NYS Council Continues Pursuit of Transparency
April 26, 2022
Lawmakers ‘returned’ to Albany yesterday after a two week break. During the budget portion of the legislative session, lawmakers voted to continue to permit themselves to meet remotely, so it is unclear how many rank and file lawmakers are actually in Albany now, but the work of the Legislature will continue through early June.
About an hour ago the Assembly Health Committee met and voted to move our new bill, A9442 to the floor! We are very grateful to Assemblyman Richard Gottfried, our bill sponsor, for moving the bill expeditiously.
The bill requires the state to give public notice when it makes changes to the state’s Medicaid managed care Model Contract – a document that lays out all of the contract provisions and other requirements that must be included in Medicaid managed care contracts for certain special needs populations where their services are carved in to MMC. The bill would require the Department of Health (DoH) to give notice on its website and via the State Register, of Model Contract changes it plans to make prior to the state submitting the changes to CMS for (formal) approval.
This issue may at first seem technical however, during the 15 months the NYS Council was FOILing NYS regulators and state agencies in search of information pertaining to the state’s enforcement of MCO expenditure targets, we learned that (in addition to failing to recoup overpayments from MCOs – funds that belonged to OASAS and OMH), the state also made retroactive changes to the 2019 Model Contract – the version currently in place. Apparently these changes have not yet been approved by CMS but the state is permitted to make most changes to the Model Contract without CMS formal approval.
The changes made by the state amended the performance requirements on MCOs, making it easier for them to meet certain targets. The changes also increased MCO risk protections, and changed how the state calculates the Behavioral Health Expenditure Targets (BHETs), thereby reducing the total amount of funds that are seen as ‘savings’ associated with the carve in that can and should be returned to the state agencies.
Our bill continues our pursuit of increased transparency and increased enforcement of all requirements on MCOs in the carve-in of behavioral health services to Medicaid managed care. The state should not be permitted to make material changes to the Model Contract without stakeholder input. At a minimum, providers that are required to uphold the terms of the contracts they sign that are based on the Model Contract have the right to know when the state makes changes to the document. Our goal is to ensure there will be no further changes to the Model Contract without our knowledge and input.
Here’s more information:
Link to 2019 Model Contract: https://www.health.ny.gov/health_care/managed_care/docs/medicaid_managed_care_fhp_hiv-snp_model_contract.pdf (Apparently a newer version of this document is in ‘draft form’ awaiting CMS approval however, as stated above, the state made changes to it retroactively that are currently in effect.)
Information about A9442: Requires notification of changes to the model contract with managed care providers under the medical assistance program on the DOH website and in the state register.
S T A T E O F N E W Y O R K ________________________________________________________________________ 9442 I N A S S E M B L Y March 7, 2022 ___________ Introduced by M. of A. GOTTFRIED -- read once and referred to the Committee on Health AN ACT to amend the social services law, in relation to notification of changes to the model contract with managed care providers under the medical assistance program THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subdivision 2 of section 364-j of the social services law is amended by adding a new paragraph (d) to read as follows: (D) EFFECTIVE ON AND AFTER APRIL FIRST, TWO THOUSAND TWENTY-TWO, WHEN- EVER THE COMMISSIONER OF HEALTH MAKES CHANGES TO THE TERMS, CONDITIONS OR TIME FRAMES CONTAINED IN THE MODEL CONTRACT WITH MANAGED CARE PROVID- ERS IN THE MANAGED CARE PROGRAM UNDER THIS SECTION, PUBLIC NOTICE DETAILING THE CHANGES SHALL BE PROVIDED ON THE DEPARTMENT'S WEBSITE AND THROUGH PUBLICATION AS A PUBLIC NOTICE IN THE STATE REGISTER PRIOR TO FINALIZING SUCH CHANGES OR SUBMITTING THE AMENDED CONTRACT TO THE CENTERS FOR MEDICARE AND MEDICAID SERVICES FOR APPROVAL, IF REQUIRED. THIS PUBLIC NOTICE SHALL ALSO APPLY TO ANY REQUEST FOR PROPOSALS ISSUED BY THE DEPARTMENT FOR MANAGED CARE PROVIDERS TO PARTICIPATE IN THE MANAGED CARE PROGRAM. § 2. This act shall take effect immediately; provided, however that the amendments to section 364-j of the social services law made by section one of this act shall not affect the repeal of such section and shall be deemed repealed therewith. EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD14878-01-2