OPEN LETTER TO GOVERNOR KATHY HOCHUL
On behalf of the thousands of New Yorkers insured by a NYS regulated commercial health insurance plan, and the OASAS and OMH community-based mental health and substance use disorder agencies who are struggling to serve them, thank you once again for the courageous leadership you demonstrated earlier this year in proposing and enacting a historic new law that requires commercial insurers to reimburse in-network OMH and OASAS community-based providers for these critical services at (a minimum) the same rate that is paid by the Medicaid program for the exact same care.
For over a decade, New Yorkers with commercial insurance have lingered on waiting lists or given up the search for treatment after spending weeks and months trying to locate a community-based agency in their local community that can afford to serve them. With current rates at approximately 30-50% less than the state mandated Medicaid rate, this ties the hands of community-based providers who cannot afford to serve them due to their inability to recruit and retain the workforce needed to meet increased demand for services.
In the remaining days leading up to the January 1, 2025 effective date of the new commercial rate mandate, we urge you to hold firm and reject any requests by insurers for a delay of implementation of Part AA – the new commercial rate mandate in the Article VII Health/Mental Hygiene section of the 2024-2025 enacted budget.
The State and community-based providers have spent significant time and resources preparing for implementation of the law. The Department of Financial Services (DFS), OMH, and OASAS have issued two Frequently Asked Questions (FAQ) guidance documents that respond to questions from impacted stakeholders. In addition, earlier this year the State hosted a Webinar in which it answered a multitude of questions and provided further technical assistance to the field (including health plans). The Offices have provided impacted health plans with a wealth of specific information to make it easy for them to implement the new law on January 1 as required by statute. The language of the new law also permits health plans to recover every penny of any expenses incurred as a result of implementation in their annual rate increase applications submitted to DFS each May.
The time for excuses is over. Insurers have had seven months to prepare for the January 1, 2025 implementation of the new law. A delay of even one day would directly impact working New Yorkers and their families who are waiting for care and as you know, delayed care is (effectively) denied care. We urge you to prioritize the wellbeing of all New Yorkers, and (in this situation) New Yorkers with commercial insurance, over the interests of large corporations that are well resourced and must continue to be required to implement this law beginning on January 1, 2025.
All New Yorkers deserve the same access to care regardless of the insurance card in their pocket. New York has made history with the enactment of this landmark law. Lives depend on its timely implementation.
NEW YORK NONPROFIT MEDIA FIRST READ FEATURES OPINION PIECE BY LAURI COLE REGARDING COMMERCIAL INSURANCE MANDATE
Compiled by Angelique Molina-Mangaroo
Tuesday, June 25, 2024
Opinion: New York is ending discriminatory insurance practices
Imagine you’ve contracted a debilitating illness, so you try to find a doctor to treat you. Then you find out that most healthcare providers won’t accept you as a patient because the insurance you have won’t adequately reimburse them for the cost of the treatment. As a result, you call every doctor in your community day after day, only to find that the list your insurance carrier gave you only included doctors not offering this care or others who aren’t even accepting new patients.
For decades, this is the stark reality many individuals with commercial insurance coverage have encountered when seeking mental health or substance use disorder treatment in New York state.
Why is this considered an acceptable standard for those living with mental illness or addiction? When left untreated, these medical conditions can have lasting detrimental impacts including premature death and permanent disability. For far too long, this discriminatory reimbursement practice has been a reality of life for millions of New Yorkers. Now, thanks to Gov. Hochul and the state Legislature, this discrimination will finally end.
Read more here.
– Lauri Cole
NYS COUNCIL RELEASES 2025-26 BUDGET/LEGISLATIVE PRIORITIES
The NYS Council has released its 2025-26 Budget/Legislative Priorities document. The Priorities focus on the following areas:
- OVERDOSE CRISIS
- WORKFORCE
- ACCESS TO CARE
- CHILDREN AND YOUTH
- REGULATORY REFORM
The full Priorities document is available online here.