September 21, 2023
Thanks to so many of you that attended our Thursday morning call. For those who did not attend, representatives from OMH including Pieter Barnett, Gwen Diamond, Chris Smith, Sarah Kuriakose and Stacey Hale joined the call for a discussion regarding the Office’s plans to invest $20M (potentially grossing up to $40M with federal participation) to address and increase Article 31 Outpatient Clinic access to care, to reduce waiting lists, and put more money in system. Note: Not all investments are subject to federal match so may/may not reach $40M for total investment.
Here’s what we heard (on top of what we already knew from the PowerPoint slide deck and notes I sent everyone last week).
I have attached the presentation so you can follow along slide by slide:
Regarding the Clinic Start Up and Expansion Proposals (slide 1)
- Increase Article 31 Clinic Services availability with particular emphasis on hard to reach and underserved areas of state: Total investment between $2-3M with RFP going out December or January. Ten awards at $250k each. OMH is willing to entertain proposals that include capital expenditures although these funds are not designated as capital dollars. Will try to be flexible.
- Another $4M (total) breaking down to about $50k per provider for @ 80 providers, to expand existing clinic capacity. RFA could come as early as October. Modest awards to many providers.
Quality Improvement Program (QIP) (slide 2)
- Currently about 80-90% of Article 31 providers are participating in this Program and they are receiving a rate increase of just under 4% for their participation. Here, OMH would bump up the rate increase for participating providers to close to 6% with intentions to increase again in ’24-’25 to around 7%.
- At present time, @85% of all Article 31 Outpatient Clinic providers participate in the QIP. OMH intends to open this Program up to hospital-based clinics in hopes of increasing participation rates. (Hospitals involved in a different QIP at present time.)
- OMH will soon issue a Federal Participation Notice (FPN) to preserve (with CMS) its intention to implement this initiative.
Paying More for Group Therapy services in Article 31 Clinics (slide 3)
- Intention is to pay more for Group Therapy services in Article 31 Clinics in hopes of reducing waiting lists/serving more individuals. Would include Group Therapy delivered by clinicians as well as group therapy by qualified peers.
- This proposal would increase the WEIGHT assigned to Group Therapy code by 50% (not the rate) but this results in increased reimbursement.
- OMHs experience is that making changes to the APG billing system is quite intricate and happens at certain times of the year and so (for expediency) OMH is exploring other ways to push this out other than via APG government rates.
Crisis / Complex Services (slides 4 & 5)
- Hoping for an October implementation however OMH is exploring ways to push these changes out through alternative vehicles other than via APG government rates since this takes time and could delay implementation.
- One of the goals is to simplify requirements to bill for Complex Care service.
EBPs and Specialty Services (slide 6)
- Intention is to add funds to encourage use of evidence-based practices including DBT where reimbursement (at the present time ) does not cover additional groups.
- Office also intends to increase reimbursement for Neuropsychological Services.
- OMH recognition that providers need funds to train on use of EBPs. Specific information regarding % of increases here TBD.