DFS/DOH Workgroup on Healthcare Simplification

November 6, 2020

Last week the Department of Financial Services distributed the Press Release (below) to healthcare stakeholders across New York.  As you will see, as of 10/27 the list of appointed members to the Workgroup did not include a representative of mental health and/or substance use disorder/addiction prevention, treatment or recovery providers. Upon receipt of the Press Release the NYS Council acted immediately to correct this situation and I was quickly appointed to serve on the Workgroup.

The first meeting of the Workgroup was held on Wednesday. The first topic being taken up is credentialing.  The goal is to simplify the process for all concerned.  I  will share more information shortly.

In related news… I can’t resist the opportunity to comment on the note at the bottom of the Press Release, pointing out that earlier this year the Department of Financial Services (DFS) approved the ‘lowest ever’ health insurance rate increases for private insurers.  It should be noted that CDPHP (health plan in the Capital District with a growing footprint across the state to include Staten Island) received the largest increase (a bit over 4%).  This may be a ‘relatively modest’ increase to some, but the fact that DFS granted this rate increase at all to CDPHP is astonishing given the fact that for the last 5 years CDPHP along with several additional insurers has failed to pay the legally required government rate for Child Health Plus mental health and substance use disorder services to many providers, and there have been no fines, no enforcements by the state to date.  FIVE YEARS.

The NYS Council continues to press DoH leaders to pay the providers who have struggled to maintain access to care for CHP beneficiaries despite this situation.  They are entitled to the full APG government rate that was established in 2015.  We will not rest until all impacted providers are reimbursed and paid interest back to the effective date of the rate change as is required by law per our recently passed Timely Payment bill that was enacted into law earlier this year.

Preserving and enhancing access to care is our north star.  Forcing adequate and timely reimbursement of these services is one of our main objectives.  We will not give up this fight.



Press Release

October 27, 2020


The New York State Department of Financial Services (DFS) and the New York State Department of Health (DOH) today announced 25 members of New York’s Health Care Administrative Simplification Workgroup. As a result of a recent change in New York law, the DFS Superintendent, in conjunction with the Commissioner of Health, is required to convene a health care administrative simplification workgroup to study and evaluate methods to reduce health care administrative costs and complexities through standardization, simplification, and technology.   

“DFS supports the workgroup’s ability to collaborate with insurers, providers, and consumers in order to remove administrative burdens on consumers and providers,“ said Superintendent of Financial Services Linda A. Lacewell. “This increases efficiencies, and fosters innovation and modernization, to ultimately make insurance simpler for everyone.”

“The workgroup will supplement our efforts to make healthcare services more affordable and more widely accessible, by recommending ways to reduce administrative complexities, create efficiencies, and promote cooperation between providers and health insurers,” said Commissioner of the New York State Department of Health Dr. Howard Zucker. “We look forward to seeing the results of their efforts.”

The workgroup will issue a report to the Superintendent, Commissioner of Health, and New York State Legislature in October 2021.

Areas to be examined by the workgroup include: 

  • Claims submission and attachments;
  • Preauthorization practices;
  • Provider credentialing;
  • Insurance eligibility verification; and
  • Access to electronic medical records

The workgroup supports DFS’s efforts to protect consumers and provide administrative relief to the insurance industry during the COVID-19 pandemic. The workgroup consists of stakeholders representing the insurance industry, consumers, hospitals, and physicians.

The members of the workgroup are: 

  • Sudha Acharya, Executive Director, South Asian Council for Social Services
  • Morris Auster, Senior Vice President and Chief Legislative Counsel, Medical Society of the State of New York
  • Susan Beane, M.D., Executive Medical Director, Healthfirst
  • Chuck Bell, Programs Director, Advocacy, Consumer Reports
  • Elisabeth Benjamin, Vice President of Health Initiatives, Community Service Society
  • John D. Bennett, M.D., President and Chief Executive Officer, Capital District Physicians’ Health Plan
  • Jennifer Briggs, Chief Operating and Financial Officer, Greater Rochester Independent Practice Association
  • Monica Chopra, Northeast Region Leader, Oscar Health
  • Kevin J. Conroy, Chief Financial Officer and Chief Population Health Officer, CareMount Medical
  • Hailey Davis, Director at Manatt, Manatt, Phelps and Phillips, LLP
  • Sean M. Doolan, Shareholder and President, Hinman Straub, P.C.
  • Thomas Faist, Legislative Counsel, New York State Association of Health Underwriters
  • Niyum Gandhi, Executive Vice President and Chief Population Health Officer, Mount Sinai Health System
  • Jeffrey Gold, Senior Vice President and Special Counsel, Insurance and Managed Care, Health Care Association of New York State
  • Karen Ignagni, President and Chief Executive Officer, EmblemHealth
  • Harold N. Iselin, Managing Shareholder and Co-Chair of Government Law and Policy Practice, Greenberg Traurig, LLP
  • Michael Mulgrew, President, United Federation of Teachers
  • Thomas J. Quatroche, Jr., President and Chief Executive Officer, Erie County Medical Center
  • Ricardo A. Rivera-Cardona, Chief Business Development Officer, SOMOS Community Care
  • Peggy Sheng, Chief Operating Officer, Coalition of Asian American IPA, Inc.
  • Kathleen Shure, Senior Vice President, Greater New York Hospital Association
  • Aimee Smith-Hopkins, Associate Vice President, Payment Innovation, Montefiore Health System
  • Denise Soffel, Member, Medicaid Matters New York
  • Abenaa Udochi, Founder and Chief Executive Officer, Concierge Health Care Consulting
  • Josephine Wilton, Manager, Facility and Ancillary Contracting, BlueCross BlueShield of Western New York, a division of HealthNow New York, Inc.

In addition to convening the workgroup with DOH to reduce administrative costs and complexities, DFS approved the lowest-ever health insurance rate increase for the individual insurance market; extended the special enrollment period for uninsured New Yorkers with DOH; and directed insurers to waive cost sharing for COVID-19 testing and tele health appointments.