- April 23, 2015
- March 12, 2015
- December 30, 2014
- October 31, 2014
- October 6, 2014
- August 21, 2014
- July 31, 2014
- July 10, 2014
- June 25, 2014
- May 27, 2014
- February 13, 2014
- January 17, 2014
- December 18, 2013
- November 21, 2013
- October 16, 2013
News & Resources
The Coalition regularly informs our members and the general
public about issues affecting the behavioral health sector via
We also provide
resource information related to specific program initiatives
such as PROS and
Medicare Part D.
Items of Interest
Behavioral Health Transition to Managed Care
BH Managed Care Transition Slides
BHMC Transition Guide
4-23-15 Webinar recording on BH Transition
OMH TCM to Health Home Claim Adjudication Process (PDF of slide show from webinar)
OMH Webinar Recording
Clinic Reengineering Project Outcomes
February 2012 A business model need to be effective and coherent. Business models are strategic models that explain how organization create the resources to do their buisness. The following is a process that helps the thinking of the executive staff and boards.
July 2010 The Coalition, with the generous support from The NY State Health Foundation, The NY Community Trust and the Fan Fox & Leslie R. Samuels Foundation, launched a 3 year project to help NY City's behavioral health providers operate more efficiently by helping them re-tool their business practices and back office operations in order to stay fically viable.
OPEN MINDS ® provided technical assistance in creating agency collaboration plans amoung the 15 small/midsize member agencies who participated initially.
11-2010 Final Report from OPEN MINDS® "Technical Assistance in Creating Agency Collaboration Plans"
The initial group selects a Group Purchasing Organziation (GPO): Council of Senior Centers and Services of New York/MedAssets Senior Nutrition Marketplace (Marketplace). Collaborative purchasing brings separate organizations together to purchases as a goup. GPOs have a long history of working with organizations to reduce costs.
2-2011 Marketplace GPO Application
Wholly Owned Addendum
Medicaid Redesign 2011 News
12-1-2011 Letter to Providers regarding BHOs
Awards of Behavioral Health Organizations are announced
BHO OMH Field Office OASAS Field Office
||Magellan Health Services
Deb Happ, VP Operations
|Central New York Field Office
Pam Wondro, Director
Upstate Field Operations
|Hudson River Region
||Community Care Behavioral Health
Kelly Lauletta, LCSW,
|Hudson River Field Office
Marcia Fazio, Director
||New York Care Coordination Project
Adele Gregory Gorges
|Western New York Field Office
Tom Wallace, Director
|New York City:
Suzanne B. Feeney, MBA
General Manager, Medicaid, Behavioral Solutions
|New York City Field Office
Anita Appel, Director
Downstate Field Operations
||Long Island Behavioral Health Management LLC.
Associate Executive Director
|Long Island Field Office
2-1-2011 The Coalition supports a behavioral health carve-out and creating capitated regional behavioral health
plans that manage Medicaid‐reimbursed mental health and substance abuse services, and help
coordinate health care delivery.
1-10-11 Cuomo administration launchs http://governor.ny.gov/medicaidredesign, which features task force reports and seeks public input on changing the Medicaid program.
1-7-11 Governor Cuomo Announces Members Of The Medicaid Redesign Team Revised: January 2011
1-5-11 Executive Order No. 5 Establishing the Medicaid Redesign Team
5-2-10 Lessons from the Field: One Medicaid Director’s Perspective 2010 Spring, NASMD Conference Boot Camp
Jason A. Helgerson [Wisconson]
State Medicaid Director
The state's new Medicaid director is expected to approach industry players with the message “you cut, or I will.” But the former Wisconsin administrator's PowerPoint presentation last spring to his national colleagues provides insight into his strategies. The upshot: “Medicaid cuts should be more about reform than about lowering costs,” Helgerson said. His style is to achieve agreement. That now means no ad campaigns blasting the new governor. “Give stakeholders an opportunity to critique proposed changes when they are in draft form,” he wrote. “This will strengthen your proposals and increase stakeholder buy-in.” Another tip: “Always include a couple of small, controversial items in your package. Items will generate a lot of resistance and push-back, which will distract from the rest of the package. Allows you to cave to pressure without it costing too much. Allows you to look reasonable. Legislators will feel like they got their pound of flesh.”
New York State Office of Mental Health Reform Projects
CLINIC RATE RESTRUCTURING
OMH Clinic Budgeting:
Considerations when Trying to Budget Clinic Treatment Program Income
The following information and tools were presented at a May 5, 2011 workshop by Gene Aronowitz and Dan Still. The workshop provided information to help providers develop their budgets for the next fiscal year.
Dan Still May 5 PresentationNotes
The OMH Clinic Project Tool was modified for this presentation. A tab called “Tool Adaptations” right after “Description of Schedules” provides some directions about where each adaptation is located and what it is for with more specific directions just above each adaptation.
Adaptation of the OMH Clinic Projection Model v.4
Adaptation of the OMH Clinic Projection Model v.4 with example data
CMS disallowance of Medicaid funds to be used for home based mental health
services to NYC seniors - 9/28/2010 City Council letter to OMH
OMH Response to City Council 9/28/2010
Conference of Local Mental Hygiene Director's letter to OMH 9/28/2010
Measure twice, cut once reschedule implementation date request - 9/20/2010 Coalition and 3 other advocacy agencies
OMH Response to Agencies 9/28/2010
Implementation of Mental Health Clinic Restructuring and Reform - 9/1/2010
PROPOSED Regulations & GUIDANCE
Implementation of Clinic Restructuring effective October 1, 2010.
12/6/2010 - DOH/OMH Letter to OMIG regarding interim billing and temporarily waiving 90 day billing requirement. DOH-OMH Letter to OMIG
9/17/10 - OMH letter regarding interim billing information
Interim billing instructions and testing information
NYC OMH Training handouts September 14, 2010
The Clinic Model
NYS Clinical Record Initiative
Part 599 Regulation Overview
Clinic Financing Update
APG Billing Instructions
Uncompenstate Care Pool
8/17/2010 Interpretive/Implementation Guidance "Clinic Treatment Programs" 14, NYCRR Part 599
6/29/10 Final Regulations - Full Text effective date October 1, 2010. Changes made to the final text as compared to the proposed rule.
Coalition response (comments) to the Part 599 Express Terms, published on March 17, 2010.
OMH issues Part 599 Regulatory Guidance: On March 23, 2010, the New York State Office of Mental Health (OMH) released the Part 599 regulations guidance document to define services, financing and program rules under clinic reform.
Proposed Part 599 Regulations - NY State Register : The March 17th State Register has been posted to the Department of State's website. The summary of the proposed Part 599 Clinic Regulations starts at the bottom of page 8. http://www.dos.state.ny.us/info/register/2010/mar17/pdfs/rules.pdf
Full text of proposed Part 599 Clinic Regulations are posted on the OMH website: http://www.omh.state.ny.us/omhweb/policy_and_regulations/
The most up-to date mental health service weights and proposed base rates can be found at the
OMH website at
Coalition Stress Test
Coalition Stress Test Report on the Impact of the NYS OMH Proposed Clinic Restructuring Initiative - Using the OMH Projection tool the Coalition reports on the results of 20 agencies representing 73 clinics in NYC, Westchester and Long Island.
Full Report - Updated 5/7/2010
Slide Show Presentation
DRAFT Regulations PART 599 -
Clinic Treatment Programs Regulations 10/15/09 (version 2)
Coalition Comments - Draft V1 and V2
Coalition Talking Points - Clinic Reform—Problems and Challenges in Meeting OMH Goal of Client Centered Care
OMH TRAINING & TOOLS
OMH Training Handouts
Workshop on Financial Issues and Clinic Restructuring
Enhancing Clinic Operations: Proven Strategies for Improving Clinic
Operations, Profits and Quality of Care
Delivering Compliant, Efficient, Person Centered Services in Clinics
OMH's Mental Health Clinic Projection Model - Version 2.1
July 31 , 2009
The Clinic Projection Model is designed to assist providers in completing the following critical tasks/activities:
- Assess the fiscal impact of Clinic Reform on outpatient clinic services;
- Estimate revenue from indigent care visits;
- Estimate revenue if services/operations are altered;
- Evaluate clinical staff productivity and revenues
Clinic Model Change Log updated 12-23-09
Clinic Model v3.1 Colored Illustrated Template - updated 12-23-09
Clinic Model v3.1 Colored Blank Template - updated 12-23-09
Clinic Model v3.1 Patterned Illustrated Template - updated 12-23-09
Clinic Model v3.1 Patterned Blank Template - updated 12-23-09
CPT Procedure Weight and Rate Schedule (Microsoft Excel) (December 16, 2009)
This schedule gives the current base weight, peer group base rates, an updated list of APG/CPT services, definitions and weights. The schedule also includes payment amounts for the CPT coded services based on current peer group rates and procedure weights.
CPT Revenue Calculator (Microsoft Excel) (December 16, 2009)
This tool enables users to calculate the projected revenue for CPT procedures based on current service weights and peer group base rates.
Clinic Impact Calculator (Microsoft Excel) (December 23, 2009)
This one page Excel based tool enables users to select eleven input variables and generate a range of summary outputs and analysis relevant to clinic restructuring. Note - The Excel macro feature must be enabled. For 2003 Excel users, after opening the worksheet, click on Tools > Macro > Security and change the level to Medium to enable. For 2007 Excel users, a security warning box is displayed above the formula bar when you open the file. Click on the "options" button and enable macros.
OMH has compiled
responses to the many questions that have been asked by stakeholders to date. These questions were received at OMH clinic forums, OMH training sessions, by phone, and by email.
Frequently Asked Questions
CLINIC RESTRUCTURING IMPLEMENTATION PLAN
OMH's Clinic Restructuring Implementation Plan
March 11, 2009
New York State has submitted a federal Medicaid waiver request to establish an indigent care funding pool for mental health clinics that is jointly funded by the state and federal government. Assuming the waiver is approved, the pool would offset a portion of losses from indigent care experienced by:
- Diagnostic and Treatment Centers licensed by DOH; and
- Mental health clinics licensed by OMH that are not affiliated with hospitals or directly operated by OMH.
Mental health clinics licensed by OMH that are not affiliated with hospitals or directly operated by OMH must complete and submit a schedule in order to participate in the uncompensated care pool in 2010.
UPDATED July 2, 2010 Changes have been made to the MHPD data submission requirements for the OMH Uncompensated Care Pool.
Uncompensated Care Data Reporting Letter to Facility Directors of Article 31 free-standing clinics and D&TCs (January 26, 2010)
Overview of the Indigent Care Pool Funding Rules and Data Collection Instructions – with example (July 29, 2009)
Uncompensated Care Letter to Providers (June 3, 2009)
ADULT AMBULATORY RESTRUCTURING PROJECT
OMH's Ambulatory Restructuring Project Report -
Ambulatory Restructuring Project Report
Federal Health Care
HHS 2010-2015 Strategic Plan - Draft
The HHS draft plan reflects the contributions of every operating and staff division, and it sets forth the Department’s overarching goals for the next five years:
• Transform Health Care
• Advance Scientific Knowledge and Innovation
• Advance the Health, Safety, and Well-Being of the American People 25
• Increase Efficiency, Transparency, and Accountability of HHS Programs
• Strengthen the Nation’s Health and Human Services Infrastructure and Workforce
Mental Health Parity
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity, which passed last year, goes into effect on Jan. 1, 2010.
The law is designed to help improve access to appropriate mental health treatment for millions of Americans suffering from mental health disorders.
The American Psychological Association offers free resources for information on the Mental Health Parity Law.
For the public: How Does the New Mental Health Parity Law
Affect My Insurance Coverage?
For employers: An Employer’s Guide to the Mental
Health Parity and Addiction Equity Act
Medicaid Managed Care Organizations must comply with Mental Health Parity: Letter from Vallencia Lloyd, NYS DOH Director, Division of Managed Care
Health Care Reform
Chairman Edward M. Kennedy and Democratic Members of the Senate Committee on Health, Education, Labor and Pensions (HELP) released the landmark “Affordable Health Choices Act.” Mark-up is scheduled to begin June 16, 2009.
Chairman Rangel of the Ways and Means Committee, Chairman Henry Waxman of the Energy and Commerce Committee and George Miller of the Education and Labor Committee released an outline of their health reform bill.
The Bazelon Center’s Summary of the Senate Finance Committee work on health care reform.
Senate Finance Committee has released two reports on health care reform
Financing Comprehensive Health Care Reform: Proposed Health System Savings and Revenue Options
Expanding Health Care Coverage:
Proposals to Provide Affordable Coverage to All Americans
Federal judge ruled that New York State violates the Americans with Disabilities Act and Section 504 of the Rehabilitation Act
On September 8, 2009, a Federal judge ruled that New York State violates the Americans with Disabilities Act and Section 504 of the Rehabilitation Act by segregating approximately 4,300 people with mental illness in for-profit adult homes. Judge Nicholas G. Garaufis found that the State’s policy prevents people with disabilities from living in the most integrated setting appropriate to their needs. The lawsuit seeks the creation of supported housing for adult home residents, who wish to live in the community with necessary supports.
Judge Nicholas G. Garaufis's complete Findings of Fact and Conclusions of Law
NY Times Article September 8, 2009
Residential Program Indicators Report for the period 7/1/08-6/30/09
Dear Housing Provider:
Attached, please find the latest Residential Program Indicators Report for the period 7/1/08-6/30/09. The data in this report is based on OMH bed counts and information entered by the agencies regarding admissions and discharges. We would like to ask your cooperation in identifying any information that appears to be inaccurate.
If after reviewing the data, you believe there are discrepancies, or if you have any questions or concerns, contact the OMH Field Office to discuss. Thank you in advance for any assistance you might be able to give us in ensuring that the data reported in the RPI are complete and accurate.
Since we no longer distribute paper copies of the report, please keep us informed of any future updates to your agency's email address to ensure the continued receipt of reports.
Please find attached the RPI Reports for the period 7/1/2008 to 6/30/2009.
The reports are in a "new" format:
- Priority Admissions have PC Admissions broken down into PC Long Stay & PC Non-Long Stay
- The column for Total % of Priority Admissions is now beside the column for # Total Admits (easier to compute exactly how many Priority admissions were made)
- Summary Reports are broken down by Provider
- County Reports are broken down by Provider AND Program Unit (so if a Provider has multiple program units within a county, each of those program units will be shown on the RPI
- Inpatient Discharges are now broken down into 2 categories; PC discharges & Art 28 discharges.
RPI Catchments - State Psych Centers
RPI Central NYS
RPI Central NYS Summary
RPI Hudson River
RPI Hudson River Summary
RPI Long Island
RPI Long Island Summary
RPI NYC Summary
RPI Statewide Summary
RPI Western NYS
RPI Western NYS Summary
Board Responsibilities / Fiscal Resources
Compliance, Information and Risk .. Oh my: Board Training (462KB PDF)
Kenneth Cerini, Managing Partner with Cerini & Associates LLP a certified public accounting firm, presented issues that Board of Directors need to be aware of and responsible for. May 2009
Not-For-Profit Fiscal Update & the New 990 (6.31MB PDF)
Kenneth Cerini made the above presentation at our April 2008 membership meeting. The update included current trends, the new 990, new 403(b) regulations, raffle regulations and new auditing standards.