Highlights of the Biennial Budget for FY 2016-FY 2017
Related to Behavioral Health Providers
Special Session Update-July 1, 2015
This document compiles line items of interest specific to the Department of Mental Health & Addiction Services budget. The figures and information provided in this document do not reflect all line items in each agency budget, but reflect those that are most likely to impact state funded behavioral health providers and service recipients.
Links to Important Special Session Budget Documents:
SB No 1502: An Act Implementing Provisions of the State Budget Re: Human Services (6.29.15)
OFA Budget Summary FY 16-17 Budget (06.30.15)
SB-1052 Fiscal Note (06.29.15)
Legislative Research Summary on SB-1502 (06.29.15)
Previous Budget Documents:
CT Nonprofits’ Final Budget Analysis-DMHAS Specific (6.03.15)
HB 7061 -An Act Concerning The State Budget (6.03.15)
OLR Bill Analysis - HB 7061 As Amended (6.03.15)
Appropriations Committee Budget FY 16 - FY 17 (04.27.15)
Governor's Proposed Budget Documents (02.18.15)
general/CROSS-SECTOR overview: (previously distributed by Jeff Shaw, CT Nonprofits)
In the End, People Matter -- State Budget Passes Protecting Funding for Human Services
As expected, the House of Representatives voted on the final state budget agreement (Senate Bill 1502) for state fiscal years 2016-2017, which passed 78-65 along mostly party lines earlier this morning. The Senate previously voted on the final budget, which passed 19-17 along mostly party lines. While the budget is far from perfect, it does reflect that our unified message of 'people matter and protect nonprofit providers' was heard. This result would not have been possible without your advocacy - emails, calls to legislators, hallway conversations, holding a sign at the Capitol, even just reading policy staff updates to stay informed - and we truly thank you for standing up for all nonprofits this session.
Considering the incredible threats to funding for nonprofit providers that peaked three weeks ago, major special session wins includes:
· Maintains 1% cost of living adjustment (COLA) for private providers for state fiscal year 2017 ($8.5 million in funding resides in OPM's account);
· Maintains $20 million for the Nonprofit Grant Program ($10 million in each fiscal year; SB-1501);
· Increases the annual cap on Neighborhood Assistance Act tax credits from $5 million to $10 million, allowing more businesses the ability to participate in the program;
· Decreases the Medicaid Audit trigger for extrapolation from 2.5% to 1.75% of total claims;
· Continues Fatherhood Initiative by contracting with the same providers that received funding in FY 2015.
· Narrows previous changes to payment in lieu of taxes formula for private, nonprofit colleges and health systems (only Yale NHHS, Hartford HealthCare, which include 8 hospitals, affected);
· Requires the DOL to set up an implementation plan for a future roll out this year's Family Medical Leave Act proposal;
· Includes nonprofit representation on the Two-Generational School Readiness and Workforce Development Work Group and an opportunity for nonprofit representation on the Low Wage Employer Advisory Board. Participation on state-wide work groups heightens our influence over future public policy decisions.
Other major changes to the $40.3 billion state budget for the next two fiscal years include:
· Approving $2.8 billion in bonding for Governor's transportation initiative;
· Capping the personal property tax on motor vehicles (32 mils-FY17; 29.36-FY18);
· Eliminating an increase in the data processing tax (it will remain at 1% sales tax in FY16);
· Delaying the unitary reporting requirement by one year (until January 1, 2016);
· Adding $30 million (back) to hospitals over two years;
· Cutting $46 million from Medicaid over two years by transitioning certain HUSKY A adults (including pregnant women) with incomes greater than 150% of the FPL to Access Health CT (the online health insurance exchange). While disappointing, the bill does require DSS and the exchange to ensure that the these individuals do not have a gap in coverage during the transition;
· Cutting $13 million money set aside for raises for state employees in 2017 (interestingly, a legislator hinted that the reduction in funding for state employee raises could to lead to layoffs);
· Cutting $12.5 million in discretionary spending (includes some human services lines/accounts); the legislature did not give the Governor increased authority to cut the budget further by an additional 1.5%;
· Applying 6.35% sales tax to car washes for the first time; among other changes.
The special session also included passage of the bonding bill ($20 million for Nonprofit Grant Program referenced above); Second Chance initaitives (HB-7104), police body cameras/excessive force, school construction and the annual land conveyance legislation. Of most interest, the Second Chance initiative lowers penalties for drug possession and streamlines the process for paroles and pardons. The legislation reclassifies most drug possession crimes as misdemeanors and allows the court to order an offender to enter a drug treatment program for a second offense (two subsequent offenses could result in a class E felony). It makes no changes in penalties for drug sales. It does repeal the two-year mandatory-minimum sentence for drug possession within 1,500 feet of a school or day care, but does not shrink the size of the zones. The bill passes 98-46 in House; 23-13 in Senate.
All of these bills now head to the Governor's desk where he is expected to sign them all. Please let us know if you have any specific questions regarding the special session and final budget.
HIGHLIGHTS FROM THE SPECIAL SESSION BUDGET IMPLEMENTER BILLS:
Specific to DMHAS Funded Behavioral Health Providers
(Refer to Final Budget-DMHAS Specific (6.03.15) for comprehensive information)
Highlights from the Office of LeGislative Research (OLR) Analysis of SB No. 1502
§ 357 — PRESCRIPTION DRUG MONITORING PROGRAM
Under the prescription drug monitoring program, DCP collects information on controlled substance prescriptions to prevent improper or illegal drug use or improper prescribing. By law, pharmacists and other controlled substance dispensers must generally report certain prescription information to DCP under the program, such as the dispensing date, dispenser identification and prescription number, and patient identifying information.
Currently, they must report this information to the program at least weekly. Starting July 1, 2016, the bill requires them to report to the program immediately after dispensing controlled substances but in no event more than 24 hours after doing so. The bill also requires the information to be submitted electronically according to a DCP-approved format. Current law allows other DCP-approved methods of reporting by pharmacies or outpatient pharmacies that do not maintain electronic records.
As under existing law, these reporting requirements apply to (1) pharmacies; (2) nonresident pharmacies (i.e., out-of-state pharmacies that send prescription drugs into the state); (3) outpatient pharmacies in hospitals or institutions; and (4) practitioners who dispense controlled substances.
EFFECTIVE DATE: October 1, 2015
§ 358 — DMHAS ACUTE CARE AND EMERGENCY BEHAVIORAL SERVICES GRANT PROGRAM
The bill establishes a grant program in the Department of Mental Health and Addiction Services (DMHAS) to provide funds to organizations providing acute care and emergency behavioral health services.
The grants are for providing community-based behavioral health services, including (1) care coordination and (2) access to information on and referrals to available health care and social service programs. The commissioner must establish eligibility criteria and an application process.
EFFECTIVE DATE: July 1, 2015
§ 359 — PSYCHIATRIC SERVICES STUDY
The bill requires the DMHAS commissioner to study the current adequacy of psychiatric services. She must do so in consultation with the children and families (DCF) and social services (DSS) commissioners and behavioral health providers, including hospitals and advocacy agencies.
The study must include:
1. a determination of how many short-term, intermediate, and long-term psychiatric beds are needed in each region of the state;
2. the average wait times for each type of bed;
3. the impact of wait times on people needing inpatient psychiatric services, their families, and providers of this type of care;
4. identification of public and private funding sources to maintain the necessary number of beds;
5. access to outpatient services, including wait times for initial appointments;
6. available housing options; and
7. access to alternatives to hospitalization, including peer-operated respite programs.
The DMHAS commissioner must report on this study to the Appropriations, Human Services, and Public Health committees by January 1, 2017. The report must include recommendations on:
1. expanding utilization criteria to increase access to acute, inpatient psychiatric services statewide;
2. increasing the number of available long-term, inpatient hospital beds for people with recurring needs for inpatient behavioral health services;
3. funding to increase the number of psychiatric beds;
4. placing additional psychiatric beds in health care facilities throughout the state; and
5. funding to increase alternatives to hospitalization, including access to outpatient services, housing, and peer-operated respite programs.
EFFECTIVE DATE: July 1, 2015
§§ 360 & 361 — BEHAVIORAL SERVICES PROGRAM
The bill renames the Department of Developmental Services “Voluntary Services Program” as the “Behavioral Services Program” to reflect current practice. The program serves children and adolescents with intellectual disabilities and emotional, behavioral, or mental health needs.
EFFECTIVE DATE: July 1, 2015
§ 373 — REDUCTION IN HUSKY A COVERAGE
By law, DSS provides Medicaid coverage to children under age 19 and their parents or caretaker relatives through HUSKY A. Under current law, the income limit for this program is 196% of the federal poverty limit (FPL). The bill reduces HUSKY A coverage by lowering the income limit for non-pregnant adults (i.e., parents or caretakers) to 150% FPL.
EFFECTIVE DATE: August 1, 2015
§ 403 — MEDICAID PROVIDER AUDITS
The bill makes several changes in the DSS Medicaid provider audit process.
Principally, it:
1. modifies the circumstances in which DSS can make findings of over- or under-payment using extrapolation of audited provider claims;
2. prohibits DSS from extrapolating an overpayment or attempting to recover an extrapolated overpayment beyond the payment's original dollar amount if the provider presents credible evidence that a DSS error caused the overpayment;
3. allows providers aggrieved by an audit finding to request a contested case hearing under the Uniform Administrative Procedures Act (UAPA), instead of a review by a DSS designee as under current law;
4. prohibits DSS from recouping a contested provider overpayment based on extrapolation until a final decision is issued after the hearing;
5. requires DSS to give providers (a) that are going to be audited written notification of the statistically valid sampling and extrapolation methodology (SVSEM) the auditors will use and (b) additional information at the start of the audit;
6. eliminates a requirement that DSS adopt regulations pertaining to its provider audit practices; and
7. requires DSS, by January 1, 2016, to establish audit protocols for homemaker companion services. The law already requires DSS to adopt such protocols for various other providers and services.
The bill also makes technical and conforming changes.
EFFECTIVE DATE: July 1, 2015
Definitions
Under the bill:
1. “clerical error” means an unintentional typographical, scrivener's, or computer error;
2. “95% confidence level” means there is at least a 95% probability that the result is reliable;
3. “stratified sampling” means a method of sampling that involves dividing a population into smaller groups (strata) based on shared attributes, characteristics, or similar paid claim amounts; and
4. “SVSEM” means a methodology that is (a) validated by a statistician who has completed graduate work in statistics and has significant experience developing statistically valid samples and extrapolating the results of the samples on behalf of government entities, (b) provides for the exclusion of highly unusual claims that do not represent the universe of paid claims, (c) has a 95% confidence level or greater, and (d) includes stratified sampling when applicable.
Extrapolation
Use in Audits. By law, extrapolation means the determination of an unknown value by projecting the results of a review of a sample of claims to the entire population of claims from which the sample was drawn.
Current law prohibits DSS from finding that an overpayment or underpayment was made to a provider based on extrapolated projections unless (1) the provider has a sustained or high level of payment error, (2) documented educational intervention has failed to correct the error levels, or (3) the aggregate claims' value exceeds $200,000 on an annual basis.
The bill instead prohibits DSS from making such findings based on extrapolation unless the total net amount of the extrapolated overpayment calculated from an SVSEM exceed 1.75% of total claims paid to the provider for the audit period.
Assessment Based on Extrapolated Claims. By law, a provider must be allowed at least 30 days to provide documentation in connection with any discrepancy found in an audit and brought to the provider's attention. The bill specifies that the documentation may include evidence that errors concerning payment and billing resulted from a provider's transition to a new payment or billing service or accounting system.
The bill prohibits DSS from extrapolating an overpayment or attempting to recover an extrapolated overpayment if the provider presents credible evidence that a DSS error or an error by a DSS-contracted auditor caused the overpayment, but it allows DSS to still recover the original overpayment amount.
Aggrievement. Under current law, a provider aggrieved by a decision contained in the final audit report can request in writing a review of all items of aggrievement. The bill instead allows a provider aggrieved by a decision in a final audit report to request in writing a contested case hearing in accordance with the UAPA. When a provider requests such a hearing to contest an overpayment based on extrapolation, the bill specifies that DSS cannot recoup the overpayment amount until a final decision is issued after the hearing. Like the review in current law, the hearing must be presided over by an impartial DSS designee who is not an employee of (1) the department's Office of Quality Assurance or (2) a DSS-contracted auditor. As under current law, a hearing decision can be appealed to court.
The bill allows a provider, during the hearing, to raise that a negative audit finding was due to a provider's compliance with a state or federal law or regulation. Following the hearing, the bill requires the designee to issue a final decision within 90 days of the close of evidence or the date final briefs are filed, whichever is later.