Problem:
Effective July 1, 2021, Article 29-I of the New York State Public Health Law went into effect which transitioned children placed with voluntary foster care agencies from Medicaid fee-for-service coverage into Medicaid managed care plans. This transition meant a shift to a for-profit mentality and the necessity for qualifying organizations to restructure their clinical and compliance approaches.
Solution:
The key to compliance management and navigating major regulatory changes like Article 29-I is anticipation and preparation. As a company operating across the nation, we had been experiencing States experimenting with Medicaid adjustments. Seeing the writing on the wall, we began to think how these operational shifts might impact our New York State clients.
Because all of our government work overlaps, Solvere Health has a unique purview and a well-developed instinct for how changes in one area of government may link to others. To illustrate, we first experienced this transition in our rural level work, where county governments did not want full exposure to a straight Medicaid program. And, so at the State level, enrollment in managed care became a mandate, and then the changes multiplied from there.
Expecting this trend to accelerate, we began to author a systematic approach to help clients pivot to the new fee-for-service model when similar regulatory changes hit their state.
Our comprehensive compliance advisory service includes
- helping organizations identify the people internally who could spearhead the changes (or help recruit and hire that person) and then we support them through the process
- evaluating plans that would be most effective for them to transition to because it aligns best with the client’s goals
- and, if the client doesn’t have an existing relationship in that plan, facilitating the conversation between the organizations
- negotiating the optimal plan terms so that the client is able to provide the maximum services within the legally mandated standard of care
Results:
This is an in-progress challenge that we continue to solve for our New York State residential institution clients. To date, we have successfully contracted with 18 plans for our clients.