An Evolving Semi-Monthly Update on Community Mental Health in New York
July 09, 2009
Coalition Honors Leaders at 25th Annual Awards Reception
On June 25, 2009, The Coalition of Behavioral Health Agencies celebrated its 25th Annual Leadership Awards Reception. The event honored outstanding individuals and groups for their outstanding leadership and commitment to improving the lives of people with behavioral health disabilities, for helping to promote their recovery and for dedicated efforts to preserve and nurture New York’s community behavioral health sector.
The Coalition presented Leadership Awards to the Honorable David A. Paterson, Governor of New York State (NYS Office of Mental Health Commissioner Michael Hogan accepted the award for the Governor); also feted were the Honorable Peter M. Rivera, Chair, Committee on Mental Health, New York State Assembly, Honorable G. Oliver Koppell, Chair, Committee on Mental Health, Mental Retardation, Alcoholism, Drug Abuse and Disability Services, New York City Council, and the Executive Committee of Timothy’s Law Campaign (TLC). The Coalition also bestowed, for the first time, Membership Service Awards to Boris Vilgorin, Associate Vice President, Business Development, F.E.G.S., and Todd Schenk, Director of Budget and Strategic Ventures, Jewish Board of Family and Children’s Services (JBFCS). We also honored our own Patricia Feinberg, Peer Educator, The Coalition of Behavioral Health Agencies.
The Coalition’s 2009 Leadership Awards Reception, held at Pfizer World Headquarters at 235 East 42nd Street, is an annual event to honor the people and organizations who have made significant contributions to raising community awareness of mental health and substance abuse issues, and to serving people with psychiatric and addictive disorders. Here is a transcript of the event’s closing remarks by The Coalition’s Executive Director Phillip A. Saperia, and photos of our Leadership Awards Reception.
On June 19, 2009, The New York City Council voted to adopt the City’s fiscal year 2010 budget at $59.4 billion. The Coalition is pleased that funding for key programs that we advocated for at City Hall were maintained at or near fiscal year 2009 levels. Please see the chart below for a comparison between funding for fiscal year 2010 in comparison with fiscal year 2009.
Full funding for the Geriatric Mental Health Initiative was restored in FY 2010 to the 24 agencies that received funding in FY 2009. Since the other programs listed above received marginal cuts, the City Council will designate provider allocations after budget adoption. The Coalition is speaking with City officials to make sure that our members continue to receive funding, and will keep you updated on this process. The Coalition wishes to thank the City Council Members and staff on the Mental Health and Finance committees who worked and met with us during the FY 2010 budget negotiating process, as well as our members who participated in briefings, press conferences and their own individual advocacy efforts!
Today the New York State Senate settled a month long leadership struggle which has stalled legislation that State localities and behavioral health providers depend upon. Senate Democrats held a press conference to announce their new conference leaders. As such, Senator Pedro Espada, Jr. will be the new Majority Leader, Senator Malcolm Smith will be President Pro Tempore and Senator Sampson will be Conference Leader. The Coalition will keep you updated on whether the new resolution will improve circumstances.
While Senate leadership issues were being worked out, bills such as Timothy’s law were awaiting a vote. Timothy’s Law requires group health insurance policies to offer parity in benefits for consumers who seek treatment for mental health conditions. It is scheduled to expire December 31, 2009. The Senate stalemate also held up local budgets, which depended on legislative approval for revenue bills to avoid making further cuts to human service programs. In New York City, Mayor Bloomberg has issued a hiring freeze on all non-essential city personnel, and has placed all contracts over $100,000 that have not yet gone to the Comptroller’s Office under review and maybe on hold. The City is exploring which contracts are considered non-essential services, including those for nonprofits and community services. According to the Mayor, the Senate leadership debacle will cost the City $60 million in July as the City waits for State legislative approval to raise the sales tax rate proposed in the Mayor’s fiscal year 2010 budget. The Coalition will keep you updated on how this policy will impact community-based behavioral health services.
OMIG Provider Compliance Regulations Take Effect July 1, 2009
On June 24, 2009, final provider compliance regulations Part 521 were published in the NY State Register. With an effective date of July 1, 2009 providers have 90 days to develop and implement compliance programs.
The regulations apply to all persons subject to the provisions of articles 28, 36, 16 and 31 regardless of amount of Medicaid income. In addition, other persons, providers, or affiliates who provide care, services or supplies for, or on behalf of another person, are required to comply when it is expected that at least $500,000 in claims or orders in a consecutive 12 month period can be reasonably expected.
Compliance programs must include policies and procedures covering billing, payments, medical necessity and quality of care, governance, mandatory reporting;, credentialing and other risk areas that are or should be identified by the provider. These may be a component of a more comprehensive compliance program. Please refer to the regulation for detailed compliance requirements: http://www.omig.state.ny.us/data/images/stories/provider_compliance/adopted_regulations_521.pdf. Providers will be required to certify annually to the OMIG that they have the required compliance programs in place.
President Obama has expressed his commitment to working with Congress to enact comprehensive health reform this year. He has asked Congress to have a bill on his desk by October 15, 2009. Several Congressional committees that have jurisdiction over health reform have put forth comprehensive healthcare reform proposals. The Kaiser Family Foundation has posted a side-by-side comparison tool that compares the leading comprehensive health reform proposals across a number of key plan components, including the House “Tri-committee” bill and the Senate Health, Education, Labor and Pensions Committee (HELP) bill.
On June 17th, the Senate HELP Committee began its markup of the Affordable Health Choices Act and has already considered more than 200 amendments. The bill includes “mental health and substance abuse services” and “rehabilitative and habilitative services” as essential health care benefits. In an effort to reduce the cost and introduce a bipartisan bill, the Senate Finance Committee has yet to release their proposal. The committee is expected to release their bill sometime next week. Senate leaders are still hoping to merge the Senate HELP and Finance Committee bills and vote on the full bill prior to the August recess.
In the House of Representatives, the Education and Labor, Energy and Commerce, and Ways and Means Committees, all of which have jurisdiction over health reform legislation, have produced a Tri-Committee Health Reform Discussion Draft. In the proposal, “rehabilitative and habilitative services” and “mental health and substance use disorder services” are included in the essential benefits package. House leaders expect to bring the bill to the floor for a vote during the week of July 27. The Coalition will continue to monitor the progress of health reform legislation and push for the inclusion of mental health and addiction parity.
Around the Water Cooler
Commissioner David A. Hansell of the NYS Office of Temporary Disability Administration (OTDA) has resigned from his post effective June 26, 2009. Commissioner Hansell will become Principal Deputy Assistant for Children and Families in the U.S. Department of Health and Human Services (HHS). The Coalition wishes him good fortune and success in his new position in health services at the Federal level.
The Coalition congratulates three of our members: Goodwill Industries of New York and New Jersey, Good Shepherd Services and Henry Street Settlement for being selected by the New York State Department of Education in round 5 of the 21st Century Community Learning Centers (CLC) program. The CLC program uses federal dollars to support the operation of programs like tutoring and other academic enhancement activities during non-school hours. CLC programs focus on enriching students who attend high-poverty and low-performing schools. A total of 60 programs will receive contracts totaling $33.2 million over a five-year period from July 1, 2009 through June 30, 2014.
When: July 15, 2009 | 9–11:30am
With New York’s mental health system currently undergoing enormous reforms, agencies face an uncertain future. During these times, it is critical that organizations employ the correct strategies and best practices necessary to ensure that their agency successfully manages these challenges.
North Carolina has undergone a 100% transformation with the passing of legislation to reform mental health services in 2001. Complicating the transition were major shifts in service delivery requirements, cost finding, and substantial new accreditation standards. This presentation will assist executive staff in looking at obstacles as opportunities and providing solutions based on practical examples to weathering storms of all types in this challenging economic and system reforming environment. Presentation topics will include:
The speaker, Gene Rodgers, is President of the North Carolina Providers Council and Vice President of a private community service agency providing mental health, developmental disabilities and substance abuse services. This presentation is sponsored by Aym Technologies, LLC.
Register online now at http://www.coalitionny.org/prof_learn_ctr/training/series.php?series_id=1091
The Coalition has learned of several auditing concerns that the State Office of Mental Health (OMH) has been alerted to or involved in. Below is a summary and recommendations.
Rehabilitation Services Reauthorizations – Office of Medicaid Inspector General (OMIG) auditors are finding client summaries (service plan reviews) missing at the time of reauthorization [MH Part 593.6(g)]. A doctor’s signature on the client summary must be in the file; checkboxes on the reauthorization are not sufficient. OMH also recommends reauthorizing services in cases where a client changes the level of care from lower intensity to higher intensity and vice versa.
Reason Code 10 Administrative Delay in Prior Authorization Process – The OMIG has agreed to review records related to claims submitted with “Reason Code 10” to explain the delayed billing rather than disallow them automatically. Providers must have documentation to support a valid reason for submitting a claim more than 90 days after service provision. It is unknown just what the OMIG will consider as a valid reason for delayed billing, however, they have indicated that delayed billing caused by software problems is not an acceptable reason to delay submitting a claim. OMIG may consider documentation from software vendors indicating that the needed changes could not be made in time. If you believe you have a compelling case for delayed billing, OMH has the authority to provide authorization for an additional 90 days delayed billing for very specific reasons. Please see OMH contact information at the end of this article.
Continuing Day Treatment (CDT) – OMH has taken issue with the way OMIG is interpreting CDT regulations prior to the April 1, 2009 changes, which say reimbursement is based on a visit that may last from 1 to 5 hours. OMIG apparently says that a service has to be provided every hour. OMH and OMIG are currently in discussions about this matter.
Audit Medicaid Integrity Contractors (Audit MICs) – OMH announced that federal Audit MICs will be looking at 300 New York State providers to identify overpayments and ultimately decrease payment of inappropriate Medicaid claims. Audit MICs have the authority to request copies of records, often via a letter. They also have the authority to request interviews with office personnel and access facilities. Any Medicaid provider may be audited, including fee for service providers, institutional and non-institutional providers, and managed care organizations. Providers are selected based on data analysis by CMS contractors and referrals by State agencies. For more information about these types of audits go to the CMS website at: http://www.cms.hhs.gov/FraudAbuseforProfs/Downloads/mipproviderauditfactsheet.pdf.
NY State Comptroller Audits – The Comptroller’s office has discovered that some doctors who work both in private practice and a clinic have filed separate private practice claims for services they provided in the clinic, resulting in same day duplicate billings.
If you are one of the agencies being audited by Audit MICs, or have other audit questions, please contact Melissa Janidlo at OMH Cofpmmj@omh.state.ny.us or (518) 474-6911.
Coalition Testifies at City Council Hearing on Clinic Rate Reform
On June 22, 2009, The Coalition testified and submitted written testimony at the New York City Council’s Committee on Mental Health, Mental Retardation, Alcoholism, Drug Abuse and Disability Services chaired by G. Oliver Koppell. The committee conducted a hearing on the clinic reimbursement restructuring initiative, which is currently being undertaken by the State Office of Mental Health (OMH). Members of the Committee have been very concerned about the potential impact of clinic reform on New York City’s neighborhoods and mental health workforce, as are we. The reform is scheduled to be phased in on January 1, 2010, yet many important issues still remain unresolved, including actual rates, equivalence for public and private health insurance reimbursement and billing and technology related issues. The Coalition is preparing a “bill of particulars,” outlining all of our concerns, which we will share with OMH and members.
According to a report released by NYS Comptroller Thomas P. DiNapoli, the rate of late not-for-profit contracts issued by State agencies may be as high as 87% forcing agencies to perform services without a registered contract or payments. Please see late contracts breakdown by region and organization. The Office of the State Comptroller (OSC) looked at a random sample of 95 late grant contracts and found the following trends:
Due to ambiguities in the law and different interpretations of its use, state agencies failed to make these payments. Based on the findings of the report, DiNapoli has proposed new regulations to ensure not-for-profits are paid interest required by law when their contracts are processed late, as well as recommendations to improve the contracting system.
The Coalition applauds Comptroller Thomas DiNapoli for his efforts to reform the New York’s States contracting process with human service entities.
State Stimulus Tracking: Last week, DiNapoli announced that the public can now track how New York is spending federal stimulus funds on his Web site Open Book New York. The website includes information about which companies were awarded federal stimulus dollars, received payments and the value of their contracts.
On June 26, 2009, The Coalition of Behavioral Health Agencies submitted comments on the definition of “Meaningful Use” of electronic health records (EHR) to the Office of the National Coordinator for Health Information Technology (ONC). The American Recovery and Reinvestment Act of 2009 (ARRA) provides Medicare and Medicaid incentive payments to eligible providers, such as physicians and hospitals, in order to promote the adoption of EHR’s. In order to receive the incentive payments, providers must demonstrate “meaningful use” of a certified EHR. The Coalition urged ONC to include community-based mental health and addiction providers in all federal Health Information Technology (HIT) funding initiatives to ensure that individuals with mental illnesses and addictions have access to the overall health benefits of provider usage of HIT. In addition to our letter, the Coalition is working with members of Congress to include HIT funding initiatives for community-based mental health and substance abuse providers in healthcare reform legislation.
Last week, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced that the administration will rescind several harmful Medicaid regulations including: school-based administration/transportation final rule, outpatient hospital services final rule and a partial rescission of the case management interim final rule. The announcement was published in the Federal Register on June 30th. HHS also announced that they will delay the enforcement of portions of a regulation that clarified limitations on health care related tax programs. The announcement was published in the Federal Register on June 30th. Each of these rules, in whole or in part, had been subject to Congressional moratoria set to expire on July 1, 2009.
Coalition Members advertise staff positions for free on The Coalition’s Job Board! Here's a sample: