September 15, 2025

At the present time and to our knowledge, three BH MCOs require at least some of their in network providers to comply with a requirement for concurrent review of certain CFTSS services, after the initial sessions are completed and when the client could benefit from additional care.  This new requirement was implemented beginning on July 1, 2025 or thereabouts.  Upon implementation we immediately heard from many NYS Council members who told us the workload associated with this new requirement would be very significant, and they were deeply worried about continuity of care for the children, youth and families that benefit from these already hard to access services.  The NYS Council began asking OMH leaders to share information that assured us that both NYS and the plans had conducted all of the tests and completed all of the compliance work they are required to perform before initiating concurrent reform.  We were also very concerned that there appears to be no simultaneous surveillance and monitoring of MCO implementation of this new requirement at this time (2 months after at least two of three MCOs implemented the requirement).  As a result and in a recent communication with OMH, we learned the state will be implementing surveillance and monitoring this shortly.

Some agencies were exempted from having to comply with this new requirement by the insurer/s.  In most instances, the agencies that did not get an exemption from the insurer were never told why they are required to comply.  As such, the NYS Council turned to our colleagues at The Legal Action Center for assistance and consultation while we continued to push OMH and DoH for further details.  After months of requests to OMH for further information, I received a response from OMH recently. I went back to LAC for advice and together we drafted the letter (attached).  

Evaluating compliance with federal and state parity laws is often complicated and time consuming.  We think it is incredibly important to lean in and make it clear to state leaders that we are monitoring this closely on behalf of the thousands of children and families that continue to struggle to gain access to these services, and the hardworking agencies that provide them/want to provide them.

Great thanks are due to Christine Khaikin and all of our colleagues at The Legal Action Center – the true experts here in New York and around the country on federal and state parity laws.  We look forward to continuing our work together to ensure adequate access to care and on demand continuity of care for any New Yorker, beginning with children and families who can benefit from these services.  

If you are an agency that has experienced denials by MCOs when you sought authorization for additional CFTSS services for a client/family, PLEASE CALL ME at 518 461-8200. or send me a note with a brief summary of your experience to date to include any raw data you have about units of services that were denied as part of a larger request you made to the insurer for additional services.  We need data – raw or otherwise.  

Please see the attached letter we just sent to the Commissioners at DOH, OASAS and OMH.  Stand by for more.