Mental Health Parity under the ACA and Cures Act

The 21st Century Cures Act, signed by President Obama on December 13, 2016, requires the Department of Labor, the Treasury, and Health and Human Services to solicit public responses and feedback on how to improve disclosures of health plan benefits in compliance with the Mental Health Parity & Addiction Equity Act of 2008 (MHPAEA).

In Section 13007 of the Cures Act, coverage for eating disorder benefits must be consistent with the requirements of MHPAEA.

The Departments' recent FAQ, released in June, defines eating disorder as a mental health condition and is requesting public comment on how MHPAEA apply to the treatment of Eating Disorders.

SAE understands the administrative and clinical complexity of eating disorder treatment. Professional services, such as nutrition services, need to be part of an outpatient team approach. However, essential components for eating disorder treatment or the continuum of treatment care have not always been approved for eating disorder patients. Additionally, "medical necessity" determinations should not be ascertained by weight only; indeed, clinical criteria for varying levels of care determinations need to be inclusive of psychiatric functional assessment. Otherwise, there are inherent concerns of non-quantitative treatment limitations (NQTLs). 

SAE will be submitting a public comment for the Departments. 

All comments to the Departments about eating disorders are due September 13, 2017 to:

NYS Develops Draft Transition Plan for the Children's Medicaid System Transformation

New York State has developed a DRAFT Transition Plan for the Children's Medicaid System Transformation. The draft Transition plan (subject to approval by Centers for Medicare & Medicaid Services) is being shared with interested stakeholders for review and comment.

Comments are due August 31, 2017 by email to, with the subject line: "Draft Children's Transition Plan Comments". In your comments, indicate the section and page number to which your comment refers to.

The State will also hold a statewide webinar on August 24, 2017 at 3PM to review the Draft Transition Plan in detail to assist stakeholders. You can register for the webinar here:

Update for New York HCBS Providers

Children Provider Applicant for HCBS and SPA

Applications for Children HCBS and SPA were due July 31. Designation letters to providers are expected in October. 

Contracting, credentialing, and claims testing may take up to nine months. The list of designated providers will be used by Medicaid Managed Care plans to develop networks for service provision expected to begin July 1, 2018. 

Adult HCBS Providers

New York State received approval from the Centers for Medicare & Medicaid Services (CMS) to increase rates retroactively for several Behavioral Health Home and Community Based Services (BH HCBS) covered by the Health and Recovery Plan (HARP) and HIV Special Need Plans (HIV SNP). 

Start-up fees have increased by 50% of the currently approved fee. 


The rate increases have been posted.

Attestation of Readiness Form from OMH and OASAS will be sent to all providers in Western New York, Central New York, Hudson River, and Long Island. Check the Provider Designation List to see if you are a recognized Adult HCBS provider and verify your contact information. Providers who are on "hiatus" for Adult HCBS may email their current updated contact information to

Contact SAE for assistance with any financial modeling, service launches, or assistance with the Attestation of Readiness Form. Email or call (212) 684-4480. 

Provider Applications for HCBS/SPA Waiver Services Should Be Submitted at the End of July

As you may know by now, the New York State (NYS) Office of Alcoholism and Substance Abuse Services (OASAS), Department of Health, Office of Mental Health (OMH), Office of Children and Family Services (OCFS), and Office for People With Developmental Disabilities (OPWDD) recently announced the re-release of the Children´s State Plan (SPA) / Home and Community Based Services (HCBS) Provider Designation Application. 

To view the full announcement from CTAC, click here.

Prep your staff on the clinical designation for Children HCBS services.

Eligibility requirements: 

  • Must be between 5 and 17 years of age, if enrolled prior to 18th birthday may remain in the Waiver up to the age of 21.
  • Have serious emotional disturbances.
  • Demonstrate complex health and mental health needs.
  • Require or be at imminent risk of needing psychiatric inpatient care.
  • Service and support needs cannot be met by one agency/system.
  • Have a consistent and viable living arrangement with family that is able and willing to participate in the waiver.
  • Appear to be capable of being cared for in the community with access to waiver services.
  • Be eligible for Medicaid; and
  • Parental income and resources are not considered when determining the child's eligibility for Medicaid.

NYS advises current system providers to submit designation application by July 31, 2017.

If you would like to explore how we can help you in this arena, email or call (212) 684-4480. 

UPDATE: NYS Re-Releases Children's SPA/HCBS Provider Designation Application

The New York State (NYS) Office of Alcoholism and Substance Abuse Services (OASAS), Department of Health, Office of Mental Health (OMH), Office of Children and Family Services (OCFS), and Office for People With Developmental Disabilities (OPWDD) have announced the re-release of the Children´s State Plan (SPA) / Home and Community Based Services (HCBS) Provider Designation Application. 

The following information is directly from the Community Technical Assistance Center of New York (CTAC).

Beginning July 1, 2018, providers must be designated through this process to provide newly aligned Children's SPA/HCBS services under the NYS Medicaid program (including both fee-for-service Medicaid and Medicaid Managed Care):

  • SPA: Other Licensed Practitioner, Community Psychiatric Supports and Treatment, Crisis Intervention, Psychosocial Rehabilitation, Family Peer Support Services, Youth Peer Support and Training.
  • HCBS: Caregiver Family Supports and Services, Habilitative Skill Building, Planned Respite, Crisis Respite, Supported Employment, Community Self-Advocacy Training and Support, Habilitation, Palliative Care, Prevocational Services.


  • State Agency Partners will prioritize reviews of applications from current 1915(c) waiver providers beginning in July 2017.
  • NYS anticipates sending out designation letters to current system providers in October 2017.
  • Lists of designated providers will be posted online. This list will be utilized by Medicaid Managed Care Plans to develop networks for service provision that begins on July 1, 2018.
  • The application was revised on June 14, 2017 to include additional questions.

**For applications that were submitted before the June 14 modification date, resubmission is not necessary. An email notification will be sent by NYS requesting additional information.

NYS advises current system providers to submit designation application by July 31, 2017. Contracting, credentialing, and claims testing typically take approximately nine months in total. Delays in submission of the application to NYS may result in delay dependent contracting, credentialing, and claims testing work, and could affect network status 

The designation application is available at:

To view the full announcement from CTAC, click here.

If you would like to explore how we can help you in this arena, email or call (212) 684-4480. 

Helping You Adjust to the Managed Care Environment

Although behavioral health Parity has been required of insurers and managed care organizations for the better part of the past 10 years, there is substantial evidence that payers have not fully implemented policies and practices consistent with parity requirements. Since 2014, SAE has functioned as an external Parity compliance administrator in NYS monitoring the progress of a health plan and its behavioral health vendor in meeting the terms of a legal settlement set by the NYS Attorney General to become Parity compliant according to the Federal Legislative Act of 2008.

In doing so, SAE has acquired the insight into the managed care utilization review process as well as the data metrics to develop an aggressive utilization review process and institutional process, and a data metrics platform to help you gain control over the claims submission process and increase your revenue. In addition, we can offer trainings that address your concerns, such as:

  • How do you launch a successful request for authorization of services?
  • How do you frame successful appeals?
  • How do you determine whether a denial is appropriate?
  • What kind of data is necessary to monitor claims denial and appeals processes?
  • What kind of data should you be developing to prepare for value-based payments?

The Parity team at SAE is available to discuss our approach, and to answer any questions you may have about how we can support your efforts to address the fiscal issues in behavioral health imposed by the emergence of managed care contracting. To do so, please contact SAE at (212)-684-4480 or email


SAE Parity Podcast Series: click here

SAE Webinar, hosted by the Hospital Association of NYS: click here




Funding Increases in DOH's Data Exchange Incentive Program

The New York eHEalth Collaborative recently announced some changes that have been made to the Data Exchange Incentive Program (DEIP). See below for details, directly from a recent NYeC announcement:

The New York State Department of Health (NYS DOH) and the Centers for Medicare Medicaid Services (CMS) established the DEIP to increase the adoption of Health Information Exchange (HIE) across the state. Building Electronic Health Record (EHR) interfaces to Qualified Entities (QEs) will increase the quantity and quality of data in the Statewide Health Information Network for New York (SHIN-NY) and build value for providers and patients at the point of care. This program is designed to help defray the cost for an organization when connecting to a QE by incentivizing the contribution of a pre-defined set of data elements. NYeC coordinates the program and the incentive payments on behalf of the NYS DOH.

An additional change to the program relates specifically to Medicare and Medicaid Eligible Professionals (EPs). NYeC and NYS DOH are sunsetting the additional $500 per EP portion of the program's incentive*. The increase in the standard Milestone 2 payment is intended to help offset the elimination of the $500 per EP. Lastly, the data contribution requirements for organizations with Medicare or Medicaid EPs has been streamlined to be consistent with the requirement for most other DEIP-eligible organizations. EPs participating in the program shall now contribute the common clinical data set in C-CDA format, as the data is available and appropriate.

The new potential incentive for eligible healthcare organizations to connect to the SHIN-NY through DEIP is $13,000 per organization. 

SAE can help you address your IT needs so you can be part of data improvement and connectivity.

If you'd like to explore how we can help you in this arena:

email us at or call (212)-684-4480.

NYS Launches Behavioral Health Value Based Payment Readiness Program

*Notifications of Intent are due June 16, 2017.

The New York State Office of Mental Health (OMH) and Office of Alcoholism and Substance Abuse Services (OASAS) have announced the launch of the NYS Behavioral Health Value Based Payment Readiness Program. OASAS and OMH expect that the program will prime behavioral health providers to be successful in the State's transformation of the health care delivery system.

OMH and OASAS are currently accepting Notifications of Interest from behavioral health providers that are interested in the program. 

The following is directly from the OMH website:

The program will fund BH providers to collaborate to form Behavioral Health Care Collaboratives (BHCC), including Independent Practice Associations (IPAs), in an effort to position them to succeed in the VBP environment. There will be funds available for planning, and a larger funding opportunity for implementing a BHCC. Funding will support the development of shared infrastructure for the BHCC, such as clinical quality standards, data collection, analytics, and reporting. The expectation is that BHCCs will leverage their shared expertise to better position themselves to enter into VBP contracts. Proposed BHCCs intending to apply must submit a Notification of Interest no later than June 16, 2017

The Notification of Interest Form: 

Do you have an OMIG headache?

Preparing to contest OMIG's final analysis of your case reviews is a daunting task and if not thoroughly conducted, it can cost your organization money. And in many cases, a lot of money!

SAE & Associates has the capacity and experience to standardize the OMIG protocol into a score sheet to review case records (in both written and electronic formats) according to reported deficiencies. Using a team of experienced clinical case record reviewers, SAE experts review chart content using these standard protocols while also determining whether additional documentation provided by the organization during the appeal process changes the final analysis.

By connecting solutions of the clinical, administrative, and technology elements for future OMIG audits, SAE is able to identify unlabeled EHR content, conduct data dives, identify failure trends, and provide corrective action plans for effective process and practice change.

SAE & Associates can provide your organization with concrete data for your OMIG appeal process and customized plans to prevent future unfavorable OMIG results.

If your OMIG audit final analysis is giving you a headache and you're looking for a way to contest the results, SAE & Associates can help you make your case.

More information on SAE's OMIG Audit Support and Appeals: 

CMS Announces Extension for Transitioning to the HCBS Model

Yesterday, the Centers for Medicare & Medicaid Services (CMS) posted an informational bulletin on its website with an update on home and community-based services (HCBS). According to the released statement, CMS is extending the transition period for states to demonstrate compliance with the HCBS criteria until March 2022. CMS expects that the three additional years will give states enough time to fully transition to the HCBS model.

To view the full informational bulletin, click the following link:

SAE Announces Its Substance Use Disorder Team of Experts!

In response to the challenges facing substance use treatment providers, SAE & Associates is pleased to announce its specialized Substance Use Disorder Initiative! For our launch, SAE has assembled a team of leading professionals who can assist in maximizing revenue, maintaining regulatory compliance, achieving fiscal efficiency, measuring outcomes and quality of care, and dealing with managed care organizations. Stay tuned, as you will also be hearing from our team as we release resource guidance for operational solutions.

Introducing Our Team

Team Leader Steven Rabinowitz recently retired after 30 years of service at NY State Office of Alcoholism and Substance Abuse Services (OASAS), where he spent the last 11 years as the Director of Downstate Field Operations, overseeing funding and program services in NYC and Long Island for over 250 substance abuse prevention, treatment, recovery and specialized services provider agencies, and supervised 35 staff associates. Besides his thorough knowledge of fiscal, programmatic and operational issues facing provider agencies, Steve was heavily involved for the last few years with initiatives like managed care, health homes, DSRIP, HCBS, Value-Based Payments, as well as serving as co-leader of a major internal reorganization effort within OASAS.

William Panepinto, LMSW, has an over 30-year history of government and consultation experience serving non-profits targeting vulnerable homeless populations and individuals with substance abuse issues. His career has included ten years of treatment experience and 25 years of state government work with OASAS. At OASAS, he brought addiction specialty care to Community Health Centers and NYC Homeless Shelters in the 1980s, and HUD Shelter Plus Care Homeless Permanent Housing grants to NYS communities in the 1990s. Under his leadership as the first Director of Bureau of Housing Services for OASAS from 2007 to 2013, the agency's Housing Portfolio increased from 850 units in NYC and ten other counties, to over 2,200 units in NYC and thirty additional counties. Recently, Bill designed the OASAS New York/New York III Homeless Initiative for Single Adults and for Families, and the OASAS MRT Supportive Housing Initiative.  Since March 2015, he has have worked as the Director of Special Projects, a part-time position for St. Joseph's Addiction Treatment and Recovery Centers. His focus has been on supportive housing, residential redesign, and co-location of primary health care and behavioral health care.

Shelley Scheffler, PhD, LCSW-R, is an early adopter of the theory and practice of integrated care and has dedicated her career to promoting it in different healthcare and treatment settings. As Vice President of Practice Innovations at Services for the UnderServed, she was instrumental in transitioning the organization to an integrated care model with new initiatives such as the Trauma Informed Care Project, including a Zero Suicide effort, and participation in the SAMHSA learning collaborative to integrate primary care into substance use treatment. Prior to this, Dr. Scheffler was the Senior Integrated Care Specialist at the Center for Excellence in Integrated Care (CEIC), a project was funded by the New York State Health Foundation to promote co-occurring capability in substance use and mental health treatment services throughout New York State. Dr. Scheffler has also provided technical assistance to FQHC's, providing organizational training and detailed outcome analysis. In her career, she has had administrative experience leading case management and substance use services at a large hospital center. She has developed workshops on trauma, substance use, homelessness as well as other social issue topics. Dr. Scheffler has taught at the NYU Silver School of Social Work, the Simmons School of Social Work and the Fordham University CASAC Program.

John Sheehan, LMSW, has focused his 35 + year career serving the substance use and homeless populations including adolescents. Starting his career as an outreach worker, Mr. Sheehan held the position of Vice President at Phoenix House and has held leadership roles at Project Samaritan, Outreach Project, and Bowery Residents Committee, where he served as Deputy Executive Director overseeing Programs for the Homeless Mentally Ill and Chemically Dependent. In addition to his consultant work with SAE & Associates, John has worked with All Souls Church and the 5th Avenue Presbyterian Church to develop social services programs for the homeless. Mr. Sheehan has been honored for his dedication by Phoenix House Foundation and does extensive volunteer work for the MS Society. He is a graduate of Adelphi University with both a Bachelors Degree and Masters Degree in Social Work. He has a Certificate in Non-profit Management from NYU Robert Wagner School. He also has completed trainings recently in Mindfulness and PTSD.

Bruce G. Trigg, MD, is a public health physician who worked for 23 years with the New Mexico Department of Health, where he was the medical director for the Sexually Transmitted Disease (STD) Program. He led the effort to implement a public health and methadone maintenance program at the Bernalillo County Metropolitan Detention Center in Albuquerque. Dr. Trigg helped to develop and expand the statewide harm reduction program, including a needle and syringe exchange program, buprenorphine treatment, and overdose prevention with provision of naloxone. Since retiring from the Department of Health in 2011, Dr. Trigg has been the medical director for Opioid Treatment Programs in New Mexico. He has worked with the University of New Mexico ECHO (Extension for Community Healthcare Outcomes) Program, a collaborative model of medical education and care management, and was on the faculty for physician buprenorphine waiver trainings. 

For more information about how we can help with the expertise you need:

Call (212)-684-4480 or email us at:

Establishing a Collaborative Support System for Children and Families in New York

According to the New York State Office of Mental Health (OMH), data shows that children with a serious emotional disturbance are more likely to reach optimal development when supported in their home and community environment. To ensure New York's children and families have access to the essential services, the HCBS Waiver demands a collaborative support system involving the family, treatment providers, core waiver services, and other natural supports.

The following information is from the NYS OMH website, which clearly defines the goals of the HCBS Waiver for children. 

The goals of the HCBS Waiver are:

  • to serve children with complex and significant mental health needs in their homes and communities;
  • to decrease the need for placements in psychiatric inpatient levels of care, including Residential Treatment Facilities;
  • to increase the array of Medicaid reimbursable community-based services available to children and adolescents with serious emotional disturbance and their families;
  • to use a culturally sensitive, individualized, strength-based approach to build resiliency, assist in the achievement of age-related developmental tasks, and promote emotional well-being;
  • to provide the services and supports that are specifically needed by each unique family to develop the ability to care for the child in their home in a supportive environment;
  • to offer children and families a choice of providers, when possible;
  • to provide services that promote better outcomes that are also cost-effective; and
  • to demonstrate an integrated model of partnership with the family, treatment provider, core waiver services, and other natural supports that are involved with the child and family.

Click the following link to see OMH's HCBS Guidance Document in its entirety:

Feel free to contact us by emailing, or by calling (212)-684-4480 to explore how we can help you in this arena.

HANYS Hosts SAE's Webinar Addressing the Mental Health Parity Act!

On April 5, the Healthcare Association of New York State (HANYS) hosted a Webinar presented by SAE & Associates titled: Mental Health Parity and Addiction Equity Act (MHPAEA): Improving Patient Care & the Bottom Line! During the presentation, SAE's Independent Compliance Administrator (ICA) team provides a brief overview of MHPAEA, reviews UM/UR practices and identifies key metrics for tracking payer patterns for level of care determinations, and also focuses on how parity rules may improve patient care and the bottom line.

Since the live webinar, we have UPDATED some of the content of the PowerPoint for public view. Click the following link to see the slides:

Click the following link to view the webinar:

(if you do not have Adobe Connect, you will be prompted to the quick download of the application)

For more information on how we can help you in this arena:

call (212)-684-4480 or email us at

Update for NYS HBCS Providers: the Community Mental Health Assessment Billing Policy

New York State recently provided an update on the Community Mental Health Billing Policy.

"Care Management Agencies (CMA) will bill NYS Medicaid directly through the eMedNY system. This process will be used for newly and previously completed assessments for individuals enrolled in Health and Recovery Plan (HARP) or HARP-eligible individuals enrolled in HIV Special Needs Plans. For dates of service beginning October 1, 2015, in New York City and July 1, 2016, throughout the rest of NYS, claims for unpaid assessments completed for these enrolled individuals can be directly submitted to eMedNY. This will be the process until direct billing to Medicaid Managed Care Organizations (MMCO) is implemented, targeted to begin Fall 2017. "

Click the following link to see the update:

Remember, in order to bill for "BH HCBS Eligibility Assessment or the Community Mental Health Assessment (CMHA) for a HARP flagged individual, the Assessor must verify the individual is enrolled in a HARP through EPACES/EMEDNY." 

See the full procedure on the NYS Department of Health website:

Stay connected as policy shifts to support practice for these services. SAE remains committed to providers and helping with service shifts toward the realization of the Medicaid Redesign.


Do you know the criteria for a child's eligibility for HCBS?

The following is from the New York State Office of Mental Health (OMH) website, which clearly defines the target population of the HCBS Waiver for children. 

The target population for the HCBS Waiver is children/adolescents:

  • with serious emotional disturbance,
  • between the ages of 5 and 17 years (prior to 18th birthday),
  • who demonstrate complex health and mental health needs,
  • who are at imminent risk of admission to a psychiatric institutional level of care or have a need for continued psychiatric hospitalization, 
  • whose service and support needs cannot be met by just one agency/system,
  • who are capable of being cared for in the home and/or community if services are provided,
  • who have a viable and consistent living environment with parents/guardians who are able and willing to participate in the HCBS Waiver, and
  • who can reasonably be expected to be served under the HCBS Waiver at a cost which does not exceed that of psychiatric institutional care.

They must be eligible for Medicaid under the HCBS Waiver (i.e., are currently enrolled in Medicaid or could be enrolled by meeting federal eligibility standards) in a county with an HCBS Waiver program and be capable of being served in the community at or below the federally approved average yearly cost which is adjusted periodically.

Click the following link to see OMH's HCBS Guidance Document in its entirety:

SAE's financial modeling service can help determine risk and ramp up of these new services based upon your agency's current service populations and activities. To learn more about this support service product, check out our recent announcement here:

Financial Guidance for HCBS Children Providers

Initial Children HCBS rates have been released!

See the newly released tentative rates here: OMH Waiver Proposed Rate Review (3/10/17).

SAE is pleased to announce services to providers looking to apply for HCBS Children Services.

Given the low rates for HCBS Children's services, choosing the right services to apply for and creating detailed financial plans are critical steps for your success. Let SAE's Financial consultants help you make an informed decision.

Our Financial Consultant Team can:

  • Draft detailed financial plans including projected profit and units of service for each selected service line.
  • Utilize a conservative approach to new business development, ensuring that whenever possible, existing resources are utilized first.
  • Customize our financial plan to take into consideration your agency's cost structure and current approach to providing clinical services.
  • Provide ramp-up budgets and break even analyses for each selected service.
  • Generate financial templates that can be used to track your service line launch.

While the application due date has been rolled back, make use of this window of time to identify the best possible selection of HCBS designation services with the least risk.

Contact us by emailing, or by calling (212)-684-4480 for inquiries on how our Children's HCBS Financial Consultant Team can help.

Deadline for the Provider Designation Application for Children's SPA/HCBS Services Has Been Extended

The New York State (NYS) agencies including the Office of Mental Health (OMH), Department of Health (DOH), Office of Alcoholism and Substance Abuse Services (OASAS), and Office of Children and Family Services (OCFS) have released an update on the Children's State Plan (SPA) / Home and Community-Based Services (HCBS) Provider Designation application.

The anticipated timeline for full implementation of the Children's Medicaid Redesign runs through January 2019. This includes Voluntary Foster Care Agency transition in January 2019, which is dependent upon the timeframes for acquiring necessary federal approvals for the two submitted SPAs and the pending submission of the 1115 Waiver. According to the Managed Care Technical Assistance Center of New York (MCTAC), the anticipated dates will be modified accordingly based on the timing of approvals and the review of incoming Federal Administration priorities and processes. 

Given the uncertain timeframes, the State has lifted the April 1 deadline for applications, and a new due date will be announced when there is clarity on the federal approval timing. Stay tuned for updates on the implementation timeline for Children's Medicaid Redesign.

If you have any questions and/or would like to speak to a member of our Kids Managed Care team, you can reach us at (212)-684-4480, or email

SAE Consultant Highlight: Bruce G. Trigg, MD

SAE's Commitment to Addiction Service: Helping Providers Address the Opioid Epidemic

SAE has a dynamic role as behavioral health experts in leading the industry with policy to practice monitoring and implementation of mental health and addiction treatment parity. SAE also supports sharing knowledge of best practices to advance direct care and give providers the critical tools they need to continue to grow.

SAE is proud to announce the addition of Dr. Bruce Trigg to the roster of SAE's Addiction Treatment Specialists. Dr. Trigg is available to facilitate trainings and seminars directly to provider agencies looking to implement or coordinate care with Medication-Assisted Treatment (MAT), as well as agencies working with the re-entry population struggling in addiction treatment engagement. 

Dr. Trigg is a public health physician who worked for 23 years with the New Mexico Department of Health where he was the medical director for the Sexually Transmitted Disease (STD) Program.  He led the effort to implement a public health and methadone maintenance program at the Bernalillo County Metropolitan Detention Center in Albuquerque. 

Dr. Trigg helped to develop and expand the statewide harm reduction program, including a needle and syringe exchange program, buprenorphine treatment, and overdose prevention with provision of naloxone.  

Since retiring from the Department of Health in 2011, Dr. Trigg has been the medical director for Opioid Treatment Programs in New Mexico. He has worked with the University of New Mexico ECHO (Extension for Community Healthcare Outcomes) Program, a collaborative model of medical education and care management, and was on the faculty for physician buprenorphine waiver trainings.

For more information on how we can assist you in the addiction arena, call us at (212)-684-4480, or email

SAE announces a new service: Managed Care Contract Analysis!

Managed care contract negotiations can be difficult to approach.

Before attempting one, you should have a comprehensive understanding of negotiated rates and payer mix, knowing the risk management issues related to your client population as well as development of a strategic book of services/products to address this. Additionally, you will need a close study of your processed claim history including denials. Contracts must also be analyzed well before they expire, because a managed care negotiation is not a quick process and will, more than likely, require multiple conversations.   

Our managed care consultant team has expert experience with managed care contract analysis with adult as well as children services.  

Individual contracts can be reviewed and recommendations offered regarding rates and next steps in provider negotiations.  All teams and projects are tailored to your specific needs.

SAE is pleased to announce a lead expert in managed care contract analysis: 



Over 20 years of progressive supervisory, program development and administrative experience in both the public and private sectors. Expertise in program evaluation, public policy, fiscal management, revenue enhancement, program development, regulatory issues, residential and community outpatient services. Worked with executive and legislative branches of government through policy committees and workgroups advising branch administrators on system development and policy related matters. Accomplished significant population reduction over a two-year period at the beginning of the deinstitutionalization movement in Connecticut, developed agency in CT that provided community based services and eventually the first supported living program in CT, co-wrote and negotiated substance abuse grants and transitioned adult residential program to adolescent residential and out-patient services.

Projects include environmental scan for Optimum Health; white papers regarding the inclusion of individuals with ID/D into managed care for long term services for Magellan; evaluation of the state of New Hampshire system’s quality assurance regulations, policies and procedures and an evaluation of a national for-profit company providing services within the ID/DD and behavioral health systems; evaluation of North Carolina MCO system of behavioral health children’s services with a corresponding analysis of the state and MCO’s regulatory systems for a pending lawsuit regarding children and families; research for systems development for children with co-occurring conditions; a multi-year project concerning a DOJ lawsuit in Texas (Steward Case) where we designed the program evaluation system, trained reviewers, analyzed reports and data and provided feedback on regulatory and community based services and the state service delivery system; consultation in the state of CT on regulatory impact of the behavioral health network for children and families and policy as well as same in the ID/DD regulatory arena; and clinical reviews for the implementation of Settlement Agreements.

If you would like to explore how we can help you in the managed care arena, feel free to reach us by phone at (212)-684-4480, or by emailing

SAMHSA's Homeless Services Grant - A Great Opportunity, but Is Your Organization Eligible?

As the newly announced SAMHSA Grants for the Benefit of Homeless Individuals (GBHI) deadline of April 25 looms closer, many organizations are questioning whether they are eligible and whether they can fulfill the proposed requirements of the Funding Opportunity Announcement (FOA).

Although eligibility is open to "domestic public and private nonprofit entities", ensuring that all enrolled individuals are placed in Permanent Housing may seem daunting causing many agencies to pass on this great opportunity.

However, in actuality, the most important thing an applicant can do, in terms of fulfilling expectations, is to ensure that every person served is linked with a "coordinated entry process".

From the FOA:

  • Page 6 - "Grantees are expected to link all enrolled individuals and/or families to permanent housing. However, at minimum grantees are required to utilize the U.S. Department of Housing and Urban Development (HUD) Coordinated Entry Process"
  • Page 20 - "Describe the availability of permanent housing in your community for the population(s) of focus and the strategies you will utilize to support linkage for all enrolled individuals and/or families to HUD's Coordinated Entry Process and how it is ultimately connected to permanent housing."

Documenting a well-functioning, coordinated entry process that meets the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) criteria is key!