LeadingAge New York State Budget Review April 2017 | Page 27

Summary of NYS Budget by Functional Area

EXECUTIVE BUDGET
FINAL BUDGET
REGULATORY/PROGRAMMATIC INITIATIVES
Mandated Recycling of Organic Waste
Requires certain high volume generators of food waste,
including health care facilities, manufacturers, supermarkets,
large restaurants and higher educational institutions to recycle
their food waste beginning Jan. 1, 2021.
Pharmacy
• Proposes legislation to increase transparency of drug prices
and rein in the costs of high priced drugs.
• Authorizes DOH to require prior authorization of any refill
of a controlled substance when more than a 7-day supply
of the previously dispensed amount should remain, if the
drugs had been used as directed.
• Makes it an “unacceptable practice” in the Medicaid
program to prescribe opioids in violation of applicable
laws or contrary to recommendations issued by the Drug
Utilization Review Board.
• Eliminates “prescriber prevails” for drugs not on preferred
drug list.
• Eliminates Medicaid managed care requirement to cover
certain non-formulary drugs.
• Proposes various changes to fee-for-service reimbursement
rates for pharmacies for generic, brand name and non-
prescription drugs, and increases dispensing fee to $10 for
generic and brand name drugs.
• Proposes $1.00 beneficiary copayment on nonprescription
drugs and modifies brand name copayments. Copayments
do not apply to MLTC plan members.
•
Expands existing Collaborative Drug Therapy Management
program currently authorized in Article 28 facilities.
Does not include Executive proposal.
• Creates Medicaid drug cap within the Medicaid global cap.
• Includes Executive proposal.
• Includes Executive proposal.
• Does not include Executive proposal.
• Does not include Executive proposal.
• Increases dispensing fee to $10 for prescription drugs
and certain non-prescription, covered out-patient drugs.
Dispensing fees increased to $10 for all prescription drugs.
• Reduces beneficiary copayments on non-preferred brand
name prescription drugs from $3.00 to $2.50. Brand
name prescription drugs costing less than their generic
equivalents and preferred brand name drugs subject to
$1.00 copayment. Generic drug copayments remain at
$1.00. Copayments do not apply to MLTC plan members.
• Does not include Executive proposal.
TBI and NHTD Waiver Transition to Managed Care
No provision. DOH commits to delay transition of NHTD and TBI waivers
into managed care for one year to Jan. 1, 2019 (side letter).
Workers’ Compensation Reforms Ensures swift access to hearings for injured workers not
receiving benefits, creates a clear formulary for prescription
drugs, and provides relief for first responders exposed to a
traumatic event at work.
No provision.
BENEFICIARY ELIGIBILITY
Spousal Refusal
Allows applicant to qualify for Medicaid without counting his/
her spouse’s income and assets only if the spouse is both absent
and unwilling to support the applicant.
LeadingAge New York/April 2017
Does not include Executive proposal.
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