2010-2011 Budget Items

Listed below are some SFY2010-2011 budget items that would have an impact on pharmacy. Special thank you goes out to Elizabeth with Capital Public Affairs for researching and pulling out these documents from the mammoth budget bill.

• Current Medicaid enrollment has increased 16% over the past two years to approximately 4.15 million due mainly from economic situation.
• The Governor proposes budget reductions (or savings) of $57.8 million (not including the $106 million AWP-rollback savings [$212million total with MFP]. The $57.8 million in savings comes from:

1. Elimination of the "wrap-around" coverage in both the Medicaid (dual-eligibles) and EPIC programs.
2. Eliminate the Medicare Advantage exemption from mandatory enrollment into a Medicare Part D plan. This will impact approximately 22,000 EPIC enrollees. Another 11,000 have already been transitioned into an MA-PD in January (saving an est. $11 million).
3. Accelerate the PDL public notice process and move more drug categories onto the list which were previously exempt.
4. Discontinue "enhanced reimbursement" for specialty HIV pharmacies (MOMS)
5. Authorize pharmacists to administer vaccinations. (No real details but we see a significant expansion here). We will research the full budget document to see what they have in mind and get back to you.
6. Discontinue certain HCRA allocations for the Disease Management Demonstration program. (This does not look like it impacts the Asthma MTM Demonstration project going on in the Bronx).
7. Require "proof of citizenship" for Child Health Plus eligibility program.
8. Implement co-pays ($5 generics and $15 brands) for the Family Health Plus "Buy-in" program. This concerns me greatly as to whether or not they have to pay these co-pays or if the co-pays drop to $1 for all PDL drugs. Also, do they come under the $200 out-of-pocket annual co-pay maximum?
9. Increase "civil penalties" for Medicaid fraud (OMIG wish list).
10. Expand income attestation for Medicaid and FHP.
11. Expand Medicaid transition assistance. I suspect this covers duals transitioning into Part D.
12. Expand the types of providers authorized to be diabetes educators. (for which Medicaid pays). Diabetes self-management training services under Medicaid. . . must be ordered by a physician, physician assistant or nurse practitioner. . . and provided by a diabetes educator certified by the National Certification Board of Diabetes Educators or by such a professional who is affiliated with a program certified by the American Diabetes Association, the American Association of Certified Diabetes Educators, the Indian Health Services, or any other national accreditation organization approved by the federal centers for medicare and medicaid services. 
13. Carve-out prescription drugs from nursing home reimbursements
14. Eliminate the 2010 "trend factor" for hopitals, nursing homes, home and personal care and assisted living programs.