federal, state and local elected representatives and agencies to influence policy, promote legislative action and secure funding.
Regis Obijiski has been named deputy director of the Division of Workforce and Talent Management. Mr. Obijiski is currently the executive director of New Horizons Resources, Inc. and has extensive experience in the nonprofit sector providing services to individuals with developmental disabilities.
Catherine Johnson has been named deputy director of State Operations Office 1. Ms. Johnson has served as a clinician and supervisor in the OPWDD system for many years. She will be responsible for coordinating the remaining transition of services from the Finger Lakes-Monroe campus to community-based opportunities.
Fran Dubester-Vick has been named deputy director of Regional Office 1. She has extensive experience administering the Home and Community Based Services Waiver and strong working relationships with voluntary provider agency executives and administrators.
Jan Williamson has been named director of State Operations Office 6. Ms. Williamson has been a deputy director at the Region 5 Brooklyn Developmental Center campus. She has extensive experience in community-based OPWDD supports and services in the New York City region.
NEW YORK STATE SENATE ADOPTS NEW RULES FORMING MAJORITY COALITION
The New York State Senate adopted new rules on January 9, 2013 to formally establish the Senate Majority Coalition. The “caucus” leadership structure involves co-leaders Senator Dean Skelos (R-Nassau) and Senator Jeffrey Klein (D-Bronx) who each have the title Senate Majority Coalition Leader. Last month, Senate Democrats made history when they voted to make Senator Andrea Stewart-Cousins (D-Yonkers) Minority Leader. Senator Stewart-Cousins is the first woman to hold a leadership position in New York State.
Where there previously were two Senate Conferences, Republican and Democrat, there are now three Senate Conferences; Republican, Democrat and Independent Democratic Caucus (IDC).
The new rules include:
Chair of Rules is the Majority Coalition Leader with the most members rather than the Temporary President; in effect it remains Senator Skelos.
Majority Coalition Leaders determine which standing committees the bills will go to upon introduction; designate jointly a date in writing after which no bill or original resolution shall be introduced; approve resolutions placed on the calendar; all were previously done by Temporary President of the Senate.
Conference leaders replace the Majority and Minority Leaders in various duties and privileges.
Conference Committee membership: IDC is given proportionate membership on committees to the size of their conference.
The sponsor of any bill may file no more than three motions for committee consideration. Previously motions for committee consideration were unlimited.
A new Education subcommittee is created – the New York City Education Subcommittee – that will consider bills solely impacting education matters in NYC.
The formula for allocating funding for central staff for the Democratic conference is changed, seemingly resulting in a reduction of funding. The Democratic conference now receives not less than 30 percent of the funds allocated for Majority Coalition central staff on a per member basis. Previously the floor for central staff funding for the Democratic conference was 33 percent of all funding for central staff.
Allocation for Community Projects: The Majority Coalition will now receive 71 percent to the Democratic Coalition’s 29 percent. Previously the Majority received 2/3 of such funds while the Minority received 1/3.
Resolution to amend the Senate rules now requires an affirmative vote of 3/5 of all Senators elected. Previously it required a majority of all Senators elected.
Motion for Chamber Consideration: A motion now needs the affirmative vote of 3/5 of the members rather than a majority for a bill to be considered by the full Senate on the first calendar legislative day after four days have passed.
NEW YORK STATE SENATE 46TH DISTRICT WINNER STILL UNKNOWN
George Amedore (R-Rotterdam) and Cecilia Tkaczyk (D-Duanesburg) are vying to represent the 46th Senate District, which stretches from Amsterdam to Kingston through Montgomery, Schenectady, Albany, Greene and Ulster counties.
Amedore was certified as the winner of the new 46th Senate District last month after a Montgomery County judge, overseeing six weeks of ballot counting, found he finished 37 votes ahead of Tkaczyk. But, the Tkaczyk campaign filed a legal appeal of Amedore's certification and on January 9, 2013, five Appellate Court Justices ruled that 99 of the ballots, previously invalidated should be opened. Tkaczyk believes that many of the 450 invalidated ballots were cast by her supporters, and that opening 99 of them could invalidate Amedore’s win.
At the request of Amedore, the Court of Appeals told election officials to wait on counting the 99 ballots in his state Senate race with Tkacyzk. The Court of Appeals will also consider hearing a formal appeal by Amedore, who declined to vote on a package of gun control measures on January 14th, pending the appeal.
Therefore, it may be several more weeks of legal wrangling before the new Senator from the 46th District is sworn in to office. This is a critical seat for it determines if the majority in the Senate is made up of Elected Republicans or Democrats. If Amedore wins it will give the Senate 32 Republican votes and the Majority in the 63 member Senate. If Tkacyzk wins, it denies the Republicans the majority of votes and puts further pressure on the Independent Democrats (IDC) to rejoin the Democratic Conference. As a result the IDC and the new Majority Coalition continue to provide interest and drama for political scientists in New York and around the country.
ASSEMBLYMEMBER MORELLE APPOINTED MAJORITY LEADER
On Wednesday, January 9, 2013, Assembly Speaker Sheldon Silver appointed Assemblymember Joseph M. Morelle (D-Irondequoit) to serve as Majority Leader. The position of Majority Leader was open due to the retirement of Assemblymember Ron Canestrari (D-Cohoes). Morelle is from the Syracuse area and, as Chair of the Assembly Insurance Committee, was the sponsor of laws requiring that Autism services be covered by insurance under certain conditions. CP of NYS looks forward to working with Assembly Majority Leader Morelle.
TECHNICAL MEDICARE CHANGES FOR 2013
On Wednesday, January 2, 2013, President Obama signed into law the American Taxpayer Relief Act of 2012. This law extends several provisions that effect Medicare services and billing.
Medicare Physician Payment Update
This new law prevents a scheduled payment cut for physicians and other practitioners who treat Medicare patients from taking effect on January 1, 2013.
The law provides for a zero percent update for claims with dates of service on or after January 1, 2012 through December 31, 2013.
CMS is currently revising the 2013 Medicare Physician Fee Schedule (MPFS).
Extension Related to Payments for Medicare Outpatient Therapy Services
Extends the exceptions process for outpatient therapy caps through December 31, 2013.
Providers of outpatient therapy services are required to submit the KX modifier on their therapy claims, when an exception to the cap is requested for medically necessary services furnished through December 31, 2013.
The therapy caps are determined for a beneficiary on a calendar year basis, so all beneficiaries began a new cap for outpatient therapy services received on January 1, 2013.
For physical therapy and speech language pathology services combined, the 2013 limit for a beneficiary on incurred expenses is $1,900. There is a separate cap for occupational therapy services which is $1,900 for 2013.
Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached, and also apply for services above the cap where the KX modifier is used.
Also extends the mandate that Medicare perform manual medical review of therapy services furnished January 1, 2013 through December 31, 2013, for which an exception was requested when the beneficiary has reached a dollar aggregate threshold amount of $3,700 for therapy services, including outpatient department therapy services, for a year.
There are two separate $3,700 aggregate annual thresholds: (1) physical therapy and speech-language pathology services, and (2) occupational therapy services.