NYAPRS Note: NYS Assembly lawmakers, led by Mental Health Committee Chairwoman Aileen Gunther convened a hearing yesterday on the impact of carve-in transition of behavioral health services into integrated managed care. While it appears that there was general support for the overall policy, several critically important questions were raised that NYAPRS has shared throughout the process:
- Our priority focus must be to ensure that the health and lives of beneficiaries affected by this transition is not compromised, that their connection to needed services and supports is improved not disrupted and that health home outreach, engagement, care planning and coordination efforts are adapted as needed to ensure their success
- Helping to keep beneficiaries out of emergency and inpatient settings will save money and be good policy…as long as the supports and services are in place to help them improve their lives and health in the community
- In that vein, we must take all steps necessary to ensure that the community recovery service sector successfully transitions and expands to address growing needs, especially given the critical importance of behavioral health to total population health outcomes. If we don’t, decades of the development of our capability to support recovery will be lost.
- We must provide the education, advocacy, legal protections and support necessary to assist beneficiaries to successfully navigate through this series of complex changes and transitions.
Special thanks to MHANYS CEO Glenn Liebman for his excellent representation at the hearing.
Lawmakers, Stakeholders Weigh Managed Care Transition
By Josefa Velasquez Capital New York October 21, 2015
ALBANY — Representatives for state agencies, mental health organizations and health plans convened in Albany Wednesday to weigh how the transition to the Medicaid managed care model is affecting individuals receiving mental health and substance abuse services.
“So far the transition of behavioral health managed care has proceeded relatively smoothly,” Gary Weiskopf, the associate commissioner for managed care at the Office of Mental Health, said at a hearing held by the Assembly committee on mental health and developmental disabilities. “Of course with any transition of this magnitude there will be issues.”
At the beginning of this month, the state’s Department of Health, OMH and Office of Alcoholism and Substance Abuse Services began transitioning behavioral health services from a fee-for-service Medicaid plan to managed care in New York City, with the rest of the state transitioning July 2016. Children will begin the transition to managed care beginning in January 2017, with a full transition expected by December.
Vallencia Lloyd, director of the division of health plan contracting and oversight for DOH, called the previous fee-for-service model “fragmented, uncoordinated,” and said it did not take a “holistic approach” to serving some of the state’s most vulnerable individuals.
“We developed an integrated monitoring team to respond to issues as they arise and will jointly conduct on-site operational surveys to ensure that all requirements are being met by managed care organizations,” Lloyd said to Assemblywoman Aileen Gunther, the committee chair, and Assemblyman Tom Abinanti.
In a sometimes contentious back-and-forth between the representatives for the state and the lawmakers, Abinanti questioned how the state arrived at the conclusion that the new model would deliver services more effectively while saving money.
“The problem is, your theory sounds good. I can’t criticize your theory, but I want to see if it’s going to work because we’re playing with the lives of people out there and we’re changing things,” Abinanti said. “Not that the other system was working really well, but people had become adjusted to it.”
The state has identified $645 million within DOH to begin implementing the transition on the basis that the spending will be offset by cost savings, Abinanti said.
“I was disappointed that they couldn’t provide me any data which would serve as the basis for their general conclusion that this is a better way to go from the point to view of service and the point of view of saving money,”Abinanti told POLITICO New York after the hearing.
Glenn Leibman, the CEO of the Mental health Association in New York State, testified to the assemblymembers that he wants to make sure that funding for mental health and substance abuse services remain within the system and that providers can bill Medicaid for reimbursements.
“These three weeks are not predictive enough for the future, though we would not be surprised to hear about glitches in the system of care in terms of billing, prompt payments, health information technology, network capacity, metrics and other areas,” he said. “We do not condone any of that, but the most significant factor in all this is about the people. Are they losing services? Are they out of touch with their providers? Have Health Homes not had the capacity to provide the necessary care coordination? Has their plan of care been negatively impacted, et cetera. Those are the things we should be measuring against early in the process and frankly throughout the process.”
Kathy Preston, the vice president of government programs at Health Plan Association — a trade group for insurers — said that plans have not yet seen the final draft premium rates and have no idea if their reimbursements will be enough to cover the additional responsibilities of managing the behavioral health benefits.
In addition, she said, plans have concerns about the three-agency design of the transition, noting that the overlap is creating “implementation difficulty.”
“The system has to save money and save people, not just save money. Saving money and losing people is a failed system,” Abinanti said.