December 31, 2022
Good morning,
For the past 20 years, the NYS Council has fought to ensure adequate access to care for New Yorkers seeking services through the public mental hygiene system. Recently, we turned our attention to enforcement of the contractual provisions governing the carve in of behavioral health services to Medicaid managed care that, when overlooked have the effect of decreasing access to care, and threatening provider viability. We have been laser focused on ensuring the state adequately surveils, monitors and enforces all contractual agreements that require MCOs to spend the vast majority of funds they receive from the state, on actual care for Medicaid beneficiaries.
Recently, and after 15 months of pointed NYS Council advocacy, the state initiated MCO recoupments that ultimately returned $222M to OMH and OASAS. Impacted MCOs had failed to meet expenditure targets as required in their contracts with the state, and the state took the overpayments back as required.
The Details: Over the course of 15 months, the NYS Council filed 25 FOILS through our attorneys, seeking information on enforcement of the expenditure requirements on MCOs, and other information. Through this process we confirmed that:
- The state had failed to recoup overpayments made to some MCOs that had missed their targets over a (recent) two year period.
- In 2020, the state made changes to the Model Contract document (lays out the terms of the carve in of our (BH) services to Medicaid managed care) without any public notice. This had the effect of reducing the amounts that could be recouped from MCOs when they missed their expenditure targets.
The information we received also confirmed that MCOs had been pushing state agencies for these changes since shortly after our services were carved in to Medicaid managed care. We initiated proposed legislation that would require the state to post information regarding changes made to the state’s Model Contract on the DoH website, and in the NYS register. In addition, earlier this year we secured budget language (enacted in April) that requires the state to post detailed information as to MCO performance meeting BH expenditure targets by health plan, and information regarding recoupments of overpayments, the methodology used to calculate the recoupment, when the recoupments were made, etc.
Last night, Governor Hochul signed our Model Contract bill into law!
Many thanks are due to the bills sponsors, Senator Gustavo Rivera, Chair, Senate Health Committee, and Assemblyman Richard Gottfried, Chair, Assembly Health Committee, for hearing our concerns and standing by our side as we continue to fight to to compel state government to do its’ job enforcing all contractual requirements on the MCOs, and specifically, for assisting us with this legislation that ensures providers and other stakeholders have a clear understanding of what is expected of the state, participating MCOs, and providers who participate in Medicaid managed care. Sincere thanks are also due to Marcy Savage, our fabulous external government relations consultant from the firm of Reid, McNally and Savage, Adam Falcone our amazing contracting attorney, and (most importantly) all NYS Council members who stood with us to advocate for increased transparency and fairness for all New Yorkers.
THANK YOU!!!
A9442A
Gottfried — Relates to notification of changes to the model contract with managed care providers under the medical assistance program
Same as S 9207 RIVERA
SUMM : And §364-j, Soc Serv L Requires notification of changes to the model contract with managed care providers under the medical assistance program on the DOH website and in the state register.
03/07/22 referred to health
04/26/22 reported
04/28/22 advanced to third reading cal.566
05/02/22 amended on third reading 9442a
05/10/22 passed assembly
05/10/22 delivered to senate
05/10/22 REFERRED TO HEALTH
06/02/22 SUBSTITUTED FOR S9207
06/02/22 3RD READING CAL.1716
06/02/22 PASSED SENATE
06/02/22 RETURNED TO ASSEMBLY
12/19/22 delivered to governor
12/30/22 signed chap.822
12/30/22 approval memo.101
SUMMARY OF PROVISIONS:
Section 1 adds a new paragraph (d) to Social Services Law section 364-j
subdivision 2 to require the Department of Health to make changes to the
model contract with managed care providers public before finalizing the
contract or submitting it to the Centers for Medicare and Medicaid
services. It requires that the new contract be posted on the Depart-
ment’s website and in the Public Notices section of the State Register,
and it applies the same requirements to requests for proposals for
managed care providers interested in participating in the managed care
program.
§ 2 is the immediate effective date.
JUSTIFICATION:
The state’s managed care model contract is a boilerplate document that
lays out the terms of the contracts between the state and Medicaid
managed care organizations (MCOs), and between MCOs and providers. The
Department of Health has amended provisions of the model contract numer-
ous times since the inception of managed care in 2011 without notifying
system stakeholders, including providers and consumers, or offering
opportunity for public input. These changes can have significant conse-
quences on access to care and provider stability. At a minimum, when the
state makes substantive changes to the model contract, public notice
should be required so all stakeholders are made aware of such actions.
This bill will change the norm to one of transparency and will prevent
significant changes from being made to the model contract in a black
box.