PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following proposed rule:
Proposed Action:
Amendment of section 98-1.11 of Title 10 NYCRR.
Statutory authority:
Public Health Law, section 4403(2)
Subject:
Managed Care Organizations.
Purpose:
To lower the contingent reserve requirement applied to the Medicaid Managed Care, Family Health Plus and HIV SNP Programs.
Text of proposed rule:
Section 98-1.2 is amended to add the following definition:
HARP (Health and Recovery Plan) – A line of business operated by a Managed Care Organization (MCO) to administer the full continuum of mental health, substance use disorder, and physical health services covered under the Medicaid State Plan as well as the enhanced Home and Community Based Services benefits (1915(i)) for adults with serious mental illness (SMI) and/or Substance Use Disorders (SUDs) who meet eligibility requirements.
Subparagraph (ii) of paragraph (1) of subdivision (e) of section 98-1.11 is amended to read as follows:
(ii) Notwithstanding the provisions of subparagraph (i) above, the contingent reserve applicable to net premium income generated from the Medicaid managed care, Family Health Plus, HIV SNP, and Health and Recovery Plans (HARPs) programs shall be:
(a) 7.25 percent of net premium income for 2011;
(b) 7.25 percent of net premium income for 2012;
(c) [8.25] 7.25 percent of net premium income for 2013;
(d) [9.25] 7.25 percent of net premium income for 2014;
(e) [10.25] 7.25 percent of net premium income for 2015;
(f) [11.25] 8.25 percent of net premium income for 2016;
(g) [12.25] 9.25 percent of net premium income for 2017;
(h) [12.5] 10.25 percent of net premium income for 2018;
(i) 11.25 percent of net premium income for 2019
(j) 12.5 percent of net premium income for 2020;
(k) 12.5 percent of net premium income for calendar years after 2020.
The provisions of this subparagraph shall not apply to HMOs and PHSPs beginning operations in 2011 or after.
Text of proposed rule and any required statements and analyses may be obtained from:
Katherine Ceroalo, DOH, Bureau of House Counsel, Reg. Affairs Unit, Room 2438, ESP Tower Building, Albany, NY 12237, (518) 473-7488, email: regsqna@health.ny.gov
Data, views or arguments may be submitted to:
Same as above.
Public comment will be received until:
45 days after publication of this notice.
Regulatory Impact Statement
Statutory Authority:
Public Health Law section 4403(2) states the Commissioner may adopt and amend rules and regulations pursuant to the state administrative procedures act to effectuate the purposes and provisions of Article 44, which governs the certification and operational requirements of Managed Care Organizations (MCOs).
Legislative Objectives:
10 NYCRR 98 was extensively amended in 2005 to further implement the provisions of Article 44 of the Public Health Law. The proposed amendment to § 98-1.11(e) allows implementation of certain provisions of the state fiscal year (SFY) 2012-2013 and 2013-2014 budgets and continues the Medicaid Redesign Team Proposal #6 (2% reduction in Medicaid premium rates) by temporarily reducing the contingent reserve requirements applied to premium revenues from the Medicaid Managed Care (MMC), Family Health Plus (FHP) and HIV Special Needs Plan (SNP) programs.
Needs and Benefits:
The approved SFY 2011-2012 and SFY 2012-2013 NYS Budgets incorporated a proposal from the Medicaid Redesign Team that reduced the premium rates of MMC, FHP and HIV SNP managed care plans by 2%. This was accomplished by lowering the rate component for surplus/reserves from 3% to 1% effective April 1, 2011.
The actuarial firm employed by the Department of Health (DOH), Mercer Consulting, must certify the actuarial soundness of the premium rates to Centers for Medicare and Medicaid Services (CMS). Mercer determined that reducing the rate component for surplus/reserves by 2% would result in rates that were not actuarially sound, as such rates would be insufficient to support the contingent reserve requirement specified in § 98-1.11(e)(1). As a result, Mercer recommended that the contingent reserve requirement for Medicaid product lines be reduced from 10.5% to 7.25% of premium revenue. This change was implemented in revised regulations promulgated on an emergency basis effective July 7, 2011 and adopted permanently on February 15, 2012. The 2% reduction of the premium rates resulted in savings to the Medicaid program of approximately $188 million (federal and state shares combined) in SFY 2011-2012 and $310 million in SFY 2012-2013.
The new revision to 98-1.11(e) maintains the 7.25% contingent reserve requirement through calendar year 2015. This will permit DOH to maintain the 2% reduction in the premium rates and allow Mercer to certify the actuarial soundness of the premium rates to CMS.
Costs:
The amended regulation imposes no compliance costs on state or local governments. There will be no additional costs incurred by the Health Department or by the MCOs.
Local Government Mandates:
The regulation imposes no new programs, services, duties or responsibilities on any county, city, town, village, school district, fire district or other special district.
Paperwork:
Paperwork associated with filings to DOH or Department of Financial Services should be minimal and would be no more substantial than the current regulation.
Duplication:
These regulations do not duplicate, overlap, or conflict with existing State and federal regulations.
Alternatives:
There were minimal alternative standards considered. Revisions to § 98-1.11(e) are needed to implement provisions of SFY 2012-2013 and SFY 2013-2014 budgets.
Federal Standards:
The rule does not exceed any minimum standards of the Federal government for the same or similar subject area.
Compliance Schedule:
Managed care organizations should be able to comply with the proposed regulations when they become effective.
Regulatory Flexibility Analysis
Effect of Rule:
Companies affected by the proposed regulation include all Managed Care Organizations (MCOs) certified under Article 44 of the Public Health Law. Inasmuch as most of these companies are not independently owned and operated and employ more than 100 individuals, they do not fall within the definition of "small business" found in section 102(8) of the State Administrative Procedure Act. No local governments will be affected.
Compliance Requirements:
The amended regulation would not impose additional reporting, recordkeeping or other requirements on small businesses or local governments since the provisions contained therein apply only to MCOs authorized to do business in New York State and regulated by the NYS Health and Insurance Departments.
Professional Services:
There are no professional services that will need to be provided by small businesses or local government as a result of the amended regulation.
Compliance Costs:
The amended regulation would not impose any new reporting, recordkeeping or other requirements on small businesses or local governments.
Economic and Technological Feasibility:
There are no compliance requirements for small businesses or local governments.
Minimizing Adverse Impacts:
The amendment will have no adverse impact on small businesses or local governments since the provisions contained therein apply only to regulated MCOs authorized to do business in New York State.
Small Business and Local Government Participation:
As the amendments have no impact on small businesses or local governments, no input was sought from these entities.
Rural Area Flexibility Analysis
Types and Estimated Number of Rural Areas:
Companies affected by the proposed regulation include all Managed Care Organizations (MCOs) certified under Article 44 of the Public Health law. The companies affected by this regulation do business in certain "rural areas" as defined under section 102(1) of the State Administrative Procedure Act, although none do so exclusively or have a significant portion of their business in rural areas. Some of the home offices of these companies may lie within rural areas. Further, companies may establish new office facilities and/or relocate in the future depending on their requirements and needs.
Reporting, Recordkeeping and Other Compliance Requirements:
None of the compliance requirements are significantly different from requirements presently contained in Part 98 and none pertain exclusively to rural areas. The amendments should not impose any significant additional paperwork, recordkeeping or compliance requirements upon any regulated party.
Costs:
The amended regulation imposes no additional compliance costs on MCOs or state and local governments.
Minimizing Adverse Impact:
The proposed regulation applies to all MCOs certified under Article 44 to do business in New York State, including rural areas. It does not impose any adverse impacts unique to rural areas.
Rural Area Participation:
In developing the amended regulation, the Health Department conducted outreach to regulated managed care organizations authorized to do business throughout New York State, including those located or domiciled in rural areas.
Job Impact Statement
Nature of Impact:
The Health Department finds that these amendments will have no adverse impact on jobs and employment opportunities.
Categories and Numbers Affected:
Not Applicable.
Regions of Adverse Impact:
No region in New York should experience an adverse impact on jobs and employment opportunities.
Minimizing Adverse Impact:
The Health Department finds that these amendments will have no adverse impact on jobs and employment opportunities.
