November 6, 2024
UPDATE
After months of advocacy, the NYS Council secured an agreement from OMH to circulate a provider survey requesting info from OMH agencies that were/are having trouble securing reimbursement for Medicaid managed care claims caught up in the CHANGE Healthcare cyber attack. Based on the feedback they received OMH representatives are now calling MCOs that were reported as having failed to sign the timely filing waiver document DFS issued back in March or those that denied claims erroneously. During our weekly Billing Geeks call last week, some agency reps that filled out the survey and sent it back to OMH reported having heard from MCOs offering to work with the provider to address the outstanding claims.
We want to know the outcome of the exchanges taking place between the plans that are now being contacted by the state, and providers they are reaching out to. Please call me or write to me if you have an ongoing concern or a success story. We will NOT give up on our efforts to rectify the issues you are continuing to experience as result of the CHANGE Healthcare cyberattack that has had lasting and (in some cases) significant financial repercussions for our members.
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WEBINAR OF INTEREST
Peer crisis respites offer voluntary, short-term overnight stays in a homelike setting for individuals experiencing a mental health crisis. They are a valuable and effective part of the behavioral health continuum of care, but face challenges securing sustainable funding. The Center for Financing Reform and Innovation (CFRI) will host a webinar on November 21 that will present findings from 26 peer respites across 16 states that contributed to a new Substance Abuse and Mental Health Services Administration (SAMHSA) report. The report explores the characteristics, services offered, and funding streams used by peer crisis respites. It will feature a panel discussion and Q&A session with national leaders of peer crisis respites who will discuss the report findings and opportunities for expanding the availability of these programs. (Register here)
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(following from the National Council)
BELOW PERTAINS TO MEDICARE
Both the CY2025 (Medicare) Physician Fee Schedule (PFS) and (Medicare) Hospital Outpatient Prospective Payment System (OPPS) Final Rules have each been issued and will come into effect on January 1, 2025.
Regarding the PFS Final Rule, the following links to CMS’ press release, fact sheet, and final rule page in the Federal Register. Some highlights concerning policy changes from the final rule include: extension of some telehealth flexibilities permitted under CMS’ authority absent Congressional action, updated payment for social determinants of health risk assessments as a part of Opioid Use Disorder (OUD) intake activities furnished at Opioid Treatment Programs (OTPs), establishment of a new add-on code to account for coordinated care, referral services, and peer supports at OTPs, payment for safety planning intervention and post-discharge follow-up, establishment of six G codes that mirror current interprofessional consultation CPT codes used by practitioners who are eligible to bill E/M visits, and recognition of responses to CMS’ request for information on Certified Community Behavioral Health Clinics.
For the OPPS Final Rule, the following links to CMS’ press release, fact sheet, and final rule page in the Federal Register. Some highlights from this final rule include: maintenance of the PHP and IOP rate structures, narrowing the definition of “custody” in Medicare’s payment exclusion rule to mitigate barriers to Medicare access by individuals who have recently been released from incarceration or are on parole, probation, or home detention, and changes to Medicaid regulation allowing states implementing the Medicaid clinic services benefit to cover clinic services outside the “four walls” of behavioral health clinics.
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Here’s an interesting communication I just received from Health Care For America Now regarding the presidential election results (please don’t kill the messenger):
Hi everyone:
So far, the election results are bearing out many of the Democrats’ worst fears. Former President Trump will return to the White House for a final term along with JD Vance, the first millennial VP, and the Senate will be controlled by the same party as the Presidency. Republicans in the Senate will also have a new Majority Leader – Mitch McConnell will retire and make way for the new leader in January.
We don’t yet know which party will control the House of Representatives. If the GOP prevails there, they will once again have a trifecta and progressives will have their hands full just stopping bad proposals and bills from advancing.
There’s a lot of election analysis coming from every direction, but so far, the trends in the exit polls are not really surprising, but the continuation of patterns we’ve seen over the last couple of cycles where it’s clear that the Obama coalition (the New American Majority) is eroding as younger voters and voters of color are shifting support to Republicans–or maybe, just to Trump. We’ll have a clearer perspective soon on what happened and state level results.
In the meantime, world leaders are reacting and the stock market is soaring in response to the news.
MORE ON TRUMP VICTORY:
Last night’s exit polls:
https://www.washingtonpost.com/elections/interactive/2024/exit-polls-2024-election/
For comparison, see the exit polls from 2020:
https://www.washingtonpost.com/elections/interactive/2024/exit-polls-2024-election/
Here’s what’s immediately apparent:
- Trump made gains within every non-white ethnic group including Latinos, Asians and Blacks (though very small among Blacks.
- Trump improved his performance with male voters by one percentage point and his performance among women by 2 percentage points. Harris underperformed with women compared to Biden by 3 points.
- Trump improved his performance with young voters significantly (18-29 years). He went from winning seniors by 2 points in 2020 to losing them by a point last night.
- Trump lost ground among college graduates (2 points) while Harris overperformed Biden’s 2020 support by 2 points with this group.
- Compared to Biden’s 2020 numbers, Harris underperformed with non-college graduates by at least 4 points.
- Harris won voters with incomes over $100,000. Biden won them in 2020. This is a reversal from last time around when Trump won voters making over $100,000.
A lot more information and analysis is coming including state specific data that will tell us exactly what happened to put Trump back in power.
The Tilt: How Trump Won
Despite Jan. 6, the end of Roe v. Wade and a felony conviction, Mr. Trump won a clear victory. He is on track to win all seven battleground states. He made gains in every corner of the country and with nearly every demographic group: If you look at The Times’s map of what has changed since 2020, you’ll see a sea of red.
According to our estimates, Mr. Trump is also on track to become the first Republican to win the national popular vote in 20 years.
At the same time, the scope of his victory shouldn’t be overstated. This was no landslide. A one- or two-percentage-point victory in the national popular vote with roughly 312 electoral votes is not unusual. It’s not as large as Barack Obama’s modest win in 2012, and falls far short of “change” elections like Mr. Obama’s in 2008 or Bill Clinton’s in 1992.
But Mr. Trump is not any ordinary candidate. As a consequence, an ordinary victory says a lot more than it usually would. A felon who sought to overturn an election wouldn’t usually be considered viable in a presidential election. But not only was he viable — he won somewhat convincingly.
Despite his victory, most voters found Mr. Trump to be an unappealing candidate. CNN’s exit poll found that just 44 percent of voters had a favorable view of him, compared with 54 percent who had an unfavorable view. A majority of voters, 55 percent, said his views are too extreme. Obviously, there are many aspects of Mr. Trump’s appeal that these simple questions do not easily measure. But Mr. Trump’s victory may say more about the Democrats and the public’s desire for change than it does about the president-elect himself.
After all, on paper, Democrats weren’t in a sound position to win this election. No party has ever retained the White House when the president’s approval rating was as low as it is today and when so many Americans thought the country was on the wrong track.