In this week’s summary, you’ll find info on a new timeline for transitioning behavioral health services to Managed Care, the role of navigators in enrolling the uninsured into health exchanges, stopping a bacterial meningitis outbreak in NYC, and more!
The New York State Medicaid Drug Utilization Review (DUR) Board will meet on September 12 from 9 – 4 in Meeting Room 6 at the Empire State Plaza Concourse. The agenda is here.
Significant news was released this week on New York Medicaid’s behavioral health front by the Office of Alcoholism and Substance Abuse Services, Office of Mental Health and Medicaid Director Jason Helgerson, regarding revised (delayed) implementation dates for transitioning behavioral health services to managed care. The announcement is copied here:
“The Medicaid Redesign Team (MRT) recommended a careful and responsible transformation of the current fee for service system to Medicaid Managed Care for Medicaid enrolled individuals with Substance Use Disorder (SUD) and Mental Health (MH) treatment needs. To implement this recommendation, program design features are being carefully constructed and revised based on feedback from a variety of key sources including BH providers, Medicaid members, MMC Plans, other states with successful track records, and the State’s consultants. While no major changes have been made to publicly discussed plans, this critical feedback on details related to program features, baseline data and rate development activities is creating some delays as the team carefully constructs this very important product.
Accordingly, this review and revision will delay final Request for Qualification (RFQ) specifications and HARP and Non-HARP rate development. As previously discussed the RFQ timing is key as the RFQ will qualify Plans as approved to manage the State Plan and new waiver-like BH services on their own or in partnership with a BHO and will establish qualification parameters for Health and Recovery Plans (HARPs) for individuals with higher levels of SUD and MH treatment and support needs. The new implementation dates are listed below and will afford NYS the opportunity to:
1. Provide Medicaid Managed Care Plans and Behavioral Health Providers more time to prepare for this major improvement in the way we provide health care to some of our most vulnerable citizens;
2. Continue to work with stakeholders, families and consumers to understand and give us feedback on this major change and to help us better leverage important community based services in the design;
3. Allow for more time to develop key performance measures for this transition and new operation;
4. Allow more time to obtain needed Federal approval for these new services and design and
5. Allow DOH, OASAS, and OMH to continue working on reasonable and efficient plan and service payment rates with the State’s actuary.
Revised Implementation Dates:
Thank you for your continued support for this critical undertaking. We look forward to eventually leading the nation in providing the best possible care to individuals with behavioral health conditions.”
Affordable Care Act/Health Insurance Exchanges
Navigators are key in helping to enroll the uninsured into health exchanges, according to the New York Times. The numbers of navigators and their success will vary across states. Some states have devoted ample resources to navigator efforts, while other state navigators are operating within tight budgets and short timeframes. New York is spending $27 million on navigators. The Obama Administration announced $67 million in new grants this week.
The Wall Street Journal reports that many new health exchange insurance plans will limit access to doctors and hospitals for enrollees as a means to manage costs. They are wagering that consumers will be open to trading limited choice for more affordable health coverage. In New York, the North Shore-Long Island Jewish Health System is creating a new health plan that will only cover care delivered in one of its 15 hospitals and possibly one other. Coverage for doctor visits will be limited to physicians who work for the health system or its affiliates.
A New York City vaccination program has halted the spread of a lethal bacterial meningitis outbreak among gay men. No new cases have been reported in six months, according to the New York Times. Twenty-two men were known to be infected, seven of which died since 2010. The meningitis is highly contagious and can be carried by gay or straight individuals. The vaccination program has reached 16,000 people so far and will continue, including at pharmacies beginning in October.
-Jaime Venditti, 8/16/13