August 27, 2025
Occasionally, the NYS Council will survey our members on high priority issues such as workforce shortages, access to care and waiting lists, and health plan compliance (or lack thereof) with the Medicaid APG government rate mandate we secured over a decade ago, and more recently, the new commercial rate mandate. Over the last several months we have been meeting with representatives from the Governor’s Office, DoB, DoH and the O agencies to discuss our ‘ask’ for a carve out of outpatient behavioral health services, and robust and immediate enforcement of the commercial rate mandate, but we need up to date data. PLEASE respond to the surveys (linked below) with the understanding that this will likely be the only time during the year that the NYS Council pushes our members to take time to gather data we can use to secure our priorities in the final state budget to be enacted April 1, 2026.
Following are links to the two surveys we recently circulated to all NYS Council members. Please help us to help you and the individuals and families you serve by completing these important surveys:
- Commercial Rate Mandate & Health Plan Compliance: https://www.surveymonkey.com/r/LTK7XVZ
- Medicaid managed care survey: https://www.surveymonkey.com/r/3DCFKHX (Attached for your convenience is a Word document containing all of the questions in this survey so you can easily assign certain questions to the correct individuals/departments in your agency)
We are extending the deadline for both surveys to September 10.
If you have any questions or if we can be of assistance in any way, we are always here to help. Just reach out to Lauri at 518 461-8200 at your convenience.
THANK YOU!!
Have a good day.
Lauri
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As you can see in the following excerpt from an article in today’s Crain’s Health Pulse, MVP just received what some might view as a slap on the wrist for significant network adequacy and other related non-compliance – and the fine relates to an investigation dating back to 2023.
According to the article, MVP had overall revenue of $3B in 2023 however the fine for non-compliance with various regulations is $250,000. Some enforcement is better than none but for a health plan with annual earnings in the billions, the fine is (in my personal opinion) a slap on the wrist and likely perceived by MVP as the cost of doing business. That’s why we need to compel state leaders and other key decision makers to get our outpatient services out of the state’s Medicaid managed care program and back to reimbursement via FFS Medicaid, where possible.
Access to care is our true north and the NYS Council will not relent on our goal to get our services out of the Medicaid managed care quagmire we find ourselves in at the present time. We have newly introduced legislation to do just that.
NYS can save a minimum of $400M by returning us to FFS reimbursement, and this is the year to do it!
Insurer to pay back patients, fix mental health provider directory in state settlement
Insurance carrier MVP Health Plan has agreed to overhaul its mental health offerings to settle claims that it offered patients spotty access to care, the state attorney general’s office announced.
MVP Health Plan, a nonprofit insurer that covers roughly 328,000 New Yorkers, must upgrade its directory of therapists, psychiatrists and social workers, as well as pay penalties to patients that weren’t able to access in-network mental health appointments as part of a settlement agreement announced Tuesday. The Schenectady-based insurer, which earned $3 billion in revenue in 2023, agreed to pay a $250,000 fine to the state and reimburse patients who wrongfully paid full price for a mental health appointment when they couldn’t find an in-network provider.