An Evolving Semi-Monthly Update on Community Mental Health in New York
August 4, 2009
Governor Signs Bill to Advance Managed Care Reform
Governor David A. Paterson signed into law three program bills on July 29, 2009 to make health insurance more affordable and improve healthcare access. One of the bills, Program Bill #13 or A.8402/S.5472, which is also known as the Managed Care Reform Act of 2009, expands a series of protective provisions for consumers and providers, including stipulations on billing, payment and recoupment. Most of the bill’s reforms are effective January 1, 2010.
The bill requires providers to submit claims to managed care and insurance companies within 120 days. It also requires a 30 day payment limit for claims submitted electronically. Claims submitted on paper or via fax will remain subject to the current 45 days requirement.
Providers will also be able to request consideration of a claim that was rejected because it was submitted after the deadline. The bill would require providers to demonstrate that non-compliance was due to an unusual occurrence and that they generally submit claims within the required timeframes. However, in this case, the health plan may reduce payment by 25%.
Protections against overpayment recoupments would also be extended to hospitals, home care agencies, diagnostic and treatment centers, mental health facilities and other licensed healthcare professionals. This means that behavioral health providers would also be able to challenge overpayments and enter into dispute resolution and arbitration.
As part of its 5 year strategic planning process, the NYS Office of Alcohol and Substance Abuse Services (OASAS) will hold dialogues for counties, providers and constituent groups to offer their input on planning and service system issues. This year, OASAS Commissioner Karen M. Carpenter-Palumbo will be hosting three dialogues to discuss the “Statewide Comprehensive Plan 2009-2013: A Strategic Plan for New York State's Addiction Services System.”
On Wednesday, August 12, 2009, from 10:00 am – 12:00 pm, the planning dialogue scheduled in Albany will be available via webcast at: http://streaming.aanet.org/ramgen/nyoasas/NYOASAS_AP081209.smil. Questions pertaining to this dialogue may be submitted in advance, or during the webcast by sending an email to email@example.com.
On Wednesday, September 2, 2009 from 1:00 pm – 3:00 pm a planning dialogue will be held in New York City at 501 7th Avenue, Main Conference Room, New York, NY 10018. For more information please access the OASAS planning dialogue webpage. A summary of OASAS’s long-term planning and service system issues please can be found in the OASAS 2009 Priorities document, which is available online.
The latest news on the State’s fiscal condition and the latest news is not encouraging. Last week, Governor David Paterson announced that an Economic and Fiscal Recovery plan will be released in September to eliminate the State’s current year 2009-10 $2.1 billion deficit and improve the state’s long term fiscal standing. Next year’s 2010-11 budget deficit is estimated at approximately $4.6 billion.
The Division of Budget (DOB) released its First Quarter Update to the State Financial Plan indicating that the major factor contributing to these deficits is a decline in revenues. Personal income tax receipts fell by 35%, or $4.2 billion, in the first quarter of 2009 when compared to the same period in 2008. State sales tax revenues are also reported to be down 6% or $159 million below budget forecasts. This shortfall will also have negative impacts on local governments, which also rely on help from State sales tax receipts.
DOB also reported that wages earned by state residents are projected to decline by 4.8% in 2009, the largest such reduction ever recorded. Since August 2008, a total of 236,000 jobs have been lost in the state. Furthermore, State unemployment figures are projected to peak to 9.1% during 2010.
According to our government relations consultants, all of these factors indicate that organizations that rely on State funding should brace themselves for potential reductions in expected funding from the State and for a series of potential budget cuts in early September when the Legislature returns to regular session. We do not know where the Governor or Legislature would focus potential cuts, but will be keeping a close eye on this situation and report to you immediately when any information becomes available.
In July, 2009 the Coalition was awarded a grant by the New York State Office of Mental Health to facilitate MBI-WPD enrollment in New York City and surrounding areas. Dramatically underutilized, the MBI-WPD is an innovative program that allows consumers to work, earn wages in excess of limits imposed by standard Medicaid rules, and keep vital health care coverage. Our effort is being undertaken as part of New York Makes Work Pay, a statewide initiative intended to dramatically increase employment outcomes for New Yorkers with disabilities. In order to enroll as many eligible consumers as possible, we plan to conduct extensive outreach to providers over the next six months. Stay tuned for more information.
House Moves One Step Closer to Passing Healthcare Reform Legislation
On Friday, July 31st the House Committee on Energy and Commerce passed The America’s Affordable Health Choice Act (HR 3200). The legislation includes an amendment introduced by Congressman Engel and Matsui that creates a definition of Federally Qualified Behavioral Health Centers (FQBHC) and allows for the creation of national standards and benefits. In June, the Coalition began working with Congressman Engel on the concept of FQBHC’s. This is a first step to bringing behavioral health to the forefront of healthcare reform and enhancing mental health and addiction treatment services.
The Coalition will continue to advocate, along with our D.C. allies, with members of Congress to ensure that this amendment is included in the final healthcare reform bill. Senator Baucus, chairman of the Senate Finance Committee, has indicated that his committee will not vote on healthcare reform prior to their August recess which begins this Friday, August 7th. House Democratic leaders have stated that they want to bring HR 3200 to the floor for a vote in September. We urge you to reach out to your Member of Congress during the August recess and urge him/her to vote “yes” for healthcare reform legislation. Click here to find out who your member of Congress is.
The Coalition’s Center for Rehabilitation and Recovery has created an instruction sheet to assist providers in using the new PROS fiscal tool developed by the New York State Office of Mental Health. The fiscal tool is designed to help providers analyze the feasibility of starting a PROS program.
To download the PROS fiscal tool and the instruction sheet, visit our website at: http://coalitionny.org/news_resources/pros/#pros_fiscal_tool. (Please note: for those people who will be directly typing this URL into your browser, the spaces between ‘news’ and ‘resources,’ ‘pros and fiscal,’ etc. are in reality underscores “_”.)
Around the Water Cooler
The Coalition wishes a fond farewell to Marc Kutner, Director of Special Initiatives in The Coalition’s Center, as he joins one of our prominent members, Services for the Underserved.
Dennis Whalen will resign as Director of State Operations in the Paterson Administration on September 8, 2009 and become the Executive Vice President of HANYS. The new State Operations Director will be
The Children's Aid Society announced the appointment of Richard R. Buery, Jr. as the agency’s new President and Chief Executive Officer. He will succeed C. Warren Moses, who will retire at the organization’s annual meeting in October. The Coalition sends good wishes to Mr. Moses, and welcomes Mr. Buery to his new post.
The Jewish Board of Family and Children’s Services (JBFCS) raised over $400,000 in its very first Hudson Valley Bike Ride on July 19, 2009, surpassing its original $250,000 goal by more than 60%.
The Brooklyn Bureau of Community Service was awarded $1 million in capital funds from Brooklyn Borough President Marty Markowitz to enhance its headquarters at 285 Schermerhorn Street in downtown, Brooklyn.
FEGS is offering free seminars for jobseekers, in New York City, Long Island and Westchester. For more information and to register, please go to www.parnossahworksFEGS.org/events or call 212-524-1790.
Services and Advocacy for LGBT Elders (SAGE) of New York was among 6 organizations from around the nation to be honored with the 2009 National Family Caregiving Awards, sponsored by the National Alliance for Caregiving and the MetLife Foundation.
The Emma L. Bowen Community Service Center (aka Upper Manhattan Mental Health Center, Inc.) will be holding a Community Health Fair on Friday, September 18, 2009 at 1727 Amsterdam Avenue, New York, NY from 10am to 4pm. The event will include free screenings, information and referrals, with games, prizes and giveaways. Call (212) 694-9200 from more information.
The Guidance Center of Westchester will be holding an event to "Celebrate the Charitableness of Our Community" to support their Latino Family Services on Thursday, September 24 at 6pm. The reception will include a buffet dinner, drinks, live music, dancing and raffles. To learn more about The Guidance Center’s Latino Family Services, please access their webpage now!
Coalition members may now post events for free on the Coalition website http://www.coalitionny.org/members/events.php.
Coalition staff attended an OASAS forum-style event on July 29, 2009 to learn more about navigating the managed care and insurance system for alcoholism and substance abuse treatment. This workshop linked OASAS offices in New York City, Albany and Rochester via webcast, and included presenters from OASAS and OASAS-licensed clinics who discussed tools to help providers negotiate the system of contracting, utilization review, and billing.
ARRA Funding for Health Professional Scholarships and Loan Repayment Programs
In past editions of Briefs, The Coalition has been providing you with updates on funding available through the stimulus package or American Recovery and Reinvestment Act (ARRA). Included in ARRA is $500 million to support and enhance health professionals. Applications are currently being accepted by the Health Resources and Services Administration (HRSA) for $200 million worth of grants, loans, loan repayment, and scholarships, specifically for healthcare professionals. The funds are expected to train approximately 8,000 students and credentialed health professionals by the end of FY2010. Since most of the money will be allocated to educational organizations, members are encouraged to partner with academic institutions to identify training opportunities in community-based organizations.
An additional $300 million in ARRA funding will be directed towards the expansion of HRSA's National Health Service Corps. The Health Service Corps. provides scholarships and loan repayment opportunities for primary care organizations serving areas that have a shortage of health professionals. Regrettably, like much of Federal ARRA funding, behavioral health providers are not included! The Coalition is working with allies to correct this unfortunate omission. For more information please visit the HRSA website.
With a downturned economy, many New Yorker’s are finding it difficult to keep prescription drug coverage. So that individuals do not stop taking the medicines they need even if they become unemployed, The Partnership for Prescription Assistance (PPA) offers useful resources to individuals and advocates looking to maintain coverage at www.pparx.org or at 1-888-4PPA-NOW.
Additional listings for prescription assistance programs can be found on the Coalition website at http://www.coalitionny.org/news_resources/prescription_drug_benefits/.
The NYC Department of Health and Mental Hygiene (DOHMH) has produced a new DVD on drug overdose prevention and intervention. The 12-minute long DVD is available in English and Spanish, and takes a look at overdose prevention, risk factors and the administration of an overdose reversal drug called naloxone or Narcan, prevention and overdose. To obtain a copy please contact Anne Siegler at firstname.lastname@example.org.
Coalition Members advertise staff positions for free on The Coalition’s Job Board! Here's a sample: