February 9, 2024

SPECTRUM News:  The state Office of Mental Health needs to do better at overseeing timely treatment for individuals under a state law that requires people in a mental health crisis receive treatment, according to an audit released Thursday by state Comptroller Tom DiNapoli’s office.

and,

According to a state audit, poor oversight and bureaucratic delays in New York state’s gold-standard program for treating mentally ill people at risk of becoming violent has led in recent years to preventable injuries and even deaths, The New York Times reports

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Spectrum news story on the request by some Managed Long-Term Care providers and care recipients to have these services carved out of the state’s Medicaid managed care program https://nystateofpolitics.com/state-of-politics/new-york/politics/2024/02/08/managed-long-term-care-plans-fight-n-y–bill-to-eliminate-them

and,

Legislative proposal to overhaul home care payment system will cost the state billions, health plans say

AMANDA D’AMBROSIO , CRAIN’S HEALTH PULSE, 2/9

Health plans and providers are pushing back on a legislative proposal that would overhaul how the state pays for home care, stating that it would cost — not save — New York upwards of $3 billion, according to a new analysis.

Late last year, legislators introduced the Home Care Savings & Reinvestment Act, a bill that would effectively move home care services from Medicaid managed care to a fee-for-service model. There’s been growing interest around the bill as the state considers cutting costs in the home care program, with backers of the legislation, including labor giant 1199 SEIU, saying that it could save the state $3 billion per year in administrative fees and profits pocketed by managed long-term care plans.

But a new fiscal analysis released by the industry yesterday says that those cost savings estimates are flawed. Instead of saving money, the proposal would cost New York between $3.1 and $4.7 billion annually, health plans and providers say.

The industry says that proponents of the Home Care Savings & Reinvestment Act have failed to account for the costs of moving home care into a fee-for-service model in their $3 billion savings estimate. The industry’s analysis estimates that additional burdens on local governments and state expenses of managing home care services through Health Homes would cost more than $1 billion a year. Additionally, they say that managed long-term care plans generate $1 billion in federal revenue each year that would not be recouped under a fee-for-service model.

Health plans and providers also say that estimates of their profit margins are overstated in advocates’ fiscal analysis. The $3 billion cost savings estimate pushed by advocates is based on an estimate of health plans’ profit margins, which averaged 5.5% in 2021 — twice the national average, according to 1199 SEIU, which commissioned the analysis that the proposal is based on. But health plans say a bulk of those profits were recouped by the state because of caps on how much plans can make from administrative payments.

“The advocates’ financial analysis, if you want to call it that, was woefully inadequate,” said Lev Ginsburg, executive director of the New York Conference of Blue Cross and Blue Shield Plans, adding that it did not take into account “about 90% of the issues” that would increase costs if the state moved home care out of managed long-term care plans.

Helen Schaub, interim political director of 1199 SEIU, said that “the insurance companies’ claims that moving to managed fee-for-service would cost federal dollars or lead to dramatic new utilization are not based on any credible analysis. She added that taxpayers pay $1 billion dollars annually in “unnecessary administrative costs and subsidizing the profits of multibillion-dollar corporations like Elevance.”

“Ten years ago, New York required Medicaid home care consumers to enroll in managed care plans with the promise that it would save money and increase coordination between Medicaid and Medicare services,” Schaub said. “That experiment has failed.” 

The Medicaid Redesign Team led by former Gov. Andrew Cuomo transitioned home care to Medicaid managed care from a fee-for-service model in 2011 in an effort to make the provision of services more efficient, improve quality and save money — all things that critics of managed care say it has failed to do. The proposal has gained steam as home care worker advocates and lawmakers scrutinize health plan profits. They say the industry pocketed $722 million in 2021.

But opposition from the industry has begun to mount. A group of 200 health plan and provider groups sent a letter to bill sponsors Assemblywoman Amy Paulin and Sen. Gustavo Rivera yesterday evening stating their opposition to the proposal.

Ginsberg said that if this proposal becomes law, it would undo a decade of progress and upend care for the 300,000 New Yorkers who rely on managed long-term care plans.

The fiscal analysis was released by the New York Conference of Blue Cross and Blue Shield Plans, the New York Health Plan Association, the Home Care Association of New York State, LeadingAge New York and the New York State Coalition of Managed Long Term Care Plans. 

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For the past two years, the Office of Mental Health has been collaborating with the Home Care Association and the University of Rochester Medical Center on  Addressing Health Disparities Through Home Care,  an initiative funded by the Mother Cabrini Health Foundation that has provided training and resources for individuals who have co-occurring physical, mental health and substance use needs.  This month, a new resource OMH would like to share with providers that is available at no cost:

• The 3D’s Delirium, Dementia, and Depression*:  A recorded presentation that provides an overview of dementia, delirium, and depression, a new point-of-care tool to help direct care staff –including personal care aides and OMH housing and Health Home case managers –to better understand the differences between the 3D’s through real-world case examples from the field, including an individual transitioning from a State-Operated to a OMH Supportive Housing program living with co-occurring serious mental illness and diabetes.

Previously recorded webinars in the series can be accessed as well: Mental Health Intensive Training Series for Meeting the Needs of Individuals with Co-Occurring Physical and Behavioral Health Needs