Mental Health Update

Terrific analysis by MHANYS Counsel and Special Assistant John Tauriello, of the budget items that are in the Health/Mental Hygiene Budget that effect mental health.  We will discuss these through budget especially around the managed care plans but an immediate concern is around Prescriber Prevails elimination and the repeal of the Quality Enhancement Program for Adult Homes. This funding was integral to the needs of adult home residents and it makes no sense to eliminate the funding.

Each year the Governor is required under Article VII of the State Constitution to introduce legislation to amend statutory provisions that are essential to enact the state budget. The statutory amendments that affect the health and mental hygiene systems are included in a bill called (in Albany-speak) the Health & Mental Hygiene-Article VII Bill.

Below is a summary of the provisions of that bill that would affect OMH and persons with mental illness.

==========

Health & Mental Hygiene-Article VII Bill Summary   

Part B, Section 2: Special Needs Plans Authority Extended 

The authority for OMH, in consultation with DOH, to certify Medicaid “special needs plans” would be extended for 5 years, until March 31, 2030.

Part B, section 5: Parity in Coverage for Telehealth Services 

Extends for one year until April 1, 2025, provisions, requiring that commercial insurance coverage and Medicaid reimbursement for services provided by via Telehealth, shall be at the same rate of payment as in-person reimbursement rates.

Part D, section 10: Extension of Regulatory Waiver Authority of “O” agencies and DOH

Extends until April 1, 2026, the authority of DOH and the four mental hygiene agencies to waive regulatory requirements related to providers involved in DSRIP projects or “authorized replication and scaling activities, to avoid duplicative requirements.”

Part H: sections 6 and 7:  Managed care plans and managed long-term care plans 

Provides for a moratorium on processing of applications for Medicaid managed care plans and managed long-term care plans or applications to expand the scope of eligible enrollee populations submitted on or after January 1, 2024. There is a limited exception to address serious concerns with care delivery, including a lack of adequate access to “special needs services.“

Prior to the approval and certification of new Medicaid managed care plans or managed long-term care plans, including special needs managed care plans, DOH would be required to conduct a competitive bidding process, under which DOH shall require new applicants to comply with a number of criteria and enrollee protections, including “adequate accessibility and geographic distribution of network providers taking into account the needs of persons with disabilities.” Further, DOH must consider all content and criteria requirements are fully met by the plan applicants, including patient protections for persons with disabilities and youth, and consultation with OMH, OPWDD, OASAS, and OCFS “as applicable.”

Part H, section 9: Enhanced Enforcement Tools Over Managed Care Organizations

DOH would be entitled, in its “sole discretion,” to recover “liquidated damages”* from managed care organizations for failure to meet contractual obligations and performance standards under their contracts with the state. Damages could range up to $25,000 per violation. Further, such damages must be paid out of the administrative costs and profits of the managed care organization and not from payments to providers for services, or payments to subcontractors.

This provision would add an important tool for DOH to enforce the contractual obligations and requirements of managed care organizations.

*(Liquidated damages are specified dollar amounts that are established in contracts, in the event of a breach by the contractee- in this case, the managed care organization.) 

Part I: Repeal of Prescriber Prevails (including antipsychotic and anti-depressant medications)

The ability of prescribers to prescribe drugs that are not on the Medicaid program “preferred drug list” would be eliminated effective 1/1/25. As a result, the state could override a prescriber’s professional judgment, including medications prescribed for persons with mental illness.

Furthermore, section 3 would repeal subdivisions 25 and 25-a of section 364-j of the Social Services Law.  (These subdivisions currently require managed care providers to cover all medically necessary atypical antipsychotic and anti-depressant medications, including non-formulary drugs, upon demonstration by the prescriber that in his or her reasonable professional judgment, such medications are medically necessary and warranted.)

Part L, Repeal of the Quality Enhancement Program for Adult Care Facilities 

The statutory authority for the DOH program called “enhanced quality of adult living program” (EQUAL) would be repealed.

The EQUAL program provides grants to improve the quality of life for adult care facility residents EQUAL grants may be used to provide clothing allowances, improve food quality, provide outdoor leisure projects and events, and improve resident quality of life. Funds could also be used to finance capital improvements to the physical environment to promote higher resident quality of life.

(It is believed that elimination of the EQUAL program would potentially impact many persons with mental illnesses who reside in adult homes.)

Part M, Expanded Medicaid Coverage for Children

Children ages birth to 6, who are determined to be eligible for Medicaid or CHIP would remain eligible for those benefits, until the last day of the month in which the child reaches the age of six.

This Part would take effect on January 1, 2025.

Part S, Healthcare Safety Net Transformation Program 

Safety net hospitals and “partner organizations“ may apply for up to $500 million in funding to improve access, equity, quality, and outcomes while improving the financial sustainability of the hospital.

Partner organizations may include community-based organizations that can assist in the transformation of the hospital.

(While there is no definition of “partner organizations,” we believe that this term would include community-based behavioral health providers.)

Part W:  Inter-agency Elder Justice Coordinating Council

A new Inter-agency Elder Justice Coordinating Council would be created to protect older adults from abuse and mistreatment and to promote greater elder justice.  The Council would develop a state plan, strategies, programs, and improve coordination and collaboration to achieve these goals. The Council would be chaired by the Director of the State Office for the Aging, and include representatives from several state agencies, including OMH.

Part Y: Reinvestment Act – Made Permanent 

This Part would make the Community Mental Health Reinvestment Act permanent. The Act is currently scheduled to sunset on March 31, 2024.

Part Z,  Makes Permanent Mental Hygiene Demonstration Program Authority

This Part would make permanent the ability of the Commissioners in the Department of Mental Hygiene, to develop three time-limited demonstration programs to test and evaluate new methods of organizing, financing, staffing and providing services for mentally disabled persons, without regard to most state purchasing requirements, including competitive bidding. These demonstration programs may include innovative financing and staffing arrangements and specific programs to serve mentally disabled persons.

Part AA, Commercial Insurance Rates for Outpatient Behavioral Health Services 

Requires commercial health insurance reimbursement rates for certain outpatient behavioral health services to be at least at the same level as comparable Medicaid rates for the same services.

OMH service rates impacted by this law would be limited to in-network, licensed outpatient services, such services provided in OMH-operated facilities, and licensed crisis stabilization center services.

OASAS outpatient services impacted by this Part include in-network services that are licensed, certified or otherwise authorized by OASAS and would include outpatient, intensive outpatient, outpatient rehabilitation, and opioid treatment.    (This part would take effect January 1, 2025, and apply to policies and contracts issued, renewed, modified or amended on and after such date.) 

Part BB, Comprehensive Psychiatric Emergency Programs (CPEPs)- Permanent 

This Part would make permanent the statutory authority for the establishment of CPEPs by OMH, which is scheduled to expire on July 1, 2024.

Part DD, Representative Payee Authority

This Part makes permanent the “representative payee” authority for directors of state-operated mental hygiene facilities to receive federal and state benefits for individuals receiving care in such facilities.

Part FF, Human Services COLA

This Part would provide a 1.5% COLA for state fiscal year 2024–25, to most community-based human services providers, including community-based mental health providers.