November 13, 2023
First of two articles (below) is a follow up to the Crain’s Health Pulse article that ran last week.
While Mr. Linzer is correct that the state enforcement announced last week dates back to a state-driven citation process that began years (and years) ago, we all know that MCO failures to pay APG government rates on time and in full have not been resolved – not even close.
Read the full story here.
State fines Medicaid managed care plans nearly $3M for failing to pay for mental health care
New York state fined five Medicaid managed care health plans $2.6 million on Thursday for failing to pay for behavioral health services required under the law and inappropriately denying claims from providers, Gov. Kathy Hochul announced.
The fines follow a comprehensive evaluation of Medicaid managed care plans that was conducted by the Office of Mental Health, which investigated complaints from providers dating back to 2017.
The report found that managed care plans denied claims for care delivered under several state specialty behavioral health programs, including assertive community treatment—also known as ACT—teams, personalized recovery-oriented services, the comprehensive psychiatric emergency program and adult behavioral health home and community-based services.
Companies penalized include Affinity Health Plan, Amida Care, EmblemHealth, MetroPlus and MVP HealthPlan. MVP was hit with the highest fine, which totaled $1 million. The other plans were fined between $200,000 and $600,000 each, according to the governor’s office.
The Office of Mental Health worked with the Department of Health to issue fines to the health plans, as the health department has the authority to enforce compliance in the Medicaid program.
Eric Linzer, president and CEO of the New York Health Plan Association, which represents managed care plans, said that the penalties announced are related to claims errors that are “several years old,” adding that these errors have long since been corrected.
Linzer added that “plans have worked tirelessly with behavioral health providers and New York’s Office of Mental Health to resolve issues—including billing issues—as they arise” in an ongoing effort to ensure New Yorkers have access to behavioral health care.
But behavioral health advocates say that billing errors made by providers are not the source of the problem with reimbursements. Lauri Cole, executive director of the New York State Council for Community Behavioral Healthcare, which represents mental health agencies, said that health plan representatives blame providers for problems with reimbursements that plans are required to pay on time and in full.
“I think that, with this most recent enforcement, along with over 200 citations that have been issued since 2019 against various insurers for numerous serious issues, we can put the mythology that providers don’t know what they are doing to bed,” Cole said.
Behavioral health agencies in New York have called on officials to exercise oversight over managed care plans, stating that the delayed and inadequate payment from plans hampers their ability to provide care. A recent survey conducted by the NYS Council for Community Behavioral Healthcare found that 60 providers across the state are collectively owed $10 million by health plans. —Amanda D’Ambrosio
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A year after Mayor Eric Adams unveiled his strategy to address serious mental illness, signs of meaningful progress remain scarce.
The plan, which emphasized police involvement and involuntary hospitalization, initially garnered backlash from advocacy organizations. Now, experts say that not much has changed in the city’s mental health landscape. The city says the issue is not an overnight fix but sparse data makes it difficult to gauge if the plan is working.
“Everyone in New York City has a particular need for something: shelter, food, medical services and the like,” said Beth Haroules, the director of disability justice litigation at the New York Civil Liberties Union. “And I think rather than the city being as creative as it can be [in] leveraging the resources that are here, they’re just walking away from everything.”
Incidents where people are pushed onto subway tracks are highly visible reminders of the city’s need to address New Yorkers’ mental health needs. Last month, a 30-year-old woman was left in critical condition after being shoved into a train by an individual who police said was “known to us in the subway system.” Adams never publicly addressed the attack.
According to the NYPD, the number of incidents where individuals are shoved into the subway tracks has declined slightly over recent years. It happened to 30 people in 2021 compared to 29 in 2022. As of Oct. 15 of this year, 15 individuals have been pushed, seven less than for the same period in 2022. The NYPD declined to provide Crain’s with the numbers for years prior to 2021.
A lack of transparency has posed a challenge to the city’s mental health system, which is a patchwork of agencies, nonprofits, law enforcement and hospitals. The complex system creates an environment where no central party is considered accountable for addressing the issue. Kimberly Blair, director of public policy and advocacy at the National Alliance on Mental Illness of New York City said that the success of the plan hinges on the city sharing data with the organizations it relies on to carry out care to these individuals.
“The public needs data. We need transparency as a community-based organization. How are we expected to partner with city agencies if we don’t know the data or the trends? We don’t know how to provide that follow-up care,” she added.
Adams’ plan aimed to address the ongoing crisis of untreated individuals experiencing mental illness who have resisted voluntary assistance but pose a danger to themselves, a small but highly visible population. It included additional training for law enforcement, a hotline staffed by Health + Hospitals clinicians to guide police officers who encounter individuals in psychiatric crisis and a directive to law enforcement and emergency medical responders that involuntary transportation to hospitals for people who appear unable to meet their basic needs falls within their purview.
The directive is the most controversial part of the plan. Last year, advocates’ uproar centered around the idea that the directive could take away individuals’ autonomy by forcing them into treatment. Mental illness-focused groups argued that involuntary hospitalization violated New Yorkers’ rights.
The city did not respond to Crain’s requests for how many involuntary transports or hospitalizations have occurred since the directive went into effect last November but a May report from Politico found that H+H had tallied just 38 involuntary commitments at that time.
Anecdotally, mental health experts say they have not seen a major uptick in involuntary hospitalizations.