NYAPRS Note: Today, upwards of 800 self and system mental health advocates are coming to Albany to participate in NYAPRS’ 14th Annual Legislative Day, urging Albany to reinvest in housing, peer support and employment, protect choice and promote alternatives in the various new healthcare initiatives, advance policies to serve New Yorkers with disabilities in the most integrated community setting and in ways that maximize self direction.
See below for excerpts from today’s legislative day positions.
Reinvest Medicaid Inpatient and ER Savings
to Expand Housing, Peer Support and Employment Services
Background: Governor Cuomo’s 2012-3 budget continues to substantively re-shape our health and mental healthcare systems in ways that are intended to:
- improve care coordination and integration and maximize alternatives to Medicaid hospital and emergency room care through the use of Behavioral Health Organizations, health homes and managed care expansion and to
- continue to close and/or consolidate state OMH psychiatric hospitals and wards.
While NYAPRS members support these approaches, we believe that they will succeed only if the state dramatically expands the amount and array of community wellness, prevention and support systems on which New Yorkers with serious medical and behavioral health conditions will rely.
Otherwise, we will only be repeating the deinstitutionalization failures of the past where we closed the door to hospitals and ERs without placing sufficient services and supports in the community.
SIMPLY IMPROVING PEOPLES’ CONNECTION TO MEDICAL SERVICES AND MEDICATIONS WILL NOT BE ENOUGH!
There is substantial data showing that addressing housing and economic instability and social isolation are needed and can produce striking results in reducing avoidable relapse rates and costly ER and hospital visits.
- A 2002 University of Pennsylvania study found supported housing produced an average of $16,282 in savings from reduced use of hospitals, ERs, shelters et al.
- A 2010 study by OptumHealth found that peer bridger hospital-to-community support services reduced Medicaid hospital days by 73% in Tennessee, 44.1% in Wisconsin
- A May 2006 Mathematica study found that working Medicaid beneficiaries dropped their Medicaid dollar utilization by 40%
NYAPRS members strongly agree with the findings of the Governor’s Medicaid Redesign Team, which concluded that “savings from better managed behavioral and physical health care should be reinvested to the extent possible for improved outcomes and reduced health costs. Reinvestment should prioritize non-clinical support services, such as housing, peer, employment, and family services.”
Recommendations:
- Expand the ‘Supportive Housing Development Reinvestment Program’ to extend discretionary reinvestment authority to OMH to include local peer support and employment services.
- As New York heads for 2013 implementation of fully capitated Medicaid managed care systems, all proposals and contracts should explicitly require reinvestment of state and plan savings into local housing, peer support and employment services.
Reinvest Savings from State Hospital Downsizing
Person-Centered State Hospital Discharge Planning
Background
Too many hospitals for too much money: New York State currently operates 27 state psychiatric hospitals (almost 7 times the national average), houses fewer individuals per campus than other similar states (most states house similar amounts in 5-7 facilities) and topped the nation in cost (our $1.2 billion comes in at more than the combined total of other top states Pennsylvania and New Jersey.
Reinvestment: In 1994, the NYS Legislature passed the Community Reinvestment Act which authorized the closure of 5 state hospitals and reinvested a portion of the savings into creating an estimated $200 million of community recovery services.
In succeeding years, the legislature has suspended the requirement to reinvest savings from closing additional hospital wards and used those funds for deficit reduction.
In 2007, the state closed Middletown Psychiatric Center and reinvested about $7 million into boosting services in the surrounding counties.
In 2011, the state authorized the closure of Hudson River Psychiatric Center and has committed several million dollars to surrounding county mental health systems.
In the proposed 2012-3 budget, the state proposes to close Kingsboro PC and several more wards without a definitive reinvestment formula.
Recommendations: The NYS Legislature should restore the original Community Reinvestment Act’s formula and requirement to reinvest a portion of savings from state hospital downsizing/closure to boost local community recovery services. This requires eliminating the ‘notwithstanding’ language in the Executive proposal.
Person-Centered State Hospital Discharge Planning
Background: NYAPRS members share strong concerns about the pace and the quality and continuity of transitional and community care afforded to residents of closing state hospital facilities and wards.
Recommendations: NYAPRS members strongly believe recovery in the community should be expected and offered to all, including those we have traditionally institutionalized in the largest and costliest state hospital system in the country. To ensure that proposed closures and downsizing of that system are done properly, we call for a process that ensures:
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Person-driven community recovery and service plans with sufficient time to put individualized supports in place prior to discharge
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Substantive use of peer supports, including peer bridgers, warm lines, crisis respite programs
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A transition team from each community being affected by the closure will meet to design a strategic plan in preparation for the closure
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Behavioral Health Organizations and Health Homes will be active members in the transition and will prioritize services for individuals
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Tracking of post-discharge Medicaid and non-Medicaid reimbursable services and recovery outcomes as outlined in the discharge plan
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Protect Consumer Rights & Choices in New Medicaid Initiatives
Background: This year’s budget incorporates an unprecedented number of groundbreaking changes and reforms to our healthcare and social support systems, in keeping with recommendations from the Medicaid Redesign Team (MRT).
While they may ultimately improve care, these changes will limit choices by:
- assigning Medicaid beneficiaries to the new health home networks of care but giving them the opportunity to “opt out,”
- requiring individuals to enroll in Medicaid managed plans that will limit choice of services and providers and
- restricting access to Medicaid medications as they have become included in the Medicaid managed care benefit.
At the same time, health homes might give people new opportunities to review the effectiveness and appeal of their current providers and treatments and to more actively direct their care….if they get the information and support they need.
Recommendations
New York must protect the health and rights of Medicaid beneficiaries by:
- Education: Improving and expanding on an array of culturally and linguistically competent and understandable educational materials and strategies, in keeping with recommendations by the MRT’s Health Disparities Work Group.
- Oversight: Step up DOH oversight over Medicaid managed care plan administration of new components, e.g. with the pharmacy program to ensure promised continued access to mental health, anticonvulsant and other previously ‘protected classes’ of medications
- Protections: Reinstating prescriber prevails protections.
- Assistance: Making available enrollment brokers ($3 million allocation in Executive Budget proposal)
- Appeals: Create and educate enrollees about clear and accessible grievance and appeals processes
- Self Direction: Ensuring that advance directives are prominently displayed in new electronic healthcare record systems
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Serve New Yorkers with Psychiatric Disabilities
in the Most Integrated Community Setting
Background
NYAPRS members are passionately committed to advancing policies that ensure that people with psychiatric and other disabilities are fully afforded their rights to live and work in the most integrated community setting, in keeping with the Americans with Disabilities Act and the Supreme Court’s Olmstead decision. Accordingly, we strongly support the following:
Housing
NYAPRS members view affordable community based housing as an essential human need that is strongly tied to good health and reduced institutional costs.
Accordingly, NYAPRS members strongly support Executive budget proposals to:
- create a Supported Housing Reinvestment fund from Medicaid savings from hospital and nursing home closures or bed de-certifications to expand supportive housing and related services, explicitly including peer support and employment services.
- 3-year commitments to create 1,000 supported housing units for residents of nursing homes ($10 million this year) and 3,400 beds for the NY-NY III program.
- In addition, NYS should establish a 10% set-aside program for high-need individuals with disabilities.
Bringing Justice to Adult Home Residents
A federal court found NYS in violation of Olmstead and the ADA in the segregation of 4,300 NYC residents with psychiatric disabilities in adult homes, which it considered “segregated institutional settings that impede integration in the community and foster learned helplessness.” The state has appealed that ruling. NYAPRS strongly feels that NYS must no longer delay meeting its responsibility to provide the supports necessary to help adult home residents with psychiatric disabilities to move into the community. Accordingly, we strongly support the Executive budget proposal to fund:
- 5,100 supported housing beds over the next 3 years to deal with “emerging needs”, including $16.8 million for adult home residents named in the lawsuit.
Expand Employment Options and Services
NYAPRS members strongly support the Governor’s and OMH’s proposal to
- expand the Ticket to Work program to boost federal employment funding incentives and reimbursements for services that successfully help New Yorkers with disabilities to return to the work force.
- support individuals to move from segregated outmoded sheltered workshops to employment focused Personalized Recovery Oriented Services.
Develop a NYS Olmstead Plan
NYAPRS members enthusiastically welcome Governor Cuomo’s commitment to
- “develop an Olmstead Implementation Plan that will guide the transition of individuals from institutional to community-based care, provide access to affordable and accessible housing, and promote employment of persons with disabilities”. Such a plan must set measurable targets and dates by which public dollars and people with disabilities are supported to move from segregated to identified most integrated settings.
- re-energize and re-focus the state’s Most Integrated Setting Coordinating Council.
Alternatives to Involuntary Outpatient Commitment
Once again, the NYAPRS community continues to strongly oppose Kendra’s Law’s highly controversial involuntary outpatient commitment program that:
- relies on coercion whose effectiveness has yet to be scientifically validated,
- is used primarily in New York City and Long Island in contrast to almost every other county,
- continues to be disproportionately (66%) used for communities of color and that
- now involves considerably more effort and costly time by local and court officials in the wake of last year’s NYS Court of Appeals ruling that sharing medical records of individuals under consideration for a Kendra’s Law order is a violation of their HIPPA privacy rights, unless their approval or a court order is obtained.
Instead, NYAPRS points to the state’s strong commitment to:
- favor the expanded use of modern, state of the art voluntary outreach and engagement approaches,
- maximize the use of peer run services, and
- to advance more coordinated and integrated and effective care approaches that are being promoted by the state’s new Behavioral Health Organization and Health Home initiatives.
In fact, included in the Medicaid Redesign Team’s recommendations to the Governor is an expectation of decreased use of involuntary court orders as a measure of these programs’ effectiveness.
Finally, NYAPRS members strongly favor non-medical “alternative treatments’ like acupuncture, reiki, shiatsu, meditation, yoga and nutritional supplements. We will be strongly advocating for the funding of these approaches in the more flexible capitated managed care environment of the future.
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Adopt Medicaid Self Directed Services and Community First Choice Options
As New York proposes and adopts new provisions to our Medicaid program, NYAPRS members strongly support the adoption of new federal regulations to spend Medicaid dollars more flexibly:
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the 1915.i Home and Community Based Services Option that expands Medicaid’s flexibility to fund rehabilitation and recovery services and permits beneficiaries to self-direct individualized budgets to meet approved health and community goals
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the 1915.k Community First Choice Option which provides for hands on assistance to promote daily living and health related functions, along with expenditures for costs such as rent and utility deposits, first month’s rent and utilities, bedding, basic kitchen supplies, and other necessities required for an individual to make the transition from a nursing, mental health institution, or intermediate care facility to a community based home setting.