NYAPRS Note: Details have been posted a short time ago indicating how OMH would like to spend increases in federal Medicaid payments to enhance mental health service delivery. See below for details about spending to enhance the OMH workforce, Housing, ACT and PROS rates, increase cultural competence and a more diverse workforce, expand the capacity of the peer workforce and increase access to CORE services. More details Monday.
Improve the OMH Workforce Funding: $16.7M State Funds Equivalent
Background: To effectively provide services to individuals with behavioral health conditions, it is essential to retain experienced and dedicated employees while recruiting new ones. These relatively low paying and highly stressful jobs lead to high employee turnover rates. Targeted loan forgiveness and tuition assistance for current and prospective staff are proven ways to invest in our behavioral health workforce and benefit the individuals we are serving.
Proposal: Eligible Providers: OMH-licensed mental health providers
Description: This proposal would provide prescribers, licensed practitioners, and program staff in community, rehabilitation, and housing settings to receive targeted loan forgiveness, tuition reimbursement, hiring and signing bonuses, longevity payments, expanded student placements, shift differential pay and expanded retirement contributions. Funds will be implemented through a directed payment preprint to Medicaid MCOs and administered as grants to providers meeting specific qualifications and based on service utilization. Funding would go directly to mental health providers. Evaluation and Reporting: In accessing these funds, MCOs would report to OMH regarding the specific goals attached to this funding and how the funds have been used to increase the recruitment and retention of prescribers, licensed practitioners, and other program staff. OMH would evaluate each MCO based on their efficiency in using the funding to achieve these outcomes.
Increase Medicaid Rehabilitation Rates for OMH Community Residence Programs Funding: $6.9M State Funds Equivalent
Background: Funding for Community Residence programs has been historically challenging, making it difficult for providers to hire and retain an adequate number of staff to safely operate these programs. Proposal: Eligible Providers: OMH-licensed Rehabilitation for Community Residence providers. Description: Rate increases will be targeted towards direct care staff costs in order to meet critical challenges to workforce recruitment and retention, which are needed to operate these programs more effectively and to address the critical workforce shortages that currently exist. Funding will be disbursed through rate increases paid across FFS Medicaid claims as services are provided to eligible Medicaid recipients.
Expand Training and Implementation Support for Evidence Based Practices (EBPs) Funding: $4M State Funds Equivalent
Background: OMH has identified EBPs that serve as the best methods to ensure quality of care, community inclusion and the ability of the individuals we serve to lead rich, full, satisfactory lives, including meaningful interpersonal relationships and employment. While OMH encourages and supports these practices, better training and educational resources are needed to support a workforce able to provide such practices more robustly.
Proposal: Eligible Providers: Funding is allocated to Training and Technical assistance agencies with expertise in EBP dissemination and to the SUNY system or other institutions of higher education. Description: OMH has undertaken a significant system redesign initiative to foster provision of evidence-based practices, recovery-oriented care, and psychiatric 17 NYS Spending Plan for Implementation of American Rescue Plan Act of 2021, Section 9817 rehabilitation services. Under this redesign, OMH must expand training and implementation support in EBP, including diagnosis and treatment across the provider continuum, with incentivization of EBP uptake and fidelity, with particular focus on the assessment and treatment of co-occurring disorders, treatment of marginalized and underrepresented demographics, and specialty clinical populations (including but not limited to clinical high risk for psychosis and obsessive-compulsive disorder), leadership training, addressing provider costs associated with training attendance, collaboration with State University of New York (SUNY) in a Certified Rehabilitation Counselor (CRC) or Masters in Psychiatric Rehabilitation program, and development/expansion of rehabilitation programs and services with in-person training. Funding will be dispersed via existing or new contracts with Training and technical assistance agencies and SUNY or other institutions of higher education.
Expand Recruitment and Retention of Culturally Competent, Culturally Responsive and Diverse Personnel Funding: $4M State Funds Equivalent
Background: Ethnic and racial minorities are very under-represented in the mental health workforce, especially in the professions and disciplines that require advanced degrees or education-based certifications. This under-representation is one of the drivers of mental health disparities for marginalized populations. Minority providers are more likely to meet the needs of underserved populations and a diverse workforce results in greater patient/client satisfaction, engagement, and retention in care. Additionally, the mental health workforce is experiencing shortages of clinicians who are multilingual – further driving disparities in access, quality, and treatment outcomes for individuals who are limited English proficient.
Proposal: Eligible Providers: OMH-certified mental health providers that demonstrate the specific diversity goals. Funding would also go to the SUNY/City University of New York (CUNY) educational institutions for tuition reimbursement and loan forgiveness programs. Description: OMH would complete an environmental scan of the current mental health workforce to identify areas of under-representation, both geographically and demographically, with the goal of ensuring an adequate level of demographic and linguistic representation within the field. Based on this analysis, the Agency will provide funding to SUNY/CUNY schools based on geographic location and programs offered to underserved students to complete study in fields with the highest identified need. These funds would be used to fully or partially support educational attainment and credentialing. 18 NYS Spending Plan for Implementation of American Rescue Plan Act of 2021, Section 9817 Students approved for acceptance in this program will certify that they will serve in the mental health field in New York State in areas identified as underserved using population health approaches for a defined period of time. To support retention in the field, loan forgiveness will be awarded to diverse/multilingual individuals in the mental health workforce and those working in underserved communities if they agree to continue to work in the field in underserved communities for a pre-determined amount of time. Additionally, funds will be allocated to SUNY/CUNY schools to support educational attainment for diverse and multilingual individuals working in the field with the goal of career advancement and retention. Funds will be administered as grants to providers meeting specific qualifications. Funding would also go to SUNY/CUNY educational institutions for tuition reimbursement and loan forgiveness programs for diverse individuals
Expand Certified and Credentialed Peer Capacity Funding: $4M State Funds Equivalent
Background: Peer Workers working in a variety of settings across our system of care do not have a centralized entity that provides leadership and support for the growth and advancement of the Peer Workforce. The majority of the helping professions employed in mental health settings belong to professions that already have mentoring components built into their education and development. The Peer Workforce is growing exponentially with the demand for Peer Services and Peer Support Services are in high demand across all OMH services due to their proven outcomes of treatment engagement and better experiences in care. The demand for Peer Support Services far exceeds the current certified and credentialed workforce capacity and infrastructure to support the Peer Workforce growth and development are needed to ensure these critical services are available to New Yorkers struggling with mental illness. The Peer Mentoring Network would match Peer Workers with Peer Mentors from across the State. An emphasis will be placed to support Peer Workers representing marginalized communities to assume leadership roles. As the demand for peerdelivered services grows, many clinical (or non-peer-run agencies) are looking to hire Peer Workers to work in traditionally clinical services. Many of these agencies do not have leadership within their organization to create and design infrastructure to support 19 NYS Spending Plan for Implementation of American Rescue Plan Act of 2021, Section 9817 successful inclusion of Peer Workers, which leads to turnover, lack of clarity of the full impact of what Peer Workers can do, and supervisors that are not equipped with the skills or training to supervise Peer Workers. The Peer Workforce has access to a core curriculum to help enable them to work in our public mental health system; however, more specialized training is needed. These specialized training programs can be parenthetic to existing peer certification and credentials. Specialized areas include (but are not limited to): forensics, crisis, older adults, transition age youth, and LGTBQIA+. Proposal: Eligible Providers: Mental health providers that are employing and/or recruiting peers, training and certification entities, and other vendors with subject matter expertise in the provision of Peer Support and Peer Delivered Services.
Description: New York proposes to expand certified peer capacity (inclusive of adult peer, youth peer, family peer) in OMH programs through investment in resources for recruitment, education/training, and career pipeline investments. As New York continues to grow its capacity to provide Peer Support Services across the OMH system of care, agencies that currently do not offer Peer Support services need additional guidance on how to implement these services effectively in their settings. The creation of a New York State Peer Workforce Advancement and Mentoring Network and a Peer-Delivered Service Inclusion Center of Excellence will help OMH in achieving these goals. Additionally, training expansion and capacity to best support underserved and emerging populations, such as justice-involved individuals and older adults with mental illness will be needed to ensure the Peer Workforce is adequately equipped to provide effective services to these groups. Funds will be implemented through a Directed Payment to Medicaid MCOs and administered as payments to providers based on Peer Services utilization when they meet specific qualifications. Funding would go directly to mental health providers that are employing and/or recruiting peers, training and certification entities, and other vendors with subject matter expertise in the provision of Peer Support and Peer Delivered Services.
Invest in Personalized Recovery Oriented Services (PROS) Redesign Funding: $3M State Funds Equivalent
Many PROS programs are closing due to fiscal and operational challenges. Continued closures would decrease access to important treatment and rehab services and would limit the State’s ability to address social determinant needs through rehab services (basic living skills, financial skills training, obtaining employment, etc.). Proposal: Eligible Providers: OMH-licensed rehabilitation for PROS providers.
Description: PROS redesign via enhanced rates within PROS, increase in offsite capacity and 1:1 services, program specific staffing investments including peers and rehabilitation staff, grants for physical plant improvements. Investment based upon Consolidated Financial Report (CFR) gap to actual costs and recent provider closure. The PROS model must be updated to accommodate changing population and system need and demographics (i.e. telehealth, desire for more 1:1, off-site capability, unemployment), while right-sizing financial model to support it. Funding would be disbursed through rate increases paid across FFS or MMC plans. Evaluation and Reporting: In accessing these funds, eligible providers would report to OMH regarding the specific goals attached to this funding and how the funds have been used to maintain and increase access to these programs. OMH would evaluate each eligible provider’s use of the funding to achieve these outcomes. This evaluation would be part of the quarterly reports submitted by OMH to DOH regarding use of this funding.
Invest in Assertive Community Treatment (ACT) Services Funding: $2.7M State Funds Equivalent
Background: Individuals with higher levels of psychiatric need and patterns of homelessness, frequent hospitalizations with low community tenure and/or forensic histories transition from institutions into the community, providers are challenged to a hire competent, skilled workforce.
Proposal: Eligible Providers: OMH-licensed ACT providers. Description: Increasing the existing service payment rates for ACT teams serving the highest need individuals in the mental health system. Funding will be disbursed through rate increases paid across FFS or MCO Medicaid claims following a state plan amendment as services are provided to eligible Medicaid recipients. Evaluation and Reporting: In accessing these funds, eligible providers would report to OMH regarding the specific goals attached to this funding and how the funds have been used to maintain and expand access to these programs and improve outcomes for program recipients. OMH would evaluate each eligible provider’s use of the funding to achieve these outcomes.
Expand and Implement HCBS and Community Oriented Recovery and Empowerment (CORE) Services Funding: $12.5M State Funds Equivalent
Background: Adult behavioral health HCBS services have had low utilization since inception due to barriers in access limiting provider referrals and their ability to serve the target Health and Recovery Plan (HARP) population. The State has made changes in these regulatory barriers, but will need funding to ensure start-up, increase access, and address workforce challenges. Proposal: Eligible Providers: Adult CORE providers
Description: HCBS CORE services expansion and implementation support aimed to complement of current infrastructure funding via enhanced rates, marketing, and outreach funds; expanded provider capacity via workforce funding; and improved access and engagement via transportation and telehealth infrastructure. Ensuring access to critical treatment and rehab services for individuals identified as having significant behavioral health need and service utilization (HARP enrollees). Funding will be disbursed through rate increases paid across MCO Medicaid claims as services are provided to eligible Medicaid recipients. Funding will be allocated to Adult CORE providers.