NYAPRS Note: Comments from advocacy groups highlighted below indicate just a few aspects of concern that some have with the proposed model of BH transition in managed care. At question is not the merit or overall design, but whether NY truly has the on-the-ground capacity to facilitate the new model. Enough money must be available to support current providers and those implementing new 1915i services, but also the type of business acuity that can invest in appropriate developments in rural or underserved areas. The balance is being decided at the state agency level, but with the eager recommendations from advocacy groups including NYAPRS, as well as MCOs, BHOs, and other businesses that stand to benefit from proper implementation.
Demand Exceeds Behavioral Health Capacity?
Crain’s Health Pulse; 2/6/2014
The state’s money-saving plan to put Medicaid patients with behavioral health problems in managed care has some providers worried. At issue, says HANYS, is whether there’s enough provider capacity for the new model. “We continue to hear from providers that there are areas in the state that lack sufficient outpatient capacity to adequately care for behavioral health and substance-use patients,” the organization said in its comments, submitted Jan. 17. “Other states have tried managing these patients through managed care companies and have learned hard lessons.
Behavioral health patients with mental and/or substance-use conditions are a high-cost population that is sometimes hard to reach, and one that requires access to a wide range of medical and social services. The entities that are selected must be capable of coordinating and managing patients’ access to services, and the state’s oversight of such entities must be diligent and ongoing.
The Coalition of Behavioral Health Agencies, which represents community-based behavioral health providers, raised concerns that the guidelines could shut out community-based organizations from participating in managed care.
“We think the guidelines are biased toward behavioral health organizations,” said Phillip Saperia, the coalition’s chief executive. BHOs are insurance companies that specialize in the behavioral health population. “If you bring them in, there’s more money for overhead and less money for care,” he said. In its comments, the coalition said that organizations, such as health homes, “would cost less and have demonstrated on-the-ground experience with vulnerable consumers.”
The coalition also asked for a reduction of the proposed requirement that plans have five years’ experience in behavioral health, which would give an advantage to national groups, Mr. Saperia said. “The national plans don’t necessarily know New York City better,” he said. “New York is huge in comparison to other places around the country, and there are all kinds of organizations—health homes, IPAs, community-based organizations—that have experience here.”
http://www.crainsnewyork.com/news