May 28, 2024

N.Y. may have to refund millions to opioid companies (following is a link to a gift article that appears in today’s Albany Times Union electronic edition)   Dan Clark, May 28
https://www.timesunion.com/capitol/article/n-y-refund-millions-opioid-companies-19476424.php?utm_content=cta&sid=593182723f92a45314a7b188&ss=P&st_rid=null&utm_source=marketing&utm_medium=copy-url-link&utm_term=breaking&utm_campaign=article-share&hash=aHR0cHM6Ly93d3cudGltZXN1bmlvbi5jb20vY2FwaXRvbC9hcnRpY2xlL24teS1yZWZ1bmQtbWlsbGlvbnMtb3Bpb2lkLWNvbXBhbmllcy0xOTQ3NjQyNC5waHA%3D&time=MTcxNjg5ODA4OTAyMA%3D%3D&rid=NTc5ZWNkYjMtYjdkMC00MTFiLWFhNjAtMjhlMmMxYmM4NDA4&sharecount=MQ%3D%3D

—————————
Ensuring Excellence in Mental Health Act

Last week, congressional sponsors from New York and additional states introduced the Ensuring Excellence in Mental Health Act in the House of Representatives. According to the National Council, this legislation will establish the infrastructure needed to achieve the long-term vision of the Certified Community Behavioral Health Clinic (CCBHC) model. This is the House version of Senate bill 2993, which was introduced in September of last year. We now have a House bill and a Senate bill to make CCBHCs more permanent.

This bill would:

• Permanently authorize a Medicaid payment system for the CCBHC model;
• Establish a definition of services & prospective payment system for CCBHCs under Medicare, ensuring that CCBHCs can also provide behavioral health care for our seniors;
• Establish a new certification & accreditation process for CCBHCs and a technical assistance program at HHS to encourage program integrity and quality of care;
• Authorize expansion grants for certified or potential CCBHCs to expand the ability of clinics to provide comprehensive care; and
• Authorize a new data infrastructure system for CCBHC data reporting.

Below please find:

• A one-page infographic on the bill
• A press release from Representative Doris Matsui (D-CA) on the bill , and
• The National Council’s statement on the bill.  

NYS Council Note:  The NYS Council was a major supporter and lead advocate for the original (federal) Excellence in Mental Health Act that included language establishing the federal CCBHC Demonstration Program.  In fact, upon learning that the Excellence Act was likely to pass, we went straight to the Governor’s Office and pressed for NYS to apply to be one of the 8 Demonstration States that would ultimately be identified to participate in the Demo Program.  And of course, two years ago the NYS Council pushed aggressively for expansion of the Demo in NYS once CMS signaled that Demo states could expand the numbers of demos in their states. Our advocacy included our publishing the NYS Council Financial Study performed by HMA that proved beyond a shadow of a doubt that NYS would benefit from a significant expansion of the Demo Program. We also proposed budget language that made its way to the Governor’s executive budget proposal two years ago, leading to the CCBHC Demo expansion from 13 agencies to a total of 39 as of July 1, 2025.    

Having said all of this, we are deeply concerned that migration to state Medicaid reimbursed CCBHC services (as envisioned in the bill discussed above) would put the reimbursement for Demo Services in the hands of Managed Care Organizations (MCOs) that are notorious for failing to pay on time or in full, and for finding every way possible to avoid their responsibilities to providers and their insured.  We understand the federal CCBHC Demonstration Program is just that – a time-limited program that  set to expire in 2027; however, if NYS is contemplating making CCBHC services reimbursable through the states Medicaid managed care program it absolutely must address the issues that continue to plague our systems of care due in large part to New York’s failure to adequately surveil, monitor and enforce all of the laws, regulations and guidance that form the rules of the road for transactions between Medicaid providers and insurers. Failure to robustly oversee, monitor, and enforce these rules has led to chaos for providers and bottlenecks for access to care that are unacceptable. 

———————–

1. Bills on Senate or Assembly Agendas for the week of May 28, 2024

               Note:  In the Assembly and Senate bills of the co-occurring disorder bill of rights legislation (versions A10261 / S9523 – listed below) there is language in the  

               bills to appropriate $2M to OASAS, presumably to ensure compliance with the bill.  These bills are unlikely to pass now that the budget portion of the           legislative session has concluded; however the versions that do NOT include the approps could pass before the end of session.