June 3, 2024

This morning we mentioned that Dr. Chinazo Cunningham was to be interviewed by David Lombardo, host of the Capitol Connect at 11:00 today.  Many thanks are due to our government relations consultant Marcy Savage who listened to the interview and recorded the following summary notes:

OASAS Commissioner Chinazo Cunningham:

• The budget overall continues to support our continuum of care, the biggest issue is that the opioid settlement funds they receive are decreasing
  • A lot of the money was allocated the first two years, she wants to clarify that those funds are going towards multi-year projects
• The overdose death rate has been increasing for years, but positively this year they have seen a small decrease
• Educating the public and providing tools like naloxone and test strips is the best method to combat the crisis, they are doing the most they can to make those available
  • They have shipped over 100,000 naloxone kits and 16 million test strips
  • Also bringing treatment to where people are like prisons, using mobile units, telehealth
  • Other states have seen a bigger rate decrease, but they are starting from a different point than NY. Also other states are still seeing increases unfortunately. Important to note how small these numbers are
• Two different overdose medications are available now and multiple ways to administer
  • Naloxone 4mg nasal spray has been around for decades
  • No additional benefit to the 8mg, but actually more adverse effects
  • OASAS focus is on access and making this transparent
• Funding for this year’s OASAS programs is intact, the $8.4 million cuts to vocation and education addiction services reinstated will not take from other programs/services.  Not coming from the opioid settlement funds, there are other OASAS funding streams that they are looking at
• No decisions yet re: OASAS Addiction Services Financial Restructuring Initiative:  The Commissioner said OASAS is changing their funding model, moving away from the net deficit model. She explained that many policies have changed and the financing model has been around for decades, but hasn’t moved forward with the field of addiction. Other NYS agencies have moved away from this model as well. This will also help OASAS provide funding to providers equitably, all parts of the State should have the opportunity to access OASAS funds. They are working with consultants, who are bringing in providers to make sure their voices are heard, and applying lessons learned from other states and agencies to change the funding model to best leverage OASAS dollars.
• How COLA funds will be distributed is not clear yet, but it will likely look like the last 2 years

And to refresh your memory, on 5/23 OASAS held a Webinar to brief stakeholders re: the ongoing OASAS Addiction Services Financial Restructuring Initiative.  We posted almost all of the slides to our Website that day and then we followed up by sending the entire slide deck from OASAS to all members.  
Here are our notes from the OASAS Webinar:

Key summary points from NY OASAS Townhall Webinar Meeting on 5/23:

·       The webinar reviewed the process of data collection and research conducted to date as well as a previewing the options being considered by OASAS

·       Information has been gathered from multiple sources

o   Survey of outpatient providers completed with 42% response rate

o   Two focus groups conducted with representative sample of providers

§  Group 1:17 participants, all Medicaid Revenue Providers

§  Group 2: 22 participants, mostly recipients of state aid

o   Research from other states focused on different funding models

·       Initial high-level findings from community input research:

o   Current structure is disjointed

o   Funding sources managed differently can result in provider burden for reporting

o   multiple layers of reporting between state, county and third-party reimbursements

§  Different systems for reporting

o   State aid for different counties and contracts is inconsistent

o   Net deficit funding works like a capped grant award

o   OASAS should consider actual costs to achieve better coverage

o   OASAS needs to move slowly. Transition to a new model will need to be phased in.

·       Initial findings from other state research:

o   FFS Medicaid matching

§  The state would leverage Medicaid spending to get a percentage match for every Medicaid $$ spent on SUD treatment or services;

§  NY has the statutory minimum match of 50% and would be able to leverage that match;

§  This would involve billing directly to the state’s Medicaid agency or alternatively the state could also consider doing this for a portion of the population and move the rest of the population to a managed care option.

o   Voucher based funding – provide a voucher for a service and get reimbursed at a set rate

§  This concept is often used for housing subsidies, e.g. housing voucher programs;

§  In this scenario the providing organization would receive vouchers for certain types of treatment and when an individual is served the voucher would be submitted for a reimbursement at some set rate;

§  Most voucher programs are not used to cover the cost of treatment but rather specific social service programs, e.g. housing, childcare, transportation, financial assistance and others which is what the new OASAS leadership is trying to achieve- addressing HRSN

§  This option would require developing a state infrastructure to manage, distribute and reimburse providers.

o   State Aid Grants with outcomes/utilization – straight grants looking at outcomes

§  IL has a similar state aid grant model to cover uninsured, underinsured or those who for whatever reason have dropped off the Medicaid rolls

§  A grant amount is awarded to an organization based on their past years’  or multiple years’ client utilization but no money is released until the people are served

§  Once people are served, the provider draws-down the funds

§  One pro for this option is that it creates flexibility and usually allows for longer lengths of stay than what is approved by commercial payers or managed care entities

§  The Cons to this model are that if you people don’t come for services, the provider doesn’t get the funds

§  Other considerations are related to how the state will develop outcome metrics and how they will determine successful outcomes, e.g. treatment completion within a certain time frame, no return to treatment within a certain time frame; follow-up engagements

o   Intermediary manages an uncompensated care pool

§  The practice of funding uncompensated services or groups of people is mostly used to fund safety net hospitals who treat high volumes of uninsured or underinsured patients

§  CMS released new rules that will impact the use of this model and will require each state to develop policies and rules for using the final rules to their advantage

§  If this option is considered for part of the population, it would most likely be the most arduous to implement but providers can learn from how hospitals and health systems are able to access resources from the model

Three early options OASAS is considering, although they stressed that no decisions have been made:

·       1 – Uncompensated Care Pool

o   Per-service based funding system based on utilization by otherwise uncompensated people.

·       2 – Program Focused

o   Payments for program enhancements, increasing provider capabilities, data reporting, and/or to mitigate losses.

·       3—Geographic & Population Served Adjustments

o   Adjustments tied to HRSN; geography, community demography, and other things that impact care delivery.