Steven R. Antico
Partner/Director
201-518-3434
Applied Behavioral Analysis and Medical and Education Services (BAMES)
- Overview
- Attorneys
- Insights
Garfunkel Wild’s Applied Behavioral Analysis and Medical and Education Services (BAMES) Practice Group is constantly evolving due to an extensive and ever-changing regulatory landscape, increasing demand for services, evolving care coordination and delivery elements, legislative mandates regarding reimbursement and licensure, and health plan enrollment, reimbursement and denial issues.
The BAMES team consists of subject-matter experts who understand the market, the continuum of care, and the complex regulatory and reimbursement environment. Uniquely positioned as a name known throughout the health care sector for excellence, Garfunkel Wild can work with your management team to achieve efficient business solutions and implement cohesive, comprehensive, and compliant delivery models.
The BAMES team works with client providers who offer a continuum of services that span a full array of coordinated program options for infants, toddlers, youth, teens, adults and seniors, including:
- Applied Behavior Analysis and Care Management Services
- Early Intervention/Special Education Programs
- Developmental Disability Centers and Hospitals
- Specialized Schools
- Mental Health and Substance Abuse Clinics
- Housing and Group Homes
- Social, Recreational and Therapeutic Services
- Federal and State Educational Support and Programs
- Home and Community Based Waiver Services
- Children’s Camps
The BAMES team often collaborates with other Garfunkel Wild Practice Groups to work with all types of health care providers, private equity funds, and industry investors to facilitate M&A transactions, real estate development and transactions, and public finance work related to the BAMES sector, and routinely:
- Assists providers and their investors to establish and build delivery models from the ground up.
- Helps clients respond to government and payor audits, investigations and compliance matters.
- Assists with all types of credentialing and reimbursement issues.
- Assists with licensure applications with state Department of Health agencies, Medicare, and Medicaid.
- Negotiates all of types agreements and arrangements, including acquisition agreements, operating or shareholders’ agreements, equity issuance documents, and employment agreements that are necessary to take our clients’ programs from concept to implementation and beyond.
Practice Group Contacts
Team
FinCEN Reporting Obligations End for Domestic (US) Entities
Following months of uncertainty surrounding the future of the Corporate Transparency Act's (CTA) beneficial ownership information (BOI) reporting requirements, the U.S. Department of the Treasury, Financial Crimes Enforcement Network (FinCEN) published an interim final rule (Interim Rule) on March 21, 2025 that removes the requirement for U.S. companies and U.S. persons to submit BOI reports to FinCEN under the CTA.
NY DOH Publishes FAQs Regarding Reporting of Health Care Transactions
In March, the New York Department of Health (DOH) published “frequently asked questions” (FAQs) related to the law that requires “health care entities” party to a “material transaction” to report the transaction to the DOH in advance.
New Telehealth Update: Medicare Waivers Extended To September 30, 2025
Congress has once again extended certain telehealth flexibilities until September 30, 2025 (which coincides with the end of the Congressional fiscal year).
CTA Reporting Requirements Partially Suspended
In a surprising new development that comes just days after a temporary ban on the Corporate Transparency Act's (CTA) beneficial ownership information (BOI) reporting requirements was lifted, the U.S. Department of the Treasury (Treasury Department), Financial Crimes Enforcement Network (FinCEN) announced in a March 2nd press release that it will not enforce the BOI reporting requirements against U.S. citizens and domestic reporting companies.
Corporate Transparency Act Reporting Requirements Back in Effect
Following nearly a year of legal challenges, the beneficial ownership information (BOI) reporting requirements under the Corporate Transparency Act (CTA) are once again back in effect, with a current filing deadline of March 21, 2025.
Marketing Arrangements in Medicare Advantage Plans Under OIG Scrutiny
On December 11, 2024, the U.S. Department of Health and Human Services, Office of the Inspector General (OIG) published a Special Fraud Alert in response to the uptick in abusive marketing practices between Medicare Advantage Organizations (MAOs), health care providers, and ancillary participants (such as agents and brokers).
Second Circuit Adopts “One Purpose” Test
The United States Court of Appeals for the Second Circuit (Second Circuit or Court), which has Federal jurisdiction in Connecticut, New York, and Vermont, recently issued an important decision regarding health care provider liability under the False Claims Act (FCA) when a whistleblower alleges a violation of the Anti-Kickback Statute (AKS). The Second Circuit explicitly adopted the “one purpose” test for the first time to determine whether a financial arrangement between a provider and a referral source violates the AKS, and thus potentially subjects the parties to substantial fines and penalties under the FCA.
New OIG Priorities Emerge in Report
The U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG) released its Semiannual Report (SAR) to Congress on December 4, 2024.
OIG Highlights New Concerns
This week, the U.S. Department of Health and Human Services (“HHS”), Office of Inspector General (“OIG”) fulfilled its annual statutory obligation by releasing its 2024 Top Management and Performance Challenges Report (the “Report”). Historically, the Report has not attracted widespread interest in the provider community because it largely focuses on HHS operational challenges. Importantly for providers and other stakeholders, however, the Report reveals crucial insights about compliance priorities for the year ahead.
Federal Rule Released to Address Mental Health Coverage Parity
This week, the Federal Departments of Treasury, Labor, and Health and Human Services (the Departments) released final rules strengthening consumer protections for patients seeking mental health and substance use disorder treatments.
OIG Report Highlights Enforcement Priorities
The U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG) released its revamped Semiannual Report (SAR) on June 3, 2024. The SAR’s new format focuses on the oversight work OIG completed during the reporting period, and emphasizes how this work directly addresses the Top Management Challenges Facing HHS.
Telehealth Update: NY Proposes Controlled Substance Prescribing, Waiting on DEA
On May 15, 2024, the New York State Department of Health (DOH) announced a pivotal change in its regulations, as it intends to permit health care providers to use telemedicine to conduct patient evaluations before prescribing controlled substances. Prior to the COVID-19 pandemic, DOH required health care providers to perform an initial in-person physical evaluation of patients before prescribing controlled substances.
New Jersey Now Requires Licensure for the Practice of Applied Behavior Analysis
Pursuant to the New Jersey Applied Behavior Analyst Licensing Act (the “Act”), the Board of Applied Behavior Analyst Examiners (the “Board”) published the official rules concerning the practice of Applied Behavior Analyst (“ABA”) therapy, effective May 6, 2024 (the “Rules”).
Be Prepared! NYS OMIG’s 2024 Work Plan Provides an Audit Roadmap for Health Care Providers of All Types
Garfunkel’s Compliance Webinar Series rolls on with an examination of the 2024 Work Plan published by the New York State Office of Medicaid Inspector General (OMIG).
FTC Bans Non-Competes Across the Nation
On Tuesday, April 23, 2024, the Federal Trade Commission (FTC) promulgated a final rule banning most non-compete agreements, in any industry, and is set to become effective 120 days after its publication in the Federal Register (the “Final Rule”).
OIG Issues New Resource for Single Audits
The United States Department of Health and Human Services (HHS), Office of Inspector General (OIG) recently posted a new educational resource on its website about Single Audits. HHS is the largest grant-making agency in the Federal government, and OIG’s new resource is designed to help key stakeholders understand the scope of Single Audits, as well as improve the overall quality of such audits.
New York OMIG Updates Self-Disclosure Guidance
The New York State Office of the Medicaid Inspector General (OMIG) recently updated its Self-Disclosure Guidance and Frequently Asked Questions (collectively, “Updates”). These Updates give participating providers and entities additional insight into how to report overpayments involving unresponsive Medicaid Managed Care Organizations (MMCOs) or multiple entities, as well as those that are untimely, have adjusted or voided claims, or lost or damaged records.
OMIG’s 2024 Work Plan Gives Critical Insights into Program Integrity Initiatives
The New York State Office of the Medicaid Inspector General (OMIG) released its 2024 work plan in furtherance of its mission to coordinate and conduct activities to prevent, detect and investigate medical assistance program fraud, waste and abuse, and to recover improperly expended Medicaid funds.
More Provider “Nuggets” From OIG’s Year-End Reporting Blitz
Continuing its year-end reporting blitz, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its Semiannual Report (SAR) to Congress on December 1, 2023.
How to Become Designated as a New York State Children’s HCBS Provider
This webinar will provide an overview of the NYS Children’s HCBS Program and outline the requirements for designation as an HCBS provider.
DOJ/HHS Jointly Release “Highlight Reel” Report
This week, the United States Department of Justice (DOJ) and the United States Department of Health and Human Services (HHS) fulfilled its annual statutory obligation by releasing its jointly-authored Health Care Fraud and Abuse Control Program (HCFAC) Report for Fiscal Year 2022.
OIG Provides Roadmap to Hot-Button Issues
The OIG fulfilled its annual statutory obligation by releasing its Top Management and Performance Challenges (TMC) document. Providers should take note because the document provides important insight into the specific areas over which HHS (and the OIG) will remain focused.
OIG Releases New General Compliance Program Reference Guide
On November 6, 2023, the OIG released its General Compliance Program Guidance, the first in a series of new, non-binding reference guides designed to share information with health care compliance professionals and other health care industry stakeholders
New Jersey Publishes Notice of Proposed Rulemaking for ABA Licensure Regulations
The Board proposed new regulations regarding the practice of ABA therapy in New Jersey, including, for example, licensing standards for applied behavior analysts and assistant applied behavior analysts, reciprocity requirements, scope of services, business practices, and telehealth requirements.
Garfunkel Wild Webinar – Federal No Surprises Act – One Month In. What Have We Learned? What Questions Remain?
Garfunkel Wild’s Debra Silverman and John Martin will present the webinar “Federal No Surprises Act – One month in. What have we learned? What questions remain?" on February 1, 2022, from 12:00 pm – 1:00 pm (EST).
Behavioral Health News Webinar “This Will Only Hurt a Little – Stoicism in the Face of EHR Implementations”
Garfunkel Wild Partner Terence Russo will present at Behavioral Health News Webinar “This Will Only Hurt a Little – Stoicism in the Face of EHR Implementations” on October 13, 2021 from 1:00 pm – 2:00 pm EDT.
New Jersey Enacts Applied Behavior Analyst Licensing Act
On January 13, 2020, Governor Phil Murphy signed the “Applied Behavior Analyst Licensing Act” (the “Act“) into law, which becomes effective on July 11, 2020. The Act creates the State Board of Applied Behavior Analysts (the “Board“) within the New Jersey Department of Law and Public Safety, Division of Consumer Affairs.
Change to Payment of Behavioral Health Services
On November 8, 2019, the New York State Legislature passed an amendment positively impacting the reimbursement made by Medicaid managed care plans and managed long-term care plans to behavioral health providers.
Garfunkel Wild’s Applied Behavioral Analysis and Medical and Education Services (BAMES) Practice Group is constantly evolving due to an extensive and ever-changing regulatory landscape, increasing demand for services, evolving care coordination and delivery elements, legislative mandates regarding reimbursement and licensure, and health plan enrollment, reimbursement and denial issues.
The BAMES team consists of subject-matter experts who understand the market, the continuum of care, and the complex regulatory and reimbursement environment. Uniquely positioned as a name known throughout the health care sector for excellence, Garfunkel Wild can work with your management team to achieve efficient business solutions and implement cohesive, comprehensive, and compliant delivery models.
The BAMES team works with client providers who offer a continuum of services that span a full array of coordinated program options for infants, toddlers, youth, teens, adults and seniors, including:
- Applied Behavior Analysis and Care Management Services
- Early Intervention/Special Education Programs
- Developmental Disability Centers and Hospitals
- Specialized Schools
- Mental Health and Substance Abuse Clinics
- Housing and Group Homes
- Social, Recreational and Therapeutic Services
- Federal and State Educational Support and Programs
- Home and Community Based Waiver Services
- Children’s Camps
The BAMES team often collaborates with other Garfunkel Wild Practice Groups to work with all types of health care providers, private equity funds, and industry investors to facilitate M&A transactions, real estate development and transactions, and public finance work related to the BAMES sector, and routinely:
- Assists providers and their investors to establish and build delivery models from the ground up.
- Helps clients respond to government and payor audits, investigations and compliance matters.
- Assists with all types of credentialing and reimbursement issues.
- Assists with licensure applications with state Department of Health agencies, Medicare, and Medicaid.
- Negotiates all of types agreements and arrangements, including acquisition agreements, operating or shareholders’ agreements, equity issuance documents, and employment agreements that are necessary to take our clients’ programs from concept to implementation and beyond.
Practice Group Contacts
Team
FinCEN Reporting Obligations End for Domestic (US) Entities
Following months of uncertainty surrounding the future of the Corporate Transparency Act's (CTA) beneficial ownership information (BOI) reporting requirements, the U.S. Department of the Treasury, Financial Crimes Enforcement Network (FinCEN) published an interim final rule (Interim Rule) on March 21, 2025 that removes the requirement for U.S. companies and U.S. persons to submit BOI reports to FinCEN under the CTA.
NY DOH Publishes FAQs Regarding Reporting of Health Care Transactions
In March, the New York Department of Health (DOH) published “frequently asked questions” (FAQs) related to the law that requires “health care entities” party to a “material transaction” to report the transaction to the DOH in advance.
New Telehealth Update: Medicare Waivers Extended To September 30, 2025
Congress has once again extended certain telehealth flexibilities until September 30, 2025 (which coincides with the end of the Congressional fiscal year).
CTA Reporting Requirements Partially Suspended
In a surprising new development that comes just days after a temporary ban on the Corporate Transparency Act's (CTA) beneficial ownership information (BOI) reporting requirements was lifted, the U.S. Department of the Treasury (Treasury Department), Financial Crimes Enforcement Network (FinCEN) announced in a March 2nd press release that it will not enforce the BOI reporting requirements against U.S. citizens and domestic reporting companies.
Corporate Transparency Act Reporting Requirements Back in Effect
Following nearly a year of legal challenges, the beneficial ownership information (BOI) reporting requirements under the Corporate Transparency Act (CTA) are once again back in effect, with a current filing deadline of March 21, 2025.
Marketing Arrangements in Medicare Advantage Plans Under OIG Scrutiny
On December 11, 2024, the U.S. Department of Health and Human Services, Office of the Inspector General (OIG) published a Special Fraud Alert in response to the uptick in abusive marketing practices between Medicare Advantage Organizations (MAOs), health care providers, and ancillary participants (such as agents and brokers).
Second Circuit Adopts “One Purpose” Test
The United States Court of Appeals for the Second Circuit (Second Circuit or Court), which has Federal jurisdiction in Connecticut, New York, and Vermont, recently issued an important decision regarding health care provider liability under the False Claims Act (FCA) when a whistleblower alleges a violation of the Anti-Kickback Statute (AKS). The Second Circuit explicitly adopted the “one purpose” test for the first time to determine whether a financial arrangement between a provider and a referral source violates the AKS, and thus potentially subjects the parties to substantial fines and penalties under the FCA.
New OIG Priorities Emerge in Report
The U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG) released its Semiannual Report (SAR) to Congress on December 4, 2024.
OIG Highlights New Concerns
This week, the U.S. Department of Health and Human Services (“HHS”), Office of Inspector General (“OIG”) fulfilled its annual statutory obligation by releasing its 2024 Top Management and Performance Challenges Report (the “Report”). Historically, the Report has not attracted widespread interest in the provider community because it largely focuses on HHS operational challenges. Importantly for providers and other stakeholders, however, the Report reveals crucial insights about compliance priorities for the year ahead.
Federal Rule Released to Address Mental Health Coverage Parity
This week, the Federal Departments of Treasury, Labor, and Health and Human Services (the Departments) released final rules strengthening consumer protections for patients seeking mental health and substance use disorder treatments.
OIG Report Highlights Enforcement Priorities
The U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG) released its revamped Semiannual Report (SAR) on June 3, 2024. The SAR’s new format focuses on the oversight work OIG completed during the reporting period, and emphasizes how this work directly addresses the Top Management Challenges Facing HHS.
Telehealth Update: NY Proposes Controlled Substance Prescribing, Waiting on DEA
On May 15, 2024, the New York State Department of Health (DOH) announced a pivotal change in its regulations, as it intends to permit health care providers to use telemedicine to conduct patient evaluations before prescribing controlled substances. Prior to the COVID-19 pandemic, DOH required health care providers to perform an initial in-person physical evaluation of patients before prescribing controlled substances.
New Jersey Now Requires Licensure for the Practice of Applied Behavior Analysis
Pursuant to the New Jersey Applied Behavior Analyst Licensing Act (the “Act”), the Board of Applied Behavior Analyst Examiners (the “Board”) published the official rules concerning the practice of Applied Behavior Analyst (“ABA”) therapy, effective May 6, 2024 (the “Rules”).
Be Prepared! NYS OMIG’s 2024 Work Plan Provides an Audit Roadmap for Health Care Providers of All Types
Garfunkel’s Compliance Webinar Series rolls on with an examination of the 2024 Work Plan published by the New York State Office of Medicaid Inspector General (OMIG).
FTC Bans Non-Competes Across the Nation
On Tuesday, April 23, 2024, the Federal Trade Commission (FTC) promulgated a final rule banning most non-compete agreements, in any industry, and is set to become effective 120 days after its publication in the Federal Register (the “Final Rule”).
OIG Issues New Resource for Single Audits
The United States Department of Health and Human Services (HHS), Office of Inspector General (OIG) recently posted a new educational resource on its website about Single Audits. HHS is the largest grant-making agency in the Federal government, and OIG’s new resource is designed to help key stakeholders understand the scope of Single Audits, as well as improve the overall quality of such audits.
New York OMIG Updates Self-Disclosure Guidance
The New York State Office of the Medicaid Inspector General (OMIG) recently updated its Self-Disclosure Guidance and Frequently Asked Questions (collectively, “Updates”). These Updates give participating providers and entities additional insight into how to report overpayments involving unresponsive Medicaid Managed Care Organizations (MMCOs) or multiple entities, as well as those that are untimely, have adjusted or voided claims, or lost or damaged records.
OMIG’s 2024 Work Plan Gives Critical Insights into Program Integrity Initiatives
The New York State Office of the Medicaid Inspector General (OMIG) released its 2024 work plan in furtherance of its mission to coordinate and conduct activities to prevent, detect and investigate medical assistance program fraud, waste and abuse, and to recover improperly expended Medicaid funds.
More Provider “Nuggets” From OIG’s Year-End Reporting Blitz
Continuing its year-end reporting blitz, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its Semiannual Report (SAR) to Congress on December 1, 2023.
How to Become Designated as a New York State Children’s HCBS Provider
This webinar will provide an overview of the NYS Children’s HCBS Program and outline the requirements for designation as an HCBS provider.
DOJ/HHS Jointly Release “Highlight Reel” Report
This week, the United States Department of Justice (DOJ) and the United States Department of Health and Human Services (HHS) fulfilled its annual statutory obligation by releasing its jointly-authored Health Care Fraud and Abuse Control Program (HCFAC) Report for Fiscal Year 2022.
OIG Provides Roadmap to Hot-Button Issues
The OIG fulfilled its annual statutory obligation by releasing its Top Management and Performance Challenges (TMC) document. Providers should take note because the document provides important insight into the specific areas over which HHS (and the OIG) will remain focused.
OIG Releases New General Compliance Program Reference Guide
On November 6, 2023, the OIG released its General Compliance Program Guidance, the first in a series of new, non-binding reference guides designed to share information with health care compliance professionals and other health care industry stakeholders
New Jersey Publishes Notice of Proposed Rulemaking for ABA Licensure Regulations
The Board proposed new regulations regarding the practice of ABA therapy in New Jersey, including, for example, licensing standards for applied behavior analysts and assistant applied behavior analysts, reciprocity requirements, scope of services, business practices, and telehealth requirements.
Garfunkel Wild Webinar – Federal No Surprises Act – One Month In. What Have We Learned? What Questions Remain?
Garfunkel Wild’s Debra Silverman and John Martin will present the webinar “Federal No Surprises Act – One month in. What have we learned? What questions remain?" on February 1, 2022, from 12:00 pm – 1:00 pm (EST).
Behavioral Health News Webinar “This Will Only Hurt a Little – Stoicism in the Face of EHR Implementations”
Garfunkel Wild Partner Terence Russo will present at Behavioral Health News Webinar “This Will Only Hurt a Little – Stoicism in the Face of EHR Implementations” on October 13, 2021 from 1:00 pm – 2:00 pm EDT.
New Jersey Enacts Applied Behavior Analyst Licensing Act
On January 13, 2020, Governor Phil Murphy signed the “Applied Behavior Analyst Licensing Act” (the “Act“) into law, which becomes effective on July 11, 2020. The Act creates the State Board of Applied Behavior Analysts (the “Board“) within the New Jersey Department of Law and Public Safety, Division of Consumer Affairs.
Change to Payment of Behavioral Health Services
On November 8, 2019, the New York State Legislature passed an amendment positively impacting the reimbursement made by Medicaid managed care plans and managed long-term care plans to behavioral health providers.