ATPA leads drafting of access to care legislation

It is with great pride that ATPA has played a pivotal role in the both the Assembly Roundtable on Health Insurance Coverage for Chemical Dependence Treatment and the Joint Senate Task Force on Heroin and Opioid Addiction.

Much of the information exchanged during the meeting was critical in achieving a comprehensive Heroin Health Care Crisis package of legislation.

Specifically the “Access to Care” legislation will much improve New Yorkers access to full recovery by the removal of the “fail first” language.

ATC-Silver

ATC-Skelos

Please send this to Governor Cuomo or use it as the basis for your own letter

Today is the day. Any amendments that are to be made to the Insurance Access to Care bill we have been working on will be completed by 11:59 tonight (and probably a lot sooner than that).

Our goal is to pressure all state leaders to keep the “same as” bills intact as currently written. That is, A. 9973a /S. 7762a.

Family members are in town today and tomorrow, working to keep the pressure on the Assembly (bill needs to come out of Assembly Insurance Cmte and to the floor).

Attached is a letter for you to complete and send to Governor Cuomo via fax today (as soon as possible). If the line is busy PLEASE keep trying!

(Letter needs your logo and some information specific to your organization in the first paragraph).

Please distribute to your coalition partners as soon as possible.

THANK YOU!

Governor’s Fax: (518) 474-1513

Exec Letter final

ATTENTION FREESTANDING CHEMICAL DEPENDENCE OUTPATIENT CLINICS, CHEMICAL DEPENDENCE OUTPATIENT REHABILITATION AND OUTPATIENT YOUTH PROGRAMS

ATTENTION FREESTANDING CHEMICAL DEPENDENCE OUTPATIENT CLINICS, CHEMICAL DEPENDENCE OUTPATIENT REHABILITATION AND OUTPATIENT YOUTH PROGRAMS

Effective January 1, 2014 APG reimbursement methodology will be fully implemented in Freestanding Chemical Dependence Outpatient Clinics, Chemical Dependence Outpatient Rehabilitation and Outpatient Youth Programs.

This is a reminder that effective January 1, 2014 APG reimbursement will be fully implemented in Freestanding Chemical Dependence Outpatient clinics, Chemical Dependence Outpatient Rehabilitation programs, and Outpatient Youth programs. This is the conclusion of the multi-year phase-in from the blended threshold/legacy APG reimbursement methodology to full APG reimbursement. Effective January 1, 2014 reimbursement for services provided will be calculated using only the APG reimbursement methodology (e.g. APG base rate X service weight, minus any applicable service discounts).

Freestanding Chemical Dependence Outpatient clinics, Chemical Dependence Outpatient Rehabilitation programs, and Outpatient Youth programs will continue to bill using their APG rate code and enter appropriate HCPCS/CPT service codes on the line level for the services that were provided to the client on that service date/visit. Reimbursement for the APG coded claim will continue to be paid using APG reimbursement methodology (including applying APG discounts when appropriate). For a listing of service codes, please refer to the on-line APG manual at: http://www.oasas.ny.gov/admin/hcf/APG/documents/APGManual.pdf.

For claims with dates of service prior to January 1, 2014 and are submitted after January 1, 2014, these claims will have the Phase three legacy blend applied to the reimbursement.

Note: Hospital-based Chemical Dependence Outpatient clinics, Chemical Dependence Outpatient Rehabilitation programs, and Outpatient Youth programs continue to be reimbursed the threshold/legacy amount.

If you have any questions regarding this notification, please e-mail the APG mailbox at APG@oasas.ny.gov

ATTENTION OASAS FREESTANDING OPIOID TREATMENT PROGRAMS

Oasas

ATTENTION OASAS FREESTANDING OPIOID TREATMENT PROGRAMS

Effective January 6, 2014 APG reimbursement methodology will be fully implemented in Freestanding Opioid Treatment programs.

This is a reminder that effective January 6, 2014 APG reimbursement will be fully implemented in Freestanding Opioid Treatment Programs. This is the conclusion of the multi-year phase-in from the blended threshold/legacy APG reimbursement methodology to full APG reimbursement. Effective January 6, 2014 reimbursement for services provided will be calculated using only the APG reimbursement methodology (e.g. APG base rate X service weight, minus any applicable service discounts). Therefore, effective January 6, 2014 the legacy reimbursement portion is phased out; meaning the rate code 1671 should no longer be used.

Effective for dates of service January 6, 2014 forward, OTP programs will only submit one claim. Using the rate code 1564, providers will code on the line level the services that were provided for the billing week. OTP providers will continue to bill the first Medication Administration (H0020) of the week with the “KP” Modifier. Reimbursement for the 1564 rate code claim will continue to be paid using APG reimbursement methodology (including applying APG discounts when appropriate).

For claims with dates of service prior to January 6, 2014, OTP programs submit two claims. Claim One—using the rate code 1671 in the header of the claim, enter the HCPCS code H0020 on the line level. This claim obtains the legacy portion of the reimbursement. Claim Two—using the rate code 1564 in the header of the claim, enter on the line level the HCPCS/CPT codes for the APG services provided to the client during the billing the week. This claim obtains the APG portion of the reimbursement.

The rate code 1471 remains unaffected by the conversion to full APG reimbursement methodology. Rate code 1471 will continue to reimburse as it has throughout the phase in of APGs.

Note: Hospital-based OTP providers continue to be reimbursed the threshold/legacy amount.

If you have questions regarding this notification, please e-mail the APG mailbox at APG@oasas.ny.gov.

OPRA and PRESCRIPTIONS

eMedNY

ATTENTION!!! IMPORTANT PRESCRIPTION INFORMATION

 

Prescribers failing to enroll in NYS Medicaid will impact patients’ ability to obtain their medications.

 

Effective October 1, 2013, a pharmacy will NOT be able to fill any prescription written for an individual with Medicaid where the prescriber is not enrolled in NYS Medicaid.  This applies to both new prescriptions and refills.

 

Prescriptions written by prescribers that are not enrolled in NYS Medicaid will deny at the point-of-service.   A pharmacist cannot override a rejected transaction if the prescriber is not enrolled.

 

NYS Medicaid enrollment forms and information: https://www.emedny.org/info/ProviderEnrollment/index.aspx

Open Enrollment in NY Insurance Exchange Begins October 1

NewYorkStateHealth

This is a reminder that open enrollment in the state insurance exchange, New York State of Health (http://www.nystateofhealth.ny.gov/), begins October 1st. Insurance coverage through the exchange will be effective January 1, 2014.

The NY State of Health website has several helpful documents which we encourage you to review, share with staff and consumers as appropriate (http://www.nystateofhealth.ny.gov/resources?f[0]=field_resource_type%3A3).

Each region of the state has local Exchange Navigators who will be available to assist employers and individuals in understanding coverage options through the exchange (http://www.nystateofhealth.ny.gov/resources?f[0]=field_resource_type%3A81). We encourage you to reach out to local navigators following October 1, especially as you assist uninsured consumers who need to find coverage.

We will certainly discuss the exchange and its implications at next week’s public policy retreat and annual membership meeting (go to www.asapnys.org for more information), we hope many of you will be joining us. Our Monday public policy calls will also serve as an opportunity to discuss the roll out of the exchange and identify any issues with navigating the system and enrollment.

Please feel free to contact us with specific questions you might have about the exchange in the days and weeks ahead.

Press Release: New York Health Benefit Exchange Announces New Name and Health and Dental Plans to be Offered

nyhealthplan

ALBANY, N.Y. (August 20, 2013) – State Health Commissioner Nirav R. Shah M.D., M.P.H., today announced the new name for the New York Health Benefit Exchange, ‘NY State of Health.’ The launch of the new name and logo (included below) is an important milestone for communications around the exchange, which will open for enrollment on Oct. 1, 2013.

“The NY State of Health name reflects our commitment to deliver what the exchange is all about –a marketplace that will provide quality, affordable health insurance for individuals and small businesses across the state,” said Commissioner Shah.

The brand and logo were developed by advertising agency, DDB New York, and is the first reveal in a campaign that will air across New York media beginning Oct.1. The brand is anchored in a mantra that defines what it is to be a New Yorker; visit www.nystateofhealth.ny.gov.

“In creating a name, we wanted it to be meaningful, memorable and capture the essence of what it is to be a New Yorker – that unique ‘can do’ attitude and state of mind,” said Donna Frescatore, NY State of Health’s executive director. “Across the state, there’s a growing sense of excitement as we move closer to enrollment. We’re confident the ‘NY State of Health’ name and campaign will inspire New Yorkers who are uninsured or underinsured to explore the options and choose the plan that fits their needs.”

Also announced today were the insurers that will offer health and dental plans to individuals and small business owners when NY State of Health opens for enrollment on Oct. 1. The New York State Department of Financial Services announced on July 17 the approved health insurance plan rates for insurers seeking to offer coverage in New York’s exchange marketplace.

“By assuring access to quality, affordable health insurance, NY State of Health will play an essential role in making New York the healthiest state in the nation,” said Commissioner Shah. “As a result of Governor Cuomo’s leadership, individuals and small businesses will soon be able to choose from a variety of plans to suit their needs.”

The health plans that will be offered in NY State of are:

  • Affinity Health Plan, Inc.
  • American Progressive Life & Health Insurance Company of New York (Today’s Options of NY, Inc.)
  • Capital District Physicians Health Plan, Inc.
  • Health Insurance Plan of Greater New York (EmblemHealth)
  • Empire BlueCross and Empire Blue Cross Blue Shield
  • Excellus (Excellus Blue Cross Blue Shield in Central NY and Univera in Western NY)
  • Fidelis Care
  • Freelancers Co-Op (Health Republic Insurance)
  • Healthfirst New York
  • HealthNow New York, Inc. (Blue Shield of NENY; Blue Cross Blue Shield of Western NY)
  • Independent Health
  • MetroPlus Health Plan (Market Plus)
  • MVP Health Plan, Inc.
  • North Shore LIJ
  • Oscar Insurance Corporation
  • United Healthcare of New York, Inc. (United, Oxford)

 

The dental plans that will be offered in NY State of Health are:

  • Delta Dental Insurance Company
  • Dentcare
  •  Dentegra Insurance Company
  • Emblem
  • Empire BlueCross and Empire Blue Cross BlueShield
  • Guardian
  •  HealthNow New York, Inc. (Blue Shield of NENY; Blue Cross Blue Shield of Western NY)
  •  Healthplex
  • MetLife
  •  Solstice

 

An interactive map that shows health plans by county is available at: www.nystateofhealth.ny.gov/PlansMap

 

Plans offered in NY State of Health will be available in four easy-to-compare metal tiers (platinum, gold, silver and bronze). Plans on the Marketplace will cover doctor’s visits; hospital stays; emergency care; maternity and newborn care; mental health and substance abuse disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services, chronic disease management and pediatric dental and vision. Some plans will offer additional benefits such as adult dental and vision coverage.

Individuals and families with incomes below certain levels ($45,960 for individuals and $94,200 for a family of four) may be eligible for financial assistance in the form of federal tax credits only available through NY State of Health. Federal tax credits limit the amount a person pays for insurance each month. Monthly payments will be far below the cost of buying insurance today. For example, if a silver level plan is selected, an individual with an annual income of $17,000 will pay $55 per month; a family of four with an income of $35,000 will pay $114 per month.

In addition, starting today, New Yorkers may use the calculator on the NY State of Health website (nystateofhealth.ny.gov) to estimate their eligibility for tax credits; see: www.nystateofhealth.ny.gov/PremiumEstimator

NY State of Health will offer New York’s small businesses with 50 or fewer employees a range of coverage options and ease the administration of employee benefits for owners. Moreover, NY State of Health will be the only place where small businesses with 25 or fewer employees and average wages of $50,000 or less per year may qualify for tax credits to reduce the cost of providing coverage.

Insurance coverage begins Jan.1, 2014. It is estimated that at full enrollment nearly 1.1 million New Yorkers will obtain insurance through NY State of Health, including 615,000 individuals and 450,000 employees of small businesses.

For more information, visit the NY State of Health website at nystateofhealth.ny.gov and on Facebook, Twitter or Google+.

NYS Moves Timeline Forward for Transition of Behavioral Health Services

On behalf of the Office of Alcoholism & Substance Abuse Services Commissioner Arlene Gonzalez-Sanchez, Office of Mental Health Acting Commissioner John Tauriello, and myself, I would like to provide you with the following update on the timeline for transition of Behavioral Health services:

The NYS Behavioral Health (BH) Transition Team for Medicaid, comprised of leads from OASAS, OMH, and DOH, is updating the target dates for implementing the transition of BH services.

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:

  • January 1, 2015:    Implementation BH Adults in NYC (HARP and Non HARP)
  •  July 1, 2015:           Implementation BH Adults in Rest of State  (HARP and Non HARP)
  • January 1, 2016:    Implementation BH Children Statewide

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.

Jason Helgerson
Medicaid Director

Behavioral Health Transition Timeline (August 2013)

 

OASAS Criminal Background Checks – Justice Center Staff Exclusion List

Justice Center 8.8

TO: Providers within Justice Center SEL Check Jurisdiction
FROM: Jeff Wise, Executive Director
DATE: August 6, 2013
SUBJECT: Interim Process: Provider Staff Exclusion List Checks

As you know, the Justice Center is responsible for maintaining a statewide register known as the Staff Exclusion List (SEL) which will contain the names of individuals found responsible for serious or repeated acts of abuse and neglect. Individuals on the SEL are subject to hiring restrictions as prescribed by law for any state operated, certified or licensed agencies or providers that serve people with special needs. As of June 30, 2013, the law requires most providers to check the SEL prior to allowing a prospective applicant to have regular and substantial contact with a service recipient.

We are cognizant of the fact that no one is currently on the SEL. The Justice Center values the input from the provider community as we work to ensure that people with special needs are protected from abuse, neglect and mistreatment. To alleviate the processing burden associated with checking the SEL, the Justice Center has considered suggestions for changing the SEL check request protocol and has decided to make available an Interim Request for Staff Exclusion List Check page on the Justice Center’s website for providers to access, instead of requiring a SEL check for each individual applicant, until such time as someone is placed on the SEL.

Until a person is placed on the SEL, providers may comply with Social Services Law §495(2), which requires a check of the SEL, by visiting www.justicecenter.ny.gov and clicking on the red banner near the top of the home page, then printing and saving a copy of the dated Interim Request for Staff Exclusion List Check page along with the employment application for each applicant for whom a provider or agency is mandated to conduct a SEL check. This document must be available for auditing purposes by your program’s State oversight agency.

When someone is placed on the SEL, the webpage will change to reflect that fact and providers will then be required to submit an SEL Check Request form for every applicant and receive a Justice Center response before proceeding with the hiring process or otherwise allowing that person to have regular and substantial contact with a service recipient.

Please note: the Justice Center has interpreted the relevant statutory language to provide that an SEL Check Request should only be submitted on a person a provider is seriously considering hiring or otherwise permitting to have regular and substantial contact with a service recipient. An SEL Check Request form should not be submitted for everyone that a provider may interview.

161 Delaware Avenue, Delmar, NY 12054

Governor Cuomo Announces Approval of 2014 Health Insurance Plan Rates for New York’s Health Benefit Exchange – Press Release & NY Times Article

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For Immediate Release: July 17, 2013

 

GOVERNOR CUOMO ANNOUNCES APPROVAL OF 2014 HEALTH INSURANCE PLAN RATES FOR NEW YORK HEALTH BENEFIT EXCHANGE

17 Health Insurers Have Rates Approved to Provide Coverage on the Exchange

 

NEW YORK, NY – Today, Governor Andrew M. Cuomo announced that the Department of Financial Services (DFS) has approved health insurance plan rates for 17 insurers seeking to offer coverage through New York’s Health Benefits Exchange, including eight new entrants into the market that do not currently offer commercial health insurance plans. Last year, Governor Cuomo took action to issue an Executive Order establishing the New York Health Benefit Exchange, which is expected to help more than one million uninsured New Yorkers access quality, affordable health care coverage.

Consumers and businesses will be able to choose among plans in four easy-to-compare metal tiers (bronze, silver, gold, and platinum) on the exchange. The plans within each metal tier will have standardized contract terms and product offerings, making it easier for consumers to truly comparison shop and encourage real price competition among insurers. Previously, New York insurers offered more than 15,000 plans that widely varied in terms of level and quality of coverage provided – which encouraged ‘competition through confusion’ and made it difficult for purchasers to effectively compare plans side by side.

“New York’s health benefits exchange will offer the type of real competition that helps drive down health insurance costs for consumers and businesses,” said Governor Cuomo. “The opportunity to choose among affordable, quality health insurance options will mean improved health outcomes, stronger economic security, and better peace of mind for New York families.”

Benjamin M. Lawsky, Superintendent of Financial Services: “In setting these rates, we worked hard to do right by consumers and small businesses so they have access to affordable, quality health insurance. Moreover, where New York previously had a dizzying array of thousands upon thousands of plans, small businesses will now be able to truly comparison shop for the best prices. New York will continue to move ahead rapidly so the exchange is up and running for 2014.”

“The approval of health plan rates marks a significant milestone for the New York Health Benefit Exchange,” said New York State Health Commissioner Nirav R. Shah, M.D., M.P.H. “The state continues to be on target to begin enrolling consumers and small business owners and their employees in health insurance coverage on October 1, 2013. Access to affordable, quality health care will mean better health, peace of mind and financial security for New Yorkers.”

On average, the approved 2014 rates for even the highest tier of plans individual New York consumers could purchase on the exchange (gold and platinum) represent a 53 percent reduction compared to last year’s direct-pay individual rates. The fact that these average individual rates are effectively being cut more than in half is primarily because a greater number of uninsured individuals are expected to obtain coverage in the individual insurance market – lowering overall premiums. (Note: That 53 percent reduction does not include the impact of federal financial assistance for individuals meeting certain income thresholds who are purchasing coverage on the exchange, which would lower costs even further for many consumers.)

Furthermore, despite the fact that health care costs per capita are approximately 18 percent higher in New York than the national average, the average approved rates for the benchmark individual “silver plan” in New York would be in line with (nearly 10 percent lower) the nationwide average previously forecast by the independent, non-partisan Congressional Budget Office (CBO) for when health care reform is implemented.

For approved 2014 small group plan rates, existing premium rates do not provide a functional year-over-year comparison. In 2013, insurers offered more than 15,000 different small group plans that significantly varied in terms of the quality and level of coverage provided. This year, insurers are offering standardized contracts and product offerings within metal tiers (bronze, silver, gold, and platinum).

The approved small group rates, however, are generally lower than indicated by the estimates of other independent forecasters. The average approved small group rate in New York for the benchmark “silver plan” is well below (nearly 32 percent lower) the nationwide average previously forecast by the independent, non-partisan CBO – notwithstanding the relatively higher per capita health care costs in New York compared other states. Moreover, a number of small businesses will be eligible for tax credits that would lower those premium costs even further.

The following companies had health insurance plan rates for the health benefits exchange approved today by DFS. The rates approved today are subject to final certification of the insurers’ participation in the exchange.

  • Aetna
  • Affinity Health Plan, Inc.
  • American Progressive Life & Health Insurance Company of New York
  • Capital District Physicians Health Plan, Inc.
  • Health Insurance Plan of Greater New York
  • Empire BlueCross BlueShield
  • Excellus
  • Fidelis Care
  • Freelancers Co-Op
  • Healthfirst New York
  • HealthNow New York, Inc.
  • Independent Health
  • MetroPlus Health Plan
  • MVP Health Plan, Inc.
  • North Shore LIJ
  • Oscar Health Insurance Co.
  • United Healthcare

Individuals with incomes below 400 percent of the federal poverty level ($45,960 for individuals and $94,200 for a family of four), could qualify for financial assistance that lowers cost of coverage. Enrollment for the exchange begins on October 1, 2013 for coverage that will be effective January 1, 2014.

“These plans and rates deliver on the promise that the Exchange will offer quality health insurance coverage at a price that works for New Yorkers,” said Donna Frescatore, Executive Director, New York Health Benefit Exchange. “We were pleased to see that there was much interest from health plans regarding participation in the Exchange. Our partners at the New York State Department of Financial Services did a thorough job of negotiating affordable prices while ensuring that consumers will have access to the providers they need. Robust competition among health plans has resulted in meaningful choices and better options for consumers.”

For more information about the New York Health Benefit Exchange, please visit, HealthBenefitExchange.ny.gov.

 

Additional news available at www.governor.ny.gov

New York State | Executive Chamber | press.office@exec.ny.gov | 518.474.8418