July 2025

This round of updates focus on prenatal screenings, osteoporosis and vaccinations.

National Minority Mental Health Awareness Month is a call to action for providers to improve care for marginalized populations. Advancing equity requires building trust, expanding access and turning awareness into meaningful, compassionate action.

Each July, National Minority Mental Health Awareness Month highlights the mental health disparities affecting historically marginalized groups. In Western New York, these disparities are daily realities shaped by trauma, inequity and barriers to care.

Across the U.S., racial and ethnic minorities experience higher rates of mental health conditions but are significantly less likely to seek or stay in treatment. Socioeconomic hardship, stigma, language challenges and a lack of culturally competent care all contribute to delayed diagnoses, worse outcomes and long-term costs for individuals and communities.

Refugees: Trauma and Access Barriers

Buffalo has one of the nation's highest refugee resettlement rates, welcoming new Americans from countries like Afghanistan, Burma, Syria, Venezuela, and the DRC. Many arrive with trauma and face barriers to care, including language challenges and cultural differences around mental health. This can lead to overlooked conditions like PTSD and depression. Providers can help by building trust, screening regularly and supporting culturally responsive referrals.

Indigenous Communities: Historical Trauma and Resilience

Historical trauma among Indigenous peoples—especially the Seneca and Tuscarora Nations in Western New York—continues to impact health today. Forced relocation, cultural suppression and systemic discrimination have contributed to higher rates of suicide, substance use and chronic mental illness, alongside deep mistrust of medical institutions due to past harms.

Culturally informed care goes beyond respect. It calls for partnership with Native organizations, inclusion of traditional healing and humility in addressing historical and ongoing injustices.

LGBTQ+ Communities: Elevated Risk, Uneven Support

LGBTQ+ individuals—especially youth and transgender people—face higher rates of mental health challenges like depression, trauma and suicidal ideation. Many avoid care due to past discrimination in clinical settings. Providers play a key role in fostering inclusive, affirming environments that support both personal and societal well-being.

Incarcerated Populations: Criminalization of Mental Illness

Mental health care failures are stark in prisons and jails, where more people with serious mental illness are housed than in psychiatric hospitals. After release, individuals face heightened risks of overdose, suicide and recidivism—worsened by fragmented care.

Organizations like Matt Urban Human Services and Buffalo’s Mobile Outreach Program offer critical support for high-risk groups, including those experiencing homelessness, addiction or recent incarceration. Strong collaboration between healthcare, community agencies and reentry programs is key to ensuring continuous, accessible care.

Black and Hispanic Populations: Disparities Rooted in Structural Racism

Black and Hispanic communities in Western New York face heightened mental health challenges due to structural racism, generational poverty and limited access to care. Historic segregation and disinvestment fuel chronic stress, trauma and treatment barriers.

Stigma, provider bias and cultural disconnects often deter care. Solutions include proactive outreach, investing in community-led mental health efforts and improving provider representation to better reflect those served.

Breaking the Cycle of Mistrust

A recurring theme across these groups is mistrust of the healthcare system, rooted in histories of neglect, discrimination and invalidation. This mistrust leads to lower treatment engagement and worsens health disparities.

Rebuilding trust takes time and action. Providers can support this by validating lived experiences, being transparent and embracing shared decision-making. Training in cultural humility, implicit bias, and trauma-informed care is key to fostering respectful, effective relationships.

Strategies for Western New York Providers

Providers can lead the way in addressing these disparities through these actionable steps:

1. Integrate routine mental health screenings using validated tools such as the PHQ-9 for depression, GAD-7 for anxiety, PCL-5 for PTSD and the CAGE-AID for substance use. These effective tools are brief and easy to use to help identify issues early—even when patients present with non-psychiatric complaints.
2. Use evidence-based tools to screen all patients for social determinants of health (SDoH). The AAFP’s framework, A Practical Approach to Screening for Social Determinants of Health, offers clear guidance. Incorporate ICD-10 Z-codes—diagnostic codes for SDoH factors—in clinical documentation (Z Codes 101: Enhancing Documentation & Value-Based Care) to identify patients impacted by systemic inequities.
3. Refer patients to behavioral health providers who reflect or understand their cultural backgrounds. Our Find a Doctor tool can help locate in-network professionals with the right expertise.
4. Link patients to community organizations that address social determinants like housing, food insecurity, legal aid and language access—factors that profoundly impact mental health.
5. Stay engaged and informed. Continuing education from programs like Think Cultural Health enhances culturally responsive care. Partnering with local organizations—such as 211 WNY or refugee advocacy groups—strengthens your ability to support patients beyond the clinical setting.

A Call to Action

National Minority Mental Health Awareness Month is a call to action for Western New York providers to improve care for marginalized populations. Recognizing the unique challenges faced by refugee, Indigenous, Black, Hispanic, LGBTQ+ and incarcerated individuals is just the beginning. Advancing equity requires building trust, expanding access and turning awareness into meaningful, compassionate action.

While lack of coordination leads to negative outcomes, communication and coordination lead to better chances for improved outcomes.

These tips can help practices avoid rework and delays in obtaining preauthorization.

Sometimes, prior authorization requests may be denied because required information was missing. Keep these tips in mind to submit prior authorization requests correctly the first time to avoid appeals, save time, and ensure timely, accurate reviews, which avoids delays in your patients’ treatment.

Ensure your documentation process is thorough and complete when submitting for review. Check medical policies on the Portal such as Independent Health, Evolent or Prime Therapeutics to know what information is required in order to properly review the service/treatment being requested.

Example 1: Advanced imaging request for back pain.

• Sometimes, coverage for advanced imaging is denied because the provider’s office didn’t include the fact that the patient was medically unable to have physical therapy.
• Check Evolent guidelines and whether conservative therapy or other imaging (x-ray or ultrasound) is required for consideration.
• Submit the documentation with the prior authorization request to support policy requirements, or indicate if conservative therapy or other imaging would be contraindicated in the member’s clinical scenario. 

Example 2: Independent Health has put in place requirements before we cover certain medications.

• Check Independent Health policies, formularies or Prime Therapeutics’ policies for the specific medication you are requesting to determine the documentation required for consideration.
• Submit documentation, such as: the patient has tried and failed the preferred product, and/or required recent laboratory workup. For GLP-1s, we require the recent member’s BMI and confirmation the member has been enrolled and participating in an evidence-based, formalized weight-management/lifestyle modification program. 

Example 3: Surgery request.

• Some surgeries require the patient to be smoke-free before we approve coverage.
• Check Independent Health policies.
• If smoking is a contraindication for surgery, submit documentation, including lab work of smoking cessation and/or nicotine levels. Include documentation if conservative treatment tried, with dates, and imaging studies supporting diagnosis. 

Medicare pre-service appeals require the following to be accepted and processed:

Medicare Part B & C

• An Enrollee’s ordering Physician signature
• Support staff of a physician’s office, or Mid-Level acting on a physician’s behalf must be submitted on the physician’s said letterhead or physician signature on the office staff appeal, or
• AOR (Appointment of Representative)

Medicare Part D Drug pre-service appeals

• An Enrollee’s prescribing physician signature or other prescriber’s signature acting on behalf of the Enrollee.
• Support staff of a physician’s office on a physician’s behalf must be submitted on the physician’s said letterhead or physician signature on the office staff appeal, or
• AOR (Appointment of Representative)

We ask providers to respond promptly to our requests for additional information.  We are under strict requirements to process all pharmacy prior authorization requirements within a short time frame.  While the timeframes vary by type of drug and the member's plan (from 48 hours to 14 days,) a lack of response will lead to a denied request. 

Refer to Part C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance on Who may Request an appeal.

The Independent Health Provider Manual explains when a prior authorization or appeal qualifies to be submitted as expedited request for review. 

This is a special needs plan designed to coordinate care between a nursing home and the individual's primary care physician. 

If you have patients who reside in skilled nursing, assisted living or adult care facilities, Independent Health’s Medicare Family Choice® HMO I-SNP plan* may be able to provide them with an extra level of support to meet their special needs while working closely with you to improve their health outcomes and quality of care.

How the plan works

Upon enrollment, each Family Choice member is assigned an Interdisciplinary Care Team consisting of the member’s Primary Care Provider (PCP), a Family Choice Nurse Practitioner (NP) or Physician Assistant (PA), and a Social Worker/Care Manager. The specially trained NP or PA is on call 24 hours a day, seven days a week to provide care and support any time it’s needed. Their responsibilities include:

• Working in collaboration with the member’s PCP and the facility’s staff to identify potential problems before they become serious.  
• Providing as many clinical services as possible in the member’s residence.
• Minimizing unnecessary and disruptive emergency room visits and hospital stays whenever it’s safe and appropriate.
• Keeping in close contact with the member’s designated family representatives, updating them about their loved one’s condition and involving them in the care-planning process.

Other key features of Family Choice

• Low or no out-of-pocket costs
• Year-round enrollment open to all eligible Medicare beneficiaries
• Frequent on-site medical assessments and visits
• Individualized care plan that addresses the member’s needs and health care preferences  
• Single point of contact nurse or coordinator for benefit authorizations and care transitions
• Over-the-counter benefit with access to hundreds of health and wellness products

Impressive survey results

Over the years, the Family Choice plan has consistently received high satisfaction marks from families and caregivers. A recent survey** of people whose loved ones are enrolled in the program showed:

• 99% are satisfied with Family Choice.
• 98% would recommend Family Choice to others.
• 98% feel their NP or PA provides their loved ones with the quality of care they expected them to receive.

To learn more

Nearly 40 skilled nursing, assisted living and adult care facilities in Western New York currently participate with the Family Choice plan. For additional information, you and your patients can visit our website

*This plan is available to all Medicare eligibles that are entitled to Medicare Part A and enrolled in Part B. Members must reside in a participating facility in Western New York. Members must receive all routine care from participating providers. **Survey conducted in January 2025 with 582 responsible parties surveyed and 21% responding.

Survey is required by New York State; your participation is important; please make your staff aware of this possible call to your practice so it may respond appropriately.

To ensure compliance with standards established by New York State for our participating providers, Independent Health has engaged with a vendor, PressGaney, to conduct brief surveys by phone regarding appointment access and availability for our members.

Over the next several weeks your office may receive a phone call from a surveyor from PressGaney to ask questions pertaining to your practice’s appointment availability times for both routine and after-hours care as outlined in our Appointment Accessibility and After Hours Access policy. 

We have revised the policy to clarify that requiring previous medical records or requesting that the patient complete a health form should not be a prerequisite for scheduling an appointment.

This survey will be directed to specific types of providers, including primary care, medical oncologists, OB/GYNs, clinical neuropsychologists, psychiatrists, psychologists, and certified social workers.

As an example, a surveyor identifying themselves as from PressGaney would call a primary care office to discuss the scenario of a patient who calls to ask for the timeframe to schedule an appointment.  Each discussion with a surveyor is recorded and shared with Independent Health.

All scenarios presented are based on the following types of care:

• Emergent
• Urgent
• Sick visits (routine non-urgent/emergent)
• Routine, non-urgent or preventive care
• Adult baseline and routine physicals

Please make your staff aware of this possible call to your practice so it may be responded to appropriately.

Thank you for your efforts to help us adhere to the New York standards for appointment access and availability.  If you have questions, please contact our Provider Relations Department at (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 5 p.m.

Recent ICD-10 updates provided an expansion of dementia codes which has been long overdue. 

Coming up: social needs self-screening, osteoporosis outreach, eye exams for patients with diabetes and more. 

View our up-to-date formularies and policies online