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.

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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.

The 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 rollout.

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, 2015.

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 been enacted.

The Coalition Devotes 2 Days to Albany; Advocating for its Behavioral Health Agenda

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 included:

  • 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 found here.

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 successful outcome.

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: