ACTS in Action: Working Closely with Department of Health-BEI for Needed E.I. Billing Changes

October 1, 2013 | ACTS in Action

Six months ago, on April 1, 2013, a new billing protocol with a Fiscal Agent intermediary was put into place. At that time ACTS was virtually alone in arguing that the process was not ready to be started and that it ought to be delayed for a number of months until a permanent Fiscal Agent was actually selected and in place, and that the new systems could be tested before they were implemented. Sadly, we were not listened to then. And even more sadly we were ultimately proven correct in our worries.

That was then and this is now.

During the past number of months we have been working very hard with DOH-BEI and the “interim” Fiscal Agent (McGuinness) to remediate some of the problems inherent to the new system that has seriously slowed payments and increased the administrative workload for agencies and therapists. We are also in dialog with key legislative persons in the State Assembly and State Senate to let them know of the amendments to the law that may be needed when the State Legislature returns to Albany in January. And we are now also in conversations with the new and permanent Fiscal Agent, Public Consulting Group (PCG).

ACTS representatives have been meeting weekly with DOH-BEI in an effort to both help individual ACTS agencies and their therapists who have found themselves in particular extremis as well as to seek more universal “fixes” to try to help speed payments. During the past several months in particular there has been a genuine willingness on the part of DOH-BEI to engage with us and try to find both short term and longer term solutions to better insure that agencies get paid more quickly for services rendered in order to pay therapists and to try to minimize the administrative hassles which have become enormous. However dealing with commercial insurers continues to be a large source of frustration.

What we have managed to do over the past number of months includes:

  • Convincing DOH-BEI to issue Medicaid checks 2 days after they are dated instead of the “normal” 16 day lag that is applied to all other Medicaid vendors. This accelerates payments by a full two weeks.
  • DOH-BEI continues to make multiple escrow payments and sometimes more than one a week.
  • We have been trying to get the many Medicaid conflict reports resolved and in particular the so called “code 35” billing problems. These are problems certainly not created by anything that agencies did wrong.
  • ACTS had advocated an “advance payment” through escrow to deal with the backlogged commercial insurance claims. And DOH-BEI agreed to do the “Safety Net Payment” last month to help agencies catch up with those delayed commercial insurance claims.
  • ACTS had suggested that a Steering Committee be established comprised of all the stakeholders to discuss and solve current and possible future problems in the claiming and payment process. That Steering Committee has now met for the first time and will continue to meet over the course of the next several months. In the next few weeks a more technical User Group will begin to meet to deal specifically with billing glitches and impediments.

We continue to meet with the leadership of the State Assembly and State Senate, and in particular the Chairs of the respective Health Committees in those chambers. Should legislation be needed (and ACTS thinks that it will be needed) the Health Committees in each House will be where legislation originates. Recently Senate Health Committee Chairman Kemp Hannon sent a very pointed letter to the Department of Health Commissioner arguing that this system was badly in need of fixing. And the State Assembly Health Committee and its Chairman Assemblyman Dick Gottfried announced that it will hold legislative Hearings later this month dealing with possible legislative changes needed to this system. These are all very good indicators that our lobbying efforts and arguments are gaining support and traction.

Other E.I. related organizations have also been stepping up to the plate with meetings and lobbying of their own and that is a very good thing. One organization has scheduled a public press conference on the steps of City Hall in Manhattan for this Sunday (at noon) for providers to express their feelings and frustrations.

Although ACTS was the first to hit the alarm button early in 2013, we are gratified that we are now joined by virtually the entirety of the E.I. community of organizations. That gives me reason to believe that 2014 will be a much better year for E.I. agencies and providers and by extension a better year for the tens of thousands of children at risk and their families that we serve.

However much work still lies ahead before we can begin to feel satisfied.

Commercial insurance and insurers must cooperate by vetting our claims properly and timely…and without the endless administrative tangles. We have been working with DOH-BEI to try to make that happen. However even in spite of the best efforts of the various State Departments which also includes the State Departments of Financial Services (DFS), I believe that the law must change to GUARANTEE that agencies and therapists will be paid promptly for services rendered either by the insurers themselves or in the alternative by the escrow account via the Fiscal Agent. Also of great importance is the need to cut down on all the administrative tasks that have been dumped in the laps of agencies to process claims. At a minimum those tasks must be reimbursable both for agencies as well as Service Coordinators. And the Fiscal Agent really needs to be responsible for more of this administrative work load and interaction with commercial insurance. It was never said that this new system would cost endless hours of time and resources for providers to be able to receive their reimbursement… and that must not continue into next year.

So although we have come quite a distance since April 1, there is still a long way to go to get the Early Intervention Program back on an even keel as it relates to billing and payments. ACTS will not relent in that effort. We intend to continue to do all that we can to right this system and restore the program to one that allows agencies and therapists to focus once again on their core mission which is to help at risk youngsters and their families realize a future as bright and full of promise as possible.