SUBJECT:

PURPOSE:

The New York State Office of Alcoholism and Substance Abuse Services (OASAS) is charged with overseeing the statewide system of chemical dependence and gambling treatment agencies. The Office licenses, funds, and supervises chemical dependence treatment programs, and inspects and monitors these programs to guarantee quality of care and to ensure compliance with state and national standards.

In order to facilitate the oversight and supervision of the agencies under its purview, New York State Mental Hygiene Law authorizes the Commissioner of OASAS to adopt standards including necessary rules and regulations pertaining to chemical dependence services. Recently, OASAS proposed extensive amendments to Part 822 of Title 14 NYCRR, relating to chemical dependence outpatient services. The proposed regulations address in part issues related to the use of Medicaid to fund chemical dependence treatment, and determining what constitutes appropriate levels of care for persons receiving treatment.

The breadth and complexity of the proposed amendments to the OASAS Part 822 operating regulations have generated a great deal of discussion among the agencies that would be affected if these regulations were to be adopted. Questions have arisen from within the treatment community as to whether the proposed amendments appropriately balance the clinical care of patients with the need for cost savings and sensible Medicaid reform. According to OASAS, these amendments will result in less Medicaid fraud and abuse. In light of the grave concerns about the amended regulations voiced by chemical dependence treatment providers, as well as the State's growing Medicaid burden, an extended discussion of this matter seems appropriate at this time.

As part of its ongoing oversight of OASAS and of the agencies OASAS regulates, the Assembly Standing Committee on Alcoholism and Drug Abuse will convene a public hearing on the proposed amendment to the OASAS Part 822 operating regulations. The hearing will provide a forum for all relevant parties to be heard in regard to the regulations, and will allow a large volume of public comment to be made available to OASAS during a single, public event.

Please see below for a list of subjects to which witnesses may direct their testimony, and for a description of the bills which will be discussed at the hearing.

Persons wishing to present pertinent testimony to the Committee at the above hearing should complete and return the reply form as soon as possible. It is important that the reply form be fully completed and returned so that persons may be notified in the event of emergency postponement or cancellation.

Oral testimony will be limited to 5 minutes' duration. In preparing the order of witnesses, the Committee will attempt to accommodate individual requests to speak at particular times in view of special circumstances. These requests should be made on the attached reply form or communicated to Committee staff as early as possible. In the absence of a request, witnesses will be scheduled in the order in which reply forms are postmarked.

Ten copies of any prepared testimony should be submitted at the hearing registration desk. The Committee would appreciate advance receipt of prepared statements.

In order to meet the needs of those who may have a disability, the Assembly, in accordance with its policy of non-discrimination on the basis of disability, as well as the 1990 Americans with Disabilities Act (ADA), has made its facilities and services available to all individuals with disabilities. For individuals with disabilities, accommodations will be provided, upon reasonable request, to afford such individuals access and admission to Assembly facilities and activities.

SELECTED ISSUES TO WHICH WITNESSES MAY DIRECT THEIR TESTIMONY:

1. To what extent are these proposed amendments clinically sound and reflective of the growing body of science-based best practices related to chemical dependence treatment?

2. The proposed amendments add new requirements intended to prohibit outpatient treatment agencies from providing or billing for unnecessary services in excess of the clinical needs of its patients. The amendments mandate that OASAS shall inspect a provider that is exceeding a calculated average number of visits per patient during a 12-month period, to determine whether the agency is providing excessive services to its patients. The new regulation also includes a list of indicators that an agency may be providing excessive services. Are these new guidelines based on accepted clinical standards? Do they reflect the growing body of science-based best practices related to chemical dependence treatment? In what ways might these new amendments impact treatment outcomes?

3. The proposed amendments include a new requirement that outpatient services provide individual counseling to patients at least 1 out of every 10 sessions. Would this meet a legitimate clinical need of the affected patients? Are staffing levels at treatment agencies adequate to absorb this new strain on time and resources? Will additional funding from the State be provided to defer the costs of all the new counseling sessions being mandated?

4. The proposed amendments alter provisions relating to utilization planning and review by allowing OASAS to review and approve utilization plans. They also add a new provision requiring that all patients who are attending a treatment program for over 365 days be subject to utilization review at the one-year point, and every 90 days thereafter. Due to the relatively small number of treatment programs believed to be in violation of the utilization standards, are these amendments unfairly punitive to the vast percentage of treatment programs across New York State who are successful and compliant with all applicable rules and regulations?

5. A number of treatment agencies have expressed that burdensome record keeping has strained their staffing and resources, and there is concern among providers that the proposed amendments altering certain record keeping requirements will further stretch their scarce staff time and resources. In the event the proposed amendments are adopted, is a further administrative burden on treatment providers been taken into consideration? If necessary, will additional resources from the State be provided to defer the costs of the new administrative actions being mandated?

6. Ongoing staff training is an essential component of maintaining the high quality of care that treatment agencies in New York State provide to those in their care. The proposed amendments contain more specificity on the types of training staff should receive, allow training to be provided directly by the provider agency or through other entities, and require that training be conducted in all areas at least every 3 years. Taking into account the current dilemma of clinical staff being overwhelmed with administrative tasks, as well as the crisis of staff recruitment and retention within the chemical dependence treatment field, will service providers be given adequate resources to perform mandated training?

7. Will capping the amount of services available to persons on Medicaid unfairly burden the minority populations within our state?

PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on Amendments To Part 822 Regulations Proposed By OASAS are requested to complete this reply form as soon as possible and mail it to:

Bill Eggler
Senior Legislative Analyst
Assembly Committee on Alcoholism And Drug Abuse
Room 522 - Capitol
Albany, New York 12248
Email: egglerw@assembly.state.ny.us
Phone: (518) 455-4371
Fax: (518) 455-4693

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