First, below there are two webinars happening – one today (Worker’s Comp) and one tomorrow (OASAS) that are of note as you review the information below.

One of the MANY values of our (now 5 1/2 year old) NYS Council Billing Geeks group that meets on Wednesday mornings is that participants often share information that is not always received by all billing staff.

Below is a Notice from the Worker’s Compensation Board that a member agency shared with attendees participating in the Billing Geeks meeting this morning, the vast majority of which had never seen this Notice before today.

Please share this with your billing staff and urge them to join our weekly meetings from 9-10 on Wednesday mornings.  It’s a great group!  

The Notice below was sent out by Worker’s Comp on 5.15.25.  Coincidentally, there is a Webinar TODAY at 12:00 regarding this new requirement.  See below.  Those on our Billing Geeks listserv received a copy of the Notice (below) right after we ended our call this morning.

RESOURCES

Providers must agree to submission of a CMS 1500 form.  And WCB provides a list of who has been approved.

Medical Portal Access and Administration: Health Care Providers

Electronic Submission information and overview:

Electronic Forms Submission – Overview

CMS-1500 Overview

Recorded Webinars

Today: CMS-1500 electronic submission mandate approaching! Learn more in our webinar series for providers

More information

Questions?

Having trouble?

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Dear Providers, Colleagues, and Community Partners,

The purpose of this update is to let you know that the RFA SETT 24029 opportunity has been extended through January 31^st, 2026.

Full RFA can be found at: https://oasas.ny.gov/request-applications-sett-24029

OASAS has announced the opening of a new certification for recovery residences. This is the first recovery support service to be certified in New York State and allows recovery residences to voluntarily apply for OASAS certification. This new initiative is designed to expand the continuum of recovery supports throughout the state and emphasizes the importance of recovery as an essential service for individuals impacted by addiction. Information for the general public as well as interested applicants can be found on the following OASAS webpages: https://oasas.ny.gov/certified-recovery-residences and https://oasas.ny.gov/become-certified-recovery-residence. In order to support this initiative, award funds are available for newly certified recovery residences.

Through Opioid Settlement Funds, OASAS is accepting funding applications on a first come, first served basis from recovery residences which have been approved for contingent certification and are seeking award funds to enhance their operations as newly certified programs. Certified recovery residences under OASAS will implement safe, secure, and quality housing for individuals in recovery from substance use disorder. Certified recovery residences will serve those in recovery, seeking a non-clinical, supportive residential environment. Operators who have received contingent approval for OASAS certification and meet additional requirements will be eligible for award funds.

Funding available:

Total available funding for this procurement is $5,000,000 will be awarded on a first come, first served basis throughout New York State, until the funds are exhausted. Providers with more than one recovery residence may apply for this one-time award for up to three (3) individual sites, and each site may receive up to $75,000 in funding each (up to a maximum possible total of $225,000). Providers may apply for OASAS certification of all their recovery residences but will only receive funding for up to three (3) recovery residences. These funds should be used to enhance certified Recovery Residences and are not available to be used for purposes of becoming OASAS-certified.

Eligible applicants:

• Recovery residences and have submitted a full certification application to OASAS.
• Have a contingent approval for a recovery residence certification for each location requesting funding from OASAS.
• Non-profit (charitable organization with tax-exempt status)
• Registered and prequalified in the Statewide Financial System (SFS)
• Completed and filed a New York State Vendor Responsibility Questionnaire (must be updated within the last six months)
• Registered and have current status with the Office of the New York State Attorney General’s Charities Bureau
• Registered with the New York State Department of State

Application Deadline:  01/31/2026, 4:00 p.m.

We would also like to extend an open invitation to an upcoming OASAS Recovery Residences Certification Webinar on This virtual WebEx is an open webinar for any organizations and individuals interested in learning more about the certification process for Recovery Residences under OASAS. Topics that will be covered during the webinar include: OASAS Website navigation, Application Requirements, Application Process, and RFA Funding Award. Feel free to share this open invitation with anyone who may be interested. The webinar will also be recorded for future viewing.

Webinar topic:

OASAS Recovery Residences – Certification Webinar

Date and time:

Thursday, July 24, 2025 10:00 AM | (UTC-04:00) Eastern Time (US & Canada)

Register link:

https://meetny-gov.webex.com/weblink/register/rba2638a3c4abe5801aadb2bfccc23e27

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Following is a paid advertisement in today’s Empire Report.  As always, it’s everyone else’s fault but the health plans.

In my opinion this is overt lobbying by the Health Plan Association to influence pending rate requests for 2026 filed by NYS health insurance companies that were required to be turned in to the Department of Financial Services (DFS)  in May (as they do every year).  I also see this as providing cover to the DFS as it makes final decisions about 2026 premiums increases.

The Issue is the Cost of Care

By Eric Linzer | July 22, 2025,  Health Plan Association of NYS 

In the next few weeks, the state’s Department of Financial Services will announce the final approved 2026 health insurance premiums for individuals and small businesses. New York’s health care costs are among the highest in the country and national forecasts project costs continuing to climb.

Affordability is the most pressing health care issue for individuals, families and employers, and the continued growth in costs exacerbates the challenge they face. Premiums are a direct reflection of the cost of care and it’s important to understand the factors contributing to premium increases. Among them:

• Hospital Prices: Hospitals and other providers continue to demand significant price increases at a time when New York’s inpatient hospital prices are the third highest in the country, with hospital prices expected to rise by twice the rate of inflation according to the Centers for Medicare and Medicaid Services.
• Prescription Drug Costs: The high and ever escalating price increases that pharmaceutical companies charge. In what has become an annual tradition, this past January, Big Pharma raised the prices on nearly 600 drugs, most above the rate of inflation, and year after year routinely hiking the prices on existing and unchanged medications without any substantial new evidence to support the price increases.
• Mandated Benefits: New York currently requires coverage of nearly four dozen specific treatments or services, many of which are for treatments or screenings that go beyond nationally recognized evidence-based guidelines. In isolation, the cost of individual mandates may be relatively small, the collective impact adds to the cost of coverage that falls disproportionately on small and medium-sized employers.
• Health Insurance Taxes: New York currently collects nearly $6.6 billion annually in taxes, assessments and surcharges on health plans. This adds more than $1,000 to the premium annually for the average family policy.
• Loss of Federal Funding: The American Rescue Plan Act included enhanced federal tax credits to assist low- and moderate-income individuals with their premiums. Unless Congress extends them, this funding will expire this year, increasing premiums for more than 140,000 New Yorkers who receive them. State estimates project average monthly costs to rise $114 per month for an individual and $228 per month for a couple.

In announcing the approved rates in 2023 and 2024, the Department of Financial Services has cited the rising cost of medical care, including inpatient hospital stays and rapid increases in drug prices, as the main drivers of premium increases. Greater scrutiny and transparency of hospital and drug companies’ costs and pricing practices, including prohibiting outlandish mark-ups on medications and excessive charges for services, is needed to make healthcare more affordable in the state.

In the absence of policy efforts to rein in these costs, it is critical that the premium rates the state will approve for 2026 fully recognize these elements as they reflect the cost of care in New York.

Eric Linzer, President and CEO, New York Health Plan Association

The New York Health Plan Association represents 20 managed care health plans that provide comprehensive health care services to more than 8 million New Yorkers.

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Please see the below from DOH regarding the NYRx formulary that may be important for individuals served in your programs.

There have been several announcements related to the NYS Medicaid NYRx Formulary that may be of interest to you and your service recipients.

1. Benzodiazepines: https://newyork.fhsc.com/downloads/providers/NYRx_EO_notification_20240229.pdf
2. Sedative Hypnotics: https://newyork.fhsc.com/downloads/providers/NYRx_EO_notification_20250616.pdf
3. Updated Medicaid Preferred Drug List: https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PDL.pdf . Psychiatric and Neurological medications are in section IV beginning on page 14.  Please note that Xanomeline-Trospium (Cobenfy™) is now on the formulary and requires a prior authorization (PA).  This medication generated extensive public comments in the most recent public meeting about the Medicaid Formulary.
4. Online PAs via CoverMyMeds: https://newyork.fhsc.com/downloads/providers/NYRx_EO_notification_20250701.pdf

In case of questions and concerns:

The NYRx Education & Outreach Call Center is available by phone at 1-833-967-7310 or by email at NYRxEO@primetherapeutics.com from 8:00 AM to 5:00 PM ET, Monday through Friday, excluding holidays. The NYRx Education & Outreach team hosts virtual office hours every week for stakeholders to ask questions related to NYRx and care coordination. Visit the NYRx Education & Outreach website for more information: https://newyork.fhsc.com/providers/education-outreach.asp .

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Tonko, Huizenga Introduce Legislation to Expand Mental Health Care for Seniors

Bipartisan parity legislation removes 190-day lifetime limit on behavioral health care under Medicare

WASHINGTON, DC—Representatives Paul D. Tonko (D-NY-20) and Bill Huizenga (R-MI-4) today reintroduced the Medicare Mental Health Inpatient Equity Act, bipartisan legislation that would improve care for millions of America’s seniors by permanently repealing the Medicare 190-day lifetime limit for inpatient psychiatric care. No such limit exists for any other Medicare inpatient health care service.

“Mental illness should be treated like any other illness, but stigma continues to limit equal, quality care — too often with dire consequences,” Congressman Tonko said. “Currently, Medicare feeds into this longstanding prejudice, setting an arbitrary cap unique to mental health care that limits treatment and provides gaps in care for seniors. We’re reintroducing our Medicare Mental Health Inpatient Equity Act to remove this unjust 190-day limit. I urge my colleagues to join us in standing up for seniors and ensuring they are supported with the quality care they need and deserve.”

“Mental health policies must be modernized to answer the growing needs of the 21st century,” Congressman Huizenga said. “I am proud to help lead on this issue with bipartisan legislation to modernize Medicare policies and bring them in line with the higher standards used by the State of Michigan and private sector. Hopefully this bipartisan bill can help provide a roadmap for additional mental health reforms and challenges Congress must address.”

Today, despite the enactment of the landmark Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, Medicare continues to discriminate against seniors with mental illnesses. The 190-day limit in care disproportionately harms individuals who receive Medicare coverage earlier in life due to disability. The vast majority of private health insurance has already removed this antiquated limit. MedPac, an independent congressional agency that advises on Medicare, released a March 2025 report recommending that Congress eliminate this limit.

This legislation is supported by more than three dozen organizations, including: AARP, Acadia Healthcare, Addiction Policy Forum, The Alliance for Rights and Recovery, American Association for Psychoanalysis in Clinical Social Work, American Association of Psychiatric Pharmacists, American College of Emergency Physicians, American Foundation for Suicide Prevention, The American Group Psychotherapy Association, American Hospital Association, American Mental Health Counselors Association, American Psychiatric Association, American Psychological Association Services, Community Catalyst, The Eating Disorders Coalition for Research, Policy, & Action, The Global Alliance for Behavioral Health & Social Justice, IC&RC, Inseparable, The Kennedy Forum, Legal Action Center, Mental Health America, MHANYS, NAMI, National Association for Behavioral Healthcare, The National Association for Rural Mental Health (NARMH), the National Association of County Behavioral Health and Developmental Disability Directors (NACBHDD), The National Association of Pediatric Nurse Practitioners, The National Association of Social Workers (NASW), National Association of State Alcohol and Drug Agency Directors (NASADAD), National Behavioral Health Association of Providers, National Black Harm Reduction Network (NBHRN), National Board for Certified Counselors & Affiliates, National Council for Mental Wellbeing, National Health Care for the Homeless Council, The National League for Nursing, Psychotherapy Action Network (PsiAN), Police Assisted Addiction and Recovery Initiative, Treatment Communities of America, Addiction Professionals of North Carolina, California Consortium of Addiction Programs & Professionals

A fact-sheet of the bill can be found below and HERE

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NYS Congressional Representative Mike Lawlor has decided against running for Governor:

https://www.nytimes.com/2025/07/23/nyregion/mike-lawler-governor-reelection.html?unlocked_article_code=1.Yk8.heyM.GatJXXenpPpS&smid=url-share

MORE FOR POLITICAL TYPES

 (POLITICO, 7/22)

State Sen. Jessica Ramos (Queens) shocked the New York political world by endorsing her longtime foe Andrew Cuomo while running for mayor.

He didn’t endorse her back. But his rejuvenated mayoral campaign is quick to compliment her in the face of a fierce primary challenge from neighboring Assemblymember Jessica González-Rojas.

Ramos has “a real record of delivering — not only for her constituents, but for working New Yorkers as a whole,” Cuomo campaign spokesperson Rich Azzopardi told Playbook. “She cares about the things that matter, and New York is all the stronger because of it. And I’m sure that’s what her constituents are going to consider.”

Of course, it’s still not an endorsement. “The cycle hasn’t even begun to begin yet,” Azzopardi added.

Meanwhile, González-Rojas is gathering star supporters for her state Senate campaign, which she officially launched Tuesday.

“Let’s GO @votejgr! We got you,” Democratic Rep. Alexandria Ocasio-Cortez wrote on X, adding a raised hands emoji. (Ramos and AOC don’t talk and don’t get along.)

City Comptroller Brad Lander, Queens Borough President Donovan Richards, Council Members Shekar Krishnan, Tiffany Caban and Shahana Hanif — and many more electeds — joined JGR’s Jackson Heights fundraiser Monday night.

Assemblywoman Catalina Cruz remarked to attendees that she had been trying to get González-Rojas to challenge Ramos for years, one elected official present told Playbook.

JGR’s run against Ramos is personal about unseating an elected official she’s found difficult to work with. But it was Zohran Mamdani’s mayoral primary win — against both Ramos and Cuomo, among others — that gave her the political push to do it.

González-Rojas endorsed Mamdani, who won Ramos’ senate district 60-40 over Cuomo in the mayoral primary.

Ramos endorsed Cuomo in that race, after sparring with him in the Legislature for years, slamming him as a creep and questioning his mental acuity on the trail.

She didn’t respond to requests for comment. While she got 0.4 percent in the mayoral primary, she’ll be in a much better position if she seeks reelection. She’s an incumbent with union allies, thanks in part to her role chairing the Senate’s powerful labor committee.

She’s in bad shape financially, though. Ramos reported just $10,492 in her state campaign account last week, after raising $70,000 and spending $68,000 in the previous six months.

(Her biggest expense was $14,000 to polling firm Slingshot Strategies, as she continues to pay for a spring 2024 district survey showing opposition to a casino. The poll was initially covered by an anonymous donor, but Ramos reversed course and said her campaign would pay for it.)

Ramos’s city account is deeply in debt as well, reporting a negative balance of nearly $126,000. She’s in a dispute with another vendor and may see her liabilities increase even more, two people familiar with her finances told Playbook.

Mamdani boosters are eager to unseat electeds who backed Cuomo, and this could be a high-profile battle — even if the politics undergirding it are a bit muddled.

Both Jessicas are to the left of moderate Democratic Gov. Kathy Hochul, and both won the Working Families Party’s endorsement in 2024. González-Rojas opted not to respond to Playbook’s questions about the key policy differences between the two, or if she plans to highlight Ramos’ Cuomo flip-flop on the trail.

“I’m running for State Senate to bring bold, inclusive leadership that delivers real results for our community,” González-Rojas said in a statement. “In this moment of national crisis, our neighbors deserve a fighter who shows up, listens, and works side by side with them to create lasting change. This campaign is about progress rooted in values — and building a future we all shape together.” — Jason Beeferman and Jeff Coltin