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The NYS Council has been leading an ongoing statewide effort to compel lawmakers to bring fairness and balance to the OMIG audit process.  Assembly Health Chair Amy Paulin and Senator Harckham are sponsoring our OMIG Audit Reform bill.  


In our continuing efforts to secure meaningful OMIG Audit Reform in the SFY25 enacted budget, we ask that everyone mobilize antake action in support of OMIG Audit Reform.  Please use this link https://nyscouncil.org/advocacy-action-center/  to create a letter you can send to your Senate and Assembly representatives in support of the OMIG Audit Reform bill.


In 2006, New York State enacted a statute that authorized an annual Cost-of-Living Adjustment (COLA) for most Human Services Organizations. Despite the law, eligible providers often did not receive the COLA due to the former Administration’s practice of ‘notwithstanding’ the statute. As a result, community-based agencies fell into a fiscal hole and at the present time we are unable to pay competitive salaries AND cover expenses associated with the operation of our programs such as gasoline, maintenance, health insurance, food, supplies, etc.

This year, the Governor proposed a 1.5% COLA for the Human Services field, to include mental health and addiction prevention, treatment, recovery and harm reduction programs and services. The Senate and Assembly support a 3.2% in total, and we are grateful for this support. However, the Senate and Assembly bills both include a restriction that would tie provider’s hands when it comes to using some of these funds to pay for their operations, bills and to keep the lights on. Restricting the COLA in such a way that eligible agencies cannot use it for several purposes defeats the point of ensuring sustainability of services for New Yorkers in need of mental health and addictions care.


Please use this link https://nyscouncil.org/advocacy-action-center/  to create a letter you can send to your Senate and Assembly representatives in support of a full 3.2% COLA with no restrictions.


Over ten years ago New York State regulators found it necessary to set a mandated minimum reimbursement rate that must be paid for community-based mental health and substance use disorder services under Medicaid. However, this did not apply to services provided to New Yorkers with
commercial insurance benefits. This has led to a serious inequity for New Yorkers with commercial insurance who are often unable to find a provider due to insurance rates that are (on average) just 50% of those paid by the Medicaid Program for the same services.

Governor Hochul included a ground-breaking proposal in her executive budget that seeks to level the access to care playing field regardless of the insurance card in the pocket of the individual seeking services. The Governor included a requirement for commercial insurers to pay community-based mental health and substance use disorder agencies (at least) the same reimbursement rate as that which is paid to providers for services to Medicaid members.

We are grateful to the Governor for her leadership on this important issue and we are so gratified to see that both the Assembly and the Senate have heard our concerns and included a similar proposal in each of their one-house budget bills to ensure equitable access to essential mental health and addiction care for New Yorkers with commercial insurance.

The New York State Council has been advocating for this reform for close to a decade. We want to express our thanks to each and every New Yorker who helped us call attention to this serious problem and advocated with us for this important reform.


Across the country and here in NY, the amount of substance use and mental health care that is provided ‘out of network’ is significantly higher than it is for physical health care. State leaders have known this for a long time and it was confirmed by Milliman in 2019. Here’s the Report: https://lnkd.in/eJbU2wJj

Today the NY Times published an important article looking at the conflicts of interest and other ways insurers and third party vendors work together to increase profits and in doing so, burden the care recipient who (in too many instances) will walk away from getting the care they need due to excessive and unexpected cost share responsibilities (co-pays, high deductibles, etc.).

Staying in-network can be especially difficult for community-based mental health and substance abuse treatment agencies due to inadequate rates paid to providers here in NY. The NYS Council has been leading the fight to ensure ALL reimbursement rates paid to community-based providers approximate the actual cost of care for a long time. We need laws, regulations and contract terms that require insurers to play it straight and deliver on the promises they make to their beneficiaries without the game playing and use of tactics that are clearly designed to discourage beneficiaries from USING their insurance. And we need regulators to bear down on insurers – to robustly surveil, monitor and enforce ALL laws, regulations and contract provisions. Bad actors must be called out and heavily fined the first time there is a citation issued against an insurer rather than waiting months and sometimes years to enforce the law.

(From the NYT article) “A California woman whose teenage son was battling opioid addiction found only one treatment center that would accept him, and it was out of network. “When your kid has hit rock bottom, they’re dying, you get them in wherever you can,” she said, speaking on the condition that she not be named to protect her son’s privacy.

They had the most expensive health plan her employer offered, but her insurer, citing MultiPlan, left the family with tens of thousands of dollars in bills. “I expected there would be some payment that wasn’t covered,” she said. “What I didn’t expect was the deceit that caused an even higher payment, an amount I never dreamed.”

Is this the insurance system we want and need? To be clear, the current youth mental health crisis, unrelenting overdose rates, increased rates of alcohol abuse and long waiting lists for mental health and addiction services across NY and across the country are directly related to the tactics insurers and their vendors use to make it nearly impossible for providers to stay in network and for beneficiaries to USE their insurance without suffering extreme consequences. This is unacceptable.


Insurers Reap Hidden Fees by Slashing Payments. You May Get the Bill.

nytimes.com • 21 min read

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