This is an FYI on a few things that have come up over the last few weeks:
- Office of Health Insurance Programs (OHIP) has contacted some PROS (without clinic), Community Residence and ACT Medicaid providers telling them they must enroll in Medicare in order to remain in the Medicaid Program. This is untrue. OMH has recently worked with DOH on this issue. DOH is amending their requirements so that they do not require providers to enroll in Medicare in order to be enrolled as Medicaid providers.
- There is some misunderstanding about the recent messaging from MCTAC on the move of residential into Managed Care (MC). The plan is still to move the program into MC, they just do not know when. They are encouraging providers to still develop relationships with MCOs.
- I’m sure that most of you know this – OMH is moving to its “targeted recertification” program. The following is from OMH. All providers should have gotten this.
- Impetus:
The New York State Office of Mental Health (OMH) regulates mental health programs statewide to ensure that quality and safety standards are met. Analysis by OMH, including feedback from licensed stakeholders, identified a need to streamline processes and functions in order to make recertification visits more effective and efficient. To address this need, an initiative was undertaken to consolidate review processes so as to have a positive impact on all stakeholders, including providers, OMH staff and, most importantly, the recipients we serve.
- Impetus:
Background:
NYS is in the midst of a monumental transformation in the array and method of delivering behavioral health services to our State’s citizens, necessitating a commensurate transformation in the culture of service delivery and oversight. While OMH is extremely cognizant of the challenges such change can pose on recipients, providers, and staff, through this initiative OMH saw an opportunity to challenge our mindset regarding the traditional recertification process. Specifically, the following concerns were identified:
1. The same intensity of monitoring has historically been applied across all providers, regardless of past performance.
2. Several visits to the same agency have resulted in redundant reviews of administrative standards.
3. Survey redundancy has reduced the availability of OMH Field Office staff to offer providers guidance or technical assistance.
4. Time constraints during the traditional process have not allowed for additional focus on programs with past performance issues or current concerns.
The result of this initiative is a new method known as “Targeted Recertification”, involving the concurrent recertification of all OMH licensed programs under the provider’s umbrella of services. This new process will allow for the identification and rectification of issues systemically, while maximizing licensing staff resources.
A provider’s level of on-site review will be determined by past performance on previous reviews, as well as current performance data. A single administrative review will be conducted for all of an agency’s programs at one time, rather than separate visits and reviews for each licensed program. Successful completion of a Targeted Recertification review will result in a 36-month Operating Certificate for all of the provider’s licensed programs.
The reduction in time spent surveying will increase OMH staff availability to conduct activities focused on increasing provider performance and reducing risk. As such, the new process seeks to ensure providers follow through on their Performance Improvement Plans (PIP) in the months following inspection. This ongoing “PIP monitoring” will assure planned corrections are implemented as expected.