NYS Council Advocacy, OASAS Rate Increases and Budget Hearings

February 21, 2023

Lawmakers, including but not limited to Senate and Assembly chairs and members of the Assembly and Senate Mental Hygiene committees convened last Thursday to receive testimony from stakeholders regarding the Governor’s executive budget proposal, and specifically, Mental Hygiene proposals therein. 

The good news is a groundswell of support from lawmakers, for an 8.5% COLA.  Many legislative committee members demonstrated clear understanding of the dire need for this increase from the Governor’s proposed 2.5% COLA for OMH, OASAS and OPWDD organizations, to 8.5%.   As I reflect back on the hearing, comments made by Assembly Mental Health Chair Aileen Gunther, Senate MH Chair Samra Brouck, and Senator John Mannion’s stand out.  All made it very clear that 2.5% cannot stand, and that 8.5% for community-based agencies is the way forward.  However, ultimately the Mental Hygiene Committee will likely not have the additional resources necessary to lift the entire 8.5% request, so this issue will ultimately wind up in front of the legislative leaders (Senate Majority Leader Stewart-Cousins, Assembly Speaker Carl Heastie and others).

Importantly,  Senate Majority Leader Andrea Stewart-Cousins made a statement on Thursday that was included in an article in an upstate newspaper regarding the current focus on the mental hygiene system of care in NY:   “It’s like so many things in the budget, there’s always more that can be done but again the fact that it is a focal point for everyone for all the best reasons, and not only outside but in our schools, in our classrooms–trying to make sure that those services are available I think will continue to be a priority for us,” Leader Stewart-Cousins said. 

The Other Good News:
Last week during her testimony OASAS Commissioner Chinazo Cunningham testified that the recouped funds the NYS Council worked so hard to force the state to the state agencies last year, will be used for rate increases for OASAS providers.

For new members:  Last year, the NYS Council worked aggressively to ensure the state finally recouped (from certain MCOs) overpayments made to those that had failed to meet contractually required expenditure targets obligating them to spend the majority of the funds they receive from the state on actual care for Medicaid beneficiaries. The contractual requirements on the plans are called Behavioral Health Expenditure Targets (BHETs).  The NYS Council tirelessly pursued state regulators, issued 25 FOIL requests, and when we had the confirmations we needed, we brought our concerns to the Governor’s lead counsel, requesting immediate enforcement of this critical contract provision.  The Hochul administration acted honorably and it was impressive how quickly they made it right, especially given the fact that this was a Cuomo Administration holdover issue.  

In total, $222M was recovered from MCOs ($111M state share that gets a federal match to bring the total to $222M) over a two year enforcement period.  The state then reinvested these funds where they belong – with OASAS and OMH.   As a result, last year OMH used its reinvested funds to pay for rate increases for a variety of programs and services across the OMH continuum to include Outpatient Clinic increases and more.  Similarly, OASAS received $37M in the current year budget (SFY 23)   and there is an additional $37M in the SFY 24 executive budget proposal.  Again, these are the funds collected through the MCO recoupment, sometimes referred to as ‘Medicaid Reinvestment’ funds in certain OASAS documents.  Please Note:  I do not have information regarding when these funds will be implemented but the dates indicate retroactive dates: Here’s the plan for use of the BHET Medicaid Reinvestment dollars:  (Note:  Public notices need to go out on some of these changes but all approps are ‘moving forward’):  

– 5% trend on every Medicaid-able OASAS service except hospital inpatient (Jan 1)

– off-site rate code enhancement for freestanding outpatient and OTP (Jan 1)

– Peer weight increase (Jan 1)

– Addiction Specific E&M APG weight increases (Jan 1)

– Part 820 Residential Rate Increases (March 1)

– Investment in Center of Excellence in coordination with OMH

plus additional efforts OASAS hopes to make public shortly.

 As you may recall, the NYS Council recently had meetings with OASAS leaders to press hard for continuity between new regulatory policies and new services, and OASAS  funding – especially with regard to recently implemented harm reduction practices that have resulted in precipitous reductions in utilization of Outpatient and Residential services across the OASAS system of care.  Our advocacy was straightforward and transparent and we are so grateful to OASAS leads for hearing our concerns and making these funding changes.

We can talk further about all of this on Thursday during our upcoming NYS Council Member Support and Public Policy call.

For now,  we wanted to share the good news although we don’t have every detail yet.