BP Adams Calls For Statewide Investigation Into Insurance Agencies’ Failure To Properly Reimburse Sadc Providers

Press release from the Office of the Brooklyn Borough President:

October 23 2020

Brooklyn, NY – Today, representatives from Sundance Social Adult Day program joined Brooklyn Borough President Eric Adams and their fellow health care providers outside their Brownsville center to highlight the challenges faced by caregivers across the city and state during the COVID-19 pandemic. A recent report by the American Association of Retired Persons (AARP), first reported in the New York Daily News, revealed a growing crisis of social isolation among seniors in New York City due largely to the COVID-19 pandemic. Social adult day cares (SADCs) help mitigate feelings of social isolation and loneliness by providing socialization, supervision, personal care, and nutrition for functionally impaired older adults. Sundance is one of several SADC centers around the state that have been struggling to provide continuity of services on which their elderly and frail members rely. Several Medicaid Managed Long-Term Care plans (MLTCs) are refusing to reimburse for services provided to qualified participants during the COVID-19 Public Emergency Period.

Due to these financial pressures, many of the providers have been unable to pay rent for months and are on the brink of permanent closure. These closures would likely exacerbate health disparities in underserved areas, which have been laid bare over the course of the COVID-19 pandemic. Borough President Adams, SADC providers, and local elected leaders called on the New York State Department of Health (DOH) and the New York City Department for the Aging (DFTA) to ensure these invaluable services continue to be available to the most vulnerable, and also call for a statewide investigation into potential predatory behavior by MLTCs to avoid paying out reimbursements.

“Our senior community has suffered disproportionately from the COVID-19 pandemic and its impacts. Now a new crisis is emerging – one of deep and painful social isolation for older adults, which can be fatal. It is unconscionable that at a time when social adult day services are needed more than ever, we are allowing insurers to imperil the very existence of these centers on which so many seniors, particularly those in underserved communities, rely. I am calling for a statewide investigation into potential predatory behavior by managed long-term care plans in order to avoid paying out reimbursements. I am sending a letter today to the State inspector general with this request, and I am prepared to escalate this matter if and when that proves necessary. We simply cannot put profits over the right of our older adults to age with dignity,” said Brooklyn Borough President Eric Adams.

“Seniors’ lives matter too. This is a community that has been forced into isolation and forgotten, and social adult day services are their lifelines to the outside world. These people are not just members; for all intents and purposes, they are family. We need to support these services, not cut them. We thank the Borough President Eric Adams and others who joined us for adding their voices to this important issue,” said Brenda Stewart, program aide at Sundance Social Adult Day Care Center.

“Adult day programs provide vital services for seniors in need, and neither the needs nor the benefits have lessened amid the pandemic — if anything, they’ve grown deeper. We cannot allow companies who claim to be committed to health care to put profits over people. I join the calls to investigate predatory behavior and ensure that older adults have access to these crucial programs,” said Public Advocate Jumaane D. Williams.

Under Mayoral Emergency Executive Order (EEO) No. 100 § 17, which was issued on March 16, 2020, all older adult congregate centers operating within the city, whether publicly or privately owned or funded, are closed and all programs suspended, with exceptions around the provision of food to older adults.

On March 23, 2020, the DOH issued guidelines called “Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services During the COVID-19 State of Emergency,” clearly outlining the need for insurance providers to reimburse for telehealth services during the pandemic. However, the MLTCs still did not comply, despite having already received funds through Medicaid to be paid to health care providers, including SADCs, for services.

On April 7, 2020, the DOH issued “COVID-19 Guidance for Providing Adult Social Day Care Services Telephonically” to assure that MLTCs and SADCs clearly understood that SADCs provide an invaluable service to functionally impaired older adults, especially at a time when isolation and anxiety are widespread and services can be provided by telehealth or telecommunications.

Borough President Adams wrote a letter on September 28th addressed a letter to the DOH, DFTA, New York State Office for the Aging (OFA), Governor Cuomo, and Mayor de Blasio outlining his concerns. In the letter, he wrote that SADC providers “need clearer guidance, reconciliation of regulations from City and State entities, and regulators on the City and State level to investigate potential failure to reimburse providers for services delivered through traditional or adapted SADC programs. Further, City and State regulators ought to investigate larger insurers for not providing services that they are under contract with the State to provide.”

A link to the livestream of the event is available here.

This press release was produced by the Office of the Brooklyn Borough President. The views expressed are the author's own.