April 27, 2023
While we wait for actual budget bills that confirm budget outcomes, I wanted to share some of the info we have been hearing about various proposals.
Please Note:
Until budget bills are printed, released and analyzed, there is no way for us to be certain of the information below. In addition, the discussion below is not inclusive of all NYS Council priorities.
Please do not make decisions based on the following information:
COLA: The persistent rumor in Albany is that the COLA is likely to be around 4%.
Insurance Proposals: Earlier this week we heard that negotiations on the package of insurance proposals we have been working on, had concluded. Generally, it appears that most of the insurance proposals have survived the negotiations process but with some changes. We have heard that the part of the Network Adequacy proposal that would require commercial insurers who need to go out of network to find a provider to serve their insured, to pay a negotiated rate or the Medicaid rate, did not survive the negotiations process. Having said this, it appears the part of the Network Adequacy proposal that would require the state to update Network Adequacy standards, survived. We have also heard that the Private Right of Action proposal that would permit clients to sue when the commercial insurer violates a parity provision, has been omitted from the package, and the proposal that would require insurers to pay for some SUD medications without prior authorization, survived the negotiations.
School-Based MH Clinics: The Medicaid Scorecard that we distributed with other state budget information shortly after the executive budget came out, includes an item that indicates a rate increase for school-based mental health clinic services. We are hearing that the rate increase for school-based mental health clinic services may be over 20% HOWEVER the range of specific services that would get the increase has yet to be determined and we think there will be a requirement that sets in motion a regulatory process to define what specific services and situations would get the increase. The Scorecard says that the increase (whatever the percentage) won’t take effect (on paper) until October ’23 and we all know that these dates tend to be ‘flexible’.
There is also a school-based MH clinic insurance proposal that would require commercial insurers to pay Medicaid rates for these services. We think this part of the insurance proposal has survived the negotiations. If so, commercial insurers would need to pay the higher rates discussed in the paragraph (above).
Health Home Program under DoH The Medicaid Scorecard (mentioned above) also includes a proposal that would reduce Health Home spending by $100M over two years. The Department of Health wants to adjust continued utilization of services by medium and low acuity Health Home clients. It is our understanding that the DoH Health Home Program will be adjusted as the Department describes, over the next two years, for a savings of $100M. This does NOT include Health Home+.
More to follow.