NYS Council Budget Discussion and Requests – 2019

Our Top Priorities: Stabilize Mental Health and Substance Use Disorder/Addictions Workforce to Preserve Access to and Continuing of Care for New Yorkers in Need.

Our preliminary list of priorities includes the items below, however, we are always poised to respond to changing conditions, opportunities, and concerns from our members.

 

Our Context

Simultaneous Public Health Crisis

  • Opioid Epidemic
  • Suicide

Catastrophic workforce shortages up and down the agency roster in even the largest agencies including those in urban, suburban, and rural settings.

Rates that do not cover actual costs and result in staff stealing and inability to recruit or retain.

Regulatory barriers that severely limit integrated services, creativity, etc.

Increased reliance on CBOs to divert from acute care and serve New Yorkers.

 

Budget/Legislative Requests

Investment in our Workforce and Quality Care go Hand in Hand

  • 2.9% (CPI) increase for our workforce
  • Appropriate $169 mil for a Workforce Recruitment and Retention Fund that includes loan forgiveness, scholarships, retention bonuses, etc.
  • Flexibility in SED regulations and ability for LMCHs, LMFTs, etc. to practice at top of license.
  • Allocation of currently unspent DSRIP Workforce funds to CBOs with accompanying directive from State to PPS’ mandating disbursement.
  • Populate stakeholder workgroup to identify formula for preservation and re-allocation of all revenues associated with legalization of adult use of marijuana to OASAS before new revenue begins to flow.
  • Continue Statewide Healthcare Facilities Transformation Grant initiative and increase set-aside for community-based organizations (CBOs).

Insurance Reforms are Imperative to Preserve Access to Care and Deliver on NYS’ Commitment to Parity Enforcement

  • Enhance State commitment to surveillance and enforcement of MHPEA via allocation of increased resources for DFS to conduct field audits.
  • Focus on enforcement of NQTLs
  • Take aggressive action against Beacon and other MCOs that fail to comply with the law.

BEACON:
- Denials on clean claims
- Failure to load rates in a timely manner
- Failure to receive claims and assign to correct program/provider despite having NPI number
- Failure to pay full APG rate
- Violating attestation regarding full APG payments

  • Inpatient access issues must be resolved to ensure continued access to acute services in local communities across New York.
  • Commercial insurance rates must be brought on par with MMC rates to resolve continued discrimination faced by these beneficiaries.
  • Continue timely and full payment of APG government rates until cost based methodology is implemented.  Immediately populate Workgroup to Examine CCBHC and other payment models –> cost based care

Major System Transitions Require New Investments and Enhanced Surveillance and Monitoring

  • Children’s Transition into Medicaid Managed Care: Adequately resource children’s transition to include implementation of 6 new services.
  • Children’s Transition: Enhance surveillance and monitoring of protective indicators that “red flag” children/families that may be falling through the cracks during this major system transition to include MMC implementation.
  • In the event CCBHC Demo is not extended by federal government, NYS must fully fund this ongoing initiative and expand it to other qualified organizations.

BHCC-IPA Agenda

  • Revise NY’s definition of what constitutes a valid VBP Level 2&3 arrangement to require participation by one of more legal entities that have met criteria for funding as BHCC.
  • Promulgate Network Adequacy criteria for entities entering into VBP 2&3 contracts to ensure Medicaid beneficiaries have access to behavioral health care.
  • Enable BHCC access to the Master Medicaid Data Warehouse.
  • Include a data sharing requirement in future contracts with MMC plans and PPS’ so that BHCCs can access necessary utilization, cost, and other data at no cost.