April 4, 2024
While the NYS OMIG is driving mental health, substance use disorder and other Medicaid providers out of business, the federal OIG seems acutely aware of the problem of access to care. See recommendation #3 in the Report (linked below) re: network (NA) adequacy standards and surveillance. A recently released OIG Report is at least partially responsible for actions taken in the last enacted state budget that require NYS to update its NA standards. The Department of Financial Services (DFS) is currently accepting public comments on draft (updated) Network Adequacy standards for commercial insurers having already collected public comments re: updated Network Adequacy standards for MCOs (the updates are 99% the same). Note: The NYS Council prepared and submitted formal comments on behalf of our members regarding the state’s proposed DoH NA standards last month having previously responded to a call for preliminary comments in January 2024, both of which are attached. We are currently preparing our comments (due April 22) for the Department of Financial Services. (DFS).
OIG Report dated 3/29/24
A Lack of Behavioral Health Providers in Medicare and Medicaid Impedes Enrollees’ Access to Care (OEI-02-22-00050)
As demand for behavioral health care rises to treat mental health problems and substance use disorder in the U.S., this data brief found a significant lack of providers amounting to a “mental health crisis.” Two-thirds of licensed behavioral health providers in the workforce did not serve Medicare or Medicaid enrollees. On average, there were fewer than 5 active behavioral health providers per 1,000 enrollees in each program in the counties we studied around the country. And we found that 1 in 4 enrollees traveled more than 1 hour to see their behavioral health providers. Read the Full Report