Budget Calls For Mental Hygiene Reforms
By Andrew Carden Legislative Gazette January 23, 2012
In his Executive Budget for the coming year, Gov. Andrew Cuomo calls for reforms to New York state’s mental hygiene agencies, which, while improving services, would also result in cost savings for the state.
The state’s mental hygiene agencies, which provide services to persons with mental illness, chemical dependencies and developmental disabilities, will aid nearly 1 million individuals over the coming year. Approximately 6,300 residents are served by the state’s institutional and research facilities, with 88,300 living in community residences funded by the state.
The Executive Budget pushes for significant reforms that would invest in improving the accountability of mental hygiene agencies, strengthen the oversight of care for persons in state institutions and community residences and increase standards for hiring staff, the governor said. By improving the system, high costs and poor conditions in certain facilities will be corrected.
The governor’s proposals for mental hygiene reform result in a funding of $8.2 billion over the coming year, which marks an annual spending increase of $85 million or 1 percent.
While the Executive Budget aims to reduce overall state operations costs, in the case of mental hygiene, funding will be redirected from high-cost institutional services to lower-cost, effective community-based programs.
There is cost-savings in mental hygiene, the Executive Budget says, through restructuring state-operated inpatient psychiatric capacity, placing aggressive cost controls on agency operations, maximizing payments from third-party payers and utilizing less costly in-state community residences. Administrative staffing levels will be reduced and individuals will continue to be moved from state institutions into more integrated settings.
Costs will be further reduced and operations improved by revamping the state’s sex offender program. When appropriate, certain persons in the program will be placed in less costly prison settings and other entities will be authorized to assist in carrying out the program.
These combined cost savings, according to the Executive Budget, will allow for a reinvestment to support 2,300 new nonresidential and 250 new community residential opportunities, training for primary care physicians to improve early identification of behavioral health issues among children and regional first-episode psychosis teams and suicide prevention programs to aide persons with psychotic disorders.
Glenn Liebman, CEO of the Mental Health Association in New York State, praised the governor for investing in suicide prevention.
“This has long been a priority of MHANYS and it is good to see reflected in the budget, even in these difficult times,” said Liebman.
In addition, a portion of the savings will be utilized to support 1,000 housing units for nursing home residents and 5,100 housing beds over the coming three years to support individuals in adult homes and those moving out of state psychiatric centers. An additional $1.5 million in funding would be available to support new housing units for homeless families dealing with a chemical dependency problem.
The most appropriate reinvestment of these savings, Liebman says, would be into community services, such as housing, peer services, employment, education, children and family services. Liebman also advocates for part of the reinvestment to be devoted around hospital closures.
“We were a major voice 20 years ago in the first reinvestment when the state closed five hospitals and provided community services of over $250 million,” said Liebman. “We must have a new reinvestment in place for closures, including a local planning process that includes recipients, families and providers.”
Mental hygiene providers garner automatic payment increases with no relation to performance outcome or actual cost growth. Eliminated in the Executive Budget is the planned 3.6 percent annual human services cost-of-living adjustment, or COLA. In advance of 2013-2014, a new program will be enacted to provide payment increases based upon meeting performance outcomes and appropriate provider costs.
While there has not been a COLA for the past four years, there has consistently been language in the state budget that would keep the promise of a COLA for future years. From the standpoint of MHNAYS, its elimination means there would be no official state commitment that, upon the economy’s improvement, a COLA will be in place for the human service work force.
“Many people in the non-for-profit world subsist on a limited income and a COLA is a significant enhancement to their paycheck,” said Liebman. “Minimally, the promise of a COLA in future years was a symbolic step to make up for some previous cuts.”
Among the governor’s other reform proposals, the state will institute a 24-hour hotline to report allegations of abuse or neglect toward the developmentally disabled, children, elderly and other vulnerable persons. And, in line with the state’s 2009 reforms to drug laws, the Executive Budget also supports the continued diversion of persons from prison into treatment programs.
Thus far, the governor has implemented a series of reforms designed to ensure the health and safety of persons with developmental disabilities, while maintaining cost-effectiveness in state services.
These reforms include an increase in hiring qualifications and training standards for prospective employees, stronger efforts to combat cases of abuse, enhanced fire safety standards in state facilities and a restructured Early Alert program to hold providers more accountable for their performance by imposing, when necessary, fines or revocation of their operating certificate.