March 12, 2015
Coalition Parachute Wiki
Resources for behavioral health providers on the value of integrating peer staff to improve care and outcomes.
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HIPAA Omnibus Policy, Procedure & BAA Template Kit
The Coalition is pleased to announce the availability of a set of 38 HIPAA Policy Templates for HIPAA Privacy, Security and Breach Notification Rules and an updated Business Associate Agreement all of which conform to the HIPAA Omnibus Update released January 25, 2013 and the technical correction published June 7, 2013.
More information and Ordering »
Professional Learning Center Store
HIPAA Business Associate Agreement Templates, now available. HITECH and Breach Notification changes apply to BAAs.
Be compliant, purchase now!! »
Coalition Video on YouTube
Empowering Lives Through Community Behavioral Health - Five stories narrated by Mike Wallace in two parts.
Watch the videos »
New York Attorney General Strikes a Blow for
Behavioral Health Parity
In a press
release dated March 5, 2015, Attorney General Eric T. Schneiderman announced
a settlement with Beacon Health Options (formerly known as ValueOptions)
requiring the managed care company to dramatically reform its claims review
process and pay a $900,000 penalty. The settlement resolves allegations of
widespread violations of mental health parity laws by the company, which serves
a total of 45 million consumers across all 50 states. An investigation by the
Attorney General’s Health Care Bureau found that ValueOptions issued denials
twice as often for behavioral health claims as insurers did for other medical or
surgical claims and four times as often for addiction recovery services.
Coalition is extremely pleased with the result here and thanks the Attorney
General and his staff for its work to reach the settlement as well as
highlighting the important issue of behavioral health parity. We hope the
settlement with Beacon Health Options will be an accurate predictor for the fate
of preauthorizations of behavioral health visits in the wider managed care
Bills Delaying the E-Prescription
Mandate Passes NYS Legislature, signed by Governor Cuomo
The legislation, S.2486
(Hannon)/A.4274 (McDonald), delays for one
year provisions which require e-prescribing of medications beginning March 27,
Many providers have not been able to obtain certification by the Drug
Enforcement Agency (due to delays on the part of the Agency) and have not
secured contracts for e-prescribing software. Moving the effective date to March
27, 2016, will allow providers sufficient time to prepare for implementation.
This bill is part of the Coalition’s Albany Agenda and we have issued a Memorandum in
Support of its passage. We are very pleased it has
Devotes 2 Days to Albany; Advocating for its Behavioral Health
On February 9th and 10th, The Coalition hosted its Annual Albany Days. A
cohort of 25 Coalition leaders and staff met with the Governor’s Office, OMH,
OASAS, DOH, visited more than 20 State legislators’ offices as well as Assembly
Ways & Means and Senate Finance staffs.
Coalition representatives represented nearly the entire range of our
membership including Article 31 and 822 clinics, residential treatment,
children’s services and supportive housing, clubhouses, criminal justice
agencies, homeless service providers and affiliate members, including a
non-profit health plan and a pharmaceutical company.
The Coalition’s agenda emphasized, among other issues, proposals related to behavioral
health’s mandated transition to Medicaid managed care. Specific agenda items
- DOH, OMH and OASAS should develop contract templates delineate a scope of
services available in the benefit packages offered by MMCOs.
- Contract templates should implement standardized billing, authorizations,
claims procedures, documentation requirements and appeals processes.
- Medicaid Managed Care Organizations (MMCO) should be prevented from
requiring preauthorizations for access to behavioral health clinic treatment
services on parity with primary care services
- NYS must enforce APG rates for behavioral health clinic treatment services
for the time frame in which they are required
- All MMCO billing and staffing guidelines for clinic treatment services
should strictly adhere to all applicable regulations
- NYS must stringently enforce prompt payment rules
- As the very complex system of care for children, adolescents and families
moves toward managed care, the State should adopt rigorous, senior, adult, child
and youth-focused behavioral health metrics that monitor plan and network access
and performance, ensure high quality care and gauge short and long-term
outcomes; commit to periodically convening plans, networks and providers to work
with State and local government to publicly issue reports on utilization,
capacity and other quality and performance measures
- APG rates with an inflation adjuster should be continued until 2020, unless
and until the Commissioners of the Office of Mental Health, the Office of
Alcoholism and Substance Abuse Services and the Department of Health together
develop and certify an alternative Value Based Payment methodology that is
actuarially sound and will provide reimbursement to providers at rates that are
at least comparable to current Medicaid rates (APGs) and
- Add $100 million to the budget to create a pool of funds to address provider
cash flow issues stemming from transition to Medicaid Managed Care.
This section of The Coalition’s agenda has been converted to “Article VII” language so that it may be adopted by the legislature as a
budget bill. Otherwise, it could be delayed until the post-budget period to be
passed as a “standalone” bill.
The Coalition’s agenda also included some issues not related Medicaid managed
care, such as:
- Creating 30,000 units of supportive housing under a NY/NY 4 initiative
- Delaying the e-prescriptions mandate for one year
- Extending the unlicensed practice exemption to 2020 and
- Added funding for OMH licensed and non-licensed supportive housing.
Although we had many appointments and were occasionally spread a little thin,
everyone consistently stayed on message. Ellen Wageman of Catholic Charities
said, “This was one of the best Albany Days I can recall. We we’re all in synch
and no one used the opportunity to promote an individual agency’s interests.”
The trip was well-timed, as the Governor’s Executive Budget had been released
just prior to the visit. The Coalition’s analysis of the budget proposal can be
We thank our members who were in attendance and those who provided advice but
could not make the trip. The Coalition is following-up with legislators and
agency staff to continue pushing our agenda until the session concludes. We hope
that our efforts on the ground in Albany and from New York City will lead to a
While some of our priorities have not appeared in the Assembly’s “one-house”
budget bills and as we review the Senate’s bills, there are still opportunities,
including post-budget, to continue to advocate for our agenda.
In this edition: