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Behavioral Health Providers Press Concerns on Medicaid Consolidation & Managed Care PDF Print E-mail
Friday, 01 March 2013 03:47

While legislators at Wednesday’s Joint Budget Hearing on Mental Hygiene focused on local impacts of the Governor’s plan to downsize and restructure the State’s psychiatric hospitals, community-based behavioral health providers and advocates pressed a very different – and in their view absolutely critical -- set of concerns.

Topping the list of issues were the potential risks to New York’s network of community-based behavioral health services if the State’s Offices of Mental Health (OMH) and Alcoholism and Substance Abuse Services (OASAS) were to step back from providing meaningful policy guidance and programmatic oversight as part of both a proposed consolidation Medicaid services under the Department of Health (DOH) and the planned transition of high-risk of populations, including those with severe mental illness and addictive disease, into Medicaid managed care.

“As the behavioral health system moves towards managed care and integration with primary health services, we cannot stress how important it is for the State behavioral health agencies (OMH and OASAS) to have meaningful input in this policymaking process,”  said Jason Lippman, Senior Associate for Policy and Advocacy at The Coalition of Behavioral Health Agencies.  “Both of these agencis should be full partners with DOH in decision making in their respective areas of expertise.  It is here that the wisdom and know-how resides, not only to oversee the delivery of community-based services for children and adults with sever mental illness and chronic substance use disorders, but the specialized knowledge andexperience of how to best provide rehabilitation and recovery services to these high-need populations.

“The 2013-14 Executive Budget proposes to consolidate all Medicaid administration activities into the Department of Health, including activities related to Medicaid managed care plans, rate setting and claims processing activities,” Lippman continued.  “Medicaid consolidation must include mechanisms to ensure that the individual state agencies like OMH and OASA rmaintain policy and programmatic responsibilities in order to insure that our Medicaid recipients make a successful transition into Managed care and that appropriate services are delivered at appropriate levels to suit individual consumer needs…”

One Executive Budget proposal raised particular concerns about a possible move to unfettered managed care.

Until relatively recently, there had been no State control over the rates paid to community behavioral health providers by Medicaid Managed Care plans. “Our members were dropping their contracts…because the rates being paid were ¼ to ½ of the Medicaid fee-for-service rate,” said Lauri Cole, Executive Director of the NYS Council for Community Behavioral Healthcare.  “We were concerned with issues of network adequacy and access to care for clients in need.”  In response, legislators had passed a provision in the FY2010 budget which both funded and required the Medicaid Managed Care plans pay providers the Medicaid ambulatory patient group (APG) fee-for-service rate.  The new requirements became effective effect in September of 2012.

The Governor’s Executive Budget, however, sunsets these requirements on March 31, 2015.

“At this time, we find no protections built into the budget or in statues that would ensure the rates won’t precipitously drop on the day our system changes over to a managed service delivery and payment model,” said Cole. “It happened once before due to a lack of government oversight and we are very concerned it will happen again.”

“Ending the pass-through at this juncture, when the community based behavioral health sector is beset by change and multiple fiscal challenges, will financially impair community based organizations, eroding services and severely limiting access to mental health and substance use clinic services by consumers,” said the Coalition of Behavioral Health Agencies’ Jason Lippman.  “We urge the Legislature to extend the proposed sunset to at least March 31, 2017.”

“The NYS Council asks… (for) a two-part plan that will embed some badly needed consumer protections into the transition to behavioral health managed care,” said Cole.  She urged that DOH in conjunction with OASAS and OMH implement “a two-year study that measures certain protective indicators during the early days of managed care” and only then,  once the Legislature is satisfied that the behavioral healthcare outpatient system is functioning reasonably well and appropriately meeting the needs and demand for services, “government may  sunset the government rates.”

NYNP will continue to report on more of the many issues raised by providers and advocates at the Joint Mental Hygiene Budget Hearing --including social work licensing issues, SAFE Act reporting requirements, reinvestment and the needs of the children's mental health services system -- in next week’s NYNP E-Newsletters.

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