May 23, 2022
During the budget negotiations portion of the 2022 Legislative Session, the NYS Council sought inclusion of language that would require the state to be transparent with regards to any changes it makes to the state’s Model Contract – a document that outlines the required, permissible and prohibited terms that can be included in contracts between the state and the MCOs that manage BH benefits in Medicaid managed care. At that time, the Assembly was reticent to add new language that was purely policy to the budget discussion and a standalone bill was crafted. Our bill, A9442A, sponsored by Assemblyman Richard Gottfried passed the Assembly last week. In the interim, Senate Health Chair Gustavo Rivera took up our cause and is sponsoring S09207, the ‘same as’ version of the bill that recently passed in the Assembly.
Our justification for this bill has everything to do with our advocacy experiences over the past several years. As you will recall, the NYS Council issued over two dozen FOIL requests (via our attorneys) to various state regulators and state agencies as we searched for confirmation of our concern that plans were not meeting performance metrics, and that the state was not recouping overpayments made to plans in instances where they had failed to spend the vast majority of these funds on actual care for beneficiaries, as required in their contracts. During this process, we learned that the state had made retroactive changes to the terms of the contracts between the state and the plans that had the effect of reducing performance targets the plans are held to. These changes impact the amount of money that must be returned to the state agencies in instances where the plans fail to meet the required performance metrics. Although our work resulted in the return of $222M to OASAS and OMH this year, we are pushing this bill to ensure the terms of the contracts between the state and the plans – terms that have great impact on outcomes for consumers and providers engaged in the carve in of BH services – are transparent. All stakeholders deserve to know if and when the state changes the terms of the contracts between the parties. In the days to come we will seek your support for our bill in the Senate. We anticipate pushback from certain corners.