NYS Council Advocacy

October 25, 2021

For almost two decades, the NYS Council has worked to ensure timely access to and continuity of care for New Yorkers with mental health and/or substance use disorder conditions.  Our work has resulted in new laws being enacted,  and regulations being implemented that require the state to protect vulnerable New Yorkers while leveling the playing field between health plans and providers.  But new laws and regulations are only effective if there is robust surveillance, monitoring and enforcement of these requirements by state regulators.

One year ago, the NYS Council retained outside counsel to file some 20+ FOILS that were directed at DoH, OMH and OASAS, the Attorney General and the Comptroller’s Office.  All of the FOILS sought information regarding key elements of the behavioral health carve in of our services to Medicaid managed care beginning in 2015.  Most of them sought information regarding health plan performance in the carve-in and several sought specific information regarding some 87+ citations that have been issued by OMH and / or OASAS to various MCOs over the last two years.

Tonight we learned that the state posted some of the information we have been requesting.  Specifically, I received a note from a lead at DoH stating that today the Department began posting MCO focused survey citations on the Managed Care Reports website Managed Care Reports (ny.gov).  Apparently the initial postings consist of results of the Medicaid/CHP MHPAEA self-assessments (2018-present) and behavioral health Medicaid managed care claims denials (2017-present). Focused surveys identify specific issues requiring compliance monitoring and correction, if needed.  I am told the postings contain the citation with the accepted plan of correction.  We are reviewing the information and will share more shortly.

We thank the Department for posting this information.  However there is still a great deal of information we do not have that we know we are entitled to including whether MCOs met certain key financial metrics that speak to how much the MCOs spend on actual care for beneficiaries   To be clear, the NYS Council will not relent until we receive all of the information we have been requesting and are entitled to.

We’ll talk more about this and related topics during our upcoming NYS Council Public Policy and Member Support call this Thursday morning at 9:15.  I hope you will join us.