NYSACRA

MEDICAID WRAPAROUND UPDATE

NYSACRA has been informed by OMRDD that effective July 1, 2006, the Medicaid wrap-around will be limited to the following four categories of drugs when the pharmacist bills and coverage is denied by the Medicare Part D plan:

   *  Atypical antipsychotics

   *  Antidepressants

   *  Antiretrovirals used in the treatment of HIV/AIDS

   *  Immunosuppressants used in the treatment of transplants.

Use of the Medicare Verification System (MVS) has been discontinued.  Prescribers will not need to obtain a plan exception denial first before Medicaid pays although DOH expects prescribers to work with their patient's plans to maximize their drug benefit.  All other drugs included in the Medicare Part D benefit will be covered only through the Medicare Part D plans 

Medicaid will continue to cover a few drugs which are excluded from the Part D benefit, such as benzodiazepines, barbiturates, select prescription vitamins and certain non-prescription drugs.

U.S. HOUSE VOTES ON FY 2007 BUDGET PROPOSAL

In a somewhat surprising move, the House voted in the dark of night at 1 a.m. on Thursday, May 18, 2006, to approve a $2.8 trillion fiscal year (FY) 2007 budget proposal.  The House narrowly approved the spending plan for next year by a vote of 218 to 210, after more than a month of delay as Republicans feuded among themselves.  Republican moderates demanded commitments to add $3 billion for education, health and community-development block grants.  The final proposal included a statement "recognizing" that those programs should receive $3.1 billion more than President Bush had requested if savings could be found in other areas.  However, unlike the successful $7 billion amendment offered during the Senate budget debate, the House budget would find that additional funding from other current programs, most likely unspent Iraqi rebuilding funds and other foreign aid contributions.  This funding shift allows the newly elected Majority Leader to keep the House's budget resolution within the $873 billion discretionary cap suggested by the President's budget in February and prevents this year from being the first time the House would have failed to pass a budget resolution in more than 30 years.

FBI BACKGROUND CHECK BILL INTRODUCED

Assemblyman Harvey Weisenberg has introduced a new bill, A. 9992, which will give providers access to the FBI database when doing the required background checks on applicants.  Providers will simply submit 2 fingerprint sets, and DCJS will send one to the FBI.  This was a serious loophole in the current law, since an applicant could come from another state with a criminal record and no one would know.  While no system is perfect, this will greatly improve the safety of individuals with developmental disabilities being served in New York State.  Please contact your Assembly and Senate reps to urge them to pass this bill.