January 7, 2023
Last week, the NYS Council completed a two-part training series for our members that focused on Contracting with Insurers, facilitated by Adam Falcone from Feldesman Tucker. Both audio recordings (parts 1 & 2) are posted on our website, along with the Power Point slides for each of the sessions. Each training was 3 hours in duration and provided highly specific information to participants that will prove useful as you negotiate/re-negotiate contracts with MCOs and commercial/private health plans. Over 120 NYS Council member agency representatives attended each event, and the feedback from our members has been excellent. Don’t overlook these resources. Ensuring you sign contracts that are in your best interest and that conform with the Model Contract, state regulations and other contract requirements is critical to your operations and fiscal viability.
Also last week, the NYS Council learned that Governor Hochul had signed our Model Contract Transparency bill into law, ending a period of intense advocacy in which our association worked with legislative leaders to ensure that state is now required to post on the DoH website and in the NYS Register any changes the state wants to make to the Model Contract – a document that lays out the requirements on MCOs, the state, and providers, for participation in the BH Medicaid managed care implementation.
Interestingly, the state recently posted an updated version of the Model Contract on the DoH website. We had complained for years that the version available on the site was old and did not reflect changes the state made to the document without public knowledge, in 2020. The state had made changes in 2020 that disadvantaged behavioral health providers and the individuals we serve by reducing the total dollars that can be returned to the state, and then to OMH and OASAS, when MCOs fail to meet important expenditure targets that are required in their contracts. As you know, earlier this year we were able to compel state leaders to collect some of these funds ($222M) and return them to OASAS and OMH, but the changes to the Model Contract that were made without stakeholder input or knowledge, limited the total resources that should be returned to our systems of care.
The Model Contract document (attached) now includes any changes made to it through April 2021 which is a huge win considering the lack of transparency we have been dealing with for years.
Providers in contract with MCOs and private insurers should familiarize themselves with the Model Contract as well as the Standard Clauses document (also attached) that identifies the various phrases, clauses and language that is permitted (or prohibited) from inclusion in contracts between providers and insurers. This information in combination with the 6 hours of training we just provided to our members should be enough to ensure you sign only those contracts that are fair and balanced.
Note: You will need a User Name and Password to access the ‘Members Only’ section of our website where the audio files and power point presentations (mentioned above) are posted. Contact Cindy Levernois at: email@example.com to obtain website credentials. The information is in the ‘Events’ section, under ‘Archived Events’ at: www.nyscouncil.org