NYS New Behavioral Health Ombuds Program

October 8, 2018

 

Dear NYS Council Members:

 

We have some exciting news to share!

 

New York’s enacted FY’19 State budget included new funding for a first of its kind Substance Use Disorder and Mental Health Ombuds Program.  This Program is designed to assist New Yorkers who are experiencing problems accessing their substance use disorder and/or mental health insurance benefits or understanding their rights as beneficiaries.  We are delighted to announce that the NYS Council is partnering with Community Service Society (CSS) and The Legal Action Center on this groundbreaking new program.   

 

Here in Albany, and around the state, the NYS Council is recognized for our strong and persistent advocacy addressing the statutory, policy, and practice barriers that delay/deny access to and continuity of care for the children and adults we serve.  For over a decade, we have worked with State government leaders to address provider issues with timely and full payments by insurers and we have secured agreements with government representatives that brought parity to Medicaid Managed Care and Child Health Plus rates.  We secured rate continuity through the transition to Medicaid Managed Care (MMC) for mental health and substance use disorder/addiction providers via the advancement of APG government rates, and we have advocated for enhanced surveillance and monitoring of insurers that has resulted in additional/increased requirements on MMC and commercial insurers regarding their use of prohibited contract clauses.  It is our effectiveness advocating on behalf of substance use disorder/addictions and mental health consumers and the providers that serve them that has led us to this unique opportunity.

 

The NYS Council will be providing consultation, education, training, and technical assistance to the organizations selected to respond to Helpline callers.  In addition, along with our partners at The Legal Action Center, we will also provide policy leadership designed to address necessary reforms that become clear to us as we collect aggregate data, and see trends related to access to care and other barriers.  To assist us with these tasks we’ve hired Lynn Goldberg, LCSW as our new (full-time) NYS Council Ombuds Project Specialist.  Lynn has strong credentials as a clinician and has also worked for several New York-based managed care organizations at the administrative and operational levels.

 

Community Service Society (CSS) operates many Ombuds-like programs and services and will provide the infrastructure required to make these services available to all New Yorkers.   The CSS model for operating these types of programs includes contracting with community-based organizations (CBOs) around the state that have experience assisting healthcare consumers.  CSS will also contract with legal experts such as the Legal Aid Society and the Empire Justice Center who will provide counsel to helpline clients who need representation and assistance through the appeals and fair hearing processes.

 

We are humbled to be in such good company as we begin to implement this game changing initiative.  We wanted to share this hopeful news with you today.

 

 

Lauri Cole, Executive Director
NYS Council for Community Behavioral Healthcare