Survey Questionnaire re Financial Issues during COVID-19 Emergency

May 7, 2020

In mid-March the Department of Financial Services (DFS) issued guidance requiring healthcare providers to waive copays, deductibles and other out-of-pocket expenses associated with the delivery of telehealth and telephonic services for insured New Yorkers during the emergency declaration period.  The client’s health plan is required to reimburse the provider the amount of the (waived) copay.  Note: Self-funded plans are not included in this mandate.  

More recently, DFS circulated an Emergency Regulation that requires healthcare providers to waive co-pays, deductibles and other out-of-pocket costs for Essential Workers.  The Emergency Regulation requires providers waive co-pays, deductibles and other out of pocket expenses for services delivered using all accepted modalities including face-to-face as well as tele health and telephonic services.  

Yesterday afternoon we had our first of two meetings with leads representing the Department of Financial Services.  Our objectives for these meetings is to get clarity around the implementation of the essential worker ‘waive the copay’ emergency regulation, to advise the Department of the inconsistent payment of copays to providers, to date, and to share important background information with them regarding the very low commercial rates paid to the vast majority of BH providers and the potential impact this could have on our providers as well as potential clients as they search for access to care.  

We request your assistance and ask that you answer the following questions (below):

Question 1:  What are your questions regarding implementation of the recent DFS Emergency Reg pertaining to waiving out-of-pocket costs for essential workers?   (DFS leads will respond to our questions in a FAQs document to come)

Question 2:  Which health plans are either not reimbursing providers for the co-pay the provider waived as required in each of the two Emergency Regs, or are doing so inconsistently?  (your response will be aggregated without any provider-specific info) 

Question 3:  Regarding timely and full payment for behavioral health services, please identify which MCOs are not paying the full APG government rate.   (We will aggregate and attach a list of plans without sharing provider names) 

Question 4:  (DFS didn’t ask this question but we need to know this information)   What % of your (Medicaid) APG government rate are you being paid (on average) for services to beneficiaries with private health insurance? (This question does not apply to Essential Plan.)

Question 5: Do you have the ability to respond to increased demand for services from beneficiaries with private health insurance?  

We know how incredibly busy you are.  That’s why (to this point) we have refrained from asking you questions/distributing surveys.   But we are now at a critical juncture where we need to gather information to inform our advocacy strategy.   

Please share your responses to the questions (above) at your earliest convenience but no later than COB on Monday.  

Your participation in this activity is greatly appreciated.  Thank you!