Discussion with OMH Leads

May 22, 2020

Good afternoon, 

Today, during a call hosted by OMH leads for provider association leads, I asked Bob Myers to discuss some of the thinking at OMH and the more specific tasks and activities going on inside the Office in an effort to advance our system of care given the enormous changes that have occurred as result of the COVID-19 crisis as well as the plans that were in the works prior to this crisis.

Continued Use of Telehealth Modality – OMH officials were not able to provide a specific date that they will issue guidance to the field around the continuation of telehealth/telephonic practice in OMH programs and services.  Right now, the Executive Order that continues the flexibility that we have been granted re: telehealth / telephonic modalities for care is set to  expire on June 20.  OMH is currently preparing a list for the Governor’s Office of recent Executive Orders that would need to be extended to allow continuation of telehealth / telephonic flexibility that have been granted during the emergency period.  It sounds to me as if leads at OMH are fully committed to advancing our requests for both extensions and permanent orders that will permit providers to continue to offer services using these modalities.  In both cases (an extension and/or permanent changes) we should expect OMH to issue accompanying guidance that addresses clinical aspects associated with the continuation of these services including when you can use them, etc.  Ultimately, decisions around permanency of the emergency regs, on a variety of topics, will depend on several factors including the data and interviews OMH is currently conducting with providers around the state.  These interviews include such topics as how the introduction or expansion of telehealth/telephonic modalities has impacted access to care and early outcomes.  Note:  These discussion have gone beyond the topic of telehealth/telephonic to cover other changes providers have experienced and regulatory changes they have appreciated during this time period.

OMH System Reform – In addition to the telehealth discussion, we also talked about reform activities OMH is currently engaged in to envision and implement a more accountable system of care, during this crisis and beyond.  Bob Myers discussed the following discussions going on at SOMH, several of which have moved beyond just discussion as of today: 

• Move OMH Outpatient Clinic Services out of the (federal) Clinic Option to the Rehab Option, thus allowing more flexibility in clinic services to include off site services and peer services (this is a concrete plan that is moving forward and will require a SPA amendment to CMS).
• Reform the model for HCBS services to more of a direct care rehabilitation service that does not rely as heavily on Health Home or Care Management assessments in order to access immediate direct care.
• Find a way to connect Health Home+ services to the rest of the system in a manner that might resemble the ICM model of care.
• Look at PROS and re-constitute it to more of a mobile service with the opportunity to offer virtual technology for PROS group services.
• Answer the question as to how providers can effectively deliver rehabilitation services telephonically.
• And finally, find a way to pull these services together in an integrated network of care through a variety of platforms including (but not limited to) BHCC/IPA networks,  CCBHCs and CCBHC extension grant agencies that already operate most of the services discussed here, and find a way to incentivize certain provider behaviors within an integrated model of care.

Caveats:  All of these plans will be impacted by the bottom line, which is that OMH only has the money it is working with now to make all these changes, and much will depend on whether State cuts (as discussed by the Governor in the Financial Plan he outlined about a month ago) include Medicaid Program cuts, and major local assistance reductions that impact our system.

Impact of PPP on CFR Reporting – There is no specific timeline, but OMH will be notifying providers that while your PPP award remains in the ‘loan’ stage, you do not need to report any of the revenue on the CFR. For NYC providers where the fiscal year ends on 6/30 receipt of a PPP Loan should have no implications.  *OMH will be developing a CFR amendment to collect relevant information in the future, after the conditions of the loan have been met and the federal government certifies that the loan has been forgiven.

Impact of PPP Award on State Aid – OMH is focused on ensuring that what they ultimately require in terms of PPP reporting and claiming is logical.  They are still discussing internally how to handle PPP loans (that have been forgiven) in close out reporting. They seem to be contemplating this alongside a parallel discussion they have been having regarding ‘agency reserves’.  OMH has been working to come up with a definition and logic around appropriate use of ‘agency reserves’.  Today it sounded as if the state will ultimately identify and provide guidance around legitimate uses of agency reserves. It is conceivable that PPP loans that have been forgiven may ultimately be seen as contributing to agency reserves making these funds subject to state regulations on the topic.